Part III

[Federal Register: August 26, 2005 (Volume 70, Number 165)]

[Proposed Rules]

[Page 50679-50886]

From the Federal Register Online via GPO Access [wais.access.gpo.gov]

[DOCID:fr26au05-42]

[[Page 50679]]

Part III

Book 2 of 2 Books

Pages 50679-50948

Department of Health and Human Services

Centers for Medicare & Medicaid Services

42 CFR Parts 419 and 485

Medicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates; Correction; Proposed Rule

[[Page 50680]]

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 419 and 485

[CMS-1501-CN]

RIN 0938-AN46

Medicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates; Correction

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Proposed rule; correction.

SUMMARY: This document corrects technical errors that appeared in the proposed rule published in the Federal Register on July 25, 2005 entitled ``Medicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates; Proposed Rule.''

FOR FURTHER INFORMATION CONTACT: Rebecca Kane, (410) 786-0378.

SUPPLEMENTARY INFORMATION:

I. Background

FR Doc. 05-14448 contains our proposed rule to update the Medicare Outpatient Prospective Payment System for calendar year (CY) 2006. We have identified a number of technical errors in the ``Summary of Errors'' section and are correcting them in the ``Correction of Errors'' section below.

II. Summary of Errors

A. Corrections Related to the Rural Adjustment Calculation

The calendar year (CY) 2006 Outpatient Prospective Payment System (OPPS) proposed rule that we published in the Federal Register on July 25, 2005 included a proposed 6.6 percent adjustment for rural sole community hospitals. The calculations used to develop the conversion factor and budget neutrality scalar inadvertently incorporated this adjustment as 6.4 percent. The rural adjustment is used in calculations that determine the scalar and conversion factor, and therefore affects the payment rates and copayment amounts published in the proposed rule. The corrected scalar is 1.003753831, and the corrected conversion factor is $59.343. The various changes to the preamble are specified under section III. of this correction notice. In addition to preamble text changes, we are correcting specific tables and addenda which also reflected the inadvertent use of a 6.4 percent rural adjustment factor, which we have described below.

On page 42709, we published Table 11. We are correcting the last column of this table to present the corrected proposed CY 2006 payment amounts. In section III. of this notice, we republish Table 11 as corrected.

On pages 42761-42762, we published Table 33. In section III. of this notice, we republish Table 33 as corrected.

On pages 42764-42775, we published Addendum A, which provides the payment rates and copayment amounts for Ambulatory Payment Classification (APC) groups used for payment purposes under the OPPS. A corrected Addendum A is posted on the OPPS Web site at http://www.cms.hhs.gov /providers /hopps/2006p/1501p.asp.

On pages 42776-42965, we published Addendum B, which provides the payment rates and copayment amounts for services payable under OPPS. A corrected Addendum B, including additional technical errors affecting HCPCS codes 78814, 78815, 78816, 91035, and 95950 is posted on the OPPS Web site at http://www.cms.hhs.gov /providers /hopps/2006p/1501p.asp.

We are posting the corrected Addendum A and Addendum B on our Web site rather than publishing them in this notice because of the large volume of data included in these addenda. Hard copies of these tables are available by contacting the CMS staff member identified above.

We note that as soon as we discovered these inadvertent errors that affected the payment rates noted in the proposed rule, we posted the corrections on the CMS Web site at: http://www.cms.hhs.gov /providers /

hopps/2006p/1501p.asp.

B. Other Corrections

We also noted other typographical, formatting, and other technical errors in the proposed rule.

On page 42714, we published Table 15. The proposed ``unadjusted'' and ``adjusted'' CY 2006 APC median cost for APC 0085 Level II Electrophysiologic Evaluation contained a typographical error and should read $2,123.38. We are correcting this under section III. of this notice.

On page 42761, column 2 includes a comparison that discusses the differences in copayments from CY 2005 to CY 2006. While the analysis of this example is correct, the example incorrectly identifies the comparison as being the ``minimum unadjusted copayment'' rather than the ``national unadjusted copayment''. We are making this correction under section III. of this notice to refer to the ``national unadjusted copayment''.

On page 42737, we published Table 26, which inadvertently excluded C2636 (Brachytherapy linear source, Palladium -103, per 1 mm) which was accurately described in the text of page 42736 as a proposed separately payable brachytherapy source. In section III. of the notice we append the excluded row to correct table 26 as published.

The other technical, typographical, formatting, and other errors that appeared on various other pages of the Federal Register are corrected as noted in section III. of this notice.

III. Correction of Errors

In FR Doc. 05-14448 of July 25, 2005 (70 FR 42674), make the following corrections:

1. On page 42690, in column 3, in the last paragraph, in line 20, the figure ``0.999207669'' is corrected to read ``1.003753831''.

2. On page 42691, in column 1, in the second full paragraph, line 8, the year ``2006'' is corrected to read ``2007''.

3. On page 42694,

a. In column 1, in the second full paragraph, in line 8, the figure ``$240.51'' is corrected to read ``$241.57''.

b. In column 1, in the second full paragraph, in line 8, the figure ``$48.10'' is corrected to read ``$48.31''.

c. In column 3, in the third full paragraph, in line 8, the figure ``1.002015212'' is corrected to read ``1.002023412''.

d. In column 3, in the third full paragraph, in line 18, the figure ``0.99652023'' is corrected to read ``0.99639633''.

e. In column 3, in the last partial paragraph, in line 5, the figure ``1.002015212'' is corrected to read ``1.002023412''.

4. On page 42695,

a. In column 1, in the first partial paragraph, in line 5, the figure ``0.99652023'' is corrected to read ``0.99639633''.

b. In column 1, in the first partial paragraph, in line 7, the figure ``$59.350'' is corrected to read ``$59.343''.

5. On page 42703,

a. In column 1, in the second full paragraph, in line 5, the figure ``$9.95'' is corrected to read ``$7.00''.

b. In column 1, in the second full paragraph, in line 5, the figure ``40'' is corrected to read ``28''.

c. In column 1, in the second full paragraph, in line 6, the figure ``$24.89'' is corrected to read ``$25.00''.

6. On page 42709,

[[Page 50681]]

a. In column 1, in the first full paragraph, in line 22, the figure ``$1,297'' is corrected to read ``$1,274''.

b. In column 1, in the first full paragraph, in line 23, the figure ``$1,366'' is corrected to read ``$1,244''.

c. In column 1, in the first full paragraph, in line 25, the figure ``$1,100'' is corrected to read ``$1,025''.

d. Table 11 is corrected to read as follows:

Table 11.--Proposed APC Reassignment of New Technology Procedures Into Clinical APCs for CY 2006

Proposed CY 2005 CY 2005 status Proposed Proposed CY 2006 CY 2005 CY 2006 HCPCS

Descriptor

APC

indicator CY 2006

status payment payment APC

indicator amount amount

0027T.......... Endoscopic

1547 T

0220 T

$850 $1,030.11 epidural lysis. 33225.......... L ventric pacing 1525 S

0418 T

3,750 6,486.45 lead add-on. 61623.......... Endovasc tempory 1555 T

0081 T

1,650 2,044.21 vessel occl. 92974.......... Cath place, cardio 1559 T

0103 T

2,250 873.18 brachytx. 93580.......... Transcath closure 1559 T

0434 T

2,250 5,387.61 of asd. 93581.......... Transcath closure 1559 T

0434 T

2,250 5,387.61 of vsd. 95965.......... Meg, spontaneous.. 1528 S

0430 T

5,250 676.75 95966.......... Meg, evoked,

1516 S

0430 T

1,450 676.75 single. 95967.......... Meg, evoked, each 1511 S

0430 T

950 676.75 add'l. C9713.......... Non-contact laser 1525 S

0429 T

3,750 2,511.08 vap prosta.

7. On page 42710, in column 2, in the first full paragraph, in line 19, the figure ``$93.71'' is corrected to read ``$93.37''.

8. On page 42714, Table 15, APC 0085, in columns 5 and 7, in row 7, both occurrences of the figure ``$2,123.46'' are corrected to read ``$2,123.38''.

9. On page 42737, Table 26, ``Proposed Separately payable Brachytherapy Sources for CY 2006'' is appended with the following row:

New status

HCPCS Long descriptor APC

APC title

indicator

C2636........ Brachytherapy

2636 Brachytx linear source, P-103....................... H linear source, Palladium-103, per 1mm.

10. On page 42756, in column 1, in the first partial paragraph, in line 5, the figure ``1.8'' is corrected to read ``1.7''.

11. On page 42758, in column 2, in the third full paragraph, in line 13, the figure ``$59.35'' is corrected to read ``$59.34''.

12. On page 42759,

a. In column 1, in the first partial paragraph, in line 21, the figure ``5.8'' is corrected to read ``5.6''.

b. In column 1, in the first partial paragraph, in line 31, the figure ``1.2'' is corrected to read ``1.3''.

c. In column 1, in the first partial paragraph, in line 31, the figure ``1.8'' is corrected to read ``1.7''.

d. In column 1, in the first partial paragraph, in line 36, the figure ``2.6'' is corrected to read ``2.5''.

e. In column 1, in the second partial paragraph, in line 22, the figure ``2.9'' is corrected to read ``2.7''.

f. In column 1, in the second partial paragraph, in line 25, the figure ``0.7'' is corrected to read ``0.6''.

g. In column 1, in the second partial paragraph, in line 30, the text ``West South Central'' is corrected to read ``New England''.

h. In column 2, in the first partial paragraph, in line 2, the figure ``1.9'' is corrected to read ``1.7''.

i. In column 2, in the first partial paragraph, in line 2, the figure ``1.8'' is corrected to read ``1.6''.

j. In column 2, in the first full paragraph, in line 4, the figure ``0.4'' is corrected to read ``0.3''.

k. In column 2, in the first full paragraph, in line 5, the figure ``0.5'' is corrected to read ``0.3''.

l. In column 2, in the first full paragraph, in line 9, the figure ``0.9'' is corrected to read ``1.6''.

m. In column 2, in the first full paragraph, in line 10, the figure ``1.4'' is corrected to read ``2.2''.

n. In column 2, in the first full paragraph, in line 21, the sentence portion ``1.3 percent and voluntary and government hospitals will gain at least 0.1 percent.'' is corrected to read ``1.1 percent, voluntary hospitals would gain 0.2 percent, and government hospitals will see no changes as a result of changes to APC structure.''

o. In column 3, in the second full paragraph, in line 7, the figure ``0.997'' is corrected to read ``0.996''.

p. In column 3, in the second full paragraph, in line 10, the figure ``0.3'' is corrected to read ``0.4''.

q. In column 3, in the second full paragraph, in line 13, the figure ``5.2'' is corrected to read ``5.4''.

13. On page 42760,

a. In column 1, in the first partial paragraph, in line 6, the figure ``0.3'' is corrected to read ``0.4''.

b. In column 1, in the first full paragraph, in line 19, the figure ``5.8'' is corrected to read ``5.6''.

c. In column 1, in the first full paragraph, in line 24, the figure ``-2.8'' is corrected to read ``-2.4''.

d. In column 1, in the first full paragraph, in line 32, the figure ``1.2'' is corrected to read ``1.3''.

e. In column 1, in the first full paragraph, in line 35, the figure ``0.3'' is corrected to read ``0.4''.

f. In column 1, in the first full paragraph, in line 37, the figure ``1.5'' is corrected to read ``1.4''.

g. In column 1, in the last paragraph, in line 7, the figure ``8.6'' is corrected to read ``8.7''.

h. In column 1, in the third partial paragraph, in line 12, the figure ``5.0'' is corrected to read ``4.7''.

i. In column 3, in the first partial paragraph, in line 6, the figure ``2.6'' is corrected to read ``2.5''.

j. In column 3, in the first partial paragraph, in line 12, the figure ``2.1'' is corrected to read ``1.8''.

k. In column 3, in the first partial paragraph, in line 32, the figure ``3.7'' is corrected to read ``3.6''.

[[Page 50682]]

l. In column 3, in the first full paragraph, in line 11, the figure ``3.4'' is corrected to read ``3.5''.

m. In column 3, in the first full paragraph, in line 13, the figure ``6.4'' is corrected to read ``6.5''.

n. In column 3, in the first full paragraph, in line 30, the text ``greater than'' is corrected to read ``of at least''.

o. In column 3, in the first full paragraph, in lines 33 and 34, the figure ``only 1.0'' is corrected to read ``1.4'' and the text ``and 0.8 percent, respectively.'' is appended to the end of the sentence.

14. On page 42761

a. In column 1, in the first partial paragraph, in line 3, the figure ``1.9'' is corrected to read ``2.6''.

b. In column 1, in the first partial paragraph, in line 6, the figure ``2.6'' is corrected to read ``3.4''.

c. In column 1, in the first partial paragraph, in line 11, the figure ``0.8'' is corrected to read ``0.6''.

d. In column 1, in line 12, the designation for the heading ``Estimated Impacts of This Proposed Rule on Beneficiaries'' is corrected from ``G'' to read ``F''.

e. In column 1, in the second partial paragraph, in line 12, the figure ``$11.86'' is corrected to read ``$11.91''.

f. In column 2, in the first partial paragraph, in lines 4 and 6, the term ``minimum'' is corrected to read ``national''.

g. In column 2, in the first partial paragraph, in line 8, the figure ``$223.91'' is corrected to read ``$224.91''.

h. Table 33 is corrected to read as follows:

Table 33.--Impact of Proposed Changes for CY 2006 Hospital Outpatient Prospective Payment System

Cumulative New adj (Cols Number of

New for rural 2,3,4) Hospital category

APC wage sole with All hospitals changes index community market changes hospitals basket update (1) (2) (3)

(4)

(5) (6)

ALL HOSPITALS...................................... 4212 0.0 0.0

0.0

3.2 1.9 URBAN HOSPITALS.................................... 2949 0.0 0.0 -0.4

2.8 1.6

LARGE URBAN.................................... 1624 -0.8 0.0 -0.4

2.0 0.8

OTHER URBAN.................................... 1325 1.0 0.0 -0.4

3.8 2.5 RURAL HOSPITALS.................................... 1263 -0.1 0.1

1.8

5.0 3.5

SOLE COMMUNITY.................................

478 -0.1 0.0

5.4

8.7 6.5

OTHER RURAL....................................

785 -0.1 0.1 -0.4

2.8 1.6 BEDS (URBAN):

0-99 BEDS......................................

917 0.0 0.2 -0.4

3.0 2.1

100-199 BEDS...................................

964 -0.4 0.0 -0.4

2.5 1.5

200-299 BEDS...................................

503 0.2 0.1 -0.4

3.2 2.4

300-499 BEDS...................................

402 -0.1 -0.1 -0.4

2.6 1.5

500 + BEDS.....................................

163 0.3 0.0 -0.4

3.1 1.0 BEDS (RURAL):

0-49 BEDS......................................

551 -0.9 0.2

2.1

4.6 3.1

50-100 BEDS....................................

419 -0.8 0.2

2.3

4.8 3.0

101-149 BEDS...................................

180 1.4 0.0

1.1

5.8 4.7

150-199 BEDS...................................

62 -0.2 -0.2

1.8

4.7 3.7

200 + BEDS.....................................

51 0.1 0.0

1.7

5.1 3.1 VOLUME (URBAN):

LT 5,000 claim lines...........................

600 -5.6 0.5 -0.4

-2.4 -1.8

5,000-10,999...................................

180 -2.4 0.2 -0.4

0.5 0.6

11,000-20,999..................................

299 -0.6 0.2 -0.4

2.4 2.5

21,000-42,999..................................

575 -0.6 0.1 -0.4

2.3 1.9

GT 42,999...................................... 1295 0.2 0.0 -0.4

3.0 1.6 VOLUME (RURAL):

LT 5,000 claim lines...........................

119 -2.7 0.0

1.4

1.7 1.4

5,000-10,999...................................

195 -1.9 0.0

2.1

3.4 2.4

11,000-20,999..................................

325 -0.9 -0.1

2.0

4.3 3.4

21,000-42,999..................................

364 -0.9 0.2

1.9

4.5 3.0

GT 42,999......................................

260 0.6 0.0

1.7

5.7 3.8 REGION (URBAN):

NEW ENGLAND....................................

166 -1.3 -0.1 -0.4

1.4 -0.2

MIDDLE ATLANTIC................................

393 0.6 -0.1 -0.4

3.4 2.1

SOUTH ATLANTIC.................................

453 -0.4 -0.4 -0.4

2.0 1.0

EAST NORTH CENT................................

466 0.4 -0.1 -0.4

3.2 1.7

EAST SOUTH CENT................................

197 1.5 0.0 -0.4

4.4 3.4

WEST NORTH CENT................................

184 2.5 -0.3 -0.4

5.1 3.6

WEST SOUTH CENT................................

445 -0.3 -0.1 -0.4

2.5 1.3

MOUNTAIN.......................................

163 -0.1 -0.2 -0.4

2.5 1.3

PACIFIC........................................

431 -1.7 1.1 -0.4

2.2 1.4

PUERTO RICO....................................

51 0.4 -0.3 -0.4

2.9 2.2 REGION (RURAL):

NEW ENGLAND....................................

37 -1.1 0.9

1.2

4.2 0.8

MIDDLE ATLANTIC................................

78 1.7 -0.4

1.4

6.0 4.1

SOUTH ATLANTIC.................................

189 -0.4 -0.2

1.7

4.4 3.3

EAST NORTH CENT................................

171 -0.6 0.1

1.4

4.1 2.2

EAST SOUTH CENT................................

202 -0.7 0.5

0.5

3.5 3.0

WEST NORTH CENT................................

188 1.6 -0.3

2.6

7.2 4.7

[[Page 50683]]

WEST SOUTH CENT................................

242 -0.9 -0.2

2.2

4.4 3.7

MOUNTAIN.......................................

95 -1.0 0.1

4.6

7.0 5.2

PACIFIC........................................

61 -0.7 1.8

2.7

7.2 5.3 TEACHING STATUS:

NON-TEACHING................................... 3115 -0.3 0.1

0.3

3.2 2.3

MINOR..........................................

769 0.3 0.0 -0.2

3.3 2.3

MAJOR..........................................

328 0.3 -0.2 -0.3

3.0 0.6 DSH PATIENT PERCENT:

0..............................................

16 0.3 0.0 -0.4

3.1 3.1

GT 0-0.10......................................

386 0.1 -0.2 -0.3

2.8 1.7

0.10-0.16......................................

555 0.0 0.1

0.2

3.5 2.4

0.16-0.23......................................

802 0.1 0.0

0.1

3.5 2.3

0.23-0.35......................................

977 0.1 -0.1

0.0

3.2 1.9

GE 0.35........................................

792 -0.3 0.1 -0.1

3.0 1.8

TEFRA: DSH NOT AVAIL 1.........................

684 -1.6 0.0 -0.4

1.2 -2.6 URBAN TEACHING/DSH:

TEACHING & DSH.................................

944 0.4 -0.1 -0.4

3.1 1.7

NO TEACHING/DSH................................ 1401 -0.3 0.1 -0.4

2.5 1.8

NO TEACHING/NO DSH.............................

16 0.3 0.0 -0.4

3.1 3.1

TEFRA: DSH NOT AVAIL 1.........................

588 -2.2 0.1 -0.4

0.7 -3.4 TYPE OF OWNERSHIP:

VOLUNTARY...................................... 2397 0.2 0.0

0.0

3.3 2.0

PROPRIETARY.................................... 1091 -1.1 0.0

0.0

2.1 1.6

GOVERNMENT.....................................

724 0.0 0.1

0.2

3.6 1.7

Col (1) Total Hospitals in 2006. Col (2) This column shows the impact of changes resulting from the reclassification of HCPCS codes among APC groups and from the addition of multiple procedure discounting for radiology procedures (budget neutral overall). Col (3) This column shows the adjustment for updating the wage index (budget neutral overall). Col (4) This column shows the adjustment for rural sole community hospitals (budget neutral overall). Col (5) This column shows the cumulative impact of cols 2 through 4 and the addition of the market basket update. Col (6) The column shows the impact of the change in MMA dollars in 2006 (drugs and 508) and outlier changes. 1 Complete DSH numbers are not available for hospitals that are not paid under IPPS.

15. On pages 42764-42775, Addendum A is corrected to read as follows:

[[Page 50684]]

Addendum A.--List of Ambulatory Payment Classifications (APCs) with Status Indicators, Relative Weights, Payment Rates, and Copayment Amounts Calendar Year 2006

National Minimum APC

Group title

SI

Relative Payment unadjusted unadjusted weight

rate copayment copayment

0001........... Level I Photochemotherapy S............... 0.4213 $25.00

$7.00

$5.00 0002........... Level I Fine Needle

T............... 0.9559 $56.73 ........... $11.35 Biopsy/Aspiration. 0003........... Bone Marrow Biopsy/

T............... 2.6530 $157.44 ........... $31.49 Aspiration. 0004........... Level I Needle Biopsy/ T............... 1.7646 $104.72 $22.36 $20.94 Aspiration Except Bone Marrow. 0005........... Level II Needle Biopsy/ T............... 3.5994 $213.60 $71.59 $42.72 Aspiration Except Bone Marrow. 0006........... Level I Incision &

T............... 1.5500 $91.98 $22.28 $18.40 Drainage. 0007........... Level II Incision &

T............... 11.4501 $679.48 ........... $135.90 Drainage. 0008........... Level III Incision and T............... 16.4989 $979.09 ........... $195.82 Drainage. 0009........... Nail Procedures.......... T............... 0.6680 $39.64

$8.34

$7.93 0010........... Level I Destruction of T............... 0.5719 $33.94

$9.65

$6.79 Lesion. 0011........... Level II Destruction of T............... 2.0839 $123.66 $25.17 $24.73 Lesion. 0012........... Level I Debridement & T............... 0.8497 $50.42 $11.18 $10.08 Destruction. 0013........... Level II Debridement & T............... 1.1078 $65.74 $14.20 $13.15 Destruction. 0015........... Level III Debridement & T............... 1.6514 $98.00 $20.29 $19.60 Destruction. 0016........... Level IV Debridement & T............... 2.5834 $153.31 $33.57 $30.66 Destruction. 0017........... Level VI Debridement & T............... 18.4211 $1,093.16 $227.84 $218.63 Destruction. 0018........... Biopsy of Skin/Puncture T............... 1.1726 $69.59 $16.04 $13.92 of Lesion. 0019........... Level I Excision/ Biopsy. T............... 4.0547 $240.62 $71.87 $48.12 0020........... Level II Excision/ Biopsy T............... 6.9433 $412.04 $107.40 $82.41 0021........... Level III Excision/

T............... 14.9776 $888.82 $219.48 $177.76 Biopsy. 0022........... Level IV Excision/ Biopsy T............... 19.6472 $1,165.92 $354.45 $233.18 0023........... Exploration Penetrating T............... 4.7775 $283.51 ........... $56.70 Wound. 0024........... Level I Skin Repair...... T............... 1.6084 $95.45 $31.25 $19.09 0025........... Level II Skin Repair..... T............... 5.4938 $326.02 $101.85 $65.20 0027........... Level IV Skin Repair..... T............... 18.4182 $1,092.99 $329.72 $218.60 0028........... Level I Breast Surgery... T............... 19.5801 $1,161.94 $303.74 $232.39 0029........... Level II Breast Surgery.. T............... 32.0476 $1,901.80 $632.64 $380.36 0030........... Level III Breast Surgery. T............... 40.0825 $2,378.62 $763.55 $475.72 0033........... Partial Hospitalization.. P............... 4.0708 $241.57 ........... $48.31 0035........... Venous Cutdown........... T............... 0.7158 $42.48 ...........

$8.50 0036........... Level II Fine Needle T............... 2.1773 $129.21 ........... $25.84 Biopsy/Aspiration. 0037........... Level IV Needle Biopsy/ T............... 9.4751 $562.28 $224.91 $112.46 Aspiration Except Bone Marrow. 0039........... Level I Implantation of S............... 181.4000 $10,764.82 ........... $2,152.96 Neurostimulator. 0040........... Level I Implantation of S............... 55.3297 $3,283.43 ........... $656.69 Neurostimulator Electrodes. 0041........... Level I Arthroscopy...... T............... 28.1318 $1,669.43 ........... $333.89 0042........... Level II Arthroscopy..... T............... 43.9753 $2,609.63 $804.74 $521.93 0043........... Closed Treatment Fracture T............... 1.7694 $105.00 ........... $21.00 Finger/Toe/Trunk. 0045........... Bone/Joint Manipulation T............... 14.4945 $860.15 $268.47 $172.03 Under Anesthesia. 0046........... Open/Percutaneous

T............... 37.7023 $2,237.37 $535.76 $447.47 Treatment Fracture or Dislocation. 0047........... Arthroplasty without T............... 31.6107 $1,875.87 $537.03 $375.17 Prosthesis. 0048........... Level I Arthroplasty with T............... 43.1288 $2,559.39 $570.30 $511.88 Prosthesis. 0049........... Level I Musculoskeletal T............... 20.3707 $1,208.86 ........... $241.77 Procedures Except Hand and Foot. 0050........... Level II Musculoskeletal T............... 23.9081 $1,418.78 ........... $283.76 Procedures Except Hand and Foot. 0051........... Level III Musculoskeletal T............... 36.5271 $2,167.63 ........... $433.53 Procedures Except Hand and Foot. 0052........... Level IV Musculoskeletal T............... 43.9378 $2,607.40 ........... $521.48 Procedures Except Hand and Foot. 0053........... Level I Hand

T............... 15.6795 $930.47 $253.49 $186.09 Musculoskeletal Procedures. 0054........... Level II Hand

T............... 25.3711 $1,505.60 ........... $301.12 Musculoskeletal Procedures. 0055........... Level I Foot

T............... 20.0692 $1,190.97 $355.34 $238.19 Musculoskeletal Procedures. 0056........... Level II Foot

T............... 40.2957 $2,391.27 ........... $478.25 Musculoskeletal Procedures. 0057........... Bunion Procedures........ T............... 27.5493 $1,634.86 $475.91 $326.97 0058........... Level I Strapping and S............... 1.0934 $64.89 ........... $12.98 Cast Application. 0060........... Manipulation Therapy..... S............... 0.4935 $29.29 ...........

$5.86 0068........... CPAP Initiation.......... S............... 1.2293 $72.95 $29.18 $14.59 0069........... Thoracoscopy............. T............... 30.6775 $1,820.49 $591.64 $364.10 0070........... Thoracentesis/Lavage T............... 3.2101 $190.50 ........... $38.10 Procedures. 0071........... Level I Endoscopy Upper T............... 0.7915 $46.97 $11.31

$9.39 Airway. 0072........... Level II Endoscopy Upper T............... 1.4361 $85.22 $21.27 $17.04 Airway. 0074........... Level IV Endoscopy Upper T............... 15.7757 $936.18 $295.70 $187.24 Airway. 0075........... Level V Endoscopy Upper T............... 21.3426 $1,266.53 $445.92 $253.31 Airway. 0076........... Level I Endoscopy Lower T............... 9.4592 $561.34 $189.82 $112.27 Airway. 0077........... Level I Pulmonary

S............... 0.3444 $20.44

$7.74

$4.09 Treatment. 0078........... Level II Pulmonary

S............... 1.0236 $60.74 $14.55 $12.15 Treatment. 0079........... Ventilation Initiation S............... 2.3482 $139.35 ........... $27.87 and Management. 0080........... Diagnostic Cardiac

T............... 37.1361 $2,203.77 $838.92 $440.75 Catheterization. 0081........... Non-Coronary Angioplasty T............... 34.4473 $2,044.21 ........... $408.84 or Atherectomy. 0082........... Coronary Atherectomy..... T............... 85.0126 $5,044.90 $1,085.20 $1,008.98 0083........... Coronary Angioplasty and T............... 50.8925 $3,020.11 ........... $604.02 Percutaneous Valvuloplasty. 0084........... Level I

S............... 10.0205 $594.65 ........... $118.93 Electrophysiologic Evaluation. 0085........... Level II

T............... 35.1882 $2,088.17 $426.25 $417.63 Electrophysiologic Evaluation.

[[Page 50685]]

0086........... Ablate Heart Dysrhythm T............... 44.2596 $2,626.50 $833.33 $525.30 Focus. 0087........... Cardiac

T............... 30.7101 $1,822.43 ........... $364.49 Electrophysiologic Recording/Mapping. 0088........... Thrombectomy............. T............... 36.5617 $2,169.68 $655.22 $433.94 0089........... Insertion/Replacement of T............... 105.6143 $6,267.47 $1,682.28 $1,253.49 Permanent Pacemaker and Electrodes. 0090........... Insertion/Replacement of T............... 89.1574 $5,290.87 $1,612.80 $1,058.17 Pacemaker Pulse Generator. 0091........... Level II Vascular

T............... 28.9999 $1,720.94 $348.23 $344.19 Ligation. 0092........... Level I Vascular Ligation T............... 23.4516 $1,391.69 ........... $278.34 0093........... Vascular Reconstruction/ ................ ........... ........... ........... ........... Fistula Repair without Device. 0094........... Level I Resuscitation and S............... 2.5363 $150.51 $47.62 $30.10 Cardioversion. 0095........... Cardiac Rehabilitation... S............... 0.5885 $34.92 $13.96

$6.98 0096........... Non-Invasive Vascular S............... 1.6307 $96.77 $38.70 $19.35 Studies. 0097........... Cardiac and Ambulatory X............... 1.0223 $60.67 $23.79 $12.13 Blood Pressure Monitoring. 0098........... Injection of Sclerosing T............... 1.1346 $67.33 ........... $13.47 Solution. 0099........... Electrocardiograms....... S............... 0.3821 $22.67 ...........

$4.53 0100........... Cardiac Stress Tests..... X............... 2.4968 $148.17 $41.44 $29.63 0101........... Tilt Table Evaluation.... S............... 4.2787 $253.91 $101.56 $50.78 0103........... Miscellaneous Vascular T............... 14.7142 $873.18 $223.63 $174.64 Procedures. 0104........... Transcatheter Placement T............... 79.0094 $4,688.65 ........... $937.73 of Intracoronary Stents. 0105........... Revision/Removal of

T............... 22.3685 $1,327.41 $370.40 $265.48 Pacemakers, AICD, or Vascular. 0106........... Insertion/Replacement/ T............... 45.4851 $2,699.22 ........... $539.84 Repair of Pacemaker and/ or Electrodes. 0107........... Insertion of Cardioverter- T............... 260.0295 $15,430.93 $3,103.22 $3,086.19 Defibrillator. 0108........... Insertion/Replacement/ T............... 349.1681 $20,720.68 ........... $4,144.14 Repair of Cardioverter- Defibrillator Leads. 0109........... Removal of Implanted T............... 11.0433 $655.34 $131.49 $131.07 Devices. 0110........... Transfusion.............. S............... 3.6594 $217.16 ........... $43.43 0111........... Blood Product Exchange... S............... 12.3956 $735.59 $200.18 $147.12 0112........... Apheresis, Photopheresis, S............... 26.7948 $1,590.08 $438.94 $318.02 and Plasmapheresis. 0113........... Excision Lymphatic System T............... 21.4653 $1,273.82 ........... $254.76 0114........... Thyroid/Lymphadenectomy T............... 40.7652 $2,419.13 $485.91 $483.83 Procedures. 0115........... Cannula/Access Device T............... 31.4727 $1,867.68 $459.35 $373.54 Procedures. 0116........... Chemotherapy

S............... 1.1453 $67.97 ........... $13.59 Administration by Other Technique Except Infusion. 0117........... Chemotherapy

S............... 3.2378 $192.14 $42.54 $38.43 Administration by Infusion Only. 0120........... Infusion Therapy Except S............... 2.0193 $119.83 $28.21 $23.97 Chemotherapy. 0121........... Level I Tube changes and T............... 2.2766 $135.10 $43.80 $27.02 Repositioning. 0122........... Level II Tube changes and T............... 6.9721 $413.75 $84.85 $82.75 Repositioning. 0123........... Bone Marrow Harvesting S............... 22.9902 $1,364.31 ........... $272.86 and Bone Marrow/Stem Cell Transplant. 0125........... Refilling of Infusion T............... 1.9331 $114.72 ........... $22.94 Pump. 0130........... Level I Laparoscopy...... T............... 31.9271 $1,894.65 $659.53 $378.93 0131........... Level II Laparoscopy..... T............... 43.3389 $2,571.86 $1,001.89 $514.37 0132........... Level III Laparoscopy.... T............... 62.9914 $3,738.10 $1,239.22 $747.62 0140........... Esophageal Dilation

T............... 5.4737 $324.83 $94.18 $64.97 without Endoscopy. 0141........... Level I Upper GI

T............... 8.1835 $485.63 $143.38 $97.13 Procedures. 0142........... Small Intestine Endoscopy T............... 9.3487 $554.78 $152.78 $110.96 0143........... Lower GI Endoscopy....... T............... 8.6869 $515.51 $186.06 $103.10 0146........... Level I Sigmoidoscopy and T............... 4.6374 $275.20 $64.40 $55.04 Anoscopy. 0147........... Level II Sigmoidoscopy T............... 7.9679 $472.84 ........... $94.57 and Anoscopy. 0148........... Level I Anal/Rectal

T............... 3.7383 $221.84 $57.21 $44.37 Procedures. 0149........... Level III Anal/Rectal T............... 18.0726 $1,072.48 $293.06 $214.50 Procedures. 0150........... Level IV Anal/Rectal T............... 23.8654 $1,416.24 $437.12 $283.25 Procedures. 0151........... Endoscopic Retrograde T............... 18.7338 $1,111.72 $245.46 $222.34 Cholangio- Pancreatography (ERCP). 0152........... Level I Percutaneous T............... 12.2833 $728.93 ........... $145.79 Abdominal and Biliary Procedures. 0153........... Peritoneal and Abdominal T............... 21.6961 $1,287.51 $382.75 $257.50 Procedures. 0154........... Hernia/Hydrocele

T............... 28.7847 $1,708.17 $464.85 $341.63 Procedures. 0155........... Level II Anal/Rectal T............... 16.2546 $964.60 ........... $192.92 Procedures. 0156........... Level II Urinary and Anal T............... 2.5751 $152.81 $40.52 $30.56 Procedures. 0157........... Colorectal Cancer

S............... 2.2904 $135.92 ........... $27.18 Screening: Barium Enema. 0158........... Colorectal Cancer

T............... 7.6588 $454.50 ........... $113.63 Screening: Colonoscopy. 0159........... Colorectal Cancer

S............... 3.1455 $186.66 ........... $46.67 Screening: Flexible Sigmoidoscopy. 0160........... Level I Cystourethroscopy T............... 6.6753 $396.13 $105.06 $79.23 and other Genitourinary Procedures. 0161........... Level II

T............... 18.5576 $1,101.26 $249.36 $220.25 Cystourethroscopy and other Genitourinary Procedures. 0162........... Level III

T............... 23.3918 $1,388.14 ........... $277.63 Cystourethroscopy and other Genitourinary Procedures. 0163........... Level IV

T............... 33.7354 $2,001.96 ........... $400.39 Cystourethroscopy and other Genitourinary Procedures. 0164........... Level I Urinary and Anal T............... 1.1855 $70.35 $17.29 $14.07 Procedures.

[[Page 50686]]

0165........... Level III Urinary and T............... 16.6689 $989.18 ........... $197.84 Anal Procedures. 0166........... Level I Urethral

T............... 17.6743 $1,048.85 $218.73 $209.77 Procedures. 0168........... Level II Urethral

T............... 28.2685 $1,677.54 $388.03 $335.51 Procedures. 0169........... Lithotripsy.............. T............... 43.0133 $2,552.54 $1,021.01 $510.51 0170........... Dialysis................. S............... 5.8994 $350.09 ........... $70.02 0180........... Circumcision............. T............... 19.8827 $1,179.90 $304.87 $235.98 0181........... Penile Procedures........ T............... 30.8663 $1,831.70 $621.82 $366.34 0183........... Testes/Epididymis

T............... 23.6415 $1,402.96 ........... $280.59 Procedures. 0184........... Prostate Biopsy.......... T............... 4.3566 $258.53 $96.27 $51.71 0188........... Level II Female

T............... 1.1400 $67.65 ........... $13.53 Reproductive Proc. 0189........... Level III Female

T............... 2.3710 $140.70 ........... $28.14 Reproductive Proc. 0190........... Level I Hysteroscopy..... T............... 21.0653 $1,250.08 $424.28 $250.02 0191........... Level I Female

T............... 0.1670

$9.91

$2.78

$1.98 Reproductive Proc. 0192........... Level IV Female

T............... 4.3082 $255.66 ........... $51.13 Reproductive Proc. 0193........... Level V Female

T............... 14.5843 $865.48 ........... $173.10 Reproductive Proc. 0194........... Level VIII Female

T............... 20.7525 $1,231.52 $397.84 $246.30 Reproductive Proc. 0195........... Level IX Female

T............... 26.6791 $1,583.22 $483.80 $316.64 Reproductive Proc. 0196........... Dilation and Curettage... T............... 17.0974 $1,014.61 $338.23 $202.92 0197........... Infertility Procedures... T............... 2.3572 $139.88 ........... $27.98 0198........... Pregnancy and Neonatal T............... 1.3683 $81.20 $32.19 $16.24 Care Procedures. 0200........... Level VII Female

T............... 17.8728 $1,060.63 $263.69 $212.13 Reproductive Proc. 0201........... Level VI Female

T............... 17.6047 $1,044.72 $329.65 $208.94 Reproductive Proc. 0202........... Level X Female

T............... 40.3866 $2,396.66 $958.66 $479.33 Reproductive Proc. 0203........... Level IV Nerve Injections T............... 10.4015 $617.26 $246.90 $123.45 0204........... Level I Nerve Injections. T............... 2.1910 $130.02 $40.13 $26.00 0206........... Level II Nerve Injections T............... 5.4920 $325.91 $75.55 $65.18 0207........... Level III Nerve

T............... 6.0109 $356.70 $86.92 $71.34 Injections. 0208........... Laminotomies and

T............... 42.3409 $2,512.64 ........... $502.53 Laminectomies. 0209........... Extended EEG Studies and S............... 11.5713 $686.68 $274.67 $137.34 Sleep Studies, Level II. 0212........... Nervous System Injections T............... 2.9740 $176.49 $70.59 $35.30 0213........... Extended EEG Studies and S............... 2.2932 $136.09 $54.43 $27.22 Sleep Studies, Level I. 0214........... Electroencephalogram..... S............... 1.1353 $67.37 $26.94 $13.47 0215........... Level I Nerve and Muscle S............... 0.6115 $36.29 $14.51

$7.26 Tests. 0216........... Level III Nerve and

S............... 2.6720 $158.56 ........... $31.71 Muscle Tests. 0218........... Level II Nerve and Muscle S............... 1.1408 $67.70 ........... $13.54 Tests. 0220........... Level I Nerve Procedures. T............... 17.3586 $1,030.11 ........... $206.02 0221........... Level II Nerve Procedures T............... 29.9209 $1,775.60 $463.62 $355.12 0222........... Implantation of

T............... 179.0982 $10,628.22 ........... $2,125.64 Neurological Device. 0223........... Implantation or Revision T............... 28.1230 $1,668.90 ........... $333.78 of Pain Management Catheter. 0224........... Implantation of Reservoir/ T............... 40.6455 $2,412.03 ........... $482.41 Pump/Shunt. 0225........... Level II Implantation of S............... 234.6925 $13,927.36 ........... $2,785.47 Neurostimulator Electrodes. 0226........... Implantation of Drug T............... 138.8695 $8,240.93 ........... $1,648.19 Infusion Reservoir. 0227........... Implantation of Drug T............... 136.4922 $8,099.86 ........... $1,619.97 Infusion Device. 0228........... Creation of Lumbar

T............... 51.7258 $3,069.56 ........... $613.91 Subarachnoid Shunt. 0229........... Transcatherter Placement T............... 64.4545 $3,824.92 $771.23 $764.98 of Intravascular Shunts. 0230........... Level I Eye Tests &

S............... 0.7858 $46.63 $14.97

$9.33 Treatments. 0231........... Level III Eye Tests & S............... 1.9278 $114.40 $44.61 $22.88 Treatments. 0232........... Level I Anterior Segment T............... 6.6732 $396.01 $103.17 $79.20 Eye Procedures. 0233........... Level II Anterior Segment T............... 14.9673 $888.20 $266.33 $177.64 Eye Procedures. 0234........... Level III Anterior

T............... 21.9741 $1,304.01 $511.31 $260.80 Segment Eye Procedures. 0235........... Level I Posterior Segment T............... 4.6593 $276.50 $67.40 $55.30 Eye Procedures. 0236........... Level II Posterior

T............... 17.0229 $1,010.19 ........... $202.04 Segment Eye Procedures. 0237........... Level III Posterior

T............... 28.9401 $1,717.39 ........... $343.48 Segment Eye Procedures. 0238........... Level I Repair and

T............... 2.5933 $153.89 ........... $30.78 Plastic Eye Procedures. 0239........... Level II Repair and

T............... 6.9097 $410.04 ........... $82.01 Plastic Eye Procedures. 0240........... Level III Repair and T............... 18.1508 $1,077.12 $315.31 $215.42 Plastic Eye Procedures. 0241........... Level IV Repair and

T............... 23.3036 $1,382.91 $384.47 $276.58 Plastic Eye Procedures. 0242........... Level V Repair and

T............... 30.5464 $1,812.72 $597.36 $362.54 Plastic Eye Procedures. 0243........... Strabismus/Muscle

T............... 22.1671 $1,315.46 $431.39 $263.09 Procedures. 0244........... Corneal Transplant....... T............... 38.3723 $2,277.13 $803.26 $455.43 0245........... Level I Cataract

T............... 13.3625 $792.97 $221.89 $158.59 Procedures without IOL Insert. 0246........... Cataract Procedures with T............... 23.4597 $1,392.17 $495.96 $278.43 IOL Insert. 0247........... Laser Eye Procedures T............... 5.0330 $298.67 $104.31 $59.73 Except Retinal. 0248........... Laser Retinal Procedures. T............... 4.6769 $277.54 $93.98 $55.51 0249........... Level II Cataract

T............... 27.9369 $1,657.86 $524.67 $331.57 Procedures without IOL Insert. 0250........... Nasal Cauterization/ T............... 1.2896 $76.53 $26.79 $15.31 Packing. 0251........... Level I ENT Procedures... T............... 2.0101 $119.29 ........... $23.86 0252........... Level II ENT Procedures.. T............... 7.8673 $466.87 $113.41 $93.37 0253........... Level III ENT Procedures. T............... 16.1357 $957.54 $282.29 $191.51

[[Page 50687]]

0254........... Level IV ENT Procedures.. T............... 23.4040 $1,388.86 $321.35 $277.77 0256........... Level V ENT Procedures... T............... 37.3204 $2,214.70 ........... $442.94 0258........... Tonsil and Adenoid

T............... 22.2466 $1,320.18 $437.25 $264.04 Procedures. 0259........... Level VI ENT Procedures.. T............... 366.3317 $21,739.22 $8,070.21 $4,347.84 0260........... Level I Plain Film Except X............... 0.7555 $44.83 $17.93

$8.97 Teeth. 0261........... Level II Plain Film

X............... 1.2901 $76.56 ........... $15.31 Except Teeth Including Bone Density Measurement. 0262........... Plain Film of Teeth...... X............... 0.9228 $54.76 ........... $10.95 0263........... Level I Miscellaneous X............... 1.7476 $103.71 $24.40 $20.74 Radiology Procedures. 0264........... Level II Miscellaneous X............... 3.5240 $209.12 $79.41 $41.82 Radiology Procedures. 0265........... Level I Diagnostic

S............... 1.0213 $60.61 $24.24 $12.12 Ultrasound. 0266........... Level II Diagnostic

S............... 1.6393 $97.28 $38.91 $19.46 Ultrasound. 0267........... Level III Diagnostic S............... 2.6327 $156.23 $62.18 $31.25 Ultrasound. 0268........... Ultrasound Guidance

S............... 1.0610 $62.96 ........... $12.59 Procedures. 0269........... Level III Echocardiogram S............... 3.2437 $192.49 $76.99 $38.50 Except Transesophageal. 0270........... Transesophageal

S............... 6.0192 $357.20 $142.88 $71.44 Echocardiogram. 0272........... Level I Fluoroscopy...... X............... 1.3801 $81.90 $32.76 $16.38 0274........... Myelography.............. S............... 3.0413 $180.48 $72.19 $36.10 0275........... Arthrography............. S............... 3.5779 $212.32 $69.09 $42.46 0276........... Level I Digestive

S............... 1.5319 $90.91 $36.36 $18.18 Radiology. 0277........... Level II Digestive

S............... 2.3852 $141.54 $56.61 $28.31 Radiology. 0278........... Diagnostic Urography..... S............... 2.6434 $156.87 $62.74 $31.37 0279........... Level II Angiography and S............... 8.9319 $530.05 $150.03 $106.01 Venography except Extremity. 0280........... Level III Angiography and S............... 20.7902 $1,233.75 $353.85 $246.75 Venography except Extremity. 0282........... Miscellaneous

S............... 1.6542 $98.17 $39.26 $19.63 Computerized Axial Tomography. 0283........... Computerized Axial

S............... 4.4253 $262.61 $105.04 $52.52 Tomography with Contrast Material. 0284........... Magnetic Resonance

S............... 6.4201 $380.99 $152.39 $76.20 Imaging and Magnetic Resonance Angiography with Contras. 0285........... Myocardial Positron

S............... 17.1798 $1,019.50 $318.72 $203.90 Emission Tomography (PET). 0288........... Bone Density: Axial

S............... 1.2568 $74.58 ........... $14.92 Skeleton. 0296........... Level I Therapeutic

S............... 2.2452 $133.24 $53.29 $26.65 Radiologic Procedures. 0297........... Level II Therapeutic S............... 5.2530 $311.73 $122.13 $62.35 Radiologic Procedures. 0299........... Miscellaneous Radiation S............... 5.8482 $347.05 ........... $69.41 Treatment. 0300........... Level I Radiation Therapy S............... 1.5198 $90.19 ........... $18.04 0301........... Level II Radiation

S............... 2.2195 $131.71 ........... $26.34 Therapy. 0302........... Level III Radiation

S............... 4.6145 $273.84 $103.74 $54.77 Therapy. 0303........... Treatment Device

X............... 2.8356 $168.27 $66.95 $33.65 Construction. 0304........... Level I Therapeutic

X............... 1.7738 $105.26 $41.52 $21.05 Radiation Treatment Preparation. 0305........... Level II Therapeutic X............... 4.0036 $237.59 $91.38 $47.52 Radiation Treatment Preparation. 0310........... Level III Therapeutic X............... 13.9490 $827.78 $325.27 $165.56 Radiation Treatment Preparation. 0312........... Radioelement Applications S............... 5.0032 $296.90 ........... $59.38 0313........... Brachytherapy............ S............... 12.8655 $763.48 ........... $152.70 0314........... Hyperthermic Therapies... S............... 5.9945 $355.73 $98.36 $71.15 0315........... Level II Implantation of T............... 290.6470 $17,247.86 ........... $3,449.57 Neurostimulator. 0320........... Electroconvulsive Therapy S............... 5.3765 $319.06 $80.06 $63.81 0321........... Biofeedback and Other S............... 1.3579 $80.58 $21.71 $16.12 Training. 0322........... Brief Individual

S............... 1.2319 $73.10 ........... $14.62 Psychotherapy. 0323........... Extended Individual

S............... 1.6227 $96.30 $20.08 $19.26 Psychotherapy. 0324........... Family Psychotherapy..... S............... 2.0997 $124.60 ........... $24.92 0325........... Group Psychotherapy...... S............... 1.3189 $78.27 $17.10 $15.65 0330........... Dental Procedures........ S............... 7.1756 $425.82 ........... $85.16 0332........... Computerized Axial

S............... 3.2694 $194.02 $77.60 $38.80 Tomography and Computerized Angiography without Contras. 0333........... Computerized Axial

S............... 5.2836 $313.54 $125.41 $62.71 Tomography and Computerized Angio w/o Contrast Material. 0335........... Magnetic Resonance

S............... 5.1581 $306.10 $122.43 $61.22 Imaging, Miscellaneous. 0336........... Magnetic Resonance

S............... 6.0742 $360.46 $144.18 $72.09 Imaging and Magnetic Resonance Angiography without Cont. 0337........... MRI and Magnetic

S............... 8.7945 $521.89 $208.75 $104.38 Resonance Angiography without Contrast Material followed. 0339........... Observation.............. S............... 7.1403 $423.73 ........... $84.75 0340........... Minor Ancillary

X............... 0.6384 $37.88 ...........

$7.58 Procedures. 0341........... Skin Tests............... X............... 0.1112

$6.60

$2.62

$1.32 0342........... Level I Pathology........ X............... 0.1560

$9.26

$3.70

$1.85 0343........... Level III Pathology...... X............... 0.4786 $28.40 $11.10

$5.68 0344........... Level IV Pathology....... X............... 0.7996 $47.45 $15.66

$9.49 0345........... Level I Transfusion

X............... 0.2277 $13.51

$3.01

$2.70 Laboratory Procedures. 0346........... Level II Transfusion X............... 0.3434 $20.38

$4.54

$4.08 Laboratory Procedures. 0347........... Level III Transfusion X............... 0.8434 $50.05 $12.35 $10.01 Laboratory Procedures.

[[Page 50688]]

0348........... Fertility Laboratory X............... 0.7927 $47.04 ...........

$9.41 Procedures. 0350........... Administration of flu and X............... 0.3954 $23.46

$0.00

$0.00 PPV vaccines. 0352........... Level I Injections....... X............... 0.1413

$8.39 ...........

$1.68 0353........... Level II Injections...... X............... 0.3954 $23.46 ...........

$4.69 0359........... Level III Injections..... X............... 0.8312 $49.33 ...........

$9.87 0360........... Level I Alimentary Tests. X............... 1.4739 $87.47 $34.98 $17.49 0361........... Level II Alimentary Tests X............... 3.6216 $214.92 $83.23 $42.98 0362........... Contact Lens and

X............... 2.6607 $157.89 ........... $31.58 Spectacle Services. 0363........... Level I

X............... 0.9128 $54.17 $17.44 $10.83 Otorhinolaryngologic Function Tests. 0364........... Level I Audiometry....... X............... 0.4708 $27.94

$9.06

$5.59 0365........... Level II Audiometry...... X............... 1.2356 $73.32 $18.95 $14.66 0366........... Level III Audiometry..... X............... 1.7743 $105.29 $30.04 $21.06 0367........... Level I Pulmonary Test... X............... 0.6659 $39.52 $14.80

$7.90 0368........... Level II Pulmonary Tests. X............... 0.9761 $57.92 $23.16 $11.58 0369........... Level III Pulmonary Tests X............... 2.7519 $163.31 $44.18 $32.66 0370........... Allergy Tests............ X............... 1.1232 $66.65 ........... $13.33 0372........... Therapeutic Phlebotomy... X............... 0.5700 $33.83 $10.09

$6.77 0373........... Neuropsychological

X............... 2.1926 $130.12 ........... $26.02 Testing. 0374........... Monitoring Psychiatric X............... 1.0414 $61.80 ........... $12.36 Drugs. 0375........... Ancillary Outpatient T............... 42.5900 $2,527.42 ........... $505.48 Services When Patient Expires. 0376........... Level II Cardiac Imaging. S............... 5.1975 $308.44 $121.42 $61.69 0377........... Level III Cardiac Imaging S............... 6.8344 $405.57 $162.22 $81.11 0378........... Level II Pulmonary

S............... 5.4997 $326.37 $130.54 $65.27 Imaging. 0379........... Injection adenosine...... K............... ........... $33.45 ...........

$6.69 0381........... Single Allergy Tests..... X............... 0.1884 $11.18

$2.35

$2.24 0384........... GI Procedures with Stents T............... 22.3392 $1,325.68 $287.93 $265.14 0385........... Level I Prosthetic

S............... 75.6446 $4,488.98 ........... $897.80 Urological Procedures. 0386........... Level II Prosthetic

S............... 120.1694 $7,131.21 ........... $1,426.24 Urological Procedures. 0387........... Level II Hysteroscopy.... T............... 32.5445 $1,931.29 $655.55 $386.26 0388........... Discography.............. S............... 12.3294 $731.66 $292.66 $146.33 0389........... Non-imaging Nuclear

S............... 1.4976 $88.87 $35.54 $17.77 Medicine. 0390........... Level I Endocrine Imaging S............... 2.5562 $151.69 $60.67 $30.34 0391........... Level II Endocrine

S............... 2.8774 $170.75 $68.30 $34.15 Imaging. 0393........... Red Cell/Plasma Studies.. S............... 3.4438 $204.37 $81.74 $40.87 0394........... Hepatobiliary Imaging.... S............... 4.4630 $264.85 $105.93 $52.97 0395........... GI Tract Imaging......... S............... 3.8699 $229.65 $91.86 $45.93 0396........... Bone Imaging............. S............... 4.1426 $245.83 $98.33 $49.17 0397........... Vascular Imaging......... S............... 2.2646 $134.39 $53.75 $26.88 0398........... Level I Cardiac Imaging.. S............... 4.3093 $255.73 $102.29 $51.15 0399........... Nuclear Medicine Add-on S............... 1.5192 $90.15 $36.06 $18.03 Imaging. 0400........... Hematopoietic Imaging.... S............... 4.1335 $245.29 $98.11 $49.06 0401........... Level I Pulmonary Imaging S............... 3.4150 $202.66 $81.06 $40.53 0402........... Brain Imaging............ S............... 5.1847 $307.68 $123.07 $61.54 0403........... CSF Imaging.............. S............... 3.6138 $214.45 $85.78 $42.89 0404........... Renal and Genitourinary S............... 3.8559 $228.82 $91.52 $45.76 Studies Level I. 0405........... Renal and Genitourinary S............... 4.2674 $253.24 $101.29 $50.65 Studies Level II. 0406........... Tumor/Infection Imaging.. S............... 4.3035 $255.38 $102.15 $51.08 0407........... Radionuclide Therapy..... S............... 3.9839 $236.42 $94.56 $47.28 0409........... Red Blood Cell Tests..... X............... 0.1258

$7.47

$2.22

$1.49 0411........... Respiratory Procedures... S............... 0.3869 $22.96 ...........

$4.59 0412........... IMRT Treatment Delivery.. S............... 5.3643 $318.33 ........... $63.67 0415........... Level II Endoscopy Lower T............... 22.0955 $1,311.21 $459.92 $262.24 Airway. 0416........... Level I Intravascular and S............... 19.5542 $1,160.40 ........... $232.08 Intracardiac Ultrasound and Flow Reserve. 0417........... Computerized

S............... 4.0750 $241.82 ........... $48.36 Reconstruction. 0418........... Insertion of Left

T............... 109.3043 $6,486.45 ........... $1,297.29 Ventricular Pacing Elect. 0421........... Prolonged Physiologic X............... 1.6600 $98.51 ........... $19.70 Monitoring. 0422........... Level II Upper GI

T............... 22.9647 $1,362.79 $448.81 $272.56 Procedures. 0423........... Level II Percutaneous T............... 40.2866 $2,390.73 ........... $478.15 Abdominal and Biliary Procedures. 0425........... Level II Arthroplasty T............... 100.2058 $5,946.51 $1,378.01 $1,189.30 with Prosthesis. 0426........... Level II Strapping and S............... 2.1243 $126.06 ........... $25.21 Cast Application. 0427........... Level III Tube Changes T............... 10.1977 $605.16 $124.11 $121.03 and Repositioning. 0428........... Level III Sigmoidoscopy T............... 19.9022 $1,181.06 ........... $236.21 and Anoscopy. 0429........... Level V Cystourethroscopy T............... 42.3147 $2,511.08 ........... $502.22 and other Genitourinary Procedures. 0430........... Level IV Nerve and Muscle T............... 11.4040 $676.75 ........... $135.35 Tests. 0432........... Health and Behavior

S............... 0.6949 $41.24 ...........

$8.25 Services. 0433........... Level II Pathology....... X............... 0.2581 $15.32

$6.12

$3.06 0434........... Cardiac Defect Repair.... T............... 90.7877 $5,387.61 ........... $1,077.52

[[Page 50689]]

0600........... Low Level Clinic Visits.. V............... 0.8688 $51.56 ........... $10.31 0601........... Mid Level Clinic Visits.. V............... 1.0038 $59.57 ........... $11.91 0602........... High Level Clinic Visits. V............... 1.4284 $84.77 ........... $16.95 0610........... Low Level Emergency

V............... 1.2947 $76.83 $19.48 $15.37 Visits. 0611........... Mid Level Emergency

V............... 2.2718 $134.82 $35.76 $26.96 Visits. 0612........... High Level Emergency V............... 3.9853 $236.50 $54.12 $47.30 Visits. 0620........... Critical Care............ S............... 8.2996 $492.52 $135.68 $98.50 0621........... Level I Vascular Access T............... 8.2986 $492.46 ........... $98.49 Procedures. 0622........... Level II Vascular Access T............... 21.2671 $1,262.05 ........... $252.41 Procedures. 0623........... Level III Vascular Access T............... 27.1105 $1,608.82 ........... $321.76 Procedures. 0648........... Breast Reconstruction T............... 50.4459 $2,993.61 ........... $598.72 with Prosthesis. 0651........... Complex Interstitial S............... 12.1448 $720.71 ........... $144.14 Radiation Source Application. 0652........... Insertion of

T............... 28.8948 $1,714.70 ........... $342.94 Intraperitoneal Catheters. 0653........... Vascular Reconstruction/ T............... 30.5339 $1,811.97 ........... $362.39 Fistula Repair with Device. 0654........... Insertion/Replacement of T............... 100.9294 $5,989.45 ........... $1,197.89 a permanent dual chamber pacemaker. 0655........... Insertion/Replacement/ T............... 133.7768 $7,938.72 ........... $1,587.74 Conversion of a permanent dual chamber pacemaker. 0656........... Transcatheter Placement T............... 109.9237 $6,523.20 ........... $1,304.64 of Intracoronary Drug- Eluting Stents. 0657........... Placement of Tissue Clips S............... 1.7092 $101.43 ........... $20.29 0658........... Percutaneous Breast

T............... 6.1049 $362.28 ........... $72.46 Biopsies. 0659........... Hyperbaric Oxygen........ S............... 1.5473 $91.82 ........... $18.36 0660........... Level II

X............... 1.6419 $97.44 $30.66 $19.49 Otorhinolaryngologic Function Tests. 0661........... Level V Pathology........ X............... 3.3775 $200.43 $80.17 $40.09 0662........... CT Angiography........... S............... 5.1621 $306.33 $122.53 $61.27 0664........... Level I Proton Beam

S............... 12.9439 $768.13 ........... $153.63 Radiation Therapy. 0665........... Bone Density:

S............... 0.6464 $38.36 ...........

$7.67 AppendicularSkeleton. 0667........... Level II Proton Beam S............... 15.4857 $918.97 ........... $183.79 Radiation Therapy. 0668........... Level I Angiography and S............... 6.5024 $385.87 $114.67 $77.17 Venography except Extremity. 0670........... Level II Intravascular S............... 25.4131 $1,508.09 $472.46 $301.62 and Intracardiac Ultrasound and Flow Reserve. 0671........... Level II Echocardiogram S............... 1.7028 $101.05 $40.42 $20.21 Except Transesophageal. 0672........... Level IV Posterior

T............... 36.9284 $2,191.44 ........... $438.29 Segment Eye Procedures. 0673........... Level IV Anterior Segment T............... 29.2582 $1,736.27 $649.56 $347.25 Eye Procedures. 0674........... Prostate Cryoablation.... T............... 95.7856 $5,684.20 ........... $1,136.84 0675........... Prostatic Thermotherapy.. T............... 43.7329 $2,595.24 ........... $519.05 0676........... Thrombolysis and

T............... 2.4105 $143.05 ........... $28.61 Thrombectomy. 0678........... External Counterpulsation T............... 1.7276 $102.52 ........... $20.50 0679........... Level II Resuscitation S............... 5.5774 $330.98 $95.30 $66.20 and Cardioversion. 0680........... Insertion of Patient S............... 62.9082 $3,733.16 ........... $746.63 Activated Event Recorders. 0681........... Knee Arthroplasty........ T............... 137.1630 $8,139.66 $2,081.48 $1,627.93 0682........... Level V Debridement & T............... 6.9107 $410.10 $162.42 $82.02 Destruction. 0683........... Level II

S............... 1.9006 $112.79 $25.34 $22.56 Photochemotherapy. 0685........... Level III Needle Biopsy/ T............... 6.0174 $357.09 $115.47 $71.42 Aspiration Except Bone Marrow. 0686........... Level III Skin Repair.... T............... 13.8287 $820.64 ........... $164.13 0687........... Revision/Removal of

T............... 19.2347 $1,141.44 $456.57 $228.29 Neurostimulator Electrodes. 0688........... Revision/Removal of

T............... 43.0444 $2,554.38 $1,021.75 $510.88 Neurostimulator Pulse Generator Receiver. 0689........... Electronic Analysis of S............... 0.5735 $34.03 ...........

$6.81 Cardioverter- defibrillators. 0690........... Electronic Analysis of S............... 0.3755 $22.28

$8.91

$4.46 Pacemakers and other Cardiac Devices. 0691........... Electronic Analysis of S............... 2.5252 $149.85 $59.94 $29.97 Programmable Shunts/ Pumps. 0692........... Electronic Analysis of S............... 2.0111 $119.34 $30.16 $23.87 Neurostimulator Pulse Generators. 0693........... Level II Breast

T............... 42.2254 $2,505.78 $798.17 $501.16 Reconstruction. 0694........... Mohs Surgery............. T............... 3.8452 $228.19 $61.86 $45.64 0695........... Level VII Debridement & T............... 20.3164 $1,205.64 $266.59 $241.13 Destruction. 0697........... Level I Echocardiogram S............... 1.5357 $91.13 $36.45 $18.23 Except Transesophageal. 0698........... Level II Eye Tests & S............... 1.2438 $73.81 $16.55 $14.76 Treatments. 0699........... Level IV Eye Tests & T............... 10.0177 $594.48 ........... $118.90 Treatments. 0700........... Antepartum Manipulation.. T............... 5.3614 $318.16 ........... $63.63 0701........... SR 89 chloride, per mCi.. H............... ........... ........... ........... ........... 0702........... SM 153 lexidronam........ H............... ........... ........... ........... ........... 0704........... IN 111 Satumomab

H............... ........... ........... ........... ........... pendetide per dose. 0705........... Technetium TC99M

H............... ........... ........... ........... ........... tetrofosmin. 0726........... Dexrazoxane hcl injection K............... ........... $216.39 ........... $43.28 0728........... Filgrastim injection..... K............... ........... $178.39 ........... $35.68 0730........... Pamidronate disodium..... K............... ........... $58.42 ........... $11.68 0731........... Sargramostim injection... K............... ........... $21.11 ...........

$4.22 0732........... Mesna injection.......... K............... ........... $13.68 ...........

$2.74 0733........... Non esrd epoetin alpha K............... ...........

$9.99 ...........

$2.00 inj.

[[Page 50690]]

0734........... Injection, darbepoetin K............... ...........

$3.28 ...........

$0.66 alfa (for non-ESRD). 0735........... Ampho b cholesteryl

K............... ........... $12.24 ...........

$2.45 sulfate. 0736........... Amphotericin b liposome K............... ........... $21.91 ...........

$4.38 inj. 0737........... Ammonia N-13, per dose... H............... ........... ........... ........... ........... 0738........... Rasburicase.............. G............... ........... $109.18 ........... $21.84 0750........... Dolasetron mesylate...... K............... ...........

$6.55 ...........

$1.31 0763........... Dolasetron mesylate oral. K............... ........... $48.54 ...........

$9.71 0764........... Granisetron HCl injection K............... ...........

$7.24 ...........

$1.45 0765........... Granisetron HCl oral..... K............... ........... $33.51 ...........

$6.70 0768........... Ondansetron hcl injection K............... ...........

$3.80 ...........

$0.76 0769........... Ondansetron hcl oral..... K............... ........... $32.02 ...........

$6.40 0800........... Leuprolide acetate....... K............... ........... $441.78 ........... $88.36 0802........... Etoposide oral........... K............... ........... $41.12 ...........

$8.22 0807........... Aldesleukin/single use K............... ........... $701.76 ........... $140.35 vial. 0809........... Bcg live intravesical vac K............... ........... $121.74 ........... $24.35 0810........... Goserelin acetate implant K............... ........... $196.25 ........... $39.25 0811........... Carboplatin injection.... K............... ........... $77.16 ........... $15.43 0812........... Carmus bischl nitro inj.. K............... ........... $141.29 ........... $28.26 0814........... Asparaginase injection... K............... ........... $55.42 ........... $11.08 0819........... Dacarbazine inj.......... K............... ...........

$6.20 ...........

$1.24 0820........... Daunorubicin............. K............... ........... $35.28 ...........

$7.06 0821........... Daunorubicin citrate K............... ........... $57.56 ........... $11.51 liposom. 0823........... Docetaxel................ K............... ........... $301.17 ........... $60.23 0827........... Floxuridine injection.... K............... ........... $60.17 ........... $12.03 0828........... Gemcitabine HCL.......... K............... ........... $117.45 ........... $23.49 0830........... Irinotecan injection..... K............... ........... $129.08 ........... $25.82 0831........... Ifosfomide injection..... K............... ........... $53.54 ........... $10.71 0832........... Idarubicin hcl injection. K............... ........... $314.00 ........... $62.80 0834........... Interferon alfa-2a inj... K............... ........... $31.75 ...........

$6.35 0835........... Inj cosyntropin.......... K............... ........... $69.27 ........... $13.85 0836........... Interferon alfa-2b inj K............... ........... $13.22 ...........

$2.64 recombinant, 1 million. 0838........... Interferon gamma 1-b inj. K............... ........... $277.79 ........... $55.56 0840........... Melphalan hydrochl....... K............... ........... $523.22 ........... $104.64 0842........... Fludarabine phosphate inj K............... ........... $262.41 ........... $52.48 0843........... Pegaspargase............. K............... ........... $1,528.80 ........... $305.76 0844........... Pentostatin injection.... K............... ........... $1,868.91 ........... $373.78 0849........... Rituximab................ K............... ........... $447.97 ........... $89.59 0850........... Streptozocin injection... K............... ........... $153.33 ........... $30.67 0851........... Thiotepa injection....... K............... ........... $44.55 ...........

$8.91 0852........... Topotecan................ K............... ........... $755.51 ........... $151.10 0855........... Vinorelbine tartrate..... K............... ........... $62.85 ........... $12.57 0856........... Porfimer sodium.......... K............... ........... $2,457.97 ........... $491.59 0857........... Bleomycin sulfate

K............... ........... $54.18 ........... $10.84 injection. 0858........... Cladribine............... K............... ........... $39.37 ...........

$7.87 0860........... Plicamycin (mithramycin) K............... ........... $80.54 ........... $16.11 inj. 0861........... Leuprolide acetate

K............... ........... $10.96 ...........

$2.19 injection. 0862........... Mitomycin................ K............... ........... $26.36 ...........

$5.27 0863........... Paclitaxel injection..... K............... ........... $19.11 ...........

$3.82 0864........... Mitoxantrone hcl......... K............... ........... $329.69 ........... $65.94 0865........... Interferon alfa-n3 inj, K............... ...........

$8.77 ...........

$1.75 human leukocyte derived, 2. 0868........... Oral aprepitant.......... G............... ...........

$4.75 ...........

$0.95 0869........... IVIG lyophil 1g.......... K............... ........... $39.46 ...........

$7.89 0870........... IVIG lyophil 10 mg....... K............... ...........

$0.40 ...........

$0.08 0871........... IVIG non-lyophil 1g...... K............... ........... $57.26 ........... $11.45 0872........... IVIG non-lyophil 10 mg... K............... ...........

$0.57 ...........

$0.11 0876........... Caffeine citrate

K............... ...........

$3.34 ...........

$0.67 injection. 0880........... Penicillin g benzathine K............... ........... $72.26 ........... $14.45 inj. 0884........... Rho d immune globulin inj K............... ........... $113.91 ........... $22.78 0887........... Azathioprine parenteral.. K............... ........... $47.40 ...........

$9.48 0888........... Cyclosporine oral........ K............... ...........

$3.94 ...........

$0.79 0890........... Lymphocyte immune

K............... ........... $290.30 ........... $58.06 globulin. 0891........... Tacrolimus oral.......... K............... ...........

$3.37 ...........

$0.67 0892........... Edetate calcium disodium K............... ........... $40.34 ...........

$8.07 inj. 0893........... Calcitonin salmon

K............... ........... $35.68 ...........

$7.14 injection. 0895........... Deferoxamine mesylate inj K............... ........... $14.91 ...........

$2.98 0900........... Alglucerase injection.... K............... ........... $39.94 ...........

$7.99 0901........... Alpha 1 proteinase

K............... ...........

$3.30 ...........

$0.66 inhibitor. 0902........... Botulinum toxin a, per K............... ...........

$4.80 ...........

$0.96 unit. 0903........... Cytomegalovirus imm IV/ K............... ........... $683.07 ........... $136.61 vial.

[[Page 50691]]

0906........... RSV-ivig................. K............... ........... $15.56 ...........

$3.11 0910........... Interferon beta-1b....... K............... ........... $81.95 ........... $16.39 0911........... Streptokinase............ K............... ........... $83.36 ........... $16.67 0912........... Interferon alfacon-1..... K............... ...........

$3.91 ...........

$0.78 0913........... Ganciclovir long act K............... ........... $4,318.68 ........... $863.74 implant. 0916........... Injection imiglucerase / K............... ...........

$3.98 ...........

$0.80 unit. 0917........... Adenosine injection...... K............... ........... $71.53 ........... $14.31 0925........... Factor viii.............. K............... ...........

$0.51 ...........

$0.10 0926........... Factor VIII (porcine).... K............... ...........

$1.75 ...........

$0.35 0927........... Factor viii recombinant.. K............... ...........

$0.94 ...........

$0.19 0928........... Factor ix complex........ K............... ...........

$0.52 ...........

$0.10 0929........... Anti-inhibitor per iu.... K............... ...........

$1.12 ...........

$0.22 0931........... Factor IX non-recombinant K............... ...........

$0.75 ...........

$0.15 0932........... Factor IX recombinant.... K............... ...........

$0.86 ...........

$0.17 0935........... Clonidine hydrochloride.. K............... ........... $57.47 ........... $11.49 0949........... Plasma, Pooled Multiple K............... 1.1956 $70.95 ........... $14.19 Donor, Solvent/Detergent T. 0950........... Blood (Whole) For

K............... 2.0123 $119.42 ........... $23.88 Transfusion. 0952........... Cryoprecipitate.......... K............... 0.7395 $43.88 ...........

$8.78 0954........... RBC leukocytes reduced... K............... 2.7370 $162.42 ........... $32.48 0955........... Plasma, Fresh Frozen..... K............... 1.2934 $76.75 ........... $15.35 0956........... Plasma Protein Fraction.. K............... 1.1226 $66.62 ........... $13.32 0957........... Platelet Concentrate..... K............... 0.8317 $49.36 ...........

$9.87 0958........... Platelet Rich Plasma..... K............... 5.1815 $307.49 ........... $61.50 0959........... Red Blood Cells.......... K............... 2.0301 $120.47 ........... $24.09 0960........... Washed Red Blood Cells... K............... 2.9707 $176.29 ........... $35.26 0961........... Infusion, Albumin (Human) K............... 0.5119 $30.38 ...........

$6.08 5%, 50 ml. 0963........... Albumin (human), 5%...... K............... 1.3869 $82.30 ........... $16.46 0964........... Albumin (human), 25%..... K............... 0.4878 $28.95 ...........

$5.79 0965........... Albumin (human), 25%..... K............... 1.1117 $65.97 ........... $13.19 0966........... Plasmaprotein fract, 5%.. K............... 4.9564 $294.13 ........... $58.83 0967........... Split unit of blood...... K............... 1.2698 $75.35 ........... $15.07 0968........... Platelets leukocyte

K............... 2.3639 $140.28 ........... $28.06 reduced irradiated. 0969........... Red blood cell leukocyte K............... 3.6451 $216.31 ........... $43.26 reduced irradiated. 1009........... Cryoprecip reduced plasma K............... 1.3062 $77.51 ........... $15.50 1010........... Blood, L/R, CMV-neg...... K............... 2.9692 $176.20 ........... $35.24 1011........... Platelets, HLA-m, L/R, K............... 10.9690 $650.93 ........... $130.19 unit. 1013........... Platelet concentrate, L/ K............... 1.6023 $95.09 ........... $19.02 R, unit. 1016........... Blood, L/R, froz/

K............... 5.2631 $312.33 ........... $62.47 deglycerol/washed. 1017........... Platelets, aph/pher, L/R, K............... 8.5998 $510.34 ........... $102.07 CMV-neg, unit. 1018........... Blood, L/R, irradiated... K............... 2.8004 $166.18 ........... $33.24 1019........... Platelets, aph/pher, L/R, K............... 9.5131 $564.54 ........... $112.91 irradiated, unit. 1020........... Pit, pher, L/R, CMV, K............... 10.1551 $602.63 ........... $120.53 irrad. 1021........... RBC, frz/deg/wsh, L/R, K............... 4.8787 $289.52 ........... $57.90 irrad. 1022........... RBC, L/R, CMV neg, irrad. K............... 4.2901 $254.59 ........... $50.92 1045........... Iobenguane sulfate I-131. H............... ........... ........... ........... ........... 1052........... Injection, Voriconazole.. K............... ...........

$4.63 ...........

$0.93 1064........... I-131 sodium iodide

H............... ........... ........... ........... ........... capsule. 1065........... I-131 sodium iodide

H............... ........... ........... ........... ........... solution. 1080........... I-131 tositumomab, dx.... H............... ........... ........... ........... ........... 1081........... I-131 tositumomab, tx.... H............... ........... ........... ........... ........... 1082........... Treprostinil............. K............... ........... $55.02 ........... $11.00 1083........... Injection, Adalimumab.... K............... ........... $300.10 ........... $60.02 1084........... Denileukin diftitox...... K............... ........... $1,235.33 ........... $247.07 1085........... Injection, Gallium

K............... ...........

$1.30 ...........

$0.26 Nitrate. 1086........... Temozolomide,oral........ K............... ...........

$7.28 ...........

$1.46 1088........... Dx I131 so iodide cap H............... ........... ........... ........... ........... millic. 1091........... IN 111 Oxyquinoline...... H............... ........... ........... ........... ........... 1092........... IN 111 Pentetate......... H............... ........... ........... ........... ........... 1093........... TC99M fanolesomab........ H............... ........... ........... ........... ........... 1096........... TC 99M Exametazime, per H............... ........... ........... ........... ........... dose. 1150........... Th I131 so iodide sol H............... ........... ........... ........... ........... millic. 1166........... Cytarabine liposome...... K............... ........... $366.43 ........... $73.29 1167........... Epirubicin hcl........... K............... ........... $25.15 ...........

$5.03 1178........... Busulfan IV.............. K............... 0.2851 $16.92 ...........

$3.38 1201........... TC 99M SUCCIMER, PER Vial H............... ........... ........... ........... ........... 1203........... Verteporfin for injection K............... ...........

$9.16 ...........

$1.83 1207........... Octreotide injection, K............... ........... $87.40 ........... $17.48 depot. 1210........... Inj dihydroergotamine K............... ........... $27.82 ...........

$5.56 mesylt. 1280........... Corticotropin injection.. K............... ........... $95.44 ........... $19.09

[[Page 50692]]

1305........... Apligraf................. K............... 12.9222 $766.84 ........... $153.37 1330........... Ergonovine maleate

K............... 0.5263 $31.23 ...........

$6.25 injection. 1409........... Factor viia recombinant.. K............... ........... $1,080.11 ........... $216.02 1436........... Etidronate disodium inj.. K............... ........... $68.69 ........... $13.74 1491........... New Technology--Level I S............... ...........

$5.00 ...........

$1.00 ($0-$10). 1492........... New Technology--Level I S............... ........... $15.00 ...........

$3.00 ($10-$20). 1493........... New Technology--Level I S............... ........... $25.00 ...........

$5.00 ($20-$30). 1494........... New Technology--Level I S............... ........... $35.00 ...........

$7.00 ($30-$40). 1495........... New Technology--Level I S............... ........... $45.00 ...........

$9.00 ($40-$50). 1496........... New Technology--Level I T............... ...........

$5.00 ...........

$1.00 ($0-$10). 1497........... New Technology--Level I T............... ........... $15.00 ...........

$3.00 ($10-$20). 1498........... New Technology--Level I T............... ........... $25.00 ...........

$5.00 ($20-$30). 1499........... New Technology--Level I T............... ........... $35.00 ...........

$7.00 ($30-$40). 1500........... New Technology--Level I T............... ........... $45.00 ...........

$9.00 ($40-$50). 1502........... New Technology--Level II S............... ........... $75.00 ........... $15.00 ($50-$100). 1503........... New Technology--Level III S............... ........... $150.00 ........... $30.00 ($100-$200). 1504........... New Technology--Level IV S............... ........... $250.00 ........... $50.00 ($200-$300). 1505........... New Technology--Level V S............... ........... $350.00 ........... $70.00 ($300-$400). 1506........... New Technology--Level VI S............... ........... $450.00 ........... $90.00 ($400-$500). 1507........... New Technology--Level VII S............... ........... $550.00 ........... $110.00 ($500-$600). 1508........... New Technology--Level S............... ........... $650.00 ........... $130.00 VIII ($600-$700). 1509........... New Technology--Level IX S............... ........... $750.00 ........... $150.00 ($700-$800). 1510........... New Technology--Level X S............... ........... $850.00 ........... $170.00 ($800-$900). 1511........... New Technology--Level XI S............... ........... $950.00 ........... $190.00 ($900-$1000). 1512........... New Technology--Level XII S............... ........... $1,050.00 ........... $210.00 ($1000-$1100). 1513........... New Technology--Level S............... ........... $1,150.00 ........... $230.00 XIII ($1100-$1200). 1514........... New Technology--Level XIV S............... ........... $1,250.00 ........... $250.00 ($1200-$1300). 1515........... New Technology--Level XV S............... ........... $1,350.00 ........... $270.00 ($1300-$1400). 1516........... New Technology--Level XVI S............... ........... $1,450.00 ........... $290.00 ($1400-$1500). 1517........... New Technology--Level S............... ........... $1,550.00 ........... $310.00 XVII ($1500-$1600). 1518........... New Technology--Level S............... ........... $1,650.00 ........... $330.00 XVIII ($1600-$1700). 1519........... New Technology--Level IXX S............... ........... $1,750.00 ........... $350.00 ($1700-$1800). 1520........... New Technology--Level XX S............... ........... $1,850.00 ........... $370.00 ($1800-$1900). 1521........... New Technology--Level XXI S............... ........... $1,950.00 ........... $390.00 ($1900-$2000). 1522........... New Technology--Level S............... ........... $2,250.00 ........... $450.00 XXII ($2000-$2500). 1523........... New Technology--Level S............... ........... $2,750.00 ........... $550.00 XXIII ($2500-$3000). 1524........... New Technology--Level XIV S............... ........... $3,250.00 ........... $650.00 ($3000-$3500). 1525........... New Technology--Level XXV S............... ........... $3,750.00 ........... $750.00 ($3500-$4000). 1526........... New Technology--Level S............... ........... $4,250.00 ........... $850.00 XXVI ($4000-$4500). 1527........... New Technology--Level S............... ........... $4,750.00 ........... $950.00 XXVII ($4500-$5000). 1528........... New Technology--Level S............... ........... $5,250.00 ........... $1,050.00 XXVIII ($5000-$5500). 1529........... New Technology--Level S............... ........... $5,750.00 ........... $1,150.00 XXIX ($5500-$6000). 1530........... New Technology--Level XXX S............... ........... $6,250.00 ........... $1,250.00 ($6000-$6500). 1531........... New Technology--Level S............... ........... $6,750.00 ........... $1,350.00 XXXI ($6500-$7000). 1532........... New Technology--Level S............... ........... $7,250.00 ........... $1,450.00 XXXII ($7000-$7500). 1533........... New Technology--Level S............... ........... $7,750.00 ........... $1,550.00 XXXIII ($7500-$8000). 1534........... New Technology--Level S............... ........... $8,250.00 ........... $1,650.00 XXXIV ($8000-$8500). 1535........... New Technology--Level S............... ........... $8,750.00 ........... $1,750.00 XXXV ($8500-$9000). 1536........... New Technology--Level S............... ........... $9,250.00 ........... $1,850.00 XXXVI ($9000-$9500). 1537........... New Technology--Level S............... ........... $9,750.00 ........... $1,950.00 XXXVII ($9500-$10000). 1539........... New Technology--Level II T............... ........... $75.00 ........... $15.00 ($50-$100). 1540........... New Technology--Level III T............... ........... $150.00 ........... $30.00 ($100-$200). 1541........... New Technology--Level IV T............... ........... $250.00 ........... $50.00 ($200-$300). 1542........... New Technology--Level V T............... ........... $350.00 ........... $70.00 ($300-$400). 1543........... New Technology--Level VI T............... ........... $450.00 ........... $90.00 ($400-$500). 1544........... New Technology--Level VII T............... ........... $550.00 ........... $110.00 ($500-$600). 1545........... New Technology--Level T............... ........... $650.00 ........... $130.00 VIII ($600-$700). 1546........... New Technology--Level IX T............... ........... $750.00 ........... $150.00 ($700-$800). 1547........... New Technology--Level X T............... ........... $850.00 ........... $170.00 ($800-$900). 1548........... New Technology--Level XI T............... ........... $950.00 ........... $190.00 ($900-$1000). 1549........... New Technology--Level XII T............... ........... $1,050.00 ........... $210.00 ($1000-$1100). 1550........... New Technology--Level T............... ........... $1,150.00 ........... $230.00 XIII ($1100-$1200). 1551........... New Technology--Level XIV T............... ........... $1,250.00 ........... $250.00 ($1200- $1300). 1552........... New Technology--Level XV T............... ........... $1,350.00 ........... $270.00 ($1300-$1400). 1553........... New Technology--Level XVI T............... ........... $1,450.00 ........... $290.00 ($1400-$1500). 1554........... New Technology--Level T............... ........... $1,550.00 ........... $310.00 XVII ($1500-$1600). 1555........... New Technology--Level T............... ........... $1,650.00 ........... $330.00 XVIII ($1600-$1700). 1556........... New Technology--Level XIX T............... ........... $1,750.00 ........... $350.00 ($1700-$1800). 1557........... New Technology--Level XX T............... ........... $1,850.00 ........... $370.00 ($1800-$1900).

[[Page 50693]]

1558........... New Technology--Level XXI T............... ........... $1,950.00 ........... $390.00 ($1900-$2000). 1559........... New Technology--Level T............... ........... $2,250.00 ........... $450.00 XXII ($2000-$2500). 1560........... New Technology--Level T............... ........... $2,750.00 ........... $550.00 XXIII ($2500-$3000). 1561........... New Technology--Level T............... ........... $3,250.00 ........... $650.00 XXIV ($3000-$3500). 1562........... New Technology--Level XXV T............... ........... $3,750.00 ........... $750.00 ($3500-$4000). 1563........... New Technology--Level T............... ........... $4,250.00 ........... $850.00 XXVI ($4000-$4500). 1564........... New Technology--Level T............... ........... $4,750.00 ........... $950.00 XXVII ($4500-$5000). 1565........... New Technology--Level T............... ........... $5,250.00 ........... $1,050.00 XXVIII ($5000-$5500). 1566........... New Technology--Level T............... ........... $5,750.00 ........... $1,150.00 XXIX ($5500-$6000). 1567........... New Technology--Level XXX T............... ........... $6,250.00 ........... $1,250.00 ($6000-$6500). 1568........... New Technology--Level T............... ........... $6,750.00 ........... $1,350.00 XXXI ($6500-$7000). 1569........... New Technology--Level T............... ........... $7,250.00 ........... $1,450.00 XXXII ($7000-$7500). 1570........... New Technology--Level T............... ........... $7,750.00 ........... $1,550.00 XXXIII ($7500-$8000). 1571........... New Technology--Level T............... ........... $8,250.00 ........... $1,650.00 XXXIV ($8000-$8500). 1572........... New Technology--Level T............... ........... $8,750.00 ........... $1,750.00 XXXV ($8500-$9000). 1573........... New Technology--Level T............... ........... $9,250.00 ........... $1,850.00 XXXVI ($9000-$9500). 1574........... New Technology--Level T............... ........... $9,750.00 ........... $1,950.00 XXXVII ($9500-$10000). 1600........... Technetium TC 99m

H............... ........... ........... ........... ........... sestamibi. 1603........... Thallous chloride TL 201. H............... ........... ........... ........... ........... 1604........... IN 111 capromab

H............... ........... ........... ........... ........... pendetide, per dose. 1605........... Abciximab injection...... K............... ........... $450.60 ........... $90.12 1607........... Eptifibatide injection... K............... ........... $12.73 ...........

$2.55 1608........... Etanercept injection..... K............... ........... $152.11 ........... $30.42 1609........... Rho(D) immune globulin h, K............... ........... $12.04 ...........

$2.41 sd. 1611........... Hylan G-F 20 injection... K............... ........... $203.15 ........... $40.63 1612........... Daclizumab, parenteral... K............... ........... $381.48 ........... $76.30 1613........... Trastuzumab.............. K............... ........... $53.98 ........... $10.80 1615........... Basiliximab.............. K............... ........... $1,473.57 ........... $294.71 1618........... Vonwillebrandfactrcmplx, K............... ...........

$0.74 ...........

$0.15 per iu. 1619........... Gallium ga 67............ H............... ........... ........... ........... ........... 1620........... Technetium tc99m bicisate H............... ........... ........... ........... ........... 1622........... Technetium tc99m

H............... ........... ........... ........... ........... mertiatide. 1624........... Sodium phosphate p32..... H............... ........... ........... ........... ........... 1625........... Indium 111-in

H............... ........... ........... ........... ........... pentetreotide. 1628........... Chromic phosphate p32.... H............... ........... ........... ........... ........... 1655........... Tinzaparin sodium

K............... ...........

$2.53 ...........

$0.51 injection. 1670........... Tetanus immune globulin K............... ........... $76.90 ........... $15.38 inj. 1716........... Brachytx source, Gold 198 H............... ........... ........... ........... ........... 1717........... Brachytx source, HDR Ir- H............... ........... ........... ........... ........... 192. 1718........... Brachytx source, Iodine H............... ........... ........... ........... ........... 125. 1719........... Brachytx sour, Non-HDR Ir- H............... ........... ........... ........... ........... 192. 1720........... Brachytx sour, Palladium H............... ........... ........... ........... ........... 103. 1740........... Diazoxide injection...... K............... ........... $113.86 ........... $22.77 1775........... FDG, per dose (4-40 mCi/ H............... ........... ........... ........... ........... ml). 2210........... Methyldopate hcl

K............... ...........

$9.58 ...........

$1.92 injection. 2616........... Brachytx source, Yttrium- H............... ........... ........... ........... ........... 90. 2632........... Brachytx sol, I-125, per H............... ........... ........... ........... ........... mCi. 2633........... Brachytx source, Cesium- H............... ........... ........... ........... ........... 131. 2634........... Brachytx source, HA, I- H............... ........... ........... ........... ........... 125. 2635........... Brachytx source, HA, P- H............... ........... ........... ........... ........... 103. 2636........... Brachytx linear source, P- H............... ........... ........... ........... ........... 103. 2730........... Pralidoxime chloride inj. K............... ........... $76.68 ........... $15.34 2770........... Quinupristin/dalfopristin K............... ........... $105.48 ........... $21.10 2940........... Somatrem injection....... K............... ........... $43.14 ...........

$8.63 3030........... Sumatriptan succinate.... K............... ........... $51.03 ........... $10.21 7000........... Amifostine............... K............... ........... $436.01 ........... $87.20 7005........... Gonadorelin hydroch...... K............... ........... $173.44 ........... $34.69 7011........... Oprelvekin injection..... K............... ........... $249.06 ........... $49.81 7015........... Busulfan, oral........... K............... ...........

$1.98 ...........

$0.40 7019........... Aprotinin................ K............... ...........

$2.20 ...........

$0.44 7024........... Corticorelin ovine

K............... ........... $386.53 ........... $77.31 triflutat. 7025........... Digoxin immune FAB

K............... ........... $552.18 ........... $110.44 (ovine). 7026........... Ethanolamine oleate...... K............... ........... $64.53 ........... $12.91 7027........... Fomepizole............... K............... ........... $12.31 ...........

$2.46 7028........... Fosphenytoin............. K............... ...........

$5.19 ...........

$1.04 7030........... Hemin.................... K............... ...........

$6.51 ...........

$1.30 7034........... Somatropin injection..... K............... ........... $42.93 ...........

$8.59 7035........... Teniposide............... K............... ........... $266.23 ........... $53.25 7036........... Urokinase inj............ K............... ........... $415.69 ........... $83.14

[[Page 50694]]

7037........... Urofollitropin........... K............... ........... $44.74 ...........

$8.95 7038........... Monoclonal antibodies.... K............... ........... $885.36 ........... $177.07 7040........... Pentastarch 10% solution. K............... ........... $12.45 ...........

$2.49 7041........... Tirofiban hcl............ K............... ...........

$7.89 ...........

$1.58 7042........... Capecitabine, oral....... K............... ...........

$3.30 ...........

$0.66 7043........... Infliximab injection..... K............... ........... $54.20 ........... $10.84 7045........... Trimetrexate glucoronate. K............... ........... $139.85 ........... $27.97 7046........... Doxorubicin hcl liposome K............... ........... $365.64 ........... $73.13 inj. 7048........... Alteplase recombinant.... K............... ........... $30.65 ...........

$6.13 7049........... Filgrastim injection..... K............... ........... $282.29 ........... $56.46 7051........... Leuprolide acetate

K............... ........... $2,262.19 ........... $452.44 implant. 7308........... Aminolevulinic acid hcl K............... ........... $96.79 ........... $19.36 top. 7316........... Sodium hyaluronate

K............... ........... $110.65 ........... $22.13 injection. 7515........... Cyclosporine oral........ K............... ...........

$1.00 ...........

$0.20 9001........... Linezolid injection...... K............... ........... $24.15 ...........

$4.83 9002........... Tenecteplase............. K............... ........... $2,052.77 ........... $410.55 9003........... Palivizumab.............. K............... 4.1491 $246.22 ........... $49.24 9004........... Gemtuzumab ozogamicin.... K............... ........... $2,245.04 ........... $449.01 9005........... Reteplase injection...... K............... ........... $898.81 ........... $179.76 9006........... Tacrolimus injection..... K............... ........... $126.61 ........... $25.32 9008........... Baclofen Refill Kit- K............... 0.2447 $14.52 ...........

$2.90 500mcg. 9009........... Baclofen refill kit--per K............... 0.7209 $42.78 ...........

$8.56 2000 mcg. 9012........... Arsenic Trioxide......... K............... ........... $33.76 ...........

$6.75 9015........... Mycophenolate mofetil K............... ...........

$2.50 ...........

$0.50 oral. 9018........... Botulinum toxin B........ K............... ...........

$7.89 ...........

$1.58 9019........... Caspofungin acetate...... K............... ........... $32.35 ...........

$6.47 9020........... Sirolimus tablet......... K............... ...........

$6.85 ...........

$1.37 9022........... IM inj interferon beta 1- K............... ........... $89.10 ........... $17.82 a. 9023........... Rho d immune globulin.... K............... ........... $25.08 ...........

$5.02 9024........... Amphotericin b lipid K............... ........... $11.95 ...........

$2.39 complex. 9025........... Rubidium-Rb-82........... H............... ........... ........... ........... ........... 9030........... Amphotericin B........... K............... ........... $30.70 ...........

$6.14 9031........... Arbutamine HCl injection. K............... ........... $163.15 ........... $32.63 9032........... Baclofen 10 MG injection. K............... ........... $188.01 ........... $37.60 9033........... Cidofovir injection...... K............... ........... $782.98 ........... $156.60 9038........... Inj estrogen conjugate... K............... ........... $57.77 ........... $11.55 9040........... Intraocular Fomivirsen na K............... ........... $203.93 ........... $40.79 9042........... Glucagon hydrochloride... K............... ........... $62.16 ........... $12.43 9044........... Ibutilide fumarate

K............... ........... $243.34 ........... $48.67 injection. 9045........... Iron dextran............. K............... ........... $11.43 ...........

$2.29 9046........... Iron sucrose injection... K............... ...........

$0.38 ...........

$0.08 9047........... Itraconazole injection... K............... ........... $36.93 ...........

$7.39 9051........... Urea injection........... K............... 1.0454 $62.04 ........... $12.41 9054........... Metabolically active K............... ........... $15.69 ...........

$3.14 tissue. 9055........... Injectable human tissue.. K............... ...........

$3.54 ...........

$0.71 9057........... Lepirudin................ K............... ........... $128.17 ........... $25.63 9100........... Iodinated I-131

H............... ........... ........... ........... ........... serumalbumin, per 5uci. 9104........... Anti-thymocycte globulin K............... ........... $299.47 ........... $59.89 rabbit. 9105........... Hep B imm glob........... K............... 1.8813 $111.64 ........... $22.33 9108........... Thyrotropin alfa......... K............... ........... $712.58 ........... $142.52 9110........... Alemtuzumab injection.... K............... ........... $516.87 ........... $103.37 9112........... Inj Perflutren lipid K............... ........... $63.51 ........... $12.70 micros, ml. 9114........... Nesiritide............... K............... ........... $75.19 ........... $15.04 9115........... Inj, zoledronic acid..... K............... ........... $202.41 ........... $40.48 9117........... Yttrium 90 ibritumomab H............... ........... ........... ........... ........... tiuxetan. 9118........... In-111 ibritumomab

H............... ........... ........... ........... ........... tiuxetan. 9119........... Pegfilgrastim............ K............... ........... $2,178.28 ........... $435.66 9120........... Inj, Fulvestrant......... K............... ........... $82.90 ........... $16.58 9121........... Inj, Argatroban.......... K............... 0.1897 $11.26 ...........

$2.25 9122........... Triptorelin pamoate...... K............... ........... $369.98 ........... $74.00 9123........... Transcyte................ K............... ........... $719.41 ........... $143.88 9124........... Injection, daptomycin.... G............... ...........

$0.30 ...........

$0.06 9125........... Risperidone, long acting. G............... ...........

$4.71 ...........

$0.94 9126........... Injection, natalizumab... G............... ...........

$6.51 ...........

$1.30 9127........... Paclitaxel protein pr.... K............... ...........

$8.59 ...........

$1.72 9128........... Inj pegaptanib sodium.... K............... ........... $1,074.27 ........... $214.85 9130........... Na chromateCr51, per H............... ........... ........... ........... ........... 0.25mCi. 9132........... 51 Na Chromate, 50mCi.... H............... ........... ........... ........... ........... 9133........... Rabies ig, im/sc......... K............... ........... $64.56 ........... $12.91

[[Page 50695]]

9134........... Rabies ig, heat treated.. K............... ........... $69.79 ........... $13.96 9135........... Varicella-zoster ig, im.. K............... ........... $96.58 ........... $19.32 9136........... Adenovirus vaccine, type K............... 0.9499 $56.37 ........... $11.27 4. 9137........... Bcg vaccine, percut...... K............... ........... $124.54 ........... $24.91 9138........... Hep a/hep b vacc, adult K............... 0.9674 $57.41 ........... $11.48 im. 9139........... Rabies vaccine, im....... K............... ........... $128.04 ........... $25.61 9140........... Rabies vaccine, id....... K............... 1.4959 $88.77 ........... $17.75 9141........... Measles-rubella vaccine, K............... 0.9467 $56.18 ........... $11.24 sc. 9142........... Chicken pox vaccine, sc.. K............... ........... $64.29 ........... $12.86 9143........... Meningococcal vaccine, sc K............... ........... $56.75 ........... $11.35 9144........... Encephalitis vaccine, sc. K............... ........... $67.73 ........... $13.55 9145........... Meningococcal vaccine, im K............... 0.8948 $53.10 ........... $10.62 9146........... Technetium TC99m

H............... ........... ........... ........... ........... Disofenin. 9147........... Technetium TC 99M

H............... ........... ........... ........... ........... Depreotide. 9148........... I-123 sodium iodide

H............... ........... ........... ........... ........... capsule. 9149........... Dx I131 so iodide

H............... ........... ........... ........... ........... microcurie. 9150........... I-125 serum albumin micro H............... ........... ........... ........... ........... 9151........... Tc 99M ARCITUMOMAB PER H............... ........... ........... ........... ........... VIAL. 9152........... Baclofen Intrathecal kit- K............... 0.8562 $50.81 ........... $10.16 1am. 9153........... Na Iothalamate I-125, 10 H............... ........... ........... ........... ........... uCi. 9154........... Technetium tc99m

H............... ........... ........... ........... ........... glucepatate. 9155........... Technetium

H............... ........... ........... ........... ........... tc99mlabeledrbcs. 9156........... Nonmetabolic active

K............... ........... $53.76 ........... $10.75 tissue. 9157........... LOCM = 400 mg/ml iodine. K............... ...........

$0.20 ...........

$0.04 9164........... Inj Gad-base MR contrast. K............... ...........

$3.01 ...........

$0.60 9165........... Oral MR contrast......... K............... ...........

$9.01 ...........

$1.80 9166........... Dyphylline injection..... K............... ...........

$7.74 ...........

$1.55 9167........... Valrubicin............... K............... ........... $376.87 ........... $75.37 9168........... Pegademase bovine........ K............... ........... $161.16 ........... $32.23 9169........... Anthrax vaccine, sc...... K............... ........... $128.95 ........... $25.79 9200........... Orcel.................... K............... 2.6893 $159.59 ........... $31.92 9201........... Dermagraft............... K............... 6.2066 $368.32 ........... $73.66 9202........... Inj Octafluoropropane K............... ........... $41.42 ...........

$8.28 mic,ml. 9203........... Inj Perflexane lipid K............... ........... $13.49 ...........

$2.70 micros, ml. 9205........... Oxaliplatin.............. K............... ........... $84.06 ........... $16.81 9206........... Integra.................. K............... ...........

$9.23 ...........

$1.85 9207........... Injection, bortezomib.... K............... ........... $28.90 ...........

$5.78 9208........... Injection, agalsidase K............... ........... $123.35 ........... $24.67 beta. 9209........... Injection, laronidase.... K............... ........... $23.16 ...........

$4.63 9210........... Injection, palonosetron K............... ...........

18.42 ...........

$3.68 HCL. 9211........... Inj, alefacept, IV....... K............... ........... $571.01 ........... $114.20 9212........... Inj, alefacept, IM....... K............... ........... $402.00 ........... $80.40 9213........... Injection, Pemetrexed.... G............... ........... $41.29 ...........

$8.26 9214........... Injection, Bevacizumab... G............... ........... $58.17 ........... $11.63 9215........... Injection, Cetuximab..... G............... ........... $50.59 ........... $10.12 9216........... Abarelix Injection....... G............... ........... $66.96 ........... $13.39 9217........... Leuprolide acetate

K............... ........... $230.87 ........... $46.17 suspnsion. 9218........... Injection, Azacitidine... K............... ...........

$4.03 ...........

$0.81 9219........... Mycophenolic Acid........ G............... ...........

$2.47 ...........

$0.49 9220........... Sodium hyaluronate....... G............... ........... $203.84 ........... $40.77 9221........... Graftjacket Reg Matrix... G............... ........... $1,234.36 ........... $246.87 9222........... Graftjacket SftTis....... G............... ........... $890.74 ........... $178.15 9300........... Injection, Omalizumab.... G............... ........... $15.98 ...........

$3.20 9500........... Platelets, irradiated.... K............... 1.3589 $80.64 ........... $16.13 9501........... Platelets, pheresis, K............... 8.1495 $483.62 ........... $96.72 leukocytes reduced. 9502........... Platelet pheresis

K............... 5.1895 $307.96 ........... $61.59 irradiated. 9503........... Fresh frozen plasma, ea K............... 1.6241 $96.38 ........... $19.28 unit. 9504........... RBC deglycerolized....... K............... 6.4314 $381.66 ........... $76.33 9505........... RBC irradiated........... K............... 2.3876 $141.69 ........... $28.34 9506........... Granulocytes, pheresis... K............... 15.6155 $926.67 ........... $185.33 9507........... Platelets, pheresis...... K............... 6.8988 $409.40 ........... $81.88 9508........... Plasma, frozen w/in 8 K............... 1.2038 $71.44 ........... $14.29 hours.

[[Page 50696]]

6. On pages 42776-42965, Addendum B is corrected to read as follows:

* Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule.

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

Copyright American Dental Association. All Rights Reserved.

Addendum B.--Payment Status by HCPCS Code and Related Information Calendar Year 2006

National Minimum CPT/HCPCS

SI

CI

Description

APC

Relative Payment unadjusted unadjusted weight

rate copayment copayment

0003T................. S.............. ............... Cervicography................

1492 ........... $15.00 ...........

$3.00 0008T................. T.............. ............... Upper gi endoscopy w/suture..

0422 22.9647 $1,362.79 $448.81 $272.56 00100................. N.............. ............... Anesth, salivary gland....... ........... ........... ........... ........... ........... 00102................. N.............. ............... Anesth, repair of cleft lip.. ........... ........... ........... ........... ........... 00103................. N.............. ............... Anesth, blepharoplasty....... ........... ........... ........... ........... ........... 00104................. N.............. ............... Anesth, electroshock......... ........... ........... ........... ........... ........... 0010T................. A.............. ............... Tb test, gamma interferon.... ........... ........... ........... ........... ........... 00120................. N.............. ............... Anesth, ear surgery.......... ........... ........... ........... ........... ........... 00124................. N.............. ............... Anesth, ear exam............. ........... ........... ........... ........... ........... 00126................. N.............. ............... Anesth, tympanotomy.......... ........... ........... ........... ........... ........... 00140................. N.............. ............... Anesth, procedures on eye.... ........... ........... ........... ........... ........... 00142................. N.............. ............... Anesth, lens surgery......... ........... ........... ........... ........... ........... 00144................. N.............. ............... Anesth, corneal transplant... ........... ........... ........... ........... ........... 00145................. N.............. ............... Anesth, vitreoretinal surg... ........... ........... ........... ........... ........... 00147................. N.............. ............... Anesth, iridectomy........... ........... ........... ........... ........... ........... 00148................. N.............. ............... Anesth, eye exam............. ........... ........... ........... ........... ........... 00160................. N.............. ............... Anesth, nose/sinus surgery... ........... ........... ........... ........... ........... 00162................. N.............. ............... Anesth, nose/sinus surgery... ........... ........... ........... ........... ........... 00164................. N.............. ............... Anesth, biopsy of nose....... ........... ........... ........... ........... ........... 0016T................. T.............. ............... Thermotx choroid vasc lesion.

0235 4.6593 $276.50 $67.40 $55.30 00170................. N.............. ............... Anesth, procedure on mouth... ........... ........... ........... ........... ........... 00172................. N.............. ............... Anesth, cleft palate repair.. ........... ........... ........... ........... ........... 00174................. N.............. ............... Anesth, pharyngeal surgery... ........... ........... ........... ........... ........... 00176................. C.............. ............... Anesth, pharyngeal surgery... ........... ........... ........... ........... ........... 0017T................. E.............. ............... Photocoagulat macular drusen. ........... ........... ........... ........... ........... 0018T................. S.............. ............... Transcranial magnetic stimul.

0215 0.6115 $36.29 $14.51

$7.26 00190................. N.............. ............... Anesth, face/skull bone surg. ........... ........... ........... ........... ........... 00192................. C.............. ............... Anesth, facial bone surgery.. ........... ........... ........... ........... ........... 0019T................. E.............. ............... Extracorp shock wave tx, ms.. ........... ........... ........... ........... ........... 0020T................. B.............. ............... Extracorp shock wave tx, ft.. ........... ........... ........... ........... ........... 00210................. N.............. ............... Anesth, open head surgery.... ........... ........... ........... ........... ........... 00212................. N.............. ............... Anesth, skull drainage....... ........... ........... ........... ........... ........... 00214................. C.............. ............... Anesth, skull drainage....... ........... ........... ........... ........... ........... 00215................. C.............. ............... Anesth, skull repair/fract... ........... ........... ........... ........... ........... 00216................. N.............. ............... Anesth, head vessel surgery.. ........... ........... ........... ........... ........... 00218................. N.............. ............... Anesth, special head surgery. ........... ........... ........... ........... ........... 0021T................. C.............. ............... Fetal oximetry, trnsvag/cerv. ........... ........... ........... ........... ........... 00220................. N.............. ............... Anesth, intrcrn nerve........ ........... ........... ........... ........... ........... 00222................. N.............. ............... Anesth, head nerve surgery... ........... ........... ........... ........... ........... 0023T................. A.............. ............... Phenotype drug test, hiv 1... ........... ........... ........... ........... ........... 0024T................. C.............. ............... Transcath cardiac reduction.. ........... ........... ........... ........... ........... 0026T................. A.............. ............... Measure remnant lipoproteins. ........... ........... ........... ........... ........... 0027T................. T.............. ............... Endoscopic epidural lysis....

0220 17.3586 $1,030.11 ........... $206.02 0028T................. N.............. ............... Dexa body composition study.. ........... ........... ........... ........... ........... 0029T................. A.............. ............... Magnetic tx for incontinence. ........... ........... ........... ........... ........... 00300................. N.............. ............... Anesth, head/neck/ptrunk..... ........... ........... ........... ........... ........... 0030T................. A.............. ............... Antiprothrombin antibody..... ........... ........... ........... ........... ........... 0031T................. N.............. ............... Speculoscopy................. ........... ........... ........... ........... ........... 00320................. N.............. ............... Anesth, neck organ, 1 & over. ........... ........... ........... ........... ........... 00322................. N.............. ............... Anesth, biopsy of thyroid.... ........... ........... ........... ........... ........... 00326................. N.............. ............... Anesth, larynx/trach, 1lev...

0203 10.4015 $617.26 $246.90 $123.45 00640................. N.............. ............... Anesth, spine manipulation... ........... ........... ........... ........... ........... 0064T................. A.............. ............... Spectroscop eval expired gas. ........... ........... ........... ........... ...........

[[Page 50698]]

0065T................. A.............. ............... Ocular photoscreen bilat..... ........... ........... ........... ........... ........... 0066T................. E.............. ............... Ct colonography screen....... ........... ........... ........... ........... ........... 00670................. C.............. ............... Anesth, spine, cord surgery.. ........... ........... ........... ........... ........... 0067T*................ S.............. ............... Ct colonography dx...........

0333 5.2836 $313.54 $125.41 $62.71 0068T................. B.............. ............... Interp/rept heart sound...... ........... ........... ........... ........... ........... 0069T................. N.............. ............... Analysis only heart sound.... ........... ........... ........... ........... ........... 00700................. N.............. ............... Anesth, abdominal wall surg.. ........... ........... ........... ........... ........... 00702................. N.............. ............... Anesth, for liver biopsy..... ........... ........... ........... ........... ........... 0070T................. N.............. ............... Interp only heart sound...... ........... ........... ........... ........... ........... 0071T................. T.............. ............... U/s leiomyomata ablate 200..

0193 14.5843 $865.48 ........... $173.10 00730................. N.............. ............... Anesth, abdominal wall surg.. ........... ........... ........... ........... ........... 0073T................. S.............. ............... Delivery, comp imrt..........

0412 5.3643 $318.33 ........... $63.67 00740................. N.............. ............... Anesth, upper gi visualize... ........... ........... ........... ........... ........... 0074T................. E.............. ............... Online physician e/m......... ........... ........... ........... ........... ........... 00750................. N.............. ............... Anesth, repair of hernia..... ........... ........... ........... ........... ........... 00752................. N.............. ............... Anesth, repair of hernia..... ........... ........... ........... ........... ........... 00754................. N.............. ............... Anesth, repair of hernia..... ........... ........... ........... ........... ........... 00756................. N.............. ............... Anesth, repair of hernia..... ........... ........... ........... ........... ........... 0075T................. C.............. ............... Perq stent/chest vert art.... ........... ........... ........... ........... ........... 0076T................. C.............. ............... S&i stent/chest vert art..... ........... ........... ........... ........... ........... 00770................. N.............. ............... Anesth, blood vessel repair.. ........... ........... ........... ........... ........... 0077T................. C.............. ............... Cereb therm perfusion probe.. ........... ........... ........... ........... ........... 0078T................. C.............. ............... Endovasc aort repr w/device.. ........... ........... ........... ........... ........... 00790................. N.............. ............... Anesth, surg upper abdomen... ........... ........... ........... ........... ........... 00792................. C.............. ............... Anesth, hemorr/excise liver.. ........... ........... ........... ........... ........... 00794................. C.............. ............... Anesth, pancreas removal..... ........... ........... ........... ........... ........... 00796................. C.............. ............... Anesth, for liver transplant. ........... ........... ........... ........... ........... 00797................. N.............. ............... Anesth, surgery for obesity.. ........... ........... ........... ........... ........... 0079T................. C.............. ............... Endovasc visc extnsn repr.... ........... ........... ........... ........... ........... 00800................. N.............. ............... Anesth, abdominal wall surg.. ........... ........... ........... ........... ........... 00802................. C.............. ............... Anesth, fat layer removal.... ........... ........... ........... ........... ........... 0080T................. C.............. ............... Endovasc aort repr rad s&i... ........... ........... ........... ........... ........... 00810................. N.............. ............... Anesth, low intestine scope.. ........... ........... ........... ........... ........... 0081T................. C.............. ............... Endovasc visc extnsn s&i..... ........... ........... ........... ........... ........... 00820................. N.............. ............... Anesth, abdominal wall surg.. ........... ........... ........... ........... ........... 0082T................. B.............. ............... Stereotactic rad delivery.... ........... ........... ........... ........... ........... 00830................. N.............. ............... Anesth, repair of hernia..... ........... ........... ........... ........... ........... 00832................. N.............. ............... Anesth, repair of hernia..... ........... ........... ........... ........... ........... 00834................. N.............. ............... Anesth, hernia repair3...

0204

2.191 $130.02 $40.13 $26.00 20600................. T.............. ............... Drain/inject, joint/bursa....

0204

2.191 $130.02 $40.13 $26.00 20605................. T.............. ............... Drain/inject, joint/bursa....

0204

2.191 $130.02 $40.13 $26.00 20610................. T.............. ............... Drain/inject, joint/bursa....

0204

2.191 $130.02 $40.13 $26.00 20612................. T.............. ............... Aspirate/inj ganglion cyst...

0204

2.191 $130.02 $40.13 $26.00 20615................. T.............. ............... Treatment of bone cyst.......

0004 1.7646 $104.72 $22.36 $20.94 20650................. T.............. ............... Insert and remove bone pin...

0049 20.3707 $1,208.86 ........... $241.77 20660................. C.............. ............... Apply, rem fixation device... ........... ........... ........... ........... ........... 20661................. C.............. ............... Application of head brace.... ........... ........... ........... ........... ........... 20662................. T.............. ............... Application of pelvis brace..

0049 20.3707 $1,208.86 ........... $241.77 20663................. T.............. ............... Application of thigh brace...

0049 20.3707 $1,208.86 ........... $241.77 20664................. C.............. ............... Halo brace application....... ........... ........... ........... ........... ........... 20665................. X.............. ............... Removal of fixation device...

0340 0.6384 $37.88 ...........

$7.58 20670................. T.............. ............... Removal of support implant...

0021 14.9776 $888.82 $219.48 $177.76 20680................. T.............. ............... Removal of support implant...

0022 19.6472 $1,165.92 $354.45 $233.18 20690................. T.............. ............... Apply bone fixation device...

0050 23.9081 $1,418.78 ........... $283.76 20692................. T.............. ............... Apply bone fixation device...

0050 23.9081 $1,418.78 ........... $283.76 20693................. T.............. ............... Adjust bone fixation device..

0049 20.3707 $1,208.86 ........... $241.77 20694................. T.............. ............... Remove bone fixation device..

0049 20.3707 $1,208.86 ........... $241.77 20802................. C.............. ............... Replantation, arm, complete.. ........... ........... ........... ........... ........... 20805................. C.............. ............... Replant forearm, complete.... ........... ........... ........... ........... ........... 20808................. C.............. ............... Replantation hand, complete.. ........... ........... ........... ........... ........... 20816................. C.............. ............... Replantation digit, complete. ........... ........... ........... ........... ........... 20822................. T.............. ............... Replantation digit, complete.

0054 25.3711 $1,505.60 ........... $301.12 20824................. C.............. ............... Replantation thumb, complete. ........... ........... ........... ........... ........... 20827................. C.............. ............... Replantation thumb, complete. ........... ........... ........... ........... ........... 20838................. C.............. ............... Replantation foot, complete.. ........... ........... ........... ........... ........... 20900................. T.............. ............... Removal of bone for graft....

0050 23.9081 $1,418.78 ........... $283.76 20902................. T.............. ............... Removal of bone for graft....

0050 23.9081 $1,418.78 ........... $283.76 20910................. T.............. ............... Remove cartilage for graft...

0027 18.4182 $1,092.99 $329.72 $218.60 20912................. T.............. ............... Remove cartilage for graft...

0027 18.4182 $1,092.99 $329.72 $218.60

[[Page 50708]]

20920................. T.............. ............... Removal of fascia for graft..

0686 13.8287 $820.64 ........... $164.13 20922................. T.............. ............... Removal of fascia for graft..

0027 18.4182 $1,092.99 $329.72 $218.60 20924................. T.............. ............... Removal of tendon for graft..

0050 23.9081 $1,418.78 ........... $283.76 20926................. T.............. ............... Removal of tissue for graft..

0686 13.8287 $820.64 ........... $164.13 20930................. C.............. ............... Spinal bone allograft........ ........... ........... ........... ........... ........... 20931................. C.............. ............... Spinal bone allograft........ ........... ........... ........... ........... ........... 20936................. C.............. ............... Spinal bone autograft........ ........... ........... ........... ........... ........... 20937................. C.............. ............... Spinal bone autograft........ ........... ........... ........... ........... ........... 20938................. C.............. ............... Spinal bone autograft........ ........... ........... ........... ........... ........... 20950................. T.............. ............... Fluid pressure, muscle.......

0006

1.55 $91.98 $22.28 $18.40 20955................. C.............. ............... Fibula bone graft, microvasc. ........... ........... ........... ........... ........... 20956................. C.............. ............... Iliac bone graft, microvasc.. ........... ........... ........... ........... ........... 20957................. C.............. ............... Mt bone graft, microvasc..... ........... ........... ........... ........... ........... 20962................. C.............. ............... Other bone graft, microvasc.. ........... ........... ........... ........... ........... 20969................. C.............. ............... Bone/skin graft, microvasc... ........... ........... ........... ........... ........... 20970................. C.............. ............... Bone/skin graft, iliac crest. ........... ........... ........... ........... ........... 20972................. T.............. ............... Bone/skin graft, metatarsal..

0056 40.2957 $2,391.27 ........... $478.25 20973................. T.............. ............... Bone/skin graft, great toe...

0056 40.2957 $2,391.27 ........... $478.25 20974................. A.............. ............... Electrical bone stimulation.. ........... ........... ........... ........... ........... 20975................. X.............. ............... Electrical bone stimulation..

0340 0.6384 $37.88 ...........

$7.58 20979................. A.............. ............... Us bone stimulation.......... ........... ........... ........... ........... ........... 20982................. T.............. ............... Ablate, bone tumor(s) perq...

1557 ........... $1,850.00 ........... $370.00 20999................. T.............. ............... Musculoskeletal surgery......

0049 20.3707 $1,208.86 ........... $241.77 21010................. T.............. ............... Incision of jaw joint........

0254 23.404 $1,388.86 $321.35 $277.77 21015................. T.............. ............... Resection of facial tumor....

0253 16.1357 $957.54 $282.29 $191.51 21025................. T.............. ............... Excision of bone, lower jaw..

0256 37.3204 $2,214.70 ........... $442.94 21026................. T.............. ............... Excision of facial bone(s)...

0256 37.3204 $2,214.70 ........... $442.94 21029................. T.............. ............... Contour of face bone lesion..

0256 37.3204 $2,214.70 ........... $442.94 21030................. T.............. ............... Removal of face bone lesion..

0254 23.404 $1,388.86 $321.35 $277.77 21031................. T.............. ............... Remove exostosis, mandible...

0254 23.404 $1,388.86 $321.35 $277.77 21032................. T.............. ............... Remove exostosis, maxilla....

0254 23.404 $1,388.86 $321.35 $277.77 21034................. T.............. ............... Removal of face bone lesion..

0256 37.3204 $2,214.70 ........... $442.94 21040................. T.............. ............... Removal of jaw bone lesion...

0254 23.404 $1,388.86 $321.35 $277.77 21044................. T.............. ............... Removal of jaw bone lesion...

0256 37.3204 $2,214.70 ........... $442.94 21045................. C.............. ............... Extensive jaw surgery........ ........... ........... ........... ........... ........... 21046................. T.............. ............... Remove mandible cyst complex.

0256 37.3204 $2,214.70 ........... $442.94 21047................. T.............. ............... Excise lwr jaw cyst w/repair.

0256 37.3204 $2,214.70 ........... $442.94 21048................. T.............. ............... Remove maxilla cyst complex..

0256 37.3204 $2,214.70 ........... $442.94 21049................. T.............. ............... Excis uppr jaw cyst w/repair.

0256 37.3204 $2,214.70 ........... $442.94 21050................. T.............. ............... Removal of jaw joint.........

0256 37.3204 $2,214.70 ........... $442.94 21060................. T.............. ............... Remove jaw joint cartilage...

0256 37.3204 $2,214.70 ........... $442.94 21070................. T.............. ............... Remove coronoid process......

0256 37.3204 $2,214.70 ........... $442.94 21076................. T.............. ............... Prepare face/oral prosthesis.

0254 23.404 $1,388.86 $321.35 $277.77 21077................. T.............. ............... Prepare face/oral prosthesis.

0256 37.3204 $2,214.70 ........... $442.94 21079................. T.............. ............... Prepare face/oral prosthesis.

0256 37.3204 $2,214.70 ........... $442.94 21080................. T.............. ............... Prepare face/oral prosthesis.

0256 37.3204 $2,214.70 ........... $442.94 21081................. T.............. ............... Prepare face/oral prosthesis.

0256 37.3204 $2,214.70 ........... $442.94 21082................. T.............. ............... Prepare face/oral prosthesis.

0256 37.3204 $2,214.70 ........... $442.94 21083................. T.............. ............... Prepare face/oral prosthesis.

0256 37.3204 $2,214.70 ........... $442.94 21084................. T.............. ............... Prepare face/oral prosthesis.

0256 37.3204 $2,214.70 ........... $442.94 21085................. T.............. ............... Prepare face/oral prosthesis.

0253 16.1357 $957.54 $282.29 $191.51 21086................. T.............. ............... Prepare face/oral prosthesis.

0256 37.3204 $2,214.70 ........... $442.94 21087................. T.............. ............... Prepare face/oral prosthesis.

0256 37.3204 $2,214.70 ........... $442.94 21088................. T.............. ............... Prepare face/oral prosthesis.

0256 37.3204 $2,214.70 ........... $442.94 21089................. T.............. ............... Prepare face/oral prosthesis.

0251 2.0101 $119.29 ........... $23.86 21100................. T.............. ............... Maxillofacial fixation.......

0256 37.3204 $2,214.70 ........... $442.94 21110................. T.............. ............... Interdental fixation.........

0252 7.8673 $466.87 $113.41 $93.37 21116................. N.............. ............... Injection, jaw joint x-ray... ........... ........... ........... ........... ........... 21120................. T.............. ............... Reconstruction of chin.......

0254 23.404 $1,388.86 $321.35 $277.77 21121................. T.............. ............... Reconstruction of chin.......

0254 23.404 $1,388.86 $321.35 $277.77 21122................. T.............. ............... Reconstruction of chin.......

0254 23.404 $1,388.86 $321.35 $277.77 21123................. T.............. ............... Reconstruction of chin.......

0254 23.404 $1,388.86 $321.35 $277.77 21125................. T.............. ............... Augmentation, lower jaw bone.

0254 23.404 $1,388.86 $321.35 $277.77 21127................. T.............. ............... Augmentation, lower jaw bone.

0256 37.3204 $2,214.70 ........... $442.94 21137................. T.............. ............... Reduction of forehead........

0254 23.404 $1,388.86 $321.35 $277.77 21138................. T.............. ............... Reduction of forehead........

0256 37.3204 $2,214.70 ........... $442.94

[[Page 50709]]

21139................. T.............. ............... Reduction of forehead........

0256 37.3204 $2,214.70 ........... $442.94 21141................. C.............. ............... Reconstruct midface, lefort.. ........... ........... ........... ........... ........... 21142................. C.............. ............... Reconstruct midface, lefort.. ........... ........... ........... ........... ........... 21143................. C.............. ............... Reconstruct midface, lefort.. ........... ........... ........... ........... ........... 21145................. C.............. ............... Reconstruct midface, lefort.. ........... ........... ........... ........... ........... 21146................. C.............. ............... Reconstruct midface, lefort.. ........... ........... ........... ........... ........... 21147................. C.............. ............... Reconstruct midface, lefort.. ........... ........... ........... ........... ........... 21150................. T.............. ............... Reconstruct midface, lefort..

0256 37.3204 $2,214.70 ........... $442.94 21151................. C.............. ............... Reconstruct midface, lefort.. ........... ........... ........... ........... ........... 21154................. C.............. ............... Reconstruct midface, lefort.. ........... ........... ........... ........... ........... 21155................. C.............. ............... Reconstruct midface, lefort.. ........... ........... ........... ........... ........... 21159................. C.............. ............... Reconstruct midface, lefort.. ........... ........... ........... ........... ........... 21160................. C.............. ............... Reconstruct midface, lefort.. ........... ........... ........... ........... ........... 21172................. C.............. ............... Reconstruct orbit/forehead... ........... ........... ........... ........... ........... 21175................. T.............. ............... Reconstruct orbit/forehead...

0256 37.3204 $2,214.70 ........... $442.94 21179................. C.............. ............... Reconstruct entire forehead.. ........... ........... ........... ........... ........... 21180................. C.............. ............... Reconstruct entire forehead.. ........... ........... ........... ........... ........... 21181................. T.............. ............... Contour cranial bone lesion..

0254 23.404 $1,388.86 $321.35 $277.77 21182................. C.............. ............... Reconstruct cranial bone..... ........... ........... ........... ........... ........... 21183................. C.............. ............... Reconstruct cranial bone..... ........... ........... ........... ........... ........... 21184................. C.............. ............... Reconstruct cranial bone..... ........... ........... ........... ........... ........... 21188................. C.............. ............... Reconstruction of midface.... ........... ........... ........... ........... ........... 21193................. C.............. ............... Reconst lwr jaw w/o graft.... ........... ........... ........... ........... ........... 21194................. C.............. ............... Reconst lwr jaw w/graft...... ........... ........... ........... ........... ........... 21195................. T.............. ............... Reconst lwr jaw w/o fixation.

0256 37.3204 $2,214.70 ........... $442.94 21196................. C.............. ............... Reconst lwr jaw w/fixation... ........... ........... ........... ........... ........... 21198................. T.............. ............... Reconstr lwr jaw segment.....

0256 37.3204 $2,214.70 ........... $442.94 21199................. T.............. ............... Reconstr lwr jaw w/advance...

0256 37.3204 $2,214.70 ........... $442.94 21206................. T.............. ............... Reconstruct upper jaw bone...

0256 37.3204 $2,214.70 ........... $442.94 21208................. T.............. ............... Augmentation of facial bones.

0256 37.3204 $2,214.70 ........... $442.94 21209................. T.............. ............... Reduction of facial bones....

0256 37.3204 $2,214.70 ........... $442.94 21210................. T.............. ............... Face bone graft..............

0256 37.3204 $2,214.70 ........... $442.94 21215................. T.............. ............... Lower jaw bone graft.........

0256 37.3204 $2,214.70 ........... $442.94 21230................. T.............. ............... Rib cartilage graft..........

0256 37.3204 $2,214.70 ........... $442.94 21235................. T.............. ............... Ear cartilage graft..........

0254 23.404 $1,388.86 $321.35 $277.77 21240................. T.............. ............... Reconstruction of jaw joint..

0256 37.3204 $2,214.70 ........... $442.94 21242................. T.............. ............... Reconstruction of jaw joint..

0256 37.3204 $2,214.70 ........... $442.94 21243................. T.............. ............... Reconstruction of jaw joint..

0256 37.3204 $2,214.70 ........... $442.94 21244................. T.............. ............... Reconstruction of lower jaw..

0256 37.3204 $2,214.70 ........... $442.94 21245................. T.............. ............... Reconstruction of jaw........

0256 37.3204 $2,214.70 ........... $442.94 21246................. T.............. ............... Reconstruction of jaw........

0256 37.3204 $2,214.70 ........... $442.94 21247................. C.............. ............... Reconstruct lower jaw bone... ........... ........... ........... ........... ........... 21248................. T.............. ............... Reconstruction of jaw........

0256 37.3204 $2,214.70 ........... $442.94 21249................. T.............. ............... Reconstruction of jaw........

0256 37.3204 $2,214.70 ........... $442.94 21255................. C.............. ............... Reconstruct lower jaw bone... ........... ........... ........... ........... ........... 21256................. C.............. ............... Reconstruction of orbit...... ........... ........... ........... ........... ........... 21260................. T.............. ............... Revise eye sockets...........

0256 37.3204 $2,214.70 ........... $442.94 21261................. T.............. ............... Revise eye sockets...........

0256 37.3204 $2,214.70 ........... $442.94 21263................. T.............. ............... Revise eye sockets...........

0256 37.3204 $2,214.70 ........... $442.94 21267................. T.............. ............... Revise eye sockets...........

0256 37.3204 $2,214.70 ........... $442.94 21268................. C.............. ............... Revise eye sockets........... ........... ........... ........... ........... ........... 21270................. T.............. ............... Augmentation, cheek bone.....

0256 37.3204 $2,214.70 ........... $442.94 21275................. T.............. ............... Revision, orbitofacial bones.

0256 37.3204 $2,214.70 ........... $442.94 21280................. T.............. ............... Revision of eyelid...........

0256 37.3204 $2,214.70 ........... $442.94 21282................. T.............. ............... Revision of eyelid...........

0253 16.1357 $957.54 $282.29 $191.51 21295................. T.............. ............... Revision of jaw muscle/bone..

0252 7.8673 $466.87 $113.41 $93.37 21296................. T.............. ............... Revision of jaw muscle/bone..

0254 23.404 $1,388.86 $321.35 $277.77 21299................. T.............. ............... Cranio/maxillofacial surgery.

0251 2.0101 $119.29 ........... $23.86 21300................. T.............. ............... Treatment of skull fracture..

0253 16.1357 $957.54 $282.29 $191.51 21310................. T.............. ............... Treatment of nose fracture...

0251 2.0101 $119.29 ........... $23.86 21315................. T.............. ............... Treatment of nose fracture...

0251 2.0101 $119.29 ........... $23.86 21320................. T.............. ............... Treatment of nose fracture...

0252 7.8673 $466.87 $113.41 $93.37 21325................. T.............. ............... Treatment of nose fracture...

0254 23.404 $1,388.86 $321.35 $277.77 21330................. T.............. ............... Treatment of nose fracture...

0254 23.404 $1,388.86 $321.35 $277.77 21335................. T.............. ............... Treatment of nose fracture...

0254 23.404 $1,388.86 $321.35 $277.77 21336................. T.............. ............... Treat nasal septal fracture..

0046 37.7023 $2,237.37 $535.76 $447.47

[[Page 50710]]

21337................. T.............. ............... Treat nasal septal fracture..

0253 16.1357 $957.54 $282.29 $191.51 21338................. T.............. ............... Treat nasoethmoid fracture...

0254 23.404 $1,388.86 $321.35 $277.77 21339................. T.............. ............... Treat nasoethmoid fracture...

0254 23.404 $1,388.86 $321.35 $277.77 21340................. T.............. ............... Treatment of nose fracture...

0256 37.3204 $2,214.70 ........... $442.94 21343................. C.............. ............... Treatment of sinus fracture.. ........... ........... ........... ........... ........... 21344................. C.............. ............... Treatment of sinus fracture.. ........... ........... ........... ........... ........... 21345................. T.............. ............... Treat nose/jaw fracture......

0254 23.404 $1,388.86 $321.35 $277.77 21346................. C.............. ............... Treat nose/jaw fracture...... ........... ........... ........... ........... ........... 21347................. C.............. ............... Treat nose/jaw fracture...... ........... ........... ........... ........... ........... 21348................. C.............. ............... Treat nose/jaw fracture...... ........... ........... ........... ........... ........... 21355................. T.............. ............... Treat cheek bone fracture....

0256 37.3204 $2,214.70 ........... $442.94 21356................. T.............. ............... Treat cheek bone fracture....

0254 23.404 $1,388.86 $321.35 $277.77 21360................. C.............. ............... Treat cheek bone fracture.... ........... ........... ........... ........... ........... 21365................. C.............. ............... Treat cheek bone fracture.... ........... ........... ........... ........... ........... 21366................. C.............. ............... Treat cheek bone fracture.... ........... ........... ........... ........... ........... 21385................. C.............. ............... Treat eye socket fracture.... ........... ........... ........... ........... ........... 21386................. C.............. ............... Treat eye socket fracture.... ........... ........... ........... ........... ........... 21387................. C.............. ............... Treat eye socket fracture.... ........... ........... ........... ........... ........... 21390................. T.............. ............... Treat eye socket fracture....

0256 37.3204 $2,214.70 ........... $442.94 21395................. C.............. ............... Treat eye socket fracture.... ........... ........... ........... ........... ........... 21400................. T.............. ............... Treat eye socket fracture....

0252 7.8673 $466.87 $113.41 $93.37 21401................. T.............. ............... Treat eye socket fracture....

0253 16.1357 $957.54 $282.29 $191.51 21406................. T.............. ............... Treat eye socket fracture....

0256 37.3204 $2,214.70 ........... $442.94 21407................. T.............. ............... Treat eye socket fracture....

0256 37.3204 $2,214.70 ........... $442.94 21408................. T.............. ............... Treat eye socket fracture....

0256 37.3204 $2,214.70 ........... $442.94 21421................. T.............. ............... Treat mouth roof fracture....

0254 23.404 $1,388.86 $321.35 $277.77 21422................. C.............. ............... Treat mouth roof fracture.... ........... ........... ........... ........... ........... 21423................. C.............. ............... Treat mouth roof fracture.... ........... ........... ........... ........... ........... 21431................. C.............. ............... Treat craniofacial fracture.. ........... ........... ........... ........... ........... 21432................. C.............. ............... Treat craniofacial fracture.. ........... ........... ........... ........... ........... 21433................. C.............. ............... Treat craniofacial fracture.. ........... ........... ........... ........... ........... 21435................. C.............. ............... Treat craniofacial fracture.. ........... ........... ........... ........... ........... 21436................. C.............. ............... Treat craniofacial fracture.. ........... ........... ........... ........... ........... 21440................. T.............. ............... Treat dental ridge fracture..

0254 23.404 $1,388.86 $321.35 $277.77 21445................. T.............. ............... Treat dental ridge fracture..

0254 23.404 $1,388.86 $321.35 $277.77 21450................. T.............. ............... Treat lower jaw fracture.....

0251 2.0101 $119.29 ........... $23.86 21451................. T.............. ............... Treat lower jaw fracture.....

0252 7.8673 $466.87 $113.41 $93.37 21452................. T.............. ............... Treat lower jaw fracture.....

0253 16.1357 $957.54 $282.29 $191.51 21453................. T.............. ............... Treat lower jaw fracture.....

0256 37.3204 $2,214.70 ........... $442.94 21454................. T.............. ............... Treat lower jaw fracture.....

0254 23.404 $1,388.86 $321.35 $277.77 21461................. T.............. ............... Treat lower jaw fracture.....

0256 37.3204 $2,214.70 ........... $442.94 21462................. T.............. ............... Treat lower jaw fracture.....

0256 37.3204 $2,214.70 ........... $442.94 21465................. T.............. ............... Treat lower jaw fracture.....

0256 37.3204 $2,214.70 ........... $442.94 21470................. T.............. ............... Treat lower jaw fracture.....

0256 37.3204 $2,214.70 ........... $442.94 21480................. T.............. ............... Reset dislocated jaw.........

0251 2.0101 $119.29 ........... $23.86 21485................. T.............. ............... Reset dislocated jaw.........

0253 16.1357 $957.54 $282.29 $191.51 21490................. T.............. ............... Repair dislocated jaw........

0256 37.3204 $2,214.70 ........... $442.94 21493................. T.............. ............... Treat hyoid bone fracture....

0252 7.8673 $466.87 $113.41 $93.37 21494................. T.............. ............... Treat hyoid bone fracture....

0252 7.8673 $466.87 $113.41 $93.37 21495................. T.............. ............... Treat hyoid bone fracture....

0253 16.1357 $957.54 $282.29 $191.51 21497................. T.............. ............... Interdental wiring...........

0253 16.1357 $957.54 $282.29 $191.51 21499................. T.............. ............... Head surgery procedure.......

0251 2.0101 $119.29 ........... $23.86 21501................. T.............. ............... Drain neck/chest lesion......

0008 16.4989 $979.09 ........... $195.82 21502................. T.............. ............... Drain chest lesion...........

0049 20.3707 $1,208.86 ........... $241.77 21510................. C.............. ............... Drainage of bone lesion...... ........... ........... ........... ........... ........... 21550................. T.............. ............... Biopsy of neck/chest.........

0021 14.9776 $888.82 $219.48 $177.76 21555................. T.............. ............... Remove lesion, neck/chest....

0022 19.6472 $1,165.92 $354.45 $233.18 21556................. T.............. ............... Remove lesion, neck/chest....

0022 19.6472 $1,165.92 $354.45 $233.18 21557................. T.............. ............... Remove tumor, neck/chest.....

0022 19.6472 $1,165.92 $354.45 $233.18 21600................. T.............. ............... Partial removal of rib.......

0050 23.9081 $1,418.78 ........... $283.76 21610................. T.............. ............... Partial removal of rib.......

0050 23.9081 $1,418.78 ........... $283.76 21615................. C.............. ............... Removal of rib............... ........... ........... ........... ........... ........... 21616................. C.............. ............... Removal of rib and nerves.... ........... ........... ........... ........... ........... 21620................. C.............. ............... Partial removal of sternum... ........... ........... ........... ........... ........... 21627................. C.............. ............... Sternal debridement.......... ........... ........... ........... ........... ........... 21630................. C.............. ............... Extensive sternum surgery.... ........... ........... ........... ........... ...........

[[Page 50711]]

21632................. C.............. ............... Extensive sternum surgery.... ........... ........... ........... ........... ........... 21685................. T.............. ............... Hyoid myotomy & suspension...

0252 7.8673 $466.87 $113.41 $93.37 21700................. T.............. ............... Revision of neck muscle......

0049 20.3707 $1,208.86 ........... $241.77 21705................. C.............. ............... Revision of neck muscle/rib.. ........... ........... ........... ........... ........... 21720................. T.............. ............... Revision of neck muscle......

0049 20.3707 $1,208.86 ........... $241.77 21725................. T.............. ............... Revision of neck muscle......

0006

1.55 $91.98 $22.28 $18.40 21740................. C.............. ............... Reconstruction of sternum.... ........... ........... ........... ........... ........... 21742................. T.............. ............... Repair stern/nuss w/o scope..

0051 36.5271 $2,167.63 ........... $433.53 21743................. T.............. ............... Repair sternum/nuss w/scope..

0051 36.5271 $2,167.63 ........... $433.53 21750................. C.............. ............... Repair of sternum separation. ........... ........... ........... ........... ........... 21800................. T.............. ............... Treatment of rib fracture....

0043 1.7694 $105.00 ........... $21.00 21805................. T.............. ............... Treatment of rib fracture....

0046 37.7023 $2,237.37 $535.76 $447.47 21810................. C.............. ............... Treatment of rib fracture(s). ........... ........... ........... ........... ........... 21820................. T.............. ............... Treat sternum fracture.......

0043 1.7694 $105.00 ........... $21.00 21825................. C.............. ............... Treat sternum fracture....... ........... ........... ........... ........... ........... 21899................. T.............. ............... Neck/chest surgery procedure.

0251 2.0101 $119.29 ........... $23.86 21920................. T.............. ............... Biopsy soft tissue of back...

0020 6.9433 $412.04 $107.40 $82.41 21925................. T.............. ............... Biopsy soft tissue of back...

0022 19.6472 $1,165.92 $354.45 $233.18 21930................. T.............. ............... Remove lesion, back or flank.

0022 19.6472 $1,165.92 $354.45 $233.18 21935................. T.............. ............... Remove tumor, back...........

0022 19.6472 $1,165.92 $354.45 $233.18 22100................. T.............. ............... Remove part of neck vertebra.

0208 42.3409 $2,512.64 ........... $502.53 22101................. T.............. ............... Remove part, thorax vertebra.

0208 42.3409 $2,512.64 ........... $502.53 22102................. T.............. ............... Remove part, lumbar vertebra.

0208 42.3409 $2,512.64 ........... $502.53 22103................. T.............. ............... Remove extra spine segment...

0208 42.3409 $2,512.64 ........... $502.53 22110................. C.............. ............... Remove part of neck vertebra. ........... ........... ........... ........... ........... 22112................. C.............. ............... Remove part, thorax vertebra. ........... ........... ........... ........... ........... 22114................. C.............. ............... Remove part, lumbar vertebra. ........... ........... ........... ........... ........... 22116................. C.............. ............... Remove extra spine segment... ........... ........... ........... ........... ........... 22210................. C.............. ............... Revision of neck spine....... ........... ........... ........... ........... ........... 22212................. C.............. ............... Revision of thorax spine..... ........... ........... ........... ........... ........... 22214................. C.............. ............... Revision of lumbar spine..... ........... ........... ........... ........... ........... 22216................. C.............. ............... Revise, extra spine segment.. ........... ........... ........... ........... ........... 22220................. C.............. ............... Revision of neck spine....... ........... ........... ........... ........... ........... 22222................. T.............. ............... Revision of thorax spine.....

0208 42.3409 $2,512.64 ........... $502.53 22224................. C.............. ............... Revision of lumbar spine..... ........... ........... ........... ........... ........... 22226................. C.............. ............... Revise, extra spine segment.. ........... ........... ........... ........... ........... 22305................. T.............. ............... Treat spine process fracture.

0043 1.7694 $105.00 ........... $21.00 22310................. T.............. ............... Treat spine fracture.........

0043 1.7694 $105.00 ........... $21.00 22315................. T.............. ............... Treat spine fracture.........

0043 1.7694 $105.00 ........... $21.00 22318................. C.............. ............... Treat odontoid fx w/o graft.. ........... ........... ........... ........... ........... 22319................. C.............. ............... Treat odontoid fx w/graft.... ........... ........... ........... ........... ........... 22325................. C.............. ............... Treat spine fracture......... ........... ........... ........... ........... ........... 22326................. C.............. ............... Treat neck spine fracture.... ........... ........... ........... ........... ........... 22327................. C.............. ............... Treat thorax spine fracture.. ........... ........... ........... ........... ........... 22328................. C.............. ............... Treat each add spine fx...... ........... ........... ........... ........... ........... 22505................. T.............. ............... Manipulation of spine........

0045 14.4945 $860.15 $268.47 $172.03 22520................. T.............. ............... Percut vertebroplasty thor...

0050 23.9081 $1,418.78 ........... $283.76 22521................. T.............. ............... Percut vertebroplasty lumb...

0050 23.9081 $1,418.78 ........... $283.76 22522................. T.............. ............... Percut vertebroplasty add'l..

0050 23.9081 $1,418.78 ........... $283.76 22532................. C.............. ............... Lat thorax spine fusion...... ........... ........... ........... ........... ........... 22533................. C.............. ............... Lat lumbar spine fusion...... ........... ........... ........... ........... ........... 22534................. C.............. ............... Lat thor/lumb, add'l seg..... ........... ........... ........... ........... ........... 22548................. C.............. ............... Neck spine fusion............ ........... ........... ........... ........... ........... 22554................. C.............. ............... Neck spine fusion............ ........... ........... ........... ........... ........... 22556................. C.............. ............... Thorax spine fusion.......... ........... ........... ........... ........... ........... 22558................. C.............. ............... Lumbar spine fusion.......... ........... ........... ........... ........... ........... 22585................. C.............. ............... Additional spinal fusion..... ........... ........... ........... ........... ........... 22590................. C.............. ............... Spine & skull spinal fusion.. ........... ........... ........... ........... ........... 22595................. C.............. ............... Neck spinal fusion........... ........... ........... ........... ........... ........... 22600................. C.............. ............... Neck spine fusion............ ........... ........... ........... ........... ........... 22610................. C.............. ............... Thorax spine fusion.......... ........... ........... ........... ........... ........... 22612................. T.............. ............... Lumbar spine fusion..........

0208 42.3409 $2,512.64 ........... $502.53 22614................. T.............. ............... Spine fusion, extra segment..

0208 42.3409 $2,512.64 ........... $502.53 22630................. C.............. ............... Lumbar spine fusion.......... ........... ........... ........... ........... ........... 22632................. C.............. ............... Spine fusion, extra segment.. ........... ........... ........... ........... ........... 22800................. C.............. ............... Fusion of spine.............. ........... ........... ........... ........... ...........

[[Page 50712]]

22802................. C.............. ............... Fusion of spine.............. ........... ........... ........... ........... ........... 22804................. C.............. ............... Fusion of spine.............. ........... ........... ........... ........... ........... 22808................. C.............. ............... Fusion of spine.............. ........... ........... ........... ........... ........... 22810................. C.............. ............... Fusion of spine.............. ........... ........... ........... ........... ........... 22812................. C.............. ............... Fusion of spine.............. ........... ........... ........... ........... ........... 22818................. C.............. ............... Kyphectomy, 1-2 segments..... ........... ........... ........... ........... ........... 22819................. C.............. ............... Kyphectomy, 3 or more........ ........... ........... ........... ........... ........... 22830................. C.............. ............... Exploration of spinal fusion. ........... ........... ........... ........... ........... 22840................. C.............. ............... Insert spine fixation device. ........... ........... ........... ........... ........... 22841................. C.............. ............... Insert spine fixation device. ........... ........... ........... ........... ........... 22842................. C.............. ............... Insert spine fixation device. ........... ........... ........... ........... ........... 22843................. C.............. ............... Insert spine fixation device. ........... ........... ........... ........... ........... 22844................. C.............. ............... Insert spine fixation device. ........... ........... ........... ........... ........... 22845................. C.............. ............... Insert spine fixation device. ........... ........... ........... ........... ........... 22846................. C.............. ............... Insert spine fixation device. ........... ........... ........... ........... ........... 22847................. C.............. ............... Insert spine fixation device. ........... ........... ........... ........... ........... 22848................. C.............. ............... Insert pelv fixation device.. ........... ........... ........... ........... ........... 22849................. C.............. ............... Reinsert spinal fixation..... ........... ........... ........... ........... ........... 22850................. C.............. ............... Remove spine fixation device. ........... ........... ........... ........... ........... 22851................. C.............. ............... Apply spine prosth device.... ........... ........... ........... ........... ........... 22852................. C.............. ............... Remove spine fixation device. ........... ........... ........... ........... ........... 22855................. C.............. ............... Remove spine fixation device. ........... ........... ........... ........... ........... 22899................. T.............. ............... Spine surgery procedure......

0043 1.7694 $105.00 ........... $21.00 22900................. T.............. ............... Remove abdominal wall lesion.

0022 19.6472 $1,165.92 $354.45 $233.18 22999................. T.............. ............... Abdomen surgery procedure....

0019 4.0547 $240.62 $71.87 $48.12 23000................. T.............. ............... Removal of calcium deposits..

0021 14.9776 $888.82 $219.48 $177.76 23020................. T.............. ............... Release shoulder joint.......

0051 36.5271 $2,167.63 ........... $433.53 23030................. T.............. ............... Drain shoulder lesion........

0008 16.4989 $979.09 ........... $195.82 23031................. T.............. ............... Drain shoulder bursa.........

0008 16.4989 $979.09 ........... $195.82 23035................. T.............. ............... Drain shoulder bone lesion...

0049 20.3707 $1,208.86 ........... $241.77 23040................. T.............. ............... Exploratory shoulder surgery.

0050 23.9081 $1,418.78 ........... $283.76 23044................. T.............. ............... Exploratory shoulder surgery.

0050 23.9081 $1,418.78 ........... $283.76 23065................. T.............. ............... Biopsy shoulder tissues......

0021 14.9776 $888.82 $219.48 $177.76 23066................. T.............. ............... Biopsy shoulder tissues......

0022 19.6472 $1,165.92 $354.45 $233.18 23075................. T.............. ............... Removal of shoulder lesion...

0021 14.9776 $888.82 $219.48 $177.76 23076................. T.............. ............... Removal of shoulder lesion...

0022 19.6472 $1,165.92 $354.45 $233.18 23077................. T.............. ............... Remove tumor of shoulder.....

0022 19.6472 $1,165.92 $354.45 $233.18 23100................. T.............. ............... Biopsy of shoulder joint.....

0049 20.3707 $1,208.86 ........... $241.77 23101................. T.............. ............... Shoulder joint surgery.......

0050 23.9081 $1,418.78 ........... $283.76 23105................. T.............. ............... Remove shoulder joint lining.

0050 23.9081 $1,418.78 ........... $283.76 23106................. T.............. ............... Incision of collarbone joint.

0050 23.9081 $1,418.78 ........... $283.76 23107................. T.............. ............... Explore treat shoulder joint.

0050 23.9081 $1,418.78 ........... $283.76 23120................. T.............. ............... Partial removal, collar bone.

0051 36.5271 $2,167.63 ........... $433.53 23125................. T.............. ............... Removal of collar bone.......

0051 36.5271 $2,167.63 ........... $433.53 23130................. T.............. ............... Remove shoulder bone, part...

0051 36.5271 $2,167.63 ........... $433.53 23140................. T.............. ............... Removal of bone lesion.......

0049 20.3707 $1,208.86 ........... $241.77 23145................. T.............. ............... Removal of bone lesion.......

0050 23.9081 $1,418.78 ........... $283.76 23146................. T.............. ............... Removal of bone lesion.......

0050 23.9081 $1,418.78 ........... $283.76 23150................. T.............. ............... Removal of humerus lesion....

0050 23.9081 $1,418.78 ........... $283.76 23155................. T.............. ............... Removal of humerus lesion....

0050 23.9081 $1,418.78 ........... $283.76 23156................. T.............. ............... Removal of humerus lesion....

0050 23.9081 $1,418.78 ........... $283.76 23170................. T.............. ............... Remove collar bone lesion....

0050 23.9081 $1,418.78 ........... $283.76 23172................. T.............. ............... Remove shoulder blade lesion.

0050 23.9081 $1,418.78 ........... $283.76 23174................. T.............. ............... Remove humerus lesion........

0050 23.9081 $1,418.78 ........... $283.76 23180................. T.............. ............... Remove collar bone lesion....

0050 23.9081 $1,418.78 ........... $283.76 23182................. T.............. ............... Remove shoulder blade lesion.

0050 23.9081 $1,418.78 ........... $283.76 23184................. T.............. ............... Remove humerus lesion........

0050 23.9081 $1,418.78 ........... $283.76 23190................. T.............. ............... Partial removal of scapula...

0050 23.9081 $1,418.78 ........... $283.76 23195................. T.............. ............... Removal of head of humerus...

0050 23.9081 $1,418.78 ........... $283.76 23200................. C.............. ............... Removal of collar bone....... ........... ........... ........... ........... ........... 23210................. C.............. ............... Removal of shoulder blade.... ........... ........... ........... ........... ........... 23220................. C.............. ............... Partial removal of humerus... ........... ........... ........... ........... ........... 23221................. C.............. ............... Partial removal of humerus... ........... ........... ........... ........... ........... 23222................. C.............. ............... Partial removal of humerus... ........... ........... ........... ........... ........... 23330................. T.............. ............... Remove shoulder foreign body.

0020 6.9433 $412.04 $107.40 $82.41 23331................. T.............. ............... Remove shoulder foreign body.

0022 19.6472 $1,165.92 $354.45 $233.18

[[Page 50713]]

23332................. C.............. ............... Remove shoulder foreign body. ........... ........... ........... ........... ........... 23350................. N.............. ............... Injection for shoulder x-ray. ........... ........... ........... ........... ........... 23395................. T.............. ............... Muscle transfer,shoulder/arm.

0051 36.5271 $2,167.63 ........... $433.53 23397................. T.............. ............... Muscle transfers.............

0052 43.9378 $2,607.40 ........... $521.48 23400................. T.............. ............... Fixation of shoulder blade...

0050 23.9081 $1,418.78 ........... $283.76 23405................. T.............. ............... Incision of tendon & muscle..

0050 23.9081 $1,418.78 ........... $283.76 23406................. T.............. ............... Incise tendon(s) & muscle(s).

0050 23.9081 $1,418.78 ........... $283.76 23410................. T.............. ............... Repair of tendon(s)..........

0052 43.9378 $2,607.40 ........... $521.48 23412................. T.............. ............... Repair rotator cuff, chronic.

0052 43.9378 $2,607.40 ........... $521.48 23415................. T.............. ............... Release of shoulder ligament.

0051 36.5271 $2,167.63 ........... $433.53 23420................. T.............. ............... Repair of shoulder...........

0052 43.9378 $2,607.40 ........... $521.48 23430................. T.............. ............... Repair biceps tendon.........

0052 43.9378 $2,607.40 ........... $521.48 23440................. T.............. ............... Remove/transplant tendon.....

0052 43.9378 $2,607.40 ........... $521.48 23450................. T.............. ............... Repair shoulder capsule......

0052 43.9378 $2,607.40 ........... $521.48 23455................. T.............. ............... Repair shoulder capsule......

0052 43.9378 $2,607.40 ........... $521.48 23460................. T.............. ............... Repair shoulder capsule......

0052 43.9378 $2,607.40 ........... $521.48 23462................. T.............. ............... Repair shoulder capsule......

0052 43.9378 $2,607.40 ........... $521.48 23465................. T.............. ............... Repair shoulder capsule......

0052 43.9378 $2,607.40 ........... $521.48 23466................. T.............. ............... Repair shoulder capsule......

0052 43.9378 $2,607.40 ........... $521.48 23470................. T.............. ............... Reconstruct shoulder joint...

0425 100.2058 $5,946.51 $1,378.01 $1,189.30 23472................. C.............. ............... Reconstruct shoulder joint... ........... ........... ........... ........... ........... 23480................. T.............. ............... Revision of collar bone......

0051 36.5271 $2,167.63 ........... $433.53 23485................. T.............. ............... Revision of collar bone......

0051 36.5271 $2,167.63 ........... $433.53 23490................. T.............. ............... Reinforce clavicle...........

0051 36.5271 $2,167.63 ........... $433.53 23491................. T.............. ............... Reinforce shoulder bones.....

0051 36.5271 $2,167.63 ........... $433.53 23500................. T.............. ............... Treat clavicle fracture......

0043 1.7694 $105.00 ........... $21.00 23505................. T.............. ............... Treat clavicle fracture......

0043 1.7694 $105.00 ........... $21.00 23515................. T.............. ............... Treat clavicle fracture......

0046 37.7023 $2,237.37 $535.76 $447.47 23520................. T.............. ............... Treat clavicle dislocation...

0043 1.7694 $105.00 ........... $21.00 23525................. T.............. ............... Treat clavicle dislocation...

0043 1.7694 $105.00 ........... $21.00 23530................. T.............. ............... Treat clavicle dislocation...

0046 37.7023 $2,237.37 $535.76 $447.47 23532................. T.............. ............... Treat clavicle dislocation...

0046 37.7023 $2,237.37 $535.76 $447.47 23540................. T.............. ............... Treat clavicle dislocation...

0043 1.7694 $105.00 ........... $21.00 23545................. T.............. ............... Treat clavicle dislocation...

0043 1.7694 $105.00 ........... $21.00 23550................. T.............. ............... Treat clavicle dislocation...

0046 37.7023 $2,237.37 $535.76 $447.47 23552................. T.............. ............... Treat clavicle dislocation...

0046 37.7023 $2,237.37 $535.76 $447.47 23570................. T.............. ............... Treat shoulder blade fx......

0043 1.7694 $105.00 ........... $21.00 23575................. T.............. ............... Treat shoulder blade fx......

0043 1.7694 $105.00 ........... $21.00 23585................. T.............. ............... Treat scapula fracture.......

0046 37.7023 $2,237.37 $535.76 $447.47 23600................. T.............. ............... Treat humerus fracture.......

0043 1.7694 $105.00 ........... $21.00 23605................. T.............. ............... Treat humerus fracture.......

0043 1.7694 $105.00 ........... $21.00 23615................. T.............. ............... Treat humerus fracture.......

0046 37.7023 $2,237.37 $535.76 $447.47 23616................. T.............. ............... Treat humerus fracture.......

0046 37.7023 $2,237.37 $535.76 $447.47 23620................. T.............. ............... Treat humerus fracture.......

0043 1.7694 $105.00 ........... $21.00 23625................. T.............. ............... Treat humerus fracture.......

0043 1.7694 $105.00 ........... $21.00 23630................. T.............. ............... Treat humerus fracture.......

0046 37.7023 $2,237.37 $535.76 $447.47 23650................. T.............. ............... Treat shoulder dislocation...

0043 1.7694 $105.00 ........... $21.00 23655................. T.............. ............... Treat shoulder dislocation...

0045 14.4945 $860.15 $268.47 $172.03 23660................. T.............. ............... Treat shoulder dislocation...

0046 37.7023 $2,237.37 $535.76 $447.47 23665................. T.............. ............... Treat dislocation/fracture...

0043 1.7694 $105.00 ........... $21.00 23670................. T.............. ............... Treat dislocation/fracture...

0046 37.7023 $2,237.37 $535.76 $447.47 23675................. T.............. ............... Treat dislocation/fracture...

0043 1.7694 $105.00 ........... $21.00 23680................. T.............. ............... Treat dislocation/fracture...

0046 37.7023 $2,237.37 $535.76 $447.47 23700................. T.............. ............... Fixation of shoulder.........

0045 14.4945 $860.15 $268.47 $172.03 23800................. T.............. ............... Fusion of shoulder joint.....

0051 36.5271 $2,167.63 ........... $433.53 23802................. T.............. ............... Fusion of shoulder joint.....

0051 36.5271 $2,167.63 ........... $433.53 23900................. C.............. ............... Amputation of arm & girdle... ........... ........... ........... ........... ........... 23920................. C.............. ............... Amputation at shoulder joint. ........... ........... ........... ........... ........... 23921................. T.............. ............... Amputation follow-up surgery.

0025 5.4938 $326.02 $101.85 $65.20 23929................. T.............. ............... Shoulder surgery procedure...

0043 1.7694 $105.00 ........... $21.00 23930................. T.............. ............... Drainage of arm lesion.......

0008 16.4989 $979.09 ........... $195.82 23931................. T.............. ............... Drainage of arm bursa........

0008 16.4989 $979.09 ........... $195.82 23935................. T.............. ............... Drain arm/elbow bone lesion..

0049 20.3707 $1,208.86 ........... $241.77 24000................. T.............. ............... Exploratory elbow surgery....

0050 23.9081 $1,418.78 ........... $283.76 24006................. T.............. ............... Release elbow joint..........

0050 23.9081 $1,418.78 ........... $283.76 24065................. T.............. ............... Biopsy arm/elbow soft tissue.

0021 14.9776 $888.82 $219.48 $177.76

[[Page 50714]]

24066................. T.............. ............... Biopsy arm/elbow soft tissue.

0021 14.9776 $888.82 $219.48 $177.76 24075................. T.............. ............... Remove arm/elbow lesion......

0021 14.9776 $888.82 $219.48 $177.76 24076................. T.............. ............... Remove arm/elbow lesion......

0022 19.6472 $1,165.92 $354.45 $233.18 24077................. T.............. ............... Remove tumor of arm/elbow....

0022 19.6472 $1,165.92 $354.45 $233.18 24100................. T.............. ............... Biopsy elbow joint lining....

0049 20.3707 $1,208.86 ........... $241.77 24101................. T.............. ............... Explore/treat elbow joint....

0050 23.9081 $1,418.78 ........... $283.76 24102................. T.............. ............... Remove elbow joint lining....

0050 23.9081 $1,418.78 ........... $283.76 24105................. T.............. ............... Removal of elbow bursa.......

0049 20.3707 $1,208.86 ........... $241.77 24110................. T.............. ............... Remove humerus lesion........

0049 20.3707 $1,208.86 ........... $241.77 24115................. T.............. ............... Remove/graft bone lesion.....

0050 23.9081 $1,418.78 ........... $283.76 24116................. T.............. ............... Remove/graft bone lesion.....

0050 23.9081 $1,418.78 ........... $283.76 24120................. T.............. ............... Remove elbow lesion..........

0049 20.3707 $1,208.86 ........... $241.77 24125................. T.............. ............... Remove/graft bone lesion.....

0050 23.9081 $1,418.78 ........... $283.76 24126................. T.............. ............... Remove/graft bone lesion.....

0050 23.9081 $1,418.78 ........... $283.76 24130................. T.............. ............... Removal of head of radius....

0050 23.9081 $1,418.78 ........... $283.76 24134................. T.............. ............... Removal of arm bone lesion...

0050 23.9081 $1,418.78 ........... $283.76 24136................. T.............. ............... Remove radius bone lesion....

0050 23.9081 $1,418.78 ........... $283.76 24138................. T.............. ............... Remove elbow bone lesion.....

0050 23.9081 $1,418.78 ........... $283.76 24140................. T.............. ............... Partial removal of arm bone..

0050 23.9081 $1,418.78 ........... $283.76 24145................. T.............. ............... Partial removal of radius....

0050 23.9081 $1,418.78 ........... $283.76 24147................. T.............. ............... Partial removal of elbow.....

0050 23.9081 $1,418.78 ........... $283.76 24149................. T.............. ............... Radical resection of elbow...

0050 23.9081 $1,418.78 ........... $283.76 24150................. T.............. ............... Extensive humerus surgery....

0052 43.9378 $2,607.40 ........... $521.48 24151................. T.............. ............... Extensive humerus surgery....

0052 43.9378 $2,607.40 ........... $521.48 24152................. T.............. ............... Extensive radius surgery.....

0052 43.9378 $2,607.40 ........... $521.48 24153................. T.............. ............... Extensive radius surgery.....

0052 43.9378 $2,607.40 ........... $521.48 24155................. T.............. ............... Removal of elbow joint.......

0051 36.5271 $2,167.63 ........... $433.53 24160................. T.............. ............... Remove elbow joint implant...

0050 23.9081 $1,418.78 ........... $283.76 24164................. T.............. ............... Remove radius head implant...

0050 23.9081 $1,418.78 ........... $283.76 24200................. T.............. ............... Removal of arm foreign body..

0019 4.0547 $240.62 $71.87 $48.12 24201................. T.............. ............... Removal of arm foreign body..

0021 14.9776 $888.82 $219.48 $177.76 24220................. N.............. ............... Injection for elbow x-ray.... ........... ........... ........... ........... ........... 24300................. T.............. ............... Manipulate elbow w/anesth....

0045 14.4945 $860.15 $268.47 $172.03 24301................. T.............. ............... Muscle/tendon transfer.......

0050 23.9081 $1,418.78 ........... $283.76 24305................. T.............. ............... Arm tendon lengthening.......

0050 23.9081 $1,418.78 ........... $283.76 24310................. T.............. ............... Revision of arm tendon.......

0049 20.3707 $1,208.86 ........... $241.77 24320................. T.............. ............... Repair of arm tendon.........

0051 36.5271 $2,167.63 ........... $433.53 24330................. T.............. ............... Revision of arm muscles......

0051 36.5271 $2,167.63 ........... $433.53 24331................. T.............. ............... Revision of arm muscles......

0051 36.5271 $2,167.63 ........... $433.53 24332................. T.............. ............... Tenolysis, triceps...........

0049 20.3707 $1,208.86 ........... $241.77 24340................. T.............. ............... Repair of biceps tendon......

0051 36.5271 $2,167.63 ........... $433.53 24341................. T.............. ............... Repair arm tendon/muscle.....

0051 36.5271 $2,167.63 ........... $433.53 24342................. T.............. ............... Repair of ruptured tendon....

0051 36.5271 $2,167.63 ........... $433.53 24343................. T.............. ............... Repr elbow lat ligmnt w/tiss.

0050 23.9081 $1,418.78 ........... $283.76 24344................. T.............. ............... Reconstruct elbow lat ligmnt.

0051 36.5271 $2,167.63 ........... $433.53 24345................. T.............. ............... Repr elbw med ligmnt w/tissu.

0050 23.9081 $1,418.78 ........... $283.76 24346................. T.............. ............... Reconstruct elbow med ligmnt.

0051 36.5271 $2,167.63 ........... $433.53 24350................. T.............. ............... Repair of tennis elbow.......

0050 23.9081 $1,418.78 ........... $283.76 24351................. T.............. ............... Repair of tennis elbow.......

0050 23.9081 $1,418.78 ........... $283.76 24352................. T.............. ............... Repair of tennis elbow.......

0050 23.9081 $1,418.78 ........... $283.76 24354................. T.............. ............... Repair of tennis elbow.......

0050 23.9081 $1,418.78 ........... $283.76 24356................. T.............. ............... Revision of tennis elbow.....

0050 23.9081 $1,418.78 ........... $283.76 24360................. T.............. ............... Reconstruct elbow joint......

0047 31.6107 $1,875.87 $537.03 $375.17 24361................. T.............. ............... Reconstruct elbow joint......

0425 100.2058 $5,946.51 $1,378.01 $1,189.30 24362................. T.............. ............... Reconstruct elbow joint......

0048 43.1288 $2,559.39 $570.30 $511.88 24363................. T.............. ............... Replace elbow joint..........

0425 100.2058 $5,946.51 $1,378.01 $1,189.30 24365................. T.............. ............... Reconstruct head of radius...

0047 31.6107 $1,875.87 $537.03 $375.17 24366................. T.............. ............... Reconstruct head of radius...

0425 100.2058 $5,946.51 $1,378.01 $1,189.30 24400................. T.............. ............... Revision of humerus..........

0050 23.9081 $1,418.78 ........... $283.76 24410................. T.............. ............... Revision of humerus..........

0050 23.9081 $1,418.78 ........... $283.76 24420................. T.............. ............... Revision of humerus..........

0051 36.5271 $2,167.63 ........... $433.53 24430................. T.............. ............... Repair of humerus............

0051 36.5271 $2,167.63 ........... $433.53 24435................. T.............. ............... Repair humerus with graft....

0051 36.5271 $2,167.63 ........... $433.53 24470................. T.............. ............... Revision of elbow joint......

0051 36.5271 $2,167.63 ........... $433.53 24495................. T.............. ............... Decompression of forearm.....

0050 23.9081 $1,418.78 ........... $283.76 24498................. T.............. ............... Reinforce humerus............

0051 36.5271 $2,167.63 ........... $433.53

[[Page 50715]]

24500................. T.............. ............... Treat humerus fracture.......

0043 1.7694 $105.00 ........... $21.00 24505................. T.............. ............... Treat humerus fracture.......

0043 1.7694 $105.00 ........... $21.00 24515................. T.............. ............... Treat humerus fracture.......

0046 37.7023 $2,237.37 $535.76 $447.47 24516................. T.............. ............... Treat humerus fracture.......

0046 37.7023 $2,237.37 $535.76 $447.47 24530................. T.............. ............... Treat humerus fracture.......

0043 1.7694 $105.00 ........... $21.00 24535................. T.............. ............... Treat humerus fracture.......

0043 1.7694 $105.00 ........... $21.00 24538................. T.............. ............... Treat humerus fracture.......

0046 37.7023 $2,237.37 $535.76 $447.47 24545................. T.............. ............... Treat humerus fracture.......

0046 37.7023 $2,237.37 $535.76 $447.47 24546................. T.............. ............... Treat humerus fracture.......

0046 37.7023 $2,237.37 $535.76 $447.47 24560................. T.............. ............... Treat humerus fracture.......

0043 1.7694 $105.00 ........... $21.00 24565................. T.............. ............... Treat humerus fracture.......

0043 1.7694 $105.00 ........... $21.00 24566................. T.............. ............... Treat humerus fracture.......

0046 37.7023 $2,237.37 $535.76 $447.47 24575................. T.............. ............... Treat humerus fracture.......

0046 37.7023 $2,237.37 $535.76 $447.47 24576................. T.............. ............... Treat humerus fracture.......

0043 1.7694 $105.00 ........... $21.00 24577................. T.............. ............... Treat humerus fracture.......

0043 1.7694 $105.00 ........... $21.00 24579................. T.............. ............... Treat humerus fracture.......

0046 37.7023 $2,237.37 $535.76 $447.47 24582................. T.............. ............... Treat humerus fracture.......

0046 37.7023 $2,237.37 $535.76 $447.47 24586................. T.............. ............... Treat elbow fracture.........

0046 37.7023 $2,237.37 $535.76 $447.47 24587................. T.............. ............... Treat elbow fracture.........

0046 37.7023 $2,237.37 $535.76 $447.47 24600................. T.............. ............... Treat elbow dislocation......

0043 1.7694 $105.00 ........... $21.00 24605................. T.............. ............... Treat elbow dislocation......

0045 14.4945 $860.15 $268.47 $172.03 24615................. T.............. ............... Treat elbow dislocation......

0046 37.7023 $2,237.37 $535.76 $447.47 24620................. T.............. ............... Treat elbow fracture.........

0043 1.7694 $105.00 ........... $21.00 24635................. T.............. ............... Treat elbow fracture.........

0046 37.7023 $2,237.37 $535.76 $447.47 24640................. T.............. ............... Treat elbow dislocation......

0043 1.7694 $105.00 ........... $21.00 24650................. T.............. ............... Treat radius fracture........

0043 1.7694 $105.00 ........... $21.00 24655................. T.............. ............... Treat radius fracture........

0043 1.7694 $105.00 ........... $21.00 24665................. T.............. ............... Treat radius fracture........

0046 37.7023 $2,237.37 $535.76 $447.47 24666................. T.............. ............... Treat radius fracture........

0046 37.7023 $2,237.37 $535.76 $447.47 24670................. T.............. ............... Treat ulnar fracture.........

0043 1.7694 $105.00 ........... $21.00 24675................. T.............. ............... Treat ulnar fracture.........

0043 1.7694 $105.00 ........... $21.00 24685................. T.............. ............... Treat ulnar fracture.........

0046 37.7023 $2,237.37 $535.76 $447.47 24800................. T.............. ............... Fusion of elbow joint........

0051 36.5271 $2,167.63 ........... $433.53 24802................. T.............. ............... Fusion/graft of elbow joint..

0051 36.5271 $2,167.63 ........... $433.53 24900................. C.............. ............... Amputation of upper arm...... ........... ........... ........... ........... ........... 24920................. C.............. ............... Amputation of upper arm...... ........... ........... ........... ........... ........... 24925................. T.............. ............... Amputation follow-up surgery.

0049 20.3707 $1,208.86 ........... $241.77 24930................. C.............. ............... Amputation follow-up surgery. ........... ........... ........... ........... ........... 24931................. C.............. ............... Amputate upper arm & implant. ........... ........... ........... ........... ........... 24935................. T.............. ............... Revision of amputation.......

0052 43.9378 $2,607.40 ........... $521.48 24940................. C.............. ............... Revision of upper arm........ ........... ........... ........... ........... ........... 24999................. T.............. ............... Upper arm/elbow surgery......

0043 1.7694 $105.00 ........... $21.00 25000................. T.............. ............... Incision of tendon sheath....

0049 20.3707 $1,208.86 ........... $241.77 25001................. T.............. ............... Incise flexor carpi radialis.

0049 20.3707 $1,208.86 ........... $241.77 25020................. T.............. ............... Decompress forearm 1 space...

0049 20.3707 $1,208.86 ........... $241.77 25023................. T.............. ............... Decompress forearm 1 space...

0050 23.9081 $1,418.78 ........... $283.76 25024................. T.............. ............... Decompress forearm 2 spaces..

0050 23.9081 $1,418.78 ........... $283.76 25025................. T.............. ............... Decompress forearm 2 spaces..

0050 23.9081 $1,418.78 ........... $283.76 25028................. T.............. ............... Drainage of forearm lesion...

0049 20.3707 $1,208.86 ........... $241.77 25031................. T.............. ............... Drainage of forearm bursa....

0049 20.3707 $1,208.86 ........... $241.77 25035................. T.............. ............... Treat forearm bone lesion....

0049 20.3707 $1,208.86 ........... $241.77 25040................. T.............. ............... Explore/treat wrist joint....

0050 23.9081 $1,418.78 ........... $283.76 25065................. T.............. ............... Biopsy forearm soft tissues..

0021 14.9776 $888.82 $219.48 $177.76 25066................. T.............. ............... Biopsy forearm soft tissues..

0022 19.6472 $1,165.92 $354.45 $233.18 25075................. T.............. ............... Removel forearm lesion subcu.

0021 14.9776 $888.82 $219.48 $177.76 25076................. T.............. ............... Removel forearm lesion deep..

0022 19.6472 $1,165.92 $354.45 $233.18 25077................. T.............. ............... Remove tumor, forearm/wrist..

0022 19.6472 $1,165.92 $354.45 $233.18 25085................. T.............. ............... Incision of wrist capsule....

0049 20.3707 $1,208.86 ........... $241.77 25100................. T.............. ............... Biopsy of wrist joint........

0049 20.3707 $1,208.86 ........... $241.77 25101................. T.............. ............... Explore/treat wrist joint....

0050 23.9081 $1,418.78 ........... $283.76 25105................. T.............. ............... Remove wrist joint lining....

0050 23.9081 $1,418.78 ........... $283.76 25107................. T.............. ............... Remove wrist joint cartilage.

0050 23.9081 $1,418.78 ........... $283.76 25110................. T.............. ............... Remove wrist tendon lesion...

0049 20.3707 $1,208.86 ........... $241.77 25111................. T.............. ............... Remove wrist tendon lesion...

0053 15.6795 $930.47 $253.49 $186.09 25112................. T.............. ............... Reremove wrist tendon lesion.

0053 15.6795 $930.47 $253.49 $186.09 25115................. T.............. ............... Remove wrist/forearm lesion..

0049 20.3707 $1,208.86 ........... $241.77

[[Page 50716]]

25116................. T.............. ............... Remove wrist/forearm lesion..

0049 20.3707 $1,208.86 ........... $241.77 25118................. T.............. ............... Excise wrist tendon sheath...

0050 23.9081 $1,418.78 ........... $283.76 25119................. T.............. ............... Partial removal of ulna......

0050 23.9081 $1,418.78 ........... $283.76 25120................. T.............. ............... Removal of forearm lesion....

0050 23.9081 $1,418.78 ........... $283.76 25125................. T.............. ............... Remove/graft forearm lesion..

0050 23.9081 $1,418.78 ........... $283.76 25126................. T.............. ............... Remove/graft forearm lesion..

0050 23.9081 $1,418.78 ........... $283.76 25130................. T.............. ............... Removal of wrist lesion......

0050 23.9081 $1,418.78 ........... $283.76 25135................. T.............. ............... Remove & graft wrist lesion..

0050 23.9081 $1,418.78 ........... $283.76 25136................. T.............. ............... Remove & graft wrist lesion..

0050 23.9081 $1,418.78 ........... $283.76 25145................. T.............. ............... Remove forearm bone lesion...

0050 23.9081 $1,418.78 ........... $283.76 25150................. T.............. ............... Partial removal of ulna......

0050 23.9081 $1,418.78 ........... $283.76 25151................. T.............. ............... Partial removal of radius....

0050 23.9081 $1,418.78 ........... $283.76 25170................. T.............. ............... Extensive forearm surgery....

0052 43.9378 $2,607.40 ........... $521.48 25210................. T.............. ............... Removal of wrist bone........

0054 25.3711 $1,505.60 ........... $301.12 25215................. T.............. ............... Removal of wrist bones.......

0054 25.3711 $1,505.60 ........... $301.12 25230................. T.............. ............... Partial removal of radius....

0050 23.9081 $1,418.78 ........... $283.76 25240................. T.............. ............... Partial removal of ulna......

0050 23.9081 $1,418.78 ........... $283.76 25246................. N.............. ............... Injection for wrist x-ray.... ........... ........... ........... ........... ........... 25248................. T.............. ............... Remove forearm foreign body..

0049 20.3707 $1,208.86 ........... $241.77 25250................. T.............. ............... Removal of wrist prosthesis..

0050 23.9081 $1,418.78 ........... $283.76 25251................. T.............. ............... Removal of wrist prosthesis..

0050 23.9081 $1,418.78 ........... $283.76 25259................. T.............. ............... Manipulate wrist w/anesthes..

0043 1.7694 $105.00 ........... $21.00 25260................. T.............. ............... Repair forearm tendon/muscle.

0050 23.9081 $1,418.78 ........... $283.76 25263................. T.............. ............... Repair forearm tendon/muscle.

0050 23.9081 $1,418.78 ........... $283.76 25265................. T.............. ............... Repair forearm tendon/muscle.

0050 23.9081 $1,418.78 ........... $283.76 25270................. T.............. ............... Repair forearm tendon/muscle.

0050 23.9081 $1,418.78 ........... $283.76 25272................. T.............. ............... Repair forearm tendon/muscle.

0050 23.9081 $1,418.78 ........... $283.76 25274................. T.............. ............... Repair forearm tendon/muscle.

0050 23.9081 $1,418.78 ........... $283.76 25275................. T.............. ............... Repair forearm tendon sheath.

0050 23.9081 $1,418.78 ........... $283.76 25280................. T.............. ............... Revise wrist/forearm tendon..

0050 23.9081 $1,418.78 ........... $283.76 25290................. T.............. ............... Incise wrist/forearm tendon..

0050 23.9081 $1,418.78 ........... $283.76 25295................. T.............. ............... Release wrist/forearm tendon.

0049 20.3707 $1,208.86 ........... $241.77 25300................. T.............. ............... Fusion of tendons at wrist...

0050 23.9081 $1,418.78 ........... $283.76 25301................. T.............. ............... Fusion of tendons at wrist...

0050 23.9081 $1,418.78 ........... $283.76 25310................. T.............. ............... Transplant forearm tendon....

0051 36.5271 $2,167.63 ........... $433.53 25312................. T.............. ............... Transplant forearm tendon....

0051 36.5271 $2,167.63 ........... $433.53 25315................. T.............. ............... Revise palsy hand tendon(s)..

0051 36.5271 $2,167.63 ........... $433.53 25316................. T.............. ............... Revise palsy hand tendon(s)..

0051 36.5271 $2,167.63 ........... $433.53 25320................. T.............. ............... Repair/revise wrist joint....

0051 36.5271 $2,167.63 ........... $433.53 25332................. T.............. ............... Revise wrist joint...........

0047 31.6107 $1,875.87 $537.03 $375.17 25335................. T.............. ............... Realignment of hand..........

0051 36.5271 $2,167.63 ........... $433.53 25337................. T.............. ............... Reconstruct ulna/radioulnar..

0051 36.5271 $2,167.63 ........... $433.53 25350................. T.............. ............... Revision of radius...........

0051 36.5271 $2,167.63 ........... $433.53 25355................. T.............. ............... Revision of radius...........

0051 36.5271 $2,167.63 ........... $433.53 25360................. T.............. ............... Revision of ulna.............

0050 23.9081 $1,418.78 ........... $283.76 25365................. T.............. ............... Revise radius & ulna.........

0050 23.9081 $1,418.78 ........... $283.76 25370................. T.............. ............... Revise radius or ulna........

0051 36.5271 $2,167.63 ........... $433.53 25375................. T.............. ............... Revise radius & ulna.........

0051 36.5271 $2,167.63 ........... $433.53 25390................. T.............. ............... Shorten radius or ulna.......

0050 23.9081 $1,418.78 ........... $283.76 25391................. T.............. ............... Lengthen radius or ulna......

0051 36.5271 $2,167.63 ........... $433.53 25392................. T.............. ............... Shorten radius & ulna........

0050 23.9081 $1,418.78 ........... $283.76 25393................. T.............. ............... Lengthen radius & ulna.......

0051 36.5271 $2,167.63 ........... $433.53 25394................. T.............. ............... Repair carpal bone, shorten..

0053 15.6795 $930.47 $253.49 $186.09 25400................. T.............. ............... Repair radius or ulna........

0050 23.9081 $1,418.78 ........... $283.76 25405................. T.............. ............... Repair/graft radius or ulna..

0050 23.9081 $1,418.78 ........... $283.76 25415................. T.............. ............... Repair radius & ulna.........

0050 23.9081 $1,418.78 ........... $283.76 25420................. T.............. ............... Repair/graft radius & ulna...

0051 36.5271 $2,167.63 ........... $433.53 25425................. T.............. ............... Repair/graft radius or ulna..

0051 36.5271 $2,167.63 ........... $433.53 25426................. T.............. ............... Repair/graft radius & ulna...

0051 36.5271 $2,167.63 ........... $433.53 25430................. T.............. ............... Vasc graft into carpal bone..

0054 25.3711 $1,505.60 ........... $301.12 25431................. T.............. ............... Repair nonunion carpal bone..

0054 25.3711 $1,505.60 ........... $301.12 25440................. T.............. ............... Repair/graft wrist bone......

0051 36.5271 $2,167.63 ........... $433.53 25441................. T.............. ............... Reconstruct wrist joint......

0425 100.2058 $5,946.51 $1,378.01 $1,189.30 25442................. T.............. ............... Reconstruct wrist joint......

0425 100.2058 $5,946.51 $1,378.01 $1,189.30 25443................. T.............. ............... Reconstruct wrist joint......

0048 43.1288 $2,559.39 $570.30 $511.88 25444................. T.............. ............... Reconstruct wrist joint......

0048 43.1288 $2,559.39 $570.30 $511.88

[[Page 50717]]

25445................. T.............. ............... Reconstruct wrist joint......

0048 43.1288 $2,559.39 $570.30 $511.88 25446................. T.............. ............... Wrist replacement............

0425 100.2058 $5,946.51 $1,378.01 $1,189.30 25447................. T.............. ............... Repair wrist joint(s)........

0047 31.6107 $1,875.87 $537.03 $375.17 25449................. T.............. ............... Remove wrist joint implant...

0047 31.6107 $1,875.87 $537.03 $375.17 25450................. T.............. ............... Revision of wrist joint......

0051 36.5271 $2,167.63 ........... $433.53 25455................. T.............. ............... Revision of wrist joint......

0051 36.5271 $2,167.63 ........... $433.53 25490................. T.............. ............... Reinforce radius.............

0051 36.5271 $2,167.63 ........... $433.53 25491................. T.............. ............... Reinforce ulna...............

0051 36.5271 $2,167.63 ........... $433.53 25492................. T.............. ............... Reinforce radius and ulna....

0051 36.5271 $2,167.63 ........... $433.53 25500................. T.............. ............... Treat fracture of radius.....

0043 1.7694 $105.00 ........... $21.00 25505................. T.............. ............... Treat fracture of radius.....

0043 1.7694 $105.00 ........... $21.00 25515................. T.............. ............... Treat fracture of radius.....

0046 37.7023 $2,237.37 $535.76 $447.47 25520................. T.............. ............... Treat fracture of radius.....

0043 1.7694 $105.00 ........... $21.00 25525................. T.............. ............... Treat fracture of radius.....

0046 37.7023 $2,237.37 $535.76 $447.47 25526................. T.............. ............... Treat fracture of radius.....

0046 37.7023 $2,237.37 $535.76 $447.47 25530................. T.............. ............... Treat fracture of ulna.......

0043 1.7694 $105.00 ........... $21.00 25535................. T.............. ............... Treat fracture of ulna.......

0043 1.7694 $105.00 ........... $21.00 25545................. T.............. ............... Treat fracture of ulna.......

0046 37.7023 $2,237.37 $535.76 $447.47 25560................. T.............. ............... Treat fracture radius & ulna.

0043 1.7694 $105.00 ........... $21.00 25565................. T.............. ............... Treat fracture radius & ulna.

0043 1.7694 $105.00 ........... $21.00 25574................. T.............. ............... Treat fracture radius & ulna.

0046 37.7023 $2,237.37 $535.76 $447.47 25575................. T.............. ............... Treat fracture radius/ulna...

0046 37.7023 $2,237.37 $535.76 $447.47 25600................. T.............. ............... Treat fracture radius/ulna...

0043 1.7694 $105.00 ........... $21.00 25605................. T.............. ............... Treat fracture radius/ulna...

0043 1.7694 $105.00 ........... $21.00 25611................. T.............. ............... Treat fracture radius/ulna...

0046 37.7023 $2,237.37 $535.76 $447.47 25620................. T.............. ............... Treat fracture radius/ulna...

0046 37.7023 $2,237.37 $535.76 $447.47 25622................. T.............. ............... Treat wrist bone fracture....

0043 1.7694 $105.00 ........... $21.00 25624................. T.............. ............... Treat wrist bone fracture....

0043 1.7694 $105.00 ........... $21.00 25628................. T.............. ............... Treat wrist bone fracture....

0046 37.7023 $2,237.37 $535.76 $447.47 25630................. T.............. ............... Treat wrist bone fracture....

0043 1.7694 $105.00 ........... $21.00 25635................. T.............. ............... Treat wrist bone fracture....

0043 1.7694 $105.00 ........... $21.00 25645................. T.............. ............... Treat wrist bone fracture....

0046 37.7023 $2,237.37 $535.76 $447.47 25650................. T.............. ............... Treat wrist bone fracture....

0043 1.7694 $105.00 ........... $21.00 25651................. T.............. ............... Pin ulnar styloid fracture...

0046 37.7023 $2,237.37 $535.76 $447.47 25652................. T.............. ............... Treat fracture ulnar styloid.

0046 37.7023 $2,237.37 $535.76 $447.47 25660................. T.............. ............... Treat wrist dislocation......

0043 1.7694 $105.00 ........... $21.00 25670................. T.............. ............... Treat wrist dislocation......

0046 37.7023 $2,237.37 $535.76 $447.47 25671................. T.............. ............... Pin radioulnar dislocation...

0046 37.7023 $2,237.37 $535.76 $447.47 25675................. T.............. ............... Treat wrist dislocation......

0043 1.7694 $105.00 ........... $21.00 25676................. T.............. ............... Treat wrist dislocation......

0046 37.7023 $2,237.37 $535.76 $447.47 25680................. T.............. ............... Treat wrist fracture.........

0043 1.7694 $105.00 ........... $21.00 25685................. T.............. ............... Treat wrist fracture.........

0046 37.7023 $2,237.37 $535.76 $447.47 25690................. T.............. ............... Treat wrist dislocation......

0043 1.7694 $105.00 ........... $21.00 25695................. T.............. ............... Treat wrist dislocation......

0046 37.7023 $2,237.37 $535.76 $447.47 25800................. T.............. ............... Fusion of wrist joint........

0051 36.5271 $2,167.63 ........... $433.53 25805................. T.............. ............... Fusion/graft of wrist joint..

0051 36.5271 $2,167.63 ........... $433.53 25810................. T.............. ............... Fusion/graft of wrist joint..

0051 36.5271 $2,167.63 ........... $433.53 25820................. T.............. ............... Fusion of hand bones.........

0053 15.6795 $930.47 $253.49 $186.09 25825................. T.............. ............... Fuse hand bones with graft...

0054 25.3711 $1,505.60 ........... $301.12 25830................. T.............. ............... Fusion, radioulnar jnt/ulna..

0051 36.5271 $2,167.63 ........... $433.53 25900................. C.............. ............... Amputation of forearm........ ........... ........... ........... ........... ........... 25905................. C.............. ............... Amputation of forearm........ ........... ........... ........... ........... ........... 25907................. T.............. ............... Amputation follow-up surgery.

0049 20.3707 $1,208.86 ........... $241.77 25909................. C.............. ............... Amputation follow-up surgery. ........... ........... ........... ........... ........... 25915................. C.............. ............... Amputation of forearm........ ........... ........... ........... ........... ........... 25920................. C.............. ............... Amputate hand at wrist....... ........... ........... ........... ........... ........... 25922................. T.............. ............... Amputate hand at wrist.......

0049 20.3707 $1,208.86 ........... $241.77 25924................. C.............. ............... Amputation follow-up surgery. ........... ........... ........... ........... ........... 25927................. C.............. ............... Amputation of hand........... ........... ........... ........... ........... ........... 25929................. T.............. ............... Amputation follow-up surgery.

0686 13.8287 $820.64 ........... $164.13 25931................. C.............. ............... Amputation follow-up surgery. ........... ........... ........... ........... ........... 25999................. T.............. ............... Forearm or wrist surgery.....

0043 1.7694 $105.00 ........... $21.00 26010................. T.............. ............... Drainage of finger abscess...

0006

1.55 $91.98 $22.28 $18.40 26011................. T.............. ............... Drainage of finger abscess...

0007 11.4501 $679.48 ........... $135.90 26020................. T.............. ............... Drain hand tendon sheath.....

0053 15.6795 $930.47 $253.49 $186.09 26025................. T.............. ............... Drainage of palm bursa.......

0053 15.6795 $930.47 $253.49 $186.09

[[Page 50718]]

26030................. T.............. ............... Drainage of palm bursa(s)....

0053 15.6795 $930.47 $253.49 $186.09 26034................. T.............. ............... Treat hand bone lesion.......

0053 15.6795 $930.47 $253.49 $186.09 26035................. T.............. ............... Decompress fingers/hand......

0053 15.6795 $930.47 $253.49 $186.09 26037................. T.............. ............... Decompress fingers/hand......

0053 15.6795 $930.47 $253.49 $186.09 26040................. T.............. ............... Release palm contracture.....

0054 25.3711 $1,505.60 ........... $301.12 26045................. T.............. ............... Release palm contracture.....

0054 25.3711 $1,505.60 ........... $301.12 26055................. T.............. ............... Incise finger tendon sheath..

0053 15.6795 $930.47 $253.49 $186.09 26060................. T.............. ............... Incision of finger tendon....

0053 15.6795 $930.47 $253.49 $186.09 26070................. T.............. ............... Explore/treat hand joint.....

0053 15.6795 $930.47 $253.49 $186.09 26075................. T.............. ............... Explore/treat finger joint...

0053 15.6795 $930.47 $253.49 $186.09 26080................. T.............. ............... Explore/treat finger joint...

0053 15.6795 $930.47 $253.49 $186.09 26100................. T.............. ............... Biopsy hand joint lining.....

0053 15.6795 $930.47 $253.49 $186.09 26105................. T.............. ............... Biopsy finger joint lining...

0053 15.6795 $930.47 $253.49 $186.09 26110................. T.............. ............... Biopsy finger joint lining...

0053 15.6795 $930.47 $253.49 $186.09 26115................. T.............. ............... Removel hand lesion subcut...

0022 19.6472 $1,165.92 $354.45 $233.18 26116................. T.............. ............... Removel hand lesion, deep....

0022 19.6472 $1,165.92 $354.45 $233.18 26117................. T.............. ............... Remove tumor, hand/finger....

0022 19.6472 $1,165.92 $354.45 $233.18 26121................. T.............. ............... Release palm contracture.....

0054 25.3711 $1,505.60 ........... $301.12 26123................. T.............. ............... Release palm contracture.....

0054 25.3711 $1,505.60 ........... $301.12 26125................. T.............. ............... Release palm contracture.....

0053 15.6795 $930.47 $253.49 $186.09 26130................. T.............. ............... Remove wrist joint lining....

0053 15.6795 $930.47 $253.49 $186.09 26135................. T.............. ............... Revise finger joint, each....

0054 25.3711 $1,505.60 ........... $301.12 26140................. T.............. ............... Revise finger joint, each....

0053 15.6795 $930.47 $253.49 $186.09 26145................. T.............. ............... Tendon excision, palm/finger.

0053 15.6795 $930.47 $253.49 $186.09 26160................. T.............. ............... Remove tendon sheath lesion..

0053 15.6795 $930.47 $253.49 $186.09 26170................. T.............. ............... Removal of palm tendon, each.

0053 15.6795 $930.47 $253.49 $186.09 26180................. T.............. ............... Removal of finger tendon.....

0053 15.6795 $930.47 $253.49 $186.09 26185................. T.............. ............... Remove finger bone...........

0053 15.6795 $930.47 $253.49 $186.09 26200................. T.............. ............... Remove hand bone lesion......

0053 15.6795 $930.47 $253.49 $186.09 26205................. T.............. ............... Remove/graft bone lesion.....

0054 25.3711 $1,505.60 ........... $301.12 26210................. T.............. ............... Removal of finger lesion.....

0053 15.6795 $930.47 $253.49 $186.09 26215................. T.............. ............... Remove/graft finger lesion...

0053 15.6795 $930.47 $253.49 $186.09 26230................. T.............. ............... Partial removal of hand bone.

0053 15.6795 $930.47 $253.49 $186.09 26235................. T.............. ............... Partial removal, finger bone.

0053 15.6795 $930.47 $253.49 $186.09 26236................. T.............. ............... Partial removal, finger bone.

0053 15.6795 $930.47 $253.49 $186.09 26250................. T.............. ............... Extensive hand surgery.......

0053 15.6795 $930.47 $253.49 $186.09 26255................. T.............. ............... Extensive hand surgery.......

0054 25.3711 $1,505.60 ........... $301.12 26260................. T.............. ............... Extensive finger surgery.....

0053 15.6795 $930.47 $253.49 $186.09 26261................. T.............. ............... Extensive finger surgery.....

0053 15.6795 $930.47 $253.49 $186.09 26262................. T.............. ............... Partial removal of finger....

0053 15.6795 $930.47 $253.49 $186.09 26320................. T.............. ............... Removal of implant from hand.

0021 14.9776 $888.82 $219.48 $177.76 26340................. T.............. ............... Manipulate finger w/anesth...

0043 1.7694 $105.00 ........... $21.00 26350................. T.............. ............... Repair finger/hand tendon....

0054 25.3711 $1,505.60 ........... $301.12 26352................. T.............. ............... Repair/graft hand tendon.....

0054 25.3711 $1,505.60 ........... $301.12 26356................. T.............. ............... Repair finger/hand tendon....

0054 25.3711 $1,505.60 ........... $301.12 26357................. T.............. ............... Repair finger/hand tendon....

0054 25.3711 $1,505.60 ........... $301.12 26358................. T.............. ............... Repair/graft hand tendon.....

0054 25.3711 $1,505.60 ........... $301.12 26370................. T.............. ............... Repair finger/hand tendon....

0054 25.3711 $1,505.60 ........... $301.12 26372................. T.............. ............... Repair/graft hand tendon.....

0054 25.3711 $1,505.60 ........... $301.12 26373................. T.............. ............... Repair finger/hand tendon....

0054 25.3711 $1,505.60 ........... $301.12 26390................. T.............. ............... Revise hand/finger tendon....

0054 25.3711 $1,505.60 ........... $301.12 26392................. T.............. ............... Repair/graft hand tendon.....

0054 25.3711 $1,505.60 ........... $301.12 26410................. T.............. ............... Repair hand tendon...........

0053 15.6795 $930.47 $253.49 $186.09 26412................. T.............. ............... Repair/graft hand tendon.....

0054 25.3711 $1,505.60 ........... $301.12 26415................. T.............. ............... Excision, hand/finger tendon.

0054 25.3711 $1,505.60 ........... $301.12 26416................. T.............. ............... Graft hand or finger tendon..

0054 25.3711 $1,505.60 ........... $301.12 26418................. T.............. ............... Repair finger tendon.........

0053 15.6795 $930.47 $253.49 $186.09 26420................. T.............. ............... Repair/graft finger tendon...

0054 25.3711 $1,505.60 ........... $301.12 26426................. T.............. ............... Repair finger/hand tendon....

0054 25.3711 $1,505.60 ........... $301.12 26428................. T.............. ............... Repair/graft finger tendon...

0054 25.3711 $1,505.60 ........... $301.12 26432................. T.............. ............... Repair finger tendon.........

0053 15.6795 $930.47 $253.49 $186.09 26433................. T.............. ............... Repair finger tendon.........

0053 15.6795 $930.47 $253.49 $186.09 26434................. T.............. ............... Repair/graft finger tendon...

0054 25.3711 $1,505.60 ........... $301.12 26437................. T.............. ............... Realignment of tendons.......

0053 15.6795 $930.47 $253.49 $186.09 26440................. T.............. ............... Release palm/finger tendon...

0053 15.6795 $930.47 $253.49 $186.09 26442................. T.............. ............... Release palm & finger tendon.

0054 25.3711 $1,505.60 ........... $301.12

[[Page 50719]]

26445................. T.............. ............... Release hand/finger tendon...

0053 15.6795 $930.47 $253.49 $186.09 26449................. T.............. ............... Release forearm/hand tendon..

0054 25.3711 $1,505.60 ........... $301.12 26450................. T.............. ............... Incision of palm tendon......

0053 15.6795 $930.47 $253.49 $186.09 26455................. T.............. ............... Incision of finger tendon....

0053 15.6795 $930.47 $253.49 $186.09 26460................. T.............. ............... Incise hand/finger tendon....

0053 15.6795 $930.47 $253.49 $186.09 26471................. T.............. ............... Fusion of finger tendons.....

0053 15.6795 $930.47 $253.49 $186.09 26474................. T.............. ............... Fusion of finger tendons.....

0053 15.6795 $930.47 $253.49 $186.09 26476................. T.............. ............... Tendon lengthening...........

0053 15.6795 $930.47 $253.49 $186.09 26477................. T.............. ............... Tendon shortening............

0053 15.6795 $930.47 $253.49 $186.09 26478................. T.............. ............... Lengthening of hand tendon...

0053 15.6795 $930.47 $253.49 $186.09 26479................. T.............. ............... Shortening of hand tendon....

0053 15.6795 $930.47 $253.49 $186.09 26480................. T.............. ............... Transplant hand tendon.......

0054 25.3711 $1,505.60 ........... $301.12 26483................. T.............. ............... Transplant/graft hand tendon.

0054 25.3711 $1,505.60 ........... $301.12 26485................. T.............. ............... Transplant palm tendon.......

0054 25.3711 $1,505.60 ........... $301.12 26489................. T.............. ............... Transplant/graft palm tendon.

0054 25.3711 $1,505.60 ........... $301.12 26490................. T.............. ............... Revise thumb tendon..........

0054 25.3711 $1,505.60 ........... $301.12 26492................. T.............. ............... Tendon transfer with graft...

0054 25.3711 $1,505.60 ........... $301.12 26494................. T.............. ............... Hand tendon/muscle transfer..

0054 25.3711 $1,505.60 ........... $301.12 26496................. T.............. ............... Revise thumb tendon..........

0054 25.3711 $1,505.60 ........... $301.12 26497................. T.............. ............... Finger tendon transfer.......

0054 25.3711 $1,505.60 ........... $301.12 26498................. T.............. ............... Finger tendon transfer.......

0054 25.3711 $1,505.60 ........... $301.12 26499................. T.............. ............... Revision of finger...........

0054 25.3711 $1,505.60 ........... $301.12 26500................. T.............. ............... Hand tendon reconstruction...

0053 15.6795 $930.47 $253.49 $186.09 26502................. T.............. ............... Hand tendon reconstruction...

0054 25.3711 $1,505.60 ........... $301.12 26504................. T.............. ............... Hand tendon reconstruction...

0054 25.3711 $1,505.60 ........... $301.12 26508................. T.............. ............... Release thumb contracture....

0053 15.6795 $930.47 $253.49 $186.09 26510................. T.............. ............... Thumb tendon transfer........

0054 25.3711 $1,505.60 ........... $301.12 26516................. T.............. ............... Fusion of knuckle joint......

0054 25.3711 $1,505.60 ........... $301.12 26517................. T.............. ............... Fusion of knuckle joints.....

0054 25.3711 $1,505.60 ........... $301.12 26518................. T.............. ............... Fusion of knuckle joints.....

0054 25.3711 $1,505.60 ........... $301.12 26520................. T.............. ............... Release knuckle contracture..

0053 15.6795 $930.47 $253.49 $186.09 26525................. T.............. ............... Release finger contracture...

0053 15.6795 $930.47 $253.49 $186.09 26530................. T.............. ............... Revise knuckle joint.........

0047 31.6107 $1,875.87 $537.03 $375.17 26531................. T.............. ............... Revise knuckle with implant..

0048 43.1288 $2,559.39 $570.30 $511.88 26535................. T.............. ............... Revise finger joint..........

0047 31.6107 $1,875.87 $537.03 $375.17 26536................. T.............. ............... Revise/implant finger joint..

0048 43.1288 $2,559.39 $570.30 $511.88 26540................. T.............. ............... Repair hand joint............

0053 15.6795 $930.47 $253.49 $186.09 26541................. T.............. ............... Repair hand joint with graft.

0054 25.3711 $1,505.60 ........... $301.12 26542................. T.............. ............... Repair hand joint with graft.

0053 15.6795 $930.47 $253.49 $186.09 26545................. T.............. ............... Reconstruct finger joint.....

0054 25.3711 $1,505.60 ........... $301.12 26546................. T.............. ............... Repair nonunion hand.........

0054 25.3711 $1,505.60 ........... $301.12 26548................. T.............. ............... Reconstruct finger joint.....

0054 25.3711 $1,505.60 ........... $301.12 26550................. T.............. ............... Construct thumb replacement..

0054 25.3711 $1,505.60 ........... $301.12 26551................. C.............. ............... Great toe-hand transfer...... ........... ........... ........... ........... ........... 26553................. C.............. ............... Single transfer, toe-hand.... ........... ........... ........... ........... ........... 26554................. C.............. ............... Double transfer, toe-hand.... ........... ........... ........... ........... ........... 26555................. T.............. ............... Positional change of finger..

0054 25.3711 $1,505.60 ........... $301.12 26556................. C.............. ............... Toe joint transfer........... ........... ........... ........... ........... ........... 26560................. T.............. ............... Repair of web finger.........

0053 15.6795 $930.47 $253.49 $186.09 26561................. T.............. ............... Repair of web finger.........

0054 25.3711 $1,505.60 ........... $301.12 26562................. T.............. ............... Repair of web finger.........

0054 25.3711 $1,505.60 ........... $301.12 26565................. T.............. ............... Correct metacarpal flaw......

0054 25.3711 $1,505.60 ........... $301.12 26567................. T.............. ............... Correct finger deformity.....

0054 25.3711 $1,505.60 ........... $301.12 26568................. T.............. ............... Lengthen metacarpal/finger...

0054 25.3711 $1,505.60 ........... $301.12 26580................. T.............. ............... Repair hand deformity........

0053 15.6795 $930.47 $253.49 $186.09 26587................. T.............. ............... Reconstruct extra finger.....

0053 15.6795 $930.47 $253.49 $186.09 26590................. T.............. ............... Repair finger deformity......

0053 15.6795 $930.47 $253.49 $186.09 26591................. T.............. ............... Repair muscles of hand.......

0054 25.3711 $1,505.60 ........... $301.12 26593................. T.............. ............... Release muscles of hand......

0053 15.6795 $930.47 $253.49 $186.09 26596................. T.............. ............... Excision constricting tissue.

0053 15.6795 $930.47 $253.49 $186.09 26600................. T.............. ............... Treat metacarpal fracture....

0043 1.7694 $105.00 ........... $21.00 26605................. T.............. ............... Treat metacarpal fracture....

0043 1.7694 $105.00 ........... $21.00 26607................. T.............. ............... Treat metacarpal fracture....

0043 1.7694 $105.00 ........... $21.00 26608................. T.............. ............... Treat metacarpal fracture....

0046 37.7023 $2,237.37 $535.76 $447.47 26615................. T.............. ............... Treat metacarpal fracture....

0046 37.7023 $2,237.37 $535.76 $447.47 26641................. T.............. ............... Treat thumb dislocation......

0043 1.7694 $105.00 ........... $21.00

[[Page 50720]]

26645................. T.............. ............... Treat thumb fracture.........

0043 1.7694 $105.00 ........... $21.00 26650................. T.............. ............... Treat thumb fracture.........

0046 37.7023 $2,237.37 $535.76 $447.47 26665................. T.............. ............... Treat thumb fracture.........

0046 37.7023 $2,237.37 $535.76 $447.47 26670................. T.............. ............... Treat hand dislocation.......

0043 1.7694 $105.00 ........... $21.00 26675................. T.............. ............... Treat hand dislocation.......

0043 1.7694 $105.00 ........... $21.00 26676................. T.............. ............... Pin hand dislocation.........

0046 37.7023 $2,237.37 $535.76 $447.47 26685................. T.............. ............... Treat hand dislocation.......

0046 37.7023 $2,237.37 $535.76 $447.47 26686................. T.............. ............... Treat hand dislocation.......

0046 37.7023 $2,237.37 $535.76 $447.47 26700................. T.............. ............... Treat knuckle dislocation....

0043 1.7694 $105.00 ........... $21.00 26705................. T.............. ............... Treat knuckle dislocation....

0043 1.7694 $105.00 ........... $21.00 26706................. T.............. ............... Pin knuckle dislocation......

0043 1.7694 $105.00 ........... $21.00 26715................. T.............. ............... Treat knuckle dislocation....

0046 37.7023 $2,237.37 $535.76 $447.47 26720................. T.............. ............... Treat finger fracture, each..

0043 1.7694 $105.00 ........... $21.00 26725................. T.............. ............... Treat finger fracture, each..

0043 1.7694 $105.00 ........... $21.00 26727................. T.............. ............... Treat finger fracture, each..

0046 37.7023 $2,237.37 $535.76 $447.47 26735................. T.............. ............... Treat finger fracture, each..

0046 37.7023 $2,237.37 $535.76 $447.47 26740................. T.............. ............... Treat finger fracture, each..

0043 1.7694 $105.00 ........... $21.00 26742................. T.............. ............... Treat finger fracture, each..

0043 1.7694 $105.00 ........... $21.00 26746................. T.............. ............... Treat finger fracture, each..

0046 37.7023 $2,237.37 $535.76 $447.47 26750................. T.............. ............... Treat finger fracture, each..

0043 1.7694 $105.00 ........... $21.00 26755................. T.............. ............... Treat finger fracture, each..

0043 1.7694 $105.00 ........... $21.00 26756................. T.............. ............... Pin finger fracture, each....

0046 37.7023 $2,237.37 $535.76 $447.47 26765................. T.............. ............... Treat finger fracture, each..

0046 37.7023 $2,237.37 $535.76 $447.47 26770................. T.............. ............... Treat finger dislocation.....

0043 1.7694 $105.00 ........... $21.00 26775................. T.............. ............... Treat finger dislocation.....

0045 14.4945 $860.15 $268.47 $172.03 26776................. T.............. ............... Pin finger dislocation.......

0046 37.7023 $2,237.37 $535.76 $447.47 26785................. T.............. ............... Treat finger dislocation.....

0046 37.7023 $2,237.37 $535.76 $447.47 26820................. T.............. ............... Thumb fusion with graft......

0054 25.3711 $1,505.60 ........... $301.12 26841................. T.............. ............... Fusion of thumb..............

0054 25.3711 $1,505.60 ........... $301.12 26842................. T.............. ............... Thumb fusion with graft......

0054 25.3711 $1,505.60 ........... $301.12 26843................. T.............. ............... Fusion of hand joint.........

0054 25.3711 $1,505.60 ........... $301.12 26844................. T.............. ............... Fusion/graft of hand joint...

0054 25.3711 $1,505.60 ........... $301.12 26850................. T.............. ............... Fusion of knuckle............

0054 25.3711 $1,505.60 ........... $301.12 26852................. T.............. ............... Fusion of knuckle with graft.

0054 25.3711 $1,505.60 ........... $301.12 26860................. T.............. ............... Fusion of finger joint.......

0054 25.3711 $1,505.60 ........... $301.12 26861................. T.............. ............... Fusion of finger jnt, add-on.

0054 25.3711 $1,505.60 ........... $301.12 26862................. T.............. ............... Fusion/graft of finger joint.

0054 25.3711 $1,505.60 ........... $301.12 26863................. T.............. ............... Fuse/graft added joint.......

0054 25.3711 $1,505.60 ........... $301.12 26910................. T.............. ............... Amputate metacarpal bone.....

0054 25.3711 $1,505.60 ........... $301.12 26951................. T.............. ............... Amputation of finger/thumb...

0053 15.6795 $930.47 $253.49 $186.09 26952................. T.............. ............... Amputation of finger/thumb...

0053 15.6795 $930.47 $253.49 $186.09 26989................. T.............. ............... Hand/finger surgery..........

0043 1.7694 $105.00 ........... $21.00 26990................. T.............. ............... Drainage of pelvis lesion....

0049 20.3707 $1,208.86 ........... $241.77 26991................. T.............. ............... Drainage of pelvis bursa.....

0049 20.3707 $1,208.86 ........... $241.77 26992................. C.............. ............... Drainage of bone lesion...... ........... ........... ........... ........... ........... 27000................. T.............. ............... Incision of hip tendon.......

0049 20.3707 $1,208.86 ........... $241.77 27001................. T.............. ............... Incision of hip tendon.......

0050 23.9081 $1,418.78 ........... $283.76 27003................. T.............. ............... Incision of hip tendon.......

0050 23.9081 $1,418.78 ........... $283.76 27005................. C.............. ............... Incision of hip tendon....... ........... ........... ........... ........... ........... 27006................. C.............. ............... Incision of hip tendons...... ........... ........... ........... ........... ........... 27025................. C.............. ............... Incision of hip/thigh fascia. ........... ........... ........... ........... ........... 27030................. C.............. ............... Drainage of hip joint........ ........... ........... ........... ........... ........... 27033................. T.............. ............... Exploration of hip joint.....

0051 36.5271 $2,167.63 ........... $433.53 27035................. T.............. ............... Denervation of hip joint.....

0052 43.9378 $2,607.40 ........... $521.48 27036................. C.............. ............... Excision of hip joint/muscle. ........... ........... ........... ........... ........... 27040................. T.............. ............... Biopsy of soft tissues.......

0020 6.9433 $412.04 $107.40 $82.41 27041................. T.............. ............... Biopsy of soft tissues.......

0020 6.9433 $412.04 $107.40 $82.41 27047................. T.............. ............... Remove hip/pelvis lesion.....

0022 19.6472 $1,165.92 $354.45 $233.18 27048................. T.............. ............... Remove hip/pelvis lesion.....

0022 19.6472 $1,165.92 $354.45 $233.18 27049................. T.............. ............... Remove tumor, hip/pelvis.....

0022 19.6472 $1,165.92 $354.45 $233.18 27050................. T.............. ............... Biopsy of sacroiliac joint...

0049 20.3707 $1,208.86 ........... $241.77 27052................. T.............. ............... Biopsy of hip joint..........

0049 20.3707 $1,208.86 ........... $241.77 27054................. C.............. ............... Removal of hip joint lining.. ........... ........... ........... ........... ........... 27060................. T.............. ............... Removal of ischial bursa.....

0049 20.3707 $1,208.86 ........... $241.77 27062................. T.............. ............... Remove femur lesion/bursa....

0049 20.3707 $1,208.86 ........... $241.77 27065................. T.............. ............... Removal of hip bone lesion...

0049 20.3707 $1,208.86 ........... $241.77

[[Page 50721]]

27066................. T.............. ............... Removal of hip bone lesion...

0050 23.9081 $1,418.78 ........... $283.76 27067................. T.............. ............... Remove/graft hip bone lesion.

0050 23.9081 $1,418.78 ........... $283.76 27070................. C.............. ............... Partial removal of hip bone.. ........... ........... ........... ........... ........... 27071................. C.............. ............... Partial removal of hip bone.. ........... ........... ........... ........... ........... 27075................. C.............. ............... Extensive hip surgery........ ........... ........... ........... ........... ........... 27076................. C.............. ............... Extensive hip surgery........ ........... ........... ........... ........... ........... 27077................. C.............. ............... Extensive hip surgery........ ........... ........... ........... ........... ........... 27078................. C.............. ............... Extensive hip surgery........ ........... ........... ........... ........... ........... 27079................. C.............. ............... Extensive hip surgery........ ........... ........... ........... ........... ........... 27080................. T.............. ............... Removal of tail bone.........

0050 23.9081 $1,418.78 ........... $283.76 27086................. T.............. ............... Remove hip foreign body......

0020 6.9433 $412.04 $107.40 $82.41 27087................. T.............. ............... Remove hip foreign body......

0049 20.3707 $1,208.86 ........... $241.77 27090................. C.............. ............... Removal of hip prosthesis.... ........... ........... ........... ........... ........... 27091................. C.............. ............... Removal of hip prosthesis.... ........... ........... ........... ........... ........... 27093................. N.............. ............... Injection for hip x-ray...... ........... ........... ........... ........... ........... 27095................. N.............. ............... Injection for hip x-ray...... ........... ........... ........... ........... ........... 27096................. B.............. ............... Inject sacroiliac joint...... ........... ........... ........... ........... ........... 27097................. T.............. ............... Revision of hip tendon.......

0050 23.9081 $1,418.78 ........... $283.76 27098................. T.............. ............... Transfer tendon to pelvis....

0050 23.9081 $1,418.78 ........... $283.76 27100................. T.............. ............... Transfer of abdominal muscle.

0051 36.5271 $2,167.63 ........... $433.53 27105................. T.............. ............... Transfer of spinal muscle....

0051 36.5271 $2,167.63 ........... $433.53 27110................. T.............. ............... Transfer of iliopsoas muscle.

0051 36.5271 $2,167.63 ........... $433.53 27111................. T.............. ............... Transfer of iliopsoas muscle.

0051 36.5271 $2,167.63 ........... $433.53 27120................. C.............. ............... Reconstruction of hip socket. ........... ........... ........... ........... ........... 27122................. C.............. ............... Reconstruction of hip socket. ........... ........... ........... ........... ........... 27125................. C.............. ............... Partial hip replacement...... ........... ........... ........... ........... ........... 27130................. C.............. ............... Total hip arthroplasty....... ........... ........... ........... ........... ........... 27132................. C.............. ............... Total hip arthroplasty....... ........... ........... ........... ........... ........... 27134................. C.............. ............... Revise hip joint replacement. ........... ........... ........... ........... ........... 27137................. C.............. ............... Revise hip joint replacement. ........... ........... ........... ........... ........... 27138................. C.............. ............... Revise hip joint replacement. ........... ........... ........... ........... ........... 27140................. C.............. ............... Transplant femur ridge....... ........... ........... ........... ........... ........... 27146................. C.............. ............... Incision of hip bone......... ........... ........... ........... ........... ........... 27147................. C.............. ............... Revision of hip bone......... ........... ........... ........... ........... ........... 27151................. C.............. ............... Incision of hip bones........ ........... ........... ........... ........... ........... 27156................. C.............. ............... Revision of hip bones........ ........... ........... ........... ........... ........... 27158................. C.............. ............... Revision of pelvis........... ........... ........... ........... ........... ........... 27161................. C.............. ............... Incision of neck of femur.... ........... ........... ........... ........... ........... 27165................. C.............. ............... Incision/fixation of femur... ........... ........... ........... ........... ........... 27170................. C.............. ............... Repair/graft femur head/neck. ........... ........... ........... ........... ........... 27175................. C.............. ............... Treat slipped epiphysis...... ........... ........... ........... ........... ........... 27176................. C.............. ............... Treat slipped epiphysis...... ........... ........... ........... ........... ........... 27177................. C.............. ............... Treat slipped epiphysis...... ........... ........... ........... ........... ........... 27178................. C.............. ............... Treat slipped epiphysis...... ........... ........... ........... ........... ........... 27179................. C.............. ............... Revise head/neck of femur.... ........... ........... ........... ........... ........... 27181................. C.............. ............... Treat slipped epiphysis...... ........... ........... ........... ........... ........... 27185................. C.............. ............... Revision of femur epiphysis.. ........... ........... ........... ........... ........... 27187................. C.............. ............... Reinforce hip bones.......... ........... ........... ........... ........... ........... 27193................. T.............. ............... Treat pelvic ring fracture...

0043 1.7694 $105.00 ........... $21.00 27194................. T.............. ............... Treat pelvic ring fracture...

0045 14.4945 $860.15 $268.47 $172.03 27200................. T.............. ............... Treat tail bone fracture.....

0043 1.7694 $105.00 ........... $21.00 27202................. T.............. ............... Treat tail bone fracture.....

0046 37.7023 $2,237.37 $535.76 $447.47 27215................. C.............. ............... Treat pelvic fracture(s)..... ........... ........... ........... ........... ........... 27216................. T.............. ............... Treat pelvic ring fracture...

0050 23.9081 $1,418.78 ........... $283.76 27217................. C.............. ............... Treat pelvic ring fracture... ........... ........... ........... ........... ........... 27218................. C.............. ............... Treat pelvic ring fracture... ........... ........... ........... ........... ........... 27220................. T.............. ............... Treat hip socket fracture....

0043 1.7694 $105.00 ........... $21.00 27222................. C.............. ............... Treat hip socket fracture.... ........... ........... ........... ........... ........... 27226................. C.............. ............... Treat hip wall fracture...... ........... ........... ........... ........... ........... 27227................. C.............. ............... Treat hip fracture(s)........ ........... ........... ........... ........... ........... 27228................. C.............. ............... Treat hip fracture(s)........ ........... ........... ........... ........... ........... 27230................. T.............. ............... Treat thigh fracture.........

0043 1.7694 $105.00 ........... $21.00 27232................. C.............. ............... Treat thigh fracture......... ........... ........... ........... ........... ........... 27235................. T.............. ............... Treat thigh fracture.........

0050 23.9081 $1,418.78 ........... $283.76 27236................. C.............. ............... Treat thigh fracture......... ........... ........... ........... ........... ........... 27238................. T.............. ............... Treat thigh fracture.........

0043 1.7694 $105.00 ........... $21.00

[[Page 50722]]

27240................. C.............. ............... Treat thigh fracture......... ........... ........... ........... ........... ........... 27244................. C.............. ............... Treat thigh fracture......... ........... ........... ........... ........... ........... 27245................. C.............. ............... Treat thigh fracture......... ........... ........... ........... ........... ........... 27246................. T.............. ............... Treat thigh fracture.........

0043 1.7694 $105.00 ........... $21.00 27248................. C.............. ............... Treat thigh fracture......... ........... ........... ........... ........... ........... 27250................. T.............. ............... Treat hip dislocation........

0043 1.7694 $105.00 ........... $21.00 27252................. T.............. ............... Treat hip dislocation........

0045 14.4945 $860.15 $268.47 $172.03 27253................. C.............. ............... Treat hip dislocation........ ........... ........... ........... ........... ........... 27254................. C.............. ............... Treat hip dislocation........ ........... ........... ........... ........... ........... 27256................. T.............. ............... Treat hip dislocation........

0043 1.7694 $105.00 ........... $21.00 27257................. T.............. ............... Treat hip dislocation........

0045 14.4945 $860.15 $268.47 $172.03 27258................. C.............. ............... Treat hip dislocation........ ........... ........... ........... ........... ........... 27259................. C.............. ............... Treat hip dislocation........ ........... ........... ........... ........... ........... 27265................. T.............. ............... Treat hip dislocation........

0043 1.7694 $105.00 ........... $21.00 27266................. T.............. ............... Treat hip dislocation........

0045 14.4945 $860.15 $268.47 $172.03 27275................. T.............. ............... Manipulation of hip joint....

0045 14.4945 $860.15 $268.47 $172.03 27280................. C.............. ............... Fusion of sacroiliac joint... ........... ........... ........... ........... ........... 27282................. C.............. ............... Fusion of pubic bones........ ........... ........... ........... ........... ........... 27284................. C.............. ............... Fusion of hip joint.......... ........... ........... ........... ........... ........... 27286................. C.............. ............... Fusion of hip joint.......... ........... ........... ........... ........... ........... 27290................. C.............. ............... Amputation of leg at hip..... ........... ........... ........... ........... ........... 27295................. C.............. ............... Amputation of leg at hip..... ........... ........... ........... ........... ........... 27299................. T.............. ............... Pelvis/hip joint surgery.....

0043 1.7694 $105.00 ........... $21.00 27301................. T.............. ............... Drain thigh/knee lesion......

0008 16.4989 $979.09 ........... $195.82 27303................. C.............. ............... Drainage of bone lesion...... ........... ........... ........... ........... ........... 27305................. T.............. ............... Incise thigh tendon & fascia.

0049 20.3707 $1,208.86 ........... $241.77 27306................. T.............. ............... Incision of thigh tendon.....

0049 20.3707 $1,208.86 ........... $241.77 27307................. T.............. ............... Incision of thigh tendons....

0049 20.3707 $1,208.86 ........... $241.77 27310................. T.............. ............... Exploration of knee joint....

0050 23.9081 $1,418.78 ........... $283.76 27315................. T.............. ............... Partial removal, thigh nerve.

0220 17.3586 $1,030.11 ........... $206.02 27320................. T.............. ............... Partial removal, thigh nerve.

0220 17.3586 $1,030.11 ........... $206.02 27323................. T.............. ............... Biopsy, thigh soft tissues...

0021 14.9776 $888.82 $219.48 $177.76 27324................. T.............. ............... Biopsy, thigh soft tissues...

0022 19.6472 $1,165.92 $354.45 $233.18 27327................. T.............. ............... Removal of thigh lesion......

0022 19.6472 $1,165.92 $354.45 $233.18 27328................. T.............. ............... Removal of thigh lesion......

0022 19.6472 $1,165.92 $354.45 $233.18 27329................. T.............. ............... Remove tumor, thigh/knee.....

0022 19.6472 $1,165.92 $354.45 $233.18 27330................. T.............. ............... Biopsy, knee joint lining....

0050 23.9081 $1,418.78 ........... $283.76 27331................. T.............. ............... Explore/treat knee joint.....

0050 23.9081 $1,418.78 ........... $283.76 27332................. T.............. ............... Removal of knee cartilage....

0050 23.9081 $1,418.78 ........... $283.76 27333................. T.............. ............... Removal of knee cartilage....

0050 23.9081 $1,418.78 ........... $283.76 27334................. T.............. ............... Remove knee joint lining.....

0050 23.9081 $1,418.78 ........... $283.76 27335................. T.............. ............... Remove knee joint lining.....

0050 23.9081 $1,418.78 ........... $283.76 27340................. T.............. ............... Removal of kneecap bursa.....

0049 20.3707 $1,208.86 ........... $241.77 27345................. T.............. ............... Removal of knee cyst.........

0049 20.3707 $1,208.86 ........... $241.77 27347................. T.............. ............... Remove knee cyst.............

0049 20.3707 $1,208.86 ........... $241.77 27350................. T.............. ............... Removal of kneecap...........

0050 23.9081 $1,418.78 ........... $283.76 27355................. T.............. ............... Remove femur lesion..........

0050 23.9081 $1,418.78 ........... $283.76 27356................. T.............. ............... Remove femur lesion/graft....

0050 23.9081 $1,418.78 ........... $283.76 27357................. T.............. ............... Remove femur lesion/graft....

0050 23.9081 $1,418.78 ........... $283.76 27358................. T.............. ............... Remove femur lesion/fixation.

0050 23.9081 $1,418.78 ........... $283.76 27360................. T.............. ............... Partial removal, leg bone(s).

0050 23.9081 $1,418.78 ........... $283.76 27365................. C.............. ............... Extensive leg surgery........ ........... ........... ........... ........... ........... 27370................. N.............. ............... Injection for knee x-ray..... ........... ........... ........... ........... ........... 27372................. T.............. ............... Removal of foreign body......

0022 19.6472 $1,165.92 $354.45 $233.18 27380................. T.............. ............... Repair of kneecap tendon.....

0049 20.3707 $1,208.86 ........... $241.77 27381................. T.............. ............... Repair/graft kneecap tendon..

0049 20.3707 $1,208.86 ........... $241.77 27385................. T.............. ............... Repair of thigh muscle.......

0049 20.3707 $1,208.86 ........... $241.77 27386................. T.............. ............... Repair/graft of thigh muscle.

0049 20.3707 $1,208.86 ........... $241.77 27390................. T.............. ............... Incision of thigh tendon.....

0049 20.3707 $1,208.86 ........... $241.77 27391................. T.............. ............... Incision of thigh tendons....

0049 20.3707 $1,208.86 ........... $241.77 27392................. T.............. ............... Incision of thigh tendons....

0049 20.3707 $1,208.86 ........... $241.77 27393................. T.............. ............... Lengthening of thigh tendon..

0050 23.9081 $1,418.78 ........... $283.76 27394................. T.............. ............... Lengthening of thigh tendons.

0050 23.9081 $1,418.78 ........... $283.76 27395................. T.............. ............... Lengthening of thigh tendons.

0051 36.5271 $2,167.63 ........... $433.53 27396................. T.............. ............... Transplant of thigh tendon...

0050 23.9081 $1,418.78 ........... $283.76 27397................. T.............. ............... Transplants of thigh tendons.

0051 36.5271 $2,167.63 ........... $433.53

[[Page 50723]]

27400................. T.............. ............... Revise thigh muscles/tendons.

0051 36.5271 $2,167.63 ........... $433.53 27403................. T.............. ............... Repair of knee cartilage.....

0050 23.9081 $1,418.78 ........... $283.76 27405................. T.............. ............... Repair of knee ligament......

0051 36.5271 $2,167.63 ........... $433.53 27407................. T.............. ............... Repair of knee ligament......

0051 36.5271 $2,167.63 ........... $433.53 27409................. T.............. ............... Repair of knee ligaments.....

0051 36.5271 $2,167.63 ........... $433.53 27412................. T.............. ............... Autochondrocyte implant knee.

0042 43.9753 $2,609.63 $804.74 $521.93 27415................. T.............. ............... Osteochondral knee allograft.

0042 43.9753 $2,609.63 $804.74 $521.93 27418................. T.............. ............... Repair degenerated kneecap...

0051 36.5271 $2,167.63 ........... $433.53 27420................. T.............. ............... Revision of unstable kneecap.

0051 36.5271 $2,167.63 ........... $433.53 27422................. T.............. ............... Revision of unstable kneecap.

0051 36.5271 $2,167.63 ........... $433.53 27424................. T.............. ............... Revision/removal of kneecap..

0051 36.5271 $2,167.63 ........... $433.53 27425................. T.............. ............... Lateral retinacular release..

0050 23.9081 $1,418.78 ........... $283.76 27427................. T.............. ............... Reconstruction, knee.........

0052 43.9378 $2,607.40 ........... $521.48 27428................. T.............. ............... Reconstruction, knee.........

0052 43.9378 $2,607.40 ........... $521.48 27429................. T.............. ............... Reconstruction, knee.........

0052 43.9378 $2,607.40 ........... $521.48 27430................. T.............. ............... Revision of thigh muscles....

0051 36.5271 $2,167.63 ........... $433.53 27435................. T.............. ............... Incision of knee joint.......

0051 36.5271 $2,167.63 ........... $433.53 27437................. T.............. ............... Revise kneecap...............

0047 31.6107 $1,875.87 $537.03 $375.17 27438................. T.............. ............... Revise kneecap with implant..

0048 43.1288 $2,559.39 $570.30 $511.88 27440................. T.............. ............... Revision of knee joint.......

0047 31.6107 $1,875.87 $537.03 $375.17 27441................. T.............. ............... Revision of knee joint.......

0047 31.6107 $1,875.87 $537.03 $375.17 27442................. T.............. ............... Revision of knee joint.......

0047 31.6107 $1,875.87 $537.03 $375.17 27443................. T.............. ............... Revision of knee joint.......

0047 31.6107 $1,875.87 $537.03 $375.17 27445................. C.............. ............... Revision of knee joint....... ........... ........... ........... ........... ........... 27446................. T.............. ............... Revision of knee joint.......

0681 137.163 $8,139.66 $2,081.48 $1,627.93 27447................. C.............. ............... Total knee arthroplasty...... ........... ........... ........... ........... ........... 27448................. C.............. ............... Incision of thigh............ ........... ........... ........... ........... ........... 27450................. C.............. ............... Incision of thigh............ ........... ........... ........... ........... ........... 27454................. C.............. ............... Realignment of thigh bone.... ........... ........... ........... ........... ........... 27455................. C.............. ............... Realignment of knee.......... ........... ........... ........... ........... ........... 27457................. C.............. ............... Realignment of knee.......... ........... ........... ........... ........... ........... 27465................. C.............. ............... Shortening of thigh bone..... ........... ........... ........... ........... ........... 27466................. C.............. ............... Lengthening of thigh bone.... ........... ........... ........... ........... ........... 27468................. C.............. ............... Shorten/lengthen thighs...... ........... ........... ........... ........... ........... 27470................. C.............. ............... Repair of thigh.............. ........... ........... ........... ........... ........... 27472................. C.............. ............... Repair/graft of thigh........ ........... ........... ........... ........... ........... 27475................. T.............. ............... Surgery to stop leg growth...

0050 23.9081 $1,418.78 ........... $283.76 27477................. C.............. ............... Surgery to stop leg growth... ........... ........... ........... ........... ........... 27479................. C.............. ............... Surgery to stop leg growth... ........... ........... ........... ........... ........... 27485................. C.............. ............... Surgery to stop leg growth... ........... ........... ........... ........... ........... 27486................. C.............. ............... Revise/replace knee joint.... ........... ........... ........... ........... ........... 27487................. C.............. ............... Revise/replace knee joint.... ........... ........... ........... ........... ........... 27488................. C.............. ............... Removal of knee prosthesis... ........... ........... ........... ........... ........... 27495................. C.............. ............... Reinforce thigh.............. ........... ........... ........... ........... ........... 27496................. T.............. ............... Decompression of thigh/knee..

0049 20.3707 $1,208.86 ........... $241.77 27497................. T.............. ............... Decompression of thigh/knee..

0049 20.3707 $1,208.86 ........... $241.77 27498................. T.............. ............... Decompression of thigh/knee..

0049 20.3707 $1,208.86 ........... $241.77 27499................. T.............. ............... Decompression of thigh/knee..

0049 20.3707 $1,208.86 ........... $241.77 27500................. T.............. ............... Treatment of thigh fracture..

0043 1.7694 $105.00 ........... $21.00 27501................. T.............. ............... Treatment of thigh fracture..

0043 1.7694 $105.00 ........... $21.00 27502................. T.............. ............... Treatment of thigh fracture..

0043 1.7694 $105.00 ........... $21.00 27503................. T.............. ............... Treatment of thigh fracture..

0043 1.7694 $105.00 ........... $21.00 27506................. C.............. ............... Treatment of thigh fracture.. ........... ........... ........... ........... ........... 27507................. C.............. ............... Treatment of thigh fracture.. ........... ........... ........... ........... ........... 27508................. T.............. ............... Treatment of thigh fracture..

0043 1.7694 $105.00 ........... $21.00 27509................. T.............. ............... Treatment of thigh fracture..

0046 37.7023 $2,237.37 $535.76 $447.47 27510................. T.............. ............... Treatment of thigh fracture..

0043 1.7694 $105.00 ........... $21.00 27511................. C.............. ............... Treatment of thigh fracture.. ........... ........... ........... ........... ........... 27513................. C.............. ............... Treatment of thigh fracture.. ........... ........... ........... ........... ........... 27514................. C.............. ............... Treatment of thigh fracture.. ........... ........... ........... ........... ........... 27516................. T.............. ............... Treat thigh fx growth plate..

0043 1.7694 $105.00 ........... $21.00 27517................. T.............. ............... Treat thigh fx growth plate..

0043 1.7694 $105.00 ........... $21.00 27519................. C.............. ............... Treat thigh fx growth plate.. ........... ........... ........... ........... ........... 27520................. T.............. ............... Treat kneecap fracture.......

0043 1.7694 $105.00 ........... $21.00 27524................. T.............. ............... Treat kneecap fracture.......

0046 37.7023 $2,237.37 $535.76 $447.47 27530................. T.............. ............... Treat knee fracture..........

0043 1.7694 $105.00 ........... $21.00

[[Page 50724]]

27532................. T.............. ............... Treat knee fracture..........

0043 1.7694 $105.00 ........... $21.00 27535................. C.............. ............... Treat knee fracture.......... ........... ........... ........... ........... ........... 27536................. C.............. ............... Treat knee fracture.......... ........... ........... ........... ........... ........... 27538................. T.............. ............... Treat knee fracture(s).......

0043 1.7694 $105.00 ........... $21.00 27540................. C.............. ............... Treat knee fracture.......... ........... ........... ........... ........... ........... 27550................. T.............. ............... Treat knee dislocation.......

0043 1.7694 $105.00 ........... $21.00 27552................. T.............. ............... Treat knee dislocation.......

0045 14.4945 $860.15 $268.47 $172.03 27556................. C.............. ............... Treat knee dislocation....... ........... ........... ........... ........... ........... 27557................. C.............. ............... Treat knee dislocation....... ........... ........... ........... ........... ........... 27558................. C.............. ............... Treat knee dislocation....... ........... ........... ........... ........... ........... 27560................. T.............. ............... Treat kneecap dislocation....

0043 1.7694 $105.00 ........... $21.00 27562................. T.............. ............... Treat kneecap dislocation....

0045 14.4945 $860.15 $268.47 $172.03 27566................. T.............. ............... Treat kneecap dislocation....

0046 37.7023 $2,237.37 $535.76 $447.47 27570................. T.............. ............... Fixation of knee joint.......

0045 14.4945 $860.15 $268.47 $172.03 27580................. C.............. ............... Fusion of knee............... ........... ........... ........... ........... ........... 27590................. C.............. ............... Amputate leg at thigh........ ........... ........... ........... ........... ........... 27591................. C.............. ............... Amputate leg at thigh........ ........... ........... ........... ........... ........... 27592................. C.............. ............... Amputate leg at thigh........ ........... ........... ........... ........... ........... 27594................. T.............. ............... Amputation follow-up surgery.

0049 20.3707 $1,208.86 ........... $241.77 27596................. C.............. ............... Amputation follow-up surgery. ........... ........... ........... ........... ........... 27598................. C.............. ............... Amputate lower leg at knee... ........... ........... ........... ........... ........... 27599................. T.............. ............... Leg surgery procedure........

0043 1.7694 $105.00 ........... $21.00 27600................. T.............. ............... Decompression of lower leg...

0049 20.3707 $1,208.86 ........... $241.77 27601................. T.............. ............... Decompression of lower leg...

0049 20.3707 $1,208.86 ........... $241.77 27602................. T.............. ............... Decompression of lower leg...

0049 20.3707 $1,208.86 ........... $241.77 27603................. T.............. ............... Drain lower leg lesion.......

0008 16.4989 $979.09 ........... $195.82 27604................. T.............. ............... Drain lower leg bursa........

0049 20.3707 $1,208.86 ........... $241.77 27605................. T.............. ............... Incision of achilles tendon..

0055 20.0692 $1,190.97 $355.34 $238.19 27606................. T.............. ............... Incision of achilles tendon..

0049 20.3707 $1,208.86 ........... $241.77 27607................. T.............. ............... Treat lower leg bone lesion..

0049 20.3707 $1,208.86 ........... $241.77 27610................. T.............. ............... Explore/treat ankle joint....

0050 23.9081 $1,418.78 ........... $283.76 27612................. T.............. ............... Exploration of ankle joint...

0050 23.9081 $1,418.78 ........... $283.76 27613................. T.............. ............... Biopsy lower leg soft tissue.

0020 6.9433 $412.04 $107.40 $82.41 27614................. T.............. ............... Biopsy lower leg soft tissue.

0022 19.6472 $1,165.92 $354.45 $233.18 27615................. T.............. ............... Remove tumor, lower leg......

0046 37.7023 $2,237.37 $535.76 $447.47 27618................. T.............. ............... Remove lower leg lesion......

0021 14.9776 $888.82 $219.48 $177.76 27619................. T.............. ............... Remove lower leg lesion......

0022 19.6472 $1,165.92 $354.45 $233.18 27620................. T.............. ............... Explore/treat ankle joint....

0050 23.9081 $1,418.78 ........... $283.76 27625................. T.............. ............... Remove ankle joint lining....

0050 23.9081 $1,418.78 ........... $283.76 27626................. T.............. ............... Remove ankle joint lining....

0050 23.9081 $1,418.78 ........... $283.76 27630................. T.............. ............... Removal of tendon lesion.....

0049 20.3707 $1,208.86 ........... $241.77 27635................. T.............. ............... Remove lower leg bone lesion.

0050 23.9081 $1,418.78 ........... $283.76 27637................. T.............. ............... Remove/graft leg bone lesion.

0050 23.9081 $1,418.78 ........... $283.76 27638................. T.............. ............... Remove/graft leg bone lesion.

0050 23.9081 $1,418.78 ........... $283.76 27640................. T.............. ............... Partial removal of tibia.....

0051 36.5271 $2,167.63 ........... $433.53 27641................. T.............. ............... Partial removal of fibula....

0050 23.9081 $1,418.78 ........... $283.76 27645................. C.............. ............... Extensive lower leg surgery.. ........... ........... ........... ........... ........... 27646................. C.............. ............... Extensive lower leg surgery.. ........... ........... ........... ........... ........... 27647................. T.............. ............... Extensive ankle/heel surgery.

0051 36.5271 $2,167.63 ........... $433.53 27648................. N.............. ............... Injection for ankle x-ray.... ........... ........... ........... ........... ........... 27650................. T.............. ............... Repair achilles tendon.......

0051 36.5271 $2,167.63 ........... $433.53 27652................. T.............. ............... Repair/graft achilles tendon.

0051 36.5271 $2,167.63 ........... $433.53 27654................. T.............. ............... Repair of achilles tendon....

0051 36.5271 $2,167.63 ........... $433.53 27656................. T.............. ............... Repair leg fascia defect.....

0049 20.3707 $1,208.86 ........... $241.77 27658................. T.............. ............... Repair of leg tendon, each...

0049 20.3707 $1,208.86 ........... $241.77 27659................. T.............. ............... Repair of leg tendon, each...

0049 20.3707 $1,208.86 ........... $241.77 27664................. T.............. ............... Repair of leg tendon, each...

0049 20.3707 $1,208.86 ........... $241.77 27665................. T.............. ............... Repair of leg tendon, each...

0050 23.9081 $1,418.78 ........... $283.76 27675................. T.............. ............... Repair lower leg tendons.....

0049 20.3707 $1,208.86 ........... $241.77 27676................. T.............. ............... Repair lower leg tendons.....

0050 23.9081 $1,418.78 ........... $283.76 27680................. T.............. ............... Release of lower leg tendon..

0050 23.9081 $1,418.78 ........... $283.76 27681................. T.............. ............... Release of lower leg tendons.

0050 23.9081 $1,418.78 ........... $283.76 27685................. T.............. ............... Revision of lower leg tendon.

0050 23.9081 $1,418.78 ........... $283.76 27686................. T.............. ............... Revise lower leg tendons.....

0050 23.9081 $1,418.78 ........... $283.76 27687................. T.............. ............... Revision of calf tendon......

0050 23.9081 $1,418.78 ........... $283.76 27690................. T.............. ............... Revise lower leg tendon......

0051 36.5271 $2,167.63 ........... $433.53

[[Page 50725]]

27691................. T.............. ............... Revise lower leg tendon......

0051 36.5271 $2,167.63 ........... $433.53 27692................. T.............. ............... Revise additional leg tendon.

0051 36.5271 $2,167.63 ........... $433.53 27695................. T.............. ............... Repair of ankle ligament.....

0050 23.9081 $1,418.78 ........... $283.76 27696................. T.............. ............... Repair of ankle ligaments....

0050 23.9081 $1,418.78 ........... $283.76 27698................. T.............. ............... Repair of ankle ligament.....

0050 23.9081 $1,418.78 ........... $283.76 27700................. T.............. ............... Revision of ankle joint......

0047 31.6107 $1,875.87 $537.03 $375.17 27702................. C.............. ............... Reconstruct ankle joint...... ........... ........... ........... ........... ........... 27703................. C.............. ............... Reconstruction, ankle joint.. ........... ........... ........... ........... ........... 27704................. T.............. ............... Removal of ankle implant.....

0049 20.3707 $1,208.86 ........... $241.77 27705................. T.............. ............... Incision of tibia............

0051 36.5271 $2,167.63 ........... $433.53 27707................. T.............. ............... Incision of fibula...........

0049 20.3707 $1,208.86 ........... $241.77 27709................. T.............. ............... Incision of tibia & fibula...

0050 23.9081 $1,418.78 ........... $283.76 27712................. C.............. ............... Realignment of lower leg..... ........... ........... ........... ........... ........... 27715................. C.............. ............... Revision of lower leg........ ........... ........... ........... ........... ........... 27720................. C.............. ............... Repair of tibia.............. ........... ........... ........... ........... ........... 27722................. C.............. ............... Repair/graft of tibia........ ........... ........... ........... ........... ........... 27724................. C.............. ............... Repair/graft of tibia........ ........... ........... ........... ........... ........... 27725................. C.............. ............... Repair of lower leg.......... ........... ........... ........... ........... ........... 27727................. C.............. ............... Repair of lower leg.......... ........... ........... ........... ........... ........... 27730................. T.............. ............... Repair of tibia epiphysis....

0050 23.9081 $1,418.78 ........... $283.76 27732................. T.............. ............... Repair of fibula epiphysis...

0050 23.9081 $1,418.78 ........... $283.76 27734................. T.............. ............... Repair lower leg epiphyses...

0050 23.9081 $1,418.78 ........... $283.76 27740................. T.............. ............... Repair of leg epiphyses......

0050 23.9081 $1,418.78 ........... $283.76 27742................. T.............. ............... Repair of leg epiphyses......

0051 36.5271 $2,167.63 ........... $433.53 27745................. T.............. ............... Reinforce tibia..............

0051 36.5271 $2,167.63 ........... $433.53 27750................. T.............. ............... Treatment of tibia fracture..

0043 1.7694 $105.00 ........... $21.00 27752................. T.............. ............... Treatment of tibia fracture..

0043 1.7694 $105.00 ........... $21.00 27756................. T.............. ............... Treatment of tibia fracture..

0046 37.7023 $2,237.37 $535.76 $447.47 27758................. T.............. ............... Treatment of tibia fracture..

0046 37.7023 $2,237.37 $535.76 $447.47 27759................. T.............. ............... Treatment of tibia fracture..

0046 37.7023 $2,237.37 $535.76 $447.47 27760................. T.............. ............... Treatment of ankle fracture..

0043 1.7694 $105.00 ........... $21.00 27762................. T.............. ............... Treatment of ankle fracture..

0043 1.7694 $105.00 ........... $21.00 27766................. T.............. ............... Treatment of ankle fracture..

0046 37.7023 $2,237.37 $535.76 $447.47 27780................. T.............. ............... Treatment of fibula fracture.

0043 1.7694 $105.00 ........... $21.00 27781................. T.............. ............... Treatment of fibula fracture.

0043 1.7694 $105.00 ........... $21.00 27784................. T.............. ............... Treatment of fibula fracture.

0046 37.7023 $2,237.37 $535.76 $447.47 27786................. T.............. ............... Treatment of ankle fracture..

0043 1.7694 $105.00 ........... $21.00 27788................. T.............. ............... Treatment of ankle fracture..

0043 1.7694 $105.00 ........... $21.00 27792................. T.............. ............... Treatment of ankle fracture..

0046 37.7023 $2,237.37 $535.76 $447.47 27808................. T.............. ............... Treatment of ankle fracture..

0043 1.7694 $105.00 ........... $21.00 27810................. T.............. ............... Treatment of ankle fracture..

0043 1.7694 $105.00 ........... $21.00 27814................. T.............. ............... Treatment of ankle fracture..

0046 37.7023 $2,237.37 $535.76 $447.47 27816................. T.............. ............... Treatment of ankle fracture..

0043 1.7694 $105.00 ........... $21.00 27818................. T.............. ............... Treatment of ankle fracture..

0043 1.7694 $105.00 ........... $21.00 27822................. T.............. ............... Treatment of ankle fracture..

0046 37.7023 $2,237.37 $535.76 $447.47 27823................. T.............. ............... Treatment of ankle fracture..

0046 37.7023 $2,237.37 $535.76 $447.47 27824................. T.............. ............... Treat lower leg fracture.....

0043 1.7694 $105.00 ........... $21.00 27825................. T.............. ............... Treat lower leg fracture.....

0043 1.7694 $105.00 ........... $21.00 27826................. T.............. ............... Treat lower leg fracture.....

0046 37.7023 $2,237.37 $535.76 $447.47 27827................. T.............. ............... Treat lower leg fracture.....

0046 37.7023 $2,237.37 $535.76 $447.47 27828................. T.............. ............... Treat lower leg fracture.....

0046 37.7023 $2,237.37 $535.76 $447.47 27829................. T.............. ............... Treat lower leg joint........

0046 37.7023 $2,237.37 $535.76 $447.47 27830................. T.............. ............... Treat lower leg dislocation..

0043 1.7694 $105.00 ........... $21.00 27831................. T.............. ............... Treat lower leg dislocation..

0043 1.7694 $105.00 ........... $21.00 27832................. T.............. ............... Treat lower leg dislocation..

0046 37.7023 $2,237.37 $535.76 $447.47 27840................. T.............. ............... Treat ankle dislocation......

0043 1.7694 $105.00 ........... $21.00 27842................. T.............. ............... Treat ankle dislocation......

0045 14.4945 $860.15 $268.47 $172.03 27846................. T.............. ............... Treat ankle dislocation......

0046 37.7023 $2,237.37 $535.76 $447.47 27848................. T.............. ............... Treat ankle dislocation......

0046 37.7023 $2,237.37 $535.76 $447.47 27860................. T.............. ............... Fixation of ankle joint......

0045 14.4945 $860.15 $268.47 $172.03 27870................. T.............. ............... Fusion of ankle joint........

0051 36.5271 $2,167.63 ........... $433.53 27871................. T.............. ............... Fusion of tibiofibular joint.

0051 36.5271 $2,167.63 ........... $433.53 27880................. C.............. ............... Amputation of lower leg...... ........... ........... ........... ........... ........... 27881................. C.............. ............... Amputation of lower leg...... ........... ........... ........... ........... ........... 27882................. C.............. ............... Amputation of lower leg...... ........... ........... ........... ........... ........... 27884................. T.............. ............... Amputation follow-up surgery.

0049 20.3707 $1,208.86 ........... $241.77

[[Page 50726]]

27886................. C.............. ............... Amputation follow-up surgery. ........... ........... ........... ........... ........... 27888................. C.............. ............... Amputation of foot at ankle.. ........... ........... ........... ........... ........... 27889................. T.............. ............... Amputation of foot at ankle..

0050 23.9081 $1,418.78 ........... $283.76 27892................. T.............. ............... Decompression of leg.........

0049 20.3707 $1,208.86 ........... $241.77 27893................. T.............. ............... Decompression of leg.........

0049 20.3707 $1,208.86 ........... $241.77 27894................. T.............. ............... Decompression of leg.........

0049 20.3707 $1,208.86 ........... $241.77 27899................. T.............. ............... Leg/ankle surgery procedure..

0043 1.7694 $105.00 ........... $21.00 28001................. T.............. ............... Drainage of bursa of foot....

0007 11.4501 $679.48 ........... $135.90 28002................. T.............. ............... Treatment of foot infection..

0049 20.3707 $1,208.86 ........... $241.77 28003................. T.............. ............... Treatment of foot infection..

0049 20.3707 $1,208.86 ........... $241.77 28005................. T.............. ............... Treat foot bone lesion.......

0055 20.0692 $1,190.97 $355.34 $238.19 28008................. T.............. ............... Incision of foot fascia......

0055 20.0692 $1,190.97 $355.34 $238.19 28010................. T.............. ............... Incision of toe tendon.......

0055 20.0692 $1,190.97 $355.34 $238.19 28011................. T.............. ............... Incision of toe tendons......

0055 20.0692 $1,190.97 $355.34 $238.19 28020................. T.............. ............... Exploration of foot joint....

0055 20.0692 $1,190.97 $355.34 $238.19 28022................. T.............. ............... Exploration of foot joint....

0055 20.0692 $1,190.97 $355.34 $238.19 28024................. T.............. ............... Exploration of toe joint.....

0055 20.0692 $1,190.97 $355.34 $238.19 28030................. T.............. ............... Removal of foot nerve........

0220 17.3586 $1,030.11 ........... $206.02 28035................. T.............. ............... Decompression of tibia nerve.

0220 17.3586 $1,030.11 ........... $206.02 28043................. T.............. ............... Excision of foot lesion......

0021 14.9776 $888.82 $219.48 $177.76 28045................. T.............. ............... Excision of foot lesion......

0055 20.0692 $1,190.97 $355.34 $238.19 28046................. T.............. ............... Resection of tumor, foot.....

0055 20.0692 $1,190.97 $355.34 $238.19 28050................. T.............. ............... Biopsy of foot joint lining..

0055 20.0692 $1,190.97 $355.34 $238.19 28052................. T.............. ............... Biopsy of foot joint lining..

0055 20.0692 $1,190.97 $355.34 $238.19 28054................. T.............. ............... Biopsy of toe joint lining...

0055 20.0692 $1,190.97 $355.34 $238.19 28060................. T.............. ............... Partial removal, foot fascia.

0055 20.0692 $1,190.97 $355.34 $238.19 28062................. T.............. ............... Removal of foot fascia.......

0055 20.0692 $1,190.97 $355.34 $238.19 28070................. T.............. ............... Removal of foot joint lining.

0055 20.0692 $1,190.97 $355.34 $238.19 28072................. T.............. ............... Removal of foot joint lining.

0055 20.0692 $1,190.97 $355.34 $238.19 28080................. T.............. ............... Removal of foot lesion.......

0055 20.0692 $1,190.97 $355.34 $238.19 28086................. T.............. ............... Excise foot tendon sheath....

0055 20.0692 $1,190.97 $355.34 $238.19 28088................. T.............. ............... Excise foot tendon sheath....

0055 20.0692 $1,190.97 $355.34 $238.19 28090................. T.............. ............... Removal of foot lesion.......

0055 20.0692 $1,190.97 $355.34 $238.19 28092................. T.............. ............... Removal of toe lesions.......

0055 20.0692 $1,190.97 $355.34 $238.19 28100................. T.............. ............... Removal of ankle/heel lesion.

0055 20.0692 $1,190.97 $355.34 $238.19 28102................. T.............. ............... Remove/graft foot lesion.....

0056 40.2957 $2,391.27 ........... $478.25 28103................. T.............. ............... Remove/graft foot lesion.....

0056 40.2957 $2,391.27 ........... $478.25 28104................. T.............. ............... Removal of foot lesion.......

0055 20.0692 $1,190.97 $355.34 $238.19 28106................. T.............. ............... Remove/graft foot lesion.....

0056 40.2957 $2,391.27 ........... $478.25 28107................. T.............. ............... Remove/graft foot lesion.....

0056 40.2957 $2,391.27 ........... $478.25 28108................. T.............. ............... Removal of toe lesions.......

0055 20.0692 $1,190.97 $355.34 $238.19 28110................. T.............. ............... Part removal of metatarsal...

0055 20.0692 $1,190.97 $355.34 $238.19 28111................. T.............. ............... Part removal of metatarsal...

0055 20.0692 $1,190.97 $355.34 $238.19 28112................. T.............. ............... Part removal of metatarsal...

0055 20.0692 $1,190.97 $355.34 $238.19 28113................. T.............. ............... Part removal of metatarsal...

0055 20.0692 $1,190.97 $355.34 $238.19 28114................. T.............. ............... Removal of metatarsal heads..

0055 20.0692 $1,190.97 $355.34 $238.19 28116................. T.............. ............... Revision of foot.............

0055 20.0692 $1,190.97 $355.34 $238.19 28118................. T.............. ............... Removal of heel bone.........

0055 20.0692 $1,190.97 $355.34 $238.19 28119................. T.............. ............... Removal of heel spur.........

0055 20.0692 $1,190.97 $355.34 $238.19 28120................. T.............. ............... Part removal of ankle/heel...

0055 20.0692 $1,190.97 $355.34 $238.19 28122................. T.............. ............... Partial removal of foot bone.

0055 20.0692 $1,190.97 $355.34 $238.19 28124................. T.............. ............... Partial removal of toe.......

0055 20.0692 $1,190.97 $355.34 $238.19 28126................. T.............. ............... Partial removal of toe.......

0055 20.0692 $1,190.97 $355.34 $238.19 28130................. T.............. ............... Removal of ankle bone........

0055 20.0692 $1,190.97 $355.34 $238.19 28140................. T.............. ............... Removal of metatarsal........

0055 20.0692 $1,190.97 $355.34 $238.19 28150................. T.............. ............... Removal of toe...............

0055 20.0692 $1,190.97 $355.34 $238.19 28153................. T.............. ............... Partial removal of toe.......

0055 20.0692 $1,190.97 $355.34 $238.19 28160................. T.............. ............... Partial removal of toe.......

0055 20.0692 $1,190.97 $355.34 $238.19 28171................. T.............. ............... Extensive foot surgery.......

0055 20.0692 $1,190.97 $355.34 $238.19 28173................. T.............. ............... Extensive foot surgery.......

0055 20.0692 $1,190.97 $355.34 $238.19 28175................. T.............. ............... Extensive foot surgery.......

0055 20.0692 $1,190.97 $355.34 $238.19 28190................. T.............. ............... Removal of foot foreign body.

0019 4.0547 $240.62 $71.87 $48.12 28192................. T.............. ............... Removal of foot foreign body.

0021 14.9776 $888.82 $219.48 $177.76 28193................. T.............. ............... Removal of foot foreign body.

0020 6.9433 $412.04 $107.40 $82.41 28200................. T.............. ............... Repair of foot tendon........

0055 20.0692 $1,190.97 $355.34 $238.19 28202................. T.............. ............... Repair/graft of foot tendon..

0055 20.0692 $1,190.97 $355.34 $238.19

[[Page 50727]]

28208................. T.............. ............... Repair of foot tendon........

0055 20.0692 $1,190.97 $355.34 $238.19 28210................. T.............. ............... Repair/graft of foot tendon..

0056 40.2957 $2,391.27 ........... $478.25 28220................. T.............. ............... Release of foot tendon.......

0055 20.0692 $1,190.97 $355.34 $238.19 28222................. T.............. ............... Release of foot tendons......

0055 20.0692 $1,190.97 $355.34 $238.19 28225................. T.............. ............... Release of foot tendon.......

0055 20.0692 $1,190.97 $355.34 $238.19 28226................. T.............. ............... Release of foot tendons......

0055 20.0692 $1,190.97 $355.34 $238.19 28230................. T.............. ............... Incision of foot tendon(s)...

0055 20.0692 $1,190.97 $355.34 $238.19 28232................. T.............. ............... Incision of toe tendon.......

0055 20.0692 $1,190.97 $355.34 $238.19 28234................. T.............. ............... Incision of foot tendon......

0055 20.0692 $1,190.97 $355.34 $238.19 28238................. T.............. ............... Revision of foot tendon......

0056 40.2957 $2,391.27 ........... $478.25 28240................. T.............. ............... Release of big toe...........

0055 20.0692 $1,190.97 $355.34 $238.19 28250................. T.............. ............... Revision of foot fascia......

0055 20.0692 $1,190.97 $355.34 $238.19 28260................. T.............. ............... Release of midfoot joint.....

0055 20.0692 $1,190.97 $355.34 $238.19 28261................. T.............. ............... Revision of foot tendon......

0055 20.0692 $1,190.97 $355.34 $238.19 28262................. T.............. ............... Revision of foot and ankle...

0055 20.0692 $1,190.97 $355.34 $238.19 28264................. T.............. ............... Release of midfoot joint.....

0056 40.2957 $2,391.27 ........... $478.25 28270................. T.............. ............... Release of foot contracture..

0055 20.0692 $1,190.97 $355.34 $238.19 28272................. T.............. ............... Release of toe joint, each...

0055 20.0692 $1,190.97 $355.34 $238.19 28280................. T.............. ............... Fusion of toes...............

0055 20.0692 $1,190.97 $355.34 $238.19 28285................. T.............. ............... Repair of hammertoe..........

0055 20.0692 $1,190.97 $355.34 $238.19 28286................. T.............. ............... Repair of hammertoe..........

0055 20.0692 $1,190.97 $355.34 $238.19 28288................. T.............. ............... Partial removal of foot bone.

0055 20.0692 $1,190.97 $355.34 $238.19 28289................. T.............. ............... Repair hallux rigidus........

0055 20.0692 $1,190.97 $355.34 $238.19 28290................. T.............. ............... Correction of bunion.........

0057 27.5493 $1,634.86 $475.91 $326.97 28292................. T.............. ............... Correction of bunion.........

0057 27.5493 $1,634.86 $475.91 $326.97 28293................. T.............. ............... Correction of bunion.........

0057 27.5493 $1,634.86 $475.91 $326.97 28294................. T.............. ............... Correction of bunion.........

0057 27.5493 $1,634.86 $475.91 $326.97 28296................. T.............. ............... Correction of bunion.........

0057 27.5493 $1,634.86 $475.91 $326.97 28297................. T.............. ............... Correction of bunion.........

0057 27.5493 $1,634.86 $475.91 $326.97 28298................. T.............. ............... Correction of bunion.........

0057 27.5493 $1,634.86 $475.91 $326.97 28299................. T.............. ............... Correction of bunion.........

0057 27.5493 $1,634.86 $475.91 $326.97 28300................. T.............. ............... Incision of heel bone........

0056 40.2957 $2,391.27 ........... $478.25 28302................. T.............. ............... Incision of ankle bone.......

0055 20.0692 $1,190.97 $355.34 $238.19 28304................. T.............. ............... Incision of midfoot bones....

0056 40.2957 $2,391.27 ........... $478.25 28305................. T.............. ............... Incise/graft midfoot bones...

0056 40.2957 $2,391.27 ........... $478.25 28306................. T.............. ............... Incision of metatarsal.......

0055 20.0692 $1,190.97 $355.34 $238.19 28307................. T.............. ............... Incision of metatarsal.......

0055 20.0692 $1,190.97 $355.34 $238.19 28308................. T.............. ............... Incision of metatarsal.......

0055 20.0692 $1,190.97 $355.34 $238.19 28309................. T.............. ............... Incision of metatarsals......

0056 40.2957 $2,391.27 ........... $478.25 28310................. T.............. ............... Revision of big toe..........

0055 20.0692 $1,190.97 $355.34 $238.19 28312................. T.............. ............... Revision of toe..............

0055 20.0692 $1,190.97 $355.34 $238.19 28313................. T.............. ............... Repair deformity of toe......

0055 20.0692 $1,190.97 $355.34 $238.19 28315................. T.............. ............... Removal of sesamoid bone.....

0055 20.0692 $1,190.97 $355.34 $238.19 28320................. T.............. ............... Repair of foot bones.........

0056 40.2957 $2,391.27 ........... $478.25 28322................. T.............. ............... Repair of metatarsals........

0056 40.2957 $2,391.27 ........... $478.25 28340................. T.............. ............... Resect enlarged toe tissue...

0055 20.0692 $1,190.97 $355.34 $238.19 28341................. T.............. ............... Resect enlarged toe..........

0055 20.0692 $1,190.97 $355.34 $238.19 28344................. T.............. ............... Repair extra toe(s)..........

0055 20.0692 $1,190.97 $355.34 $238.19 28345................. T.............. ............... Repair webbed toe(s).........

0055 20.0692 $1,190.97 $355.34 $238.19 28360................. T.............. ............... Reconstruct cleft foot.......

0056 40.2957 $2,391.27 ........... $478.25 28400................. T.............. ............... Treatment of heel fracture...

0043 1.7694 $105.00 ........... $21.00 28405................. T.............. ............... Treatment of heel fracture...

0043 1.7694 $105.00 ........... $21.00 28406................. T.............. ............... Treatment of heel fracture...

0046 37.7023 $2,237.37 $535.76 $447.47 28415................. T.............. ............... Treat heel fracture..........

0046 37.7023 $2,237.37 $535.76 $447.47 28420................. T.............. ............... Treat/graft heel fracture....

0046 37.7023 $2,237.37 $535.76 $447.47 28430................. T.............. ............... Treatment of ankle fracture..

0043 1.7694 $105.00 ........... $21.00 28435................. T.............. ............... Treatment of ankle fracture..

0043 1.7694 $105.00 ........... $21.00 28436................. T.............. ............... Treatment of ankle fracture..

0046 37.7023 $2,237.37 $535.76 $447.47 28445................. T.............. ............... Treat ankle fracture.........

0046 37.7023 $2,237.37 $535.76 $447.47 28450................. T.............. ............... Treat midfoot fracture, each.

0043 1.7694 $105.00 ........... $21.00 28455................. T.............. ............... Treat midfoot fracture, each.

0043 1.7694 $105.00 ........... $21.00 28456................. T.............. ............... Treat midfoot fracture.......

0046 37.7023 $2,237.37 $535.76 $447.47 28465................. T.............. ............... Treat midfoot fracture, each.

0046 37.7023 $2,237.37 $535.76 $447.47 28470................. T.............. ............... Treat metatarsal fracture....

0043 1.7694 $105.00 ........... $21.00 28475................. T.............. ............... Treat metatarsal fracture....

0043 1.7694 $105.00 ........... $21.00 28476................. T.............. ............... Treat metatarsal fracture....

0046 37.7023 $2,237.37 $535.76 $447.47

[[Page 50728]]

28485................. T.............. ............... Treat metatarsal fracture....

0046 37.7023 $2,237.37 $535.76 $447.47 28490................. T.............. ............... Treat big toe fracture.......

0043 1.7694 $105.00 ........... $21.00 28495................. T.............. ............... Treat big toe fracture.......

0043 1.7694 $105.00 ........... $21.00 28496................. T.............. ............... Treat big toe fracture.......

0046 37.7023 $2,237.37 $535.76 $447.47 28505................. T.............. ............... Treat big toe fracture.......

0046 37.7023 $2,237.37 $535.76 $447.47 28510................. T.............. ............... Treatment of toe fracture....

0043 1.7694 $105.00 ........... $21.00 28515................. T.............. ............... Treatment of toe fracture....

0043 1.7694 $105.00 ........... $21.00 28525................. T.............. ............... Treat toe fracture...........

0046 37.7023 $2,237.37 $535.76 $447.47 28530................. T.............. ............... Treat sesamoid bone fracture.

0043 1.7694 $105.00 ........... $21.00 28531................. T.............. ............... Treat sesamoid bone fracture.

0046 37.7023 $2,237.37 $535.76 $447.47 28540................. T.............. ............... Treat foot dislocation.......

0043 1.7694 $105.00 ........... $21.00 28545................. T.............. ............... Treat foot dislocation.......

0045 14.4945 $860.15 $268.47 $172.03 28546................. T.............. ............... Treat foot dislocation.......

0046 37.7023 $2,237.37 $535.76 $447.47 28555................. T.............. ............... Repair foot dislocation......

0046 37.7023 $2,237.37 $535.76 $447.47 28570................. T.............. ............... Treat foot dislocation.......

0043 1.7694 $105.00 ........... $21.00 28575................. T.............. ............... Treat foot dislocation.......

0043 1.7694 $105.00 ........... $21.00 28576................. T.............. ............... Treat foot dislocation.......

0046 37.7023 $2,237.37 $535.76 $447.47 28585................. T.............. ............... Repair foot dislocation......

0046 37.7023 $2,237.37 $535.76 $447.47 28600................. T.............. ............... Treat foot dislocation.......

0043 1.7694 $105.00 ........... $21.00 28605................. T.............. ............... Treat foot dislocation.......

0043 1.7694 $105.00 ........... $21.00 28606................. T.............. ............... Treat foot dislocation.......

0046 37.7023 $2,237.37 $535.76 $447.47 28615................. T.............. ............... Repair foot dislocation......

0046 37.7023 $2,237.37 $535.76 $447.47 28630................. T.............. ............... Treat toe dislocation........

0043 1.7694 $105.00 ........... $21.00 28635................. T.............. ............... Treat toe dislocation........

0045 14.4945 $860.15 $268.47 $172.03 28636................. T.............. ............... Treat toe dislocation........

0046 37.7023 $2,237.37 $535.76 $447.47 28645................. T.............. ............... Repair toe dislocation.......

0046 37.7023 $2,237.37 $535.76 $447.47 28660................. T.............. ............... Treat toe dislocation........

0043 1.7694 $105.00 ........... $21.00 28665................. T.............. ............... Treat toe dislocation........

0045 14.4945 $860.15 $268.47 $172.03 28666................. T.............. ............... Treat toe dislocation........

0046 37.7023 $2,237.37 $535.76 $447.47 28675................. T.............. ............... Repair of toe dislocation....

0046 37.7023 $2,237.37 $535.76 $447.47 28705................. T.............. ............... Fusion of foot bones.........

0056 40.2957 $2,391.27 ........... $478.25 28715................. T.............. ............... Fusion of foot bones.........

0056 40.2957 $2,391.27 ........... $478.25 28725................. T.............. ............... Fusion of foot bones.........

0056 40.2957 $2,391.27 ........... $478.25 28730................. T.............. ............... Fusion of foot bones.........

0056 40.2957 $2,391.27 ........... $478.25 28735................. T.............. ............... Fusion of foot bones.........

0056 40.2957 $2,391.27 ........... $478.25 28737................. T.............. ............... Revision of foot bones.......

0056 40.2957 $2,391.27 ........... $478.25 28740................. T.............. ............... Fusion of foot bones.........

0056 40.2957 $2,391.27 ........... $478.25 28750................. T.............. ............... Fusion of big toe joint......

0056 40.2957 $2,391.27 ........... $478.25 28755................. T.............. ............... Fusion of big toe joint......

0055 20.0692 $1,190.97 $355.34 $238.19 28760................. T.............. ............... Fusion of big toe joint......

0056 40.2957 $2,391.27 ........... $478.25 28800................. C.............. ............... Amputation of midfoot........ ........... ........... ........... ........... ........... 28805................. C.............. ............... Amputation thru metatarsal... ........... ........... ........... ........... ........... 28810................. T.............. ............... Amputation toe & metatarsal..

0055 20.0692 $1,190.97 $355.34 $238.19 28820................. T.............. ............... Amputation of toe............

0055 20.0692 $1,190.97 $355.34 $238.19 28825................. T.............. ............... Partial amputation of toe....

0055 20.0692 $1,190.97 $355.34 $238.19 28899................. T.............. ............... Foot/toes surgery procedure..

0043 1.7694 $105.00 ........... $21.00 29000................. S.............. ............... Application of body cast.....

0058 1.0934 $64.89 ........... $12.98 29010................. S.............. ............... Application of body cast.....

0426 2.1243 $126.06 ........... $25.21 29015................. S.............. ............... Application of body cast.....

0426 2.1243 $126.06 ........... $25.21 29020................. S.............. ............... Application of body cast.....

0058 1.0934 $64.89 ........... $12.98 29025................. S.............. ............... Application of body cast.....

0058 1.0934 $64.89 ........... $12.98 29035................. S.............. ............... Application of body cast.....

0426 2.1243 $126.06 ........... $25.21 29040................. S.............. ............... Application of body cast.....

0058 1.0934 $64.89 ........... $12.98 29044................. S.............. ............... Application of body cast.....

0426 2.1243 $126.06 ........... $25.21 29046................. S.............. ............... Application of body cast.....

0426 2.1243 $126.06 ........... $25.21 29049................. S.............. ............... Application of figure eight..

0058 1.0934 $64.89 ........... $12.98 29055................. S.............. ............... Application of shoulder cast.

0426 2.1243 $126.06 ........... $25.21 29058................. S.............. ............... Application of shoulder cast.

0058 1.0934 $64.89 ........... $12.98 29065................. S.............. ............... Application of long arm cast.

0426 2.1243 $126.06 ........... $25.21 29075................. S.............. ............... Application of forearm cast..

0426 2.1243 $126.06 ........... $25.21 29085................. S.............. ............... Apply hand/wrist cast........

0058 1.0934 $64.89 ........... $12.98 29086................. S.............. ............... Apply finger cast............

0058 1.0934 $64.89 ........... $12.98 29105................. S.............. ............... Apply long arm splint........

0058 1.0934 $64.89 ........... $12.98 29125................. S.............. ............... Apply forearm splint.........

0058 1.0934 $64.89 ........... $12.98 29126................. S.............. ............... Apply forearm splint.........

0058 1.0934 $64.89 ........... $12.98 29130................. S.............. ............... Application of finger splint.

0058 1.0934 $64.89 ........... $12.98

[[Continued on page 50729]]

From the Federal Register Online via GPO Access [wais.access.gpo.gov] ]

[[pp. 50729-50778]] Medicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates; Correction

[[Continued from page 50728]]

[[Page 50729]]

29131................. S.............. ............... Application of finger splint.

0058 1.0934 $64.89 ........... $12.98 29200................. S.............. ............... Strapping of chest...........

0058 1.0934 $64.89 ........... $12.98 29220................. S.............. ............... Strapping of low back........

0058 1.0934 $64.89 ........... $12.98 29240................. S.............. ............... Strapping of shoulder........

0058 1.0934 $64.89 ........... $12.98 29260................. S.............. ............... Strapping of elbow or wrist..

0058 1.0934 $64.89 ........... $12.98 29280................. S.............. ............... Strapping of hand or finger..

0058 1.0934 $64.89 ........... $12.98 29305................. S.............. ............... Application of hip cast......

0426 2.1243 $126.06 ........... $25.21 29325................. S.............. ............... Application of hip casts.....

0426 2.1243 $126.06 ........... $25.21 29345................. S.............. ............... Application of long leg cast.

0426 2.1243 $126.06 ........... $25.21 29355................. S.............. ............... Application of long leg cast.

0426 2.1243 $126.06 ........... $25.21 29358................. S.............. ............... Apply long leg cast brace....

0426 2.1243 $126.06 ........... $25.21 29365................. S.............. ............... Application of long leg cast.

0426 2.1243 $126.06 ........... $25.21 29405................. S.............. ............... Apply short leg cast.........

0426 2.1243 $126.06 ........... $25.21 29425................. S.............. ............... Apply short leg cast.........

0426 2.1243 $126.06 ........... $25.21 29435................. S.............. ............... Apply short leg cast.........

0426 2.1243 $126.06 ........... $25.21 29440................. S.............. ............... Addition of walker to cast...

0058 1.0934 $64.89 ........... $12.98 29445................. S.............. ............... Apply rigid leg cast.........

0426 2.1243 $126.06 ........... $25.21 29450................. S.............. ............... Application of leg cast......

0058 1.0934 $64.89 ........... $12.98 29505................. S.............. ............... Application, long leg splint.

0058 1.0934 $64.89 ........... $12.98 29515................. S.............. ............... Application lower leg splint.

0058 1.0934 $64.89 ........... $12.98 29520................. S.............. ............... Strapping of hip.............

0058 1.0934 $64.89 ........... $12.98 29530................. S.............. ............... Strapping of knee............

0058 1.0934 $64.89 ........... $12.98 29540................. S.............. ............... Strapping of ankle...........

0058 1.0934 $64.89 ........... $12.98 29550................. S.............. ............... Strapping of toes............

0058 1.0934 $64.89 ........... $12.98 29580................. S.............. ............... Application of paste boot....

0058 1.0934 $64.89 ........... $12.98 29590................. S.............. ............... Application of foot splint...

0058 1.0934 $64.89 ........... $12.98 29700................. S.............. ............... Removal/revision of cast.....

0058 1.0934 $64.89 ........... $12.98 29705................. S.............. ............... Removal/revision of cast.....

0058 1.0934 $64.89 ........... $12.98 29710................. S.............. ............... Removal/revision of cast.....

0426 2.1243 $126.06 ........... $25.21 29715................. S.............. ............... Removal/revision of cast.....

0058 1.0934 $64.89 ........... $12.98 29720................. S.............. ............... Repair of body cast..........

0058 1.0934 $64.89 ........... $12.98 29730................. S.............. ............... Windowing of cast............

0058 1.0934 $64.89 ........... $12.98 29740................. S.............. ............... Wedging of cast..............

0058 1.0934 $64.89 ........... $12.98 29750................. S.............. ............... Wedging of clubfoot cast.....

0058 1.0934 $64.89 ........... $12.98 29799................. S.............. ............... Casting/strapping procedure..

0058 1.0934 $64.89 ........... $12.98 29800................. T.............. ............... Jaw arthroscopy/surgery......

0041 28.1318 $1,669.43 ........... $333.89 29804................. T.............. ............... Jaw arthroscopy/surgery......

0041 28.1318 $1,669.43 ........... $333.89 29805................. T.............. ............... Shoulder arthroscopy, dx.....

0041 28.1318 $1,669.43 ........... $333.89 29806................. T.............. ............... Shoulder arthroscopy/surgery.

0042 43.9753 $2,609.63 $804.74 $521.93 29807................. T.............. ............... Shoulder arthroscopy/surgery.

0042 43.9753 $2,609.63 $804.74 $521.93 29819................. T.............. ............... Shoulder arthroscopy/surgery.

0041 28.1318 $1,669.43 ........... $333.89 29820................. T.............. ............... Shoulder arthroscopy/surgery.

0041 28.1318 $1,669.43 ........... $333.89 29821................. T.............. ............... Shoulder arthroscopy/surgery.

0041 28.1318 $1,669.43 ........... $333.89 29822................. T.............. ............... Shoulder arthroscopy/surgery.

0041 28.1318 $1,669.43 ........... $333.89 29823................. T.............. ............... Shoulder arthroscopy/surgery.

0041 28.1318 $1,669.43 ........... $333.89 29824................. T.............. ............... Shoulder arthroscopy/surgery.

0041 28.1318 $1,669.43 ........... $333.89 29825................. T.............. ............... Shoulder arthroscopy/surgery.

0041 28.1318 $1,669.43 ........... $333.89 29826................. T.............. ............... Shoulder arthroscopy/surgery.

0042 43.9753 $2,609.63 $804.74 $521.93 29827................. T.............. ............... Arthroscop rotator cuff repr.

0042 43.9753 $2,609.63 $804.74 $521.93 29830................. T.............. ............... Elbow arthroscopy............

0041 28.1318 $1,669.43 ........... $333.89 29834................. T.............. ............... Elbow arthroscopy/surgery....

0041 28.1318 $1,669.43 ........... $333.89 29835................. T.............. ............... Elbow arthroscopy/surgery....

0041 28.1318 $1,669.43 ........... $333.89 29836................. T.............. ............... Elbow arthroscopy/surgery....

0041 28.1318 $1,669.43 ........... $333.89 29837................. T.............. ............... Elbow arthroscopy/surgery....

0041 28.1318 $1,669.43 ........... $333.89 29838................. T.............. ............... Elbow arthroscopy/surgery....

0041 28.1318 $1,669.43 ........... $333.89 29840................. T.............. ............... Wrist arthroscopy............

0041 28.1318 $1,669.43 ........... $333.89 29843................. T.............. ............... Wrist arthroscopy/surgery....

0041 28.1318 $1,669.43 ........... $333.89 29844................. T.............. ............... Wrist arthroscopy/surgery....

0041 28.1318 $1,669.43 ........... $333.89 29845................. T.............. ............... Wrist arthroscopy/surgery....

0041 28.1318 $1,669.43 ........... $333.89 29846................. T.............. ............... Wrist arthroscopy/surgery....

0041 28.1318 $1,669.43 ........... $333.89 29847................. T.............. ............... Wrist arthroscopy/surgery....

0041 28.1318 $1,669.43 ........... $333.89 29848................. T.............. ............... Wrist endoscopy/surgery......

0041 28.1318 $1,669.43 ........... $333.89 29850................. T.............. ............... Knee arthroscopy/surgery.....

0041 28.1318 $1,669.43 ........... $333.89 29851................. T.............. ............... Knee arthroscopy/surgery.....

0042 43.9753 $2,609.63 $804.74 $521.93 29855................. T.............. ............... Tibial arthroscopy/surgery...

0042 43.9753 $2,609.63 $804.74 $521.93 29856................. T.............. ............... Tibial arthroscopy/surgery...

0041 28.1318 $1,669.43 ........... $333.89

[[Page 50730]]

29860................. T.............. ............... Hip arthroscopy, dx..........

0041 28.1318 $1,669.43 ........... $333.89 29861................. T.............. ............... Hip arthroscopy/surgery......

0041 28.1318 $1,669.43 ........... $333.89 29862................. T.............. ............... Hip arthroscopy/surgery......

0042 43.9753 $2,609.63 $804.74 $521.93 29863................. T.............. ............... Hip arthroscopy/surgery......

0042 43.9753 $2,609.63 $804.74 $521.93 29866................. T.............. ............... Autgrft implnt, knee w/scope.

0042 43.9753 $2,609.63 $804.74 $521.93 29867................. T.............. ............... Allgrft implnt, knee w/scope.

0042 43.9753 $2,609.63 $804.74 $521.93 29868................. T.............. ............... Meniscal trnspl, knee w/scpe.

0042 43.9753 $2,609.63 $804.74 $521.93 29870................. T.............. ............... Knee arthroscopy, dx.........

0041 28.1318 $1,669.43 ........... $333.89 29871................. T.............. ............... Knee arthroscopy/drainage....

0041 28.1318 $1,669.43 ........... $333.89 29873................. T.............. ............... Knee arthroscopy/surgery.....

0041 28.1318 $1,669.43 ........... $333.89 29874................. T.............. ............... Knee arthroscopy/surgery.....

0041 28.1318 $1,669.43 ........... $333.89 29875................. T.............. ............... Knee arthroscopy/surgery.....

0041 28.1318 $1,669.43 ........... $333.89 29876................. T.............. ............... Knee arthroscopy/surgery.....

0041 28.1318 $1,669.43 ........... $333.89 29877................. T.............. ............... Knee arthroscopy/surgery.....

0041 28.1318 $1,669.43 ........... $333.89 29879................. T.............. ............... Knee arthroscopy/surgery.....

0041 28.1318 $1,669.43 ........... $333.89 29880................. T.............. ............... Knee arthroscopy/surgery.....

0041 28.1318 $1,669.43 ........... $333.89 29881................. T.............. ............... Knee arthroscopy/surgery.....

0041 28.1318 $1,669.43 ........... $333.89 29882................. T.............. ............... Knee arthroscopy/surgery.....

0041 28.1318 $1,669.43 ........... $333.89 29883................. T.............. ............... Knee arthroscopy/surgery.....

0041 28.1318 $1,669.43 ........... $333.89 29884................. T.............. ............... Knee arthroscopy/surgery.....

0041 28.1318 $1,669.43 ........... $333.89 29885................. T.............. ............... Knee arthroscopy/surgery.....

0042 43.9753 $2,609.63 $804.74 $521.93 29886................. T.............. ............... Knee arthroscopy/surgery.....

0041 28.1318 $1,669.43 ........... $333.89 29887................. T.............. ............... Knee arthroscopy/surgery.....

0041 28.1318 $1,669.43 ........... $333.89 29888................. T.............. ............... Knee arthroscopy/surgery.....

0042 43.9753 $2,609.63 $804.74 $521.93 29889................. T.............. ............... Knee arthroscopy/surgery.....

0042 43.9753 $2,609.63 $804.74 $521.93 29891................. T.............. ............... Ankle arthroscopy/surgery....

0041 28.1318 $1,669.43 ........... $333.89 29892................. T.............. ............... Ankle arthroscopy/surgery....

0041 28.1318 $1,669.43 ........... $333.89 29893................. T.............. ............... Scope, plantar fasciotomy....

0055 20.0692 $1,190.97 $355.34 $238.19 29894................. T.............. ............... Ankle arthroscopy/surgery....

0041 28.1318 $1,669.43 ........... $333.89 29895................. T.............. ............... Ankle arthroscopy/surgery....

0041 28.1318 $1,669.43 ........... $333.89 29897................. T.............. ............... Ankle arthroscopy/surgery....

0041 28.1318 $1,669.43 ........... $333.89 29898................. T.............. ............... Ankle arthroscopy/surgery....

0041 28.1318 $1,669.43 ........... $333.89 29899................. T.............. ............... Ankle arthroscopy/surgery....

0042 43.9753 $2,609.63 $804.74 $521.93 29900................. T.............. ............... Mcp joint arthroscopy, dx....

0053 15.6795 $930.47 $253.49 $186.09 29901................. T.............. ............... Mcp joint arthroscopy, surg..

0053 15.6795 $930.47 $253.49 $186.09 29902................. T.............. ............... Mcp joint arthroscopy, surg..

0053 15.6795 $930.47 $253.49 $186.09 29999................. T.............. ............... Arthroscopy of joint.........

0041 28.1318 $1,669.43 ........... $333.89 30000................. T.............. ............... Drainage of nose lesion......

0251 2.0101 $119.29 ........... $23.86 30020................. T.............. ............... Drainage of nose lesion......

0251 2.0101 $119.29 ........... $23.86 30100................. T.............. ............... Intranasal biopsy............

0252 7.8673 $466.87 $113.41 $93.37 30110................. T.............. ............... Removal of nose polyp(s).....

0253 16.1357 $957.54 $282.29 $191.51 30115................. T.............. ............... Removal of nose polyp(s).....

0253 16.1357 $957.54 $282.29 $191.51 30117................. T.............. ............... Removal of intranasal lesion.

0253 16.1357 $957.54 $282.29 $191.51 30118................. T.............. ............... Removal of intranasal lesion.

0254 23.404 $1,388.86 $321.35 $277.77 30120................. T.............. ............... Revision of nose.............

0253 16.1357 $957.54 $282.29 $191.51 30124................. T.............. ............... Removal of nose lesion.......

0252 7.8673 $466.87 $113.41 $93.37 30125................. T.............. ............... Removal of nose lesion.......

0256 37.3204 $2,214.70 ........... $442.94 30130................. T.............. ............... Removal of turbinate bones...

0253 16.1357 $957.54 $282.29 $191.51 30140................. T.............. ............... Removal of turbinate bones...

0254 23.404 $1,388.86 $321.35 $277.77 30150................. T.............. ............... Partial removal of nose......

0256 37.3204 $2,214.70 ........... $442.94 30160................. T.............. ............... Removal of nose..............

0256 37.3204 $2,214.70 ........... $442.94 30200................. T.............. ............... Injection treatment of nose..

0252 7.8673 $466.87 $113.41 $93.37 30210................. T.............. ............... Nasal sinus therapy..........

0252 7.8673 $466.87 $113.41 $93.37 30220................. T.............. ............... Insert nasal septal button...

0252 7.8673 $466.87 $113.41 $93.37 30300................. X.............. ............... Remove nasal foreign body....

0340 0.6384 $37.88 ...........

$7.58 30310................. T.............. ............... Remove nasal foreign body....

0253 16.1357 $957.54 $282.29 $191.51 30320................. T.............. ............... Remove nasal foreign body....

0253 16.1357 $957.54 $282.29 $191.51 30400................. T.............. ............... Reconstruction of nose.......

0256 37.3204 $2,214.70 ........... $442.94 30410................. T.............. ............... Reconstruction of nose.......

0256 37.3204 $2,214.70 ........... $442.94 30420................. T.............. ............... Reconstruction of nose.......

0256 37.3204 $2,214.70 ........... $442.94 30430................. T.............. ............... Revision of nose.............

0254 23.404 $1,388.86 $321.35 $277.77 30435................. T.............. ............... Revision of nose.............

0256 37.3204 $2,214.70 ........... $442.94 30450................. T.............. ............... Revision of nose.............

0256 37.3204 $2,214.70 ........... $442.94 30460................. T.............. ............... Revision of nose.............

0256 37.3204 $2,214.70 ........... $442.94 30462................. T.............. ............... Revision of nose.............

0256 37.3204 $2,214.70 ........... $442.94 30465................. T.............. ............... Repair nasal stenosis........

0256 37.3204 $2,214.70 ........... $442.94

[[Page 50731]]

30520................. T.............. ............... Repair of nasal septum.......

0254 23.404 $1,388.86 $321.35 $277.77 30540................. T.............. ............... Repair nasal defect..........

0256 37.3204 $2,214.70 ........... $442.94 30545................. T.............. ............... Repair nasal defect..........

0256 37.3204 $2,214.70 ........... $442.94 30560................. T.............. ............... Release of nasal adhesions...

0251 2.0101 $119.29 ........... $23.86 30580................. T.............. ............... Repair upper jaw fistula.....

0256 37.3204 $2,214.70 ........... $442.94 30600................. T.............. ............... Repair mouth/nose fistula....

0256 37.3204 $2,214.70 ........... $442.94 30620................. T.............. ............... Intranasal reconstruction....

0256 37.3204 $2,214.70 ........... $442.94 30630................. T.............. ............... Repair nasal septum defect...

0254 23.404 $1,388.86 $321.35 $277.77 30801................. T.............. ............... Cauterization, inner nose....

0252 7.8673 $466.87 $113.41 $93.37 30802................. T.............. ............... Cauterization, inner nose....

0252 7.8673 $466.87 $113.41 $93.37 30901................. T.............. ............... Control of nosebleed.........

0250 1.2896 $76.53 $26.79 $15.31 30903................. T.............. ............... Control of nosebleed.........

0250 1.2896 $76.53 $26.79 $15.31 30905................. T.............. ............... Control of nosebleed.........

0250 1.2896 $76.53 $26.79 $15.31 30906................. T.............. ............... Repeat control of nosebleed..

0250 1.2896 $76.53 $26.79 $15.31 30915................. T.............. ............... Ligation, nasal sinus artery.

0091 28.9999 $1,720.94 $348.23 $344.19 30920................. T.............. ............... Ligation, upper jaw artery...

0092 26.482 $1,571.52 $505.37 $314.30 30930................. T.............. ............... Therapy, fracture of nose....

0253 16.1357 $957.54 $282.29 $191.51 30999................. T.............. ............... Nasal surgery procedure......

0251 2.0101 $119.29 ........... $23.86 31000................. T.............. ............... Irrigation, maxillary sinus..

0251 2.0101 $119.29 ........... $23.86 31002................. T.............. ............... Irrigation, sphenoid sinus...

0252 7.8673 $466.87 $113.41 $93.37 31020................. T.............. ............... Exploration, maxillary sinus.

0254 23.404 $1,388.86 $321.35 $277.77 31030................. T.............. ............... Exploration, maxillary sinus.

0256 37.3204 $2,214.70 ........... $442.94 31032................. T.............. ............... Explore sinus, remove polyps.

0256 37.3204 $2,214.70 ........... $442.94 31040................. T.............. ............... Exploration behind upper jaw.

0254 23.404 $1,388.86 $321.35 $277.77 31050................. T.............. ............... Exploration, sphenoid sinus..

0256 37.3204 $2,214.70 ........... $442.94 31051................. T.............. ............... Sphenoid sinus surgery.......

0256 37.3204 $2,214.70 ........... $442.94 31070................. T.............. ............... Exploration of frontal sinus.

0254 23.404 $1,388.86 $321.35 $277.77 31075................. T.............. ............... Exploration of frontal sinus.

0256 37.3204 $2,214.70 ........... $442.94 31080................. T.............. ............... Removal of frontal sinus.....

0256 37.3204 $2,214.70 ........... $442.94 31081................. T.............. ............... Removal of frontal sinus.....

0256 37.3204 $2,214.70 ........... $442.94 31084................. T.............. ............... Removal of frontal sinus.....

0256 37.3204 $2,214.70 ........... $442.94 31085................. T.............. ............... Removal of frontal sinus.....

0256 37.3204 $2,214.70 ........... $442.94 31086................. T.............. ............... Removal of frontal sinus.....

0256 37.3204 $2,214.70 ........... $442.94 31087................. T.............. ............... Removal of frontal sinus.....

0256 37.3204 $2,214.70 ........... $442.94 31090................. T.............. ............... Exploration of sinuses.......

0256 37.3204 $2,214.70 ........... $442.94 31200................. T.............. ............... Removal of ethmoid sinus.....

0256 37.3204 $2,214.70 ........... $442.94 31201................. T.............. ............... Removal of ethmoid sinus.....

0256 37.3204 $2,214.70 ........... $442.94 31205................. T.............. ............... Removal of ethmoid sinus.....

0256 37.3204 $2,214.70 ........... $442.94 31225................. C.............. ............... Removal of upper jaw......... ........... ........... ........... ........... ........... 31230................. C.............. ............... Removal of upper jaw......... ........... ........... ........... ........... ........... 31231................. T.............. ............... Nasal endoscopy, dx..........

0072 1.4361 $85.22 $21.27 $17.04 31233................. T.............. ............... Nasal/sinus endoscopy, dx....

0072 1.4361 $85.22 $21.27 $17.04 31235................. T.............. ............... Nasal/sinus endoscopy, dx....

0074 15.7757 $936.18 $295.70 $187.24 31237................. T.............. ............... Nasal/sinus endoscopy, surg..

0075 21.3426 $1,266.53 $445.92 $253.31 31238................. T.............. ............... Nasal/sinus endoscopy, surg..

0074 15.7757 $936.18 $295.70 $187.24 31239................. T.............. ............... Nasal/sinus endoscopy, surg..

0075 21.3426 $1,266.53 $445.92 $253.31 31240................. T.............. ............... Nasal/sinus endoscopy, surg..

0074 15.7757 $936.18 $295.70 $187.24 31254................. T.............. ............... Revision of ethmoid sinus....

0075 21.3426 $1,266.53 $445.92 $253.31 31255................. T.............. ............... Removal of ethmoid sinus.....

0075 21.3426 $1,266.53 $445.92 $253.31 31256................. T.............. ............... Exploration maxillary sinus..

0075 21.3426 $1,266.53 $445.92 $253.31 31267................. T.............. ............... Endoscopy, maxillary sinus...

0075 21.3426 $1,266.53 $445.92 $253.31 31276................. T.............. ............... Sinus endoscopy, surgical....

0075 21.3426 $1,266.53 $445.92 $253.31 31287................. T.............. ............... Nasal/sinus endoscopy, surg..

0075 21.3426 $1,266.53 $445.92 $253.31 31288................. T.............. ............... Nasal/sinus endoscopy, surg..

0075 21.3426 $1,266.53 $445.92 $253.31 31290................. C.............. ............... Nasal/sinus endoscopy, surg.. ........... ........... ........... ........... ........... 31291................. C.............. ............... Nasal/sinus endoscopy, surg.. ........... ........... ........... ........... ........... 31292................. T.............. ............... Nasal/sinus endoscopy, surg..

0075 21.3426 $1,266.53 $445.92 $253.31 31293................. T.............. ............... Nasal/sinus endoscopy, surg..

0075 21.3426 $1,266.53 $445.92 $253.31 31294................. T.............. ............... Nasal/sinus endoscopy, surg..

0075 21.3426 $1,266.53 $445.92 $253.31 31299................. T.............. ............... Sinus surgery procedure......

0251 2.0101 $119.29 ........... $23.86 31300................. T.............. ............... Removal of larynx lesion.....

0254 23.404 $1,388.86 $321.35 $277.77 31320................. T.............. ............... Diagnostic incision, larynx..

0256 37.3204 $2,214.70 ........... $442.94 31360................. C.............. ............... Removal of larynx............ ........... ........... ........... ........... ........... 31365................. C.............. ............... Removal of larynx............ ........... ........... ........... ........... ........... 31367................. C.............. ............... Partial removal of larynx.... ........... ........... ........... ........... ........... 31368................. C.............. ............... Partial removal of larynx.... ........... ........... ........... ........... ...........

[[Page 50732]]

31370................. C.............. ............... Partial removal of larynx.... ........... ........... ........... ........... ........... 31375................. C.............. ............... Partial removal of larynx.... ........... ........... ........... ........... ........... 31380................. C.............. ............... Partial removal of larynx.... ........... ........... ........... ........... ........... 31382................. C.............. ............... Partial removal of larynx.... ........... ........... ........... ........... ........... 31390................. C.............. ............... Removal of larynx & pharynx.. ........... ........... ........... ........... ........... 31395................. C.............. ............... Reconstruct larynx & pharynx. ........... ........... ........... ........... ........... 31400................. T.............. ............... Revision of larynx...........

0256 37.3204 $2,214.70 ........... $442.94 31420................. T.............. ............... Removal of epiglottis........

0256 37.3204 $2,214.70 ........... $442.94 31500................. S.............. ............... Insert emergency airway......

0094 2.5363 $150.51 $47.62 $30.10 31502................. T.............. ............... Change of windpipe airway....

0121 2.2766 $135.10 $43.80 $27.02 31505................. T.............. ............... Diagnostic laryngoscopy......

0071 0.7915 $46.97 $11.31

$9.39 31510................. T.............. ............... Laryngoscopy with biopsy.....

0074 15.7757 $936.18 $295.70 $187.24 31511................. T.............. ............... Remove foreign body, larynx..

0072 1.4361 $85.22 $21.27 $17.04 31512................. T.............. ............... Removal of larynx lesion.....

0074 15.7757 $936.18 $295.70 $187.24 31513................. T.............. ............... Injection into vocal cord....

0072 1.4361 $85.22 $21.27 $17.04 31515................. T.............. ............... Laryngoscopy for aspiration..

0074 15.7757 $936.18 $295.70 $187.24 31520................. T.............. ............... Diagnostic laryngoscopy......

0072 1.4361 $85.22 $21.27 $17.04 31525................. T.............. ............... Diagnostic laryngoscopy......

0074 15.7757 $936.18 $295.70 $187.24 31526................. T.............. ............... Diagnostic laryngoscopy......

0075 21.3426 $1,266.53 $445.92 $253.31 31527................. T.............. ............... Laryngoscopy for treatment...

0075 21.3426 $1,266.53 $445.92 $253.31 31528................. T.............. ............... Laryngoscopy and dilation....

0074 15.7757 $936.18 $295.70 $187.24 31529................. T.............. ............... Laryngoscopy and dilation....

0074 15.7757 $936.18 $295.70 $187.24 31530................. T.............. ............... Operative laryngoscopy.......

0075 21.3426 $1,266.53 $445.92 $253.31 31531................. T.............. ............... Operative laryngoscopy.......

0075 21.3426 $1,266.53 $445.92 $253.31 31535................. T.............. ............... Operative laryngoscopy.......

0075 21.3426 $1,266.53 $445.92 $253.31 31536................. T.............. ............... Operative laryngoscopy.......

0075 21.3426 $1,266.53 $445.92 $253.31 31540................. T.............. ............... Operative laryngoscopy.......

0075 21.3426 $1,266.53 $445.92 $253.31 31541................. T.............. ............... Operative laryngoscopy.......

0075 21.3426 $1,266.53 $445.92 $253.31 31545................. T.............. ............... Remove vc lesion w/scope.....

0075 21.3426 $1,266.53 $445.92 $253.31 31546................. T.............. ............... Remove vc lesion scope/graft.

0075 21.3426 $1,266.53 $445.92 $253.31 31560................. T.............. ............... Operative laryngoscopy.......

0075 21.3426 $1,266.53 $445.92 $253.31 31561................. T.............. ............... Operative laryngoscopy.......

0075 21.3426 $1,266.53 $445.92 $253.31 31570................. T.............. ............... Laryngoscopy with injection..

0074 15.7757 $936.18 $295.70 $187.24 31571................. T.............. ............... Laryngoscopy with injection..

0075 21.3426 $1,266.53 $445.92 $253.31 31575................. T.............. ............... Diagnostic laryngoscopy......

0072 1.4361 $85.22 $21.27 $17.04 31576................. T.............. ............... Laryngoscopy with biopsy.....

0075 21.3426 $1,266.53 $445.92 $253.31 31577................. T.............. ............... Remove foreign body, larynx..

0073 4.1609 $246.92 $73.38 $49.38 31578................. T.............. ............... Removal of larynx lesion.....

0075 21.3426 $1,266.53 $445.92 $253.31 31579................. T.............. ............... Diagnostic laryngoscopy......

0073 4.1609 $246.92 $73.38 $49.38 31580................. T.............. ............... Revision of larynx...........

0256 37.3204 $2,214.70 ........... $442.94 31582................. T.............. ............... Revision of larynx...........

0256 37.3204 $2,214.70 ........... $442.94 31584................. C.............. ............... Treat larynx fracture........ ........... ........... ........... ........... ........... 31585................. T.............. ............... Treat larynx fracture........

0253 16.1357 $957.54 $282.29 $191.51 31586................. T.............. ............... Treat larynx fracture........

0256 37.3204 $2,214.70 ........... $442.94 31587................. C.............. ............... Revision of larynx........... ........... ........... ........... ........... ........... 31588................. T.............. ............... Revision of larynx...........

0256 37.3204 $2,214.70 ........... $442.94 31590................. T.............. ............... Reinnervate larynx...........

0256 37.3204 $2,214.70 ........... $442.94 31595................. T.............. ............... Larynx nerve surgery.........

0256 37.3204 $2,214.70 ........... $442.94 31599................. T.............. ............... Larynx surgery procedure.....

0251 2.0101 $119.29 ........... $23.86 31600................. T.............. ............... Incision of windpipe.........

0254 23.404 $1,388.86 $321.35 $277.77 31601................. T.............. ............... Incision of windpipe.........

0254 23.404 $1,388.86 $321.35 $277.77 31603................. T.............. ............... Incision of windpipe.........

0252 7.8673 $466.87 $113.41 $93.37 31605................. T.............. ............... Incision of windpipe.........

0252 7.8673 $466.87 $113.41 $93.37 31610................. T.............. ............... Incision of windpipe.........

0254 23.404 $1,388.86 $321.35 $277.77 31611................. T.............. ............... Surgery/speech prosthesis....

0254 23.404 $1,388.86 $321.35 $277.77 31612................. T.............. ............... Puncture/clear windpipe......

0254 23.404 $1,388.86 $321.35 $277.77 31613................. T.............. ............... Repair windpipe opening......

0254 23.404 $1,388.86 $321.35 $277.77 31614................. T.............. ............... Repair windpipe opening......

0256 37.3204 $2,214.70 ........... $442.94 31615................. T.............. ............... Visualization of windpipe....

0076 9.4592 $561.34 $189.82 $112.27 31620................. S.............. ............... Endobronchial us add-on......

0670 25.4131 $1,508.09 $472.46 $301.62 31622................. T.............. ............... Dx bronchoscope/wash.........

0076 9.4592 $561.34 $189.82 $112.27 31623................. T.............. ............... Dx bronchoscope/brush........

0076 9.4592 $561.34 $189.82 $112.27 31624................. T.............. ............... Dx bronchoscope/lavage.......

0076 9.4592 $561.34 $189.82 $112.27 31625................. T.............. ............... Bronchoscopy w/biopsy(s).....

0076 9.4592 $561.34 $189.82 $112.27 31628................. T.............. ............... Bronchoscopy/lung bx, each...

0076 9.4592 $561.34 $189.82 $112.27 31629................. T.............. ............... Bronchoscopy/needle bx, each.

0076 9.4592 $561.34 $189.82 $112.27

[[Page 50733]]

31630................. T.............. ............... Bronchoscopy dilate/fx repr..

0415 22.0955 $1,311.21 $459.92 $262.24 31631................. T.............. ............... Bronchoscopy, dilate w/stent.

0415 22.0955 $1,311.21 $459.92 $262.24 31632................. T.............. ............... Bronchoscopy/lung bx, add'l..

0076 9.4592 $561.34 $189.82 $112.27 31633................. T.............. ............... Bronchoscopy/needle bx add'l.

0076 9.4592 $561.34 $189.82 $112.27 31635................. T.............. ............... Bronchoscopy w/fb removal....

0076 9.4592 $561.34 $189.82 $112.27 31636................. T.............. ............... Bronchoscopy, bronch stents..

0415 22.0955 $1,311.21 $459.92 $262.24 31637................. T.............. ............... Bronchoscopy, stent add-on...

0076 9.4592 $561.34 $189.82 $112.27 31638................. T.............. ............... Bronchoscopy, revise stent...

0415 22.0955 $1,311.21 $459.92 $262.24 31640................. T.............. ............... Bronchoscopy w/tumor excise..

0415 22.0955 $1,311.21 $459.92 $262.24 31641................. T.............. ............... Bronchoscopy, treat blockage.

0415 22.0955 $1,311.21 $459.92 $262.24 31643................. T.............. ............... Diag bronchoscope/catheter...

0076 9.4592 $561.34 $189.82 $112.27 31645................. T.............. ............... Bronchoscopy, clear airways..

0076 9.4592 $561.34 $189.82 $112.27 31646................. T.............. ............... Bronchoscopy, reclear airway.

0076 9.4592 $561.34 $189.82 $112.27 31656................. T.............. ............... Bronchoscopy, inj for x-ray..

0076 9.4592 $561.34 $189.82 $112.27 31700................. T.............. ............... Insertion of airway catheter.

0072 1.4361 $85.22 $21.27 $17.04 31708................. N.............. ............... Instill airway contrast dye.. ........... ........... ........... ........... ........... 31710................. N.............. ............... Insertion of airway catheter. ........... ........... ........... ........... ........... 31715................. N.............. ............... Injection for bronchus x-ray. ........... ........... ........... ........... ........... 31717................. T.............. ............... Bronchial brush biopsy.......

0073 4.1609 $246.92 $73.38 $49.38 31720................. T.............. ............... Clearance of airways.........

0071 0.7915 $46.97 $11.31

$9.39 31725................. C.............. ............... Clearance of airways......... ........... ........... ........... ........... ........... 31730................. T.............. ............... Intro, windpipe wire/tube....

0073 4.1609 $246.92 $73.38 $49.38 31750................. T.............. ............... Repair of windpipe...........

0256 37.3204 $2,214.70 ........... $442.94 31755................. T.............. ............... Repair of windpipe...........

0256 37.3204 $2,214.70 ........... $442.94 31760................. C.............. ............... Repair of windpipe........... ........... ........... ........... ........... ........... 31766................. C.............. ............... Reconstruction of windpipe... ........... ........... ........... ........... ........... 31770................. C.............. ............... Repair/graft of bronchus..... ........... ........... ........... ........... ........... 31775................. C.............. ............... Reconstruct bronchus......... ........... ........... ........... ........... ........... 31780................. C.............. ............... Reconstruct windpipe......... ........... ........... ........... ........... ........... 31781................. C.............. ............... Reconstruct windpipe......... ........... ........... ........... ........... ........... 31785................. T.............. ............... Remove windpipe lesion.......

0254 23.404 $1,388.86 $321.35 $277.77 31786................. C.............. ............... Remove windpipe lesion....... ........... ........... ........... ........... ........... 31800................. C.............. ............... Repair of windpipe injury.... ........... ........... ........... ........... ........... 31805................. C.............. ............... Repair of windpipe injury.... ........... ........... ........... ........... ........... 31820................. T.............. ............... Closure of windpipe lesion...

0253 16.1357 $957.54 $282.29 $191.51 31825................. T.............. ............... Repair of windpipe defect....

0254 23.404 $1,388.86 $321.35 $277.77 31830................. T.............. ............... Revise windpipe scar.........

0254 23.404 $1,388.86 $321.35 $277.77 31899................. T.............. ............... Airways surgical procedure...

0076 9.4592 $561.34 $189.82 $112.27 32000................. T.............. ............... Drainage of chest............

0070 3.2101 $190.50 ........... $38.10 32002................. T.............. ............... Treatment of collapsed lung..

0070 3.2101 $190.50 ........... $38.10 32005................. T.............. ............... Treat lung lining chemically.

0070 3.2101 $190.50 ........... $38.10 32019................. T.............. ............... Insert pleural catheter......

0070 3.2101 $190.50 ........... $38.10 32020................. T.............. ............... Insertion of chest tube......

0070 3.2101 $190.50 ........... $38.10 32035................. C.............. ............... Exploration of chest......... ........... ........... ........... ........... ........... 32036................. C.............. ............... Exploration of chest......... ........... ........... ........... ........... ........... 32095................. C.............. ............... Biopsy through chest wall.... ........... ........... ........... ........... ........... 32100................. C.............. ............... Exploration/biopsy of chest.. ........... ........... ........... ........... ........... 32110................. C.............. ............... Explore/repair chest......... ........... ........... ........... ........... ........... 32120................. C.............. ............... Re-exploration of chest...... ........... ........... ........... ........... ........... 32124................. C.............. ............... Explore chest free adhesions. ........... ........... ........... ........... ........... 32140................. C.............. ............... Removal of lung lesion(s).... ........... ........... ........... ........... ........... 32141................. C.............. ............... Remove/treat lung lesions.... ........... ........... ........... ........... ........... 32150................. C.............. ............... Removal of lung lesion(s).... ........... ........... ........... ........... ........... 32151................. C.............. ............... Remove lung foreign body..... ........... ........... ........... ........... ........... 32160................. C.............. ............... Open chest heart massage..... ........... ........... ........... ........... ........... 32200................. C.............. ............... Drain, open, lung lesion..... ........... ........... ........... ........... ........... 32201................. T.............. ............... Drain, percut, lung lesion...

0070 3.2101 $190.50 ........... $38.10 32215................. C.............. ............... Treat chest lining........... ........... ........... ........... ........... ........... 32220................. C.............. ............... Release of lung.............. ........... ........... ........... ........... ........... 32225................. C.............. ............... Partial release of lung...... ........... ........... ........... ........... ........... 32310................. C.............. ............... Removal of chest lining...... ........... ........... ........... ........... ........... 32320................. C.............. ............... Free/remove chest lining..... ........... ........... ........... ........... ........... 32400................. T.............. ............... Needle biopsy chest lining...

0685 6.0174 $357.09 $115.47 $71.42 32402................. C.............. ............... Open biopsy chest lining..... ........... ........... ........... ........... ........... 32405................. T.............. ............... Biopsy, lung or mediastinum..

0685 6.0174 $357.09 $115.47 $71.42 32420................. T.............. ............... Puncture/clear lung..........

0070 3.2101 $190.50 ........... $38.10

[[Page 50734]]

32440................. C.............. ............... Removal of lung.............. ........... ........... ........... ........... ........... 32442................. C.............. ............... Sleeve pneumonectomy......... ........... ........... ........... ........... ........... 32445................. C.............. ............... Removal of lung.............. ........... ........... ........... ........... ........... 32480................. C.............. ............... Partial removal of lung...... ........... ........... ........... ........... ........... 32482................. C.............. ............... Bilobectomy.................. ........... ........... ........... ........... ........... 32484................. C.............. ............... Segmentectomy................ ........... ........... ........... ........... ........... 32486................. C.............. ............... Sleeve lobectomy............. ........... ........... ........... ........... ........... 32488................. C.............. ............... Completion pneumonectomy..... ........... ........... ........... ........... ........... 32491................. C.............. ............... Lung volume reduction........ ........... ........... ........... ........... ........... 32500................. C.............. ............... Partial removal of lung...... ........... ........... ........... ........... ........... 32501................. C.............. ............... Repair bronchus add-on....... ........... ........... ........... ........... ........... 32520................. C.............. ............... Remove lung & revise chest... ........... ........... ........... ........... ........... 32522................. C.............. ............... Remove lung & revise chest... ........... ........... ........... ........... ........... 32525................. C.............. ............... Remove lung & revise chest... ........... ........... ........... ........... ........... 32540................. C.............. ............... Removal of lung lesion....... ........... ........... ........... ........... ........... 32601................. T.............. ............... Thoracoscopy, diagnostic.....

0069 30.6775 $1,820.49 $591.64 $364.10 32602................. T.............. ............... Thoracoscopy, diagnostic.....

0069 30.6775 $1,820.49 $591.64 $364.10 32603................. T.............. ............... Thoracoscopy, diagnostic.....

0069 30.6775 $1,820.49 $591.64 $364.10 32604................. T.............. ............... Thoracoscopy, diagnostic.....

0069 30.6775 $1,820.49 $591.64 $364.10 32605................. T.............. ............... Thoracoscopy, diagnostic.....

0069 30.6775 $1,820.49 $591.64 $364.10 32606................. T.............. ............... Thoracoscopy, diagnostic.....

0069 30.6775 $1,820.49 $591.64 $364.10 32650................. C.............. ............... Thoracoscopy, surgical....... ........... ........... ........... ........... ........... 32651................. C.............. ............... Thoracoscopy, surgical....... ........... ........... ........... ........... ........... 32652................. C.............. ............... Thoracoscopy, surgical....... ........... ........... ........... ........... ........... 32653................. C.............. ............... Thoracoscopy, surgical....... ........... ........... ........... ........... ........... 32654................. C.............. ............... Thoracoscopy, surgical....... ........... ........... ........... ........... ........... 32655................. C.............. ............... Thoracoscopy, surgical....... ........... ........... ........... ........... ........... 32656................. C.............. ............... Thoracoscopy, surgical....... ........... ........... ........... ........... ........... 32657................. C.............. ............... Thoracoscopy, surgical....... ........... ........... ........... ........... ........... 32658................. C.............. ............... Thoracoscopy, surgical....... ........... ........... ........... ........... ........... 32659................. C.............. ............... Thoracoscopy, surgical....... ........... ........... ........... ........... ........... 32660................. C.............. ............... Thoracoscopy, surgical....... ........... ........... ........... ........... ........... 32661................. C.............. ............... Thoracoscopy, surgical....... ........... ........... ........... ........... ........... 32662................. C.............. ............... Thoracoscopy, surgical....... ........... ........... ........... ........... ........... 32663................. C.............. ............... Thoracoscopy, surgical....... ........... ........... ........... ........... ........... 32664................. C.............. ............... Thoracoscopy, surgical....... ........... ........... ........... ........... ........... 32665................. C.............. ............... Thoracoscopy, surgical....... ........... ........... ........... ........... ........... 32800................. C.............. ............... Repair lung hernia........... ........... ........... ........... ........... ........... 32810................. C.............. ............... Close chest after drainage... ........... ........... ........... ........... ........... 32815................. C.............. ............... Close bronchial fistula...... ........... ........... ........... ........... ........... 32820................. C.............. ............... Reconstruct injured chest.... ........... ........... ........... ........... ........... 32850................. C.............. ............... Donor pneumonectomy.......... ........... ........... ........... ........... ........... 32851................. C.............. ............... Lung transplant, single...... ........... ........... ........... ........... ........... 32852................. C.............. ............... Lung transplant with bypass.. ........... ........... ........... ........... ........... 32853................. C.............. ............... Lung transplant, double...... ........... ........... ........... ........... ........... 32854................. C.............. ............... Lung transplant with bypass.. ........... ........... ........... ........... ........... 32855................. C.............. ............... Prepare donor lung, single... ........... ........... ........... ........... ........... 32856................. C.............. ............... Prepare donor lung, double... ........... ........... ........... ........... ........... 32900................. C.............. ............... Removal of rib(s)............ ........... ........... ........... ........... ........... 32905................. C.............. ............... Revise & repair chest wall... ........... ........... ........... ........... ........... 32906................. C.............. ............... Revise & repair chest wall... ........... ........... ........... ........... ........... 32940................. C.............. ............... Revision of lung............. ........... ........... ........... ........... ........... 32960................. T.............. ............... Therapeutic pneumothorax.....

0070 3.2101 $190.50 ........... $38.10 32997................. C.............. ............... Total lung lavage............ ........... ........... ........... ........... ........... 32999................. T.............. ............... Chest surgery procedure......

0070 3.2101 $190.50 ........... $38.10 33010................. T.............. ............... Drainage of heart sac........

0070 3.2101 $190.50 ........... $38.10 33011................. T.............. ............... Repeat drainage of heart sac.

0070 3.2101 $190.50 ........... $38.10 33015................. C.............. ............... Incision of heart sac........ ........... ........... ........... ........... ........... 33020................. C.............. ............... Incision of heart sac........ ........... ........... ........... ........... ........... 33025................. C.............. ............... Incision of heart sac........ ........... ........... ........... ........... ........... 33030................. C.............. ............... Partial removal of heart sac. ........... ........... ........... ........... ........... 33031................. C.............. ............... Partial removal of heart sac. ........... ........... ........... ........... ........... 33050................. C.............. ............... Removal of heart sac lesion.. ........... ........... ........... ........... ........... 33120................. C.............. ............... Removal of heart lesion...... ........... ........... ........... ........... ........... 33130................. C.............. ............... Removal of heart lesion...... ........... ........... ........... ........... ........... 33140................. C.............. ............... Heart revascularize (tmr).... ........... ........... ........... ........... ...........

[[Page 50735]]

33141................. C.............. ............... Heart tmr w/other procedure.. ........... ........... ........... ........... ........... 33200................. C.............. ............... Insertion of heart pacemaker. ........... ........... ........... ........... ........... 33201................. C.............. ............... Insertion of heart pacemaker. ........... ........... ........... ........... ........... 33206................. T.............. ............... Insertion of heart pacemaker.

0089 105.6143 $6,267.47 $1,682.28 $1,253.49 33207................. T.............. ............... Insertion of heart pacemaker.

0089 105.6143 $6,267.47 $1,682.28 $1,253.49 33208................. T.............. ............... Insertion of heart pacemaker.

0655 133.7768 $7,938.72 ........... $1,587.74 33210................. T.............. ............... Insertion of heart electrode.

0106 45.4851 $2,699.22 ........... $539.84 33211................. T.............. ............... Insertion of heart electrode.

0106 45.4851 $2,699.22 ........... $539.84 33212................. T.............. ............... Insertion of pulse generator.

0090 89.1574 $5,290.87 $1,612.80 $1,058.17 33213................. T.............. ............... Insertion of pulse generator.

0654 100.9294 $5,989.45 ........... $1,197.89 33214................. T.............. ............... Upgrade of pacemaker system..

0655 133.7768 $7,938.72 ........... $1,587.74 33215................. T.............. ............... Reposition pacing-defib lead.

0105 22.3685 $1,327.41 $370.40 $265.48 33216................. T.............. ............... Revise eltrd pacing-defib....

0106 45.4851 $2,699.22 ........... $539.84 33217................. T.............. ............... Insert lead pace-defib, dual.

0106 45.4851 $2,699.22 ........... $539.84 33218................. T.............. ............... Repair lead pace-defib, one..

0106 45.4851 $2,699.22 ........... $539.84 33220................. T.............. ............... Repair lead pace-defib, dual.

0106 45.4851 $2,699.22 ........... $539.84 33222................. T.............. ............... Revise pocket, acemaker......

0027 18.4182 $1,092.99 $329.72 $218.60 33223................. T.............. ............... Revise pocket, pacing-defib..

0027 18.4182 $1,092.99 $329.72 $218.60 33224................. T.............. ............... Insert pacing lead & connect.

0418 109.3043 $6,486.45 ........... $1,297.29 33225................. T.............. ............... L ventric pacing lead add-on.

0418 109.3043 $6,486.45 ........... $1,297.29 33226................. T.............. ............... Reposition l ventric lead....

0105 22.3685 $1,327.41 $370.40 $265.48 33233................. T.............. ............... Removal of pacemaker system..

0105 22.3685 $1,327.41 $370.40 $265.48 33234................. T.............. ............... Removal of pacemaker system..

0105 22.3685 $1,327.41 $370.40 $265.48 33235................. T.............. ............... Removal pacemaker electrode..

0105 22.3685 $1,327.41 $370.40 $265.48 33236................. C.............. ............... Remove electrode/thoracotomy. ........... ........... ........... ........... ........... 33237................. C.............. ............... Remove electrode/thoracotomy. ........... ........... ........... ........... ........... 33238................. C.............. ............... Remove electrode/thoracotomy. ........... ........... ........... ........... ........... 33240................. B.............. ............... Insert pulse generator....... ........... ........... ........... ........... ........... 33241................. T.............. ............... Remove pulse generator.......

0105 22.3685 $1,327.41 $370.40 $265.48 33243................. C.............. ............... Remove eltrd/thoracotomy..... ........... ........... ........... ........... ........... 33244................. T.............. ............... Remove eltrd, transven.......

0105 22.3685 $1,327.41 $370.40 $265.48 33245................. C.............. ............... Insert epic eltrd pace-defib. ........... ........... ........... ........... ........... 33246................. C.............. ............... Insert epic eltrd/generator.. ........... ........... ........... ........... ........... 33249................. B.............. ............... Eltrd/insert pace-defib...... ........... ........... ........... ........... ........... 33250................. C.............. ............... Ablate heart dysrhythm focus. ........... ........... ........... ........... ........... 33251................. C.............. ............... Ablate heart dysrhythm focus. ........... ........... ........... ........... ........... 33253................. C.............. ............... Reconstruct atria............ ........... ........... ........... ........... ........... 33261................. C.............. ............... Ablate heart dysrhythm focus. ........... ........... ........... ........... ........... 33282................. S.............. ............... Implant pat-active ht record.

0680 62.9082 $3,733.16 ........... $746.63 33284................. T.............. ............... Remove pat-active ht record..

0109 11.0433 $655.34 $131.49 $131.07 33300................. C.............. ............... Repair of heart wound........ ........... ........... ........... ........... ........... 33305................. C.............. ............... Repair of heart wound........ ........... ........... ........... ........... ........... 33310................. C.............. ............... Exploratory heart surgery.... ........... ........... ........... ........... ........... 33315................. C.............. ............... Exploratory heart surgery.... ........... ........... ........... ........... ........... 33320................. C.............. ............... Repair major blood vessel(s). ........... ........... ........... ........... ........... 33321................. C.............. ............... Repair major vessel.......... ........... ........... ........... ........... ........... 33322................. C.............. ............... Repair major blood vessel(s). ........... ........... ........... ........... ........... 33330................. C.............. ............... Insert major vessel graft.... ........... ........... ........... ........... ........... 33332................. C.............. ............... Insert major vessel graft.... ........... ........... ........... ........... ........... 33335................. C.............. ............... Insert major vessel graft.... ........... ........... ........... ........... ........... 33400................. C.............. ............... Repair of aortic valve....... ........... ........... ........... ........... ........... 33401................. C.............. ............... Valvuloplasty, open.......... ........... ........... ........... ........... ........... 33403................. C.............. ............... Valvuloplasty, w/cp bypass... ........... ........... ........... ........... ........... 33404................. C.............. ............... Prepare heart-aorta conduit.. ........... ........... ........... ........... ........... 33405................. C.............. ............... Replacement of aortic valve.. ........... ........... ........... ........... ........... 33406................. C.............. ............... Replacement of aortic valve.. ........... ........... ........... ........... ........... 33410................. C.............. ............... Replacement of aortic valve.. ........... ........... ........... ........... ........... 33411................. C.............. ............... Replacement of aortic valve.. ........... ........... ........... ........... ........... 33412................. C.............. ............... Replacement of aortic valve.. ........... ........... ........... ........... ........... 33413................. C.............. ............... Replacement of aortic valve.. ........... ........... ........... ........... ........... 33414................. C.............. ............... Repair of aortic valve....... ........... ........... ........... ........... ........... 33415................. C.............. ............... Revision, subvalvular tissue. ........... ........... ........... ........... ........... 33416................. C.............. ............... Revise ventricle muscle...... ........... ........... ........... ........... ........... 33417................. C.............. ............... Repair of aortic valve....... ........... ........... ........... ........... ........... 33420................. C.............. ............... Revision of mitral valve..... ........... ........... ........... ........... ........... 33422................. C.............. ............... Revision of mitral valve..... ........... ........... ........... ........... ...........

[[Page 50736]]

33425................. C.............. ............... Repair of mitral valve....... ........... ........... ........... ........... ........... 33426................. C.............. ............... Repair of mitral valve....... ........... ........... ........... ........... ........... 33427................. C.............. ............... Repair of mitral valve....... ........... ........... ........... ........... ........... 33430................. C.............. ............... Replacement of mitral valve.. ........... ........... ........... ........... ........... 33460................. C.............. ............... Revision of tricuspid valve.. ........... ........... ........... ........... ........... 33463................. C.............. ............... Valvuloplasty, tricuspid..... ........... ........... ........... ........... ........... 33464................. C.............. ............... Valvuloplasty, tricuspid..... ........... ........... ........... ........... ........... 33465................. C.............. ............... Replace tricuspid valve...... ........... ........... ........... ........... ........... 33468................. C.............. ............... Revision of tricuspid valve.. ........... ........... ........... ........... ........... 33470................. C.............. ............... Revision of pulmonary valve.. ........... ........... ........... ........... ........... 33471................. C.............. ............... Valvotomy, pulmonary valve... ........... ........... ........... ........... ........... 33472................. C.............. ............... Revision of pulmonary valve.. ........... ........... ........... ........... ........... 33474................. C.............. ............... Revision of pulmonary valve.. ........... ........... ........... ........... ........... 33475................. C.............. ............... Replacement, pulmonary valve. ........... ........... ........... ........... ........... 33476................. C.............. ............... Revision of heart chamber.... ........... ........... ........... ........... ........... 33478................. C.............. ............... Revision of heart chamber.... ........... ........... ........... ........... ........... 33496................. C.............. ............... Repair, prosth valve clot.... ........... ........... ........... ........... ........... 33500................. C.............. ............... Repair heart vessel fistula.. ........... ........... ........... ........... ........... 33501................. C.............. ............... Repair heart vessel fistula.. ........... ........... ........... ........... ........... 33502................. C.............. ............... Coronary artery correction... ........... ........... ........... ........... ........... 33503................. C.............. ............... Coronary artery graft........ ........... ........... ........... ........... ........... 33504................. C.............. ............... Coronary artery graft........ ........... ........... ........... ........... ........... 33505................. C.............. ............... Repair artery w/tunnel....... ........... ........... ........... ........... ........... 33506................. C.............. ............... Repair artery, translocation. ........... ........... ........... ........... ........... 33508................. N.............. ............... Endoscopic vein harvest...... ........... ........... ........... ........... ........... 33510................. C.............. ............... CABG, vein, single........... ........... ........... ........... ........... ........... 33511................. C.............. ............... CABG, vein, two.............. ........... ........... ........... ........... ........... 33512................. C.............. ............... CABG, vein, three............ ........... ........... ........... ........... ........... 33513................. C.............. ............... CABG, vein, four............. ........... ........... ........... ........... ........... 33514................. C.............. ............... CABG, vein, five............. ........... ........... ........... ........... ........... 33516................. C.............. ............... Cabg, vein, six or more...... ........... ........... ........... ........... ........... 33517................. C.............. ............... CABG, artery-vein, single.... ........... ........... ........... ........... ........... 33518................. C.............. ............... CABG, artery-vein, two....... ........... ........... ........... ........... ........... 33519................. C.............. ............... CABG, artery-vein, three..... ........... ........... ........... ........... ........... 33521................. C.............. ............... CABG, artery-vein, four...... ........... ........... ........... ........... ........... 33522................. C.............. ............... CABG, artery-vein, five...... ........... ........... ........... ........... ........... 33523................. C.............. ............... Cabg, art-vein, six or more.. ........... ........... ........... ........... ........... 33530................. C.............. ............... Coronary artery, bypass/reop. ........... ........... ........... ........... ........... 33533................. C.............. ............... CABG, arterial, single....... ........... ........... ........... ........... ........... 33534................. C.............. ............... CABG, arterial, two.......... ........... ........... ........... ........... ........... 33535................. C.............. ............... CABG, arterial, three........ ........... ........... ........... ........... ........... 33536................. C.............. ............... Cabg, arterial, four or more. ........... ........... ........... ........... ........... 33542................. C.............. ............... Removal of heart lesion...... ........... ........... ........... ........... ........... 33545................. C.............. ............... Repair of heart damage....... ........... ........... ........... ........... ........... 33572................. C.............. ............... Open coronary endarterectomy. ........... ........... ........... ........... ........... 33600................. C.............. ............... Closure of valve............. ........... ........... ........... ........... ........... 33602................. C.............. ............... Closure of valve............. ........... ........... ........... ........... ........... 33606................. C.............. ............... Anastomosis/artery-aorta..... ........... ........... ........... ........... ........... 33608................. C.............. ............... Repair anomaly w/conduit..... ........... ........... ........... ........... ........... 33610................. C.............. ............... Repair by enlargement........ ........... ........... ........... ........... ........... 33611................. C.............. ............... Repair double ventricle...... ........... ........... ........... ........... ........... 33612................. C.............. ............... Repair double ventricle...... ........... ........... ........... ........... ........... 33615................. C.............. ............... Repair, modified fontan...... ........... ........... ........... ........... ........... 33617................. C.............. ............... Repair single ventricle...... ........... ........... ........... ........... ........... 33619................. C.............. ............... Repair single ventricle...... ........... ........... ........... ........... ........... 33641................. C.............. ............... Repair heart septum defect... ........... ........... ........... ........... ........... 33645................. C.............. ............... Revision of heart veins...... ........... ........... ........... ........... ........... 33647................. C.............. ............... Repair heart septum defects.. ........... ........... ........... ........... ........... 33660................. C.............. ............... Repair of heart defects...... ........... ........... ........... ........... ........... 33665................. C.............. ............... Repair of heart defects...... ........... ........... ........... ........... ........... 33670................. C.............. ............... Repair of heart chambers..... ........... ........... ........... ........... ........... 33681................. C.............. ............... Repair heart septum defect... ........... ........... ........... ........... ........... 33684................. C.............. ............... Repair heart septum defect... ........... ........... ........... ........... ........... 33688................. C.............. ............... Repair heart septum defect... ........... ........... ........... ........... ........... 33690................. C.............. ............... Reinforce pulmonary artery... ........... ........... ........... ........... ........... 33692................. C.............. ............... Repair of heart defects...... ........... ........... ........... ........... ...........

[[Page 50737]]

33694................. C.............. ............... Repair of heart defects...... ........... ........... ........... ........... ........... 33697................. C.............. ............... Repair of heart defects...... ........... ........... ........... ........... ........... 33702................. C.............. ............... Repair of heart defects...... ........... ........... ........... ........... ........... 33710................. C.............. ............... Repair of heart defects...... ........... ........... ........... ........... ........... 33720................. C.............. ............... Repair of heart defect....... ........... ........... ........... ........... ........... 33722................. C.............. ............... Repair of heart defect....... ........... ........... ........... ........... ........... 33730................. C.............. ............... Repair heart-vein defect(s).. ........... ........... ........... ........... ........... 33732................. C.............. ............... Repair heart-vein defect..... ........... ........... ........... ........... ........... 33735................. C.............. ............... Revision of heart chamber.... ........... ........... ........... ........... ........... 33736................. C.............. ............... Revision of heart chamber.... ........... ........... ........... ........... ........... 33737................. C.............. ............... Revision of heart chamber.... ........... ........... ........... ........... ........... 33750................. C.............. ............... Major vessel shunt........... ........... ........... ........... ........... ........... 33755................. C.............. ............... Major vessel shunt........... ........... ........... ........... ........... ........... 33762................. C.............. ............... Major vessel shunt........... ........... ........... ........... ........... ........... 33764................. C.............. ............... Major vessel shunt & graft... ........... ........... ........... ........... ........... 33766................. C.............. ............... Major vessel shunt........... ........... ........... ........... ........... ........... 33767................. C.............. ............... Major vessel shunt........... ........... ........... ........... ........... ........... 33770................. C.............. ............... Repair great vessels defect.. ........... ........... ........... ........... ........... 33771................. C.............. ............... Repair great vessels defect.. ........... ........... ........... ........... ........... 33774................. C.............. ............... Repair great vessels defect.. ........... ........... ........... ........... ........... 33775................. C.............. ............... Repair great vessels defect.. ........... ........... ........... ........... ........... 33776................. C.............. ............... Repair great vessels defect.. ........... ........... ........... ........... ........... 33777................. C.............. ............... Repair great vessels defect.. ........... ........... ........... ........... ........... 33778................. C.............. ............... Repair great vessels defect.. ........... ........... ........... ........... ........... 33779................. C.............. ............... Repair great vessels defect.. ........... ........... ........... ........... ........... 33780................. C.............. ............... Repair great vessels defect.. ........... ........... ........... ........... ........... 33781................. C.............. ............... Repair great vessels defect.. ........... ........... ........... ........... ........... 33786................. C.............. ............... Repair arterial trunk........ ........... ........... ........... ........... ........... 33788................. C.............. ............... Revision of pulmonary artery. ........... ........... ........... ........... ........... 33800................. C.............. ............... Aortic suspension............ ........... ........... ........... ........... ........... 33802................. C.............. ............... Repair vessel defect......... ........... ........... ........... ........... ........... 33803................. C.............. ............... Repair vessel defect......... ........... ........... ........... ........... ........... 33813................. C.............. ............... Repair septal defect......... ........... ........... ........... ........... ........... 33814................. C.............. ............... Repair septal defect......... ........... ........... ........... ........... ........... 33820................. C.............. ............... Revise major vessel.......... ........... ........... ........... ........... ........... 33822................. C.............. ............... Revise major vessel.......... ........... ........... ........... ........... ........... 33824................. C.............. ............... Revise major vessel.......... ........... ........... ........... ........... ........... 33840................. C.............. ............... Remove aorta constriction.... ........... ........... ........... ........... ........... 33845................. C.............. ............... Remove aorta constriction.... ........... ........... ........... ........... ........... 33851................. C.............. ............... Remove aorta constriction.... ........... ........... ........... ........... ........... 33852................. C.............. ............... Repair septal defect......... ........... ........... ........... ........... ........... 33853................. C.............. ............... Repair septal defect......... ........... ........... ........... ........... ........... 33860................. C.............. ............... Ascending aortic graft....... ........... ........... ........... ........... ........... 33861................. C.............. ............... Ascending aortic graft....... ........... ........... ........... ........... ........... 33863................. C.............. ............... Ascending aortic graft....... ........... ........... ........... ........... ........... 33870................. C.............. ............... Transverse aortic arch graft. ........... ........... ........... ........... ........... 33875................. C.............. ............... Thoracic aortic graft........ ........... ........... ........... ........... ........... 33877................. C.............. ............... Thoracoabdominal graft....... ........... ........... ........... ........... ........... 33910................. C.............. ............... Remove lung artery emboli.... ........... ........... ........... ........... ........... 33915................. C.............. ............... Remove lung artery emboli.... ........... ........... ........... ........... ........... 33916................. C.............. ............... Surgery of great vessel...... ........... ........... ........... ........... ........... 33917................. C.............. ............... Repair pulmonary artery...... ........... ........... ........... ........... ........... 33918................. C.............. ............... Repair pulmonary atresia..... ........... ........... ........... ........... ........... 33919................. C.............. ............... Repair pulmonary atresia..... ........... ........... ........... ........... ........... 33920................. C.............. ............... Repair pulmonary atresia..... ........... ........... ........... ........... ........... 33922................. C.............. ............... Transect pulmonary artery.... ........... ........... ........... ........... ........... 33924................. C.............. ............... Remove pulmonary shunt....... ........... ........... ........... ........... ........... 33930................. C.............. ............... Removal of donor heart/lung.. ........... ........... ........... ........... ........... 33933................. C.............. ............... Prepare donor heart/lung..... ........... ........... ........... ........... ........... 33935................. C.............. ............... Transplantation, heart/lung.. ........... ........... ........... ........... ........... 33940................. C.............. ............... Removal of donor heart....... ........... ........... ........... ........... ........... 33944................. C.............. ............... Prepare donor heart.......... ........... ........... ........... ........... ........... 33945................. C.............. ............... Transplantation of heart..... ........... ........... ........... ........... ........... 33960................. C.............. ............... External circulation assist.. ........... ........... ........... ........... ........... 33961................. C.............. ............... External circulation assist.. ........... ........... ........... ........... ........... 33967................. C.............. ............... Insert ia percut device...... ........... ........... ........... ........... ...........

[[Page 50738]]

33968................. C.............. ............... Remove aortic assist device.. ........... ........... ........... ........... ........... 33970................. C.............. ............... Aortic circulation assist.... ........... ........... ........... ........... ........... 33971................. C.............. ............... Aortic circulation assist.... ........... ........... ........... ........... ........... 33973................. C.............. ............... Insert balloon device........ ........... ........... ........... ........... ........... 33974................. C.............. ............... Remove intra-aortic balloon.. ........... ........... ........... ........... ........... 33975................. C.............. ............... Implant ventricular device... ........... ........... ........... ........... ........... 33976................. C.............. ............... Implant ventricular device... ........... ........... ........... ........... ........... 33977................. C.............. ............... Remove ventricular device.... ........... ........... ........... ........... ........... 33978................. C.............. ............... Remove ventricular device.... ........... ........... ........... ........... ........... 33979................. C.............. ............... Insert intracorporeal device. ........... ........... ........... ........... ........... 33980................. C.............. ............... Remove intracorporeal device. ........... ........... ........... ........... ........... 33999................. T.............. ............... Cardiac surgery procedure....

0070 3.2101 $190.50 ........... $38.10 34001................. C.............. ............... Removal of artery clot....... ........... ........... ........... ........... ........... 34051................. C.............. ............... Removal of artery clot....... ........... ........... ........... ........... ........... 34101................. T.............. ............... Removal of artery clot.......

0088 36.5617 $2,169.68 $655.22 $433.94 34111................. T.............. ............... Removal of arm artery clot...

0088 36.5617 $2,169.68 $655.22 $433.94 34151................. C.............. ............... Removal of artery clot....... ........... ........... ........... ........... ........... 34201................. T.............. ............... Removal of artery clot.......

0088 36.5617 $2,169.68 $655.22 $433.94 34203................. T.............. ............... Removal of leg artery clot...

0088 36.5617 $2,169.68 $655.22 $433.94 34401................. C.............. ............... Removal of vein clot......... ........... ........... ........... ........... ........... 34421................. T.............. ............... Removal of vein clot.........

0088 36.5617 $2,169.68 $655.22 $433.94 34451................. C.............. ............... Removal of vein clot......... ........... ........... ........... ........... ........... 34471................. T.............. ............... Removal of vein clot.........

0088 36.5617 $2,169.68 $655.22 $433.94 34490................. T.............. ............... Removal of vein clot.........

0088 36.5617 $2,169.68 $655.22 $433.94 34501................. T.............. ............... Repair valve, femoral vein...

0088 36.5617 $2,169.68 $655.22 $433.94 34502................. C.............. ............... Reconstruct vena cava........ ........... ........... ........... ........... ........... 34510................. T.............. ............... Transposition of vein valve..

0088 36.5617 $2,169.68 $655.22 $433.94 34520................. T.............. ............... Cross-over vein graft........

0088 36.5617 $2,169.68 $655.22 $433.94 34530................. T.............. ............... Leg vein fusion..............

0088 36.5617 $2,169.68 $655.22 $433.94 34800................. C.............. ............... Endovasc abdo repair w/tube.. ........... ........... ........... ........... ........... 34802................. C.............. ............... Endovasc abdo repr w/device.. ........... ........... ........... ........... ........... 34803................. C.............. ............... Endovas aaa repr w/3-p part.. ........... ........... ........... ........... ........... 34804................. C.............. ............... Endovasc abdo repr w/device.. ........... ........... ........... ........... ........... 34805................. C.............. ............... Endovasc abdo repair w/pros.. ........... ........... ........... ........... ........... 34808................. C.............. ............... Endovasc abdo occlud device.. ........... ........... ........... ........... ........... 34812................. C.............. ............... Xpose for endoprosth, aortic. ........... ........... ........... ........... ........... 34813................. C.............. ............... Femoral endovas graft add-on. ........... ........... ........... ........... ........... 34820................. C.............. ............... Xpose for endoprosth, iliac.. ........... ........... ........... ........... ........... 34825................. C.............. ............... Endovasc extend prosth, init. ........... ........... ........... ........... ........... 34826................. C.............. ............... Endovasc exten prosth, add'l. ........... ........... ........... ........... ........... 34830................. C.............. ............... Open aortic tube prosth repr. ........... ........... ........... ........... ........... 34831................. C.............. ............... Open aortoiliac prosth repr.. ........... ........... ........... ........... ........... 34832................. C.............. ............... Open aortofemor prosth repr.. ........... ........... ........... ........... ........... 34833................. C.............. ............... Xpose for endoprosth, iliac.. ........... ........... ........... ........... ........... 34834................. C.............. ............... Xpose, endoprosth, brachial.. ........... ........... ........... ........... ........... 34900................. C.............. ............... Endovasc iliac repr w/graft.. ........... ........... ........... ........... ........... 35001................. C.............. ............... Repair defect of artery...... ........... ........... ........... ........... ........... 35002................. C.............. ............... Repair artery rupture, neck.. ........... ........... ........... ........... ........... 35005................. C.............. ............... Repair defect of artery...... ........... ........... ........... ........... ........... 35011................. T.............. ............... Repair defect of artery......

0653 30.5339 $1,811.97 ........... $362.39 35013................. C.............. ............... Repair artery rupture, arm... ........... ........... ........... ........... ........... 35021................. C.............. ............... Repair defect of artery...... ........... ........... ........... ........... ........... 35022................. C.............. ............... Repair artery rupture, chest. ........... ........... ........... ........... ........... 35045................. C.............. ............... Repair defect of arm artery.. ........... ........... ........... ........... ........... 35081................. C.............. ............... Repair defect of artery...... ........... ........... ........... ........... ........... 35082................. C.............. ............... Repair artery rupture, aorta. ........... ........... ........... ........... ........... 35091................. C.............. ............... Repair defect of artery...... ........... ........... ........... ........... ........... 35092................. C.............. ............... Repair artery rupture, aorta. ........... ........... ........... ........... ........... 35102................. C.............. ............... Repair defect of artery...... ........... ........... ........... ........... ........... 35103................. C.............. ............... Repair artery rupture, groin. ........... ........... ........... ........... ........... 35111................. C.............. ............... Repair defect of artery...... ........... ........... ........... ........... ........... 35112................. C.............. ............... Repair artery rupture,spleen. ........... ........... ........... ........... ........... 35121................. C.............. ............... Repair defect of artery...... ........... ........... ........... ........... ........... 35122................. C.............. ............... Repair artery rupture, belly. ........... ........... ........... ........... ........... 35131................. C.............. ............... Repair defect of artery...... ........... ........... ........... ........... ........... 35132................. C.............. ............... Repair artery rupture, groin. ........... ........... ........... ........... ...........

[[Page 50739]]

35141................. C.............. ............... Repair defect of artery...... ........... ........... ........... ........... ........... 35142................. C.............. ............... Repair artery rupture, thigh. ........... ........... ........... ........... ........... 35151................. C.............. ............... Repair defect of artery...... ........... ........... ........... ........... ........... 35152................. C.............. ............... Repair artery rupture, knee.. ........... ........... ........... ........... ........... 35180................. T.............. ............... Repair blood vessel lesion...

0093 23.4516 $1,391.69 ........... $278.34 35182................. C.............. ............... Repair blood vessel lesion... ........... ........... ........... ........... ........... 35184................. T.............. ............... Repair blood vessel lesion...

0093 23.4516 $1,391.69 ........... $278.34 35188................. T.............. ............... Repair blood vessel lesion...

0088 36.5617 $2,169.68 $655.22 $433.94 35189................. C.............. ............... Repair blood vessel lesion... ........... ........... ........... ........... ........... 35190................. T.............. ............... Repair blood vessel lesion...

0093 23.4516 $1,391.69 ........... $278.34 35201................. T.............. ............... Repair blood vessel lesion...

0093 23.4516 $1,391.69 ........... $278.34 35206................. T.............. ............... Repair blood vessel lesion...

0093 23.4516 $1,391.69 ........... $278.34 35207................. T.............. ............... Repair blood vessel lesion...

0088 36.5617 $2,169.68 $655.22 $433.94 35211................. C.............. ............... Repair blood vessel lesion... ........... ........... ........... ........... ........... 35216................. C.............. ............... Repair blood vessel lesion... ........... ........... ........... ........... ........... 35221................. C.............. ............... Repair blood vessel lesion... ........... ........... ........... ........... ........... 35226................. T.............. ............... Repair blood vessel lesion...

0093 23.4516 $1,391.69 ........... $278.34 35231................. T.............. ............... Repair blood vessel lesion...

0093 23.4516 $1,391.69 ........... $278.34 35236................. T.............. ............... Repair blood vessel lesion...

0093 23.4516 $1,391.69 ........... $278.34 35241................. C.............. ............... Repair blood vessel lesion... ........... ........... ........... ........... ........... 35246................. C.............. ............... Repair blood vessel lesion... ........... ........... ........... ........... ........... 35251................. C.............. ............... Repair blood vessel lesion... ........... ........... ........... ........... ........... 35256................. T.............. ............... Repair blood vessel lesion...

0093 23.4516 $1,391.69 ........... $278.34 35261................. T.............. ............... Repair blood vessel lesion...

0653 30.5339 $1,811.97 ........... $362.39 35266................. T.............. ............... Repair blood vessel lesion...

0653 30.5339 $1,811.97 ........... $362.39 35271................. C.............. ............... Repair blood vessel lesion... ........... ........... ........... ........... ........... 35276................. C.............. ............... Repair blood vessel lesion... ........... ........... ........... ........... ........... 35281................. C.............. ............... Repair blood vessel lesion... ........... ........... ........... ........... ........... 35286................. T.............. ............... Repair blood vessel lesion...

0653 30.5339 $1,811.97 ........... $362.39 35301................. C.............. ............... Rechanneling of artery....... ........... ........... ........... ........... ........... 35311................. C.............. ............... Rechanneling of artery....... ........... ........... ........... ........... ........... 35321................. T.............. ............... Rechanneling of artery.......

0093 23.4516 $1,391.69 ........... $278.34 35331................. C.............. ............... Rechanneling of artery....... ........... ........... ........... ........... ........... 35341................. C.............. ............... Rechanneling of artery....... ........... ........... ........... ........... ........... 35351................. C.............. ............... Rechanneling of artery....... ........... ........... ........... ........... ........... 35355................. C.............. ............... Rechanneling of artery....... ........... ........... ........... ........... ........... 35361................. C.............. ............... Rechanneling of artery....... ........... ........... ........... ........... ........... 35363................. C.............. ............... Rechanneling of artery....... ........... ........... ........... ........... ........... 35371................. C.............. ............... Rechanneling of artery....... ........... ........... ........... ........... ........... 35372................. C.............. ............... Rechanneling of artery....... ........... ........... ........... ........... ........... 35381................. C.............. ............... Rechanneling of artery....... ........... ........... ........... ........... ........... 35390................. C.............. ............... Reoperation, carotid add-on.. ........... ........... ........... ........... ........... 35400................. C.............. ............... Angioscopy................... ........... ........... ........... ........... ........... 35450................. C.............. ............... Repair arterial blockage..... ........... ........... ........... ........... ........... 35452................. C.............. ............... Repair arterial blockage..... ........... ........... ........... ........... ........... 35454................. C.............. ............... Repair arterial blockage..... ........... ........... ........... ........... ........... 35456................. C.............. ............... Repair arterial blockage..... ........... ........... ........... ........... ........... 35458................. T.............. ............... Repair arterial blockage.....

0081 34.4473 $2,044.21 ........... $408.84 35459................. T.............. ............... Repair arterial blockage.....

0081 34.4473 $2,044.21 ........... $408.84 35460................. T.............. ............... Repair venous blockage.......

0081 34.4473 $2,044.21 ........... $408.84 35470................. T.............. ............... Repair arterial blockage.....

0081 34.4473 $2,044.21 ........... $408.84 35471................. T.............. ............... Repair arterial blockage.....

0081 34.4473 $2,044.21 ........... $408.84 35472................. T.............. ............... Repair arterial blockage.....

0081 34.4473 $2,044.21 ........... $408.84 35473................. T.............. ............... Repair arterial blockage.....

0081 34.4473 $2,044.21 ........... $408.84 35474................. T.............. ............... Repair arterial blockage.....

0081 34.4473 $2,044.21 ........... $408.84 35475................. T.............. ............... Repair arterial blockage.....

0081 34.4473 $2,044.21 ........... $408.84 35476................. T.............. ............... Repair venous blockage.......

0081 34.4473 $2,044.21 ........... $408.84 35480................. C.............. ............... Atherectomy, open............ ........... ........... ........... ........... ........... 35481................. C.............. ............... Atherectomy, open............ ........... ........... ........... ........... ........... 35482................. C.............. ............... Atherectomy, open............ ........... ........... ........... ........... ........... 35483................. C.............. ............... Atherectomy, open............ ........... ........... ........... ........... ........... 35484................. T.............. ............... Atherectomy, open............

0081 34.4473 $2,044.21 ........... $408.84 35485................. T.............. ............... Atherectomy, open............

0081 34.4473 $2,044.21 ........... $408.84 35490................. T.............. ............... Atherectomy, percutaneous....

0081 34.4473 $2,044.21 ........... $408.84 35491................. T.............. ............... Atherectomy, percutaneous....

0081 34.4473 $2,044.21 ........... $408.84 35492................. T.............. ............... Atherectomy, percutaneous....

0081 34.4473 $2,044.21 ........... $408.84

[[Page 50740]]

35493................. T.............. ............... Atherectomy, percutaneous....

0081 34.4473 $2,044.21 ........... $408.84 35494................. T.............. ............... Atherectomy, percutaneous....

0081 34.4473 $2,044.21 ........... $408.84 35495................. T.............. ............... Atherectomy, percutaneous....

0081 34.4473 $2,044.21 ........... $408.84 35500................. T.............. ............... Harvest vein for bypass......

0081 34.4473 $2,044.21 ........... $408.84 35501................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35506................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35507................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35508................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35509................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35510................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35511................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35512................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35515................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35516................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35518................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35521................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35522................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35525................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35526................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35531................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35533................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35536................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35541................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35546................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35548................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35549................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35551................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35556................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35558................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35560................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35563................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35565................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35566................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35571................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35572................. N.............. ............... Harvest femoropopliteal vein. ........... ........... ........... ........... ........... 35583................. C.............. ............... Vein bypass graft............ ........... ........... ........... ........... ........... 35585................. C.............. ............... Vein bypass graft............ ........... ........... ........... ........... ........... 35587................. C.............. ............... Vein bypass graft............ ........... ........... ........... ........... ........... 35600................. C.............. ............... Harvest artery for cabg...... ........... ........... ........... ........... ........... 35601................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35606................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35612................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35616................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35621................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35623................. C.............. ............... Bypass graft, not vein....... ........... ........... ........... ........... ........... 35626................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35631................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35636................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35641................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35642................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35645................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35646................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35647................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35650................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35651................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35654................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35656................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35661................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35663................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35665................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35666................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35671................. C.............. ............... Artery bypass graft.......... ........... ........... ........... ........... ........... 35681................. C.............. ............... Composite bypass graft....... ........... ........... ........... ........... ........... 35682................. C.............. ............... Composite bypass graft....... ........... ........... ........... ........... ........... 35683................. C.............. ............... Composite bypass graft....... ........... ........... ........... ........... ........... 35685................. T.............. ............... Bypass graft patency/patch...

0093 23.4516 $1,391.69 ........... $278.34

[[Page 50741]]

35686................. T.............. ............... Bypass graft/av fist patency.

0093 23.4516 $1,391.69 ........... $278.34 35691................. C.............. ............... Arterial transposition....... ........... ........... ........... ........... ........... 35693................. C.............. ............... Arterial transposition....... ........... ........... ........... ........... ........... 35694................. C.............. ............... Arterial transposition....... ........... ........... ........... ........... ........... 35695................. C.............. ............... Arterial transposition....... ........... ........... ........... ........... ........... 35697................. C.............. ............... Reimplant artery each........ ........... ........... ........... ........... ........... 35700................. C.............. ............... Reoperation, bypass graft.... ........... ........... ........... ........... ........... 35701................. C.............. ............... Exploration, carotid artery.. ........... ........... ........... ........... ........... 35721................. C.............. ............... Exploration, femoral artery.. ........... ........... ........... ........... ........... 35741................. C.............. ............... Exploration popliteal artery. ........... ........... ........... ........... ........... 35761................. T.............. ............... Exploration of artery/vein...

0115 31.4727 $1,867.68 $459.35 $373.54 35800................. C.............. ............... Explore neck vessels......... ........... ........... ........... ........... ........... 35820................. C.............. ............... Explore chest vessels........ ........... ........... ........... ........... ........... 35840................. C.............. ............... Explore abdominal vessels.... ........... ........... ........... ........... ........... 35860................. T.............. ............... Explore limb vessels.........

0093 23.4516 $1,391.69 ........... $278.34 35870................. C.............. ............... Repair vessel graft defect... ........... ........... ........... ........... ........... 35875................. T.............. ............... Removal of clot in graft.....

0088 36.5617 $2,169.68 $655.22 $433.94 35876................. T.............. ............... Removal of clot in graft.....

0088 36.5617 $2,169.68 $655.22 $433.94 35879................. T.............. ............... Revise graft w/vein..........

0088 36.5617 $2,169.68 $655.22 $433.94 35881................. T.............. ............... Revise graft w/vein..........

0088 36.5617 $2,169.68 $655.22 $433.94 35901................. C.............. ............... Excision, graft, neck........ ........... ........... ........... ........... ........... 35903................. T.............. ............... Excision, graft, extremity...

0115 31.4727 $1,867.68 $459.35 $373.54 35905................. C.............. ............... Excision, graft, thorax...... ........... ........... ........... ........... ........... 35907................. C.............. ............... Excision, graft, abdomen..... ........... ........... ........... ........... ........... 36000................. N.............. ............... Place needle in vein......... ........... ........... ........... ........... ........... 36002................. S.............. ............... Pseudoaneurysm injection trt.

0267 2.6327 $156.23 $62.18 $31.25 36005................. N.............. ............... Injection ext venography..... ........... ........... ........... ........... ........... 36010................. N.............. ............... Place catheter in vein....... ........... ........... ........... ........... ........... 36011................. N.............. ............... Place catheter in vein....... ........... ........... ........... ........... ........... 36012................. N.............. ............... Place catheter in vein....... ........... ........... ........... ........... ........... 36013................. N.............. ............... Place catheter in artery..... ........... ........... ........... ........... ........... 36014................. N.............. ............... Place catheter in artery..... ........... ........... ........... ........... ........... 36015................. N.............. ............... Place catheter in artery..... ........... ........... ........... ........... ........... 36100................. N.............. ............... Establish access to artery... ........... ........... ........... ........... ........... 36120................. N.............. ............... Establish access to artery... ........... ........... ........... ........... ........... 36140................. N.............. ............... Establish access to artery... ........... ........... ........... ........... ........... 36145................. N.............. ............... Artery to vein shunt......... ........... ........... ........... ........... ........... 36160................. N.............. ............... Establish access to aorta.... ........... ........... ........... ........... ........... 36200................. N.............. ............... Place catheter in aorta...... ........... ........... ........... ........... ........... 36215................. N.............. ............... Place catheter in artery..... ........... ........... ........... ........... ........... 36216................. N.............. ............... Place catheter in artery..... ........... ........... ........... ........... ........... 36217................. N.............. ............... Place catheter in artery..... ........... ........... ........... ........... ........... 36218................. N.............. ............... Place catheter in artery..... ........... ........... ........... ........... ........... 36245................. N.............. ............... Place catheter in artery..... ........... ........... ........... ........... ........... 36246................. N.............. ............... Place catheter in artery..... ........... ........... ........... ........... ........... 36247................. N.............. ............... Place catheter in artery..... ........... ........... ........... ........... ........... 36248................. N.............. ............... Place catheter in artery..... ........... ........... ........... ........... ........... 36260................. T.............. ............... Insertion of infusion pump...

0623 27.1105 $1,608.82 ........... $321.76 36261................. T.............. ............... Revision of infusion pump....

0623 27.1105 $1,608.82 ........... $321.76 36262................. T.............. ............... Removal of infusion pump.....

0622 21.2671 $1,262.05 ........... $252.41 36299................. N.............. ............... Vessel injection procedure... ........... ........... ........... ........... ........... 36400................. N.............. ............... Bl draw 3 yrs.. ........... ........... ........... ........... ........... 36415................. A.............. ............... Drawing blood................ ........... ........... ........... ........... ........... 36416................. N.............. ............... Capillary blood draw......... ........... ........... ........... ........... ........... 36420................. T.............. ............... Vein access cutdown 1 yr...

0035 0.7158 $42.48 ...........

$8.50 36430................. S.............. ............... Blood transfusion service....

0110 3.6594 $217.16 ........... $43.43 36440................. S.............. ............... Bl push transfuse, 2 yr or 5 yr...

0154 28.7847 $1,708.17 $464.85 $341.63 49507................. T.............. ............... Prp i/hern init block>5 yr...

0154 28.7847 $1,708.17 $464.85 $341.63 49520................. T.............. ............... Rerepair ing hernia, reduce..

0154 28.7847 $1,708.17 $464.85 $341.63 49521................. T.............. ............... Rerepair ing hernia, blocked.

0154 28.7847 $1,708.17 $464.85 $341.63 49525................. T.............. ............... Repair ing hernia, sliding...

0154 28.7847 $1,708.17 $464.85 $341.63 49540................. T.............. ............... Repair lumbar hernia.........

0154 28.7847 $1,708.17 $464.85 $341.63 49550................. T.............. ............... Rpr rem hernia, init, reduce.

0154 28.7847 $1,708.17 $464.85 $341.63 49553................. T.............. ............... Rpr fem hernia, init blocked.

0154 28.7847 $1,708.17 $464.85 $341.63 49555................. T.............. ............... Rerepair fem hernia, reduce..

0154 28.7847 $1,708.17 $464.85 $341.63 49557................. T.............. ............... Rerepair fem hernia, blocked.

0154 28.7847 $1,708.17 $464.85 $341.63 49560................. T.............. ............... Rpr ventral hern init, reduc.

0154 28.7847 $1,708.17 $464.85 $341.63 49561................. T.............. ............... Rpr ventral hern init, block.

0154 28.7847 $1,708.17 $464.85 $341.63 49565................. T.............. ............... Rerepair ventrl hern, reduce.

0154 28.7847 $1,708.17 $464.85 $341.63 49566................. T.............. ............... Rerepair ventrl hern, block..

0154 28.7847 $1,708.17 $464.85 $341.63 49568................. T.............. ............... Hernia repair w/mesh.........

0154 28.7847 $1,708.17 $464.85 $341.63 49570................. T.............. ............... Rpr epigastric hern, reduce..

0154 28.7847 $1,708.17 $464.85 $341.63 49572................. T.............. ............... Rpr epigastric hern, blocked.

0154 28.7847 $1,708.17 $464.85 $341.63 49580................. T.............. ............... Rpr umbil hern, reduc 5 yr.

0154 28.7847 $1,708.17 $464.85 $341.63 49587................. T.............. ............... Rpr umbil hern, block > 5 yr.

0154 28.7847 $1,708.17 $464.85 $341.63 49590................. T.............. ............... Repair spigilian hernia......

0154 28.7847 $1,708.17 $464.85 $341.63 49600................. T.............. ............... Repair umbilical lesion......

0154 28.7847 $1,708.17 $464.85 $341.63 49605................. C.............. ............... Repair umbilical lesion...... ........... ........... ........... ........... ........... 49606................. C.............. ............... Repair umbilical lesion...... ........... ........... ........... ........... ........... 49610................. C.............. ............... Repair umbilical lesion...... ........... ........... ........... ........... ........... 49611................. C.............. ............... Repair umbilical lesion...... ........... ........... ........... ........... ........... 49650................. T.............. ............... Laparo hernia repair initial.

0131 43.3389 $2,571.86 $1,001.89 $514.37 49651................. T.............. ............... Laparo hernia repair recur...

0131 43.3389 $2,571.86 $1,001.89 $514.37 49659................. T.............. ............... Laparo proc, hernia repair...

0130 31.9271 $1,894.65 $659.53 $378.93 49900................. C.............. ............... Repair of abdominal wall..... ........... ........... ........... ........... ........... 49904................. C.............. ............... Omental flap, extra-abdom.... ........... ........... ........... ........... ........... 49905................. C.............. ............... Omental flap................. ........... ........... ........... ........... ........... 49906................. C.............. ............... Free omental flap, microvasc. ........... ........... ........... ........... ........... 49999................. T.............. ............... Abdomen surgery procedure....

0153 21.6961 $1,287.51 $382.75 $257.50 50010................. C.............. ............... Exploration of kidney........ ........... ........... ........... ........... ........... 50020................. T.............. ............... Renal abscess, open drain....

0162 23.3918 $1,388.14 ........... $277.63 50021................. T.............. ............... Renal abscess, percut drain..

0037 9.4751 $562.28 $224.91 $112.46 50040................. C.............. ............... Drainage of kidney........... ........... ........... ........... ........... ........... 50045................. C.............. ............... Exploration of kidney........ ........... ........... ........... ........... ........... 50060................. C.............. ............... Removal of kidney stone...... ........... ........... ........... ........... ........... 50065................. C.............. ............... Incision of kidney........... ........... ........... ........... ........... ........... 50070................. C.............. ............... Incision of kidney........... ........... ........... ........... ........... ........... 50075................. C.............. ............... Removal of kidney stone...... ........... ........... ........... ........... ........... 50080................. T.............. ............... Removal of kidney stone......

0429 42.3147 $2,511.08 ........... $502.22 50081................. T.............. ............... Removal of kidney stone......

0429 42.3147 $2,511.08 ........... $502.22 50100................. C.............. ............... Revise kidney blood vessels.. ........... ........... ........... ........... ........... 50120................. C.............. ............... Exploration of kidney........ ........... ........... ........... ........... ........... 50125................. C.............. ............... Explore and drain kidney..... ........... ........... ........... ........... ........... 50130................. C.............. ............... Removal of kidney stone...... ........... ........... ........... ........... ........... 50135................. C.............. ............... Exploration of kidney........ ........... ........... ........... ........... ........... 50200................. T.............. ............... Biopsy of kidney.............

0685 6.0174 $357.09 $115.47 $71.42 50205................. C.............. ............... Biopsy of kidney............. ........... ........... ........... ........... ........... 50220................. C.............. ............... Remove kidney, open.......... ........... ........... ........... ........... ........... 50225................. C.............. ............... Removal kidney open, complex. ........... ........... ........... ........... ........... 50230................. C.............. ............... Removal kidney open, radical. ........... ........... ........... ........... ........... 50234................. C.............. ............... Removal of kidney & ureter... ........... ........... ........... ........... ........... 50236................. C.............. ............... Removal of kidney & ureter... ........... ........... ........... ........... ........... 50240................. C.............. ............... Partial removal of kidney.... ........... ........... ........... ........... ........... 50280................. C.............. ............... Removal of kidney lesion..... ........... ........... ........... ........... ........... 50290................. C.............. ............... Removal of kidney lesion..... ........... ........... ........... ........... ........... 50300................. C.............. ............... Removal of donor kidney...... ........... ........... ........... ........... ........... 50320................. C.............. ............... Removal of donor kidney...... ........... ........... ........... ........... ........... 50323................. C.............. ............... Prep cadaver renal allograft. ........... ........... ........... ........... ........... 50325................. C.............. ............... Prep donor renal graft....... ........... ........... ........... ........... ........... 50327................. C.............. ............... Prep renal graft/venous...... ........... ........... ........... ........... ........... 50328................. C.............. ............... Prep renal graft/arterial.... ........... ........... ........... ........... ........... 50329................. C.............. ............... Prep renal graft/ureteral.... ........... ........... ........... ........... ........... 50340................. C.............. ............... Removal of kidney............ ........... ........... ........... ........... ........... 50360................. C.............. ............... Transplantation of kidney.... ........... ........... ........... ........... ........... 50365................. C.............. ............... Transplantation of kidney.... ........... ........... ........... ........... ........... 50370................. C.............. ............... Remove transplanted kidney... ........... ........... ........... ........... ........... 50380................. C.............. ............... Reimplantation of kidney..... ........... ........... ........... ........... ........... 50390................. T.............. ............... Drainage of kidney lesion....

0685 6.0174 $357.09 $115.47 $71.42 50391................. T.............. ............... Instll rx agnt into rnal tub.

0156 2.5751 $152.81 $40.52 $30.56 50392................. T.............. ............... Insert kidney drain..........

0161 18.5576 $1,101.26 $249.36 $220.25 50393................. T.............. ............... Insert ureteral tube.........

0161 18.5576 $1,101.26 $249.36 $220.25 50394................. N.............. ............... Injection for kidney x-ray... ........... ........... ........... ........... ........... 50395................. T.............. ............... Create passage to kidney.....

0161 18.5576 $1,101.26 $249.36 $220.25 50396................. T.............. ............... Measure kidney pressure......

0164 1.1855 $70.35 $17.29 $14.07 50398................. T.............. ............... Change kidney tube...........

0122 6.9721 $413.75 $84.85 $82.75 50400................. C.............. ............... Revision of kidney/ureter.... ........... ........... ........... ........... ........... 50405................. C.............. ............... Revision of kidney/ureter.... ........... ........... ........... ........... ........... 50500................. C.............. ............... Repair of kidney wound....... ........... ........... ........... ........... ...........

[[Page 50758]]

50520................. C.............. ............... Close kidney-skin fistula.... ........... ........... ........... ........... ........... 50525................. C.............. ............... Repair renal-abdomen fistula. ........... ........... ........... ........... ........... 50526................. C.............. ............... Repair renal-abdomen fistula. ........... ........... ........... ........... ........... 50540................. C.............. ............... Revision of horseshoe kidney. ........... ........... ........... ........... ........... 50541................. T.............. ............... Laparo ablate renal cyst.....

0130 31.9271 $1,894.65 $659.53 $378.93 50542................. T.............. ............... Laparo ablate renal mass.....

0131 43.3389 $2,571.86 $1,001.89 $514.37 50543................. T.............. ............... Laparo partial nephrectomy...

0131 43.3389 $2,571.86 $1,001.89 $514.37 50544................. T.............. ............... Laparoscopy, pyeloplasty.....

0130 31.9271 $1,894.65 $659.53 $378.93 50545................. C.............. ............... Laparo radical nephrectomy... ........... ........... ........... ........... ........... 50546................. C.............. ............... Laparoscopic nephrectomy..... ........... ........... ........... ........... ........... 50547................. C.............. ............... Laparo removal donor kidney.. ........... ........... ........... ........... ........... 50548................. C.............. ............... Laparo remove w/ ureter...... ........... ........... ........... ........... ........... 50549................. T.............. ............... Laparoscope proc, renal......

0130 31.9271 $1,894.65 $659.53 $378.93 50551................. T.............. ............... Kidney endoscopy.............

0160 6.6753 $396.13 $105.06 $79.23 50553................. T.............. ............... Kidney endoscopy.............

0161 18.5576 $1,101.26 $249.36 $220.25 50555................. T.............. ............... Kidney endoscopy & biopsy....

0160 6.6753 $396.13 $105.06 $79.23 50557................. T.............. ............... Kidney endoscopy & treatment.

0162 23.3918 $1,388.14 ........... $277.63 50561................. T.............. ............... Kidney endoscopy & treatment.

0161 18.5576 $1,101.26 $249.36 $220.25 50562................. T.............. ............... Renal scope w/tumor resect...

0160 6.6753 $396.13 $105.06 $79.23 50570................. T.............. ............... Kidney endoscopy.............

0160 6.6753 $396.13 $105.06 $79.23 50572................. T.............. ............... Kidney endoscopy.............

0160 6.6753 $396.13 $105.06 $79.23 50574................. T.............. ............... Kidney endoscopy & biopsy....

0160 6.6753 $396.13 $105.06 $79.23 50575................. T.............. ............... Kidney endoscopy.............

0163 33.7354 $2,001.96 ........... $400.39 50576................. T.............. ............... Kidney endoscopy & treatment.

0161 18.5576 $1,101.26 $249.36 $220.25 50580................. C.............. ............... Kidney endoscopy & treatment. ........... ........... ........... ........... ........... 50590................. T.............. ............... Fragmenting of kidney stone..

0169 43.0133 $2,552.54 $1,021.01 $510.51 50600................. C.............. ............... Exploration of ureter........ ........... ........... ........... ........... ........... 50605................. C.............. ............... Insert ureteral support...... ........... ........... ........... ........... ........... 50610................. C.............. ............... Removal of ureter stone...... ........... ........... ........... ........... ........... 50620................. C.............. ............... Removal of ureter stone...... ........... ........... ........... ........... ........... 50630................. C.............. ............... Removal of ureter stone...... ........... ........... ........... ........... ........... 50650................. C.............. ............... Removal of ureter............ ........... ........... ........... ........... ........... 50660................. C.............. ............... Removal of ureter............ ........... ........... ........... ........... ........... 50684................. N.............. ............... Injection for ureter x-ray... ........... ........... ........... ........... ........... 50686................. T.............. ............... Measure ureter pressure......

0164 1.1855 $70.35 $17.29 $14.07 50688................. T.............. ............... Change of ureter tube........

0122 6.9721 $413.75 $84.85 $82.75 50690................. N.............. ............... Injection for ureter x-ray... ........... ........... ........... ........... ........... 50700................. C.............. ............... Revision of ureter........... ........... ........... ........... ........... ........... 50715................. C.............. ............... Release of ureter............ ........... ........... ........... ........... ........... 50722................. C.............. ............... Release of ureter............ ........... ........... ........... ........... ........... 50725................. C.............. ............... Release/revise ureter........ ........... ........... ........... ........... ........... 50727................. C.............. ............... Revise ureter................ ........... ........... ........... ........... ........... 50728................. C.............. ............... Revise ureter................ ........... ........... ........... ........... ........... 50740................. C.............. ............... Fusion of ureter & kidney.... ........... ........... ........... ........... ........... 50750................. C.............. ............... Fusion of ureter & kidney.... ........... ........... ........... ........... ........... 50760................. C.............. ............... Fusion of ureters............ ........... ........... ........... ........... ........... 50770................. C.............. ............... Splicing of ureters.......... ........... ........... ........... ........... ........... 50780................. C.............. ............... Reimplant ureter in bladder.. ........... ........... ........... ........... ........... 50782................. C.............. ............... Reimplant ureter in bladder.. ........... ........... ........... ........... ........... 50783................. C.............. ............... Reimplant ureter in bladder.. ........... ........... ........... ........... ........... 50785................. C.............. ............... Reimplant ureter in bladder.. ........... ........... ........... ........... ........... 50800................. C.............. ............... Implant ureter in bowel...... ........... ........... ........... ........... ........... 50810................. C.............. ............... Fusion of ureter & bowel..... ........... ........... ........... ........... ........... 50815................. C.............. ............... Urine shunt to intestine..... ........... ........... ........... ........... ........... 50820................. C.............. ............... Construct bowel bladder...... ........... ........... ........... ........... ........... 50825................. C.............. ............... Construct bowel bladder...... ........... ........... ........... ........... ........... 50830................. C.............. ............... Revise urine flow............ ........... ........... ........... ........... ........... 50840................. C.............. ............... Replace ureter by bowel...... ........... ........... ........... ........... ........... 50845................. C.............. ............... Appendico-vesicostomy........ ........... ........... ........... ........... ........... 50860................. C.............. ............... Transplant ureter to skin.... ........... ........... ........... ........... ........... 50900................. C.............. ............... Repair of ureter............. ........... ........... ........... ........... ........... 50920................. C.............. ............... Closure ureter/skin fistula.. ........... ........... ........... ........... ........... 50930................. C.............. ............... Closure ureter/bowel fistula. ........... ........... ........... ........... ........... 50940................. C.............. ............... Release of ureter............ ........... ........... ........... ........... ........... 50945................. T.............. ............... Laparoscopy ureterolithotomy.

0131 43.3389 $2,571.86 $1,001.89 $514.37 50947................. T.............. ............... Laparo new ureter/bladder....

0131 43.3389 $2,571.86 $1,001.89 $514.37

[[Page 50759]]

50948................. T.............. ............... Laparo new ureter/bladder....

0131 43.3389 $2,571.86 $1,001.89 $514.37 50949................. T.............. ............... Laparoscope proc, ureter.....

0130 31.9271 $1,894.65 $659.53 $378.93 50951................. T.............. ............... Endoscopy of ureter..........

0160 6.6753 $396.13 $105.06 $79.23 50953................. T.............. ............... Endoscopy of ureter..........

0160 6.6753 $396.13 $105.06 $79.23 50955................. T.............. ............... Ureter endoscopy & biopsy....

0161 18.5576 $1,101.26 $249.36 $220.25 50957................. T.............. ............... Ureter endoscopy & treatment.

0161 18.5576 $1,101.26 $249.36 $220.25 50961................. T.............. ............... Ureter endoscopy & treatment.

0161 18.5576 $1,101.26 $249.36 $220.25 50970................. T.............. ............... Ureter endoscopy.............

0160 6.6753 $396.13 $105.06 $79.23 50972................. T.............. ............... Ureter endoscopy & catheter..

0160 6.6753 $396.13 $105.06 $79.23 50974................. T.............. ............... Ureter endoscopy & biopsy....

0161 18.5576 $1,101.26 $249.36 $220.25 50976................. T.............. ............... Ureter endoscopy & treatment.

0161 18.5576 $1,101.26 $249.36 $220.25 50980................. T.............. ............... Ureter endoscopy & treatment.

0161 18.5576 $1,101.26 $249.36 $220.25 51000................. T.............. ............... Drainage of bladder..........

0164 1.1855 $70.35 $17.29 $14.07 51005................. T.............. ............... Drainage of bladder..........

0164 1.1855 $70.35 $17.29 $14.07 51010................. T.............. ............... Drainage of bladder..........

0165 16.6689 $989.18 ........... $197.84 51020................. T.............. ............... Incise & treat bladder.......

0162 23.3918 $1,388.14 ........... $277.63 51030................. T.............. ............... Incise & treat bladder.......

0162 23.3918 $1,388.14 ........... $277.63 51040................. T.............. ............... Incise & drain bladder.......

0162 23.3918 $1,388.14 ........... $277.63 51045................. T.............. ............... Incise bladder/drain ureter..

0160 6.6753 $396.13 $105.06 $79.23 51050................. T.............. ............... Removal of bladder stone.....

0162 23.3918 $1,388.14 ........... $277.63 51060................. C.............. ............... Removal of ureter stone...... ........... ........... ........... ........... ........... 51065................. T.............. ............... Remove ureter calculus.......

0162 23.3918 $1,388.14 ........... $277.63 51080................. T.............. ............... Drainage of bladder abscess..

0008 16.4989 $979.09 ........... $195.82 51500................. T.............. ............... Removal of bladder cyst......

0154 28.7847 $1,708.17 $464.85 $341.63 51520................. T.............. ............... Removal of bladder lesion....

0162 23.3918 $1,388.14 ........... $277.63 51525................. C.............. ............... Removal of bladder lesion.... ........... ........... ........... ........... ........... 51530................. C.............. ............... Removal of bladder lesion.... ........... ........... ........... ........... ........... 51535................. C.............. ............... Repair of ureter lesion...... ........... ........... ........... ........... ........... 51550................. C.............. ............... Partial removal of bladder... ........... ........... ........... ........... ........... 51555................. C.............. ............... Partial removal of bladder... ........... ........... ........... ........... ........... 51565................. C.............. ............... Revise bladder & ureter(s)... ........... ........... ........... ........... ........... 51570................. C.............. ............... Removal of bladder........... ........... ........... ........... ........... ........... 51575................. C.............. ............... Removal of bladder & nodes... ........... ........... ........... ........... ........... 51580................. C.............. ............... Remove bladder/revise tract.. ........... ........... ........... ........... ........... 51585................. C.............. ............... Removal of bladder & nodes... ........... ........... ........... ........... ........... 51590................. C.............. ............... Remove bladder/revise tract.. ........... ........... ........... ........... ........... 51595................. C.............. ............... Remove bladder/revise tract.. ........... ........... ........... ........... ........... 51596................. C.............. ............... Remove bladder/create pouch.. ........... ........... ........... ........... ........... 51597................. C.............. ............... Removal of pelvic structures. ........... ........... ........... ........... ........... 51600................. N.............. ............... Injection for bladder x-ray.. ........... ........... ........... ........... ........... 51605................. N.............. ............... Preparation for bladder xray. ........... ........... ........... ........... ........... 51610................. N.............. ............... Injection for bladder x-ray.. ........... ........... ........... ........... ........... 51700................. T.............. ............... Irrigation of bladder........

0164 1.1855 $70.35 $17.29 $14.07 51701................. X.............. ............... Insert bladder catheter......

0340 0.6384 $37.88 ...........

$7.58 51702................. X.............. ............... Insert temp bladder cath.....

0340 0.6384 $37.88 ...........

$7.58 51703................. T.............. ............... Insert bladder cath, complex.

0164 1.1855 $70.35 $17.29 $14.07 51705................. T.............. ............... Change of bladder tube.......

0121 2.2766 $135.10 $43.80 $27.02 51710................. T.............. ............... Change of bladder tube.......

0122 6.9721 $413.75 $84.85 $82.75 51715................. T.............. ............... Endoscopic injection/implant.

0168 28.2685 $1,677.54 $388.03 $335.51 51720................. T.............. ............... Treatment of bladder lesion..

0156 2.5751 $152.81 $40.52 $30.56 51725................. T.............. ............... Simple cystometrogram........

0156 2.5751 $152.81 $40.52 $30.56 51726................. T.............. ............... Complex cystometrogram.......

0156 2.5751 $152.81 $40.52 $30.56 51736................. T.............. ............... Urine flow measurement.......

0164 1.1855 $70.35 $17.29 $14.07 51741................. T.............. ............... Electro-uroflowmetry, first..

0164 1.1855 $70.35 $17.29 $14.07 51772................. T.............. ............... Urethra pressure profile.....

0156 2.5751 $152.81 $40.52 $30.56 51784................. T.............. ............... Anal/urinary muscle study....

0164 1.1855 $70.35 $17.29 $14.07 51785................. T.............. ............... Anal/urinary muscle study....

0164 1.1855 $70.35 $17.29 $14.07 51792................. T.............. ............... Urinary reflex study.........

0164 1.1855 $70.35 $17.29 $14.07 51795................. T.............. ............... Urine voiding pressure study.

0164 1.1855 $70.35 $17.29 $14.07 51797................. T.............. ............... Intraabdominal pressure test.

0164 1.1855 $70.35 $17.29 $14.07 51798................. X.............. ............... Us urine capacity measure....

0340 0.6384 $37.88 ...........

$7.58 51800................. C.............. ............... Revision of bladder/urethra.. ........... ........... ........... ........... ........... 51820................. C.............. ............... Revision of urinary tract.... ........... ........... ........... ........... ........... 51840................. C.............. ............... Attach bladder/urethra....... ........... ........... ........... ........... ........... 51841................. C.............. ............... Attach bladder/urethra....... ........... ........... ........... ........... ........... 51845................. C.............. ............... Repair bladder neck.......... ........... ........... ........... ........... ...........

[[Page 50760]]

51860................. C.............. ............... Repair of bladder wound...... ........... ........... ........... ........... ........... 51865................. C.............. ............... Repair of bladder wound...... ........... ........... ........... ........... ........... 51880................. T.............. ............... Repair of bladder opening....

0162 23.3918 $1,388.14 ........... $277.63 51900................. C.............. ............... Repair bladder/vagina lesion. ........... ........... ........... ........... ........... 51920................. C.............. ............... Close bladder-uterus fistula. ........... ........... ........... ........... ........... 51925................. C.............. ............... Hysterectomy/bladder repair.. ........... ........... ........... ........... ........... 51940................. C.............. ............... Correction of bladder defect. ........... ........... ........... ........... ........... 51960................. C.............. ............... Revision of bladder & bowel.. ........... ........... ........... ........... ........... 51980................. C.............. ............... Construct bladder opening.... ........... ........... ........... ........... ........... 51990................. T.............. ............... Laparo urethral suspension...

0131 43.3389 $2,571.86 $1,001.89 $514.37 51992................. T.............. ............... Laparo sling operation.......

0132 62.9914 $3,738.10 $1,239.22 $747.62 52000................. T.............. ............... Cystoscopy...................

0160 6.6753 $396.13 $105.06 $79.23 52001................. T.............. ............... Cystoscopy, removal of clots.

0160 6.6753 $396.13 $105.06 $79.23 52005................. T.............. ............... Cystoscopy & ureter catheter.

0161 18.5576 $1,101.26 $249.36 $220.25 52007................. T.............. ............... Cystoscopy and biopsy........

0161 18.5576 $1,101.26 $249.36 $220.25 52010................. T.............. ............... Cystoscopy & duct catheter...

0160 6.6753 $396.13 $105.06 $79.23 52204................. T.............. ............... Cystoscopy...................

0161 18.5576 $1,101.26 $249.36 $220.25 52214................. T.............. ............... Cystoscopy and treatment.....

0162 23.3918 $1,388.14 ........... $277.63 52224................. T.............. ............... Cystoscopy and treatment.....

0162 23.3918 $1,388.14 ........... $277.63 52234................. T.............. ............... Cystoscopy and treatment.....

0162 23.3918 $1,388.14 ........... $277.63 52235................. T.............. ............... Cystoscopy and treatment.....

0162 23.3918 $1,388.14 ........... $277.63 52240................. T.............. ............... Cystoscopy and treatment.....

0162 23.3918 $1,388.14 ........... $277.63 52250................. T.............. ............... Cystoscopy and radiotracer...

0162 23.3918 $1,388.14 ........... $277.63 52260................. T.............. ............... Cystoscopy and treatment.....

0161 18.5576 $1,101.26 $249.36 $220.25 52265................. T.............. ............... Cystoscopy and treatment.....

0160 6.6753 $396.13 $105.06 $79.23 52270................. T.............. ............... Cystoscopy & revise urethra..

0161 18.5576 $1,101.26 $249.36 $220.25 52275................. T.............. ............... Cystoscopy & revise urethra..

0161 18.5576 $1,101.26 $249.36 $220.25 52276................. T.............. ............... Cystoscopy and treatment.....

0161 18.5576 $1,101.26 $249.36 $220.25 52277................. T.............. ............... Cystoscopy and treatment.....

0162 23.3918 $1,388.14 ........... $277.63 52281................. T.............. ............... Cystoscopy and treatment.....

0161 18.5576 $1,101.26 $249.36 $220.25 52282................. T.............. ............... Cystoscopy, implant stent....

0163 33.7354 $2,001.96 ........... $400.39 52283................. T.............. ............... Cystoscopy and treatment.....

0161 18.5576 $1,101.26 $249.36 $220.25 52285................. T.............. ............... Cystoscopy and treatment.....

0161 18.5576 $1,101.26 $249.36 $220.25 52290................. T.............. ............... Cystoscopy and treatment.....

0161 18.5576 $1,101.26 $249.36 $220.25 52300................. T.............. ............... Cystoscopy and treatment.....

0161 18.5576 $1,101.26 $249.36 $220.25 52301................. T.............. ............... Cystoscopy and treatment.....

0161 18.5576 $1,101.26 $249.36 $220.25 52305................. T.............. ............... Cystoscopy and treatment.....

0161 18.5576 $1,101.26 $249.36 $220.25 52310................. T.............. ............... Cystoscopy and treatment.....

0160 6.6753 $396.13 $105.06 $79.23 52315................. T.............. ............... Cystoscopy and treatment.....

0161 18.5576 $1,101.26 $249.36 $220.25 52317................. T.............. ............... Remove bladder stone.........

0162 23.3918 $1,388.14 ........... $277.63 52318................. T.............. ............... Remove bladder stone.........

0162 23.3918 $1,388.14 ........... $277.63 52320................. T.............. ............... Cystoscopy and treatment.....

0162 23.3918 $1,388.14 ........... $277.63 52325................. T.............. ............... Cystoscopy, stone removal....

0162 23.3918 $1,388.14 ........... $277.63 52327................. T.............. ............... Cystoscopy, inject material..

0162 23.3918 $1,388.14 ........... $277.63 52330................. T.............. ............... Cystoscopy and treatment.....

0162 23.3918 $1,388.14 ........... $277.63 52332................. T.............. ............... Cystoscopy and treatment.....

0162 23.3918 $1,388.14 ........... $277.63 52334................. T.............. ............... Create passage to kidney.....

0162 23.3918 $1,388.14 ........... $277.63 52341................. T.............. ............... Cysto w/ureter stricture tx..

0162 23.3918 $1,388.14 ........... $277.63 52342................. T.............. ............... Cysto w/up stricture tx......

0162 23.3918 $1,388.14 ........... $277.63 52343................. T.............. ............... Cysto w/renal stricture tx...

0162 23.3918 $1,388.14 ........... $277.63 52344................. T.............. ............... Cysto/uretero, stone remove..

0162 23.3918 $1,388.14 ........... $277.63 52345................. T.............. ............... Cysto/uretero w/up stricture.

0162 23.3918 $1,388.14 ........... $277.63 52346................. T.............. ............... Cystouretero w/renal strict..

0162 23.3918 $1,388.14 ........... $277.63 52351................. T.............. ............... Cystouretero & or pyeloscope.

0161 18.5576 $1,101.26 $249.36 $220.25 52352................. T.............. ............... Cystouretero w/stone remove..

0162 23.3918 $1,388.14 ........... $277.63 52353................. T.............. ............... Cystouretero w/lithotripsy...

0163 33.7354 $2,001.96 ........... $400.39 52354................. T.............. ............... Cystouretero w/biopsy........

0162 23.3918 $1,388.14 ........... $277.63 52355................. T.............. ............... Cystouretero w/excise tumor..

0162 23.3918 $1,388.14 ........... $277.63 52400................. T.............. ............... Cystouretero w/congen repr...

0162 23.3918 $1,388.14 ........... $277.63 52402................. T.............. ............... Cystourethro cut ejacul duct.

0162 23.3918 $1,388.14 ........... $277.63 52450................. T.............. ............... Incision of prostate.........

0162 23.3918 $1,388.14 ........... $277.63 52500................. T.............. ............... Revision of bladder neck.....

0162 23.3918 $1,388.14 ........... $277.63 52510................. T.............. ............... Dilation prostatic urethra...

0161 18.5576 $1,101.26 $249.36 $220.25 52601................. T.............. ............... Prostatectomy (TURP).........

0163 33.7354 $2,001.96 ........... $400.39 52606................. T.............. ............... Control postop bleeding......

0162 23.3918 $1,388.14 ........... $277.63 52612................. T.............. ............... Prostatectomy, first stage...

0163 33.7354 $2,001.96 ........... $400.39

[[Page 50761]]

52614................. T.............. ............... Prostatectomy, second stage..

0163 33.7354 $2,001.96 ........... $400.39 52620................. T.............. ............... Remove residual prostate.....

0163 33.7354 $2,001.96 ........... $400.39 52630................. T.............. ............... Remove prostate regrowth.....

0163 33.7354 $2,001.96 ........... $400.39 52640................. T.............. ............... Relieve bladder contracture..

0162 23.3918 $1,388.14 ........... $277.63 52647................. T.............. ............... Laser surgery of prostate....

0429 42.3147 $2,511.08 ........... $502.22 52648................. T.............. ............... Laser surgery of prostate....

0429 42.3147 $2,511.08 ........... $502.22 52700................. T.............. ............... Drainage of prostate abscess.

0162 23.3918 $1,388.14 ........... $277.63 53000................. T.............. ............... Incision of urethra..........

0166 17.6743 $1,048.85 $218.73 $209.77 53010................. T.............. ............... Incision of urethra..........

0166 17.6743 $1,048.85 $218.73 $209.77 53020................. T.............. ............... Incision of urethra..........

0166 17.6743 $1,048.85 $218.73 $209.77 53025................. T.............. ............... Incision of urethra..........

0166 17.6743 $1,048.85 $218.73 $209.77 53040................. T.............. ............... Drainage of urethra abscess..

0166 17.6743 $1,048.85 $218.73 $209.77 53060................. T.............. ............... Drainage of urethra abscess..

0166 17.6743 $1,048.85 $218.73 $209.77 53080................. T.............. ............... Drainage of urinary leakage..

0166 17.6743 $1,048.85 $218.73 $209.77 53085................. T.............. ............... Drainage of urinary leakage..

0166 17.6743 $1,048.85 $218.73 $209.77 53200................. T.............. ............... Biopsy of urethra............

0166 17.6743 $1,048.85 $218.73 $209.77 53210................. T.............. ............... Removal of urethra...........

0168 28.2685 $1,677.54 $388.03 $335.51 53215................. T.............. ............... Removal of urethra...........

0166 17.6743 $1,048.85 $218.73 $209.77 53220................. T.............. ............... Treatment of urethra lesion..

0168 28.2685 $1,677.54 $388.03 $335.51 53230................. T.............. ............... Removal of urethra lesion....

0168 28.2685 $1,677.54 $388.03 $335.51 53235................. T.............. ............... Removal of urethra lesion....

0166 17.6743 $1,048.85 $218.73 $209.77 53240................. T.............. ............... Surgery for urethra pouch....

0168 28.2685 $1,677.54 $388.03 $335.51 53250................. T.............. ............... Removal of urethra gland.....

0166 17.6743 $1,048.85 $218.73 $209.77 53260................. T.............. ............... Treatment of urethra lesion..

0166 17.6743 $1,048.85 $218.73 $209.77 53265................. T.............. ............... Treatment of urethra lesion..

0166 17.6743 $1,048.85 $218.73 $209.77 53270................. T.............. ............... Removal of urethra gland.....

0166 17.6743 $1,048.85 $218.73 $209.77 53275................. T.............. ............... Repair of urethra defect.....

0166 17.6743 $1,048.85 $218.73 $209.77 53400................. T.............. ............... Revise urethra, stage 1......

0168 28.2685 $1,677.54 $388.03 $335.51 53405................. T.............. ............... Revise urethra, stage 2......

0168 128.2685 $1,677.54 $388.03 $335.51 53410................. T.............. ............... Reconstruction of urethra....

0168 28.2685 $1,677.54 $388.03 $335.51 53415................. C.............. ............... Reconstruction of urethra.... ........... ........... ........... ........... ........... 53420................. T.............. ............... Reconstruct urethra, stage 1.

0168 28.2685 $1,677.54 $388.03 $335.51 53425................. T.............. ............... Reconstruct urethra, stage 2.

0168 28.2685 $1,677.54 $388.03 $335.51 53430................. T.............. ............... Reconstruction of urethra....

0168 28.2685 $1,677.54 $388.03 $335.51 53431................. T.............. ............... Reconstruct urethra/bladder..

0168 28.2685 $1,677.54 $388.03 $335.51 53440................. S.............. ............... Correct bladder function.....

0385 75.6446 $4,488.98 ........... $897.80 53442................. T.............. ............... Remove perineal prosthesis...

0168 28.2685 $1,677.54 $388.03 $335.51 53444................. S.............. ............... Insert tandem cuff...........

0385 75.6446 $4,488.98 ........... $897.80 53445................. S.............. ............... Insert uro/ves nck sphincter.

0386 120.1694 $7,131.21 ........... $1,426.24 53446................. T.............. ............... Remove uro sphincter.........

0168 28.2685 $1,677.54 $388.03 $335.51 53447................. S.............. ............... Remove/replace ur sphincter..

0386 120.1694 $7,131.21 ........... $1,426.24 53448................. C.............. ............... Remov/replc ur sphinctr comp. ........... ........... ........... ........... ........... 53449................. T.............. ............... Repair uro sphincter.........

0168 28.2685 $1,677.54 $388.03 $335.51 53450................. T.............. ............... Revision of urethra..........

0168 28.2685 $1,677.54 $388.03 $335.51 53460................. T.............. ............... Revision of urethra..........

0166 17.6743 $1,048.85 $218.73 $209.77 53500................. T.............. ............... Urethrlys, transvag w/ scope.

0168 28.2685 $1,677.54 $388.03 $335.51 53502................. T.............. ............... Repair of urethra injury.....

0166 17.6743 $1,048.85 $218.73 $209.77 53505................. T.............. ............... Repair of urethra injury.....

0168 28.2685 $1,677.54 $388.03 $335.51 53510................. T.............. ............... Repair of urethra injury.....

0166 17.6743 $1,048.85 $218.73 $209.77 53515................. T.............. ............... Repair of urethra injury.....

0168 28.2685 $1,677.54 $388.03 $335.51 53520................. T.............. ............... Repair of urethra defect.....

0168 28.2685 $1,677.54 $388.03 $335.51 53600................. T.............. ............... Dilate urethra stricture.....

0156 2.5751 $152.81 $40.52 $30.56 53601................. T.............. ............... Dilate urethra stricture.....

0164 1.1855 $70.35 $17.29 $14.07 53605................. T.............. ............... Dilate urethra stricture.....

0161 18.5576 $1,101.26 $249.36 $220.25 53620................. T.............. ............... Dilate urethra stricture.....

0165 16.6689 $989.18 ........... $197.84 53621................. T.............. ............... Dilate urethra stricture.....

0164 1.1855 $70.35 $17.29 $14.07 53660................. T.............. ............... Dilation of urethra..........

0164 1.1855 $70.35 $17.29 $14.07 53661................. T.............. ............... Dilation of urethra..........

0164 1.1855 $70.35 $17.29 $14.07 53665................. T.............. ............... Dilation of urethra..........

0166 17.6743 $1,048.85 $218.73 $209.77 53850................. T.............. ............... Prostatic microwave thermotx.

0675 43.7329 $2,595.24 ........... $519.05 53852................. T.............. ............... Prostatic rf thermotx........

0675 43.7329 $2,595.24 ........... $519.05 53853................. T.............. ............... Prostatic water thermother...

0162 23.3918 $1,388.14 ........... $277.63 53899................. T.............. ............... Urology surgery procedure....

0164 1.1855 $70.35 $17.29 $14.07 54000................. T.............. ............... Slitting of prepuce..........

0166 17.6743 $1,048.85 $218.73 $209.77 54001................. T.............. ............... Slitting of prepuce..........

0166 17.6743 $1,048.85 $218.73 $209.77 54015................. T.............. ............... Drain penis lesion...........

0008 16.4989 $979.09 ........... $195.82

[[Page 50762]]

54050................. T.............. ............... Destruction, penis lesion(s).

0013 1.1078 $65.74 $14.20 $13.15 54055................. T.............. ............... Destruction, penis lesion(s).

0017 18.4211 $1,093.16 $227.84 $218.63 54056................. T.............. ............... Cryosurgery, penis lesion(s).

0012 0.8497 $50.42 $11.18 $10.08 54057................. T.............. ............... Laser surg, penis lesion(s)..

0017 18.4211 $1,093.16 $227.84 $218.63 54060................. T.............. ............... Excision of penis lesion(s)..

0017 18.4211 $1,093.16 $227.84 $218.63 54065................. T.............. ............... Destruction, penis lesion(s).

0695 20.3164 $1,205.64 $266.59 $241.13 54100................. T.............. ............... Biopsy of penis..............

0021 14.9776 $888.82 $219.48 $177.76 54105................. T.............. ............... Biopsy of penis..............

0022 19.6472 $1,165.92 $354.45 $233.18 54110................. T.............. ............... Treatment of penis lesion....

0181 30.8663 $1,831.70 $621.82 $366.34 54111................. T.............. ............... Treat penis lesion, graft....

0181 30.8663 $1,831.70 $621.82 $366.34 54112................. T.............. ............... Treat penis lesion, graft....

0181 30.8663 $1,831.70 $621.82 $366.34 54115................. T.............. ............... Treatment of penis lesion....

0008 16.4989 $979.09 ........... $195.82 54120................. T.............. ............... Partial removal of penis.....

0181 30.8663 $1,831.70 $621.82 $366.34 54125................. C.............. ............... Removal of penis............. ........... ........... ........... ........... ........... 54130................. C.............. ............... Remove penis & nodes......... ........... ........... ........... ........... ........... 54135................. C.............. ............... Remove penis & nodes......... ........... ........... ........... ........... ........... 54150................. T.............. ............... Circumcision.................

0180 19.8827 $1,179.90 $304.87 $235.98 54152................. T.............. ............... Circumcision.................

0180 19.8827 $1,179.90 $304.87 $235.98 54160................. T.............. ............... Circumcision.................

0180 19.8827 $1,179.90 $304.87 $235.98 54161................. T.............. ............... Circumcision.................

0180 19.8827 $1,179.90 $304.87 $235.98 54162................. T.............. ............... Lysis penil circumic lesion..

0180 19.8827 $1,179.90 $304.87 $235.98 54163................. T.............. ............... Repair of circumcision.......

0180 19.8827 $1,179.90 $304.87 $235.98 54164................. T.............. ............... Frenulotomy of penis.........

0180 19.8827 $1,179.90 $304.87 $235.98 54200................. T.............. ............... Treatment of penis lesion....

0156 2.5751 $152.81 $40.52 $30.56 54205................. T.............. ............... Treatment of penis lesion....

0181 30.8663 $1,831.70 $621.82 $366.34 54220................. T.............. ............... Treatment of penis lesion....

0156 2.5751 $152.81 $40.52 $30.56 54230................. N.............. ............... Prepare penis study.......... ........... ........... ........... ........... ........... 54231................. T.............. ............... Dynamic cavernosometry.......

0165 16.6689 $989.18 ........... $197.84 54235................. T.............. ............... Penile injection.............

0164 1.1855 $70.35 $17.29 $14.07 54240................. T.............. ............... Penis study..................

0164 1.1855 $70.35 $17.29 $14.07 54250................. T.............. ............... Penis study..................

0164 1.1855 $70.35 $17.29 $14.07 54300................. T.............. ............... Revision of penis............

0181 30.8663 $1,831.70 $621.82 $366.34 54304................. T.............. ............... Revision of penis............

0181 30.8663 $1,831.70 $621.82 $366.34 54308................. T.............. ............... Reconstruction of urethra....

0181 30.8663 $1,831.70 $621.82 $366.34 54312................. T.............. ............... Reconstruction of urethra....

0181 30.8663 $1,831.70 $621.82 $366.34 54316................. T.............. ............... Reconstruction of urethra....

0181 30.8663 $1,831.70 $621.82 $366.34 54318................. T.............. ............... Reconstruction of urethra....

0181 30.8663 $1,831.70 $621.82 $366.34 54322................. T.............. ............... Reconstruction of urethra....

0181 30.8663 $1,831.70 $621.82 $366.34 54324................. T.............. ............... Reconstruction of urethra....

0181 30.8663 $1,831.70 $621.82 $366.34 54326................. T.............. ............... Reconstruction of urethra....

0181 30.8663 $1,831.70 $621.82 $366.34 54328................. T.............. ............... Revise penis/urethra.........

0181 30.8663 $1,831.70 $621.82 $366.34 54332................. C.............. ............... Revise penis/urethra......... ........... ........... ........... ........... ........... 54336................. C.............. ............... Revise penis/urethra......... ........... ........... ........... ........... ........... 54340................. T.............. ............... Secondary urethral surgery...

0181 30.8663 $1,831.70 $621.82 $366.34 54344................. T.............. ............... Secondary urethral surgery...

0181 30.8663 $1,831.70 $621.82 $366.34 54348................. T.............. ............... Secondary urethral surgery...

0181 30.8663 $1,831.70 $621.82 $366.34 54352................. T.............. ............... Reconstruct urethra/penis....

0181 30.8663 $1,831.70 $621.82 $366.34 54360................. T.............. ............... Penis plastic surgery........

0181 30.8663 $1,831.70 $621.82 $366.34 54380................. T.............. ............... Repair penis.................

0181 30.8663 $1,831.70 $621.82 $366.34 54385................. T.............. ............... Repair penis.................

0181 30.8663 $1,831.70 $621.82 $366.34 54390................. C.............. ............... Repair penis and bladder..... ........... ........... ........... ........... ........... 54400................. S.............. ............... Insert semi-rigid prosthesis.

0385 75.6446 $4,488.98 ........... $897.80 54401................. S.............. ............... Insert self-contd prosthesis.

0386 120.1694 $7,131.21 ........... $1,426.24 54405................. S.............. ............... Insert multi-comp penis pros.

0386 120.1694 $7,131.21 ........... $1,426.24 54406................. T.............. ............... Remove muti-comp penis pros..

0181 30.8663 $1,831.70 $621.82 $366.34 54408................. T.............. ............... Repair multi-comp penis pros.

0181 30.8663 $1,831.70 $621.82 $366.34 54410................. S.............. ............... Remove/replace penis prosth..

0386 120.1694 $7,131.21 ........... $1,426.24 54411................. C.............. ............... Remov/replc penis pros, comp. ........... ........... ........... ........... ........... 54415................. T.............. ............... Remove self-contd penis pros.

0181 30.8663 $1,831.70 $621.82 $366.34 54416................. S.............. ............... Remv/repl penis contain pros.

0386 120.1694 $7,131.21 ........... $1,426.24 54417................. C.............. ............... Remv/replc penis pros, compl. ........... ........... ........... ........... ........... 54420................. T.............. ............... Revision of penis............

0181 30.8663 $1,831.70 $621.82 $366.34 54430................. C.............. ............... Revision of penis............ ........... ........... ........... ........... ........... 54435................. T.............. ............... Revision of penis............

0181 30.8663 $1,831.70 $621.82 $366.34 54440................. T.............. ............... Repair of penis..............

0181 30.8663 $1,831.70 $621.82 $366.34 54450................. T.............. ............... Preputial stretching.........

0156 2.5751 $152.81 $40.52 $30.56

[[Page 50763]]

54500................. T.............. ............... Biopsy of testis.............

0037 9.4751 $562.28 $224.91 $112.46 54505................. T.............. ............... Biopsy of testis.............

0183 23.6415 $1,402.96 ........... $280.59 54512................. T.............. ............... Excise lesion testis.........

0183 23.6415 $1,402.96 ........... $280.59 54520................. T.............. ............... Removal of testis............

0183 23.6415 $1,402.96 ........... $280.59 54522................. T.............. ............... Orchiectomy, partial.........

0183 23.6415 $1,402.96 ........... $280.59 54530................. T.............. ............... Removal of testis............

0154 28.7847 $1,708.17 $464.85 $341.63 54535................. C.............. ............... Extensive testis surgery..... ........... ........... ........... ........... ........... 54550................. T.............. ............... Exploration for testis.......

0154 28.7847 $1,708.17 $464.85 $341.63 54560................. T.............. ............... Exploration for testis.......

0183 23.6415 $1,402.96 ........... $280.59 54600................. T.............. ............... Reduce testis torsion........

0183 23.6415 $1,402.96 ........... $280.59 54620................. T.............. ............... Suspension of testis.........

0183 23.6415 $1,402.96 ........... $280.59 54640................. T.............. ............... Suspension of testis.........

0154 28.7847 $1,708.17 $464.85 $341.63 54650................. C.............. ............... Orchiopexy (Fowler-Stephens). ........... ........... ........... ........... ........... 54660................. T.............. ............... Revision of testis...........

0183 23.6415 $1,402.96 ........... $280.59 54670................. T.............. ............... Repair testis injury.........

0183 23.6415 $1,402.96 ........... $280.59 54680................. T.............. ............... Relocation of testis(es).....

0183 23.6415 $1,402.96 ........... $280.59 54690................. T.............. ............... Laparoscopy, orchiectomy.....

0131 43.3389 $2,571.86 $1,001.89 $514.37 54692................. T.............. ............... Laparoscopy, orchiopexy......

0132 62.9914 $3,738.10 $1,239.22 $747.62 54699................. T.............. ............... Laparoscope proc, testis.....

0130 31.9271 $1,894.65 $659.53 $378.93 54700................. T.............. ............... Drainage of scrotum..........

0183 23.6415 $1,402.96 ........... $280.59 54800................. T.............. ............... Biopsy of epididymis.........

0004 1.7646 $104.72 $22.36 $20.94 54820................. T.............. ............... Exploration of epididymis....

0183 23.6415 $1,402.96 ........... $280.59 54830................. T.............. ............... Remove epididymis lesion.....

0183 23.6415 $1,402.96 ........... $280.59 54840................. T.............. ............... Remove epididymis lesion.....

0183 23.6415 $1,402.96 ........... $280.59 54860................. T.............. ............... Removal of epididymis........

0183 23.6415 $1,402.96 ........... $280.59 54861................. T.............. ............... Removal of epididymis........

0183 23.6415 $1,402.96 ........... $280.59 54900................. T.............. ............... Fusion of spermatic ducts....

0183 23.6415 $1,402.96 ........... $280.59 54901................. T.............. ............... Fusion of spermatic ducts....

0183 23.6415 $1,402.96 ........... $280.59 55000................. T.............. ............... Drainage of hydrocele........

0004 1.7646 $104.72 $22.36 $20.94 55040................. T.............. ............... Removal of hydrocele.........

0154 28.7847 $1,708.17 $464.85 $341.63 55041................. T.............. ............... Removal of hydroceles........

0154 28.7847 $1,708.17 $464.85 $341.63 55060................. T.............. ............... Repair of hydrocele..........

0183 23.6415 $1,402.96 ........... $280.59 55100................. T.............. ............... Drainage of scrotum abscess..

0008 16.4989 $979.09 ........... $195.82 55110................. T.............. ............... Explore scrotum..............

0183 23.6415 $1,402.96 ........... $280.59 55120................. T.............. ............... Removal of scrotum lesion....

0183 23.6415 $1,402.96 ........... $280.59 55150................. T.............. ............... Removal of scrotum...........

0183 23.6415 $1,402.96 ........... $280.59 55175................. T.............. ............... Revision of scrotum..........

0183 23.6415 $1,402.96 ........... $280.59 55180................. T.............. ............... Revision of scrotum..........

0183 23.6415 $1,402.96 ........... $280.59 55200................. T.............. ............... Incision of sperm duct.......

0183 23.6415 $1,402.96 ........... $280.59 55250................. T.............. ............... Removal of sperm duct(s).....

0183 23.6415 $1,402.96 ........... $280.59 55300................. N.............. ............... Prepare, sperm duct x-ray.... ........... ........... ........... ........... ........... 55400................. T.............. ............... Repair of sperm duct.........

0183 23.6415 $1,402.96 ........... $280.59 55450................. T.............. ............... Ligation of sperm duct.......

0183 23.6415 $1,402.96 ........... $280.59 55500................. T.............. ............... Removal of hydrocele.........

0183 23.6415 $1,402.96 ........... $280.59 55520................. T.............. ............... Removal of sperm cord lesion.

0183 23.6415 $1,402.96 ........... $280.59 55530................. T.............. ............... Revise spermatic cord veins..

0183 23.6415 $1,402.96 ........... $280.59 55535................. T.............. ............... Revise spermatic cord veins..

0154 28.7847 $1,708.17 $464.85 $341.63 55540................. T.............. ............... Revise hernia & sperm veins..

0154 28.7847 $1,708.17 $464.85 $341.63 55550................. T.............. ............... Laparo ligate spermatic vein.

0131 43.3389 $2,571.86 $1,001.89 $514.37 55559................. T.............. ............... Laparo proc, spermatic cord..

0130 31.9271 $1,894.65 $659.53 $378.93 55600................. T.............. ............... Incise sperm duct pouch......

0183 23.6415 $1,402.96 ........... $280.59 55605................. C.............. ............... Incise sperm duct pouch...... ........... ........... ........... ........... ........... 55650................. C.............. ............... Remove sperm duct pouch...... ........... ........... ........... ........... ........... 55680................. T.............. ............... Remove sperm pouch lesion....

0183 23.6415 $1,402.96 ........... $280.59 55700................. T.............. ............... Biopsy of prostate...........

0184 4.3566 $258.53 $96.27 $51.71 55705................. T.............. ............... Biopsy of prostate...........

0184 4.3566 $258.53 $96.27 $51.71 55720................. T.............. ............... Drainage of prostate abscess.

0162 23.3918 $1,388.14 ........... $277.63 55725................. T.............. ............... Drainage of prostate abscess.

0162 23.3918 $1,388.14 ........... $277.63 55801................. C.............. ............... Removal of prostate.......... ........... ........... ........... ........... ........... 55810................. C.............. ............... Extensive prostate surgery... ........... ........... ........... ........... ........... 55812................. C.............. ............... Extensive prostate surgery... ........... ........... ........... ........... ........... 55815................. C.............. ............... Extensive prostate surgery... ........... ........... ........... ........... ........... 55821................. C.............. ............... Removal of prostate.......... ........... ........... ........... ........... ........... 55831................. C.............. ............... Removal of prostate.......... ........... ........... ........... ........... ........... 55840................. C.............. ............... Extensive prostate surgery... ........... ........... ........... ........... ........... 55842................. C.............. ............... Extensive prostate surgery... ........... ........... ........... ........... ...........

[[Page 50764]]

55845................. C.............. ............... Extensive prostate surgery... ........... ........... ........... ........... ........... 55859................. T.............. ............... Percut/needle insert, pros...

0163 33.7354 $2,001.96 ........... $400.39 55860................. T.............. ............... Surgical exposure, prostate..

0165 16.6689 $989.18 ........... $197.84 55862................. C.............. ............... Extensive prostate surgery... ........... ........... ........... ........... ........... 55865................. C.............. ............... Extensive prostate surgery... ........... ........... ........... ........... ........... 55866................. C.............. ............... Laparo radical prostatectomy. ........... ........... ........... ........... ........... 55870................. T.............. ............... Electroejaculation...........

0197 2.3572 $139.88 ........... $27.98 55873................. T.............. ............... Cryoablate prostate..........

0674 95.7856 $5,684.20 ........... $1,136.84 55899................. T.............. ............... Genital surgery procedure....

0164 1.1855 $70.35 $17.29 $14.07 55970................. E.............. ............... Sex transformation, M to F... ........... ........... ........... ........... ........... 55980................. E.............. ............... Sex transformation, F to M... ........... ........... ........... ........... ........... 56405................. T.............. ............... I & D of vulva/perineum......

0189

2.371 $140.70 ........... $28.14 56420................. T.............. ............... Drainage of gland abscess....

0189

2.371 $140.70 ........... $28.14 56440................. T.............. ............... Surgery for vulva lesion.....

0194 20.7525 $1,231.52 $397.84 $246.30 56441................. T.............. ............... Lysis of labial lesion(s)....

0193 14.5843 $865.48 ........... $173.10 56501................. T.............. ............... Destroy, vulva lesions, sim..

0017 18.4211 $1,093.16 $227.84 $218.63 56515................. T.............. ............... Destroy vulva lesion/s compl.

0695 20.3164 $1,205.64 $266.59 $241.13 56605................. T.............. ............... Biopsy of vulva/perineum.....

0019 4.0547 $240.62 $71.87 $48.12 56606................. T.............. ............... Biopsy of vulva/perineum.....

0019 4.0547 $240.62 $71.87 $48.12 56620................. T.............. ............... Partial removal of vulva.....

0195 26.6791 $1,583.22 $483.80 $316.64 56625................. T.............. ............... Complete removal of vulva....

0195 26.6791 $1,583.22 $483.80 $316.64 56630................. C.............. ............... Extensive vulva surgery...... ........... ........... ........... ........... ........... 56631................. C.............. ............... Extensive vulva surgery...... ........... ........... ........... ........... ........... 56632................. C.............. ............... Extensive vulva surgery...... ........... ........... ........... ........... ........... 56633................. C.............. ............... Extensive vulva surgery...... ........... ........... ........... ........... ........... 56634................. C.............. ............... Extensive vulva surgery...... ........... ........... ........... ........... ........... 56637................. C.............. ............... Extensive vulva surgery...... ........... ........... ........... ........... ........... 56640................. C.............. ............... Extensive vulva surgery...... ........... ........... ........... ........... ........... 56700................. T.............. ............... Partial removal of hymen.....

0194 20.7525 $1,231.52 $397.84 $246.30 56720................. T.............. ............... Incision of hymen............

0193 14.5843 $865.48 ........... $173.10 56740................. T.............. ............... Remove vagina gland lesion...

0194 20.7525 $1,231.52 $397.84 $246.30 56800................. T.............. ............... Repair of vagina.............

0194 20.7525 $1,231.52 $397.84 $246.30 56805................. T.............. ............... Repair clitoris..............

0193 14.5843 $865.48 ........... $173.10 56810................. T.............. ............... Repair of perineum...........

0194 20.7525 $1,231.52 $397.84 $246.30 56820................. T.............. ............... Exam of vulva w/scope........

0188

1.14 $67.65 ........... $13.53 56821................. T.............. ............... Exam/biopsy of vulva w/scope.

0189

2.371 $140.70 ........... $28.14 57000................. T.............. ............... Exploration of vagina........

0193 14.5843 $865.48 ........... $173.10 57010................. T.............. ............... Drainage of pelvic abscess...

0193 14.5843 $865.48 ........... $173.10 57020................. T.............. ............... Drainage of pelvic fluid.....

0192 4.3082 $255.66 ........... $51.13 57022................. T.............. ............... I & d vaginal hematoma, pp...

0007 11.4501 $679.48 ........... $135.90 57023................. T.............. ............... I & d vag hematoma, non-ob...

0008 16.4989 $979.09 ........... $195.82 57061................. T.............. ............... Destroy vag lesions, simple..

0194 20.7525 $1,231.52 $397.84 $246.30 57065................. T.............. ............... Destroy vag lesions, complex.

0194 20.7525 $1,231.52 $397.84 $246.30 57100................. T.............. ............... Biopsy of vagina.............

0192 4.3082 $255.66 ........... $51.13 57105................. T.............. ............... Biopsy of vagina.............

0194 20.7525 $1,231.52 $397.84 $246.30 57106................. T.............. ............... Remove vagina wall, partial..

0194 20.7525 $1,231.52 $397.84 $246.30 57107................. T.............. ............... Remove vagina tissue, part...

0195 26.6791 $1,583.22 $483.80 $316.64 57109................. T.............. ............... Vaginectomy partial w/nodes..

0195 26.6791 $1,583.22 $483.80 $316.64 57110................. C.............. ............... Remove vagina wall, complete. ........... ........... ........... ........... ........... 57111................. C.............. ............... Remove vagina tissue, compl.. ........... ........... ........... ........... ........... 57112................. C.............. ............... Vaginectomy w/nodes, compl... ........... ........... ........... ........... ........... 57120................. T.............. ............... Closure of vagina............

0195 26.6791 $1,583.22 $483.80 $316.64 57130................. T.............. ............... Remove vagina lesion.........

0194 20.7525 $1,231.52 $397.84 $246.30 57135................. T.............. ............... Remove vagina lesion.........

0194 20.7525 $1,231.52 $397.84 $246.30 57150................. T.............. ............... Treat vagina infection.......

0191

0.167

$9.91

$2.78

$1.98 57155................. T.............. ............... Insert uteri tandems/ovoids..

0192 4.3082 $255.66 ........... $51.13 57160................. T.............. ............... Insert pessary/other device..

0188

1.14 $67.65 ........... $13.53 57170................. T.............. ............... Fitting of diaphragm/cap.....

0191

0.167

$9.91

$2.78

$1.98 57180................. T.............. ............... Treat vaginal bleeding.......

0189

2.371 $140.70 ........... $28.14 57200................. T.............. ............... Repair of vagina.............

0194 20.7525 $1,231.52 $397.84 $246.30 57210................. T.............. ............... Repair vagina/perineum.......

0194 20.7525 $1,231.52 $397.84 $246.30 57220................. T.............. ............... Revision of urethra..........

0202 40.3866 $2,396.66 $958.66 $479.33 57230................. T.............. ............... Repair of urethral lesion....

0195 26.6791 $1,583.22 $483.80 $316.64 57240................. T.............. ............... Repair bladder & vagina......

0195 26.6791 $1,583.22 $483.80 $316.64 57250................. T.............. ............... Repair rectum & vagina.......

0195 26.6791 $1,583.22 $483.80 $316.64 57260................. T.............. ............... Repair of vagina.............

0195 26.6791 $1,583.22 $483.80 $316.64

[[Page 50765]]

57265................. T.............. ............... Extensive repair of vagina...

0202 40.3866 $2,396.66 $958.66 $479.33 57267................. T.............. ............... Insert mesh/pelvic flr addon.

0154 28.7847 $1,708.17 $464.85 $341.63 57268................. T.............. ............... Repair of bowel bulge........

0195 26.6791 $1,583.22 $483.80 $316.64 57270................. C.............. ............... Repair of bowel pouch........ ........... ........... ........... ........... ........... 57280................. C.............. ............... Suspension of vagina......... ........... ........... ........... ........... ........... 57282................. C.............. ............... Repair of vaginal prolapse... ........... ........... ........... ........... ........... 57283................. C.............. ............... Colpopexy, intraperitoneal... ........... ........... ........... ........... ........... 57284................. T.............. ............... Repair paravaginal defect....

0202 40.3866 $2,396.66 $958.66 $479.33 57287................. T.............. ............... Revise/remove sling repair...

0202 40.3866 $2,396.66 $958.66 $479.33 57288................. T.............. ............... Repair bladder defect........

0202 40.3866 $2,396.66 $958.66 $479.33 57289................. T.............. ............... Repair bladder & vagina......

0195 26.6791 $1,583.22 $483.80 $316.64 57291................. T.............. ............... Construction of vagina.......

0195 26.6791 $1,583.22 $483.80 $316.64 57292................. C.............. ............... Construct vagina with graft.. ........... ........... ........... ........... ........... 57300................. T.............. ............... Repair rectum-vagina fistula.

0195 26.6791 $1,583.22 $483.80 $316.64 57305................. C.............. ............... Repair rectum-vagina fistula. ........... ........... ........... ........... ........... 57307................. C.............. ............... Fistula repair & colostomy... ........... ........... ........... ........... ........... 57308................. C.............. ............... Fistula repair, transperine.. ........... ........... ........... ........... ........... 57310................. T.............. ............... Repair urethrovaginal lesion.

0202 40.3866 $2,396.66 $958.66 $479.33 57311................. C.............. ............... Repair urethrovaginal lesion. ........... ........... ........... ........... ........... 57320................. T.............. ............... Repair bladder-vagina lesion.

0195 26.6791 $1,583.22 $483.80 $316.64 57330................. T.............. ............... Repair bladder-vagina lesion.

0195 26.6791 $1,583.22 $483.80 $316.64 57335................. C.............. ............... Repair vagina................ ........... ........... ........... ........... ........... 57400................. T.............. ............... Dilation of vagina...........

0194 20.7525 $1,231.52 $397.84 $246.30 57410................. T.............. ............... Pelvic examination...........

0193 14.5843 $865.48 ........... $173.10 57415................. T.............. ............... Remove vaginal foreign body..

0194 20.7525 $1,231.52 $397.84 $246.30 57420................. T.............. ............... Exam of vagina w/scope.......

0189

2.371 $140.70 ........... $28.14 57421................. T.............. ............... Exam/biopsy of vag w/scope...

0189

2.371 $140.70 ........... $28.14 57425................. T.............. ............... Laparoscopy, surg, colpopexy.

0130 31.9271 $1,894.65 $659.53 $378.93 57452................. T.............. ............... Examination of vagina........

0189

2.371 $140.70 ........... $28.14 57454................. T.............. ............... Vagina examination & biopsy..

0189

2.371 $140.70 ........... $28.14 57455................. T.............. ............... Biopsy of cervix w/scope.....

0189

2.371 $140.70 ........... $28.14 57456................. T.............. ............... Endocerv curettage w/scope...

0189

2.371 $140.70 ........... $28.14 57460................. T.............. ............... Cervix excision..............

0193 14.5843 $865.48 ........... $173.10 57461................. T.............. ............... Conz of cervix w/scope, leep.

0194 20.7525 $1,231.52 $397.84 $246.30 57500................. T.............. ............... Biopsy of cervix.............

0192 4.3082 $255.66 ........... $51.13 57505................. T.............. ............... Endocervical curettage.......

0189

2.371 $140.70 ........... $28.14 57510................. T.............. ............... Cauterization of cervix......

0193 14.5843 $865.48 ........... $173.10 57511................. T.............. ............... Cryocautery of cervix........

0189

2.371 $140.70 ........... $28.14 57513................. T.............. ............... Laser surgery of cervix......

0193 14.5843 $865.48 ........... $173.10 57520................. T.............. ............... Conization of cervix.........

0194 20.7525 $1,231.52 $397.84 $246.30 57522................. T.............. ............... Conization of cervix.........

0195 26.6791 $1,583.22 $483.80 $316.64 57530................. T.............. ............... Removal of cervix............

0195 26.6791 $1,583.22 $483.80 $316.64 57531................. C.............. ............... Removal of cervix, radical... ........... ........... ........... ........... ........... 57540................. C.............. ............... Removal of residual cervix... ........... ........... ........... ........... ........... 57545................. C.............. ............... Remove cervix/repair pelvis.. ........... ........... ........... ........... ........... 57550................. T.............. ............... Removal of residual cervix...

0195 26.6791 $1,583.22 $483.80 $316.64 57555................. T.............. ............... Remove cervix/repair vagina..

0195 26.6791 $1,583.22 $483.80 $316.64 57556................. T.............. ............... Remove cervix, repair bowel..

0202 40.3866 $2,396.66 $958.66 $479.33 57700................. T.............. ............... Revision of cervix...........

0194 20.7525 $1,231.52 $397.84 $246.30 57720................. T.............. ............... Revision of cervix...........

0194 20.7525 $1,231.52 $397.84 $246.30 57800................. T.............. ............... Dilation of cervical canal...

0193 14.5843 $865.48 ........... $173.10 57820................. T.............. ............... D & c of residual cervix.....

0196 17.0974 $1,014.61 $338.23 $202.92 58100................. T.............. ............... Biopsy of uterus lining......

0188

1.14 $67.65 ........... $13.53 58120................. T.............. ............... Dilation and curettage.......

0196 17.0974 $1,014.61 $338.23 $202.92 58140................. C.............. ............... Removal of uterus lesion..... ........... ........... ........... ........... ........... 58145................. T.............. ............... Myomectomy vag method........

0195 26.6791 $1,583.22 $483.80 $316.64 58146................. C.............. ............... Myomectomy abdom complex..... ........... ........... ........... ........... ........... 58150................. C.............. ............... Total hysterectomy........... ........... ........... ........... ........... ........... 58152................. C.............. ............... Total hysterectomy........... ........... ........... ........... ........... ........... 58180................. C.............. ............... Partial hysterectomy......... ........... ........... ........... ........... ........... 58200................. C.............. ............... Extensive hysterectomy....... ........... ........... ........... ........... ........... 58210................. C.............. ............... Extensive hysterectomy....... ........... ........... ........... ........... ........... 58240................. C.............. ............... Removal of pelvis contents... ........... ........... ........... ........... ........... 58260................. C.............. ............... Vaginal hysterectomy......... ........... ........... ........... ........... ........... 58262................. C.............. ............... Vag hyst including t/o....... ........... ........... ........... ........... ........... 58263................. C.............. ............... Vag hyst w/t/o & vag repair.. ........... ........... ........... ........... ...........

[[Page 50766]]

58267................. C.............. ............... Vag hyst w/urinary repair.... ........... ........... ........... ........... ........... 58270................. C.............. ............... Vag hyst w/enterocele repair. ........... ........... ........... ........... ........... 58275................. C.............. ............... Hysterectomy/revise vagina... ........... ........... ........... ........... ........... 58280................. C.............. ............... Hysterectomy/revise vagina... ........... ........... ........... ........... ........... 58285................. C.............. ............... Extensive hysterectomy....... ........... ........... ........... ........... ........... 58290................. C.............. ............... Vag hyst complex............. ........... ........... ........... ........... ........... 58291................. C.............. ............... Vag hyst incl t/o, complex... ........... ........... ........... ........... ........... 58292................. C.............. ............... Vag hyst t/o & repair, compl. ........... ........... ........... ........... ........... 58293................. C.............. ............... Vag hyst w/uro repair, compl. ........... ........... ........... ........... ........... 58294................. C.............. ............... Vag hyst w/enterocele, compl. ........... ........... ........... ........... ........... 58300................. E.............. ............... Insert intrauterine device... ........... ........... ........... ........... ........... 58301................. T.............. ............... Remove intrauterine device...

0189

2.371 $140.70 ........... $28.14 58321................. T.............. ............... Artificial insemination......

0197 2.3572 $139.88 ........... $27.98 58322................. T.............. ............... Artificial insemination......

0197 2.3572 $139.88 ........... $27.98 58323................. T.............. ............... Sperm washing................

0197 2.3572 $139.88 ........... $27.98 58340................. N.............. ............... Catheter for hysterography... ........... ........... ........... ........... ........... 58345................. T.............. ............... Reopen fallopian tube........

0193 14.5843 $865.48 ........... $173.10 58346................. T.............. ............... Insert heyman uteri capsule..

0193 14.5843 $865.48 ........... $173.10 58350................. T.............. ............... Reopen fallopian tube........

0195 26.6791 $1,583.22 $483.80 $316.64 58353................. T.............. ............... Endometr ablate, thermal.....

0195 26.6791 $1,583.22 $483.80 $316.64 58356................. T.............. ............... Endometrial cryoablation.....

0202 40.3866 $2,396.66 $958.66 $479.33 58400................. C.............. ............... Suspension of uterus......... ........... ........... ........... ........... ........... 58410................. C.............. ............... Suspension of uterus......... ........... ........... ........... ........... ........... 58520................. C.............. ............... Repair of ruptured uterus.... ........... ........... ........... ........... ........... 58540................. C.............. ............... Revision of uterus........... ........... ........... ........... ........... ........... 58545................. T.............. ............... Laparoscopic myomectomy......

0130 31.9271 $1,894.65 $659.53 $378.93 58546................. T.............. ............... Laparo-myomectomy, complex...

0131 43.3389 $2,571.86 $1,001.89 $514.37 58550................. T.............. ............... Laparo-asst vag hysterectomy.

0132 62.9914 $3,738.10 $1,239.22 $747.62 58552................. T.............. ............... Laparo-vag hyst incl t/o.....

0131 43.3389 $2,571.86 $1,001.89 $514.37 58553................. T.............. ............... Laparo-vag hyst, complex.....

0131 43.3389 $2,571.86 $1,001.89 $514.37 58554................. T.............. ............... Laparo-vag hyst w/t/o, compl.

0131 43.3389 $2,571.86 $1,001.89 $514.37 58555................. T.............. ............... Hysteroscopy, dx, sep proc...

0190 21.0653 $1,250.08 $424.28 $250.02 58558................. T.............. ............... Hysteroscopy, biopsy.........

0190 21.0653 $1,250.08 $424.28 $250.02 58559................. T.............. ............... Hysteroscopy, lysis..........

0190 21.0653 $1,250.08 $424.28 $250.02 58560................. T.............. ............... Hysteroscopy, resect septum..

0387 32.5445 $1,931.29 $655.55 $386.26 58561................. T.............. ............... Hysteroscopy, remove myoma...

0387 32.5445 $1,931.29 $655.55 $386.26 58562................. T.............. ............... Hysteroscopy, remove fb......

0190 21.0653 $1,250.08 $424.28 $250.02 58563................. T.............. ............... Hysteroscopy, ablation.......

0387 32.5445 $1,931.29 $655.55 $386.26 58565................. T.............. ............... Hysteroscopy, sterilization..

0202 40.3866 $2,396.66 $958.66 $479.33 58578................. T.............. ............... Laparo proc, uterus..........

0130 31.9271 $1,894.65 $659.53 $378.93 58579................. T.............. ............... Hysteroscope procedure.......

0190 21.0653 $1,250.08 $424.28 $250.02 58600................. T.............. ............... Division of fallopian tube...

0195 26.6791 $1,583.22 $483.80 $316.64 58605................. C.............. ............... Division of fallopian tube... ........... ........... ........... ........... ........... 58611................. C.............. ............... Ligate oviduct(s) add-on..... ........... ........... ........... ........... ........... 58615................. T.............. ............... Occlude fallopian tube(s)....

0194 20.7525 $1,231.52 $397.84 $246.30 58660................. T.............. ............... Laparoscopy, lysis...........

0131 43.3389 $2,571.86 $1,001.89 $514.37 58661................. T.............. ............... Laparoscopy, remove adnexa...

0131 43.3389 $2,571.86 $1,001.89 $514.37 58662................. T.............. ............... Laparoscopy, excise lesions..

0131 43.3389 $2,571.86 $1,001.89 $514.37 58670................. T.............. ............... Laparoscopy, tubal cautery...

0131 43.3389 $2,571.86 $1,001.89 $514.37 58671................. T.............. ............... Laparoscopy, tubal block.....

0131 43.3389 $2,571.86 $1,001.89 $514.37 58672................. T.............. ............... Laparoscopy, fimbrioplasty...

0131 43.3389 $2,571.86 $1,001.89 $514.37 58673................. T.............. ............... Laparoscopy, salpingostomy...

0131 43.3389 $2,571.86 $1,001.89 $514.37 58679................. T.............. ............... Laparo proc, oviduct-ovary...

0130 31.9271 $1,894.65 $659.53 $378.93 58700................. C.............. ............... Removal of fallopian tube.... ........... ........... ........... ........... ........... 58720................. C.............. ............... Removal of ovary/tube(s)..... ........... ........... ........... ........... ........... 58740................. C.............. ............... Revise fallopian tube(s)..... ........... ........... ........... ........... ........... 58750................. C.............. ............... Repair oviduct............... ........... ........... ........... ........... ........... 58752................. C.............. ............... Revise ovarian tube(s)....... ........... ........... ........... ........... ........... 58760................. C.............. ............... Remove tubal obstruction..... ........... ........... ........... ........... ........... 58770................. T.............. ............... Create new tubal opening.....

0195 26.6791 $1,583.22 $483.80 $316.64 58800................. T.............. ............... Drainage of ovarian cyst(s)..

0193 14.5843 $865.48 ........... $173.10 58805................. C.............. ............... Drainage of ovarian cyst(s).. ........... ........... ........... ........... ........... 58820................. T.............. ............... Drain ovary abscess, open....

0195 26.6791 $1,583.22 $483.80 $316.64 58822................. C.............. ............... Drain ovary abscess, percut.. ........... ........... ........... ........... ........... 58823................. T.............. ............... Drain pelvic abscess, percut.

0193 14.5843 $865.48 ........... $173.10 58825................. C.............. ............... Transposition, ovary(s)...... ........... ........... ........... ........... ...........

[[Page 50767]]

58900................. T.............. ............... Biopsy of ovary(s)...........

0193 14.5843 $865.48 ........... $173.10 58920................. T.............. ............... Partial removal of ovary(s)..

0195 26.6791 $1,583.22 $483.80 $316.64 58925................. T.............. ............... Removal of ovarian cyst(s)...

0195 26.6791 $1,583.22 $483.80 $316.64 58940................. C.............. ............... Removal of ovary(s).......... ........... ........... ........... ........... ........... 58943................. C.............. ............... Removal of ovary(s).......... ........... ........... ........... ........... ........... 58950................. C.............. ............... Resect ovarian malignancy.... ........... ........... ........... ........... ........... 58951................. C.............. ............... Resect ovarian malignancy.... ........... ........... ........... ........... ........... 58952................. C.............. ............... Resect ovarian malignancy.... ........... ........... ........... ........... ........... 58953................. C.............. ............... Tah, rad dissect for debulk.. ........... ........... ........... ........... ........... 58954................. C.............. ............... Tah rad debulk/lymph remove.. ........... ........... ........... ........... ........... 58956................. C.............. ............... Bso, omentectomy w/tah....... ........... ........... ........... ........... ........... 58960................. C.............. ............... Exploration of abdomen....... ........... ........... ........... ........... ........... 58970................. T.............. ............... Retrieval of oocyte..........

0197 2.3572 $139.88 ........... $27.98 58974................. T.............. ............... Transfer of embryo...........

0197 2.3572 $139.88 ........... $27.98 58976................. T.............. ............... Transfer of embryo...........

0197 2.3572 $139.88 ........... $27.98 58999................. T.............. ............... Genital surgery procedure....

0191

0.167

$9.91

$2.78

$1.98 59000................. T.............. ............... Amniocentesis, diagnostic....

0198 1.3683 $81.20 $32.19 $16.24 59001................. T.............. ............... Amniocentesis, therapeutic...

0192 4.3082 $255.66 ........... $51.13 59012................. T.............. ............... Fetal cord puncture,prenatal.

0198 1.3683 $81.20 $32.19 $16.24 59015................. T.............. ............... Chorion biopsy...............

0198 1.3683 $81.20 $32.19 $16.24 59020................. T.............. ............... Fetal contract stress test...

0192 4.3082 $255.66 ........... $51.13 59025................. T.............. ............... Fetal non-stress test........

0198 1.3683 $81.20 $32.19 $16.24 59030................. T.............. ............... Fetal scalp blood sample.....

0198 1.3683 $81.20 $32.19 $16.24 59050................. E.............. ............... Fetal monitor w/report....... ........... ........... ........... ........... ........... 59051................. B.............. ............... Fetal monitor/interpret only. ........... ........... ........... ........... ........... 59070................. T.............. ............... Transabdom amnioinfus w/ us..

0198 1.3683 $81.20 $32.19 $16.24 59072................. T.............. ............... Umbilical cord occlud w/ us..

0198 1.3683 $81.20 $32.19 $16.24 59074................. T.............. ............... Fetal fluid drainage w/ us...

0198 1.3683 $81.20 $32.19 $16.24 59076................. T.............. ............... Fetal shunt placement, w/ us.

0198 1.3683 $81.20 $32.19 $16.24 59100................. T.............. ............... Remove uterus lesion.........

0195 26.6791 $1,583.22 $483.80 $316.64 59120................. C.............. ............... Treat ectopic pregnancy...... ........... ........... ........... ........... ........... 59121................. C.............. ............... Treat ectopic pregnancy...... ........... ........... ........... ........... ........... 59130................. C.............. ............... Treat ectopic pregnancy...... ........... ........... ........... ........... ........... 59135................. C.............. ............... Treat ectopic pregnancy...... ........... ........... ........... ........... ........... 59136................. C.............. ............... Treat ectopic pregnancy...... ........... ........... ........... ........... ........... 59140................. C.............. ............... Treat ectopic pregnancy...... ........... ........... ........... ........... ........... 59150................. T.............. ............... Treat ectopic pregnancy......

0131 43.3389 $2,571.86 $1,001.89 $514.37 59151................. T.............. ............... Treat ectopic pregnancy......

0131 43.3389 $2,571.86 $1,001.89 $514.37 59160................. T.............. ............... D & c after delivery.........

0196 17.0974 $1,014.61 $338.23 $202.92 59200................. T.............. ............... Insert cervical dilator......

0189

2.371 $140.70 ........... $28.14 59300................. T.............. ............... Episiotomy or vaginal repair.

0193 14.5843 $865.48 ........... $173.10 59320................. T.............. ............... Revision of cervix...........

0194 20.7525 $1,231.52 $397.84 $246.30 59325................. C.............. ............... Revision of cervix........... ........... ........... ........... ........... ........... 59350................. C.............. ............... Repair of uterus............. ........... ........... ........... ........... ........... 59400................. B.............. ............... Obstetrical care............. ........... ........... ........... ........... ........... 59409................. T.............. ............... Obstetrical care.............

0194 20.7525 $1,231.52 $397.84 $246.30 59410................. B.............. ............... Obstetrical care............. ........... ........... ........... ........... ........... 59412................. T.............. ............... Antepartum manipulation......

0700 5.3614 $318.16 ........... $63.63 59414................. T.............. ............... Deliver placenta.............

0193 14.5843 $865.48 ........... $173.10 59425................. B.............. ............... Antepartum care only......... ........... ........... ........... ........... ........... 59426................. B.............. ............... Antepartum care only......... ........... ........... ........... ........... ........... 59430................. B.............. ............... Care after delivery.......... ........... ........... ........... ........... ........... 59510................. E.............. ............... Cesarean delivery............ ........... ........... ........... ........... ........... 59514................. C.............. ............... Cesarean delivery only....... ........... ........... ........... ........... ........... 59515................. E.............. ............... Cesarean delivery............ ........... ........... ........... ........... ........... 59525................. C.............. ............... Remove uterus after cesarean. ........... ........... ........... ........... ........... 59610................. E.............. ............... Vbac delivery................ ........... ........... ........... ........... ........... 59612................. T.............. ............... Vbac delivery only...........

0194 20.7525 $1,231.52 $397.84 $246.30 59614................. E.............. ............... Vbac care after delivery..... ........... ........... ........... ........... ........... 59618................. E.............. ............... Attempted vbac delivery...... ........... ........... ........... ........... ........... 59620................. C.............. ............... Attempted vbac delivery only. ........... ........... ........... ........... ........... 59622................. E.............. ............... Attempted vbac after care.... ........... ........... ........... ........... ........... 59812................. T.............. ............... Treatment of miscarriage.....

0201 17.6047 $1,044.72 $329.65 $208.94 59820................. T.............. ............... Care of miscarriage..........

0201 17.6047 $1,044.72 $329.65 $208.94 59821................. T.............. ............... Treatment of miscarriage.....

0201 17.6047 $1,044.72 $329.65 $208.94 59830................. C.............. ............... Treat uterus infection....... ........... ........... ........... ........... ...........

[[Page 50768]]

59840................. T.............. ............... Abortion.....................

0200 17.8728 $1,060.63 $263.69 $212.13 59841................. T.............. ............... Abortion.....................

0200 17.8728 $1,060.63 $263.69 $212.13 59850................. C.............. ............... Abortion..................... ........... ........... ........... ........... ........... 59851................. C.............. ............... Abortion..................... ........... ........... ........... ........... ........... 59852................. C.............. ............... Abortion..................... ........... ........... ........... ........... ........... 59855................. C.............. ............... Abortion..................... ........... ........... ........... ........... ........... 59856................. C.............. ............... Abortion..................... ........... ........... ........... ........... ........... 59857................. C.............. ............... Abortion..................... ........... ........... ........... ........... ........... 59866................. T.............. ............... Abortion (mpr)...............

0198 1.3683 $81.20 $32.19 $16.24 59870................. T.............. ............... Evacuate mole of uterus......

0201 17.6047 $1,044.72 $329.65 $208.94 59871................. T.............. ............... Remove cerclage suture.......

0194 20.7525 $1,231.52 $397.84 $246.30 59897................. T.............. ............... Fetal invas px w/ us.........

0198 1.3683 $81.20 $32.19 $16.24 59898................. T.............. ............... Laparo proc, ob care/deliver.

0130 31.9271 $1,894.65 $659.53 $378.93 59899................. T.............. ............... Maternity care procedure.....

0198 1.3683 $81.20 $32.19 $16.24 60000................. T.............. ............... Drain thyroid/tongue cyst....

0252 7.8673 $466.87 $113.41 $93.37 60001................. T.............. ............... Aspirate/inject thyriod cyst.

0004 1.7646 $104.72 $22.36 $20.94 60100................. T.............. ............... Biopsy of thyroid............

0004 1.7646 $104.72 $22.36 $20.94 60200................. T.............. ............... Remove thyroid lesion........

0114 40.7652 $2,419.13 $485.91 $483.83 60210................. T.............. ............... Partial thyroid excision.....

0114 40.7652 $2,419.13 $485.91 $483.83 60212................. T.............. ............... Partial thyroid excision.....

0114 40.7652 $2,419.13 $485.91 $483.83 60220................. T.............. ............... Partial removal of thyroid...

0114 40.7652 $2,419.13 $485.91 $483.83 60225................. T.............. ............... Partial removal of thyroid...

0114 40.7652 $2,419.13 $485.91 $483.83 60240................. T.............. ............... Removal of thyroid...........

0114 40.7652 $2,419.13 $485.91 $483.83 60252................. T.............. ............... Removal of thyroid...........

0256 37.3204 $2,214.70 ........... $442.94 60254................. C.............. ............... Extensive thyroid surgery.... ........... ........... ........... ........... ........... 60260................. T.............. ............... Repeat thyroid surgery.......

0256 37.3204 $2,214.70 ........... $442.94 60270................. C.............. ............... Removal of thyroid........... ........... ........... ........... ........... ........... 60271................. C.............. ............... Removal of thyroid........... ........... ........... ........... ........... ........... 60280................. T.............. ............... Remove thyroid duct lesion...

0114 40.7652 $2,419.13 $485.91 $483.83 60281................. T.............. ............... Remove thyroid duct lesion...

0114 40.7652 $2,419.13 $485.91 $483.83 60500................. T.............. ............... Explore parathyroid glands...

0256 37.3204 $2,214.70 ........... $442.94 60502................. C.............. ............... Re-explore parathyroids...... ........... ........... ........... ........... ........... 60505................. C.............. ............... Explore parathyroid glands... ........... ........... ........... ........... ........... 60512................. T.............. ............... Autotransplant parathyroid...

0022 19.6472 $1,165.92 $354.45 $233.18 60520................. C.............. ............... Removal of thymus gland...... ........... ........... ........... ........... ........... 60521................. C.............. ............... Removal of thymus gland...... ........... ........... ........... ........... ........... 60522................. C.............. ............... Removal of thymus gland...... ........... ........... ........... ........... ........... 60540................. C.............. ............... Explore adrenal gland........ ........... ........... ........... ........... ........... 60545................. C.............. ............... Explore adrenal gland........ ........... ........... ........... ........... ........... 60600................. C.............. ............... Remove carotid body lesion... ........... ........... ........... ........... ........... 60605................. C.............. ............... Remove carotid body lesion... ........... ........... ........... ........... ........... 60650................. C.............. ............... Laparoscopy adrenalectomy.... ........... ........... ........... ........... ........... 60659................. T.............. ............... Laparo proc, endocrine.......

0130 31.9271 $1,894.65 $659.53 $378.93 60699................. T.............. ............... Endocrine surgery procedure..

0114 40.7652 $2,419.13 $485.91 $483.83 61000................. T.............. ............... Remove cranial cavity fluid..

0212

2.974 $176.49 $70.59 $35.30 61001................. T.............. ............... Remove cranial cavity fluid..

0212

2.974 $176.49 $70.59 $35.30 61020................. T.............. ............... Remove brain cavity fluid....

0212

2.974 $176.49 $70.59 $35.30 61026................. T.............. ............... Injection into brain canal...

0212

2.974 $176.49 $70.59 $35.30 61050................. T.............. ............... Remove brain canal fluid.....

0212

2.974 $176.49 $70.59 $35.30 61055................. T.............. ............... Injection into brain canal...

0212

2.974 $176.49 $70.59 $35.30 61070................. T.............. ............... Brain canal shunt procedure..

0212

2.974 $176.49 $70.59 $35.30 61105................. C.............. ............... Twist drill hole............. ........... ........... ........... ........... ........... 61107................. C.............. ............... Drill skull for implantation. ........... ........... ........... ........... ........... 61108................. C.............. ............... Drill skull for drainage..... ........... ........... ........... ........... ........... 61120................. C.............. ............... Burr hole for puncture....... ........... ........... ........... ........... ........... 61140................. C.............. ............... Pierce skull for biopsy...... ........... ........... ........... ........... ........... 61150................. C.............. ............... Pierce skull for drainage.... ........... ........... ........... ........... ........... 61151................. C.............. ............... Pierce skull for drainage.... ........... ........... ........... ........... ........... 61154................. C.............. ............... Pierce skull & remove clot... ........... ........... ........... ........... ........... 61156................. C.............. ............... Pierce skull for drainage.... ........... ........... ........... ........... ........... 61210................. C.............. ............... Pierce skull, implant device. ........... ........... ........... ........... ........... 61215................. T.............. ............... Insert brain-fluid device....

0224 40.6455 $2,412.03 ........... $482.41 61250................. C.............. ............... Pierce skull & explore....... ........... ........... ........... ........... ........... 61253................. C.............. ............... Pierce skull & explore....... ........... ........... ........... ........... ........... 61304................. C.............. ............... Open skull for exploration... ........... ........... ........... ........... ........... 61305................. C.............. ............... Open skull for exploration... ........... ........... ........... ........... ...........

[[Page 50769]]

61312................. C.............. ............... Open skull for drainage...... ........... ........... ........... ........... ........... 61313................. C.............. ............... Open skull for drainage...... ........... ........... ........... ........... ........... 61314................. C.............. ............... Open skull for drainage...... ........... ........... ........... ........... ........... 61315................. C.............. ............... Open skull for drainage...... ........... ........... ........... ........... ........... 61316................. C.............. ............... Implt cran bone flap to abdo. ........... ........... ........... ........... ........... 61320................. C.............. ............... Open skull for drainage...... ........... ........... ........... ........... ........... 61321................. C.............. ............... Open skull for drainage...... ........... ........... ........... ........... ........... 61322................. C.............. ............... Decompressive craniotomy..... ........... ........... ........... ........... ........... 61323................. C.............. ............... Decompressive lobectomy...... ........... ........... ........... ........... ........... 61330................. T.............. ............... Decompress eye socket........

0256 37.3204 $2,214.70 ........... $442.94 61332................. C.............. ............... Explore/biopsy eye socket.... ........... ........... ........... ........... ........... 61333................. C.............. ............... Explore orbit/remove lesion.. ........... ........... ........... ........... ........... 61334................. T.............. ............... Explore orbit/remove object..

0256 37.3204 $2,214.70 ........... $442.94 61340................. C.............. ............... Relieve cranial pressure..... ........... ........... ........... ........... ........... 61343................. C.............. ............... Incise skull (press relief).. ........... ........... ........... ........... ........... 61345................. C.............. ............... Relieve cranial pressure..... ........... ........... ........... ........... ........... 61440................. C.............. ............... Incise skull for surgery..... ........... ........... ........... ........... ........... 61450................. C.............. ............... Incise skull for surgery..... ........... ........... ........... ........... ........... 61458................. C.............. ............... Incise skull for brain wound. ........... ........... ........... ........... ........... 61460................. C.............. ............... Incise skull for surgery..... ........... ........... ........... ........... ........... 61470................. C.............. ............... Incise skull for surgery..... ........... ........... ........... ........... ........... 61480................. C.............. ............... Incise skull for surgery..... ........... ........... ........... ........... ........... 61490................. C.............. ............... Incise skull for surgery..... ........... ........... ........... ........... ........... 61500................. C.............. ............... Removal of skull lesion...... ........... ........... ........... ........... ........... 61501................. C.............. ............... Remove infected skull bone... ........... ........... ........... ........... ........... 61510................. C.............. ............... Removal of brain lesion...... ........... ........... ........... ........... ........... 61512................. C.............. ............... Remove brain lining lesion... ........... ........... ........... ........... ........... 61514................. C.............. ............... Removal of brain abscess..... ........... ........... ........... ........... ........... 61516................. C.............. ............... Removal of brain lesion...... ........... ........... ........... ........... ........... 61517................. C.............. ............... Implt brain chemotx add-on... ........... ........... ........... ........... ........... 61518................. C.............. ............... Removal of brain lesion...... ........... ........... ........... ........... ........... 61519................. C.............. ............... Remove brain lining lesion... ........... ........... ........... ........... ........... 61520................. C.............. ............... Removal of brain lesion...... ........... ........... ........... ........... ........... 61521................. C.............. ............... Removal of brain lesion...... ........... ........... ........... ........... ........... 61522................. C.............. ............... Removal of brain abscess..... ........... ........... ........... ........... ........... 61524................. C.............. ............... Removal of brain lesion...... ........... ........... ........... ........... ........... 61526................. C.............. ............... Removal of brain lesion...... ........... ........... ........... ........... ........... 61530................. C.............. ............... Removal of brain lesion...... ........... ........... ........... ........... ........... 61531................. C.............. ............... Implant brain electrodes..... ........... ........... ........... ........... ........... 61533................. C.............. ............... Implant brain electrodes..... ........... ........... ........... ........... ........... 61534................. C.............. ............... Removal of brain lesion...... ........... ........... ........... ........... ........... 61535................. C.............. ............... Remove brain electrodes...... ........... ........... ........... ........... ........... 61536................. C.............. ............... Removal of brain lesion...... ........... ........... ........... ........... ........... 61537................. C.............. ............... Removal of brain tissue...... ........... ........... ........... ........... ........... 61538................. C.............. ............... Removal of brain tissue...... ........... ........... ........... ........... ........... 61539................. C.............. ............... Removal of brain tissue...... ........... ........... ........... ........... ........... 61540................. C.............. ............... Removal of brain tissue...... ........... ........... ........... ........... ........... 61541................. C.............. ............... Incision of brain tissue..... ........... ........... ........... ........... ........... 61542................. C.............. ............... Removal of brain tissue...... ........... ........... ........... ........... ........... 61543................. C.............. ............... Removal of brain tissue...... ........... ........... ........... ........... ........... 61544................. C.............. ............... Remove & treat brain lesion.. ........... ........... ........... ........... ........... 61545................. C.............. ............... Excision of brain tumor...... ........... ........... ........... ........... ........... 61546................. C.............. ............... Removal of pituitary gland... ........... ........... ........... ........... ........... 61548................. C.............. ............... Removal of pituitary gland... ........... ........... ........... ........... ........... 61550................. C.............. ............... Release of skull seams....... ........... ........... ........... ........... ........... 61552................. C.............. ............... Release of skull seams....... ........... ........... ........... ........... ........... 61556................. C.............. ............... Incise skull/sutures......... ........... ........... ........... ........... ........... 61557................. C.............. ............... Incise skull/sutures......... ........... ........... ........... ........... ........... 61558................. C.............. ............... Excision of skull/sutures.... ........... ........... ........... ........... ........... 61559................. C.............. ............... Excision of skull/sutures.... ........... ........... ........... ........... ........... 61563................. C.............. ............... Excision of skull tumor...... ........... ........... ........... ........... ........... 61564................. C.............. ............... Excision of skull tumor...... ........... ........... ........... ........... ........... 61566................. C.............. ............... Removal of brain tissue...... ........... ........... ........... ........... ........... 61567................. C.............. ............... Incision of brain tissue..... ........... ........... ........... ........... ........... 61570................. C.............. ............... Remove foreign body, brain... ........... ........... ........... ........... ........... 61571................. C.............. ............... Incise skull for brain wound. ........... ........... ........... ........... ...........

[[Page 50770]]

61575................. C.............. ............... Skull base/brainstem surgery. ........... ........... ........... ........... ........... 61576................. C.............. ............... Skull base/brainstem surgery. ........... ........... ........... ........... ........... 61580................. C.............. ............... Craniofacial approach, skull. ........... ........... ........... ........... ........... 61581................. C.............. ............... Craniofacial approach, skull. ........... ........... ........... ........... ........... 61582................. C.............. ............... Craniofacial approach, skull. ........... ........... ........... ........... ........... 61583................. C.............. ............... Craniofacial approach, skull. ........... ........... ........... ........... ........... 61584................. C.............. ............... Orbitocranial approach/skull. ........... ........... ........... ........... ........... 61585................. C.............. ............... Orbitocranial approach/skull. ........... ........... ........... ........... ........... 61586................. C.............. ............... Resect nasopharynx, skull.... ........... ........... ........... ........... ........... 61590................. C.............. ............... Infratemporal approach/skull. ........... ........... ........... ........... ........... 61591................. C.............. ............... Infratemporal approach/skull. ........... ........... ........... ........... ........... 61592................. C.............. ............... Orbitocranial approach/skull. ........... ........... ........... ........... ........... 61595................. C.............. ............... Transtemporal approach/skull. ........... ........... ........... ........... ........... 61596................. C.............. ............... Transcochlear approach/skull. ........... ........... ........... ........... ........... 61597................. C.............. ............... Transcondylar approach/skull. ........... ........... ........... ........... ........... 61598................. C.............. ............... Transpetrosal approach/skull. ........... ........... ........... ........... ........... 61600................. C.............. ............... Resect/excise cranial lesion. ........... ........... ........... ........... ........... 61601................. C.............. ............... Resect/excise cranial lesion. ........... ........... ........... ........... ........... 61605................. C.............. ............... Resect/excise cranial lesion. ........... ........... ........... ........... ........... 61606................. C.............. ............... Resect/excise cranial lesion. ........... ........... ........... ........... ........... 61607................. C.............. ............... Resect/excise cranial lesion. ........... ........... ........... ........... ........... 61608................. C.............. ............... Resect/excise cranial lesion. ........... ........... ........... ........... ........... 61609................. C.............. ............... Transect artery, sinus....... ........... ........... ........... ........... ........... 61610................. C.............. ............... Transect artery, sinus....... ........... ........... ........... ........... ........... 61611................. C.............. ............... Transect artery, sinus....... ........... ........... ........... ........... ........... 61612................. C.............. ............... Transect artery, sinus....... ........... ........... ........... ........... ........... 61613................. C.............. ............... Remove aneurysm, sinus....... ........... ........... ........... ........... ........... 61615................. C.............. ............... Resect/excise lesion, skull.. ........... ........... ........... ........... ........... 61616................. C.............. ............... Resect/excise lesion, skull.. ........... ........... ........... ........... ........... 61618................. C.............. ............... Repair dura.................. ........... ........... ........... ........... ........... 61619................. C.............. ............... Repair dura.................. ........... ........... ........... ........... ........... 61623................. T.............. ............... Endovasc tempory vessel occl.

0081 34.4473 $2,044.21 ........... $408.84 61624................. C.............. ............... Occlusion/embolization cath.. ........... ........... ........... ........... ........... 61626................. T.............. ............... Transcath occlusion, non-cns.

0081 34.4473 $2,044.21 ........... $408.84 61680................. C.............. ............... Intracranial vessel surgery.. ........... ........... ........... ........... ........... 61682................. C.............. ............... Intracranial vessel surgery.. ........... ........... ........... ........... ........... 61684................. C.............. ............... Intracranial vessel surgery.. ........... ........... ........... ........... ........... 61686................. C.............. ............... Intracranial vessel surgery.. ........... ........... ........... ........... ........... 61690................. C.............. ............... Intracranial vessel surgery.. ........... ........... ........... ........... ........... 61692................. C.............. ............... Intracranial vessel surgery.. ........... ........... ........... ........... ........... 61697................. C.............. ............... Brain aneurysm repr, complx.. ........... ........... ........... ........... ........... 61698................. C.............. ............... Brain aneurysm repr, complx.. ........... ........... ........... ........... ........... 61700................. C.............. ............... Brain aneurysm repr, simple.. ........... ........... ........... ........... ........... 61702................. C.............. ............... Inner skull vessel surgery... ........... ........... ........... ........... ........... 61703................. C.............. ............... Clamp neck artery............ ........... ........... ........... ........... ........... 61705................. C.............. ............... Revise circulation to head... ........... ........... ........... ........... ........... 61708................. C.............. ............... Revise circulation to head... ........... ........... ........... ........... ........... 61710................. C.............. ............... Revise circulation to head... ........... ........... ........... ........... ........... 61711................. C.............. ............... Fusion of skull arteries..... ........... ........... ........... ........... ........... 61720................. C.............. ............... Incise skull/brain surgery... ........... ........... ........... ........... ........... 61735................. C.............. ............... Incise skull/brain surgery... ........... ........... ........... ........... ........... 61750................. C.............. ............... Incise skull/brain biopsy.... ........... ........... ........... ........... ........... 61751................. C.............. ............... Brain biopsy w/ ct/mr guide.. ........... ........... ........... ........... ........... 61760................. C.............. ............... Implant brain electrodes..... ........... ........... ........... ........... ........... 61770................. C.............. ............... Incise skull for treatment... ........... ........... ........... ........... ........... 61790................. T.............. ............... Treat trigeminal nerve.......

0220 17.3586 $1,030.11 ........... $206.02 61791................. T.............. ............... Treat trigeminal tract.......

0206

5.492 $325.91 $75.55 $65.18 61793................. E.............. ............... Focus radiation beam......... ........... ........... ........... ........... ........... 61795................. S.............. ............... Brain surgery using computer.

0302 4.6145 $273.84 $103.74 $54.77 61850................. C.............. ............... Implant neuroelectrodes...... ........... ........... ........... ........... ........... 61860................. C.............. ............... Implant neuroelectrodes...... ........... ........... ........... ........... ........... 61863................. C.............. ............... Implant neuroelectrode....... ........... ........... ........... ........... ........... 61864................. C.............. ............... Implant neuroelectrde, add'l. ........... ........... ........... ........... ........... 61867................. C.............. ............... Implant neuroelectrode....... ........... ........... ........... ........... ........... 61868................. C.............. ............... Implant neuroelectrde, add'l. ........... ........... ........... ........... ........... 61870................. C.............. ............... Implant neuroelectrodes...... ........... ........... ........... ........... ...........

[[Page 50771]]

61875................. C.............. ............... Implant neuroelectrodes...... ........... ........... ........... ........... ........... 61880................. T.............. ............... Revise/remove neuroelectrode.

0687 19.2347 $1,141.44 $456.57 $228.29 61885................. S.............. ............... Implant neurostim one array..

0039

181.4 $10,764.82 ........... $2,152.96 61886................. T.............. ............... Implant neurostim arrays.....

0315 290.647 $17,247.86 ........... $3,449.57 61888................. T.............. ............... Revise/remove neuroreceiver..

0688 43.0444 $2,554.38 $1,021.75 $510.88 62000................. C.............. ............... Treat skull fracture......... ........... ........... ........... ........... ........... 62005................. C.............. ............... Treat skull fracture......... ........... ........... ........... ........... ........... 62010................. C.............. ............... Treatment of head injury..... ........... ........... ........... ........... ........... 62100................. C.............. ............... Repair brain fluid leakage... ........... ........... ........... ........... ........... 62115................. C.............. ............... Reduction of skull defect.... ........... ........... ........... ........... ........... 62116................. C.............. ............... Reduction of skull defect.... ........... ........... ........... ........... ........... 62117................. C.............. ............... Reduction of skull defect.... ........... ........... ........... ........... ........... 62120................. C.............. ............... Repair skull cavity lesion... ........... ........... ........... ........... ........... 62121................. C.............. ............... Incise skull repair.......... ........... ........... ........... ........... ........... 62140................. C.............. ............... Repair of skull defect....... ........... ........... ........... ........... ........... 62141................. C.............. ............... Repair of skull defect....... ........... ........... ........... ........... ........... 62142................. C.............. ............... Remove skull plate/flap...... ........... ........... ........... ........... ........... 62143................. C.............. ............... Replace skull plate/flap..... ........... ........... ........... ........... ........... 62145................. C.............. ............... Repair of skull & brain...... ........... ........... ........... ........... ........... 62146................. C.............. ............... Repair of skull with graft... ........... ........... ........... ........... ........... 62147................. C.............. ............... Repair of skull with graft... ........... ........... ........... ........... ........... 62148................. C.............. ............... Retr bone flap to fix skull.. ........... ........... ........... ........... ........... 62160................. T.............. ............... Neuroendoscopy add-on........

0122 6.9721 $413.75 $84.85 $82.75 62161................. C.............. ............... Dissect brain w/scope........ ........... ........... ........... ........... ........... 62162................. C.............. ............... Remove colloid cyst w/scope.. ........... ........... ........... ........... ........... 62163................. C.............. ............... Neuroendoscopy w/fb removal.. ........... ........... ........... ........... ........... 62164................. C.............. ............... Remove brain tumor w/scope... ........... ........... ........... ........... ........... 62165................. C.............. ............... Remove pituit tumor w/scope.. ........... ........... ........... ........... ........... 62180................. C.............. ............... Establish brain cavity shunt. ........... ........... ........... ........... ........... 62190................. C.............. ............... Establish brain cavity shunt. ........... ........... ........... ........... ........... 62192................. C.............. ............... Establish brain cavity shunt. ........... ........... ........... ........... ........... 62194................. T.............. ............... Replace/irrigate catheter....

0427 10.1977 $605.16 $124.11 $121.03 62200................. C.............. ............... Establish brain cavity shunt. ........... ........... ........... ........... ........... 62201................. C.............. ............... Establish brain cavity shunt. ........... ........... ........... ........... ........... 62220................. C.............. ............... Establish brain cavity shunt. ........... ........... ........... ........... ........... 62223................. C.............. ............... Establish brain cavity shunt. ........... ........... ........... ........... ........... 62225................. T.............. ............... Replace/irrigate catheter....

0427 10.1977 $605.16 $124.11 $121.03 62230................. T.............. ............... Replace/revise brain shunt...

0224 40.6455 $2,412.03 ........... $482.41 62252................. S.............. ............... Csf shunt reprogram..........

0691 2.5252 $149.85 $59.94 $29.97 62256................. C.............. ............... Remove brain cavity shunt.... ........... ........... ........... ........... ........... 62258................. C.............. ............... Replace brain cavity shunt... ........... ........... ........... ........... ........... 62263................. T.............. ............... Lysis epidural adhesions.....

0203 10.4015 $617.26 $246.90 $123.45 62264................. T.............. ............... Epidural lysis on single day.

0203 10.4015 $617.26 $246.90 $123.45 62268................. T.............. ............... Drain spinal cord cyst.......

0212

2.974 $176.49 $70.59 $35.30 62269................. T.............. ............... Needle biopsy, spinal cord...

0685 6.0174 $357.09 $115.47 $71.42 62270................. T.............. ............... Spinal fluid tap, diagnostic.

0204

2.191 $130.02 $40.13 $26.00 62272................. T.............. ............... Drain cerebro spinal fluid...

0204

2.191 $130.02 $40.13 $26.00 62273................. T.............. ............... Treat epidural spine lesion..

0206

5.492 $325.91 $75.55 $65.18 62280................. T.............. ............... Treat spinal cord lesion.....

0207 6.0109 $356.70 $86.92 $71.34 62281................. T.............. ............... Treat spinal cord lesion.....

0207 6.0109 $356.70 $86.92 $71.34 62282................. T.............. ............... Treat spinal canal lesion....

0207 6.0109 $356.70 $86.92 $71.34 62284................. N.............. ............... Injection for myelogram...... ........... ........... ........... ........... ........... 62287................. T.............. ............... Percutaneous diskectomy......

0221 29.9209 $1,775.60 $463.62 $355.12 62290................. N.............. ............... Inject for spine disk x-ray.. ........... ........... ........... ........... ........... 62291................. N.............. ............... Inject for spine disk x-ray.. ........... ........... ........... ........... ........... 62292................. T.............. ............... Injection into disk lesion...

0212

2.974 $176.49 $70.59 $35.30 62294................. T.............. ............... Injection into spinal artery.

0212

2.974 $176.49 $70.59 $35.30 62310................. T.............. ............... Inject spine c/t.............

0207 6.0109 $356.70 $86.92 $71.34 62311................. T.............. ............... Inject spine l/s (cd)........

0207 6.0109 $356.70 $86.92 $71.34 62318................. T.............. ............... Inject spine w/cath, c/t.....

0207 6.0109 $356.70 $86.92 $71.34 62319................. T.............. ............... Inject spine w/cath l/s (cd).

0207 6.0109 $356.70 $86.92 $71.34 62350................. T.............. ............... Implant spinal canal cath....

0223 28.123 $1,668.90 ........... $333.78 62351................. T.............. ............... Implant spinal canal cath....

0208 42.3409 $2,512.64 ........... $502.53 62355................. T.............. ............... Remove spinal canal catheter.

0203 10.4015 $617.26 $246.90 $123.45 62360................. T.............. ............... Insert spine infusion device.

0226 138.8695 $8,240.93 ........... $1,648.19 62361................. T.............. ............... Implant spine infusion pump..

0227 136.4922 $8,099.86 ........... $1,619.97

[[Page 50772]]

62362................. T.............. ............... Implant spine infusion pump..

0227 136.4922 $8,099.86 ........... $1,619.97 62365................. T.............. ............... Remove spine infusion device.

0221 29.9209 $1,775.60 $463.62 $355.12 62367................. S.............. ............... Analyze spine infusion pump..

0691 2.5252 $149.85 $59.94 $29.97 62368................. S.............. ............... Analyze spine infusion pump..

0691 2.5252 $149.85 $59.94 $29.97 63001................. T.............. ............... Removal of spinal lamina.....

0208 42.3409 $2,512.64 ........... $502.53 63003................. T.............. ............... Removal of spinal lamina.....

0208 42.3409 $2,512.64 ........... $502.53 63005................. T.............. ............... Removal of spinal lamina.....

0208 42.3409 $2,512.64 ........... $502.53 63011................. T.............. ............... Removal of spinal lamina.....

0208 42.3409 $2,512.64 ........... $502.53 63012................. T.............. ............... Removal of spinal lamina.....

0208 42.3409 $2,512.64 ........... $502.53 63015................. T.............. ............... Removal of spinal lamina.....

0208 42.3409 $2,512.64 ........... $502.53 63016................. T.............. ............... Removal of spinal lamina.....

0208 42.3409 $2,512.64 ........... $502.53 63017................. T.............. ............... Removal of spinal lamina.....

0208 42.3409 $2,512.64 ........... $502.53 63020................. T.............. ............... Neck spine disk surgery......

0208 42.3409 $2,512.64 ........... $502.53 63030................. T.............. ............... Low back disk surgery........

0208 42.3409 $2,512.64 ........... $502.53 63035................. T.............. ............... Spinal disk surgery add-on...

0208 42.3409 $2,512.64 ........... $502.53 63040................. T.............. ............... Laminotomy, single cervical..

0208 42.3409 $2,512.64 ........... $502.53 63042................. T.............. ............... Laminotomy, single lumbar....

0208 42.3409 $2,512.64 ........... $502.53 63043................. C.............. ............... Laminotomy, add'l cervical... ........... ........... ........... ........... ........... 63044................. C.............. ............... Laminotomy, add'l lumbar..... ........... ........... ........... ........... ........... 63045................. T.............. ............... Removal of spinal lamina.....

0208 42.3409 $2,512.64 ........... $502.53 63046................. T.............. ............... Removal of spinal lamina.....

0208 42.3409 $2,512.64 ........... $502.53 63047................. T.............. ............... Removal of spinal lamina.....

0208 42.3409 $2,512.64 ........... $502.53 63048................. T.............. ............... Remove spinal lamina add-on..

0208 42.3409 $2,512.64 ........... $502.53 63050................. C.............. ............... Cervical laminoplasty........ ........... ........... ........... ........... ........... 63051................. C.............. ............... C-laminoplasty w/graft/plate. ........... ........... ........... ........... ........... 63055................. T.............. ............... Decompress spinal cord.......

0208 42.3409 $2,512.64 ........... $502.53 63056................. T.............. ............... Decompress spinal cord.......

0208 42.3409 $2,512.64 ........... $502.53 63057................. T.............. ............... Decompress spine cord add-on.

0208 42.3409 $2,512.64 ........... $502.53 63064................. T.............. ............... Decompress spinal cord.......

0208 42.3409 $2,512.64 ........... $502.53 63066................. T.............. ............... Decompress spine cord add-on.

0208 42.3409 $2,512.64 ........... $502.53 63075................. C.............. ............... Neck spine disk surgery...... ........... ........... ........... ........... ........... 63076................. C.............. ............... Neck spine disk surgery...... ........... ........... ........... ........... ........... 63077................. C.............. ............... Spine disk surgery, thorax... ........... ........... ........... ........... ........... 63078................. C.............. ............... Spine disk surgery, thorax... ........... ........... ........... ........... ........... 63081................. C.............. ............... Removal of vertebral body.... ........... ........... ........... ........... ........... 63082................. C.............. ............... Remove vertebral body add-on. ........... ........... ........... ........... ........... 63085................. C.............. ............... Removal of vertebral body.... ........... ........... ........... ........... ........... 63086................. C.............. ............... Remove vertebral body add-on. ........... ........... ........... ........... ........... 63087................. C.............. ............... Removal of vertebral body.... ........... ........... ........... ........... ........... 63088................. C.............. ............... Remove vertebral body add-on. ........... ........... ........... ........... ........... 63090................. C.............. ............... Removal of vertebral body.... ........... ........... ........... ........... ........... 63091................. C.............. ............... Remove vertebral body add-on. ........... ........... ........... ........... ........... 63101................. C.............. ............... Removal of vertebral body.... ........... ........... ........... ........... ........... 63102................. C.............. ............... Removal of vertebral body.... ........... ........... ........... ........... ........... 63103................. C.............. ............... Remove vertebral body add-on. ........... ........... ........... ........... ........... 63170................. C.............. ............... Incise spinal cord tract(s).. ........... ........... ........... ........... ........... 63172................. C.............. ............... Drainage of spinal cyst...... ........... ........... ........... ........... ........... 63173................. C.............. ............... Drainage of spinal cyst...... ........... ........... ........... ........... 63180................. C.............. ............... Revise spinal cord ligaments. ........... ........... ........... ........... ........... 63182................. C.............. ............... Revise spinal cord ligaments. ........... ........... ........... ........... ........... 63185................. C.............. ............... Incise spinal column/nerves.. ........... ........... ........... ........... ........... 63190................. C.............. ............... Incise spinal column/nerves.. ........... ........... ........... ........... ........... 63191................. C.............. ............... Incise spinal column/nerves.. ........... ........... ........... ........... ........... 63194................. C.............. ............... Incise spinal column & cord.. ........... ........... ........... ........... ........... 63195................. C.............. ............... Incise spinal column & cord.. ........... ........... ........... ........... ........... 63196................. C.............. ............... Incise spinal column & cord.. ........... ........... ........... ........... ........... 63197................. C.............. ............... Incise spinal column & cord.. ........... ........... ........... ........... ........... 63198................. C.............. ............... Incise spinal column & cord.. ........... ........... ........... ........... ........... 63199................. C.............. ............... Incise spinal column & cord.. ........... ........... ........... ........... ........... 63200................. C.............. ............... Release of spinal cord....... ........... ........... ........... ........... ........... 63250................. C.............. ............... Revise spinal cord vessels... ........... ........... ........... ........... ........... 63251................. C.............. ............... Revise spinal cord vessels... ........... ........... ........... ........... ........... 63252................. C.............. ............... Revise spinal cord vessels... ........... ........... ........... ........... ........... 63265................. C.............. ............... Excise intraspinal lesion.... ........... ........... ........... ........... ........... 63266................. C.............. ............... Excise intraspinal lesion.... ........... ........... ........... ........... ........... 63267................. C.............. ............... Excise intraspinal lesion.... ........... ........... ........... ........... ...........

[[Page 50773]]

63268................. C.............. ............... Excise intraspinal lesion.... ........... ........... ........... ........... ........... 63270................. C.............. ............... Excise intraspinal lesion.... ........... ........... ........... ........... ........... 63271................. C.............. ............... Excise intraspinal lesion.... ........... ........... ........... ........... ........... 63272................. C.............. ............... Excise intraspinal lesion.... ........... ........... ........... ........... ........... 63273................. C.............. ............... Excise intraspinal lesion.... ........... ........... ........... ........... ........... 63275................. C.............. ............... Biopsy/excise spinal tumor... ........... ........... ........... ........... ........... 63276................. C.............. ............... Biopsy/excise spinal tumor... ........... ........... ........... ........... ........... 63277................. C.............. ............... Biopsy/excise spinal tumor... ........... ........... ........... ........... ........... 63278................. C.............. ............... Biopsy/excise spinal tumor... ........... ........... ........... ........... ........... 63280................. C.............. ............... Biopsy/excise spinal tumor... ........... ........... ........... ........... ........... 63281................. C.............. ............... Biopsy/excise spinal tumor... ........... ........... ........... ........... ........... 63282................. C.............. ............... Biopsy/excise spinal tumor... ........... ........... ........... ........... ........... 63283................. C.............. ............... Biopsy/excise spinal tumor... ........... ........... ........... ........... ........... 63285................. C.............. ............... Biopsy/excise spinal tumor... ........... ........... ........... ........... ........... 63286................. C.............. ............... Biopsy/excise spinal tumor... ........... ........... ........... ........... ........... 63287................. C.............. ............... Biopsy/excise spinal tumor... ........... ........... ........... ........... ........... 63290................. C.............. ............... Biopsy/excise spinal tumor... ........... ........... ........... ........... ........... 63295................. C.............. ............... Repair of laminectomy defect. ........... ........... ........... ........... ........... 63300................. C.............. ............... Removal of vertebral body.... ........... ........... ........... ........... ........... 63301................. C.............. ............... Removal of vertebral body.... ........... ........... ........... ........... ........... 63302................. C.............. ............... Removal of vertebral body.... ........... ........... ........... ........... ........... 63303................. C.............. ............... Removal of vertebral body.... ........... ........... ........... ........... ........... 63304................. C.............. ............... Removal of vertebral body.... ........... ........... ........... ........... ........... 63305................. C.............. ............... Removal of vertebral body.... ........... ........... ........... ........... ........... 63306................. C.............. ............... Removal of vertebral body.... ........... ........... ........... ........... ........... 63307................. C.............. ............... Removal of vertebral body.... ........... ........... ........... ........... ........... 63308................. C.............. ............... Remove vertebral body add-on. ........... ........... ........... ........... ........... 63600................. T.............. ............... Remove spinal cord lesion....

0220 17.3586 $1,030.11 ........... $206.02 63610................. T.............. ............... Stimulation of spinal cord...

0220 17.3586 $1,030.11 ........... $206.02 63615................. T.............. ............... Remove lesion of spinal cord.

0220 17.3586 $1,030.11 ........... $206.02 63650................. S.............. ............... Implant neuroelectrodes......

0040 55.3297 $3,283.43 ........... $656.69 63655................. S.............. ............... Implant neuroelectrodes......

0040 55.3297 $3,283.43 ........... $656.69 63660................. T.............. ............... Revise/remove neuroelectrode.

0687 19.2347 $1,141.44 $456.57 $228.29 63685................. T.............. ............... Implant neuroreceiver........

0222 179.0982 $10,628.22 ........... $2,125.64 63688................. T.............. ............... Revise/remove neuroreceiver..

0688 43.0444 $2,554.38 $1,021.75 $510.88 63700................. C.............. ............... Repair of spinal herniation.. ........... ........... ........... ........... ........... 63702................. C.............. ............... Repair of spinal herniation.. ........... ........... ........... ........... ........... 63704................. C.............. ............... Repair of spinal herniation.. ........... ........... ........... ........... ........... 63706................. C.............. ............... Repair of spinal herniation.. ........... ........... ........... ........... ........... 63707................. C.............. ............... Repair spinal fluid leakage.. ........... ........... ........... ........... ........... 63709................. C.............. ............... Repair spinal fluid leakage.. ........... ........... ........... ........... ........... 63710................. C.............. ............... Graft repair of spine defect. ........... ........... ........... ........... ........... 63740................. C.............. ............... Install spinal shunt......... ........... ........... ........... ........... ........... 63741................. T.............. ............... Install spinal shunt.........

0228 51.7258 $3,069.56 ........... $613.91 63744................. T.............. ............... Revision of spinal shunt.....

0228 51.7258 $3,069.56 ........... $613.91 63746................. T.............. ............... Removal of spinal shunt......

0109 11.0433 $655.34 $131.49 $131.07 64400................. T.............. ............... N block inj, trigeminal......

0204

2.191 $130.02 $40.13 $26.00 64402................. T.............. ............... N block inj, facial..........

0204

2.191 $130.02 $40.13 $26.00 64405................. T.............. ............... N block inj, occipital.......

0204

2.191 $130.02 $40.13 $26.00 64408................. T.............. ............... N block inj, vagus...........

0204

2.191 $130.02 $40.13 $26.00 64410................. T.............. ............... N block inj, phrenic.........

0206

5.492 $325.91 $75.55 $65.18 64412................. T.............. ............... N block inj, spinal accessor.

0206

5.492 $325.91 $75.55 $65.18 64413................. T.............. ............... N block inj, cervical plexus.

0204

2.191 $130.02 $40.13 $26.00 64415................. T.............. ............... Injection for nerve block....

0204

2.191 $130.02 $40.13 $26.00 64416................. T.............. ............... N block cont infuse, b plex..

0204

2.191 $130.02 $40.13 $26.00 64417................. T.............. ............... N block inj, axillary........

0204

2.191 $130.02 $40.13 $26.00 64418................. T.............. ............... N block inj, suprascapular...

0204

2.191 $130.02 $40.13 $26.00 64420................. T.............. ............... N block inj, intercost, sng..

0204

2.191 $130.02 $40.13 $26.00 64421................. T.............. ............... N block inj, intercost, mlt..

0206

5.492 $325.91 $75.55 $65.18 64425................. T.............. ............... N block inj ilio-ing/hypogi..

0204

2.191 $130.02 $40.13 $26.00 64430................. T.............. ............... N block inj, pudendal........

0204

2.191 $130.02 $40.13 $26.00 64435................. T.............. ............... N block inj, paracervical....

0204

2.191 $130.02 $40.13 $26.00 64445................. T.............. ............... Injection for nerve block....

0204

2.191 $130.02 $40.13 $26.00 64446................. T.............. ............... N blk inj, sciatic, cont inf.

0206

5.492 $325.91 $75.55 $65.18 64447................. T.............. ............... N block inj fem, single......

0204

2.191 $130.02 $40.13 $26.00 64448................. T.............. ............... N block inj fem, cont inf....

0204

2.191 $130.02 $40.13 $26.00

[[Page 50774]]

64449................. T.............. ............... N block inj, lumbar plexus...

0204

2.191 $130.02 $40.13 $26.00 64450................. T.............. ............... N block, other peripheral....

0204

2.191 $130.02 $40.13 $26.00 64470................. T.............. ............... Inj paravertebral c/t........

0207 6.0109 $356.70 $86.92 $71.34 64472................. T.............. ............... Inj paravertebral c/t add-on.

0206

5.492 $325.91 $75.55 $65.18 64475................. T.............. ............... Inj paravertebral l/s........

0207 6.0109 $356.70 $86.92 $71.34 64476................. T.............. ............... Inj paravertebral l/s add-on.

0206

5.492 $325.91 $75.55 $65.18 64479................. T.............. ............... Inj foramen epidural c/t.....

0207 6.0109 $356.70 $86.92 $71.34 64480................. T.............. ............... Inj foramen epidural add-on..

0207 6.0109 $356.70 $86.92 $71.34 64483................. T.............. ............... Inj foramen epidural l/s.....

0207 6.0109 $356.70 $86.92 $71.34 64484................. T.............. ............... Inj foramen epidural add-on..

0207 6.0109 $356.70 $86.92 $71.34 64505................. T.............. ............... N block, spenopalatine gangl.

0204

2.191 $130.02 $40.13 $26.00 64508................. T.............. ............... N block, carotid sinus s/p...

0204

2.191 $130.02 $40.13 $26.00 64510................. T.............. ............... N block, stellate ganglion...

0207 6.0109 $356.70 $86.92 $71.34 64517................. T.............. ............... N block inj, hypogas plxs....

0204

2.191 $130.02 $40.13 $26.00 64520................. T.............. ............... N block, lumbar/thoracic.....

0207 6.0109 $356.70 $86.92 $71.34 64530................. T.............. ............... N block inj, celiac pelus....

0207 6.0109 $356.70 $86.92 $71.34 64550................. A.............. ............... Apply neurostimulator........ ........... ........... ........... ........... ........... 64553................. S.............. ............... Implant neuroelectrodes......

0225 234.6925 $13,927.36 ........... $2,785.47 64555................. S.............. ............... Implant neuroelectrodes......

0040 55.3297 $3,283.43 ........... $656.69 64560................. S.............. ............... Implant neuroelectrodes......

0040 55.3297 $3,283.43 ........... $656.69 64561................. S.............. ............... Implant neuroelectrodes......

0040 55.3297 $3,283.43 ........... $656.69 64565................. S.............. ............... Implant neuroelectrodes......

0040 55.3297 $3,283.43 ........... $656.69 64573................. S.............. ............... Implant neuroelectrodes......

0225 234.6925 $13,927.36 ........... $2,785.47 64575................. S.............. ............... Implant neuroelectrodes......

0040 55.3297 $3,283.43 ........... $656.69 64577................. S.............. ............... Implant neuroelectrodes......

0225 234.6925 $13,927.36 ........... $2,785.47 64580................. S.............. ............... Implant neuroelectrodes......

0040 55.3297 $3,283.43 ........... $656.69 64581................. S.............. ............... Implant neuroelectrodes......

0040 55.3297 $3,283.43 ........... $656.69 64585................. T.............. ............... Revise/remove neuroelectrode.

0687 19.2347 $1,141.44 $456.57 $228.29 64590................. T.............. ............... Implant neuroreceiver........

0222 179.0982 $10,628.22 ........... $2,125.64 64595................. T.............. ............... Revise/remove neuroreceiver..

0688 43.0444 $2,554.38 $1,021.75 $510.88 64600................. T.............. ............... Injection treatment of nerve.

0203 10.4015 $617.26 $246.90 $123.45 64605................. T.............. ............... Injection treatment of nerve.

0203 10.4015 $617.26 $246.90 $123.45 64610................. T.............. ............... Injection treatment of nerve.

0203 10.4015 $617.26 $246.90 $123.45 64612................. T.............. ............... Destroy nerve, face muscle...

0204

2.191 $130.02 $40.13 $26.00 64613................. T.............. ............... Destroy nerve, spine muscle..

0204

2.191 $130.02 $40.13 $26.00 64614................. T.............. ............... Destroy nerve, extrem musc...

0204

2.191 $130.02 $40.13 $26.00 64620................. T.............. ............... Injection treatment of nerve.

0203 10.4015 $617.26 $246.90 $123.45 64622................. T.............. ............... Destr paravertebrl nerve l/s.

0203 10.4015 $617.26 $246.90 $123.45 64623................. T.............. ............... Destr paravertebral n add-on.

0207 6.0109 $356.70 $86.92 $71.34 64626................. T.............. ............... Destr paravertebrl nerve c/t.

0203 10.4015 $617.26 $246.90 $123.45 64627................. T.............. ............... Destr paravertebral n add-on.

0207 6.0109 $356.70 $86.92 $71.34 64630................. T.............. ............... Injection treatment of nerve.

0206

5.492 $325.91 $75.55 $65.18 64640................. T.............. ............... Injection treatment of nerve.

0206

5.492 $325.91 $75.55 $65.18 64680................. T.............. ............... Injection treatment of nerve.

0207 6.0109 $356.70 $86.92 $71.34 64681................. T.............. ............... Injection treatment of nerve.

0203 10.4015 $617.26 $246.90 $123.45 64702................. T.............. ............... Revise finger/toe nerve......

0220 17.3586 $1,030.11 ........... $206.02 64704................. T.............. ............... Revise hand/foot nerve.......

0220 17.3586 $1,030.11 ........... $206.02 64708................. T.............. ............... Revise arm/leg nerve.........

0220 17.3586 $1,030.11 ........... $206.02 64712................. T.............. ............... Revision of sciatic nerve....

0220 17.3586 $1,030.11 ........... $206.02 64713................. T.............. ............... Revision of arm nerve(s).....

0220 17.3586 $1,030.11 ........... $206.02 64714................. T.............. ............... Revise low back nerve(s).....

0220 17.3586 $1,030.11 ........... $206.02 64716................. T.............. ............... Revision of cranial nerve....

0220 17.3586 $1,030.11 ........... $206.02 64718................. T.............. ............... Revise ulnar nerve at elbow..

0220 17.3586 $1,030.11 ........... $206.02 64719................. T.............. ............... Revise ulnar nerve at wrist..

0220 17.3586 $1,030.11 ........... $206.02 64721................. T.............. ............... Carpal tunnel surgery........

0220 17.3586 $1,030.11 ........... $206.02 64722................. T.............. ............... Relieve pressure on nerve(s).

0220 17.3586 $1,030.11 ........... $206.02 64726................. T.............. ............... Release foot/toe nerve.......

0220 17.3586 $1,030.11 ........... $206.02 64727................. T.............. ............... Internal nerve revision......

0220 17.3586 $1,030.11 ........... $206.02 64732................. T.............. ............... Incision of brow nerve.......

0220 17.3586 $1,030.11 ........... $206.02 64734................. T.............. ............... Incision of cheek nerve......

0220 17.3586 $1,030.11 ........... $206.02 64736................. T.............. ............... Incision of chin nerve.......

0220 17.3586 $1,030.11 ........... $206.02 64738................. T.............. ............... Incision of jaw nerve........

0220 17.3586 $1,030.11 ........... $206.02 64740................. T.............. ............... Incision of tongue nerve.....

0220 17.3586 $1,030.11 ........... $206.02 64742................. T.............. ............... Incision of facial nerve.....

0220 17.3586 $1,030.11 ........... $206.02 64744................. T.............. ............... Incise nerve, back of head...

0220 17.3586 $1,030.11 ........... $206.02 64746................. T.............. ............... Incise diaphragm nerve.......

0220 17.3586 $1,030.11 ........... $206.02

[[Page 50775]]

64752................. C.............. ............... Incision of vagus nerve...... ........... ........... ........... ........... ........... 64755................. C.............. ............... Incision of stomach nerves... ........... ........... ........... ........... ........... 64760................. C.............. ............... Incision of vagus nerve...... ........... ........... ........... ........... ........... 64761................. T.............. ............... Incision of pelvis nerve.....

0220 17.3586 $1,030.11 ........... $206.02 64763................. T.............. ............... Incise hip/thigh nerve.......

0220 17.3586 $1,030.11 ........... $206.02 64766................. T.............. ............... Incise hip/thigh nerve.......

0221 29.9209 $1,775.60 $463.62 $355.12 64771................. T.............. ............... Sever cranial nerve..........

0220 17.3586 $1,030.11 ........... $206.02 64772................. T.............. ............... Incision of spinal nerve.....

0220 17.3586 $1,030.11 ........... $206.02 64774................. T.............. ............... Remove skin nerve lesion.....

0220 17.3586 $1,030.11 ........... $206.02 64776................. T.............. ............... Remove digit nerve lesion....

0220 17.3586 $1,030.11 ........... $206.02 64778................. T.............. ............... Digit nerve surgery add-on...

0220 17.3586 $1,030.11 ........... $206.02 64782................. T.............. ............... Remove limb nerve lesion.....

0220 17.3586 $1,030.11 ........... $206.02 64783................. T.............. ............... Limb nerve surgery add-on....

0220 17.3586 $1,030.11 ........... $206.02 64784................. T.............. ............... Remove nerve lesion..........

0220 17.3586 $1,030.11 ........... $206.02 64786................. T.............. ............... Remove sciatic nerve lesion..

0221 29.9209 $1,775.60 $463.62 $355.12 64787................. T.............. ............... Implant nerve end............

0220 17.3586 $1,030.11 ........... $206.02 64788................. T.............. ............... Remove skin nerve lesion.....

0220 17.3586 $1,030.11 ........... $206.02 64790................. T.............. ............... Removal of nerve lesion......

0220 17.3586 $1,030.11 ........... $206.02 64792................. T.............. ............... Removal of nerve lesion......

0221 29.9209 $1,775.60 $463.62 $355.12 64795................. T.............. ............... Biopsy of nerve..............

0220 17.3586 $1,030.11 ........... $206.02 64802................. T.............. ............... Remove sympathetic nerves....

0220 17.3586 $1,030.11 ........... $206.02 64804................. C.............. ............... Remove sympathetic nerves.... ........... ........... ........... ........... ........... 64809................. C.............. ............... Remove sympathetic nerves.... ........... ........... ........... ........... ........... 64818................. C.............. ............... Remove sympathetic nerves.... ........... ........... ........... ........... ........... 64820................. T.............. ............... Remove sympathetic nerves....

0220 17.3586 $1,030.11 ........... $206.02 64821................. T.............. ............... Remove sympathetic nerves....

0054 25.3711 $1,505.60 ........... $301.12 64822................. T.............. ............... Remove sympathetic nerves....

0054 25.3711 $1,505.60 ........... $301.12 64823................. T.............. ............... Remove sympathetic nerves....

0054 25.3711 $1,505.60 ........... $301.12 64831................. T.............. ............... Repair of digit nerve........

0221 29.9209 $1,775.60 $463.62 $355.12 64832................. T.............. ............... Repair nerve add-on..........

0221 29.9209 $1,775.60 $463.62 $355.12 64834................. T.............. ............... Repair of hand or foot nerve.

0221 29.9209 $1,775.60 $463.62 $355.12 64835................. T.............. ............... Repair of hand or foot nerve.

0221 29.9209 $1,775.60 $463.62 $355.12 64836................. T.............. ............... Repair of hand or foot nerve.

0221 29.9209 $1,775.60 $463.62 $355.12 64837................. T.............. ............... Repair nerve add-on..........

0221 29.9209 $1,775.60 $463.62 $355.12 64840................. T.............. ............... Repair of leg nerve..........

0221 29.9209 $1,775.60 $463.62 $355.12 64856................. T.............. ............... Repair/transpose nerve.......

0221 29.9209 $1,775.60 $463.62 $355.12 64857................. T.............. ............... Repair arm/leg nerve.........

0221 29.9209 $1,775.60 $463.62 $355.12 64858................. T.............. ............... Repair sciatic nerve.........

0221 29.9209 $1,775.60 $463.62 $355.12 64859................. T.............. ............... Nerve surgery................

0221 29.9209 $1,775.60 $463.62 $355.12 64861................. T.............. ............... Repair of arm nerves.........

0221 29.9209 $1,775.60 $463.62 $355.12 64862................. T.............. ............... Repair of low back nerves....

0221 29.9209 $1,775.60 $463.62 $355.12 64864................. T.............. ............... Repair of facial nerve.......

0221 29.9209 $1,775.60 $463.62 $355.12 64865................. T.............. ............... Repair of facial nerve.......

0221 29.9209 $1,775.60 $463.62 $355.12 64866................. C.............. ............... Fusion of facial/other nerve. ........... ........... ........... ........... ........... 64868................. C.............. ............... Fusion of facial/other nerve. ........... ........... ........... ........... ........... 64870................. T.............. ............... Fusion of facial/other nerve.

0221 29.9209 $1,775.60 $463.62 $355.12 64872................. T.............. ............... Subsequent repair of nerve...

0221 29.9209 $1,775.60 $463.62 $355.12 64874................. T.............. ............... Repair & revise nerve add-on.

0221 29.9209 $1,775.60 $463.62 $355.12 64876................. T.............. ............... Repair nerve/shorten bone....

0221 29.9209 $1,775.60 $463.62 $355.12 64885................. T.............. ............... Nerve graft, head or neck....

0221 29.9209 $1,775.60 $463.62 $355.12 64886................. T.............. ............... Nerve graft, head or neck....

0221 29.9209 $1,775.60 $463.62 $355.12 64890................. T.............. ............... Nerve graft, hand or foot....

0221 29.9209 $1,775.60 $463.62 $355.12 64891................. T.............. ............... Nerve graft, hand or foot....

0221 29.9209 $1,775.60 $463.62 $355.12 64892................. T.............. ............... Nerve graft, arm or leg......

0221 29.9209 $1,775.60 $463.62 $355.12 64893................. T.............. ............... Nerve graft, arm or leg......

0221 29.9209 $1,775.60 $463.62 $355.12 64895................. T.............. ............... Nerve graft, hand or foot....

0221 29.9209 $1,775.60 $463.62 $355.12 64896................. T.............. ............... Nerve graft, hand or foot....

0221 29.9209 $1,775.60 $463.62 $355.12 64897................. T.............. ............... Nerve graft, arm or leg......

0221 29.9209 $1,775.60 $463.62 $355.12 64898................. T.............. ............... Nerve graft, arm or leg......

0221 29.9209 $1,775.60 $463.62 $355.12 64901................. T.............. ............... Nerve graft add-on...........

0221 29.9209 $1,775.60 $463.62 $355.12 64902................. T.............. ............... Nerve graft add-on...........

0221 29.9209 $1,775.60 $463.62 $355.12 64905................. T.............. ............... Nerve pedicle transfer.......

0221 29.9209 $1,775.60 $463.62 $355.12 64907................. T.............. ............... Nerve pedicle transfer.......

0221 29.9209 $1,775.60 $463.62 $355.12 64999................. T.............. ............... Nervous system surgery.......

0204

2.191 $130.02 $40.13 $26.00 65091................. T.............. ............... Revise eye...................

0242 30.5464 $1,812.72 $597.36 $362.54 65093................. T.............. ............... Revise eye with implant......

0241 23.3036 $1,382.91 $384.47 $276.58

[[Page 50776]]

65101................. T.............. ............... Removal of eye...............

0242 30.5464 $1,812.72 $597.36 $362.54 65103................. T.............. ............... Remove eye/insert implant....

0242 30.5464 $1,812.72 $597.36 $362.54 65105................. T.............. ............... Remove eye/attach implant....

0242 30.5464 $1,812.72 $597.36 $362.54 65110................. T.............. ............... Removal of eye...............

0242 30.5464 $1,812.72 $597.36 $362.54 65112................. T.............. ............... Remove eye/revise socket.....

0242 30.5464 $1,812.72 $597.36 $362.54 65114................. T.............. ............... Remove eye/revise socket.....

0242 30.5464 $1,812.72 $597.36 $362.54 65125................. T.............. ............... Revise ocular implant........

0240 18.1508 $1,077.12 $315.31 $215.42 65130................. T.............. ............... Insert ocular implant........

0241 23.3036 $1,382.91 $384.47 $276.58 65135................. T.............. ............... Insert ocular implant........

0241 23.3036 $1,382.91 $384.47 $276.58 65140................. T.............. ............... Attach ocular implant........

0242 30.5464 $1,812.72 $597.36 $362.54 65150................. T.............. ............... Revise ocular implant........

0241 23.3036 $1,382.91 $384.47 $276.58 65155................. T.............. ............... Reinsert ocular implant......

0242 30.5464 $1,812.72 $597.36 $362.54 65175................. T.............. ............... Removal of ocular implant....

0240 18.1508 $1,077.12 $315.31 $215.42 65205................. S.............. ............... Remove foreign body from eye.

0698 1.2438 $73.81 $16.55 $14.76 65210................. S.............. ............... Remove foreign body from eye.

0698 1.2438 $73.81 $16.55 $14.76 65220................. S.............. ............... Remove foreign body from eye.

0698 1.2438 $73.81 $16.55 $14.76 65222................. S.............. ............... Remove foreign body from eye.

0698 1.2438 $73.81 $16.55 $14.76 65235................. T.............. ............... Remove foreign body from eye.

0233 14.9673 $888.20 $266.33 $177.64 65260................. T.............. ............... Remove foreign body from eye.

0236 17.0229 $1,010.19 ........... $202.04 65265................. T.............. ............... Remove foreign body from eye.

0237 28.9401 $1,717.39 ........... $343.48 65270................. T.............. ............... Repair of eye wound..........

0240 18.1508 $1,077.12 $315.31 $215.42 65272................. T.............. ............... Repair of eye wound..........

0234 21.9741 $1,304.01 $511.31 $260.80 65273................. C.............. ............... Repair of eye wound.......... ........... ........... ........... ........... ........... 65275................. T.............. ............... Repair of eye wound..........

0234 21.9741 $1,304.01 $511.31 $260.80 65280................. T.............. ............... Repair of eye wound..........

0236 17.0229 $1,010.19 ........... $202.04 65285................. T.............. ............... Repair of eye wound..........

0672 36.9284 $2,191.44 ........... $438.29 65286................. T.............. ............... Repair of eye wound..........

0232 6.6732 $396.01 $103.17 $79.20 65290................. T.............. ............... Repair of eye socket wound...

0243 22.1671 $1,315.46 $431.39 $263.09 65400................. T.............. ............... Removal of eye lesion........

0233 14.9673 $888.20 $266.33 $177.64 65410................. T.............. ............... Biopsy of cornea.............

0233 14.9673 $888.20 $266.33 $177.64 65420................. T.............. ............... Removal of eye lesion........

0233 14.9673 $888.20 $266.33 $177.64 65426................. T.............. ............... Removal of eye lesion........

0234 21.9741 $1,304.01 $511.31 $260.80 65430................. S.............. ............... Corneal smear................

0698 1.2438 $73.81 $16.55 $14.76 65435................. T.............. ............... Curette/treat cornea.........

0239 6.9097 $410.04 ........... $82.01 65436................. T.............. ............... Curette/treat cornea.........

0233 14.9673 $888.20 $266.33 $177.64 65450................. S.............. ............... Treatment of corneal lesion..

0231 1.9278 $114.40 $44.61 $22.88 65600................. T.............. ............... Revision of cornea...........

0240 18.1508 $1,077.12 $315.31 $215.42 65710................. T.............. ............... Corneal transplant...........

0244 38.3723 $2,277.13 $803.26 $455.43 65730................. T.............. ............... Corneal transplant...........

0244 38.3723 $2,277.13 $803.26 $455.43 65750................. T.............. ............... Corneal transplant...........

0244 38.3723 $2,277.13 $803.26 $455.43 65755................. T.............. ............... Corneal transplant...........

0244 38.3723 $2,277.13 $803.26 $455.43 65760................. E.............. ............... Revision of cornea........... ........... ........... ........... ........... ........... 65765................. E.............. ............... Revision of cornea........... ........... ........... ........... ........... ........... 65767................. E.............. ............... Corneal tissue transplant.... ........... ........... ........... ........... ........... 65770................. T.............. ............... Revise cornea with implant...

0244 38.3723 $2,277.13 $803.26 $455.43 65771................. E.............. ............... Radial keratotomy............ ........... ........... ........... ........... ........... 65772................. T.............. ............... Correction of astigmatism....

0233 14.9673 $888.20 $266.33 $177.64 65775................. T.............. ............... Correction of astigmatism....

0233 14.9673 $888.20 $266.33 $177.64 65780................. T.............. ............... Ocular reconst, transplant...

0244 38.3723 $2,277.13 $803.26 $455.43 65781................. T.............. ............... Ocular reconst, transplant...

0244 38.3723 $2,277.13 $803.26 $455.43 65782................. T.............. ............... Ocular reconst, transplant...

0244 38.3723 $2,277.13 $803.26 $455.43 65800................. T.............. ............... Drainage of eye..............

0233 14.9673 $888.20 $266.33 $177.64 65805................. T.............. ............... Drainage of eye..............

0233 14.9673 $888.20 $266.33 $177.64 65810................. T.............. ............... Drainage of eye..............

0234 21.9741 $1,304.01 $511.31 $260.80 65815................. T.............. ............... Drainage of eye..............

0234 21.9741 $1,304.01 $511.31 $260.80 65820................. T.............. ............... Relieve inner eye pressure...

0232 6.6732 $396.01 $103.17 $79.20 65850................. T.............. ............... Incision of eye..............

0234 21.9741 $1,304.01 $511.31 $260.80 65855................. T.............. ............... Laser surgery of eye.........

0247

5.033 $298.67 $104.31 $59.73 65860................. T.............. ............... Incise inner eye adhesions...

0247

5.033 $298.67 $104.31 $59.73 65865................. T.............. ............... Incise inner eye adhesions...

0233 14.9673 $888.20 $266.33 $177.64 65870................. T.............. ............... Incise inner eye adhesions...

0234 21.9741 $1,304.01 $511.31 $260.80 65875................. T.............. ............... Incise inner eye adhesions...

0234 21.9741 $1,304.01 $511.31 $260.80 65880................. T.............. ............... Incise inner eye adhesions...

0233 14.9673 $888.20 $266.33 $177.64 65900................. T.............. ............... Remove eye lesion............

0233 14.9673 $888.20 $266.33 $177.64 65920................. T.............. ............... Remove implant of eye........

0234 21.9741 $1,304.01 $511.31 $260.80 65930................. T.............. ............... Remove blood clot from eye...

0234 21.9741 $1,304.01 $511.31 $260.80

[[Page 50777]]

66020................. T.............. ............... Injection treatment of eye...

0233 14.9673 $888.20 $266.33 $177.64 66030................. T.............. ............... Injection treatment of eye...

0232 6.6732 $396.01 $103.17 $79.20 66130................. T.............. ............... Remove eye lesion............

0234 21.9741 $1,304.01 $511.31 $260.80 66150................. T.............. ............... Glaucoma surgery.............

0234 21.9741 $1,304.01 $511.31 $260.80 66155................. T.............. ............... Glaucoma surgery.............

0234 21.9741 $1,304.01 $511.31 $260.80 66160................. T.............. ............... Glaucoma surgery.............

0234 21.9741 $1,304.01 $511.31 $260.80 66165................. T.............. ............... Glaucoma surgery.............

0234 21.9741 $1,304.01 $511.31 $260.80 66170................. T.............. ............... Glaucoma surgery.............

0234 21.9741 $1,304.01 $511.31 $260.80 66172................. T.............. ............... Incision of eye..............

0673 29.2582 $1,736.27 $649.56 $347.25 66180................. T.............. ............... Implant eye shunt............

0673 29.2582 $1,736.27 $649.56 $347.25 66185................. T.............. ............... Revise eye shunt.............

0673 29.2582 $1,736.27 $649.56 $347.25 66220................. T.............. ............... Repair eye lesion............

0672 36.9284 $2,191.44 ........... $438.29 66225................. T.............. ............... Repair/graft eye lesion......

0673 29.2582 $1,736.27 $649.56 $347.25 66250................. T.............. ............... Follow-up surgery of eye.....

0233 14.9673 $888.20 $266.33 $177.64 66500................. T.............. ............... Incision of iris.............

0232 6.6732 $396.01 $103.17 $79.20 66505................. T.............. ............... Incision of iris.............

0232 6.6732 $396.01 $103.17 $79.20 66600................. T.............. ............... Remove iris and lesion.......

0234 21.9741 $1,304.01 $511.31 $260.80 66605................. T.............. ............... Removal of iris..............

0234 21.9741 $1,304.01 $511.31 $260.80 66625................. T.............. ............... Removal of iris..............

0232 6.6732 $396.01 $103.17 $79.20 66630................. T.............. ............... Removal of iris..............

0234 21.9741 $1,304.01 $511.31 $260.80 66635................. T.............. ............... Removal of iris..............

0234 21.9741 $1,304.01 $511.31 $260.80 66680................. T.............. ............... Repair iris & ciliary body...

0234 21.9741 $1,304.01 $511.31 $260.80 66682................. T.............. ............... Repair iris & ciliary body...

0234 21.9741 $1,304.01 $511.31 $260.80 66700................. T.............. ............... Destruction, ciliary body....

0233 14.9673 $888.20 $266.33 $177.64 66710................. T.............. ............... Destruction, ciliary body....

0233 14.9673 $888.20 $266.33 $177.64 66711................. T.............. ............... Ciliary endoscopic ablation..

0233 14.9673 $888.20 $266.33 $177.64 66720................. T.............. ............... Destruction, ciliary body....

0233 14.9673 $888.20 $266.33 $177.64 66740................. T.............. ............... Destruction, ciliary body....

0234 21.9741 $1,304.01 $511.31 $260.80 66761................. T.............. ............... Revision of iris.............

0247

5.033 $298.67 $104.31 $59.73 66762................. T.............. ............... Revision of iris.............

0247

5.033 $298.67 $104.31 $59.73 66770................. T.............. ............... Removal of inner eye lesion..

0247

5.033 $298.67 $104.31 $59.73 66820................. T.............. ............... Incision, secondary cataract.

0232 6.6732 $396.01 $103.17 $79.20 66821................. T.............. ............... After cataract laser surgery.

0247

5.033 $298.67 $104.31 $59.73 66825................. T.............. ............... Reposition intraocular lens..

0234 21.9741 $1,304.01 $511.31 $260.80 66830................. T.............. ............... Removal of lens lesion.......

0232 6.6732 $396.01 $103.17 $79.20 66840................. T.............. ............... Removal of lens material.....

0245 13.3625 $792.97 $221.89 $158.59 66850................. T.............. ............... Removal of lens material.....

0249 27.9369 $1,657.86 $524.67 $331.57 66852................. T.............. ............... Removal of lens material.....

0249 27.9369 $1,657.86 $524.67 $331.57 66920................. T.............. ............... Extraction of lens...........

0249 27.9369 $1,657.86 $524.67 $331.57 66930................. T.............. ............... Extraction of lens...........

0249 27.9369 $1,657.86 $524.67 $331.57 66940................. T.............. ............... Extraction of lens...........

0245 13.3625 $792.97 $221.89 $158.59 66982................. T.............. ............... Cataract surgery, complex....

0246 23.4597 $1,392.17 $495.96 $278.43 66983................. T.............. ............... Cataract surg w/iol, 1 stage.

0246 23.4597 $1,392.17 $495.96 $278.43 66984................. T.............. ............... Cataract surg w/iol, 1 stage.

0246 23.4597 $1,392.17 $495.96 $278.43 66985................. T.............. ............... Insert lens prosthesis.......

0246 23.4597 $1,392.17 $495.96 $278.43 66986................. T.............. ............... Exchange lens prosthesis.....

0246 23.4597 $1,392.17 $495.96 $278.43 66990................. N.............. ............... Ophthalmic endoscope add-on.. ........... ........... ........... ........... ........... 66999................. T.............. ............... Eye surgery procedure........

0232 6.6732 $396.01 $103.17 $79.20 67005................. T.............. ............... Partial removal of eye fluid.

0237 28.9401 $1,717.39 ........... $343.48 67010................. T.............. ............... Partial removal of eye fluid.

0237 28.9401 $1,717.39 ........... $343.48 67015................. T.............. ............... Release of eye fluid.........

0237 28.9401 $1,717.39 ........... $343.48 67025................. T.............. ............... Replace eye fluid............

0237 28.9401 $1,717.39 ........... $343.48 67027................. T.............. ............... Implant eye drug system......

0672 36.9284 $2,191.44 ........... $438.29 67028................. T.............. ............... Injection eye drug...........

0235 4.6593 $276.50 $67.40 $55.30 67030................. T.............. ............... Incise inner eye strands.....

0236 17.0229 $1,010.19 ........... $202.04 67031................. T.............. ............... Laser surgery, eye strands...

0247

5.033 $298.67 $104.31 $59.73 67036................. T.............. ............... Removal of inner eye fluid...

0672 36.9284 $2,191.44 ........... $438.29 67038................. T.............. ............... Strip retinal membrane.......

0672 36.9284 $2,191.44 ........... $438.29 67039................. T.............. ............... Laser treatment of retina....

0672 36.9284 $2,191.44 ........... $438.29 67040................. T.............. ............... Laser treatment of retina....

0672 36.9284 $2,191.44 ........... $438.29 67101................. T.............. ............... Repair detached retina.......

0236 17.0229 $1,010.19 ........... $202.04 67105................. T.............. ............... Repair detached retina.......

0248 4.6769 $277.54 $93.98 $55.51 67107................. T.............. ............... Repair detached retina.......

0672 36.9284 $2,191.44 ........... $438.29 67108................. T.............. ............... Repair detached retina.......

0672 36.9284 $2,191.44 ........... $438.29 67110................. T.............. ............... Repair detached retina.......

0236 17.0229 $1,010.19 ........... $202.04 67112................. T.............. ............... Rerepair detached retina.....

0672 36.9284 $2,191.44 ........... $438.29

[[Page 50778]]

67115................. T.............. ............... Release encircling material..

0236 17.0229 $1,010.19 ........... $202.04 67120................. T.............. ............... Remove eye implant material..

0236 17.0229 $1,010.19 ........... $202.04 67121................. T.............. ............... Remove eye implant material..

0237 28.9401 $1,717.39 ........... $343.48 67141................. T.............. ............... Treatment of retina..........

0235 4.6593 $276.50 $67.40 $55.30 67145................. T.............. ............... Treatment of retina..........

0248 4.6769 $277.54 $93.98 $55.51 67208................. T.............. ............... Treatment of retinal lesion..

0236 17.0229 $1,010.19 ........... $202.04 67210................. T.............. ............... Treatment of retinal lesion..

0248 4.6769 $277.54 $93.98 $55.51 67218................. T.............. ............... Treatment of retinal lesion..

0236 17.0229 $1,010.19 ........... $202.04 67220................. T.............. ............... Treatment of choroid lesion..

0235 4.6593 $276.50 $67.40 $55.30 67221................. T.............. ............... Ocular photodynamic ther.....

0235 4.6593 $276.50 $67.40 $55.30 67225................. T.............. ............... Eye photodynamic ther add-on.

0235 4.6593 $276.50 $67.40 $55.30 67227................. T.............. ............... Treatment of retinal lesion..

0236 17.0229 $1,010.19 ........... $202.04 67228................. T.............. ............... Treatment of retinal lesion..

0248 4.6769 $277.54 $93.98 $55.51 67250................. T.............. ............... Reinforce eye wall...........

0240 18.1508 $1,077.12 $315.31 $215.42 67255................. T.............. ............... Reinforce/graft eye wall.....

0237 28.9401 $1,717.39 ........... $343.48 67299................. T.............. ............... Eye surgery procedure........

0235 4.6593 $276.50 $67.40 $55.30 67311................. T.............. ............... Revise eye muscle............

0243 22.1671 $1,315.46 $431.39 $263.09 67312................. T.............. ............... Revise two eye muscles.......

0243 22.1671 $1,315.46 $431.39 $263.09 67314................. T.............. ............... Revise eye muscle............

0243 22.1671 $1,315.46 $431.39 $263.09 67316................. T.............. ............... Revise two eye muscles.......

0243 22.1671 $1,315.46 $431.39 $263.09 67318................. T.............. ............... Revise eye muscle(s).........

0243 22.1671 $1,315.46 $431.39 $263.09 67320................. T.............. ............... Revise eye muscle(s) add-on..

0243 22.1671 $1,315.46 $431.39 $263.09 67331................. T.............. ............... Eye surgery follow-up add-on.

0243 22.1671 $1,315.46 $431.39 $263.09 67332................. T.............. ............... Rerevise eye muscles add-on..

0243 22.1671 $1,315.46 $431.39 $263.09 67334................. T.............. ............... Revise eye muscle w/suture...

0243 22.1671 $1,315.46 $431.39 $263.09 67335................. T.............. ............... Eye suture during surgery....

0243 22.1671 $1,315.46 $431.39 $263.09 67340................. T.............. ............... Revise eye muscle add-on.....

0243 22.1671 $1,315.46 $431.39 $263.09 67343................. T.............. ............... Release eye tissue...........

0243 22.1671 $1,315.46 $431.39 $263.09 67345................. T.............. ............... Destroy nerve of eye muscle..

0238 2.5933 $153.89 ........... $30.78 67350................. T.............. ............... Biopsy eye muscle............

0699 10.0177 $594.48 ........... $118.90 67399................. T.............. ............... Eye muscle surgery procedure.

0243 22.1671 $1,315.46 $431.39 $263.09 67400................. T.............. ............... Explore/biopsy eye socket....

0241 23.3036 $1,382.91 $384.47 $276.58 67405................. T.............. ............... Explore/drain eye socket.....

0241 23.3036 $1,382.91 $384.47 $276.58 67412................. T.............. ............... Explore/treat eye socket.....

0241 23.3036 $1,382.91 $384.47 $276.58 67413................. T.............. ............... Explore/treat eye socket.....

0241 23.3036 $1,382.91 $384.47 $276.58 67414................. T.............. ............... Explr/decompress eye socket..

0242 30.5464 $1,812.72 $597.36 $362.54 67415................. T.............. ............... Aspiration, orbital contents.

0240 18.1508 $1,077.12 $315.31 $215.42 67420................. T.............. ............... Explore/treat eye socket.....

0242 30.5464 $1,812.72 $597.36 $362.54 67430................. T.............. ............... Explore/treat eye socket.....

0242 30.5464 $1,812.72 $597.36 $362.54 67440................. T.............. ............... Explore/drain eye socket.....

0242 30.5464 $1,812.72 $597.36 $362.54 67445................. T.............. ............... Explr/decompress eye socket..

0242 30.5464 $1,812.72 $597.36 $362.54 67450................. T.............. ............... Explore/biopsy eye socket....

0242 30.5464 $1,812.72 $597.36 $362.54 67500................. S.............. ............... Inject/treat eye socket......

0231 1.9278 $114.40 $44.61 $22.88 67505................. T.............. ............... Inject/treat eye socket......

0238 2.5933 $153.89 ........... $30.78 67515................. T.............. ............... Inject/treat eye socket......

0238 2.5933 $153.89 ........... $30.78 67550................. T.............. ............... Insert eye socket implant....

0242 30.5464 $1,812.72 $597.36 $362.54 67560................. T.............. ............... Revise eye socket implant....

0241 23.3036 $1,382.91 $384.47 $276.58 67570................. T.............. ............... Decompress optic nerve.......

0242 30.5464 $1,812.72 $597.36 $362.54 67599................. T.............. ............... Orbit surgery procedure......

0238 2.5933 $153.89 ........... $30.78 67700................. T.............. ............... Drainage of eyelid abscess...

0238 2.5933 $153.89 ........... $30.78 67710................. T.............. ............... Incision of eyelid...........

0239 6.9097 $410.04 ........... $82.01 67715................. T.............. ............... Incision of eyelid fold......

0240 18.1508 $1,077.12 $315.31 $215.42 67800................. T.............. ............... Remove eyelid lesion.........

0238 2.5933 $153.89 ........... $30.78 67801................. T.............. ............... Remove eyelid lesions........

0239 6.9097 $410.04 ........... $82.01 67805................. T.............. ............... Remove eyelid lesions........

0238 2.5933 $153.89 ........... $30.78 67808................. T.............. ............... Remove eyelid lesion(s)......

0240 18.1508 $1,077.12 $315.31 $215.42 67810................. T.............. ............... Biopsy of eyelid.............

0238 2.5933 $153.89 ........... $30.78 67820................. S.............. ............... Revise eyelashes.............

0698 1.2438 $73.81 $16.55 $14.76 67825................. T.............. ............... Revise eyelashes.............

0238 2.5933 $153.89 ........... $30.78 67830................. T.............. ............... Revise eyelashes.............

0239 6.9097 $410.04 ........... $82.01 67835................. T.............. ............... Revise eyelashes.............

0240 18.1508 $1,077.12 $315.31 $215.42 67840................. T.............. ............... Remove eyelid lesion.........

0239 6.9097 $410.04 ........... $82.01 67850................. T.............. ............... Treat eyelid lesion..........

0239 6.9097 $410.04 ........... $82.01 67875................. T.............. ............... Closure of eyelid by suture..

0239 6.9097 $410.04 ........... $82.01 67880................. T.............. ............... Revision of eyelid...........

0233 14.9673 $888.20 $266.33 $177.64 67882................. T.............. ............... Revision of eyelid...........

0240 18.1508 $1,077.12 $315.31 $215.42

[[Continued on page 50779]]

From the Federal Register Online via GPO Access [wais.access.gpo.gov] ]

[[pp. 50779-50828]] Medicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates; Correction

[[Continued from page 50778]]

[[Page 50779]]

67900................. T.............. ............... Repair brow defect...........

0240 18.1508 $1,077.12 $315.31 $215.42 67901................. T.............. ............... Repair eyelid defect.........

0240 18.1508 $1,077.12 $315.31 $215.42 67902................. T.............. ............... Repair eyelid defect.........

0240 18.1508 $1,077.12 $315.31 $215.42 67903................. T.............. ............... Repair eyelid defect.........

0240 18.1508 $1,077.12 $315.31 $215.42 67904................. T.............. ............... Repair eyelid defect.........

0240 18.1508 $1,077.12 $315.31 $215.42 67906................. T.............. ............... Repair eyelid defect.........

0240 18.1508 $1,077.12 $315.31 $215.42 67908................. T.............. ............... Repair eyelid defect.........

0240 18.1508 $1,077.12 $315.31 $215.42 67909................. T.............. ............... Revise eyelid defect.........

0240 18.1508 $1,077.12 $315.31 $215.42 67911................. T.............. ............... Revise eyelid defect.........

0240 18.1508 $1,077.12 $315.31 $215.42 67912................. T.............. ............... Correction eyelid w/ implant.

0240 18.1508 $1,077.12 $315.31 $215.42 67914................. T.............. ............... Repair eyelid defect.........

0240 18.1508 $1,077.12 $315.31 $215.42 67915................. T.............. ............... Repair eyelid defect.........

0240 18.1508 $1,077.12 $315.31 $215.42 67916................. T.............. ............... Repair eyelid defect.........

0240 18.1508 $1,077.12 $315.31 $215.42 67917................. T.............. ............... Repair eyelid defect.........

0240 18.1508 $1,077.12 $315.31 $215.42 67921................. T.............. ............... Repair eyelid defect.........

0240 18.1508 $1,077.12 $315.31 $215.42 67922................. T.............. ............... Repair eyelid defect.........

0240 18.1508 $1,077.12 $315.31 $215.42 67923................. T.............. ............... Repair eyelid defect.........

0240 18.1508 $1,077.12 $315.31 $215.42 67924................. T.............. ............... Repair eyelid defect.........

0240 18.1508 $1,077.12 $315.31 $215.42 67930................. T.............. ............... Repair eyelid wound..........

0240 18.1508 $1,077.12 $315.31 $215.42 67935................. T.............. ............... Repair eyelid wound..........

0240 18.1508 $1,077.12 $315.31 $215.42 67938................. S.............. ............... Remove eyelid foreign body...

0698 1.2438 $73.81 $16.55 $14.76 67950................. T.............. ............... Revision of eyelid...........

0240 18.1508 $1,077.12 $315.31 $215.42 67961................. T.............. ............... Revision of eyelid...........

0240 18.1508 $1,077.12 $315.31 $215.42 67966................. T.............. ............... Revision of eyelid...........

0240 18.1508 $1,077.12 $315.31 $215.42 67971................. T.............. ............... Reconstruction of eyelid.....

0241 23.3036 $1,382.91 $384.47 $276.58 67973................. T.............. ............... Reconstruction of eyelid.....

0241 23.3036 $1,382.91 $384.47 $276.58 67974................. T.............. ............... Reconstruction of eyelid.....

0241 23.3036 $1,382.91 $384.47 $276.58 67975................. T.............. ............... Reconstruction of eyelid.....

0240 18.1508 $1,077.12 $315.31 $215.42 67999................. T.............. ............... Revision of eyelid...........

0238 2.5933 $153.89 ........... $30.78 68020................. T.............. ............... Incise/drain eyelid lining...

0240 18.1508 $1,077.12 $315.31 $215.42 68040................. S.............. ............... Treatment of eyelid lesions..

0698 1.2438 $73.81 $16.55 $14.76 68100................. T.............. ............... Biopsy of eyelid lining......

0232 6.6732 $396.01 $103.17 $79.20 68110................. T.............. ............... Remove eyelid lining lesion..

0699 10.0177 $594.48 ........... $118.90 68115................. T.............. ............... Remove eyelid lining lesion..

0240 18.1508 $1,077.12 $315.31 $215.42 68130................. T.............. ............... Remove eyelid lining lesion..

0233 14.9673 $888.20 $266.33 $177.64 68135................. T.............. ............... Remove eyelid lining lesion..

0239 6.9097 $410.04 ........... $82.01 68200................. S.............. ............... Treat eyelid by injection....

0230 0.7858 $46.63 $14.97

$9.33 68320................. T.............. ............... Revise/graft eyelid lining...

0240 18.1508 $1,077.12 $315.31 $215.42 68325................. T.............. ............... Revise/graft eyelid lining...

0242 30.5464 $1,812.72 $597.36 $362.54 68326................. T.............. ............... Revise/graft eyelid lining...

0241 23.3036 $1,382.91 $384.47 $276.58 68328................. T.............. ............... Revise/graft eyelid lining...

0241 23.3036 $1,382.91 $384.47 $276.58 68330................. T.............. ............... Revise eyelid lining.........

0234 21.9741 $1,304.01 $511.31 $260.80 68335................. T.............. ............... Revise/graft eyelid lining...

0241 23.3036 $1,382.91 $384.47 $276.58 68340................. T.............. ............... Separate eyelid adhesions....

0240 18.1508 $1,077.12 $315.31 $215.42 68360................. T.............. ............... Revise eyelid lining.........

0234 21.9741 $1,304.01 $511.31 $260.80 68362................. T.............. ............... Revise eyelid lining.........

0234 21.9741 $1,304.01 $511.31 $260.80 68371................. T.............. ............... Harvest eye tissue, alograft.

0233 14.9673 $888.20 $266.33 $177.64 68399................. T.............. ............... Eyelid lining surgery........

0238 2.5933 $153.89 ........... $30.78 68400................. T.............. ............... Incise/drain tear gland......

0238 2.5933 $153.89 ........... $30.78 68420................. T.............. ............... Incise/drain tear sac........

0240 18.1508 $1,077.12 $315.31 $215.42 68440................. T.............. ............... Incise tear duct opening.....

0238 2.5933 $153.89 ........... $30.78 68500................. T.............. ............... Removal of tear gland........

0241 23.3036 $1,382.91 $384.47 $276.58 68505................. T.............. ............... Partial removal, tear gland..

0241 23.3036 $1,382.91 $384.47 $276.58 68510................. T.............. ............... Biopsy of tear gland.........

0240 18.1508 $1,077.12 $315.31 $215.42 68520................. T.............. ............... Removal of tear sac..........

0241 23.3036 $1,382.91 $384.47 $276.58 68525................. T.............. ............... Biopsy of tear sac...........

0240 18.1508 $1,077.12 $315.31 $215.42 68530................. T.............. ............... Clearance of tear duct.......

0240 18.1508 $1,077.12 $315.31 $215.42 68540................. T.............. ............... Remove tear gland lesion.....

0241 23.3036 $1,382.91 $384.47 $276.58 68550................. T.............. ............... Remove tear gland lesion.....

0242 30.5464 $1,812.72 $597.36 $362.54 68700................. T.............. ............... Repair tear ducts............

0241 23.3036 $1,382.91 $384.47 $276.58 68705................. T.............. ............... Revise tear duct opening.....

0238 2.5933 $153.89 ........... $30.78 68720................. T.............. ............... Create tear sac drain........

0242 30.5464 $1,812.72 $597.36 $362.54 68745................. T.............. ............... Create tear duct drain.......

0241 23.3036 $1,382.91 $384.47 $276.58 68750................. T.............. ............... Create tear duct drain.......

0242 30.5464 $1,812.72 $597.36 $362.54 68760................. S.............. ............... Close tear duct opening......

0698 1.2438 $73.81 $16.55 $14.76 68761................. S.............. ............... Close tear duct opening......

0231 1.9278 $114.40 $44.61 $22.88

[[Page 50780]]

68770................. T.............. ............... Close tear system fistula....

0240 18.1508 $1,077.12 $315.31 $215.42 68801................. S.............. ............... Dilate tear duct opening.....

0698 1.2438 $73.81 $16.55 $14.76 68810................. S.............. ............... Probe nasolacrimal duct......

0231 1.9278 $114.40 $44.61 $22.88 68811................. T.............. ............... Probe nasolacrimal duct......

0240 18.1508 $1,077.12 $315.31 $215.42 68815................. T.............. ............... Probe nasolacrimal duct......

0240 18.1508 $1,077.12 $315.31 $215.42 68840................. S.............. ............... Explore/irrigate tear ducts..

0231 1.9278 $114.40 $44.61 $22.88 68850................. N.............. ............... Injection for tear sac x-ray. ........... ........... ........... ........... ........... 68899................. S.............. ............... Tear duct system surgery.....

0230 0.7858 $46.63 $14.97

$9.33 69000................. T.............. ............... Drain external ear lesion....

0006

1.55 $91.98 $22.28 $18.40 69005................. T.............. ............... Drain external ear lesion....

0008 16.4989 $979.09 ........... $195.82 69020................. T.............. ............... Drain outer ear canal lesion.

0006

1.55 $91.98 $22.28 $18.40 69090................. E.............. ............... Pierce earlobes.............. ........... ........... ........... ........... ........... 69100................. T.............. ............... Biopsy of external ear.......

0019 4.0547 $240.62 $71.87 $48.12 69105................. T.............. ............... Biopsy of external ear canal.

0253 16.1357 $957.54 $282.29 $191.51 69110................. T.............. ............... Remove external ear, partial.

0021 14.9776 $888.82 $219.48 $177.76 69120................. T.............. ............... Removal of external ear......

0254 23.404 $1,388.86 $321.35 $277.77 69140................. T.............. ............... Remove ear canal lesion(s)...

0254 23.404 $1,388.86 $321.35 $277.77 69145................. T.............. ............... Remove ear canal lesion(s)...

0021 14.9776 $888.82 $219.48 $177.76 69150................. T.............. ............... Extensive ear canal surgery..

0252 7.8673 $466.87 $113.41 $93.37 69155................. C.............. ............... Extensive ear/neck surgery... ........... ........... ........... ........... ........... 69200................. X.............. ............... Clear outer ear canal........

0340 0.6384 $37.88 ...........

$7.58 69205................. T.............. ............... Clear outer ear canal........

0022 19.6472 $1,165.92 $354.45 $233.18 69210................. X.............. ............... Remove impacted ear wax......

0340 0.6384 $37.88 ...........

$7.58 69220................. T.............. ............... Clean out mastoid cavity.....

0012 0.8497 $50.42 $11.18 $10.08 69222................. T.............. ............... Clean out mastoid cavity.....

0253 16.1357 $957.54 $282.29 $191.51 69300................. T.............. ............... Revise external ear..........

0254 23.404 $1,388.86 $321.35 $277.77 69310................. T.............. ............... Rebuild outer ear canal......

0256 37.3204 $2,214.70 ........... $442.94 69320................. T.............. ............... Rebuild outer ear canal......

0256 37.3204 $2,214.70 ........... $442.94 69399................. T.............. ............... Outer ear surgery procedure..

0251 2.0101 $119.29 ........... $23.86 69400................. T.............. ............... Inflate middle ear canal.....

0251 2.0101 $119.29 ........... $23.86 69401................. T.............. ............... Inflate middle ear canal.....

0251 2.0101 $119.29 ........... $23.86 69405................. T.............. ............... Catheterize middle ear canal.

0252 7.8673 $466.87 $113.41 $93.37 69410................. T.............. ............... Inset middle ear (baffle)....

0251 2.0101 $119.29 ........... $23.86 69420................. T.............. ............... Incision of eardrum..........

0251 2.0101 $119.29 ........... $23.86 69421................. T.............. ............... Incision of eardrum..........

0253 16.1357 $957.54 $282.29 $191.51 69424................. T.............. ............... Remove ventilating tube......

0252 7.8673 $466.87 $113.41 $93.37 69433................. T.............. ............... Create eardrum opening.......

0252 7.8673 $466.87 $113.41 $93.37 69436................. T.............. ............... Create eardrum opening.......

0253 16.1357 $957.54 $282.29 $191.51 69440................. T.............. ............... Exploration of middle ear....

0254 23.404 $1,388.86 $321.35 $277.77 69450................. T.............. ............... Eardrum revision.............

0256 37.3204 $2,214.70 ........... $442.94 69501................. T.............. ............... Mastoidectomy................

0256 37.3204 $2,214.70 ........... $442.94 69502................. T.............. ............... Mastoidectomy................

0254 23.404 $1,388.86 $321.35 $277.77 69505................. T.............. ............... Remove mastoid structures....

0256 37.3204 $2,214.70 ........... $442.94 69511................. T.............. ............... Extensive mastoid surgery....

0256 37.3204 $2,214.70 ........... $442.94 69530................. T.............. ............... Extensive mastoid surgery....

0256 37.3204 $2,214.70 ........... $442.94 69535................. C.............. ............... Remove part of temporal bone. ........... ........... ........... ........... ........... 69540................. T.............. ............... Remove ear lesion............

0253 16.1357 $957.54 $282.29 $191.51 69550................. T.............. ............... Remove ear lesion............

0256 37.3204 $2,214.70 ........... $442.94 69552................. T.............. ............... Remove ear lesion............

0256 37.3204 $2,214.70 ........... $442.94 69554................. C.............. ............... Remove ear lesion............ ........... ........... ........... ........... ........... 69601................. T.............. ............... Mastoid surgery revision.....

0256 37.3204 $2,214.70 ........... $442.94 69602................. T.............. ............... Mastoid surgery revision.....

0256 37.3204 $2,214.70 ........... $442.94 69603................. T.............. ............... Mastoid surgery revision.....

0256 37.3204 $2,214.70 ........... $442.94 69604................. T.............. ............... Mastoid surgery revision.....

0256 37.3204 $2,214.70 ........... $442.94 69605................. T.............. ............... Mastoid surgery revision.....

0256 37.3204 $2,214.70 ........... $442.94 69610................. T.............. ............... Repair of eardrum............

0254 23.404 $1,388.86 $321.35 $277.77 69620................. T.............. ............... Repair of eardrum............

0254 23.404 $1,388.86 $321.35 $277.77 69631................. T.............. ............... Repair eardrum structures....

0256 37.3204 $2,214.70 ........... $442.94 69632................. T.............. ............... Rebuild eardrum structures...

0256 37.3204 $2,214.70 ........... $442.94 69633................. T.............. ............... Rebuild eardrum structures...

0256 37.3204 $2,214.70 ........... $442.94 69635................. T.............. ............... Repair eardrum structures....

0256 37.3204 $2,214.70 ........... $442.94 69636................. T.............. ............... Rebuild eardrum structures...

0256 37.3204 $2,214.70 ........... $442.94 69637................. T.............. ............... Rebuild eardrum structures...

0256 37.3204 $2,214.70 ........... $442.94 69641................. T.............. ............... Revise middle ear & mastoid..

0256 37.3204 $2,214.70 ........... $442.94 69642................. T.............. ............... Revise middle ear & mastoid..

0256 37.3204 $2,214.70 ........... $442.94 69643................. T.............. ............... Revise middle ear & mastoid..

0256 37.3204 $2,214.70 ........... $442.94

[[Page 50781]]

69644................. T.............. ............... Revise middle ear & mastoid..

0256 37.3204 $2,214.70 ........... $442.94 69645................. T.............. ............... Revise middle ear & mastoid..

0256 37.3204 $2,214.70 ........... $442.94 69646................. T.............. ............... Revise middle ear & mastoid..

0256 37.3204 $2,214.70 ........... $442.94 69650................. T.............. ............... Release middle ear bone......

0254 23.404 $1,388.86 $321.35 $277.77 69660................. T.............. ............... Revise middle ear bone.......

0256 37.3204 $2,214.70 ........... $442.94 69661................. T.............. ............... Revise middle ear bone.......

0256 37.3204 $2,214.70 ........... $442.94 69662................. T.............. ............... Revise middle ear bone.......

0256 37.3204 $2,214.70 ........... $442.94 69666................. T.............. ............... Repair middle ear structures.

0256 37.3204 $2,214.70 ........... $442.94 69667................. T.............. ............... Repair middle ear structures.

0256 37.3204 $2,214.70 ........... $442.94 69670................. T.............. ............... Remove mastoid air cells.....

0256 37.3204 $2,214.70 ........... $442.94 69676................. T.............. ............... Remove middle ear nerve......

0256 37.3204 $2,214.70 ........... $442.94 69700................. T.............. ............... Close mastoid fistula........

0256 37.3204 $2,214.70 ........... $442.94 69710................. E.............. ............... Implant/replace hearing aid.. ........... ........... ........... ........... ........... 69711................. T.............. ............... Remove/repair hearing aid....

0256 37.3204 $2,214.70 ........... $442.94 69714................. T.............. ............... Implant temple bone w/stimul.

0256 37.3204 $2,214.70 ........... $442.94 69715................. T.............. ............... Temple bne implnt w/stimulat.

0256 37.3204 $2,214.70 ........... $442.94 69717................. T.............. ............... Temple bone implant revision.

0256 37.3204 $2,214.70 ........... $442.94 69718................. T.............. ............... Revise temple bone implant...

0256 37.3204 $2,214.70 ........... $442.94 69720................. T.............. ............... Release facial nerve.........

0256 37.3204 $2,214.70 ........... $442.94 69725................. T.............. ............... Release facial nerve.........

0256 37.3204 $2,214.70 ........... $442.94 69740................. T.............. ............... Repair facial nerve..........

0256 37.3204 $2,214.70 ........... $442.94 69745................. T.............. ............... Repair facial nerve..........

0256 37.3204 $2,214.70 ........... $442.94 69799................. T.............. ............... Middle ear surgery procedure.

0251 2.0101 $119.29 ........... $23.86 69801................. T.............. ............... Incise inner ear.............

0256 37.3204 $2,214.70 ........... $442.94 69802................. T.............. ............... Incise inner ear.............

0256 37.3204 $2,214.70 ........... $442.94 69805................. T.............. ............... Explore inner ear............

0256 37.3204 $2,214.70 ........... $442.94 69806................. T.............. ............... Explore inner ear............

0256 37.3204 $2,214.70 ........... $442.94 69820................. T.............. ............... Establish inner ear window...

0256 37.3204 $2,214.70 ........... $442.94 69840................. T.............. ............... Revise inner ear window......

0256 37.3204 $2,214.70 ........... $442.94 69905................. T.............. ............... Remove inner ear.............

0256 37.3204 $2,214.70 ........... $442.94 69910................. T.............. ............... Remove inner ear & mastoid...

0256 37.3204 $2,214.70 ........... $442.94 69915................. T.............. ............... Incise inner ear nerve.......

0256 37.3204 $2,214.70 ........... $442.94 69930................. T.............. ............... Implant cochlear device......

0259 366.3317 $21,739.22 $8,070.21 $4,347.84 69949................. T.............. ............... Inner ear surgery procedure..

0251 2.0101 $119.29 ........... $23.86 69950................. C.............. ............... Incise inner ear nerve....... ........... ........... ........... ........... ........... 69955................. T.............. ............... Release facial nerve.........

0256 37.3204 $2,214.70 ........... $442.94 69960................. T.............. ............... Release inner ear canal......

0256 37.3204 $2,214.70 ........... $442.94 69970................. C.............. ............... Remove inner ear lesion...... ........... ........... ........... ........... ........... 69979................. T.............. ............... Temporal bone surgery........

0251 2.0101 $119.29 ........... $23.86 69990................. N.............. ............... Microsurgery add-on.......... ........... ........... ........... ........... ........... 70010................. S.............. ............... Contrast x-ray of brain......

0274 3.0413 $180.48 $72.19 $36.10 70015................. S.............. ............... Contrast x-ray of brain......

0274 3.0413 $180.48 $72.19 $36.10 70030................. X.............. ............... X-ray eye for foreign body...

0260 0.7555 $44.83 $17.93

$8.97 70100................. X.............. ............... X-ray exam of jaw............

0260 0.7555 $44.83 $17.93

$8.97 70110................. X.............. ............... X-ray exam of jaw............

0260 0.7555 $44.83 $17.93

$8.97 70120................. X.............. ............... X-ray exam of mastoids.......

0260 0.7555 $44.83 $17.93

$8.97 70130................. X.............. ............... X-ray exam of mastoids.......

0260 0.7555 $44.83 $17.93

$8.97 70134................. X.............. ............... X-ray exam of middle ear.....

0261 1.2901 $76.56 ........... $15.31 70140................. X.............. ............... X-ray exam of facial bones...

0260 0.7555 $44.83 $17.93

$8.97 70150................. X.............. ............... X-ray exam of facial bones...

0260 0.7555 $44.83 $17.93

$8.97 70160................. X.............. ............... X-ray exam of nasal bones....

0260 0.7555 $44.83 $17.93

$8.97 70170................. X.............. ............... X-ray exam of tear duct......

0264

3.524 $209.12 $79.41 $41.82 70190................. X.............. ............... X-ray exam of eye sockets....

0260 0.7555 $44.83 $17.93

$8.97 70200................. X.............. ............... X-ray exam of eye sockets....

0260 0.7555 $44.83 $17.93

$8.97 70210................. X.............. ............... X-ray exam of sinuses........

0260 0.7555 $44.83 $17.93

$8.97 70220................. X.............. ............... X-ray exam of sinuses........

0260 0.7555 $44.83 $17.93

$8.97 70240................. X.............. ............... X-ray exam, pituitary saddle.

0260 0.7555 $44.83 $17.93

$8.97 70250................. X.............. ............... X-ray exam of skull..........

0260 0.7555 $44.83 $17.93

$8.97 70260................. X.............. ............... X-ray exam of skull..........

0261 1.2901 $76.56 ........... $15.31 70300................. X.............. ............... X-ray exam of teeth..........

0262 0.9228 $54.76 ........... $10.95 70310................. X.............. ............... X-ray exam of teeth..........

0262 0.9228 $54.76 ........... $10.95 70320................. X.............. ............... Full mouth x-ray of teeth....

0262 0.9228 $54.76 ........... $10.95 70328................. X.............. ............... X-ray exam of jaw joint......

0260 0.7555 $44.83 $17.93

$8.97 70330................. X.............. ............... X-ray exam of jaw joints.....

0260 0.7555 $44.83 $17.93

$8.97 70332................. S.............. ............... X-ray exam of jaw joint......

0275 3.5779 $212.32 $69.09 $42.46 70336................. S.............. ............... Magnetic image, jaw joint....

0335 5.1581 $306.10 $122.43 $61.22

[[Page 50782]]

70350................. X.............. ............... X-ray head for orthodontia...

0260 0.7555 $44.83 $17.93

$8.97 70355................. X.............. ............... Panoramic x-ray of jaws......

0260 0.7555 $44.83 $17.93

$8.97 70360................. X.............. ............... X-ray exam of neck...........

0260 0.7555 $44.83 $17.93

$8.97 70370................. X.............. ............... Throat x-ray & fluoroscopy...

0272 1.3801 $81.90 $32.76 $16.38 70371................. X.............. ............... Speech evaluation, complex...

0272 1.3801 $81.90 $32.76 $16.38 70373................. X.............. ............... Contrast x-ray of larynx.....

0263 1.7476 $103.71 $24.40 $20.74 70380................. X.............. ............... X-ray exam of salivary gland.

0260 0.7555 $44.83 $17.93

$8.97 70390................. X.............. ............... X-ray exam of salivary duct..

0263 1.7476 $103.71 $24.40 $20.74 70450*................ S.............. ............... Ct head/brain w/o dye........

0332 3.2694 $194.02 $77.60 $38.80 70460*................ S.............. ............... Ct head/brain w/dye..........

0283 4.4253 $262.61 $105.04 $52.52 70470*................ S.............. ............... Ct head/brain w/o & w/ dye...

0333 5.2836 $313.54 $125.41 $62.71 70480*................ S.............. ............... Ct orbit/ear/fossa w/o dye...

0332 3.2694 $194.02 $77.60 $38.80 70481*................ S.............. ............... Ct orbit/ear/fossa w/dye.....

0283 4.4253 $262.61 $105.04 $52.52 70482*................ S.............. ............... Ct orbit/ear/fossa w/o&w dye.

0333 5.2836 $313.54 $125.41 $62.71 70486*................ S.............. ............... Ct maxillofacial w/o dye.....

0332 3.2694 $194.02 $77.60 $38.80 70487*................ S.............. ............... Ct maxillofacial w/dye.......

0283 4.4253 $262.61 $105.04 $52.52 70488*................ S.............. ............... Ct maxillofacial w/o & w dye.

0333 5.2836 $313.54 $125.41 $62.71 70490*................ S.............. ............... Ct soft tissue neck w/o dye..

0332 3.2694 $194.02 $77.60 $38.80 70491*................ S.............. ............... Ct soft tissue neck w/dye....

0283 4.4253 $262.61 $105.04 $52.52 70492*................ S.............. ............... Ct sft tsue nck w/o & w/dye..

0333 5.2836 $313.54 $125.41 $62.71 70496*................ S.............. ............... Ct angiography, head.........

0662 5.1621 $306.33 $122.53 $61.27 70498*................ S.............. ............... Ct angiography, neck.........

0662 5.1621 $306.33 $122.53 $61.27 70540*................ S.............. ............... Mri orbit/face/neck w/o dye..

0336 6.0742 $360.46 $144.18 $72.09 70542*................ S.............. ............... Mri orbit/face/neck w/dye....

0284 6.4201 $380.99 $152.39 $76.20 70543*................ S.............. ............... Mri orbt/fac/nck w/o & w dye.

0337 8.7945 $521.89 $208.75 $104.38 70544*................ S.............. ............... Mr angiography head w/o dye..

0336 6.0742 $360.46 $144.18 $72.09 70545*................ S.............. ............... Mr angiography head w/dye....

0284 6.4201 $380.99 $152.39 $76.20 70546*................ S.............. ............... Mr angiograph head w/o&w dye.

0337 8.7945 $521.89 $208.75 $104.38 70547*................ S.............. ............... Mr angiography neck w/o dye..

0336 6.0742 $360.46 $144.18 $72.09 70548*................ S.............. ............... Mr angiography neck w/dye....

0284 6.4201 $380.99 $152.39 $76.20 70549*................ S.............. ............... Mr angiograph neck w/o&w dye.

0337 8.7945 $521.89 $208.75 $104.38 70551*................ S.............. ............... Mri brain w/o dye............

0336 6.0742 $360.46 $144.18 $72.09 70552*................ S.............. ............... Mri brain w/ dye.............

0284 6.4201 $380.99 $152.39 $76.20 70553*................ S.............. ............... Mri brain w/o & w/ dye.......

0337 8.7945 $521.89 $208.75 $104.38 70557................. S.............. ............... Mri brain w/o dye............

0336 6.0742 $360.46 $144.18 $72.09 70558................. S.............. ............... Mri brain w/ dye.............

0284 6.4201 $380.99 $152.39 $76.20 70559................. S.............. ............... Mri brain w/o & w/ dye.......

0337 8.7945 $521.89 $208.75 $104.38 71010................. X.............. ............... Chest x-ray..................

0260 0.7555 $44.83 $17.93

$8.97 71015................. X.............. ............... Chest x-ray..................

0260 0.7555 $44.83 $17.93

$8.97 71020................. X.............. ............... Chest x-ray..................

0260 0.7555 $44.83 $17.93

$8.97 71021................. X.............. ............... Chest x-ray..................

0260 0.7555 $44.83 $17.93

$8.97 71022................. X.............. ............... Chest x-ray..................

0260 0.7555 $44.83 $17.93

$8.97 71023................. X.............. ............... Chest x-ray and fluoroscopy..

0272 1.3801 $81.90 $32.76 $16.38 71030................. X.............. ............... Chest x-ray..................

0260 0.7555 $44.83 $17.93

$8.97 71034................. X.............. ............... Chest x-ray and fluoroscopy..

0272 1.3801 $81.90 $32.76 $16.38 71035................. X.............. ............... Chest x-ray..................

0260 0.7555 $44.83 $17.93

$8.97 71040................. X.............. ............... Contrast x-ray of bronchi....

0263 1.7476 $103.71 $24.40 $20.74 71060................. X.............. ............... Contrast x-ray of bronchi....

0263 1.7476 $103.71 $24.40 $20.74 71090................. X.............. ............... X-ray & pacemaker insertion..

0272 1.3801 $81.90 $32.76 $16.38 71100................. X.............. ............... X-ray exam of ribs...........

0260 0.7555 $44.83 $17.93

$8.97 71101................. X.............. ............... X-ray exam of ribs/chest.....

0260 0.7555 $44.83 $17.93

$8.97 71110................. X.............. ............... X-ray exam of ribs...........

0260 0.7555 $44.83 $17.93

$8.97 71111................. X.............. ............... X-ray exam of ribs/ chest....

0261 1.2901 $76.56 ........... $15.31 71120................. X.............. ............... X-ray exam of breastbone.....

0260 0.7555 $44.83 $17.93

$8.97 71130................. X.............. ............... X-ray exam of breastbone.....

0260 0.7555 $44.83 $17.93

$8.97 71250*................ S.............. ............... Ct thorax w/o dye............

0332 3.2694 $194.02 $77.60 $38.80 71260*................ S.............. ............... Ct thorax w/dye..............

0283 4.4253 $262.61 $105.04 $52.52 71270*................ S.............. ............... Ct thorax w/o & w/ dye.......

0333 5.2836 $313.54 $125.41 $62.71 71275*................ S.............. ............... Ct angiography, chest........

0662 5.1621 $306.33 $122.53 $61.27 71550*................ S.............. ............... Mri chest w/o dye............

0336 6.0742 $360.46 $144.18 $72.09 71551*................ S.............. ............... Mri chest w/dye..............

0284 6.4201 $380.99 $152.39 $76.20 71552*................ S.............. ............... Mri chest w/o & w/dye........

0337 8.7945 $521.89 $208.75 $104.38 71555................. B.............. ............... Mri angio chest w or w/o dye. ........... ........... ........... ........... ........... 72010................. X.............. ............... X-ray exam of spine..........

0260 0.7555 $44.83 $17.93

$8.97 72020................. X.............. ............... X-ray exam of spine..........

0260 0.7555 $44.83 $17.93

$8.97 72040................. X.............. ............... X-ray exam of neck spine.....

0260 0.7555 $44.83 $17.93

$8.97

[[Page 50783]]

72050................. X.............. ............... X-ray exam of neck spine.....

0261 1.2901 $76.56 ........... $15.31 72052................. X.............. ............... X-ray exam of neck spine.....

0261 1.2901 $76.56 ........... $15.31 72069................. X.............. ............... X-ray exam of trunk spine....

0260 0.7555 $44.83 $17.93

$8.97 72070................. X.............. ............... X-ray exam of thoracic spine.

0260 0.7555 $44.83 $17.93

$8.97 72072................. X.............. ............... X-ray exam of thoracic spine.

0260 0.7555 $44.83 $17.93

$8.97 72074................. X.............. ............... X-ray exam of thoracic spine.

0260 0.7555 $44.83 $17.93

$8.97 72080................. X.............. ............... X-ray exam of trunk spine....

0260 0.7555 $44.83 $17.93

$8.97 72090................. X.............. ............... X-ray exam of trunk spine....

0261 1.2901 $76.56 ........... $15.31 72100................. X.............. ............... X-ray exam of lower spine....

0260 0.7555 $44.83 $17.93

$8.97 72110................. X.............. ............... X-ray exam of lower spine....

0261 1.2901 $76.56 ........... $15.31 72114................. X.............. ............... X-ray exam of lower spine....

0261 1.2901 $76.56 ........... $15.31 72120................. X.............. ............... X-ray exam of lower spine....

0261 1.2901 $76.56 ........... $15.31 72125*................ S.............. ............... Ct neck spine w/o dye........

0332 3.2694 $194.02 $77.60 $38.80 72126*................ S.............. ............... Ct neck spine w/dye..........

0283 4.4253 $262.61 $105.04 $52.52 72127*................ S.............. ............... Ct neck spine w/o & w/dye....

0333 5.2836 $313.54 $125.41 $62.71 72128*................ S.............. ............... Ct chest spine w/o dye.......

0332 3.2694 $194.02 $77.60 $38.80 72129*................ S.............. ............... Ct chest spine w/dye.........

0283 4.4253 $262.61 $105.04 $52.52 72130*................ S.............. ............... Ct chest spine w/o & w/dye...

0333 5.2836 $313.54 $125.41 $62.71 72131*................ S.............. ............... Ct lumbar spine w/o dye......

0332 3.2694 $194.02 $77.60 $38.80 72132*................ S.............. ............... Ct lumbar spine w/dye........

0283 4.4253 $262.61 $105.04 $52.52 72133*................ S.............. ............... Ct lumbar spine w/o & w/dye..

0333 5.2836 $313.54 $125.41 $62.71 72141*................ S.............. ............... Mri neck spine w/o dye.......

0336 6.0742 $360.46 $144.18 $72.09 72142*................ S.............. ............... Mri neck spine w/dye.........

0284 6.4201 $380.99 $152.39 $76.20 72146*................ S.............. ............... Mri chest spine w/o dye......

0336 6.0742 $360.46 $144.18 $72.09 72147*................ S.............. ............... Mri chest spine w/dye........

0284 6.4201 $380.99 $152.39 $76.20 72148*................ S.............. ............... Mri lumbar spine w/o dye.....

0336 6.0742 $360.46 $144.18 $72.09 72149*................ S.............. ............... Mri lumbar spine w/dye.......

0284 6.4201 $380.99 $152.39 $76.20 72156*................ S.............. ............... Mri neck spine w/o & w/dye...

0337 8.7945 $521.89 $208.75 $104.38 72157*................ S.............. ............... Mri chest spine w/o & w/dye..

0337 8.7945 $521.89 $208.75 $104.38 72158*................ S.............. ............... Mri lumbar spine w/o & w/dye.

0337 8.7945 $521.89 $208.75 $104.38 72159................. E.............. ............... Mr angio spine w/o&w/dye..... ........... ........... ........... ........... ........... 72170................. X.............. ............... X-ray exam of pelvis.........

0260 0.7555 $44.83 $17.93

$8.97 72190................. X.............. ............... X-ray exam of pelvis.........

0260 0.7555 $44.83 $17.93

$8.97 72191*................ S.............. ............... Ct angiograph pelv w/o&w/dye.

0662 5.1621 $306.33 $122.53 $61.27 72192*................ S.............. ............... Ct pelvis w/o dye............

0332 3.2694 $194.02 $77.60 $38.80 72193*................ S.............. ............... Ct pelvis w/dye..............

0283 4.4253 $262.61 $105.04 $52.52 72194*................ S.............. ............... Ct pelvis w/o & w/dye........

0333 5.2836 $313.54 $125.41 $62.71 72195*................ S.............. ............... Mri pelvis w/o dye...........

0336 6.0742 $360.46 $144.18 $72.09 72196*................ S.............. ............... Mri pelvis w/dye.............

0284 6.4201 $380.99 $152.39 $76.20 72197*................ S.............. ............... Mri pelvis w/o & w/dye.......

0337 8.7945 $521.89 $208.75 $104.38 72198................. B.............. ............... Mr angio pelvis w/o & w/dye.. ........... ........... ........... ........... ........... 72200................. X.............. ............... X-ray exam sacroiliac joints.

0260 0.7555 $44.83 $17.93

$8.97 72202................. X.............. ............... X-ray exam sacroiliac joints.

0260 0.7555 $44.83 $17.93

$8.97 72220................. X.............. ............... X-ray exam of tailbone.......

0260 0.7555 $44.83 $17.93

$8.97 72240................. S.............. ............... Contrast x-ray of neck spine.

0274 3.0413 $180.48 $72.19 $36.10 72255................. S.............. ............... Contrast x-ray, thorax spine.

0274 3.0413 $180.48 $72.19 $36.10 72265................. S.............. ............... Contrast x-ray, lower spine..

0274 3.0413 $180.48 $72.19 $36.10 72270................. S.............. ............... Contrast x-ray, spine........

0274 3.0413 $180.48 $72.19 $36.10 72275................. S.............. ............... Epidurography................

0274 3.0413 $180.48 $72.19 $36.10 72285................. S.............. ............... X-ray c/t spine disk.........

0388 12.3294 $731.66 $292.66 $146.33 72295................. S.............. ............... X-ray of lower spine disk....

0388 12.3294 $731.66 $292.66 $146.33 73000................. X.............. ............... X-ray exam of collar bone....

0260 0.7555 $44.83 $17.93

$8.97 73010................. X.............. ............... X-ray exam of shoulder blade.

0260 0.7555 $44.83 $17.93

$8.97 73020................. X.............. ............... X-ray exam of shoulder.......

0260 0.7555 $44.83 $17.93

$8.97 73030................. X.............. ............... X-ray exam of shoulder.......

0260 0.7555 $44.83 $17.93

$8.97 73040................. S.............. ............... Contrast x-ray of shoulder...

0275 3.5779 $212.32 $69.09 $42.46 73050................. X.............. ............... X-ray exam of shoulders......

0260 0.7555 $44.83 $17.93

$8.97 73060................. X.............. ............... X-ray exam of humerus........

0260 0.7555 $44.83 $17.93

$8.97 73070................. X.............. ............... X-ray exam of elbow..........

0260 0.7555 $44.83 $17.93

$8.97 73080................. X.............. ............... X-ray exam of elbow..........

0260 0.7555 $44.83 $17.93

$8.97 73085................. S.............. ............... Contrast x-ray of elbow......

0275 3.5779 $212.32 $69.09 $42.46 73090................. X.............. ............... X-ray exam of forearm........

0260 0.7555 $44.83 $17.93

$8.97 73092................. X.............. ............... X-ray exam of arm, infant....

0260 0.7555 $44.83 $17.93

$8.97 73100................. X.............. ............... X-ray exam of wrist..........

0260 0.7555 $44.83 $17.93

$8.97 73110................. X.............. ............... X-ray exam of wrist..........

0260 0.7555 $44.83 $17.93

$8.97 73115................. S.............. ............... Contrast x-ray of wrist......

0275 3.5779 $212.32 $69.09 $42.46

[[Page 50784]]

73120................. X.............. ............... X-ray exam of hand...........

0260 0.7555 $44.83 $17.93

$8.97 73130................. X.............. ............... X-ray exam of hand...........

0260 0.7555 $44.83 $17.93

$8.97 73140................. X.............. ............... X-ray exam of finger(s)......

0260 0.7555 $44.83 $17.93

$8.97 73200*................ S.............. ............... Ct upper extremity w/o dye...

0332 3.2694 $194.02 $77.60 $38.80 73201*................ S.............. ............... Ct upper extremity w/dye.....

0283 4.4253 $262.61 $105.04 $52.52 73202*................ S.............. ............... Ct uppr extremity w/o&w/dye..

0333 5.2836 $313.54 $125.41 $62.71 73206*................ S.............. ............... Ct angio upr extrm w/o&w/dye.

0662 5.1621 $306.33 $122.53 $61.27 73218*................ S.............. ............... Mri upper extremity w/o dye..

0336 6.0742 $360.46 $144.18 $72.09 73219*................ S.............. ............... Mri upper extremity w/dye....

0284 6.4201 $380.99 $152.39 $76.20 73220*................ S.............. ............... Mri uppr extremity w/o&w/dye.

0337 8.7945 $521.89 $208.75 $104.38 73221*................ S.............. ............... Mri joint upr extrem w/o dye.

0336 6.0742 $360.46 $144.18 $72.09 73222*................ S.............. ............... Mri joint upr extrem w/dye...

0284 6.4201 $380.99 $152.39 $76.20 73223*................ S.............. ............... Mri joint upr extr w/o&w/dye.

0337 8.7945 $521.89 $208.75 $104.38 73225................. E.............. ............... Mr angio upr extr w/o&w/dye.. ........... ........... ........... ........... ........... 73500................. X.............. ............... X-ray exam of hip............

0260 0.7555 $44.83 $17.93

$8.97 73510................. X.............. ............... X-ray exam of hip............

0260 0.7555 $44.83 $17.93

$8.97 73520................. X.............. ............... X-ray exam of hips...........

0261 1.2901 $76.56 ........... $15.31 73525................. S.............. ............... Contrast x-ray of hip........

0275 3.5779 $212.32 $69.09 $42.46 73530................. X.............. ............... X-ray exam of hip............

0261 1.2901 $76.56 ........... $15.31 73540................. X.............. ............... X-ray exam of pelvis & hips..

0260 0.7555 $44.83 $17.93

$8.97 73542................. S.............. ............... X-ray exam, sacroiliac joint.

0275 3.5779 $212.32 $69.09 $42.46 73550................. X.............. ............... X-ray exam of thigh..........

0260 0.7555 $44.83 $17.93

$8.97 73560................. X.............. ............... X-ray exam of knee, 1 or 2...

0260 0.7555 $44.83 $17.93

$8.97 73562................. X.............. ............... X-ray exam of knee, 3........

0260 0.7555 $44.83 $17.93

$8.97 73564................. X.............. ............... X-ray exam, knee, 4 or more..

0260 0.7555 $44.83 $17.93

$8.97 73565................. X.............. ............... X-ray exam of knees..........

0260 0.7555 $44.83 $17.93

$8.97 73580................. S.............. ............... Contrast x-ray of knee joint.

0275 3.5779 $212.32 $69.09 $42.46 73590................. X.............. ............... X-ray exam of lower leg......

0260 0.7555 $44.83 $17.93

$8.97 73592................. X.............. ............... X-ray exam of leg, infant....

0260 0.7555 $44.83 $17.93

$8.97 73600................. X.............. ............... X-ray exam of ankle..........

0260 0.7555 $44.83 $17.93

$8.97 73610................. X.............. ............... X-ray exam of ankle..........

0260 0.7555 $44.83 $17.93

$8.97 73615................. S.............. ............... Contrast x-ray of ankle......

0275 3.5779 $212.32 $69.09 $42.46 73620................. X.............. ............... X-ray exam of foot...........

0260 0.7555 $44.83 $17.93

$8.97 73630................. X.............. ............... X-ray exam of foot...........

0260 0.7555 $44.83 $17.93

$8.97 73650................. X.............. ............... X-ray exam of heel...........

0260 0.7555 $44.83 $17.93

$8.97 73660................. X.............. ............... X-ray exam of toe(s).........

0260 0.7555 $44.83 $17.93

$8.97 73700*................ S.............. ............... Ct lower extremity w/o dye...

0332 3.2694 $194.02 $77.60 $38.80 73701*................ S.............. ............... Ct lower extremity w/dye.....

0283 4.4253 $262.61 $105.04 $52.52 73702*................ S.............. ............... Ct lwr extremity w/o&w/dye...

0333 5.2836 $313.54 $125.41 $62.71 73706*................ S.............. ............... Ct angio lwr extr w/o&w/dye..

0662 5.1621 $306.33 $122.53 $61.27 73718*................ S.............. ............... Mri lower extremity w/o dye..

0336 6.0742 $360.46 $144.18 $72.09 73719*................ S.............. ............... Mri lower extremity w/dye....

0284 6.4201 $380.99 $152.39 $76.20 73720*................ S.............. ............... Mri lwr extremity w/o&w/dye..

0337 8.7945 $521.89 $208.75 $104.38 73721*................ S.............. ............... Mri jnt of lwr extre w/o dye.

0336 6.0742 $360.46 $144.18 $72.09 73722*................ S.............. ............... Mri joint of lwr extr w/dye..

0284 6.4201 $380.99 $152.39 $76.20 73723*................ S.............. ............... Mri joint lwr extr w/o&w/dye.

0337 8.7945 $521.89 $208.75 $104.38 73725................. B.............. ............... Mr ang lwr ext w or w/o dye.. ........... ........... ........... ........... ........... 74000................. X.............. ............... X-ray exam of abdomen........

0260 0.7555 $44.83 $17.93

$8.97 74010................. X.............. ............... X-ray exam of abdomen........

0260 0.7555 $44.83 $17.93

$8.97 74020................. X.............. ............... X-ray exam of abdomen........

0260 0.7555 $44.83 $17.93

$8.97 74022................. X.............. ............... X-ray exam series, abdomen...

0261 1.2901 $76.56 ........... $15.31 74150*................ S.............. ............... Ct abdomen w/o dye...........

0332 3.2694 $194.02 $77.60 $38.80 74160*................ S.............. ............... Ct abdomen w/dye.............

0283 4.4253 $262.61 $105.04 $52.52 74170*................ S.............. ............... Ct abdomen w/o &w /dye.......

0333 5.2836 $313.54 $125.41 $62.71 74175*................ S.............. ............... Ct angio abdom w/o & w/dye...

0662 5.1621 $306.33 $122.53 $61.27 74181*................ S.............. ............... Mri abdomen w/o dye..........

0336 6.0742 $360.46 $144.18 $72.09 74182*................ S.............. ............... Mri abdomen w/dye............

0284 6.4201 $380.99 $152.39 $76.20 74183*................ S.............. ............... Mri abdomen w/o & w/dye......

0337 8.7945 $521.89 $208.75 $104.38 74185................. B.............. ............... Mri angio, abdom w orw/o dye. ........... ........... ........... ........... ........... 74190................. X.............. ............... X-ray exam of peritoneum.....

0264

3.524 $209.12 $79.41 $41.82 74210................. S.............. ............... Contrst x-ray exam of throat.

0276 1.5319 $90.91 $36.36 $18.18 74220................. S.............. ............... Contrast x-ray, esophagus....

0276 1.5319 $90.91 $36.36 $18.18 74230................. S.............. ............... Cine/vid x-ray, throat/esoph.

0276 1.5319 $90.91 $36.36 $18.18 74235................. S.............. ............... Remove esophagus obstruction.

0296 2.2452 $133.24 $53.29 $26.65 74240................. S.............. ............... X-ray exam, upper gi tract...

0276 1.5319 $90.91 $36.36 $18.18 74241................. S.............. ............... X-ray exam, upper gi tract...

0276 1.5319 $90.91 $36.36 $18.18

[[Page 50785]]

74245................. S.............. ............... X-ray exam, upper gi tract...

0277 2.3852 $141.54 $56.61 $28.31 74246................. S.............. ............... Contrst x-ray uppr gi tract..

0276 1.5319 $90.91 $36.36 $18.18 74247................. S.............. ............... Contrst x-ray uppr gi tract..

0276 1.5319 $90.91 $36.36 $18.18 74249................. S.............. ............... Contrst x-ray uppr gi tract..

0277 2.3852 $141.54 $56.61 $28.31 74250................. S.............. ............... X-ray exam of small bowel....

0276 1.5319 $90.91 $36.36 $18.18 74251................. S.............. ............... X-ray exam of small bowel....

0277 2.3852 $141.54 $56.61 $28.31 74260................. S.............. ............... X-ray exam of small bowel....

0277 2.3852 $141.54 $56.61 $28.31 74270................. S.............. ............... Contrast x-ray exam of colon.

0276 1.5319 $90.91 $36.36 $18.18 74280................. S.............. ............... Contrast x-ray exam of colon.

0277 2.3852 $141.54 $56.61 $28.31 74283................. S.............. ............... Contrast x-ray exam of colon.

0276 1.5319 $90.91 $36.36 $18.18 74290................. S.............. ............... Contrast x-ray, gallbladder..

0276 1.5319 $90.91 $36.36 $18.18 74291................. S.............. ............... Contrast x-rays, gallbladder.

0276 1.5319 $90.91 $36.36 $18.18 74300................. X.............. ............... X-ray bile ducts/pancreas....

0263 1.7476 $103.71 $24.40 $20.74 74301................. X.............. ............... X-rays at surgery add-on.....

0263 1.7476 $103.71 $24.40 $20.74 74305................. X.............. ............... X-ray bile ducts/pancreas....

0263 1.7476 $103.71 $24.40 $20.74 74320................. X.............. ............... Contrast x-ray of bile ducts.

0264

3.524 $209.12 $79.41 $41.82 74327................. S.............. ............... X-ray bile stone removal.....

0296 2.2452 $133.24 $53.29 $26.65 74328................. N.............. ............... X-ray bile duct endoscopy.... ........... ........... ........... ........... ........... 74329................. N.............. ............... X-ray for pancreas endoscopy. ........... ........... ........... ........... ........... 74330................. N.............. ............... X-ray bile/panc endoscopy.... ........... ........... ........... ........... ........... 74340................. X.............. ............... X-ray guide for GI tube......

0272 1.3801 $81.90 $32.76 $16.38 74350................. X.............. ............... X-ray guide, stomach tube....

0263 1.7476 $103.71 $24.40 $20.74 74355................. X.............. ............... X-ray guide, intestinal tube.

0263 1.7476 $103.71 $24.40 $20.74 74360................. S.............. ............... X-ray guide, GI dilation.....

0296 2.2452 $133.24 $53.29 $26.65 74363................. S.............. ............... X-ray, bile duct dilation....

0297

5.253 $311.73 $122.13 $62.35 74400................. S.............. ............... Contrst x-ray, urinary tract.

0278 2.6434 $156.87 $62.74 $31.37 74410................. S.............. ............... Contrst x-ray, urinary tract.

0278 2.6434 $156.87 $62.74 $31.37 74415................. S.............. ............... Contrst x-ray, urinary tract.

0278 2.6434 $156.87 $62.74 $31.37 74420................. S.............. ............... Contrst x-ray, urinary tract.

0278 2.6434 $156.87 $62.74 $31.37 74425................. S.............. ............... Contrst x-ray, urinary tract.

0278 2.6434 $156.87 $62.74 $31.37 74430................. S.............. ............... Contrast x-ray, bladder......

0278 2.6434 $156.87 $62.74 $31.37 74440................. S.............. ............... X-ray, male genital tract....

0278 2.6434 $156.87 $62.74 $31.37 74445................. S.............. ............... X-ray exam of penis..........

0278 2.6434 $156.87 $62.74 $31.37 74450................. S.............. ............... X-ray, urethra/bladder.......

0278 2.6434 $156.87 $62.74 $31.37 74455................. S.............. ............... X-ray, urethra/bladder.......

0278 2.6434 $156.87 $62.74 $31.37 74470................. X.............. ............... X-ray exam of kidney lesion..

0263 1.7476 $103.71 $24.40 $20.74 74475................. S.............. ............... X-ray control, cath insert...

0297

5.253 $311.73 $122.13 $62.35 74480................. S.............. ............... X-ray control, cath insert...

0296 2.2452 $133.24 $53.29 $26.65 74485................. S.............. ............... X-ray guide, GU dilation.....

0296 2.2452 $133.24 $53.29 $26.65 74710................. X.............. ............... X-ray measurement of pelvis..

0261 1.2901 $76.56 ........... $15.31 74740................. X.............. ............... X-ray, female genital tract..

0264

3.524 $209.12 $79.41 $41.82 74742................. X.............. ............... X-ray, fallopian tube........

0264

3.524 $209.12 $79.41 $41.82 74775................. S.............. ............... X-ray exam of perineum.......

0278 2.6434 $156.87 $62.74 $31.37 75552................. S.............. ............... Heart mri for morph w/o dye..

0336 6.0742 $360.46 $144.18 $72.09 75553................. S.............. ............... Heart mri for morph w/dye....

0284 6.4201 $380.99 $152.39 $76.20 75554................. S.............. ............... Cardiac MRI/function.........

0336 6.0742 $360.46 $144.18 $72.09 75555................. S.............. ............... Cardiac MRI/limited study....

0336 6.0742 $360.46 $144.18 $72.09 75556................. E.............. ............... Cardiac MRI/flow mapping..... ........... ........... ........... ........... ........... 75600................. S.............. ............... Contrast x-ray exam of aorta.

0280 20.7902 $1,233.75 $353.85 $246.75 75605................. S.............. ............... Contrast x-ray exam of aorta.

0280 20.7902 $1,233.75 $353.85 $246.75 75625................. S.............. ............... Contrast x-ray exam of aorta.

0280 20.7902 $1,233.75 $353.85 $246.75 75630................. S.............. ............... X-ray aorta, leg arteries....

0280 20.7902 $1,233.75 $353.85 $246.75 75635*................ S.............. ............... Ct angio abdominal arteries..

0662 5.1621 $306.33 $122.53 $61.27 75650................. S.............. ............... Artery x-rays, head & neck...

0280 20.7902 $1,233.75 $353.85 $246.75 75658................. S.............. ............... Artery x-rays, arm...........

0279 8.9319 $530.05 $150.03 $106.01 75660................. S.............. ............... Artery x-rays, head & neck...

0668 6.5024 $385.87 $114.67 $77.17 75662................. S.............. ............... Artery x-rays, head & neck...

0280 20.7902 $1,233.75 $353.85 $246.75 75665................. S.............. ............... Artery x-rays, head & neck...

0280 20.7902 $1,233.75 $353.85 $246.75 75671................. S.............. ............... Artery x-rays, head & neck...

0280 20.7902 $1,233.75 $353.85 $246.75 75676................. S.............. ............... Artery x-rays, neck..........

0280 20.7902 $1,233.75 $353.85 $246.75 75680................. S.............. ............... Artery x-rays, neck..........

0280 20.7902 $1,233.75 $353.85 $246.75 75685................. S.............. ............... Artery x-rays, spine.........

0280 20.7902 $1,233.75 $353.85 $246.75 75705................. S.............. ............... Artery x-rays, spine.........

0668 6.5024 $385.87 $114.67 $77.17 75710................. S.............. ............... Artery x-rays, arm/leg.......

0280 20.7902 $1,233.75 $353.85 $246.75 75716................. S.............. ............... Artery x-rays, arms/legs.....

0280 20.7902 $1,233.75 $353.85 $246.75 75722................. S.............. ............... Artery x-rays, kidney........

0280 20.7902 $1,233.75 $353.85 $246.75

[[Page 50786]]

75724................. S.............. ............... Artery x-rays, kidneys.......

0280 20.7902 $1,233.75 $353.85 $246.75 75726................. S.............. ............... Artery x-rays, abdomen.......

0280 20.7902 $1,233.75 $353.85 $246.75 75731................. S.............. ............... Artery x-rays, adrenal gland.

0280 20.7902 $1,233.75 $353.85 $246.75 75733................. S.............. ............... Artery x-rays, adrenals......

0668 6.5024 $385.87 $114.67 $77.17 75736................. S.............. ............... Artery x-rays, pelvis........

0280 20.7902 $1,233.75 $353.85 $246.75 75741................. S.............. ............... Artery x-rays, lung..........

0279 8.9319 $530.05 $150.03 $106.01 75743................. S.............. ............... Artery x-rays, lungs.........

0280 20.7902 $1,233.75 $353.85 $246.75 75746................. S.............. ............... Artery x-rays, lung..........

0279 8.9319 $530.05 $150.03 $106.01 75756................. S.............. ............... Artery x-rays, chest.........

0279 8.9319 $530.05 $150.03 $106.01 75774................. S.............. ............... Artery x-ray, each vessel....

0279 8.9319 $530.05 $150.03 $106.01 75790................. S.............. ............... Visualize A-V shunt..........

0279 8.9319 $530.05 $150.03 $106.01 75801................. X.............. ............... Lymph vessel x-ray, arm/leg..

0264

3.524 $209.12 $79.41 $41.82 75803................. X.............. ............... Lymph vessel x-ray,arms/legs.

0264

3.524 $209.12 $79.41 $41.82 75805................. X.............. ............... Lymph vessel x-ray, trunk....

0264

3.524 $209.12 $79.41 $41.82 75807................. X.............. ............... Lymph vessel x-ray, trunk....

0264

3.524 $209.12 $79.41 $41.82 75809................. X.............. ............... Nonvascular shunt, x-ray.....

0263 1.7476 $103.71 $24.40 $20.74 75810................. S.............. ............... Vein x-ray, spleen/liver.....

0279 8.9319 $530.05 $150.03 $106.01 75820................. S.............. ............... Vein x-ray, arm/leg..........

0668 6.5024 $385.87 $114.67 $77.17 75822................. S.............. ............... Vein x-ray, arms/legs........

0668 6.5024 $385.87 $114.67 $77.17 75825................. S.............. ............... Vein x-ray, trunk............

0279 8.9319 $530.05 $150.03 $106.01 75827................. S.............. ............... Vein x-ray, chest............

0279 8.9319 $530.05 $150.03 $106.01 75831................. S.............. ............... Vein x-ray, kidney...........

0279 8.9319 $530.05 $150.03 $106.01 75833................. S.............. ............... Vein x-ray, kidneys..........

0279 8.9319 $530.05 $150.03 $106.01 75840................. S.............. ............... Vein x-ray, adrenal gland....

0280 20.7902 $1,233.75 $353.85 $246.75 75842................. S.............. ............... Vein x-ray, adrenal glands...

0280 20.7902 $1,233.75 $353.85 $246.75 75860................. S.............. ............... Vein x-ray, neck.............

0668 6.5024 $385.87 $114.67 $77.17 75870................. S.............. ............... Vein x-ray, skull............

0668 6.5024 $385.87 $114.67 $77.17 75872................. S.............. ............... Vein x-ray, skull............

0279 8.9319 $530.05 $150.03 $106.01 75880................. S.............. ............... Vein x-ray, eye socket.......

0668 6.5024 $385.87 $114.67 $77.17 75885................. S.............. ............... Vein x-ray, liver............

0280 20.7902 $1,233.75 $353.85 $246.75 75887................. S.............. ............... Vein x-ray, liver............

0279 8.9319 $530.05 $150.03 $106.01 75889................. S.............. ............... Vein x-ray, liver............

0280 20.7902 $1,233.75 $353.85 $246.75 75891................. S.............. ............... Vein x-ray, liver............

0279 8.9319 $530.05 $150.03 $106.01 75893................. N.............. ............... Venous sampling by catheter.. ........... ........... ........... ........... ........... 75894................. S.............. ............... X-rays, transcath therapy....

0297

5.253 $311.73 $122.13 $62.35 75896................. S.............. ............... X-rays, transcath therapy....

0297

5.253 $311.73 $122.13 $62.35 75898................. X.............. ............... Follow-up angiography........

0263 1.7476 $103.71 $24.40 $20.74 75900................. C.............. ............... Arterial catheter exchange... ........... ........... ........... ........... ........... 75901................. X.............. ............... Remove cva device obstruct...

0263 1.7476 $103.71 $24.40 $20.74 75902................. X.............. ............... Remove cva lumen obstruct....

0263 1.7476 $103.71 $24.40 $20.74 75940................. S.............. ............... X-ray placement, vein filter.

0297

5.253 $311.73 $122.13 $62.35 75945................. S.............. ............... Intravascular us.............

0267 2.6327 $156.23 $62.18 $31.25 75946................. S.............. ............... Intravascular us add-on......

0266 1.6393 $97.28 $38.91 $19.46 75952................. C.............. ............... Endovasc repair abdom aorta.. ........... ........... ........... ........... ........... 75953................. C.............. ............... Abdom aneurysm endovas rpr... ........... ........... ........... ........... ........... 75954................. C.............. ............... Iliac aneurysm endovas rpr... ........... ........... ........... ........... ........... 75960................. S.............. ............... Transcatheter intro, stent...

0668 6.5024 $385.87 $114.67 $77.17 75961................. S.............. ............... Retrieval, broken catheter...

0668 6.5024 $385.87 $114.67 $77.17 75962................. S.............. ............... Repair arterial blockage.....

0668 6.5024 $385.87 $114.67 $77.17 75964................. S.............. ............... Repair artery blockage, each.

0668 6.5024 $385.87 $114.67 $77.17 75966................. S.............. ............... Repair arterial blockage.....

0668 6.5024 $385.87 $114.67 $77.17 75968................. S.............. ............... Repair artery blockage, each.

0668 6.5024 $385.87 $114.67 $77.17 75970................. S.............. ............... Vascular biopsy..............

0668 6.5024 $385.87 $114.67 $77.17 75978................. S.............. ............... Repair venous blockage.......

0668 6.5024 $385.87 $114.67 $77.17 75980................. S.............. ............... Contrast xray exam bile duct.

0297

5.253 $311.73 $122.13 $62.35 75982................. S.............. ............... Contrast xray exam bile duct.

0297

5.253 $311.73 $122.13 $62.35 75984................. X.............. ............... Xray control catheter change.

0263 1.7476 $103.71 $24.40 $20.74 75989................. N.............. ............... Abscess drainage under x-ray. ........... ........... ........... ........... ........... 75992................. S.............. ............... Atherectomy, x-ray exam......

0279 8.9319 $530.05 $150.03 $106.01 75993................. S.............. ............... Atherectomy, x-ray exam......

0279 8.9319 $530.05 $150.03 $106.01 75994................. S.............. ............... Atherectomy, x-ray exam......

0279 8.9319 $530.05 $150.03 $106.01 75995................. S.............. ............... Atherectomy, x-ray exam......

0279 8.9319 $530.05 $150.03 $106.01 75996................. S.............. ............... Atherectomy, x-ray exam......

0279 8.9319 $530.05 $150.03 $106.01 75998................. N.............. ............... Fluoroguide for vein device.. ........... ........... ........... ........... ........... 76000................. X.............. ............... Fluoroscope examination......

0272 1.3801 $81.90 $32.76 $16.38 76001................. N.............. ............... Fluoroscope exam, extensive.. ........... ........... ........... ........... ...........

[[Page 50787]]

76003................. N.............. ............... Needle localization by x-ray. ........... ........... ........... ........... ........... 76005................. N.............. ............... Fluoroguide for spine inject. ........... ........... ........... ........... ........... 76006................. X.............. ............... X-ray stress view............

0260 0.7555 $44.83 $17.93

$8.97 76010................. X.............. ............... X-ray, nose to rectum........

0260 0.7555 $44.83 $17.93

$8.97 76012................. S.............. ............... Percut vertebroplasty fluor..

0274 3.0413 $180.48 $72.19 $36.10 76013................. S.............. ............... Percut vertebroplasty, ct....

0274 3.0413 $180.48 $72.19 $36.10 76020................. X.............. ............... X-rays for bone age..........

0260 0.7555 $44.83 $17.93

$8.97 76040................. X.............. ............... X-rays, bone evaluation......

0261 1.2901 $76.56 ........... $15.31 76061................. X.............. ............... X-rays, bone survey..........

0261 1.2901 $76.56 ........... $15.31 76062................. X.............. ............... X-rays, bone survey..........

0261 1.2901 $76.56 ........... $15.31 76065................. X.............. ............... X-rays, bone evaluation......

0261 1.2901 $76.56 ........... $15.31 76066................. X.............. ............... Joint survey, single view....

0260 0.7555 $44.83 $17.93

$8.97 76070................. S.............. ............... CT scan, bone density study..

0288 1.2568 $74.58 ........... $14.92 76071................. S.............. ............... Ct bone density, peripheral..

0282 1.6542 $98.17 $39.26 $19.63 76075................. S.............. ............... Dexa, axial skeleton study...

0288 1.2568 $74.58 ........... $14.92 76076................. S.............. ............... Dexa, peripheral study.......

0665 0.6464 $38.36 ...........

$7.67 76077................. X.............. ............... Dxa bone density/v-fracture..

0260 0.7555 $44.83 $17.93

$8.97 76078................. X.............. ............... Radiographic absorptiometry..

0260 0.7555 $44.83 $17.93

$8.97 76080................. X.............. ............... X-ray exam of fistula........

0263 1.7476 $103.71 $24.40 $20.74 76082................. A.............. ............... Computer mammogram add-on.... ........... ........... ........... ........... ........... 76083................. A.............. ............... Computer mammogram add-on.... ........... ........... ........... ........... ........... 76086................. X.............. ............... X-ray of mammary duct........

0263 1.7476 $103.71 $24.40 $20.74 76088................. X.............. ............... X-ray of mammary ducts.......

0263 1.7476 $103.71 $24.40 $20.74 76090................. A.............. ............... Mammogram, one breast........ ........... ........... ........... ........... ........... 76091................. A.............. ............... Mammogram, both breasts...... ........... ........... ........... ........... ........... 76092................. A.............. ............... Mammogram, screening......... ........... ........... ........... ........... ........... 76093................. E.............. ............... Magnetic image, breast....... ........... ........... ........... ........... ........... 76094................. E.............. ............... Magnetic image, both breasts. ........... ........... ........... ........... ........... 76095................. X.............. ............... Stereotactic breast biopsy...

0264

3.524 $209.12 $79.41 $41.82 76096................. X.............. ............... X-ray of needle wire, breast.

0263 1.7476 $103.71 $24.40 $20.74 76098................. X.............. ............... X-ray exam, breast specimen..

0260 0.7555 $44.83 $17.93

$8.97 76100................. X.............. ............... X-ray exam of body section...

0261 1.2901 $76.56 ........... $15.31 76101................. X.............. ............... Complex body section x-ray...

0263 1.7476 $103.71 $24.40 $20.74 76102................. X.............. ............... Complex body section x-rays..

0264

3.524 $209.12 $79.41 $41.82 76120................. X.............. ............... Cine/video x-rays............

0272 1.3801 $81.90 $32.76 $16.38 76125................. X.............. ............... Cine/video x-rays add-on.....

0260 0.7555 $44.83 $17.93

$8.97 76140................. E.............. ............... X-ray consultation........... ........... ........... ........... ........... ........... 76150................. X.............. ............... X-ray exam, dry process......

0260 0.7555 $44.83 $17.93

$8.97 76350................. N.............. ............... Special x-ray contrast study. ........... ........... ........... ........... ........... 76355................. S.............. ............... Ct scan for localization.....

0283 4.4253 $262.61 $105.04 $52.52 76360................. S.............. ............... Ct scan for needle biopsy....

0283 4.4253 $262.61 $105.04 $52.52 76362................. S.............. ............... Ct guide for tissue ablation.

0332 3.2694 $194.02 $77.60 $38.80 76370................. S.............. ............... Ct scan for therapy guide....

0282 1.6542 $98.17 $39.26 $19.63 76375................. S.............. ............... 3d/holograph reconstr add-on.

0282 1.6542 $98.17 $39.26 $19.63 76380................. S.............. ............... CAT scan follow-up study.....

0282 1.6542 $98.17 $39.26 $19.63 76390................. E.............. ............... Mr spectroscopy.............. ........... ........... ........... ........... ........... 76393................. S.............. ............... Mr guidance for needle place.

0335 5.1581 $306.10 $122.43 $61.22 76394................. S.............. ............... Mri for tissue ablation......

0335 5.1581 $306.10 $122.43 $61.22 76400................. S.............. ............... Magnetic image, bone marrow..

0335 5.1581 $306.10 $122.43 $61.22 76496................. X.............. ............... Fluoroscopic procedure.......

0272 1.3801 $81.90 $32.76 $16.38 76497................. S.............. ............... Ct procedure.................

0282 1.6542 $98.17 $39.26 $19.63 76498................. S.............. ............... Mri procedure................

0335 5.1581 $306.10 $122.43 $61.22 76499................. X.............. ............... Radiographic procedure.......

0260 0.7555 $44.83 $17.93

$8.97 76506................. S.............. ............... Echo exam of head............

0265 1.0213 $60.61 $24.24 $12.12 76510................. S.............. ............... Ophth us, b & quant a........

0266 1.6393 $97.28 $38.91 $19.46 76511................. S.............. ............... Echo exam of eye.............

0266 1.6393 $97.28 $38.91 $19.46 76512................. S.............. ............... Echo exam of eye.............

0266 1.6393 $97.28 $38.91 $19.46 76513................. S.............. ............... Echo exam of eye, water bath.

0266 1.6393 $97.28 $38.91 $19.46 76514................. X.............. ............... Echo exam of eye, thickness..

0340 0.6384 $37.88 ...........

$7.58 76516................. S.............. ............... Echo exam of eye.............

0265 1.0213 $60.61 $24.24 $12.12 76519................. S.............. ............... Echo exam of eye.............

0266 1.6393 $97.28 $38.91 $19.46 76529................. S.............. ............... Echo exam of eye.............

0265 1.0213 $60.61 $24.24 $12.12 76536................. S.............. ............... Us exam of head and neck.....

0266 1.6393 $97.28 $38.91 $19.46 76604*................ S.............. ............... Us exam, chest, b-scan.......

0266 1.6393 $97.28 $38.91 $19.46 76645*................ S.............. ............... Us exam, breast(s)...........

0265 1.0213 $60.61 $24.24 $12.12 76700*................ S.............. ............... Us exam, abdom, complete.....

0266 1.6393 $97.28 $38.91 $19.46

[[Page 50788]]

76705*................ S.............. ............... Echo exam of abdomen.........

0266 1.6393 $97.28 $38.91 $19.46 76770*................ S.............. ............... Us exam abdo back wall, comp.

0266 1.6393 $97.28 $38.91 $19.46 76775*................ S.............. ............... Us exam abdo back wall, lim..

0266 1.6393 $97.28 $38.91 $19.46 76778*................ S.............. ............... Us exam kidney transplant....

0266 1.6393 $97.28 $38.91 $19.46 76800................. S.............. ............... Us exam, spinal canal........

0266 1.6393 $97.28 $38.91 $19.46 76801................. S.............. ............... Ob us ...

0343 0.4786 $28.40 $11.10

$5.68 88199................. A.............. ............... Cytopathology procedure...... ........... ........... ........... ........... ........... 88230................. A.............. ............... Tissue culture, lymphocyte... ........... ........... ........... ........... ........... 88233................. A.............. ............... Tissue culture, skin/biopsy.. ........... ........... ........... ........... ........... 88235................. A.............. ............... Tissue culture, placenta..... ........... ........... ........... ........... ........... 88237................. A.............. ............... Tissue culture, bone marrow.. ........... ........... ........... ........... ........... 88239................. A.............. ............... Tissue culture, tumor........ ........... ........... ........... ........... ........... 88240................. A.............. ............... Cell cryopreserve/storage.... ........... ........... ........... ........... ........... 88241................. A.............. ............... Frozen cell preparation...... ........... ........... ........... ........... ........... 88245................. A.............. ............... Chromosome analysis, 20-25... ........... ........... ........... ........... ........... 88248................. A.............. ............... Chromosome analysis, 50-100.. ........... ........... ........... ........... ........... 88249................. A.............. ............... Chromosome analysis, 100..... ........... ........... ........... ........... ........... 88261................. A.............. ............... Chromosome analysis, 5....... ........... ........... ........... ........... ........... 88262................. A.............. ............... Chromosome analysis, 15-20... ........... ........... ........... ........... ........... 88263................. A.............. ............... Chromosome analysis, 45...... ........... ........... ........... ........... ........... 88264................. A.............. ............... Chromosome analysis, 20-25... ........... ........... ........... ........... ........... 88267................. A.............. ............... Chromosome analys, placenta.. ........... ........... ........... ........... ........... 88269................. A.............. ............... Chromosome analys, amniotic.. ........... ........... ........... ........... ........... 88271................. A.............. ............... Cytogenetics, dna probe...... ........... ........... ........... ........... ........... 88272................. A.............. ............... Cytogenetics, 3-5............ ........... ........... ........... ........... ........... 88273................. A.............. ............... Cytogenetics, 10-30.......... ........... ........... ........... ........... ........... 88274................. A.............. ............... Cytogenetics, 25-99.......... ........... ........... ........... ........... ........... 88275................. A.............. ............... Cytogenetics, 100-300........ ........... ........... ........... ........... ........... 88280................. A.............. ............... Chromosome karyotype study... ........... ........... ........... ........... ........... 88283................. A.............. ............... Chromosome banding study..... ........... ........... ........... ........... ........... 88285................. A.............. ............... Chromosome count, additional. ........... ........... ........... ........... ........... 88289................. A.............. ............... Chromosome study, additional. ........... ........... ........... ........... ........... 88291................. A.............. ............... Cyto/molecular report........ ........... ........... ........... ........... ........... 88299................. X.............. ............... Cytogenetic study............

0342

0.156

$9.26

$3.70

$1.85 88300................. X.............. ............... Surgical path, gross.........

0433 0.2581 $15.32

$6.12

$3.06 88302................. X.............. ............... Tissue exam by pathologist...

0433 0.2581 $15.32

$6.12

$3.06 88304................. X.............. ............... Tissue exam by pathologist...

0343 0.4786 $28.40 $11.10

$5.68 88305................. X.............. ............... Tissue exam by pathologist...

0343 0.4786 $28.40 $11.10

$5.68 88307................. X.............. ............... Tissue exam by pathologist...

0344 0.7996 $47.45 $15.66

$9.49 88309................. X.............. ............... Tissue exam by pathologist...

0344 0.7996 $47.45 $15.66

$9.49 88311................. X.............. ............... Decalcify tissue.............

0342

0.156

$9.26

$3.70

$1.85

[[Page 50809]]

88312................. X.............. ............... Special stains...............

0433 0.2581 $15.32

$6.12

$3.06 88313................. X.............. ............... Special stains...............

0433 0.2581 $15.32

$6.12

$3.06 88314................. X.............. ............... Histochemical stain..........

0342

0.156

$9.26

$3.70

$1.85 88318................. X.............. ............... Chemical histochemistry......

0433 0.2581 $15.32

$6.12

$3.06 88319................. X.............. ............... Enzyme histochemistry........

0343 0.4786 $28.40 $11.10

$5.68 88321................. X.............. ............... Microslide consultation......

0433 0.2581 $15.32

$6.12

$3.06 88323................. X.............. ............... Microslide consultation......

0343 0.4786 $28.40 $11.10

$5.68 88325................. X.............. ............... Comprehensive review of data.

0344 0.7996 $47.45 $15.66

$9.49 88329................. X.............. ............... Path consult introp..........

0433 0.2581 $15.32

$6.12

$3.06 88331................. X.............. ............... Path consult intraop, 1 bloc.

0343 0.4786 $28.40 $11.10

$5.68 88332................. X.............. ............... Path consult intraop, add'l..

0433 0.2581 $15.32

$6.12

$3.06 88342................. X.............. ............... Immunohistochemistry.........

0343 0.4786 $28.40 $11.10

$5.68 88346................. X.............. ............... Immunofluorescent study......

0343 0.4786 $28.40 $11.10

$5.68 88347................. X.............. ............... Immunofluorescent study......

0343 0.4786 $28.40 $11.10

$5.68 88348................. X.............. ............... Electron microscopy..........

0661 3.3775 $200.43 $80.17 $40.09 88349................. X.............. ............... Scanning electron microscopy.

0661 3.3775 $200.43 $80.17 $40.09 88355................. X.............. ............... Analysis, skeletal muscle....

0343 0.4786 $28.40 $11.10

$5.68 88356................. X.............. ............... Analysis, nerve..............

0344 0.7996 $47.45 $15.66

$9.49 88358................. X.............. ............... Analysis, tumor..............

0344 0.7996 $47.45 $15.66

$9.49 88360................. X.............. ............... Tumor immunohistochem/manual.

0344 0.7996 $47.45 $15.66

$9.49 88361................. X.............. ............... Immunohistochemistry, tumor..

0344 0.7996 $47.45 $15.66

$9.49 88362................. X.............. ............... Nerve teasing preparations...

0344 0.7996 $47.45 $15.66

$9.49 88365................. X.............. ............... Tissue hybridization.........

0344 0.7996 $47.45 $15.66

$9.49 88367................. X.............. ............... Insitu hybridization, auto...

0344 0.7996 $47.45 $15.66

$9.49 88368................. X.............. ............... Insitu hybridization, manual.

0344 0.7996 $47.45 $15.66

$9.49 88371................. A.............. ............... Protein, western blot tissue. ........... ........... ........... ........... ........... 88372................. A.............. ............... Protein analysis w/probe..... ........... ........... ........... ........... ........... 88380................. A.............. ............... Microdissection.............. ........... ........... ........... ........... ........... 88399................. A.............. ............... Surgical pathology procedure. ........... ........... ........... ........... ........... 88400................. A.............. ............... Bilirubin total transcut..... ........... ........... ........... ........... ........... 89050................. A.............. ............... Body fluid cell count........ ........... ........... ........... ........... ........... 89051................. A.............. ............... Body fluid cell count........ ........... ........... ........... ........... ........... 89055................. A.............. ............... Leukocyte assessment, fecal.. ........... ........... ........... ........... ........... 89060................. A.............. ............... Exam,synovial fluid crystals. ........... ........... ........... ........... ........... 89100................. X.............. ............... Sample intestinal contents...

0360 1.4739 $87.47 $34.98 $17.49 89105................. X.............. ............... Sample intestinal contents...

0360 1.4739 $87.47 $34.98 $17.49 89125................. A.............. ............... Specimen fat stain........... ........... ........... ........... ........... ........... 89130................. X.............. ............... Sample stomach contents......

0360 1.4739 $87.47 $34.98 $17.49 89132................. X.............. ............... Sample stomach contents......

0360 1.4739 $87.47 $34.98 $17.49 89135................. X.............. ............... Sample stomach contents......

0360 1.4739 $87.47 $34.98 $17.49 89136................. X.............. ............... Sample stomach contents......

0360 1.4739 $87.47 $34.98 $17.49 89140................. X.............. ............... Sample stomach contents......

0360 1.4739 $87.47 $34.98 $17.49 89141................. X.............. ............... Sample stomach contents......

0360 1.4739 $87.47 $34.98 $17.49 89160................. A.............. ............... Exam feces for meat fibers... ........... ........... ........... ........... ........... 89190................. A.............. ............... Nasal smear for eosinophils.. ........... ........... ........... ........... ........... 89220................. X.............. ............... Sputum specimen collection...

0343 0.4786 $28.40 $11.10

$5.68 89225................. A.............. ............... Starch granules, feces....... ........... ........... ........... ........... ........... 89230................. X.............. ............... Collect sweat for test.......

0433 0.2581 $15.32

$6.12

$3.06 89235................. A.............. ............... Water load test.............. ........... ........... ........... ........... ........... 89240................. A.............. ............... Pathology lab procedure...... ........... ........... ........... ........... ........... 89250................. X.............. ............... Cultr oocyte/embryo . ........... ........... ........... ........... ........... 90657................. L.............. ............... Flu vaccine, 6-35 mo, im..... ........... ........... ........... ........... ........... 90658................. L.............. ............... Flu vaccine, 3 yrs, im....... ........... ........... ........... ........... ........... 90660................. E.............. ............... Flu vaccine, nasal........... ........... ........... ........... ........... ........... 90665................. N.............. ............... Lyme disease vaccine, im..... ........... ........... ........... ........... ........... 90669................. E.............. ............... Pneumococcal vacc, ped 7 im........... ........... ........... ........... ........... ........... 90716................. K.............. ............... Chicken pox vaccine, sc......

9142 ........... $64.29 ........... $12.86 90717................. N.............. ............... Yellow fever vaccine, sc..... ........... ........... ........... ........... ........... 90718................. N.............. ............... Td vaccine > 7, im........... ........... ........... ........... ........... ........... 90719................. N.............. ............... Diphtheria vaccine, im....... ........... ........... ........... ........... ........... 90720................. N.............. ............... Dtp/hib vaccine, im.......... ........... ........... ........... ........... ........... 90721................. N.............. ............... Dtap/hib vaccine, im......... ........... ........... ........... ........... ........... 90723................. E.............. ............... Dtap-hep b-ipv vaccine, im... ........... ........... ........... ........... ........... 90725................. N.............. ............... Cholera vaccine, injectable.. ........... ........... ........... ........... ........... 90727................. N.............. ............... Plague vaccine, im........... ........... ........... ........... ........... ........... 90732................. L.............. ............... Pneumococcal vaccine......... ........... ........... ........... ........... ........... 90733................. K.............. ............... Meningococcal vaccine, sc....

9143 ........... $56.75 ........... $11.35 90734................. K.............. ............... Meningococcal vaccine, im....

9145 0.8948 $53.10 ........... $10.62 90735................. K.............. ............... Encephalitis vaccine, sc.....

9144 ........... $67.73 ........... $13.55 90740................. F.............. ............... Hepb vacc, ill pat 3 dose im. ........... ........... ........... ........... ........... 90743................. F.............. ............... Hep b vacc, adol, 2 dose, im. ........... ........... ........... ........... ........... 90744................. F.............. ............... Hepb vacc ped/adol 3 dose im. ........... ........... ........... ........... ........... 90746................. F.............. ............... Hep b vaccine, adult, im..... ........... ........... ........... ........... ........... 90747................. F.............. ............... Hepb vacc, ill pat 4 dose im. ........... ........... ........... ........... ........... 90748................. E.............. ............... Hep b/hib vaccine, im........ ........... ........... ........... ........... ........... 90749................. N.............. ............... Vaccine toxoid............... ........... ........... ........... ........... ........... 90780................. S.............. ............... IV infusion therapy, 1 hour..

0120 2.0193 $119.83 $28.21 $23.97 90781................. N.............. ............... IV infusion, additional hour. ........... ........... ........... ........... ........... 90782................. X.............. ............... Injection, sc/im.............

0353 0.3954 $23.46 ...........

$4.69 90783................. X.............. ............... Injection, ia................

0359 0.8312 $49.33 ...........

$9.87 90784................. X.............. ............... Injection, iv................

0359 0.8312 $49.33 ...........

$9.87 90788................. X.............. ............... Injection of antibiotic......

0359 0.8312 $49.33 ...........

$9.87 90799................. X.............. ............... Ther/prophylactic/dx inject..

0352 0.1413

$8.39 ...........

$1.68 90801................. S.............. ............... Psy dx interview.............

0323 1.6227 $96.30 $20.08 $19.26 90802................. S.............. ............... Intac psy dx interview.......

0323 1.6227 $96.30 $20.08 $19.26 90804................. S.............. ............... Psytx, office, 20-30 min.....

0322 1.2319 $73.10 ........... $14.62 90805................. S.............. ............... Psytx, off, 20-30 min w/e&m..

0322 1.2319 $73.10 ........... $14.62 90806................. S.............. ............... Psytx, off, 45-50 min........

0323 1.6227 $96.30 $20.08 $19.26 90807................. S.............. ............... Psytx, off, 45-50 min w/e&m..

0323 1.6227 $96.30 $20.08 $19.26 90808................. S.............. ............... Psytx, office, 75-80 min.....

0323 1.6227 $96.30 $20.08 $19.26 90809................. S.............. ............... Psytx, off, 75-80, w/e&m.....

0323 1.6227 $96.30 $20.08 $19.26 90810................. S.............. ............... Intac psytx, off, 20-30 min..

0322 1.2319 $73.10 ........... $14.62 90811................. S.............. ............... Intac psytx, 20-30, w/e&m....

0322 1.2319 $73.10 ........... $14.62 90812................. S.............. ............... Intac psytx, off, 45-50 min..

0323 1.6227 $96.30 $20.08 $19.26 90813................. S.............. ............... Intac psytx, 45-50 min w/e&m.

0323 1.6227 $96.30 $20.08 $19.26 90814................. S.............. ............... Intac psytx, off, 75-80 min..

0323 1.6227 $96.30 $20.08 $19.26 90815................. S.............. ............... Intac psytx, 75-80 w/e&m.....

0323 1.6227 $96.30 $20.08 $19.26 90816................. S.............. ............... Psytx, hosp, 20-30 min.......

0322 1.2319 $73.10 ........... $14.62 90817................. S.............. ............... Psytx, hosp, 20-30 min w/e&m.

0322 1.2319 $73.10 ........... $14.62 90818................. S.............. ............... Psytx, hosp, 45-50 min.......

0323 1.6227 $96.30 $20.08 $19.26 90819................. S.............. ............... Psytx, hosp, 45-50 min w/e&m.

0323 1.6227 $96.30 $20.08 $19.26 90821................. S.............. ............... Psytx, hosp, 75-80 min.......

0323 1.6227 $96.30 $20.08 $19.26 90822................. S.............. ............... Psytx, hosp, 75-80 min w/e&m.

0323 1.6227 $96.30 $20.08 $19.26 90823................. S.............. ............... Intac psytx, hosp, 20-30 min.

0322 1.2319 $73.10 ........... $14.62

[[Page 50812]]

90824................. S.............. ............... Intac psytx, hsp 20-30 w/e&m.

0322 1.2319 $73.10 ........... $14.62 90826................. S.............. ............... Intac psytx, hosp, 45-50 min.

0323 1.6227 $96.30 $20.08 $19.26 90827................. S.............. ............... Intac psytx, hsp 45-50 w/e&m.

0323 1.6227 $96.30 $20.08 $19.26 90828................. S.............. ............... Intac psytx, hosp, 75-80 min.

0323 1.6227 $96.30 $20.08 $19.26 90829................. S.............. ............... Intac psytx, hsp 75-80 w/e&m.

0323 1.6227 $96.30 $20.08 $19.26 90845................. S.............. ............... Psychoanalysis...............

0323 1.6227 $96.30 $20.08 $19.26 90846................. S.............. ............... Family psytx w/o patient.....

0324 2.0997 $124.60 ........... $24.92 90847................. S.............. ............... Family psytx w/patient.......

0324 2.0997 $124.60 ........... $24.92 90849................. S.............. ............... Multiple family group psytx..

0325 1.3189 $78.27 $17.10 $15.65 90853................. S.............. ............... Group psychotherapy..........

0325 1.3189 $78.27 $17.10 $15.65 90857................. S.............. ............... Intac group psytx............

0325 1.3189 $78.27 $17.10 $15.65 90862................. X.............. ............... Medication management........

0374 1.0414 $61.80 ........... $12.36 90865................. S.............. ............... Narcosynthesis...............

0323 1.6227 $96.30 $20.08 $19.26 90870................. S.............. ............... Electroconvulsive therapy....

0320 5.3765 $319.06 $80.06 $63.81 90871................. E.............. ............... Electroconvulsive therapy.... ........... ........... ........... ........... ........... 90875................. E.............. ............... Psychophysiological therapy.. ........... ........... ........... ........... ........... 90876................. E.............. ............... Psychophysiological therapy.. ........... ........... ........... ........... ........... 90880................. S.............. ............... Hypnotherapy.................

0323 1.6227 $96.30 $20.08 $19.26 90882................. E.............. ............... Environmental manipulation... ........... ........... ........... ........... ........... 90885................. N.............. ............... Psy evaluation of records.... ........... ........... ........... ........... ........... 90887................. N.............. ............... Consultation with family..... ........... ........... ........... ........... ........... 90889................. N.............. ............... Preparation of report........ ........... ........... ........... ........... ........... 90899................. S.............. ............... Psychiatric service/therapy..

0322 1.2319 $73.10 ........... $14.62 90901................. A.............. ............... Biofeedback train, any meth.. ........... ........... ........... ........... ........... 90911................. S.............. ............... Biofeedback peri/uro/rectal..

0321 1.3579 $80.58 $21.71 $16.12 90918................. E.............. ............... ESRD related services, month. ........... ........... ........... ........... ........... 90919................. E.............. ............... ESRD related services, month. ........... ........... ........... ........... ........... 90920................. E.............. ............... ESRD related services, month. ........... ........... ........... ........... ........... 90921................. E.............. ............... ESRD related services, month. ........... ........... ........... ........... ........... 90922................. E.............. ............... ESRD related services, day... ........... ........... ........... ........... ........... 90923................. E.............. ............... Esrd related services, day... ........... ........... ........... ........... ........... 90924................. E.............. ............... Esrd related services, day... ........... ........... ........... ........... ........... 90925................. E.............. ............... Esrd related services, day... ........... ........... ........... ........... ........... 90935................. S.............. ............... Hemodialysis, one evaluation.

0170 5.8994 $350.09 ........... $70.02 90937................. E.............. ............... Hemodialysis, repeated eval.. ........... ........... ........... ........... ........... 90939................. N.............. ............... Hemodialysis study, transcut. ........... ........... ........... ........... ........... 90940................. N.............. ............... Hemodialysis access study.... ........... ........... ........... ........... ........... 90945................. S.............. ............... Dialysis, one evaluation.....

0170 5.8994 $350.09 ........... $70.02 90947................. E.............. ............... Dialysis, repeated eval...... ........... ........... ........... ........... ........... 90989................. B.............. ............... Dialysis training, complete.. ........... ........... ........... ........... ........... 90993................. B.............. ............... Dialysis training, incompl... ........... ........... ........... ........... ........... 90997................. E.............. ............... Hemoperfusion................ ........... ........... ........... ........... ........... 90999................. B.............. ............... Dialysis procedure........... ........... ........... ........... ........... ........... 91000................. X.............. ............... Esophageal intubation........

0361 3.6216 $214.92 $83.23 $42.98 91010................. X.............. ............... Esophagus motility study.....

0361 3.6216 $214.92 $83.23 $42.98 91011................. X.............. ............... Esophagus motility study.....

0361 3.6216 $214.92 $83.23 $42.98 91012................. X.............. ............... Esophagus motility study.....

0361 3.6216 $214.92 $83.23 $42.98 91020................. X.............. ............... Gastric motility.............

0361 3.6216 $214.92 $83.23 $42.98 91030................. X.............. ............... Acid perfusion of esophagus..

0361 3.6216 $214.92 $83.23 $42.98 91034................. X.............. ............... Gastroesophageal reflux test.

0361 3.6216 $214.92 $83.23 $42.98 91035................. S.............. ............... G-esoph reflx tst w/electrod.

1506 ........... $450.00 ........... $90.00 91037................. X.............. ............... Esoph imped function test....

0361 3.6216 $214.92 $83.23 $42.98 91038................. X.............. ............... Esoph imped funct test > 1h..

0361 3.6216 $214.92 $83.23 $42.98 91040................. X.............. ............... Esoph balloon distension tst.

0360 1.4739 $87.47 $34.98 $17.49 91052................. X.............. ............... Gastric analysis test........

0361 3.6216 $214.92 $83.23 $42.98 91055................. X.............. ............... Gastric intubation for smear.

0360 1.4739 $87.47 $34.98 $17.49 91060................. X.............. ............... Gastric saline load test.....

0360 1.4739 $87.47 $34.98 $17.49 91065................. X.............. ............... Breath hydrogen test.........

0360 1.4739 $87.47 $34.98 $17.49 91100................. X.............. ............... Pass intestine bleeding tube.

0360 1.4739 $87.47 $34.98 $17.49 91105................. X.............. ............... Gastric intubation treatment.

0360 1.4739 $87.47 $34.98 $17.49 91110................. T.............. ............... Gi tract capsule endoscopy...

0142 9.3487 $554.78 $152.78 $110.96 91120................. T.............. ............... Rectal sensation test........

0156 2.5751 $152.81 $40.52 $30.56 91122................. T.............. ............... Anal pressure record.........

0156 2.5751 $152.81 $40.52 $30.56 91123................. N.............. ............... Irrigate fecal impaction..... ........... ........... ........... ........... ........... 91132................. X.............. ............... Electrogastrography..........

0360 1.4739 $87.47 $34.98 $17.49 91133................. X.............. ............... Electrogastrography w/test...

0360 1.4739 $87.47 $34.98 $17.49

[[Page 50813]]

91299................. X.............. ............... Gastroenterology procedure...

0360 1.4739 $87.47 $34.98 $17.49 92002................. V.............. ............... Eye exam, new patient........

0601 1.0038 $59.57 ........... $11.91 92004................. V.............. ............... Eye exam, new patient........

0601 1.0038 $59.57 ........... $11.91 92012................. V.............. ............... Eye exam established pat.....

0600 0.8688 $51.56 ........... $10.31 92014................. V.............. ............... Eye exam & treatment.........

0601 1.0038 $59.57 ........... $11.91 92015................. E.............. ............... Refraction................... ........... ........... ........... ........... ........... 92018................. T.............. ............... New eye exam & treatment.....

0699 10.0177 $594.48 ........... $118.90 92019................. T.............. ............... Eye exam & treatment.........

0699 10.0177 $594.48 ........... $118.90 92020................. S.............. ............... Special eye evaluation.......

0230 0.7858 $46.63 $14.97

$9.33 92060................. S.............. ............... Special eye evaluation.......

0230 0.7858 $46.63 $14.97

$9.33 92065................. S.............. ............... Orthoptic/pleoptic training..

0698 1.2438 $73.81 $16.55 $14.76 92070................. N.............. ............... Fitting of contact lens...... ........... ........... ........... ........... ........... 92081................. S.............. ............... Visual field examination(s)..

0230 0.7858 $46.63 $14.97

$9.33 92082................. S.............. ............... Visual field examination(s)..

0230 0.7858 $46.63 $14.97

$9.33 92083................. S.............. ............... Visual field examination(s)..

0230 0.7858 $46.63 $14.97

$9.33 92100................. N.............. ............... Serial tonometry exam(s)..... ........... ........... ........... ........... ........... 92120................. S.............. ............... Tonography & eye evaluation..

0230 0.7858 $46.63 $14.97

$9.33 92130................. S.............. ............... Water provocation tonography.

0230 0.7858 $46.63 $14.97

$9.33 92135................. S.............. ............... Opthalmic dx imaging.........

0230 0.7858 $46.63 $14.97

$9.33 92136................. S.............. ............... Ophthalmic biometry..........

0698 1.2438 $73.81 $16.55 $14.76 92140................. S.............. ............... Glaucoma provocative tests...

0698 1.2438 $73.81 $16.55 $14.76 92225................. S.............. ............... Special eye exam, initial....

0230 0.7858 $46.63 $14.97

$9.33 92226................. S.............. ............... Special eye exam, subsequent.

0230 0.7858 $46.63 $14.97

$9.33 92230................. T.............. ............... Eye exam with photos.........

0699 10.0177 $594.48 ........... $118.90 92235................. S.............. ............... Eye exam with photos.........

0231 1.9278 $114.40 $44.61 $22.88 92240................. S.............. ............... Icg angiography..............

0231 1.9278 $114.40 $44.61 $22.88 92250................. S.............. ............... Eye exam with photos.........

0230 0.7858 $46.63 $14.97

$9.33 92260................. S.............. ............... Ophthalmoscopy/dynamometry...

0698 1.2438 $73.81 $16.55 $14.76 92265................. S.............. ............... Eye muscle evaluation........

0230 0.7858 $46.63 $14.97

$9.33 92270................. S.............. ............... Electro-oculography..........

0230 0.7858 $46.63 $14.97

$9.33 92275................. S.............. ............... Electroretinography..........

0231 1.9278 $114.40 $44.61 $22.88 92283................. S.............. ............... Color vision examination.....

0230 0.7858 $46.63 $14.97

$9.33 92284................. S.............. ............... Dark adaptation eye exam.....

0698 1.2438 $73.81 $16.55 $14.76 92285................. S.............. ............... Eye photography..............

0230 0.7858 $46.63 $14.97

$9.33 92286................. S.............. ............... Internal eye photography.....

0698 1.2438 $73.81 $16.55 $14.76 92287................. S.............. ............... Internal eye photography.....

0698 1.2438 $73.81 $16.55 $14.76 92310................. E.............. ............... Contact lens fitting......... ........... ........... ........... ........... ........... 92311................. X.............. ............... Contact lens fitting.........

0362 2.6607 $157.89 ........... $31.58 92312................. X.............. ............... Contact lens fitting.........

0362 2.6607 $157.89 ........... $31.58 92313................. X.............. ............... Contact lens fitting.........

0362 2.6607 $157.89 ........... $31.58 92314................. E.............. ............... Prescription of contact lens. ........... ........... ........... ........... ........... 92315................. X.............. ............... Prescription of contact lens.

0362 2.6607 $157.89 ........... $31.58 92316................. X.............. ............... Prescription of contact lens.

0362 2.6607 $157.89 ........... $31.58 92317................. X.............. ............... Prescription of contact lens.

0362 2.6607 $157.89 ........... $31.58 92325................. X.............. ............... Modification of contact lens.

0362 2.6607 $157.89 ........... $31.58 92326................. X.............. ............... Replacement of contact lens..

0362 2.6607 $157.89 ........... $31.58 92330................. S.............. ............... Fitting of artificial eye....

0230 0.7858 $46.63 $14.97

$9.33 92335................. N.............. ............... Fitting of artificial eye.... ........... ........... ........... ........... ........... 92340................. E.............. ............... Fitting of spectacles........ ........... ........... ........... ........... ........... 92341................. E.............. ............... Fitting of spectacles........ ........... ........... ........... ........... ........... 92342................. E.............. ............... Fitting of spectacles........ ........... ........... ........... ........... ........... 92352................. X.............. ............... Special spectacles fitting...

0362 2.6607 $157.89 ........... $31.58 92353................. X.............. ............... Special spectacles fitting...

0362 2.6607 $157.89 ........... $31.58 92354................. X.............. ............... Special spectacles fitting...

0362 2.6607 $157.89 ........... $31.58 92355................. X.............. ............... Special spectacles fitting...

0362 2.6607 $157.89 ........... $31.58 92358................. X.............. ............... Eye prosthesis service.......

0362 2.6607 $157.89 ........... $31.58 92370................. E.............. ............... Repair & adjust spectacles... ........... ........... ........... ........... ........... 92371................. X.............. ............... Repair & adjust spectacles...

0362 2.6607 $157.89 ........... $31.58 92390................. E.............. ............... Supply of spectacles......... ........... ........... ........... ........... ........... 92391................. E.............. ............... Supply of contact lenses..... ........... ........... ........... ........... ........... 92392................. E.............. ............... Supply of low vision aids.... ........... ........... ........... ........... ........... 92393................. E.............. ............... Supply of artificial eye..... ........... ........... ........... ........... ........... 92395................. E.............. ............... Supply of spectacles......... ........... ........... ........... ........... ........... 92396................. E.............. ............... Supply of contact lenses..... ........... ........... ........... ........... ........... 92499................. S.............. ............... Eye service or procedure.....

0230 0.7858 $46.63 $14.97

$9.33 92502................. T.............. ............... Ear and throat examination...

0251 2.0101 $119.29 ........... $23.86

[[Page 50814]]

92504................. N.............. ............... Ear microscopy examination... ........... ........... ........... ........... ........... 92506................. A.............. ............... Speech/hearing evaluation.... ........... ........... ........... ........... ........... 92507................. A.............. ............... Speech/hearing therapy....... ........... ........... ........... ........... ........... 92508................. A.............. ............... Speech/hearing therapy....... ........... ........... ........... ........... ........... 92510................. E.............. ............... Rehab for ear implant........ ........... ........... ........... ........... ........... 92511................. T.............. ............... Nasopharyngoscopy............

0071 0.7915 $46.97 $11.31

$9.39 92512................. X.............. ............... Nasal function studies.......

0363 0.9128 $54.17 $17.44 $10.83 92516................. X.............. ............... Facial nerve function test...

0660 1.6419 $97.44 $30.66 $19.49 92520................. X.............. ............... Laryngeal function studies...

0660 1.6419 $97.44 $30.66 $19.49 92526................. A.............. ............... Oral function therapy........ ........... ........... ........... ........... ........... 92531................. N.............. ............... Spontaneous nystagmus study.. ........... ........... ........... ........... ........... 92532................. N.............. ............... Positional nystagmus test.... ........... ........... ........... ........... ........... 92533................. N.............. ............... Caloric vestibular test...... ........... ........... ........... ........... ........... 92534................. N.............. ............... Optokinetic nystagmus test... ........... ........... ........... ........... ........... 92541................. X.............. ............... Spontaneous nystagmus test...

0363 0.9128 $54.17 $17.44 $10.83 92542................. X.............. ............... Positional nystagmus test....

0363 0.9128 $54.17 $17.44 $10.83 92543................. X.............. ............... Caloric vestibular test......

0660 1.6419 $97.44 $30.66 $19.49 92544................. X.............. ............... Optokinetic nystagmus test...

0363 0.9128 $54.17 $17.44 $10.83 92545................. X.............. ............... Oscillating tracking test....

0363 0.9128 $54.17 $17.44 $10.83 92546................. X.............. ............... Sinusoidal rotational test...

0660 1.6419 $97.44 $30.66 $19.49 92547................. X.............. ............... Supplemental electrical test.

0363 0.9128 $54.17 $17.44 $10.83 92548................. X.............. ............... Posturography................

0660 1.6419 $97.44 $30.66 $19.49 92551................. E.............. ............... Pure tone hearing test, air.. ........... ........... ........... ........... ........... 92552................. X.............. ............... Pure tone audiometry, air....

0364 0.4708 $27.94

$9.06

$5.59 92553................. X.............. ............... Audiometry, air & bone.......

0365 1.2356 $73.32 $18.95 $14.66 92555................. X.............. ............... Speech threshold audiometry..

0364 0.4708 $27.94

$9.06

$5.59 92556................. X.............. ............... Speech audiometry, complete..

0364 0.4708 $27.94

$9.06

$5.59 92557................. X.............. ............... Comprehensive hearing test...

0365 1.2356 $73.32 $18.95 $14.66 92559................. E.............. ............... Group audiometric testing.... ........... ........... ........... ........... ........... 92560................. E.............. ............... Bekesy audiometry, screen.... ........... ........... ........... ........... ........... 92561................. X.............. ............... Bekesy audiometry, diagnosis.

0364 0.4708 $27.94

$9.06

$5.59 92562................. X.............. ............... Loudness balance test........

0364 0.4708 $27.94

$9.06

$5.59 92563................. X.............. ............... Tone decay hearing test......

0364 0.4708 $27.94

$9.06

$5.59 92564................. X.............. ............... Sisi hearing test............

0364 0.4708 $27.94

$9.06

$5.59 92565................. X.............. ............... Stenger test, pure tone......

0364 0.4708 $27.94

$9.06

$5.59 92567................. X.............. ............... Tympanometry.................

0364 0.4708 $27.94

$9.06

$5.59 92568................. X.............. ............... Acoustic reflex testing......

0364 0.4708 $27.94

$9.06

$5.59 92569................. X.............. ............... Acoustic reflex decay test...

0364 0.4708 $27.94

$9.06

$5.59 92571................. X.............. ............... Filtered speech hearing test.

0364 0.4708 $27.94

$9.06

$5.59 92572................. X.............. ............... Staggered spondaic word test.

0365 1.2356 $73.32 $18.95 $14.66 92573................. X.............. ............... Lombard test.................

0364 0.4708 $27.94

$9.06

$5.59 92575................. X.............. ............... Sensorineural acuity test....

0364 0.4708 $27.94

$9.06

$5.59 92576................. X.............. ............... Synthetic sentence test......

0364 0.4708 $27.94

$9.06

$5.59 92577................. X.............. ............... Stenger test, speech.........

0366 1.7743 $105.29 $30.04 $21.06 92579................. X.............. ............... Visual audiometry (vra)......

0365 1.2356 $73.32 $18.95 $14.66 92582................. X.............. ............... Conditioning play audiometry.

0365 1.2356 $73.32 $18.95 $14.66 92583................. X.............. ............... Select picture audiometry....

0364 0.4708 $27.94

$9.06

$5.59 92584................. X.............. ............... Electrocochleography.........

0660 1.6419 $97.44 $30.66 $19.49 92585................. S.............. ............... Auditor evoke potent, compre.

0216

2.672 $158.56 ........... $31.71 92586................. S.............. ............... Auditor evoke potent, limit..

0218 1.1408 $67.70 ........... $13.54 92587................. X.............. ............... Evoked auditory test.........

0363 0.9128 $54.17 $17.44 $10.83 92588................. X.............. ............... Evoked auditory test.........

0363 0.9128 $54.17 $17.44 $10.83 92590................. E.............. ............... Hearing aid exam, one ear.... ........... ........... ........... ........... ........... 92591................. E.............. ............... Hearing aid exam, both ears.. ........... ........... ........... ........... ........... 92592................. E.............. ............... Hearing aid check, one ear... ........... ........... ........... ........... ........... 92593................. E.............. ............... Hearing aid check, both ears. ........... ........... ........... ........... ........... 92594................. E.............. ............... Electro hearng aid test, one. ........... ........... ........... ........... ........... 92595................. E.............. ............... Electro hearng aid tst, both. ........... ........... ........... ........... ........... 92596................. X.............. ............... Ear protector evaluation.....

0364 0.4708 $27.94

$9.06

$5.59 92597................. A.............. ............... Voice Prosthetic Evaluation.. ........... ........... ........... ........... ........... 92601................. X.............. ............... Cochlear implt f/up exam .

0366 1.7743 $105.29 $30.04 $21.06 92604................. X.............. ............... Reprogram cochlear implt 7 >.

0366 1.7743 $105.29 $30.04 $21.06 92605................. A.............. ............... Eval for nonspeech device rx. ........... ........... ........... ........... ........... 92606................. A.............. ............... Non-speech device service.... ........... ........... ........... ........... ...........

[[Page 50815]]

92607................. A.............. ............... Ex for speech device rx, 1hr. ........... ........... ........... ........... ........... 92608................. A.............. ............... Ex for speech device rx addl. ........... ........... ........... ........... ........... 92609................. A.............. ............... Use of speech device service. ........... ........... ........... ........... ........... 92610................. A.............. ............... Evaluate swallowing function. ........... ........... ........... ........... ........... 92611................. A.............. ............... Motion fluoroscopy/swallow... ........... ........... ........... ........... ........... 92612................. A.............. ............... Endoscopy swallow tst (fees). ........... ........... ........... ........... ........... 92613................. E.............. ............... Endoscopy swallow tst (fees). ........... ........... ........... ........... ........... 92614................. A.............. ............... Laryngoscopic sensory test... ........... ........... ........... ........... ........... 92615................. E.............. ............... Eval laryngoscopy sense tst.. ........... ........... ........... ........... ........... 92616................. A.............. ............... Fees w/laryngeal sense test.. ........... ........... ........... ........... ........... 92617................. E.............. ............... Interprt fees/laryngeal test. ........... ........... ........... ........... ........... 92620................. X.............. ............... Auditory function, 60 min....

0364 0.4708 $27.94

$9.06

$5.59 92621................. N.............. ............... Auditory function, + 15 min.. ........... ........... ........... ........... ........... 92625................. X.............. ............... Tinnitus assessment..........

0364 0.4708 $27.94

$9.06

$5.59 92700................. X.............. ............... Ent procedure/service........

0364 0.4708 $27.94

$9.06

$5.59 92950................. S.............. ............... Heart/lung resuscitation cpr.

0094 2.5363 $150.51 $47.62 $30.10 92953................. S.............. ............... Temporary external pacing....

0094 2.5363 $150.51 $47.62 $30.10 92960................. S.............. ............... Cardioversion electric, ext..

0679 5.5774 $330.98 $95.30 $66.20 92961................. S.............. ............... Cardioversion, electric, int.

0679 5.5774 $330.98 $95.30 $66.20 92970................. C.............. ............... Cardioassist, internal....... ........... ........... ........... ........... ........... 92971................. C.............. ............... Cardioassist, external....... ........... ........... ........... ........... ........... 92973................. T.............. ............... Percut coronary thrombectomy.

0676 2.4105 $143.05 ........... $28.61 92974................. T.............. ............... Cath place, cardio brachytx..

0103 14.7142 $873.18 $223.63 $174.64 92975................. C.............. ............... Dissolve clot, heart vessel.. ........... ........... ........... ........... ........... 92977................. T.............. ............... Dissolve clot, heart vessel..

0676 2.4105 $143.05 ........... $28.61 92978................. S.............. ............... Intravasc us, heart add-on...

0670 25.4131 $1,508.09 $472.46 $301.62 92979................. S.............. ............... Intravasc us, heart add-on...

0416 19.5542 $1,160.40 ........... $232.08 92980................. T.............. ............... Insert intracoronary stent...

0104 79.0094 $4,688.65 ........... $937.73 92981................. T.............. ............... Insert intracoronary stent...

0104 79.0094 $4,688.65 ........... $937.73 92982................. T.............. ............... Coronary artery dilation.....

0083 50.8925 $3,020.11 ........... $604.02 92984................. T.............. ............... Coronary artery dilation.....

0083 50.8925 $3,020.11 ........... $604.02 92986................. T.............. ............... Revision of aortic valve.....

0083 50.8925 $3,020.11 ........... $604.02 92987................. T.............. ............... Revision of mitral valve.....

0083 50.8925 $3,020.11 ........... $604.02 92990................. T.............. ............... Revision of pulmonary valve..

0083 50.8925 $3,020.11 ........... $604.02 92992................. C.............. ............... Revision of heart chamber.... ........... ........... ........... ........... ........... 92993................. C.............. ............... Revision of heart chamber.... ........... ........... ........... ........... ........... 92995................. T.............. ............... Coronary atherectomy.........

0082 85.0126 $5,044.90 $1,085.20 $1,008.98 92996................. T.............. ............... Coronary atherectomy add-on..

0082 85.0126 $5,044.90 $1,085.20 $1,008.98 92997................. T.............. ............... Pul art balloon repr, percut.

0081 34.4473 $2,044.21 ........... $408.84 92998................. T.............. ............... Pul art balloon repr, percut.

0081 34.4473 $2,044.21 ........... $408.84 93000................. B.............. ............... Electrocardiogram, complete.. ........... ........... ........... ........... ........... 93005................. S.............. ............... Electrocardiogram, tracing...

0099 0.3821 $22.67 ...........

$4.53 93010................. A.............. ............... Electrocardiogram report..... ........... ........... ........... ........... ........... 93012................. N.............. ............... Transmission of ecg.......... ........... ........... ........... ........... ........... 93014................. B.............. ............... Report on transmitted ecg.... ........... ........... ........... ........... ........... 93015................. B.............. ............... Cardiovascular stress test... ........... ........... ........... ........... ........... 93016................. B.............. ............... Cardiovascular stress test... ........... ........... ........... ........... ........... 93017................. X.............. ............... Cardiovascular stress test...

0100 2.4968 $148.17 $41.44 $29.63 93018................. B.............. ............... Cardiovascular stress test... ........... ........... ........... ........... ........... 93024................. X.............. ............... Cardiac drug stress test.....

0100 2.4968 $148.17 $41.44 $29.63 93025................. X.............. ............... Microvolt t-wave assess......

0100 2.4968 $148.17 $41.44 $29.63 93040................. B.............. ............... Rhythm ECG with report....... ........... ........... ........... ........... ........... 93041................. S.............. ............... Rhythm ECG, tracing..........

0099 0.3821 $22.67 ...........

$4.53 93042................. B.............. ............... Rhythm ECG, report........... ........... ........... ........... ........... ........... 93224................. B.............. ............... ECG monitor/report, 24 hrs... ........... ........... ........... ........... ........... 93225................. X.............. ............... ECG monitor/record, 24 hrs...

0097 1.0223 $60.67 $23.79 $12.13 93226................. X.............. ............... ECG monitor/report, 24 hrs...

0097 1.0223 $60.67 $23.79 $12.13 93227................. B.............. ............... ECG monitor/review, 24 hrs... ........... ........... ........... ........... ........... 93230................. B.............. ............... ECG monitor/report, 24 hrs... ........... ........... ........... ........... ........... 93231................. X.............. ............... Ecg monitor/record, 24 hrs...

0097 1.0223 $60.67 $23.79 $12.13 93232................. X.............. ............... ECG monitor/report, 24 hrs...

0097 1.0223 $60.67 $23.79 $12.13 93233................. B.............. ............... ECG monitor/review, 24 hrs... ........... ........... ........... ........... ........... 93235................. B.............. ............... ECG monitor/report, 24 hrs... ........... ........... ........... ........... ........... 93236................. X.............. ............... ECG monitor/report, 24 hrs...

0097 1.0223 $60.67 $23.79 $12.13 93237................. B.............. ............... ECG monitor/review, 24 hrs... ........... ........... ........... ........... ........... 93268................. B.............. ............... ECG record/review............ ........... ........... ........... ........... ...........

[[Page 50816]]

93270................. X.............. ............... ECG recording................

0097 1.0223 $60.67 $23.79 $12.13 93271................. X.............. ............... Ecg/monitoring and analysis..

0097 1.0223 $60.67 $23.79 $12.13 93272................. B.............. ............... Ecg/review, interpret only... ........... ........... ........... ........... ........... 93278................. S.............. ............... ECG/signal-averaged..........

0099 0.3821 $22.67 ...........

$4.53 93303................. S.............. ............... Echo transthoracic...........

0269 3.2437 $192.49 $76.99 $38.50 93304................. S.............. ............... Echo transthoracic...........

0697 1.5357 $91.13 $36.45 $18.23 93307................. S.............. ............... Echo exam of heart...........

0269 3.2437 $192.49 $76.99 $38.50 93308................. S.............. ............... Echo exam of heart...........

0697 1.5357 $91.13 $36.45 $18.23 93312................. S.............. ............... Echo transesophageal.........

0270 6.0192 $357.20 $142.88 $71.44 93313................. S.............. ............... Echo transesophageal.........

0270 6.0192 $357.20 $142.88 $71.44 93314................. N.............. ............... Echo transesophageal......... ........... ........... ........... ........... ........... 93315................. S.............. ............... Echo transesophageal.........

0270 6.0192 $357.20 $142.88 $71.44 93316................. S.............. ............... Echo transesophageal.........

0270 6.0192 $357.20 $142.88 $71.44 93317................. N.............. ............... Echo transesophageal......... ........... ........... ........... ........... ........... 93318................. S.............. ............... Echo transesophageal intraop.

0270 6.0192 $357.20 $142.88 $71.44 93320................. S.............. ............... Doppler echo exam, heart.....

0671 1.7028 $101.05 $40.42 $20.21 93321................. S.............. ............... Doppler echo exam, heart.....

0697 1.5357 $91.13 $36.45 $18.23 93325................. S.............. ............... Doppler color flow add-on....

0697 1.5357 $91.13 $36.45 $18.23 93350................. S.............. ............... Echo transthoracic...........

0269 3.2437 $192.49 $76.99 $38.50 93501................. T.............. ............... Right heart catheterization..

0080 37.1361 $2,203.77 $838.92 $440.75 93503................. T.............. ............... Insert/place heart catheter..

0103 14.7142 $873.18 $223.63 $174.64 93505................. T.............. ............... Biopsy of heart lining.......

0103 14.7142 $873.18 $223.63 $174.64 93508................. T.............. ............... Cath placement, angiography..

0080 37.1361 $2,203.77 $838.92 $440.75 93510................. T.............. ............... Left heart catheterization...

000 37.1361 $2,203.77 $838.92 $440.75 93511................. T.............. ............... Left heart catheterization...

0080 37.1361 $2,203.77 $838.92 $440.75 93514................. T.............. ............... Left heart catheterization...

0080 37.1361 $2,203.77 $838.92 $440.75 93524................. T.............. ............... Left heart catheterization...

0080 37.1361 $2,203.77 $838.92 $440.75 93526................. T.............. ............... Rt & Lt heart catheters......

0080 37.1361 $2,203.77 $838.92 $440.75 93527................. T.............. ............... Rt & Lt heart catheters......

0080 37.1361 $2,203.77 $838.92 $440.75 93528................. T.............. ............... Rt & Lt heart catheters......

0080 37.1361 $2,203.77 $838.92 $440.75 93529................. T.............. ............... Rt, lt heart catheterization.

0080 37.1361 $2,203.77 $838.92 $440.75 93530................. T.............. ............... Rt heart cath, congenital....

0080 37.1361 $2,203.77 $838.92 $440.75 93531................. T.............. ............... R & l heart cath, congenital.

0080 37.1361 $2,203.77 $838.92 $440.75 93532................. T.............. ............... R & l heart cath, congenital.

0080 37.1361 $2,203.77 $838.92 $440.75 93533................. T.............. ............... R & l heart cath, congenital.

0080 37.1361 $2,203.77 $838.92 $440.75 93539................. N.............. ............... Injection, cardiac cath...... ........... ........... ........... ........... ........... 93540................. N.............. ............... Injection, cardiac cath...... ........... ........... ........... ........... ........... 93541................. N.............. ............... Injection for lung angiogram. ........... ........... ........... ........... ........... 93542................. N.............. ............... Injection for heart x-rays... ........... ........... ........... ........... ........... 93543................. N.............. ............... Injection for heart x-rays... ........... ........... ........... ........... ........... 93544................. N.............. ............... Injection for aortography.... ........... ........... ........... ........... ........... 93545................. N.............. ............... Inject for coronary x-rays... ........... ........... ........... ........... ........... 93555................. N.............. ............... Imaging, cardiac cath........ ........... ........... ........... ........... ........... 93556................. N.............. ............... Imaging, cardiac cath........ ........... ........... ........... ........... ........... 93561................. N.............. ............... Cardiac output measurement... ........... ........... ........... ........... ........... 93562................. N.............. ............... Cardiac output measurement... ........... ........... ........... ........... ........... 93571................. S.............. ............... Heart flow reserve measure...

0670 25.4131 $1,508.09 $472.46 $301.62 93572................. S.............. ............... Heart flow reserve measure...

0416 19.5542 $1,160.40 ........... $232.08 93580................. T.............. ............... Transcath closure of asd.....

0434 90.7877 $5,387.61 ........... $1,077.52 93581................. T.............. ............... Transcath closure of vsd.....

0434 90.7877 $5,387.61 ........... $1,077.52 93600................. T.............. ............... Bundle of His recording......

0087 30.7101 $1,822.43 ........... $364.49 93602................. T.............. ............... Intra-atrial recording.......

0087 30.7101 $1,822.43 ........... $364.49 93603................. T.............. ............... Right ventricular recording..

0087 30.7101 $1,822.43 ........... $364.49 93609................. T.............. ............... Map tachycardia, add-on......

0087 30.7101 $1,822.43 ........... $364.49 93610................. T.............. ............... Intra-atrial pacing..........

0087 30.7101 $1,822.43 ........... $364.49 93612................. T.............. ............... Intraventricular pacing......

0087 30.7101 $1,822.43 ........... $364.49 93613................. T.............. ............... Electrophys map 3d, add-on...

0087 30.7101 $1,822.43 ........... $364.49 93615................. T.............. ............... Esophageal recording.........

0087 30.7101 $1,822.43 ........... $364.49 93616................. T.............. ............... Esophageal recording.........

0087 30.7101 $1,822.43 ........... $364.49 93618................. T.............. ............... Heart rhythm pacing..........

0087 30.7101 $1,822.43 ........... $364.49 93619................. T.............. ............... Electrophysiology evaluation.

0085 35.1882 $2,088.17 $426.25 $417.63 93620................. T.............. ............... Electrophysiology evaluation.

0085 35.1882 $2,088.17 $426.25 $417.63 93621................. T.............. ............... Electrophysiology evaluation.

0085 35.1882 $2,088.17 $426.25 $417.63 93622................. T.............. ............... Electrophysiology evaluation.

0085 35.1882 $2,088.17 $426.25 $417.63 93623................. T.............. ............... Stimulation, pacing heart....

0087 30.7101 $1,822.43 ........... $364.49 93624................. T.............. ............... Electrophysiologic study.....

0085 35.1882 $2,088.17 $426.25 $417.63

[[Page 50817]]

93631................. T.............. ............... Heart pacing, mapping........

0087 30.7101 $1,822.43 ........... $364.49 93640................. S.............. ............... Evaluation heart device......

0084 10.0205 $594.65 ........... $118.93 93641................. S.............. ............... Electrophysiology evaluation.

0084 10.0205 $594.65 ........... $118.93 93642................. S.............. ............... Electrophysiology evaluation.

0084 10.0205 $594.65 ........... $118.93 93650................. T.............. ............... Ablate heart dysrhythm focus.

0086 44.2596 $2,626.50 $833.33 $525.30 93651................. T.............. ............... Ablate heart dysrhythm focus.

0086 44.2596 $2,626.50 $833.33 $525.30 93652................. T.............. ............... Ablate heart dysrhythm focus.

0086 44.2596 $2,626.50 $833.33 $525.30 93660................. S.............. ............... Tilt table evaluation........

0101 4.2787 $253.91 $101.56 $50.78 93662................. S.............. ............... Intracardiac ecg (ice).......

0670 25.4131 $1,508.09 $472.46 $301.62 93668................. E.............. ............... Peripheral vascular rehab.... ........... ........... ........... ........... ........... 93701................. S.............. ............... Bioimpedance, thoracic.......

0099 0.3821 $22.67 ...........

$4.53 93720................. B.............. ............... Total body plethysmography... ........... ........... ........... ........... ........... 93721................. X.............. ............... Plethysmography tracing......

0368 0.9761 $57.92 $23.16 $11.58 93722................. B.............. ............... Plethysmography report....... ........... ........... ........... ........... ........... 93724................. S.............. ............... Analyze pacemaker system.....

0690 0.3755 $22.28

$8.91

$4.46 93727................. S.............. ............... Analyze ilr system...........

0690 0.3755 $22.28

$8.91

$4.46 93731................. S.............. ............... Analyze pacemaker system.....

0690 0.3755 $22.28

$8.91

$4.46 93732................. S.............. ............... Analyze pacemaker system.....

0690 0.3755 $22.28

$8.91

$4.46 93733................. S.............. ............... Telephone analy, pacemaker...

0690 0.3755 $22.28

$8.91

$4.46 93734................. S.............. ............... Analyze pacemaker system.....

0690 0.3755 $22.28

$8.91

$4.46 93735................. S.............. ............... Analyze pacemaker system.....

0690 0.3755 $22.28

$8.91

$4.46 93736................. S.............. ............... Telephonic analy, pacemaker..

0690 0.3755 $22.28

$8.91

$4.46 93740................. X.............. ............... Temperature gradient studies.

0368 0.9761 $57.92 $23.16 $11.58 93741................. S.............. ............... Analyze ht pace device sngl..

0689 0.5735 $34.03 ...........

$6.81 93742................. S.............. ............... Analyze ht pace device sngl..

0689 0.5735 $34.03 ...........

$6.81 93743................. S.............. ............... Analyze ht pace device dual..

0689 0.5735 $34.03 ...........

$6.81 93744................. S.............. ............... Analyze ht pace device dual..

0689 0.5735 $34.03 ...........

$6.81 93745................. S.............. ............... Set-up cardiovert-defibrill..

0689 0.5735 $34.03 ...........

$6.81 93760................. E.............. ............... Cephalic thermogram.......... ........... ........... ........... ........... ........... 93762................. E.............. ............... Peripheral thermogram........ ........... ........... ........... ........... ........... 93770................. N.............. ............... Measure venous pressure...... ........... ........... ........... ........... ........... 93784................. E.............. ............... Ambulatory BP monitoring..... ........... ........... ........... ........... ........... 93786................. X.............. ............... Ambulatory BP recording......

0097 1.0223 $60.67 $23.79 $12.13 93788................. X.............. ............... Ambulatory BP analysis.......

0097 1.0223 $60.67 $23.79 $12.13 93790................. B.............. ............... Review/report BP recording... ........... ........... ........... ........... ........... 93797................. S.............. ............... Cardiac rehab................

0095 0.5885 $34.92 $13.96

$6.98 93798................. S.............. ............... Cardiac rehab/monitor........

0095 0.5885 $34.92 $13.96

$6.98 93799................. S.............. ............... Cardiovascular procedure.....

0096 1.6307 $96.77 $38.70 $19.35 93875................. S.............. ............... Extracranial study...........

0096 1.6307 $96.77 $38.70 $19.35 93880................. S.............. ............... Extracranial study...........

0267 2.6327 $156.23 $62.18 $31.25 93882................. S.............. ............... Extracranial study...........

0267 2.6327 $156.23 $62.18 $31.25 93886................. S.............. ............... Intracranial study...........

0267 2.6327 $156.23 $62.18 $31.25 93888................. S.............. ............... Intracranial study...........

0266 1.6393 $97.28 $38.91 $19.46 93890................. S.............. ............... Tcd, vasoreactivity study....

0266 1.6393 $97.28 $38.91 $19.46 93892................. S.............. ............... Tcd, emboli detect w/o inj...

0266 1.6393 $97.28 $38.91 $19.46 93893................. S.............. ............... Tcd, emboli detect w/inj.....

0266 1.6393 $97.28 $38.91 $19.46 93922................. S.............. ............... Extremity study..............

0096 1.6307 $96.77 $38.70 $19.35 93923................. S.............. ............... Extremity study..............

0096 1.6307 $96.77 $38.70 $19.35 93924................. S.............. ............... Extremity study..............

0096 1.6307 $96.77 $38.70 $19.35 93925................. S.............. ............... Lower extremity study........

0267 2.6327 $156.23 $62.18 $31.25 93926................. S.............. ............... Lower extremity study........

0266 1.6393 $97.28 $38.91 $19.46 93930................. S.............. ............... Upper extremity study........

0267 2.6327 $156.23 $62.18 $31.25 93931................. S.............. ............... Upper extremity study........

0266 1.6393 $97.28 $38.91 $19.46 93965................. S.............. ............... Extremity study..............

0096 1.6307 $96.77 $38.70 $19.35 93970................. S.............. ............... Extremity study..............

0267 2.6327 $156.23 $62.18 $31.25 93971................. S.............. ............... Extremity study..............

0266 1.6393 $97.28 $38.91 $19.46 93975................. S.............. ............... Vascular study...............

0267 2.6327 $156.23 $62.18 $31.25 93976................. S.............. ............... Vascular study...............

0267 2.6327 $156.23 $62.18 $31.25 93978................. S.............. ............... Vascular study...............

0266 1.6393 $97.28 $38.91 $19.46 93979................. S.............. ............... Vascular study...............

0266 1.6393 $97.28 $38.91 $19.46 93980................. S.............. ............... Penile vascular study........

0267 2.6327 $156.23 $62.18 $31.25 93981................. S.............. ............... Penile vascular study........

0266 1.6393 $97.28 $38.91 $19.46 93990................. S.............. ............... Doppler flow testing.........

0266 1.6393 $97.28 $38.91 $19.46 94010................. X.............. ............... Breathing capacity test......

0368 0.9761 $57.92 $23.16 $11.58 94014................. X.............. ............... Patient recorded spirometry..

0367 0.6659 $39.52 $14.80

$7.90 94015................. X.............. ............... Patient recorded spirometry..

0367 0.6659 $39.52 $14.80

$7.90

[[Page 50818]]

94016................. A.............. ............... Review patient spirometry.... ........... ........... ........... ........... ........... 94060................. X.............. ............... Evaluation of wheezing.......

0368 0.9761 $57.92 $23.16 $11.58 94070................. X.............. ............... Evaluation of wheezing.......

0369 2.7519 $163.31 $44.18 $32.66 94150................. X.............. ............... Vital capacity test..........

0367 0.6659 $39.52 $14.80

$7.90 94200................. X.............. ............... Lung function test (MBC/MVV).

0367 0.6659 $39.52 $14.80

$7.90 94240................. X.............. ............... Residual lung capacity.......

0368 0.9761 $57.92 $23.16 $11.58 94250................. X.............. ............... Expired gas collection.......

0367 0.6659 $39.52 $14.80

$7.90 94260................. X.............. ............... Thoracic gas volume..........

0367 0.6659 $39.52 $14.80

$7.90 94350................. X.............. ............... Lung nitrogen washout curve..

0367 0.6659 $39.52 $14.80

$7.90 94360................. X.............. ............... Measure airflow resistance...

0367 0.6659 $39.52 $14.80

$7.90 94370................. X.............. ............... Breath airway closing volume.

0367 0.6659 $39.52 $14.80

$7.90 94375................. X.............. ............... Respiratory flow volume loop.

0367 0.6659 $39.52 $14.80

$7.90 94400................. X.............. ............... CO2 breathing response curve.

0367 0.6659 $39.52 $14.80

$7.90 94450................. X.............. ............... Hypoxia response curve.......

0368 0.9761 $57.92 $23.16 $11.58 94452................. X.............. ............... Hast w/report................

0368 0.9761 $57.92 $23.16 $11.58 94453................. X.............. ............... Hast w/oxygen titrate........

0368 0.9761 $57.92 $23.16 $11.58 94620................. X.............. ............... Pulmonary stress test/simple.

0368 0.9761 $57.92 $23.16 $11.58 94621................. X.............. ............... Pulm stress test/complex.....

0369 2.7519 $163.31 $44.18 $32.66 94640................. S.............. ............... Airway inhalation treatment..

0077 0.3444 $20.44

$7.74

$4.09 94642................. S.............. ............... Aerosol inhalation treatment.

0078 1.0236 $60.74 $14.55 $12.15 94656................. S.............. ............... Initial ventilator mgmt......

0079 2.3482 $139.35 ........... $27.87 94657................. S.............. ............... Continued ventilator mgmt....

0079 2.3482 $139.35 ........... $27.87 94660................. S.............. ............... Pos airway pressure, CPAP....

0068 1.2293 $72.95 $29.18 $14.59 94662................. S.............. ............... Neg press ventilation, cnp...

0079 2.3482 $139.35 ........... $27.87 94664................. S.............. ............... Aerosol or vapor inhalations.

0077 0.3444 $20.44

$7.74

$4.09 94667................. S.............. ............... Chest wall manipulation......

0077 0.3444 $20.44

$7.74

$4.09 94668................. S.............. ............... Chest wall manipulation......

0077 0.3444 $20.44

$7.74

$4.09 94680................. X.............. ............... Exhaled air analysis, o2.....

0367 0.6659 $39.52 $14.80

$7.90 94681................. X.............. ............... Exhaled air analysis, o2/co2.

0368 0.9761 $57.92 $23.16 $11.58 94690................. X.............. ............... Exhaled air analysis.........

0368 0.9761 $57.92 $23.16 $11.58 94720................. X.............. ............... Monoxide diffusing capacity..

0368 0.9761 $57.92 $23.16 $11.58 94725................. X.............. ............... Membrane diffusion capacity..

0368 0.9761 $57.92 $23.16 $11.58 94750................. X.............. ............... Pulmonary compliance study...

0368 0.9761 $57.92 $23.16 $11.58 94760................. N.............. ............... Measure blood oxygen level... ........... ........... ........... ........... ........... 94761................. N.............. ............... Measure blood oxygen level... ........... ........... ........... ........... ........... 94762................. N.............. ............... Measure blood oxygen level... ........... ........... ........... ........... ........... 94770................. X.............. ............... Exhaled carbon dioxide test..

0367 0.6659 $39.52 $14.80

$7.90 94772................. X.............. ............... Breath recording, infant.....

0369 2.7519 $163.31 $44.18 $32.66 94799................. X.............. ............... Pulmonary service/procedure..

0367 0.6659 $39.52 $14.80

$7.90 95004................. X.............. ............... Percut allergy skin tests....

0381 0.1884 $11.18

$2.35

$2.24 95010................. X.............. ............... Percut allergy titrate test..

0381 0.1884 $11.18

$2.35

$2.24 95015................. X.............. ............... Id allergy titrate-drug/bug..

0381 0.1884 $11.18

$2.35

$2.24 95024................. X.............. ............... Id allergy test, drug/bug....

0381 0.1884 $11.18

$2.35

$2.24 95027................. X.............. ............... Skin end point titration.....

0381 0.1884 $11.18

$2.35

$2.24 95028................. X.............. ............... Id allergy test-delayed type.

0381 0.1884 $11.18

$2.35

$2.24 95044................. X.............. ............... Allergy patch tests..........

0381 0.1884 $11.18

$2.35

$2.24 95052................. X.............. ............... Photo patch test.............

0381 0.1884 $11.18

$2.35

$2.24 95056................. X.............. ............... Photosensitivity tests.......

0370 1.1232 $66.65 ........... $13.33 95060................. X.............. ............... Eye allergy tests............

0370 1.1232 $66.65 ........... $13.33 95065................. X.............. ............... Nose allergy test............

0381 0.1884 $11.18

$2.35

$2.24 95070................. X.............. ............... Bronchial allergy tests......

0369 2.7519 $163.31 $44.18 $32.66 95071................. X.............. ............... Bronchial allergy tests......

0369 2.7519 $163.31 $44.18 $32.66 95075................. X.............. ............... Ingestion challenge test.....

0361 3.6216 $214.92 $83.23 $42.98 95078................. X.............. ............... Provocative testing..........

0370 1.1232 $66.65 ........... $13.33 95115................. X.............. ............... Immunotherapy, one injection.

0352 0.1413

$8.39 ...........

$1.68 95117................. X.............. ............... Immunotherapy injections.....

0353 0.3954 $23.46 ...........

$4.69 95120................. B.............. ............... Immunotherapy, one injection. ........... ........... ........... ........... ........... 95125................. B.............. ............... Immunotherapy, many antigens. ........... ........... ........... ........... ........... 95130................. B.............. ............... Immunotherapy, insect venom.. ........... ........... ........... ........... ........... 95131................. B.............. ............... Immunotherapy, insect venoms. ........... ........... ........... ........... ........... 95132................. B.............. ............... Immunotherapy, insect venoms. ........... ........... ........... ........... ........... 95133................. B.............. ............... Immunotherapy, insect venoms. ........... ........... ........... ........... ........... 95134................. B.............. ............... Immunotherapy, insect venoms. ........... ........... ........... ........... ........... 95144................. X.............. ............... Antigen therapy services.....

0353 0.3954 $23.46 ...........

$4.69 95145................. X.............. ............... Antigen therapy services.....

0353 0.3954 $23.46 ...........

$4.69 95146................. X.............. ............... Antigen therapy services.....

0359 0.8312 $49.33 ...........

$9.87

[[Page 50819]]

95147................. X.............. ............... Antigen therapy services.....

0359 0.8312 $49.33 ...........

$9.87 95148................. X.............. ............... Antigen therapy services.....

0353 0.3954 $23.46 ...........

$4.69 95149................. X.............. ............... Antigen therapy services.....

0352 0.1413

$8.39 ...........

$1.68 95165................. X.............. ............... Antigen therapy services.....

0353 0.3954 $23.46 ...........

$4.69 95170................. X.............. ............... Antigen therapy services.....

0352 0.1413

$8.39 ...........

$1.68 95180................. X.............. ............... Rapid desensitization........

0370 1.1232 $66.65 ........... $13.33 95199................. X.............. ............... Allergy immunology services..

0370 1.1232 $66.65 ........... $13.33 95250................. X.............. ............... Glucose monitoring, cont.....

0421

1.66 $98.51 ........... $19.70 95805................. S.............. ............... Multiple sleep latency test..

0209 11.5713 $686.68 $274.67 $137.34 95806................. S.............. ............... Sleep study, unattended......

0213 2.2932 $136.09 $54.43 $27.22 95807................. S.............. ............... Sleep study, attended........

0209 11.5713 $686.68 $274.67 $137.34 95808................. S.............. ............... Polysomnography, 1-3.........

0209 11.5713 $686.68 $274.67 $137.34 95810................. S.............. ............... Polysomnography, 4 or more...

0209 11.5713 $686.68 $274.67 $137.34 95811................. S.............. ............... Polysomnography w/cpap.......

0209 11.5713 $686.68 $274.67 $137.34 95812................. S.............. ............... Electroencephalogram (EEG)...

0213 2.2932 $136.09 $54.43 $27.22 95813................. S.............. ............... Eeg, over 1 hour.............

0213 2.2932 $136.09 $54.43 $27.22 95816................. S.............. ............... Electroencephalogram (EEG)...

0213 2.2932 $136.09 $54.43 $27.22 95819................. S.............. ............... Electroencephalogram (EEG)...

0213 2.2932 $136.09 $54.43 $27.22 95822................. S.............. ............... Sleep electroencephalogram...

0213 2.2932 $136.09 $54.43 $27.22 95824................. S.............. ............... Eeg, cerebral death only.....

0214 1.1353 $67.37 $26.94 $13.47 95827................. S.............. ............... night electroencephalogram...

0213 2.2932 $136.09 $54.43 $27.22 95829................. S.............. ............... Surgery electrocorticogram...

0214 1.1353 $67.37 $26.94 $13.47 95830................. B.............. ............... Insert electrodes for EEG.... ........... ........... ........... ........... ........... 95831................. A.............. ............... Limb muscle testing, manual.. ........... ........... ........... ........... ........... 95832................. A.............. ............... Hand muscle testing, manual.. ........... ........... ........... ........... ........... 95833................. A.............. ............... Body muscle testing, manual.. ........... ........... ........... ........... ........... 95834................. A.............. ............... Body muscle testing, manual.. ........... ........... ........... ........... ........... 95851................. A.............. ............... Range of motion measurements. ........... ........... ........... ........... ........... 95852................. A.............. ............... Range of motion measurements. ........... ........... ........... ........... ........... 95857................. S.............. ............... Tensilon test................

0218 1.1408 $67.70 ........... $13.54 95858................. S.............. ............... Tensilon test & myogram......

0215 0.6115 $36.29 $14.51

$7.26 95860................. S.............. ............... Muscle test, one limb........

0218 1.1408 $67.70 ........... $13.54 95861................. S.............. ............... Muscle test, 2 limbs.........

0218 1.1408 $67.70 ........... $13.54 95863................. S.............. ............... Muscle test, 3 limbs.........

0218 1.1408 $67.70 ........... $13.54 95864................. S.............. ............... Muscle test, 4 limbs.........

0218 1.1408 $67.70 ........... $13.54 95867................. S.............. ............... Muscle test, head or neck....

0218 1.1408 $67.70 ........... $13.54 95868................. S.............. ............... Muscle test cran nerve bilat.

0218 1.1408 $67.70 ........... $13.54 95869................. S.............. ............... Muscle test, thor paraspinal.

0215 0.6115 $36.29 $14.51

$7.26 95870................. S.............. ............... Muscle test, nonparaspinal...

0215 0.6115 $36.29 $14.51

$7.26 95872................. S.............. ............... Muscle test, one fiber.......

0218 1.1408 $67.70 ........... $13.54 95875................. S.............. ............... Limb exercise test...........

0215 0.6115 $36.29 $14.51

$7.26 95900................. S.............. ............... Motor nerve conduction test..

0215 0.6115 $36.29 $14.51

$7.26 95903................. S.............. ............... Motor nerve conduction test..

0215 0.6115 $36.29 $14.51

$7.26 95904................. S.............. ............... Sense nerve conduction test..

0215 0.6115 $36.29 $14.51

$7.26 95920................. S.............. ............... Intraop nerve test add-on....

0216

2.672 $158.56 ........... $31.71 95921................. S.............. ............... Autonomic nerv function test.

0218 1.1408 $67.70 ........... $13.54 95922................. S.............. ............... Autonomic nerv function test.

0218 1.1408 $67.70 ........... $13.54 95923................. S.............. ............... Autonomic nerv function test.

0218 1.1408 $67.70 ........... $13.54 95925................. S.............. ............... Somatosensory testing........

0216

2.672 $158.56 ........... $31.71 95926................. S.............. ............... Somatosensory testing........

0216

2.672 $158.56 ........... $31.71 95927................. S.............. ............... Somatosensory testing........

0216

2.672 $158.56 ........... $31.71 95928................. S.............. ............... C motor evoked, uppr limbs...

0218 1.1408 $67.70 ........... $13.54 95929................. S.............. ............... C motor evoked, lwr limbs....

0218 1.1408 $67.70 ........... $13.54 95930................. S.............. ............... Visual evoked potential test.

0216

2.672 $158.56 ........... $31.71 95933................. S.............. ............... Blink reflex test............

0215 0.6115 $36.29 $14.51

$7.26 95934................. S.............. ............... H-reflex test................

0215 0.6115 $36.29 $14.51

$7.26 95936................. S.............. ............... H-reflex test................

0215 0.6115 $36.29 $14.51

$7.26 95937................. S.............. ............... Neuromuscular junction test..

0218 1.1408 $67.70 ........... $13.54 95950................. S.............. ............... Ambulatory eeg monitoring....

0209 11.5713 $686.68 $274.67 $137.34 95951................. S.............. ............... EEG monitoring/videorecord...

0209 11.5713 $686.68 $274.67 $137.34 95953................. S.............. ............... EEG monitoring/computer......

0209 11.5713 $686.68 $274.67 $137.34 95954................. S.............. ............... EEG monitoring/giving drugs..

0214 1.1353 $67.37 $26.94 $13.47 95955................. S.............. ............... EEG during surgery...........

0213 2.2932 $136.09 $54.43 $27.22 95956................. S.............. ............... Eeg monitoring, cable/radio..

0209 11.5713 $686.68 $274.67 $137.34 95957................. S.............. ............... EEG digital analysis.........

0214 1.1353 $67.37 $26.94 $13.47 95958................. S.............. ............... EEG monitoring/function test.

0213 2.2932 $136.09 $54.43 $27.22

[[Page 50820]]

95961................. S.............. ............... Electrode stimulation, brain.

0216

2.672 $158.56 ........... $31.71 95962................. S.............. ............... Electrode stim, brain add-on.

0216

2.672 $158.56 ........... $31.71 95965................. T.............. ............... Meg, spontaneous.............

0430 11.404 $676.75 ........... $135.35 95966................. T.............. ............... Meg, evoked, single..........

0430 11.404 $676.75 ........... $135.35 95967................. T.............. ............... Meg, evoked, each add'l......

0430 11.404 $676.75 ........... $135.35 95970................. S.............. ............... Analyze neurostim, no prog...

0218 1.1408 $67.70 ........... $13.54 95971................. S.............. ............... Analyze neurostim, simple....

0692 2.0111 $119.34 $30.16 $23.87 95972................. S.............. ............... Analyze neurostim, complex...

0692 2.0111 $119.34 $30.16 $23.87 95973................. S.............. ............... Analyze neurostim, complex...

0692 2.0111 $119.34 $30.16 $23.87 95974................. S.............. ............... Cranial neurostim, complex...

0692 2.0111 $119.34 $30.16 $23.87 95975................. S.............. ............... Cranial neurostim, complex...

0692 2.0111 $119.34 $30.16 $23.87 95978................. S.............. ............... Analyze neurostim brain/1h...

0692 2.0111 $119.34 $30.16 $23.87 95979................. S.............. ............... Analyz neurostim brain addon.

0692 2.0111 $119.34 $30.16 $23.87 95990................. T.............. ............... Spin/brain pump refil & main.

0125 1.9331 $114.72 ........... $22.94 95991................. T.............. ............... Spin/brain pump refil & main.

0125 1.9331 $114.72 ........... $22.94 95999................. S.............. ............... Neurological procedure.......

0215 0.6115 $36.29 $14.51

$7.26 96000................. S.............. ............... Motion analysis, video/3d....

0216

2.672 $158.56 ........... $31.71 96001................. S.............. ............... Motion test w/ft press meas..

0216

2.672 $158.56 ........... $31.71 96002................. S.............. ............... Dynamic surface emg..........

0218 1.1408 $67.70 ........... $13.54 96003................. S.............. ............... Dynamic fine wire emg........

0215 0.6115 $36.29 $14.51

$7.26 96004................. E.............. ............... Phys review of motion tests.. ........... ........... ........... ........... ........... 96100................. X.............. ............... Psychological testing........

0373 2.1926 $130.12 ........... $26.02 96105................. A.............. ............... Assessment of aphasia........ ........... ........... ........... ........... ........... 96110................. X.............. ............... Developmental test, lim......

0373 2.1926 $130.12 ........... $26.02 96111................. X.............. ............... Developmental test, extend...

0373 2.1926 $130.12 ........... $26.02 96115................. X.............. ............... Neurobehavior status exam....

0373 2.1926 $130.12 ........... $26.02 96117................. X.............. ............... Neuropsych test battery......

0373 2.1926 $130.12 ........... $26.02 96150................. S.............. ............... Assess lth/behave, init......

0432 0.6949 $41.24 ...........

$8.25 96151................. S.............. ............... Assess hlth/behave, subseq...

0432 0.6949 $41.24 ...........

$8.25 96152................. S.............. ............... Intervene hlth/behave, indiv.

0432 0.6949 $41.24 ...........

$8.25 96153................. S.............. ............... Intervene hlth/behave, group.

0432 0.6949 $41.24 ...........

$8.25 96154................. S.............. ............... Interv hlth/behav, fam w/pt..

0432 0.6949 $41.24 ...........

$8.25 96155................. E.............. ............... Interv hlth/behav fam no pt.. ........... ........... ........... ........... ........... 96400................. S.............. ............... Chemotherapy, sc/im..........

0116 1.1453 $67.97 ........... $13.59 96405................. S.............. ............... Intralesional chemo admin....

0116 1.1453 $67.97 ........... $13.59 96406................. S.............. ............... Intralesional chemo admin....

0116 1.1453 $67.97 ........... $13.59 96408................. S.............. ............... Chemotherapy, push technique.

0116 1.1453 $67.97 ........... $13.59 96410................. S.............. ............... Chemotherapy,infusion method.

0117 3.2378 $192.14 $42.54 $38.43 96412................. N.............. ............... Chemo, infuse method add-on.. ........... ........... ........... ........... ........... 96414................. S.............. ............... Chemo, infuse method add-on..

0117 3.2378 $192.14 $42.54 $38.43 96420................. S.............. ............... Chemotherapy, push technique.

0116 1.1453 $67.97 ........... $13.59 96422................. S.............. ............... Chemotherapy,infusion method.

0117 3.2378 $192.14 $42.54 $38.43 96423................. N.............. ............... Chemo, infuse method add-on.. ........... ........... ........... ........... ........... 96425................. S.............. ............... Chemotherapy,infusion method.

0117 3.2378 $192.14 $42.54 $38.43 96440................. S.............. ............... Chemotherapy, intracavitary..

0116 1.1453 $67.97 ........... $13.59 96445................. S.............. ............... Chemotherapy, intracavitary..

0116 1.1453 $67.97 ........... $13.59 96450................. S.............. ............... Chemotherapy, into CNS.......

0116 1.1453 $67.97 ........... $13.59 96520................. T.............. ............... Port pump refill & main......

0125 1.9331 $114.72 ........... $22.94 96530................. T.............. ............... Pump refilling, maintenance..

0125 1.9331 $114.72 ........... $22.94 96542................. S.............. ............... Chemotherapy injection.......

0116 1.1453 $67.97 ........... $13.59 96545................. N.............. ............... Provide chemotherapy agent... ........... ........... ........... ........... ........... 96549................. S.............. ............... Chemotherapy, unspecified....

0116 1.1453 $67.97 ........... $13.59 96567................. T.............. ............... Photodynamic tx, skin........

0016 2.5834 $153.31 $33.57 $30.66 96570................. T.............. ............... Photodynamic tx, 30 min......

0015 1.6514 $98.00 $20.29 $19.60 96571................. T.............. ............... Photodynamic tx, addl 15 min.

0015 1.6514 $98.00 $20.29 $19.60 96900................. S.............. ............... Ultraviolet light therapy....

0001 0.4213 $25.00

$7.00

$5.00 96902................. N.............. ............... Trichogram................... ........... ........... ........... ........... ........... 96910................. S.............. ............... Photochemotherapy with UV-B..

0001 0.4213 $25.00

$7.00

$5.00 96912................. S.............. ............... Photochemotherapy with UV-A..

0001 0.4213 $25.00

$7.00

$5.00 96913................. S.............. ............... Photochemotherapy, UV-A or B.

0683 1.9006 $112.79 $25.34 $22.56 96920................. T.............. ............... Laser tx, skin 500 sq cm...

0013 1.1078 $65.74 $14.20 $13.15 96999................. T.............. ............... Dermatological procedure.....

0010 0.5719 $33.94

$9.65

$6.79 97001................. A.............. ............... Pt evaluation................ ........... ........... ........... ........... ........... 97002................. A.............. ............... Pt re-evaluation............. ........... ........... ........... ........... ...........

[[Page 50821]]

97003................. A.............. ............... Ot evaluation................ ........... ........... ........... ........... ........... 97004................. A.............. ............... Ot re-evaluation............. ........... ........... ........... ........... ........... 97005................. E.............. ............... Athletic train eval.......... ........... ........... ........... ........... ........... 97006................. E.............. ............... Athletic train reeval........ ........... ........... ........... ........... ........... 97010................. A.............. ............... Hot or cold packs therapy.... ........... ........... ........... ........... ........... 97012................. A.............. ............... Mechanical traction therapy.. ........... ........... ........... ........... ........... 97014................. E.............. ............... Electric stimulation therapy. ........... ........... ........... ........... ........... 97016................. A.............. ............... Vasopneumatic device therapy. ........... ........... ........... ........... ........... 97018................. A.............. ............... Paraffin bath therapy........ ........... ........... ........... ........... ........... 97020................. A.............. ............... Microwave therapy............ ........... ........... ........... ........... ........... 97022................. A.............. ............... Whirlpool therapy............ ........... ........... ........... ........... ........... 97024................. A.............. ............... Diathermy treatment.......... ........... ........... ........... ........... ........... 97026................. A.............. ............... Infrared therapy............. ........... ........... ........... ........... ........... 97028................. A.............. ............... Ultraviolet therapy.......... ........... ........... ........... ........... ........... 97032................. A.............. ............... Electrical stimulation....... ........... ........... ........... ........... ........... 97033................. A.............. ............... Electric current therapy..... ........... ........... ........... ........... ........... 97034................. A.............. ............... Contrast bath therapy........ ........... ........... ........... ........... ........... 97035................. A.............. ............... Ultrasound therapy........... ........... ........... ........... ........... ........... 97036................. A.............. ............... Hydrotherapy................. ........... ........... ........... ........... ........... 97039................. A.............. ............... Physical therapy treatment... ........... ........... ........... ........... ........... 97110................. A.............. ............... Therapeutic exercises........ ........... ........... ........... ........... ........... 97112................. A.............. ............... Neuromuscular reeducation.... ........... ........... ........... ........... ........... 97113................. A.............. ............... Aquatic therapy/exercises.... ........... ........... ........... ........... ........... 97116................. A.............. ............... Gait training therapy........ ........... ........... ........... ........... ........... 97124................. A.............. ............... Massage therapy.............. ........... ........... ........... ........... ........... 97139................. A.............. ............... Physical medicine procedure.. ........... ........... ........... ........... ........... 97140................. A.............. ............... Manual therapy............... ........... ........... ........... ........... ........... 97150................. A.............. ............... Group therapeutic procedures. ........... ........... ........... ........... ........... 97504................. A.............. ............... Orthotic training............ ........... ........... ........... ........... ........... 97520................. A.............. ............... Prosthetic training.......... ........... ........... ........... ........... ........... 97530................. A.............. ............... Therapeutic activities....... ........... ........... ........... ........... ........... 97532................. A.............. ............... Cognitive skills development. ........... ........... ........... ........... ........... 97533................. A.............. ............... Sensory integration.......... ........... ........... ........... ........... ........... 97535................. A.............. ............... Self care mngment training... ........... ........... ........... ........... ........... 97537................. A.............. ............... Community/work reintegration. ........... ........... ........... ........... ........... 97542................. A.............. ............... Wheelchair mngment training.. ........... ........... ........... ........... ........... 97545................. A.............. ............... Work hardening............... ........... ........... ........... ........... ........... 97546................. A.............. ............... Work hardening add-on........ ........... ........... ........... ........... ........... 97597................. A.............. ............... Active wound care/20 cm or 20 cm.... ........... ........... ........... ........... ........... 97602................. A.............. ............... Wound(s) care non-selective.. ........... ........... ........... ........... ........... 97605................. A.............. ............... Neg press wound tx, 50 cm.. ........... ........... ........... ........... ........... 97703................. A.............. ............... Prosthetic checkout.......... ........... ........... ........... ........... ........... 97750................. A.............. ............... Physical performance test.... ........... ........... ........... ........... ........... 97755................. A.............. ............... Assistive technology assess.. ........... ........... ........... ........... ........... 97799................. A.............. ............... Physical medicine procedure.. ........... ........... ........... ........... ........... 97802................. A.............. ............... Medical nutrition, indiv, in. ........... ........... ........... ........... ........... 97803................. A.............. ............... Med nutrition, indiv, subseq. ........... ........... ........... ........... ........... 97804................. A.............. ............... Medical nutrition, group..... ........... ........... ........... ........... ........... 97810................. E.............. ............... Acupunct w/o stimul 15 min... ........... ........... ........... ........... ........... 97811................. E.............. ............... Acupunct w/o stimul addl 15m. ........... ........... ........... ........... ........... 97813................. E.............. ............... Acupunct w/stimul 15 min..... ........... ........... ........... ........... ........... 97814................. E.............. ............... Acupunct w/stimul addl 15m... ........... ........... ........... ........... ........... 98925................. S.............. ............... Osteopathic manipulation.....

0060 0.4935 $29.29 ...........

$5.86 98926................. S.............. ............... Osteopathic manipulation.....

0060 0.4935 $29.29 ...........

$5.86 98927................. S.............. ............... Osteopathic manipulation.....

0060 0.4935 $29.29 ...........

$5.86 98928................. S.............. ............... Osteopathic manipulation.....

0060 0.4935 $29.29 ...........

$5.86 98929................. S.............. ............... Osteopathic manipulation.....

0060 0.4935 $29.29 ...........

$5.86 98940................. S.............. ............... Chiropractic manipulation....

0060 0.4935 $29.29 ...........

$5.86 98941................. S.............. ............... Chiropractic manipulation....

0060 0.4935 $29.29 ...........

$5.86 98942................. S.............. ............... Chiropractic manipulation....

0060 0.4935 $29.29 ...........

$5.86 98943................. E.............. ............... Chiropractic manipulation.... ........... ........... ........... ........... ........... 99000................. B.............. ............... Specimen handling............ ........... ........... ........... ........... ........... 99001................. B.............. ............... Specimen handling............ ........... ........... ........... ........... ........... 99002................. B.............. ............... Device handling.............. ........... ........... ........... ........... ...........

[[Page 50822]]

99024................. B.............. ............... Postop follow-up visit....... ........... ........... ........... ........... ........... 99026................. E.............. ............... In-hospital on call service.. ........... ........... ........... ........... ........... 99027................. E.............. ............... Out-of-hosp on call service.. ........... ........... ........... ........... ........... 99050................. B.............. ............... Medical services after hrs... ........... ........... ........... ........... ........... 99052................. B.............. ............... Medical services at night.... ........... ........... ........... ........... ........... 99054................. B.............. ............... Medical servcs, unusual hrs.. ........... ........... ........... ........... ........... 99056................. B.............. ............... Non-office medical services.. ........... ........... ........... ........... ........... 99058................. B.............. ............... Office emergency care........ ........... ........... ........... ........... ........... 99070................. B.............. ............... Special supplies............. ........... ........... ........... ........... ........... 99071................. B.............. ............... Patient education materials.. ........... ........... ........... ........... ........... 99075................. E.............. ............... Medical testimony............ ........... ........... ........... ........... ........... 99078................. N.............. ............... Group health education....... ........... ........... ........... ........... ........... 99080................. B.............. ............... Special reports or forms..... ........... ........... ........... ........... ........... 99082................. B.............. ............... Unusual physician travel..... ........... ........... ........... ........... ........... 99090................. B.............. ............... Computer data analysis....... ........... ........... ........... ........... ........... 99091................. E.............. ............... Collect/review data from pt.. ........... ........... ........... ........... ........... 99100................. B.............. ............... Special anesthesia service... ........... ........... ........... ........... ........... 99116................. B.............. ............... Anesthesia with hypothermia.. ........... ........... ........... ........... ........... 99135................. B.............. ............... Special anesthesia procedure. ........... ........... ........... ........... ........... 99140................. B.............. ............... Emergency anesthesia......... ........... ........... ........... ........... ........... 99141................. N.............. ............... Sedation, iv/im or inhalant.. ........... ........... ........... ........... ........... 99142................. N.............. ............... Sedation, oral/rectal/nasal.. ........... ........... ........... ........... ........... 99170................. T.............. ............... Anogenital exam, child.......

0191

0.167

$9.91

$2.78

$1.98 99172................. E.............. ............... Ocular function screen....... ........... ........... ........... ........... ........... 99173................. E.............. ............... Visual acuity screen......... ........... ........... ........... ........... ........... 99175................. N.............. ............... Induction of vomiting........ ........... ........... ........... ........... ........... 99183................. B.............. ............... Hyperbaric oxygen therapy.... ........... ........... ........... ........... ........... 99185................. N.............. ............... Regional hypothermia......... ........... ........... ........... ........... ........... 99186................. N.............. ............... Total body hypothermia....... ........... ........... ........... ........... ........... 99190................. C.............. ............... Special pump services........ ........... ........... ........... ........... ........... 99191................. C.............. ............... Special pump services........ ........... ........... ........... ........... ........... 99192................. C.............. ............... Special pump services........ ........... ........... ........... ........... ........... 99195................. X.............. ............... Phlebotomy...................

0372

0.57 $33.83 $10.09

$6.77 99199................. B.............. ............... Special service/proc/report.. ........... ........... ........... ........... ........... 99201................. V.............. ............... Office/outpatient visit, new.

0600 0.8688 $51.56 ........... $10.31 99202................. V.............. ............... Office/outpatient visit, new.

0600 0.8688 $51.56 ........... $10.31 99203................. V.............. ............... Office/outpatient visit, new.

0601 1.0038 $59.57 ........... $11.91 99204................. V.............. ............... Office/outpatient visit, new.

0602 1.4284 $84.77 ........... $16.95 99205................. V.............. ............... Office/outpatient visit, new.

0602 1.4284 $84.77 ........... $16.95 99211................. V.............. ............... Office/outpatient visit, est.

0600 0.8688 $51.56 ........... $10.31 99212................. V.............. ............... Office/outpatient visit, est.

0600 0.8688 $51.56 ........... $10.31 99213................. V.............. ............... Office/outpatient visit, est.

0601 1.0038 $59.57 ........... $11.91 99214................. V.............. ............... Office/outpatient visit, est.

0602 1.4284 $84.77 ........... $16.95 99215................. V.............. ............... Office/outpatient visit, est.

0602 1.4284 $84.77 ........... $16.95 99217................. B.............. ............... Observation care discharge... ........... ........... ........... ........... ........... 99218................. B.............. ............... Observation care............. ........... ........... ........... ........... ........... 99219................. B.............. ............... Observation care............. ........... ........... ........... ........... ........... 99220................. B.............. ............... Observation care............. ........... ........... ........... ........... ........... 99221................. E.............. ............... Initial hospital care........ ........... ........... ........... ........... ........... 99222................. E.............. ............... Initial hospital care........ ........... ........... ........... ........... ........... 99223................. E.............. ............... Initial hospital care........ ........... ........... ........... ........... ........... 99231................. E.............. ............... Subsequent hospital care..... ........... ........... ........... ........... ........... 99232................. E.............. ............... Subsequent hospital care..... ........... ........... ........... ........... ........... 99233................. E.............. ............... Subsequent hospital care..... ........... ........... ........... ........... ........... 99234................. B.............. ............... Observ/hosp same date........ ........... ........... ........... ........... ........... 99235................. B.............. ............... Observ/hosp same date........ ........... ........... ........... ........... ........... 99236................. B.............. ............... Observ/hosp same date........ ........... ........... ........... ........... ........... 99238................. E.............. ............... Hospital discharge day....... ........... ........... ........... ........... ........... 99239................. E.............. ............... Hospital discharge day....... ........... ........... ........... ........... ........... 99241................. V.............. ............... Office consultation..........

0600 0.8688 $51.56 ........... $10.31 99242................. V.............. ............... Office consultation..........

0600 0.8688 $51.56 ........... $10.31 99243................. V.............. ............... Office consultation..........

0601 1.0038 $59.57 ........... $11.91 99244................. V.............. ............... Office consultation..........

0602 1.4284 $84.77 ........... $16.95 99245................. V.............. ............... Office consultation..........

0602 1.4284 $84.77 ........... $16.95 99251................. C.............. ............... Initial inpatient consult.... ........... ........... ........... ........... ........... 99252................. C.............. ............... Initial inpatient consult.... ........... ........... ........... ........... ...........

[[Page 50823]]

99253................. C.............. ............... Initial inpatient consult.... ........... ........... ........... ........... ........... 99254................. C.............. ............... Initial inpatient consult.... ........... ........... ........... ........... ........... 99255................. C.............. ............... Initial inpatient consult.... ........... ........... ........... ........... ........... 99261................. C.............. ............... Follow-up inpatient consult.. ........... ........... ........... ........... ........... 99262................. C.............. ............... Follow-up inpatient consult.. ........... ........... ........... ........... ........... 99263................. C.............. ............... Follow-up inpatient consult.. ........... ........... ........... ........... ........... 99271................. V.............. ............... Confirmatory consultation....

0600 0.8688 $51.56 ........... $10.31 99272................. V.............. ............... Confirmatory consultation....

0600 0.8688 $51.56 ........... $10.31 99273................. V.............. ............... Confirmatory consultation....

0601 1.0038 $59.57 ........... $11.91 99274................. V.............. ............... Confirmatory consultation....

0602 1.4284 $84.77 ........... $16.95 99275................. V.............. ............... Confirmatory consultation....

0602 1.4284 $84.77 ........... $16.95 99281................. V.............. ............... Emergency dept visit.........

0610 1.2947 $76.83 $19.48 $15.37 99282................. V.............. ............... Emergency dept visit.........

0610 1.2947 $76.83 $19.48 $15.37 99283................. V.............. ............... Emergency dept visit.........

0611 2.2718 $134.82 $35.76 $26.96 99284................. V.............. ............... Emergency dept visit.........

0612 3.9853 $236.50 $54.12 $47.30 99285................. V.............. ............... Emergency dept visit.........

0612 3.9853 $236.50 $54.12 $47.30 99288................. B.............. ............... Direct advanced life support. ........... ........... ........... ........... ........... 99289................. N.............. ............... Pt transport, 30-74 min...... ........... ........... ........... ........... ........... 99290................. N.............. ............... Pt transport, addl 30 min.... ........... ........... ........... ........... ........... 99291................. S.............. ............... Critical care, first hour....

0620 8.2996 $492.52 $135.68 $98.50 99292................. N.............. ............... Critical care, add=l 30 min.. ........... ........... ........... ........... ........... 99293................. C.............. ............... Ped critical care, initial... ........... ........... ........... ........... ........... 99294................. C.............. ............... Ped critical care, subseq.... ........... ........... ........... ........... ........... 99295................. C.............. ............... Neonatal critical care....... ........... ........... ........... ........... ........... 99296................. C.............. ............... Neonatal critical care....... ........... ........... ........... ........... ........... 99298................. C.............. ............... Neonatal critical care....... ........... ........... ........... ........... ........... 99299................. C.............. ............... Ic, lbw infant 1500-2500 gm.. ........... ........... ........... ........... ........... 99301................. B.............. ............... Nursing facility care........ ........... ........... ........... ........... ........... 99302................. B.............. ............... Nursing facility care........ ........... ........... ........... ........... ........... 99303................. B.............. ............... Nursing facility care........ ........... ........... ........... ........... ........... 99311................. B.............. ............... Nursing fac care, subseq..... ........... ........... ........... ........... ........... 99312................. B.............. ............... Nursing fac care, subseq..... ........... ........... ........... ........... ........... 99313................. B.............. ............... Nursing fac care, subseq..... ........... ........... ........... ........... ........... 99315................. B.............. ............... Nursing fac discharge day.... ........... ........... ........... ........... ........... 99316................. B.............. ............... Nursing fac discharge day.... ........... ........... ........... ........... ........... 99321................. B.............. ............... Rest home visit, new patient. ........... ........... ........... ........... ........... 99322................. B.............. ............... Rest home visit, new patient. ........... ........... ........... ........... ........... 99323................. B.............. ............... Rest home visit, new patient. ........... ........... ........... ........... ........... 99331................. B.............. ............... Rest home visit, est pat..... ........... ........... ........... ........... ........... 99332................. B.............. ............... Rest home visit, est pat..... ........... ........... ........... ........... ........... 99333................. B.............. ............... Rest home visit, est pat..... ........... ........... ........... ........... ........... 99341................. B.............. ............... Home visit, new patient...... ........... ........... ........... ........... ........... 99342................. B.............. ............... Home visit, new patient...... ........... ........... ........... ........... ........... 99343................. B.............. ............... Home visit, new patient...... ........... ........... ........... ........... ........... 99344................. B.............. ............... Home visit, new patient...... ........... ........... ........... ........... ........... 99345................. B.............. ............... Home visit, new patient...... ........... ........... ........... ........... ........... 99347................. B.............. ............... Home visit, est patient...... ........... ........... ........... ........... ........... 99348................. B.............. ............... Home visit, est patient...... ........... ........... ........... ........... ........... 99349................. B.............. ............... Home visit, est patient...... ........... ........... ........... ........... ........... 99350................. B.............. ............... Home visit, est patient...... ........... ........... ........... ........... ........... 99354................. N.............. ............... Prolonged service, office.... ........... ........... ........... ........... ........... 99355................. N.............. ............... Prolonged service, office.... ........... ........... ........... ........... ........... 99356................. C.............. ............... Prolonged service, inpatient. ........... ........... ........... ........... ........... 99357................. C.............. ............... Prolonged service, inpatient. ........... ........... ........... ........... ........... 99358................. N.............. ............... Prolonged serv, w/o contact.. ........... ........... ........... ........... ........... 99359................. N.............. ............... Prolonged serv, w/o contact.. ........... ........... ........... ........... ........... 99360................. B.............. ............... Physician standby services... ........... ........... ........... ........... ........... 99361................. E.............. ............... Physician/team conference.... ........... ........... ........... ........... ........... 99362................. E.............. ............... Physician/team conference.... ........... ........... ........... ........... ........... 99371................. B.............. ............... Physician phone consultation. ........... ........... ........... ........... ........... 99372................. B.............. ............... Physician phone consultation. ........... ........... ........... ........... ........... 99373................. B.............. ............... Physician phone consultation. ........... ........... ........... ........... ........... 99374................. B.............. ............... Home health care supervision. ........... ........... ........... ........... ........... 99375................. E.............. ............... Home health care supervision. ........... ........... ........... ........... ........... 99377................. B.............. ............... Hospice care supervision..... ........... ........... ........... ........... ........... 99378................. E.............. ............... Hospice care supervision..... ........... ........... ........... ........... ...........

[[Page 50824]]

99379................. B.............. ............... Nursing fac care supervision. ........... ........... ........... ........... ........... 99380................. B.............. ............... Nursing fac care supervision. ........... ........... ........... ........... ........... 99381................. E.............. ............... Prev visit, new, infant...... ........... ........... ........... ........... ........... 99382................. E.............. ............... Prev visit, new, age 1-4..... ........... ........... ........... ........... ........... 99383................. E.............. ............... Prev visit, new, age 5-11.... ........... ........... ........... ........... ........... 99384................. E.............. ............... Prev visit, new, age 12-17... ........... ........... ........... ........... ........... 99385................. E.............. ............... Prev visit, new, age 18-39... ........... ........... ........... ........... ........... 99386................. E.............. ............... Prev visit, new, age 40-64... ........... ........... ........... ........... ........... 99387................. E.............. ............... Prev visit, new, 65 & over... ........... ........... ........... ........... ........... 99391................. E.............. ............... Prev visit, est, infant...... ........... ........... ........... ........... ........... 99392................. E.............. ............... Prev visit, est, age 1-4..... ........... ........... ........... ........... ........... 99393................. E.............. ............... Prev visit, est, age 5-11.... ........... ........... ........... ........... ........... 99394................. E.............. ............... Prev visit, est, age 12-17... ........... ........... ........... ........... ........... 99395................. E.............. ............... Prev visit, est, age 18-39... ........... ........... ........... ........... ........... 99396................. E.............. ............... Prev visit, est, age 40-64... ........... ........... ........... ........... ........... 99397................. E.............. ............... Prev visit, est, 65 & over... ........... ........... ........... ........... ........... 99401................. E.............. ............... Preventive counseling, indiv. ........... ........... ........... ........... ........... 99402................. E.............. ............... Preventive counseling, indiv. ........... ........... ........... ........... ........... 99403................. E.............. ............... Preventive counseling, indiv. ........... ........... ........... ........... ........... 99404................. E.............. ............... Preventive counseling, indiv. ........... ........... ........... ........... ........... 99411................. E.............. ............... Preventive counseling, group. ........... ........... ........... ........... ........... 99412................. E.............. ............... Preventive counseling, group. ........... ........... ........... ........... ........... 99420................. E.............. ............... Health risk assessment test.. ........... ........... ........... ........... ........... 99429................. E.............. ............... Unlisted preventive service.. ........... ........... ........... ........... ........... 99431................. V.............. ............... Initial care, normal newborn.

0600 0.8688 $51.56 ........... $10.31 99432................. N.............. ............... Newborn care, not in hosp.... ........... ........... ........... ........... ........... 99433................. C.............. ............... Normal newborn care/hospital. ........... ........... ........... ........... ........... 99435................. E.............. ............... Newborn discharge day hosp... ........... ........... ........... ........... ........... 99436................. N.............. ............... Attendance, birth............ ........... ........... ........... ........... ........... 99440................. S.............. ............... Newborn resuscitation........

0094 2.5363 $150.51 $47.62 $30.10 99450................. E.............. ............... Life/disability evaluation... ........... ........... ........... ........... ........... 99455................. B.............. ............... Disability examination....... ........... ........... ........... ........... ........... 99456................. B.............. ............... Disability examination....... ........... ........... ........... ........... ........... 99499................. B.............. ............... Unlisted e&m service......... ........... ........... ........... ........... ........... 99500................. E.............. ............... Home visit, prenatal......... ........... ........... ........... ........... ........... 99501................. E.............. ............... Home visit, postnatal........ ........... ........... ........... ........... ........... 99502................. E.............. ............... Home visit, nb care.......... ........... ........... ........... ........... ........... 99503................. E.............. ............... Home visit, resp therapy..... ........... ........... ........... ........... ........... 99504................. E.............. ............... Home visit mech ventilator... ........... ........... ........... ........... ........... 99505................. E.............. ............... Home visit, stoma care....... ........... ........... ........... ........... ........... 99506................. E.............. ............... Home visit, im injection..... ........... ........... ........... ........... ........... 99507................. E.............. ............... Home visit, cath maintain.... ........... ........... ........... ........... ........... 99509................. E.............. ............... Home visit day life activity. ........... ........... ........... ........... ........... 99510................. E.............. ............... Home visit, sing/m/fam couns. ........... ........... ........... ........... ........... 99511................. E.............. ............... Home visit, fecal/enema mgmt. ........... ........... ........... ........... ........... 99512................. E.............. ............... Home visit for hemodialysis.. ........... ........... ........... ........... ........... 99600................. E.............. ............... Home visit nos............... ........... ........... ........... ........... ........... 99601................. E.............. ............... Home infusion/visit, 2 hrs... ........... ........... ........... ........... ........... 99602................. E.............. ............... Home infusion, each addtl hr. ........... ........... ........... ........... ........... A0021................. E.............. ............... Outside state ambulance serv. ........... ........... ........... ........... ........... A0080................. E.............. ............... Noninterest escort in non er. ........... ........... ........... ........... ........... A0090................. E.............. ............... Interest escort in non er.... ........... ........... ........... ........... ........... A0100................. E.............. ............... Nonemergency transport taxi.. ........... ........... ........... ........... ........... A0110................. E.............. ............... Nonemergency transport bus... ........... ........... ........... ........... ........... A0120................. E.............. ............... Noner transport mini-bus..... ........... ........... ........... ........... ........... A0130................. E.............. ............... Noner transport wheelch van.. ........... ........... ........... ........... ........... A0140................. E.............. ............... Nonemergency transport air... ........... ........... ........... ........... ........... A0160................. E.............. ............... Noner transport case worker.. ........... ........... ........... ........... ........... A0170................. E.............. ............... Noner transport parking fees. ........... ........... ........... ........... ........... A0180................. E.............. ............... Noner transport lodgng recip. ........... ........... ........... ........... ........... A0190................. E.............. ............... Noner transport meals recip.. ........... ........... ........... ........... ........... A0200................. E.............. ............... Noner transport lodgng escrt. ........... ........... ........... ........... ........... A0210................. E.............. ............... Noner transport meals escort. ........... ........... ........... ........... ........... A0225................. A.............. ............... Neonatal emergency transport. ........... ........... ........... ........... ........... A0380................. A.............. ............... Basic life support mileage... ........... ........... ........... ........... ........... A0382................. A.............. ............... Basic support routine suppls. ........... ........... ........... ........... ...........

[[Page 50825]]

A0384................. A.............. ............... Bls defibrillation supplies.. ........... ........... ........... ........... ........... A0390................. A.............. ............... Advanced life support mileag. ........... ........... ........... ........... ........... A0392................. A.............. ............... Als defibrillation supplies.. ........... ........... ........... ........... ........... A0394................. A.............. ............... Als IV drug therapy supplies. ........... ........... ........... ........... ........... A0396................. A.............. ............... Als esophageal intub suppls.. ........... ........... ........... ........... ........... A0398................. A.............. ............... Als routine disposble suppls. ........... ........... ........... ........... ........... A0420................. A.............. ............... Ambulance waiting 1/2 hr..... ........... ........... ........... ........... ........... A0422................. A.............. ............... Ambulance 02 life sustaining. ........... ........... ........... ........... ........... A0424................. A.............. ............... Extra ambulance attendant.... ........... ........... ........... ........... ........... A0425................. A.............. ............... Ground mileage............... ........... ........... ........... ........... ........... A0426................. A.............. ............... Als 1........................ ........... ........... ........... ........... ........... A0427................. A.............. ............... ALS1-emergency............... ........... ........... ........... ........... ........... A0428................. A.............. ............... bls.......................... ........... ........... ........... ........... ........... A0429................. A.............. ............... BLS-emergency................ ........... ........... ........... ........... ........... A0430................. A.............. ............... Fixed wing air transport..... ........... ........... ........... ........... ........... A0431................. A.............. ............... Rotary wing air transport.... ........... ........... ........... ........... ........... A0432................. A.............. ............... PI volunteer ambulance co.... ........... ........... ........... ........... ........... A0433................. A.............. ............... als 2........................ ........... ........... ........... ........... ........... A0434................. A.............. ............... Specialty care transport..... ........... ........... ........... ........... ........... A0435................. A.............. ............... Fixed wing air mileage....... ........... ........... ........... ........... ........... A0436................. A.............. ............... Rotary wing air mileage...... ........... ........... ........... ........... ........... A0800................. B.............. ............... Amb trans 7pm-7am............ ........... ........... ........... ........... ........... A0888................. E.............. ............... Noncovered ambulance mileage. ........... ........... ........... ........... ........... A0999................. A.............. ............... Unlisted ambulance service... ........... ........... ........... ........... ........... A4206................. E.............. ............... 1 CC sterile syringe&needle.. ........... ........... ........... ........... ........... A4207................. E.............. ............... 2 CC sterile syringe&needle.. ........... ........... ........... ........... ........... A4208................. E.............. ............... 3 CC sterile syringe&needle.. ........... ........... ........... ........... ........... A4209................. E.............. ............... 5+ CC sterile syringe&needle. ........... ........... ........... ........... ........... A4210................. E.............. ............... Nonneedle injection device... ........... ........... ........... ........... ........... A4211................. B.............. ............... Supp for self-adm injections. ........... ........... ........... ........... ........... A4212................. B.............. ............... Non coring needle or stylet.. ........... ........... ........... ........... ........... A4213................. E.............. ............... 20+ CC syringe only.......... ........... ........... ........... ........... ........... A4215................. E.............. ............... Sterile needle............... ........... ........... ........... ........... ........... A4216................. A.............. ............... Sterile water/saline, 10 ml.. ........... ........... ........... ........... ........... A4217................. A.............. ............... Sterile water/saline, 500 ml. ........... ........... ........... ........... ........... A4220................. N.............. ............... Infusion pump refill kit..... ........... ........... ........... ........... ........... A4221................. Y.............. ............... Maint drug infus cath per wk. ........... ........... ........... ........... ........... A4222................. Y.............. ............... Drug infusion pump supplies.. ........... ........... ........... ........... ........... A4223................. E.............. ............... Infusion supplies w/o pump... ........... ........... ........... ........... ........... A4230................. Y.............. ............... Infus insulin pump non needl. ........... ........... ........... ........... ........... A4231................. Y.............. ............... Infusion insulin pump needle. ........... ........... ........... ........... ........... A4232................. Y.............. ............... Syringe w/needle insulin 3cc. ........... ........... ........... ........... ........... A4244................. E.............. ............... Alcohol or peroxide per pint. ........... ........... ........... ........... ........... A4245................. E.............. ............... Alcohol wipes per box........ ........... ........... ........... ........... ........... A4246................. E.............. ............... Betadine/phisohex solution... ........... ........... ........... ........... ........... A4247................. E.............. ............... Betadine/iodine swabs/wipes.. ........... ........... ........... ........... ........... A4248................. N.............. ............... Chlorhexidine antisept....... ........... ........... ........... ........... ........... A4250................. E.............. ............... Urine reagent strips/tablets. ........... ........... ........... ........... ........... A4253................. Y.............. ............... Blood glucose/reagent strips. ........... ........... ........... ........... ........... A4254................. Y.............. ............... Battery for glucose monitor.. ........... ........... ........... ........... ........... A4255................. Y.............. ............... Glucose monitor platforms.... ........... ........... ........... ........... ........... A4256................. Y.............. ............... Calibrator solution/chips.... ........... ........... ........... ........... ........... A4257................. Y.............. ............... Replace Lensshield Cartridge. ........... ........... ........... ........... ........... A4258................. Y.............. ............... Lancet device each........... ........... ........... ........... ........... ........... A4259................. Y.............. ............... Lancets per box.............. ........... ........... ........... ........... ........... A4260................. E.............. ............... Levonorgestrel implant....... ........... ........... ........... ........... ........... A4261................. E.............. ............... Cervical cap contraceptive... ........... ........... ........... ........... ........... A4262................. N.............. ............... Temporary tear duct plug..... ........... ........... ........... ........... ........... A4263................. N.............. ............... Permanent tear duct plug..... ........... ........... ........... ........... ........... A4265................. Y.............. ............... Paraffin..................... ........... ........... ........... ........... ........... A4266................. E.............. ............... Diaphragm.................... ........... ........... ........... ........... ........... A4267................. E.............. ............... Male condom.................. ........... ........... ........... ........... ........... A4268................. E.............. ............... Female condom................ ........... ........... ........... ........... ........... A4269................. E.............. ............... Spermicide................... ........... ........... ........... ........... ........... A4270................. A.............. ............... Disposable endoscope sheath.. ........... ........... ........... ........... ........... A4280................. A.............. ............... Brst prsths adhsv attchmnt... ........... ........... ........... ........... ...........

[[Page 50826]]

A4281................. E.............. ............... Replacement breastpump tube.. ........... ........... ........... ........... ........... A4282................. E.............. ............... Replacement breastpump adpt.. ........... ........... ........... ........... ........... A4283................. E.............. ............... Replacement breastpump cap... ........... ........... ........... ........... ........... A4284................. E.............. ............... Replcmnt breast pump shield.. ........... ........... ........... ........... ........... A4285................. E.............. ............... Replcmnt breast pump bottle.. ........... ........... ........... ........... ........... A4286................. E.............. ............... Replcmnt breastpump lok ring. ........... ........... ........... ........... ........... A4290................. B.............. ............... Sacral nerve stim test lead.. ........... ........... ........... ........... ........... A4300................. N.............. ............... Cath impl vasc access portal. ........... ........... ........... ........... ........... A4301................. N.............. ............... Implantable access syst perc. ........... ........... ........... ........... ........... A4305................. A.............. ............... Drug delivery system >=50 ML. ........... ........... ........... ........... ........... A4306................. A.............. ............... Drug delivery system 4sq/.. ........... ........... ........... ........... ........... A4409................. A.............. ............... Ost skn barr w flng 4sq/.... ........... ........... ........... ........... ........... A4413................. A.............. ............... 2 pc drainable ost pouch..... ........... ........... ........... ........... ........... A4414................. A.............. ............... Ostomy sknbarr w flng 4sq/. ........... ........... ........... ........... ........... A4416................. A.............. ............... Ost pch clsd w barrier/filtr. ........... ........... ........... ........... ........... A4417................. A.............. ............... Ost pch w bar/bltinconv/fltr. ........... ........... ........... ........... ........... A4418................. A.............. ............... Ost pch clsd w/o bar w filtr. ........... ........... ........... ........... ........... A4419................. A.............. ............... Ost pch for bar w flange/flt. ........... ........... ........... ........... ........... A4420................. A.............. ............... Ost pch clsd for bar w lk fl. ........... ........... ........... ........... ........... A4421................. E.............. ............... Ostomy supply misc........... ........... ........... ........... ........... ........... A4422................. A.............. ............... Ost pouch absorbent material. ........... ........... ........... ........... ........... A4423................. A.............. ............... Ost pch for bar w lk fl/fltr. ........... ........... ........... ........... ........... A4424................. A.............. ............... Ost pch drain w bar & filter. ........... ........... ........... ........... ........... A4425................. A.............. ............... Ost pch drain for barrier fl. ........... ........... ........... ........... ........... A4426................. A.............. ............... Ost pch drain 2 piece system. ........... ........... ........... ........... ........... A4427................. A.............. ............... Ost pch drain/barr lk flng/f. ........... ........... ........... ........... ........... A4428................. A.............. ............... Urine ost pouch w faucet/tap. ........... ........... ........... ........... ........... A4429................. A.............. ............... Urine ost pch bar w lock fln. ........... ........... ........... ........... ........... A4430................. A.............. ............... Ost pch urine w lock flng/ft. ........... ........... ........... ........... ........... A4431................. A.............. ............... Urine ost pch bar w lock fln. ........... ........... ........... ........... ........... A4432................. A.............. ............... Ost pch urine w lock flng/ft. ........... ........... ........... ........... ........... A4433................. A.............. ............... Urine ost pch bar w lock fln. ........... ........... ........... ........... ........... A4434................. A.............. ............... Ost pch urine w lock flng/ft. ........... ........... ........... ........... ........... A4450................. A.............. ............... Non-waterproof tape.......... ........... ........... ........... ........... ........... A4452................. A.............. ............... Waterproof tape.............. ........... ........... ........... ........... ........... A4455................. A.............. ............... Adhesive remover per ounce... ........... ........... ........... ........... ........... A4458................. E.............. ............... Reusable enema bag........... ........... ........... ........... ........... ........... A4462................. A.............. ............... Abdmnl drssng holder/binder.. ........... ........... ........... ........... ........... A4465................. A.............. ............... Non-elastic extremity binder. ........... ........... ........... ........... ........... A4470................. A.............. ............... Gravlee jet washer........... ........... ........... ........... ........... ........... A4480................. A.............. ............... Vabra aspirator.............. ........... ........... ........... ........... ........... A4481................. A.............. ............... Tracheostoma filter.......... ........... ........... ........... ........... ........... A4483................. A.............. ............... Moisture exchanger........... ........... ........... ........... ........... ........... A4490................. E.............. ............... Above knee surgical stocking. ........... ........... ........... ........... ........... A4495................. E.............. ............... Thigh length surg stocking... ........... ........... ........... ........... ........... A4500................. E.............. ............... Below knee surgical stocking. ........... ........... ........... ........... ........... A4510................. E.............. ............... Full length surg stocking.... ........... ........... ........... ........... ........... A4520................. E.............. ............... Incontinence garment anytype. ........... ........... ........... ........... ........... A4550................. B.............. ............... Surgical trays............... ........... ........... ........... ........... ........... A4554................. E.............. ............... Disposable underpads......... ........... ........... ........... ........... ........... A4555................. E.............. ............... Disposable underpad small.... ........... ........... ........... ........... ........... A4556................. Y.............. ............... Electrodes, pair............. ........... ........... ........... ........... ........... A4557................. Y.............. ............... Lead wires, pair............. ........... ........... ........... ........... ........... A4558................. Y.............. ............... Conductive paste or gel...... ........... ........... ........... ........... ...........

[[Page 50828]]

A4561................. N.............. ............... Pessary rubber, any type..... ........... ........... ........... ........... ........... A4562................. N.............. ............... Pessary, non rubber,any type. ........... ........... ........... ........... ........... A4565................. A.............. ............... Slings....................... ........... ........... ........... ........... ........... A4570................. E.............. ............... Splint....................... ........... ........... ........... ........... ........... A4575................. E.............. ............... Hyperbaric o2 chamber disps.. ........... ........... ........... ........... ........... A4580................. E.............. ............... Cast supplies (plaster)...... ........... ........... ........... ........... ........... A4590................. E.............. ............... Special casting material..... ........... ........... ........... ........... ........... A4595................. Y.............. ............... TENS suppl 2 lead per month.. ........... ........... ........... ........... ........... A4605................. Y.............. ............... Trach suction cath close sys. ........... ........... ........... ........... ........... A4606................. A.............. ............... Oxygen probe used w oximeter. ........... ........... ........... ........... ........... A4608................. Y.............. ............... Transtracheal oxygen cath.... ........... ........... ........... ........... ........... A4611................. Y.............. ............... Heavy duty battery........... ........... ........... ........... ........... ........... A4612................. Y.............. ............... Battery cables............... ........... ........... ........... ........... ........... A4613................. Y.............. ............... Battery charger.............. ........... ........... ........... ........... ........... A4614................. A.............. ............... Hand-held PEFR meter......... ........... ........... ........... ........... ........... A4615................. Y.............. ............... Cannula nasal................ ........... ........... ........... ........... ........... A4616................. Y.............. ............... Tubing (oxygen) per foot..... ........... ........... ........... ........... ........... A4617................. Y.............. ............... Mouth piece.................. ........... ........... ........... ........... ........... A4618................. Y.............. ............... Breathing circuits........... ........... ........... ........... ........... ........... A4619................. Y.............. ............... Face tent.................... ........... ........... ........... ........... ........... A4620................. Y.............. ............... Variable concentration mask.. ........... ........... ........... ........... ........... A4623................. A.............. ............... Tracheostomy inner cannula... ........... ........... ........... ........... ........... A4624................. Y.............. ............... Tracheal suction tube........ ........... ........... ........... ........... ........... A4625................. A.............. ............... Trach care kit for new trach. ........... ........... ........... ........... ........... A4626................. A.............. ............... Tracheostomy cleaning brush.. ........... ........... ........... ........... ........... A4627................. E.............. ............... Spacer bag/reservoir......... ........... ........... ........... ........... ........... A4628................. Y.............. ............... Oropharyngeal suction cath... ........... ........... ........... ........... ........... A4629................. A.............. ............... Tracheostomy care kit........ ........... ........... ........... ........... ........... A4630................. Y.............. ............... Repl bat t.e.n.s. own by pt.. ........... ........... ........... ........... ........... A4632................. Y.............. ............... Infus pump rplcemnt battery.. ........... ........... ........... ........... ........... A4633................. Y.............. ............... Uvl replacement bulb......... ........... ........... ........... ........... ........... A4634................. A.............. ............... Replacement bulb th lightbox. ........... ........... ........... ........... ........... A4635................. Y.............. ............... Underarm crutch pad.......... ........... ........... ........... ........... ........... A4636................. Y.............. ............... Handgrip for cane etc........ ........... ........... ........... ........... ........... A4637................. Y.............. ............... Repl tip cane/crutch/walker.. ........... ........... ........... ........... ........... A4638................. Y.............. ............... Repl batt pulse gen sys...... ........... ........... ........... ........... ........... A4639................. Y.............. ............... Infrared ht sys replcmnt pad. ........... ........... ........... ........... ........... A4640................. Y.............. ............... Alternating pressure pad..... ........... ........... ........... ........... ........... A4641................. N.............. ............... Diagnostic imaging agent..... ........... ........... ........... ........... ........... A4642................. H.............. ............... Satumomab pendetide per dose.

0704 ........... ........... ........... ........... A4643................. B.............. ............... High dose contrast MRI....... ........... ........... ........... ........... ........... A4644................. B.............. ............... Contrast 100-199 MGs iodine.. ........... ........... ........... ........... ........... A4645................. B.............. ............... Contrast 200-299 MGs iodine.. ........... ........... ........... ........... ........... A4646................. B.............. ............... Contrast 300-399 MGs iodine.. ........... ........... ........... ........... ........... A4647................. B.............. ............... Supp- paramagnetic contr mat. ........... ........... ........... ........... ........... A4649................. A.............. ............... Surgical supplies............ ........... ........... ........... ........... ........... A4651................. A.............. ............... Calibrated microcap tube..... ........... ........... ........... ........... ........... A4652................. A.............. ............... Microcapillary tube sealant.. ........... ........... ........... ........... ........... A4653................. A.............. ............... PD catheter anchor belt...... ........... ........... ........... ........... ........... A4656................. A.............. ............... Dialysis needle.............. ........... ........... ........... ........... ........... A4657................. A.............. ............... Dialysis syringe w/wo needle. ........... ........... ........... ........... ........... A4660................. A.............. ............... Sphyg/bp app w cuff and stet. ........... ........... ........... ........... ........... A4663................. A.............. ............... Dialysis blood pressure cuff. ........... ........... ........... ........... ........... A4670................. E.............. ............... Automatic bp monitor, dial... ........... ........... ........... ........... ........... A4671................. B.............. ............... Disposable cycler set........ ........... ........... ........... ........... ........... A4672................. B.............. ............... Drainage ext line, dialysis.. ........... ........... ........... ........... ........... A4673................. B.............. ............... Ext line w easy lock connect. ........... ........... ........... ........... ........... A4674................. B.............. ............... Chem/antisept solution, 8oz.. ........... ........... ........... ........... ........... A4680................. A.............. ............... Activated carbon filter, ea.. ........... ........... ........... ........... ........... A4690................. A.............. ............... Dialyzer, each............... ........... ........... ........... ........... ........... A4706................. A.............. ............... Bicarbonate conc sol per gal. ........... ........... ........... ........... ........... A4707................. A.............. ............... Bicarbonate conc pow per pac. ........... ........... ........... ........... ........... A4708................. A.............. ............... Acetate conc sol per gallon.. ........... ........... ........... ........... ........... A4709................. A.............. ............... Acid conc sol per gallon..... ........... ........... ........... ........... ........... A4714................. A.............. ............... Treated water per gallon..... ........... ........... ........... ........... ........... A4719................. A.............. ............... /Y set/ tubing............... ........... ........... ........... ........... ...........

[[Continued on page 50829]]

From the Federal Register Online via GPO Access [wais.access.gpo.gov] ]

[[pp. 50829-50878]] Medicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates; Correction

[[Continued from page 50828]]

[[Page 50829]]

A4720................. A.............. ............... Dialysat sol fld vol > 249cc. ........... ........... ........... ........... ........... A4721................. A.............. ............... Dialysat sol fld vol > 999cc. ........... ........... ........... ........... ........... A4722................. A.............. ............... Dialys sol fld vol > 1999cc.. ........... ........... ........... ........... ........... A4723................. A.............. ............... Dialys sol fld vol > 2999cc.. ........... ........... ........... ........... ........... A4724................. A.............. ............... Dialys sol fld vol > 3999cc.. ........... ........... ........... ........... ........... A4725................. A.............. ............... Dialys sol fld vol > 4999cc.. ........... ........... ........... ........... ........... A4726................. A.............. ............... Dialys sol fld vol > 5999cc.. ........... ........... ........... ........... ........... A4728................. B.............. ............... Dialysate solution, non-dex.. ........... ........... ........... ........... ........... A4730................. A.............. ............... Fistula cannulation set, ea.. ........... ........... ........... ........... ........... A4736................. A.............. ............... Topical anesthetic, per gram. ........... ........... ........... ........... ........... A4737................. A.............. ............... Inj anesthetic per 10 ml..... ........... ........... ........... ........... ........... A4740................. A.............. ............... Shunt accessory.............. ........... ........... ........... ........... ........... A4750................. A.............. ............... Art or venous blood tubing... ........... ........... ........... ........... ........... A4755................. A.............. ............... Comb art/venous blood tubing. ........... ........... ........... ........... ........... A4760................. A.............. ............... Dialysate sol test kit, each. ........... ........... ........... ........... ........... A4765................. A.............. ............... Dialysate conc pow per pack.. ........... ........... ........... ........... ........... A4766................. A.............. ............... Dialysate conc sol add 10 ml. ........... ........... ........... ........... ........... A4770................. A.............. ............... Blood collection tube/vacuum. ........... ........... ........... ........... ........... A4771................. A.............. ............... Serum clotting time tube..... ........... ........... ........... ........... ........... A4772................. A.............. ............... Blood glucose test strips.... ........... ........... ........... ........... ........... A4773................. A.............. ............... Occult blood test strips..... ........... ........... ........... ........... ........... A4774................. A.............. ............... Ammonia test strips.......... ........... ........... ........... ........... ........... A4802................. A.............. ............... Protamine sulfate per 50 mg.. ........... ........... ........... ........... ........... A4860................. A.............. ............... Disposable catheter tips..... ........... ........... ........... ........... ........... A4870................. A.............. ............... Plumb/elec wk hm hemo equip.. ........... ........... ........... ........... ........... A4890................. A.............. ............... Repair/maint cont hemo equip. ........... ........... ........... ........... ........... A4911................. A.............. ............... Drain bag/bottle............. ........... ........... ........... ........... ........... A4913................. A.............. ............... Misc dialysis supplies noc... ........... ........... ........... ........... ........... A4918................. A.............. ............... Venous pressure clamp........ ........... ........... ........... ........... ........... A4927................. A.............. ............... Non-sterile gloves........... ........... ........... ........... ........... ........... A4928................. A.............. ............... Surgical mask................ ........... ........... ........... ........... ........... A4929................. A.............. ............... Tourniquet for dialysis, ea.. ........... ........... ........... ........... ........... A4930................. A.............. ............... Sterile, gloves per pair..... ........... ........... ........... ........... ........... A4931................. A.............. ............... Reusable oral thermometer.... ........... ........... ........... ........... ........... A4932................. E.............. ............... Reusable rectal thermometer.. ........... ........... ........... ........... ........... A5051................. A.............. ............... Pouch clsd w barr attached... ........... ........... ........... ........... ........... A5052................. A.............. ............... Clsd ostomy pouch w/o barr... ........... ........... ........... ........... ........... A5053................. A.............. ............... Clsd ostomy pouch faceplate.. ........... ........... ........... ........... ........... A5054................. A.............. ............... Clsd ostomy pouch w/flange... ........... ........... ........... ........... ........... A5055................. A.............. ............... Stoma cap.................... ........... ........... ........... ........... ........... A5061................. A.............. ............... Pouch drainable w barrier at. ........... ........... ........... ........... ........... A5062................. A.............. ............... Drnble ostomy pouch w/o barr. ........... ........... ........... ........... ........... A5063................. A.............. ............... Drain ostomy pouch w/flange.. ........... ........... ........... ........... ........... A5071................. A.............. ............... Urinary pouch w/barrier...... ........... ........... ........... ........... ........... A5072................. A.............. ............... Urinary pouch w/o barrier.... ........... ........... ........... ........... ........... A5073................. A.............. ............... Urinary pouch on barr w/flng. ........... ........... ........... ........... ........... A5081................. A.............. ............... Continent stoma plug......... ........... ........... ........... ........... ........... A5082................. A.............. ............... Continent stoma catheter..... ........... ........... ........... ........... ........... A5093................. A.............. ............... Ostomy accessory convex inse. ........... ........... ........... ........... ........... A5102................. A.............. ............... Bedside drain btl w/wo tube.. ........... ........... ........... ........... ........... A5105................. A.............. ............... Urinary suspensory........... ........... ........... ........... ........... ........... A5112................. A.............. ............... Urinary leg bag.............. ........... ........... ........... ........... ........... A5113................. A.............. ............... Latex leg strap.............. ........... ........... ........... ........... ........... A5114................. A.............. ............... Foam/fabric leg strap........ ........... ........... ........... ........... ........... A5119................. A.............. ............... Skin barrier wipes box pr 50. ........... ........... ........... ........... ........... A5121................. A.............. ............... Solid skin barrier 6x6....... ........... ........... ........... ........... ........... A5122................. A.............. ............... Solid skin barrier 8x8....... ........... ........... ........... ........... ........... A5126................. A.............. ............... Disk/foam pad +or- adhesive.. ........... ........... ........... ........... ........... A5131................. A.............. ............... Appliance cleaner............ ........... ........... ........... ........... ........... A5200................. A.............. ............... Percutaneous catheter anchor. ........... ........... ........... ........... ........... A5500................. Y.............. ............... Diab shoe for density insert. ........... ........... ........... ........... ........... A5501................. Y.............. ............... Diabetic custom molded shoe.. ........... ........... ........... ........... ........... A5503................. Y.............. ............... Diabetic shoe w/roller/rockr. ........... ........... ........... ........... ........... A5504................. Y.............. ............... Diabetic shoe with wedge..... ........... ........... ........... ........... ........... A5505................. Y.............. ............... Diab shoe w/metatarsal bar... ........... ........... ........... ........... ........... A5506................. Y.............. ............... Diabetic shoe w/off set heel. ........... ........... ........... ........... ...........

[[Page 50830]]

A5507................. Y.............. ............... Modification diabetic shoe... ........... ........... ........... ........... ........... A5508................. Y.............. ............... Diabetic deluxe shoe......... ........... ........... ........... ........... ........... A5509................. E.............. ............... Direct heat form shoe insert. ........... ........... ........... ........... ........... A5510................. E.............. ............... Compression form shoe insert. ........... ........... ........... ........... ........... A5511................. E.............. ............... Custom fab molded shoe inser. ........... ........... ........... ........... ........... A6000................. E.............. ............... Wound warming wound cover.... ........... ........... ........... ........... ........... A6010................. A.............. ............... Collagen based wound filler.. ........... ........... ........... ........... ........... A6011................. A.............. ............... Collagen gel/paste wound fil. ........... ........... ........... ........... ........... A6021................. A.............. ............... Collagen dressing 648 sq in.. ........... ........... ........... ........... ........... A6024................. A.............. ............... Collagen dsg wound filler.... ........... ........... ........... ........... ........... A6025................. E.............. ............... Silicone gel sheet, each..... ........... ........... ........... ........... ........... A6154................. A.............. ............... Wound pouch each............. ........... ........... ........... ........... ........... A6196................. A.............. ............... Alginate dressing 16 48 sq in. ........... ........... ........... ........... ........... A6199................. A.............. ............... Alginate drsg wound filler... ........... ........... ........... ........... ........... A6200................. A.............. ............... Compos drsg 1648 no border.... ........... ........... ........... ........... ........... A6203................. A.............. ............... Composite drsg 1648 sq in.... ........... ........... ........... ........... ........... A6206................. A.............. ............... Contact layer 1648 sq in..... ........... ........... ........... ........... ........... A6209................. A.............. ............... Foam drsg 1648 sq in w/o brdr. ........... ........... ........... ........... ........... A6212................. A.............. ............... Foam drg 1648 sq in w/border. ........... ........... ........... ........... ........... A6215................. A.............. ............... Foam dressing wound filler... ........... ........... ........... ........... ........... A6216................. A.............. ............... Non-sterile gauze1648 sq in. ........... ........... ........... ........... ........... A6219................. A.............. ............... Gauze 16 48 sq in w/border.... ........... ........... ........... ........... ........... A6222................. A.............. ............... Gauze 1648 in no w/sal w/o b. ........... ........... ........... ........... ........... A6228................. A.............. ............... Gauze 1648 sq in water/salne. ........... ........... ........... ........... ........... A6231................. A.............. ............... Hydrogel dsg1648 sq in.. ........... ........... ........... ........... ........... A6234................. A.............. ............... Hydrocolld drg 1648 in w/o b. ........... ........... ........... ........... ........... A6237................. A.............. ............... Hydrocolld drg 1648 in w/bdr. ........... ........... ........... ........... ........... A6240................. A.............. ............... Hydrocolld drg filler paste.. ........... ........... ........... ........... ........... A6241................. A.............. ............... Hydrocolloid drg filler dry.. ........... ........... ........... ........... ........... A6242................. A.............. ............... Hydrogel drg 1648 in w/o bdr.. ........... ........... ........... ........... ........... A6245................. A.............. ............... Hydrogel drg 1648 sq in w/b.. ........... ........... ........... ........... ........... A6248................. A.............. ............... Hydrogel drsg gel filler..... ........... ........... ........... ........... ........... A6250................. A.............. ............... Skin seal protect moisturizr. ........... ........... ........... ........... ........... A6251................. A.............. ............... Absorpt drg 16 48 sq in w/o b. ........... ........... ........... ........... ........... A6254................. A.............. ............... Absorpt drg 1648 sq in w/bdr. ........... ........... ........... ........... ........... A6257................. A.............. ............... Transparent film 1648 sq in.. ........... ........... ........... ........... ........... A6260................. A.............. ............... Wound cleanser any type/size. ........... ........... ........... ........... ........... A6261................. A.............. ............... Wound filler gel/paste /oz... ........... ........... ........... ........... ........... A6262................. A.............. ............... Wound filler dry form / gram. ........... ........... ........... ........... ........... A6266................. A.............. ............... Impreg gauze no h20/sal/yard. ........... ........... ........... ........... ........... A6402................. A.............. ............... Sterile gauze 16 48 sq in..... ........... ........... ........... ........... ........... A6407................. A.............. ............... Packing strips, non-impreg... ........... ........... ........... ........... ........... A6410................. A.............. ............... Sterile eye pad.............. ........... ........... ........... ........... ........... A6411................. A.............. ............... Non-sterile eye pad.......... ........... ........... ........... ........... ........... A6412................. E.............. ............... Occlusive eye patch.......... ........... ........... ........... ........... ........... A6441................. A.............. ............... Pad band w>=3/ =3/=5//yd.... ........... ........... ........... ........... ........... A6445................. A.............. ............... Conform band s w =3/ =5//yd..... ........... ........... ........... ........... ........... A6448................. A.............. ............... Lt compres band =3/ =5//yd...... ........... ........... ........... ........... ........... A6451................. A.............. ............... Mod compres band w>=3/=3/=3/ =5//yd...... ........... ........... ........... ........... ........... A6456................. A.............. ............... Zinc paste band w >=3// ........... ........... ........... ........... ........... =0.7kc. B4161................. Y.............. ............... EF ped hydrolyzed/amino acid. ........... ........... ........... ........... ........... B4162................. Y.............. ............... EF ped specmetabolic inherit. ........... ........... ........... ........... ........... B4164................. A.............. ............... Parenteral 50% dextrose solu. ........... ........... ........... ........... ........... B4168................. A.............. ............... Parenteral sol amino acid 3.. ........... ........... ........... ........... ........... B4172................. A.............. ............... Parenteral sol amino acid 5.. ........... ........... ........... ........... ........... B4176................. A.............. ............... Parenteral sol amino acid 7-. ........... ........... ........... ........... ........... B4178................. A.............. ............... Parenteral sol amino acid >.. ........... ........... ........... ........... ........... B4180................. A.............. ............... Parenteral sol carb > 50%.... ........... ........... ........... ........... ........... B4184................. A.............. ............... Parenteral sol lipids 10%.... ........... ........... ........... ........... ........... B4186................. A.............. ............... Parenteral sol lipids 20%.... ........... ........... ........... ........... ........... B4189................. A.............. ............... Parenteral sol amino acid &.. ........... ........... ........... ........... ........... B4193................. A.............. ............... Parenteral sol 52-73 gm prot. ........... ........... ........... ........... ........... B4197................. A.............. ............... Parenteral sol 74-100 gm pro. ........... ........... ........... ........... ........... B4199................. A.............. ............... Parenteral sol > 100gm prote. ........... ........... ........... ........... ........... B4216................. A.............. ............... Parenteral nutrition additiv. ........... ........... ........... ........... ........... B4220................. A.............. ............... Parenteral supply kit premix. ........... ........... ........... ........... ........... B4222................. A.............. ............... Parenteral supply kit homemi. ........... ........... ........... ........... ........... B4224................. A.............. ............... Parenteral administration ki. ........... ........... ........... ........... ........... B5000................. A.............. ............... Parenteral sol renal-amirosy. ........... ........... ........... ........... ........... B5100................. A.............. ............... Parenteral sol hepatic-fream. ........... ........... ........... ........... ........... B5200................. A.............. ............... Parenteral sol stres-brnch c. ........... ........... ........... ........... ........... B9000................. A.............. ............... Enter infusion pump w/o alrm. ........... ........... ........... ........... ........... B9002................. A.............. ............... Enteral infusion pump w/ ala. ........... ........... ........... ........... ........... B9004................. A.............. ............... Parenteral infus pump portab. ........... ........... ........... ........... ........... B9006................. A.............. ............... Parenteral infus pump statio. ........... ........... ........... ........... ........... B9998................. A.............. ............... Enteral supp not otherwise c. ........... ........... ........... ........... ........... B9999................. A.............. ............... Parenteral supp not othrws c. ........... ........... ........... ........... ........... C1079................. N.............. ............... CO 57/58 per 0.5 uCi......... ........... ........... ........... ........... ........... C1080................. H.............. ............... I-131 tositumomab, dx........

1080 ........... ........... ........... ...........

[[Page 50834]]

C1081................. H.............. ............... I-131 tositumomab, tx........

1081 ........... ........... ........... ........... C1082................. H.............. ............... In-111 ibritumomab tiuxetan..

9118 ........... ........... ........... ........... C1083................. H.............. ............... Yttrium 90 ibritumomab tiuxe.

9117 ........... ........... ........... ........... C1091................. H.............. ............... IN111 oxyquinoline,per 0.5

1091 ........... ........... ........... ........... mCi. C1092................. H.............. ............... IN 111 pentetate per 0.5 mCi.

1092 ........... ........... ........... ........... C1093................. H.............. ............... TC99M fanolesomab............

1093 ........... ........... ........... ........... C1122................. H.............. ............... Tc 99M ARCITUMOMAB PER VIAL..

9151 ........... ........... ........... ........... C1178................. K.............. ............... BUSULFAN IV, 6 Mg............

1178 0.2851 $16.92 ...........

$3.38 C1200................. N.............. ............... TC 99M Sodium Glucoheptonat.. ........... ........... ........... ........... ........... C1201................. H.............. ............... TC 99M SUCCIMER, PER Vial....

1201 ........... ........... ........... ........... C1300................. S.............. ............... HYPERBARIC Oxygen............

0659 1.5473 $91.82 ........... $18.36 C1305................. K.............. ............... Apligraf, 44cm2..............

1305 12.9222 $766.84 ........... $153.37 C1713................. N.............. ............... Anchor/screw bn/bn,tis/bn.... ........... ........... ........... ........... ........... C1714................. N.............. ............... Cath, trans atherectomy, dir. ........... ........... ........... ........... ........... C1715................. N.............. ............... Brachytherapy needle......... ........... ........... ........... ........... ........... C1716................. H.............. ............... Brachytx source, Gold 198....

1716 ........... ........... ........... ........... C1717................. H.............. ............... Brachytx source, HDR Ir-192..

1717 ........... ........... ........... ........... C1718................. H.............. ............... Brachytx source, Iodine 125..

1718 ........... ........... ........... ........... C1719................. H.............. ............... Brachytx sour,Non-HDR Ir-192.

1719 ........... ........... ........... ........... C1720................. H.............. ............... Brachytx sour, Palladium 103.

1720 ........... ........... ........... ........... C1721................. N.............. ............... AICD, dual chamber........... ........... ........... ........... ........... ........... C1722................. N.............. ............... AICD, single chamber......... ........... ........... ........... ........... ........... C1724................. N.............. ............... Cath, trans atherec,rotation. ........... ........... ........... ........... ........... C1725................. N.............. ............... Cath, translumin non-laser... ........... ........... ........... ........... ........... C1726................. N.............. ............... Cath, bal dil, non-vascular.. ........... ........... ........... ........... ........... C1727................. N.............. ............... Cath, bal tis dis, non-vas... ........... ........... ........... ........... ........... C1728................. N.............. ............... Cath, brachytx seed adm...... ........... ........... ........... ........... ........... C1729................. N.............. ............... Cath, drainage............... ........... ........... ........... ........... ........... C1730................. N.............. ............... Cath, EP, 19 or few elect.... ........... ........... ........... ........... ........... C1731................. N.............. ............... Cath, EP, 20 or more elec.... ........... ........... ........... ........... ........... C1732................. N.............. ............... Cath, EP, diag/abl, 3D/vect.. ........... ........... ........... ........... ........... C1733................. N.............. ............... Cath, EP, othr than cool-tip. ........... ........... ........... ........... ........... C1750................. N.............. ............... Cath, hemodialysis,long-term. ........... ........... ........... ........... ........... C1751................. N.............. ............... Cath, inf, per/cent/midline.. ........... ........... ........... ........... ........... C1752................. N.............. ............... Cath,hemodialysis,short-term. ........... ........... ........... ........... ........... C1753................. N.............. ............... Cath, intravas ultrasound.... ........... ........... ........... ........... ........... C1754................. N.............. ............... Catheter, intradiscal........ ........... ........... ........... ........... ........... C1755................. N.............. ............... Catheter, intraspinal........ ........... ........... ........... ........... ........... C1756................. N.............. ............... Cath, pacing, transesoph..... ........... ........... ........... ........... ........... C1757................. N.............. ............... Cath, thrombectomy/embolect.. ........... ........... ........... ........... ........... C1758................. N.............. ............... Catheter, ureteral........... ........... ........... ........... ........... ........... C1759................. N.............. ............... Cath, intra echocardiography. ........... ........... ........... ........... ........... C1760................. N.............. ............... Closure dev, vasc............ ........... ........... ........... ........... ........... C1762................. N.............. ............... Conn tiss, human(inc fascia). ........... ........... ........... ........... ........... C1763................. N.............. ............... Conn tiss, non-human......... ........... ........... ........... ........... ........... C1764................. N.............. ............... Event recorder, cardiac...... ........... ........... ........... ........... ........... C1765................. N.............. ............... Adhesion barrier............. ........... ........... ........... ........... ........... C1766................. N.............. ............... Intro/sheath,strble,non-peel. ........... ........... ........... ........... ........... C1767................. N.............. ............... Generator, neurostim, imp.... ........... ........... ........... ........... ........... C1768................. N.............. ............... Graft, vascular.............. ........... ........... ........... ........... ........... C1769................. N.............. ............... Guide wire................... ........... ........... ........... ........... ........... C1770................. N.............. ............... Imaging coil, MR, insertable. ........... ........... ........... ........... ........... C1771................. N.............. ............... Rep dev, urinary, w/sling.... ........... ........... ........... ........... ........... C1772................. N.............. ............... Infusion pump, programmable.. ........... ........... ........... ........... ........... C1773................. N.............. ............... Ret dev, insertable.......... ........... ........... ........... ........... ........... C1775................. H.............. ............... FDG, per dose (4-40 mCi/ml)..

1775 ........... ........... ........... ........... C1776................. N.............. ............... Joint device (implantable)... ........... ........... ........... ........... ........... C1777................. N.............. ............... Lead, AICD, endo single coil. ........... ........... ........... ........... ........... C1778................. N.............. ............... Lead, neurostimulator........ ........... ........... ........... ........... ........... C1779................. N.............. ............... Lead, pmkr, transvenous VDD.. ........... ........... ........... ........... ........... C1780................. N.............. ............... Lens, intraocular (new tech). ........... ........... ........... ........... ........... C1781................. N.............. ............... Mesh (implantable)........... ........... ........... ........... ........... ........... C1782................. N.............. ............... Morcellator.................. ........... ........... ........... ........... ........... C1783................. N.............. ............... Ocular imp, aqueous drain de. ........... ........... ........... ........... ........... C1784................. N.............. ............... Ocular dev, intraop, det ret. ........... ........... ........... ........... ........... C1785................. N.............. ............... Pmkr, dual, rate-resp........ ........... ........... ........... ........... ...........

[[Page 50835]]

C1786................. N.............. ............... Pmkr, single, rate-resp...... ........... ........... ........... ........... ........... C1787................. N.............. ............... Patient progr, neurostim..... ........... ........... ........... ........... ........... C1788................. N.............. ............... Port, indwelling, imp........ ........... ........... ........... ........... ........... C1789................. N.............. ............... Prosthesis, breast, imp...... ........... ........... ........... ........... ........... C1813................. N.............. ............... Prosthesis, penile, inflatab. ........... ........... ........... ........... ........... C1814................. N.............. ............... Retinal tamp, silicone oil... ........... ........... ........... ........... ........... C1815................. N.............. ............... Pros, urinary sph, imp....... ........... ........... ........... ........... ........... C1816................. N.............. ............... Receiver/transmitter, neuro.. ........... ........... ........... ........... ........... C1817................. N.............. ............... Septal defect imp sys........ ........... ........... ........... ........... ........... C1818................. N.............. ............... Integrated keratoprosthesis.. ........... ........... ........... ........... ........... C1819................. N.............. ............... Tissue local excision........ ........... ........... ........... ........... ........... C1874................. N.............. ............... Stent, coated/cov w/del sys.. ........... ........... ........... ........... ........... C1875................. N.............. ............... Stent, coated/cov w/o del sy. ........... ........... ........... ........... ........... C1876................. N.............. ............... Stent, non-coa/non-cov w/del. ........... ........... ........... ........... ........... C1877................. N.............. ............... Stent, non-coat/cov w/o del.. ........... ........... ........... ........... ........... C1878................. N.............. ............... Matrl for vocal cord......... ........... ........... ........... ........... ........... C1879................. N.............. ............... Tissue marker, implantable... ........... ........... ........... ........... ........... C1880................. N.............. ............... Vena cava filter............. ........... ........... ........... ........... ........... C1881................. N.............. ............... Dialysis access system....... ........... ........... ........... ........... ........... C1882................. N.............. ............... AICD, other than sing/dual... ........... ........... ........... ........... ........... C1883................. N.............. ............... Adapt/ext, pacing/neuro lead. ........... ........... ........... ........... ........... C1884................. N.............. ............... Embolization Protect syst.... ........... ........... ........... ........... ........... C1885................. N.............. ............... Cath, translumin angio laser. ........... ........... ........... ........... ........... C1887................. N.............. ............... Catheter, guiding............ ........... ........... ........... ........... ........... C1888................. N.............. ............... Endovas non-cardiac abl cath. ........... ........... ........... ........... ........... C1891................. N.............. ............... Infusion pump,non-prog, perm. ........... ........... ........... ........... ........... C1892................. N.............. ............... Intro/sheath,fixed,peel-away. ........... ........... ........... ........... ........... C1893................. N.............. ............... Intro/sheath, fixed,non-peel. ........... ........... ........... ........... ........... C1894................. N.............. ............... Intro/sheath, non-laser...... ........... ........... ........... ........... ........... C1895................. N.............. ............... Lead, AICD, endo dual coil... ........... ........... ........... ........... ........... C1896................. N.............. ............... Lead, AICD, non sing/dual.... ........... ........... ........... ........... ........... C1897................. N.............. ............... Lead, neurostim test kit..... ........... ........... ........... ........... ........... C1898................. N.............. ............... Lead, pmkr, other than trans. ........... ........... ........... ........... ........... C1899................. N.............. ............... Lead, pmkr/AICD combination.. ........... ........... ........... ........... ........... C1900................. N.............. ............... Lead coronary venous......... ........... ........... ........... ........... ........... C2614................. N.............. ............... Probe, perc lumb disc........ ........... ........... ........... ........... ........... C2615................. N.............. ............... Sealant, pulmonary, liquid... ........... ........... ........... ........... ........... C2616................. H.............. ............... Brachytx source, Yttrium-90..

2616 ........... ........... ........... ........... C2617................. N.............. ............... Stent, non-cor, tem w/o del.. ........... ........... ........... ........... ........... C2618................. N.............. ............... Probe, cryoablation.......... ........... ........... ........... ........... ........... C2619................. N.............. ............... Pmkr, dual, non rate-resp.... ........... ........... ........... ........... ........... C2620................. N.............. ............... Pmkr, single, non rate-resp.. ........... ........... ........... ........... ........... C2621................. N.............. ............... Pmkr, other than sing/dual... ........... ........... ........... ........... ........... C2622................. N.............. ............... Prosthesis, penile, non-inf.. ........... ........... ........... ........... ........... C2625................. N.............. ............... Stent, non-cor, tem w/del sy. ........... ........... ........... ........... ........... C2626................. N.............. ............... Infusion pump, non-prog,temp. ........... ........... ........... ........... ........... C2627................. N.............. ............... Cath, suprapubic/cystoscopic. ........... ........... ........... ........... ........... C2628................. N.............. ............... Catheter, occlusion.......... ........... ........... ........... ........... ........... C2629................. N.............. ............... Intro/sheath, laser.......... ........... ........... ........... ........... ........... C2630................. N.............. ............... Cath, EP, cool-tip........... ........... ........... ........... ........... ........... C2631................. N.............. ............... Rep dev, urinary, w/o sling.. ........... ........... ........... ........... ........... C2632................. H.............. ............... Brachytx sol, I-125, per mCi.

2632 ........... ........... ........... ........... C2633................. H.............. ............... Brachytx source, Cesium-131..

2633 ........... ........... ........... ........... C2634................. H.............. ............... Brachytx source, HA, I-125...

2634 ........... ........... ........... ........... C2635................. H.............. ............... Brachytx source, HA, P-103...

2635 ........... ........... ........... ........... C2636................. H.............. ............... Brachytx linear source, P-10.

2636 ........... ........... ........... ........... C8900*................ S.............. ............... MRA w/cont, abd..............

0284 6.4201 $380.99 $152.39 $76.20 C8901*................ S.............. ............... MRA w/o cont, abd............

0336 6.0742 $360.46 $144.18 $72.09 C8902*................ S.............. ............... MRA w/o fol w/cont, abd......

0337 8.7945 $521.89 $208.75 $104.38 C8903*................ S.............. ............... MRI w/cont, breast, uni......

0284 6.4201 $380.99 $152.39 $76.20 C8904*................ S.............. ............... MRI w/o cont, breast, uni....

0336 6.0742 $360.46 $144.18 $72.09 C8905*................ S.............. ............... MRI w/o fol w/cont, brst, un.

0337 8.7945 $521.89 $208.75 $104.38 C8906*................ S.............. ............... MRI w/cont, breast, bi.......

0284 6.4201 $380.99 $152.39 $76.20 C8907*................ S.............. ............... MRI w/o cont, breast, bi.....

0336 6.0742 $360.46 $144.18 $72.09 C8908*................ S.............. ............... MRI w/o fol w/cont, breast,..

0337 8.7945 $521.89 $208.75 $104.38 C8909*................ S.............. ............... MRA w/cont, chest............

0284 6.4201 $380.99 $152.39 $76.20

[[Page 50836]]

C8910*................ S.............. ............... MRA w/o cont, chest..........

0336 6.0742 $360.46 $144.18 $72.09 C8911*................ S.............. ............... MRA w/o fol w/cont, chest....

0337 8.7945 $521.89 $208.75 $104.38 C8912*................ S.............. ............... MRA w/cont, lwr ext..........

0284 6.4201 $380.99 $152.39 $76.20 C8913*................ S.............. ............... MRA w/o cont, lwr ext........

0336 6.0742 $360.46 $144.18 $72.09 C8914*................ S.............. ............... MRA w/o fol w/cont, lwr ext..

0337 8.7945 $521.89 $208.75 $104.38 C8918*................ S.............. ............... MRA w/cont, pelvis...........

0284 6.4201 $380.99 $152.39 $76.20 C8919*................ S.............. ............... MRA w/o cont, pelvis.........

0336 6.0742 $360.46 $144.18 $72.09 C8920*................ S.............. ............... MRA w/o fol w/cont, pelvis...

0337 8.7945 $521.89 $208.75 $104.38 C9000................. H.............. ............... Na chromateCr51, per 0.25mCi.

9130 ........... ........... ........... ........... C9003................. K.............. ............... Palivizumab, per 50 mg.......

9003 4.1491 $246.22 ........... $49.24 C9007................. K.............. ............... Baclofen Intrathecal kit-1am.

9152 0.8562 $50.81 ........... $10.16 C9008................. K.............. ............... Baclofen Refill Kit-500mcg...

9008 0.2447 $14.52 ...........

$2.90 C9009................. K.............. ............... Baclofen Refill Kit-2000mcg..

9009 0.7209 $42.78 ...........

$8.56 C9013................. N.............. ............... Co 57 cobaltous chloride..... ........... ........... ........... ........... ........... C9102................. H.............. ............... 51 Na Chromate, 50mCi........

9132 ........... ........... ........... ........... C9103................. H.............. ............... Na Iothalamate I-125, 10 uCi.

9153 ........... ........... ........... ........... C9105................. K.............. ............... Hep B imm glob, per 1 ml.....

9105 1.8813 $111.64 ........... $22.33 C9112................. D.............. ............... Perflutren lipid micro, 2ml.. ........... ........... ........... ........... ........... C9113................. N.............. ............... Inj pantoprazole sodium, via. ........... ........... ........... ........... ........... C9121................. K.............. ............... Injection, argatroban........

9121 0.1897 $11.26 ...........

$2.25 C9123................. K.............. ............... Transcyte, 247cm2............

9123 ........... $719.41 ........... $143.88 C9127................. K.............. ............... Paclitaxel protein pr........

9127 ...........

$8.59 ...........

$1.72 C9128................. K.............. ............... Inj pegaptanib sodium........

9128 ........... $1,074.27 ........... $214.85 C9200................. K.............. ............... Orcel, 36 cm2................

9200 2.6893 $159.59 ........... $31.92 C9201................. K.............. ............... Dermagraft, 37.5cm2..........

9201 6.2066 $368.32 ........... $73.66 C9202................. D.............. ............... Octafluoropropane............ ........... ........... ........... ........... ........... C9203................. D.............. ............... Perflexane lipid micro....... ........... ........... ........... ........... ........... C9205................. K.............. ............... Oxaliplatin..................

9205 ........... $84.06 ........... $16.81 C9206................. K.............. ............... Integra, per cm2.............

9206 ...........

$9.23 ...........

$1.85 C9211................. K.............. ............... Inj, alefacept, IV...........

9211 ........... $571.01 ........... $114.20 C9212................. K.............. ............... Inj, alefacept, IM...........

9212 ........... $402.00 ........... $80.40 C9218................. K.............. ............... Injection, Azacitidine.......

9218 ...........

$4.03 ...........

$0.81 C9220................. G.............. ............... Sodium hyaluronate...........

9220 ........... $203.84 ........... $40.77 C9221................. G.............. ............... Graftjacket Reg Matrix.......

9221 ........... $1,234.36 ........... $246.87 C9222................. G.............. ............... Graftjacket SftTis...........

9222 ........... $890.74 ........... $178.15 C9223................. D.............. ............... Inj adenosine, tx dx......... ........... ........... ........... ........... ........... C9399................. A.............. ............... Unclass drugs/biologicals.... ........... ........... ........... ........... ........... C9400................. D.............. ............... Thallous chloride, brand..... ........... ........... ........... ........... ........... C9401................. D.............. ............... Strontium-89 chloride, brand. ........... ........... ........... ........... ........... C9402................. D.............. ............... Th I131 so iodide cap, brand. ........... ........... ........... ........... ........... C9403................. D.............. ............... Dx I131 so iodide cap, brand. ........... ........... ........... ........... ........... C9404................. D.............. ............... Dx I131 so iodide sol, brand. ........... ........... ........... ........... ........... C9405................. D.............. ............... Th I131 so iodide sol, brand. ........... ........... ........... ........... ........... C9410................. D.............. ............... Dexrazoxane HCl inj, brand... ........... ........... ........... ........... ........... C9411................. D.............. ............... Pamidronate disodium, brand.. ........... ........... ........... ........... ........... C9413................. D.............. ............... Na hyaluronate bran.......... ........... ........... ........... ........... ........... C9414................. D.............. ............... Etoposide oral, brand........ ........... ........... ........... ........... ........... C9415................. D.............. ............... Doxorubic hcl chemo, brand... ........... ........... ........... ........... ........... C9417................. D.............. ............... Bleomycin sulfate inj, brand. ........... ........... ........... ........... ........... C9418................. D.............. ............... Cisplatin inj, brand......... ........... ........... ........... ........... ........... C9419................. D.............. ............... Inj cladribine, brand........ ........... ........... ........... ........... ........... C9420................. D.............. ............... Cyclophosphamide inj, brand.. ........... ........... ........... ........... ........... C9421................. D.............. ............... Cyclophosphamide lyo, brand.. ........... ........... ........... ........... ........... C9422................. D.............. ............... Cytarabine hcl inj, brand.... ........... ........... ........... ........... ........... C9423................. D.............. ............... Dacarbazine inj, brand....... ........... ........... ........... ........... ........... C9424................. D.............. ............... Daunorubicin, brand.......... ........... ........... ........... ........... ........... C9425................. D.............. ............... Etoposide inj, brand......... ........... ........... ........... ........... ........... C9426................. D.............. ............... Floxuridine inj, brand....... ........... ........... ........... ........... ........... C9427................. D.............. ............... Ifosfomide inj, brand........ ........... ........... ........... ........... ........... C9428................. D.............. ............... Mesna injection, brand....... ........... ........... ........... ........... ........... C9429................. D.............. ............... Idarubicin hcl inj, brand.... ........... ........... ........... ........... ........... C9430................. D.............. ............... Leuprolide acetate bran...... ........... ........... ........... ........... ........... C9431................. D.............. ............... Paclitaxel inj, brand........ ........... ........... ........... ........... ........... C9432................. D.............. ............... Mitomycin inj, brand......... ........... ........... ........... ........... ........... C9433................. D.............. ............... Thiotepa inj, brand.......... ........... ........... ........... ........... ........... C9435................. D.............. ............... Gonadorelin hydroch, brand... ........... ........... ........... ........... ...........

[[Page 50837]]

C9436................. D.............. ............... Azathioprine parenteral,brnd. ........... ........... ........... ........... ........... C9437................. D.............. ............... Carmus bischl nitro inj...... ........... ........... ........... ........... ........... C9438................. D.............. ............... Cyclosporine oral, brand..... ........... ........... ........... ........... ........... C9439................. D.............. ............... Diethylstilbestrol injection. ........... ........... ........... ........... ........... C9440................. D.............. ............... Vinorelbine tar,brand........ ........... ........... ........... ........... ........... C9704................. T.............. ............... Inj inert subs upper GI......

1556 ........... $1,750.00 ........... $350.00 C9713................. T.............. ............... Non-contact laser vap prosta.

0429 42.3147 $2,511.08 ........... $502.22 C9716................. S.............. ............... RF Energy to Anus............

1519 ........... $1,750.00 ........... $350.00 C9718................. T.............. ............... Kyphoplasty, first vertebra..

0051 36.5271 $2,167.63 ........... $433.53 C9719................. T.............. ............... Kyphoplasty, each addl.......

0051 36.5271 $2,167.63 ........... $433.53 C9720................. T.............. ............... HE ESW tx, tennis elbow......

1547 ........... $850.00 ........... $170.00 C9721................. T.............. ............... HE ESW tx, plantar fasciitis.

1547 ........... $850.00 ........... $170.00 C9722................. S.............. ............... KV imaging w/IR tracking.....

1502 ........... $75.00 ........... $15.00 C9723................. S.............. ............... Dyn IR Perf Img..............

1502 ........... $75.00 ........... $15.00 C9724................. T.............. ............... EPS gast cardia plic.........

0422 22.9647 $1,362.79 $448.81 $272.56 D0120................. E.............. ............... Periodic oral evaluation..... ........... ........... ........... ........... ........... D0140................. E.............. ............... Limit oral eval problm focus. ........... ........... ........... ........... ........... D0150................. S.............. ............... Comprehensve oral evaluation.

0330 7.1756 $425.82 ........... $85.16 D0160................. E.............. ............... Extensv oral eval prob focus. ........... ........... ........... ........... ........... D0170................. E.............. ............... Re-eval,est pt,problem focus. ........... ........... ........... ........... ........... D0180................. E.............. ............... Comp periodontal evaluation.. ........... ........... ........... ........... ........... D0210................. E.............. ............... Intraor complete film series. ........... ........... ........... ........... ........... D0220................. E.............. ............... Intraoral periapical first f. ........... ........... ........... ........... ........... D0230................. E.............. ............... Intraoral periapical ea add.. ........... ........... ........... ........... ........... D0240................. S.............. ............... Intraoral occlusal film......

0330 7.1756 $425.82 ........... $85.16 D0250................. S.............. ............... Extraoral first film.........

0330 7.1756 $425.82 ........... $85.16 D0260................. S.............. ............... Extraoral ea additional film.

0330 7.1756 $425.82 ........... $85.16 D0270................. S.............. ............... Dental bitewing single film..

0330 7.1756 $425.82 ........... $85.16 D0272................. S.............. ............... Dental bitewings two films...

0330 7.1756 $425.82 ........... $85.16 D0274................. S.............. ............... Dental bitewings four films..

0330 7.1756 $425.82 ........... $85.16 D0277................. S.............. ............... Vert bitewings-sev to eight..

0330 7.1756 $425.82 ........... $85.16 D0290................. E.............. ............... Dental film skull/facial bon. ........... ........... ........... ........... ........... D0310................. E.............. ............... Dental saliography........... ........... ........... ........... ........... ........... D0320................. E.............. ............... Dental tmj arthrogram incl i. ........... ........... ........... ........... ........... D0321................. E.............. ............... Dental other tmj films....... ........... ........... ........... ........... ........... D0322................. E.............. ............... Dental tomographic survey.... ........... ........... ........... ........... ........... D0330................. E.............. ............... Dental panoramic film........ ........... ........... ........... ........... ........... D0340................. E.............. ............... Dental cephalometric film.... ........... ........... ........... ........... ........... D0350................. E.............. ............... Oral/facial images........... ........... ........... ........... ........... ........... D0415................. E.............. ............... Bacteriologic study.......... ........... ........... ........... ........... ........... D0416................. B.............. ............... Viral culture................ ........... ........... ........... ........... ........... D0421................. B.............. ............... Gen tst suscept oral disease. ........... ........... ........... ........... ........... D0425................. E.............. ............... Caries susceptibility test... ........... ........... ........... ........... ........... D0431................. B.............. ............... Diag tst detect mucos abnorm. ........... ........... ........... ........... ........... D0460................. S.............. ............... Pulp vitality test...........

0330 7.1756 $425.82 ........... $85.16 D0470................. E.............. ............... Diagnostic casts............. ........... ........... ........... ........... ........... D0472................. B.............. ............... Gross exam, prep & report.... ........... ........... ........... ........... ........... D0473................. B.............. ............... Micro exam, prep & report.... ........... ........... ........... ........... ........... D0474................. B.............. ............... Micro w exam of surg margins. ........... ........... ........... ........... ........... D0475................. B.............. ............... Decalcification procedure.... ........... ........... ........... ........... ........... D0476................. B.............. ............... Spec stains for microorganis. ........... ........... ........... ........... ........... D0477................. B.............. ............... Spec stains not for microorg. ........... ........... ........... ........... ........... D0478................. B.............. ............... Immunohistochemical stains... ........... ........... ........... ........... ........... D0479................. B.............. ............... Tissue in-situ hybridization. ........... ........... ........... ........... ........... D0480................. B.............. ............... Cytopath smear prep & report. ........... ........... ........... ........... ........... D0481................. B.............. ............... Electron microscopy diagnost. ........... ........... ........... ........... ........... D0482................. B.............. ............... Direct immunofluorescence.... ........... ........... ........... ........... ........... D0483................. B.............. ............... Indirect immunofluorescence.. ........... ........... ........... ........... ........... D0484................. B.............. ............... Consult slides prep elsewher. ........... ........... ........... ........... ........... D0485................. B.............. ............... Consult inc prep of slides... ........... ........... ........... ........... ........... D0502................. B.............. ............... Other oral pathology procedu. ........... ........... ........... ........... ........... D0999................. B.............. ............... Unspecified diagnostic proce. ........... ........... ........... ........... ........... D1110................. E.............. ............... Dental prophylaxis adult..... ........... ........... ........... ........... ........... D1120................. E.............. ............... Dental prophylaxis child..... ........... ........... ........... ........... ........... D1201................. E.............. ............... Topical fluor w prophy child. ........... ........... ........... ........... ........... D1203................. E.............. ............... Topical fluor w/o prophy chi. ........... ........... ........... ........... ...........

[[Page 50838]]

D1204................. E.............. ............... Topical fluor w/o prophy adu. ........... ........... ........... ........... ........... D1205................. E.............. ............... Topical fluoride w/ prophy a. ........... ........... ........... ........... ........... D1310................. E.............. ............... Nutri counsel-control caries. ........... ........... ........... ........... ........... D1320................. E.............. ............... Tobacco counseling........... ........... ........... ........... ........... ........... D1330................. E.............. ............... Oral hygiene instruction..... ........... ........... ........... ........... ........... D1351................. E.............. ............... Dental sealant per tooth..... ........... ........... ........... ........... ........... D1510................. S.............. ............... Space maintainer fxd unilat..

0330 7.1756 $425.82 ........... $85.16 D1515................. S.............. ............... Fixed bilat space maintainer.

0330 7.1756 $425.82 ........... $85.16 D1520................. S.............. ............... Remove unilat space maintain.

0330 7.1756 $425.82 ........... $85.16 D1525................. S.............. ............... Remove bilat space maintain..

0330 7.1756 $425.82 ........... $85.16 D1550................. S.............. ............... Recement space maintainer....

0330 7.1756 $425.82 ........... $85.16 D2140................. E.............. ............... Amalgam one surface permanen. ........... ........... ........... ........... ........... D2150................. E.............. ............... Amalgam two surfaces permane. ........... ........... ........... ........... ........... D2160................. E.............. ............... Amalgam three surfaces perma. ........... ........... ........... ........... ........... D2161................. E.............. ............... Amalgam 4 or > surfaces perm. ........... ........... ........... ........... ........... D2330................. E.............. ............... Resin one surface-anterior... ........... ........... ........... ........... ........... D2331................. E.............. ............... Resin two surfaces-anterior.. ........... ........... ........... ........... ........... D2332................. E.............. ............... Resin three surfaces-anterio. ........... ........... ........... ........... ........... D2335................. E.............. ............... Resin 4/> surf or w incis an. ........... ........... ........... ........... ........... D2390................. E.............. ............... Ant resin-based cmpst crown.. ........... ........... ........... ........... ........... D2391................. E.............. ............... Post 1 srfc resinbased cmpst. ........... ........... ........... ........... ........... D2392................. E.............. ............... Post 2 srfc resinbased cmpst. ........... ........... ........... ........... ........... D2393................. E.............. ............... Post 3 srfc resinbased cmpst. ........... ........... ........... ........... ........... D2394................. E.............. ............... Post >=4srfc resinbase cmpst. ........... ........... ........... ........... ........... D2410................. E.............. ............... Dental gold foil one surface. ........... ........... ........... ........... ........... D2420................. E.............. ............... Dental gold foil two surface. ........... ........... ........... ........... ........... D2430................. E.............. ............... Dental gold foil three surfa. ........... ........... ........... ........... ........... D2510................. E.............. ............... Dental inlay metalic 1 surf.. ........... ........... ........... ........... ........... D2520................. E.............. ............... Dental inlay metallic 2 surf. ........... ........... ........... ........... ........... D2530................. E.............. ............... Dental inlay metl 3/more sur. ........... ........... ........... ........... ........... D2542................. E.............. ............... Dental onlay metallic 2 surf. ........... ........... ........... ........... ........... D2543................. E.............. ............... Dental onlay metallic 3 surf. ........... ........... ........... ........... ........... D2544................. E.............. ............... Dental onlay metl 4/more sur. ........... ........... ........... ........... ........... D2610................. E.............. ............... Inlay porcelain/ceramic 1 su. ........... ........... ........... ........... ........... D2620................. E.............. ............... Inlay porcelain/ceramic 2 su. ........... ........... ........... ........... ........... D2630................. E.............. ............... Dental onlay porc 3/more sur. ........... ........... ........... ........... ........... D2642................. E.............. ............... Dental onlay porcelin 2 surf. ........... ........... ........... ........... ........... D2643................. E.............. ............... Dental onlay porcelin 3 surf. ........... ........... ........... ........... ........... D2644................. E.............. ............... Dental onlay porc 4/more sur. ........... ........... ........... ........... ........... D2650................. E.............. ............... Inlay composite/resin one su. ........... ........... ........... ........... ........... D2651................. E.............. ............... Inlay composite/resin two su. ........... ........... ........... ........... ........... D2652................. E.............. ............... Dental inlay resin 3/mre sur. ........... ........... ........... ........... ........... D2662................. E.............. ............... Dental onlay resin 2 surface. ........... ........... ........... ........... ........... D2663................. E.............. ............... Dental onlay resin 3 surface. ........... ........... ........... ........... ........... D2664................. E.............. ............... Dental onlay resin 4/mre sur. ........... ........... ........... ........... ........... D2710................. E.............. ............... Crown resin laboratory....... ........... ........... ........... ........... ........... D2712................. E.............. ............... Crown 3/4 resin-based compos. ........... ........... ........... ........... ........... D2720................. E.............. ............... Crown resin w/ high noble me. ........... ........... ........... ........... ........... D2721................. E.............. ............... Crown resin w/ base metal.... ........... ........... ........... ........... ........... D2722................. E.............. ............... Crown resin w/ noble metal... ........... ........... ........... ........... ........... D2740................. E.............. ............... Crown porcelain/ceramic subs. ........... ........... ........... ........... ........... D2750................. E.............. ............... Crown porcelain w/ h noble m. ........... ........... ........... ........... ........... D2751................. E.............. ............... Crown porcelain fused base m. ........... ........... ........... ........... ........... D2752................. E.............. ............... Crown porcelain w/ noble met. ........... ........... ........... ........... ........... D2780................. E.............. ............... Crown 3/4 cast hi noble met.. ........... ........... ........... ........... ........... D2781................. E.............. ............... Crown 3/4 cast base metal.... ........... ........... ........... ........... ........... D2782................. E.............. ............... Crown 3/4 cast noble metal... ........... ........... ........... ........... ........... D2783................. E.............. ............... Crown 3/4 porcelain/ceramic.. ........... ........... ........... ........... ........... D2790................. E.............. ............... Crown full cast high noble m. ........... ........... ........... ........... ........... D2791................. E.............. ............... Crown full cast base metal... ........... ........... ........... ........... ........... D2792................. E.............. ............... Crown full cast noble metal.. ........... ........... ........... ........... ........... D2794................. E.............. ............... Crown-titanium............... ........... ........... ........... ........... ........... D2799................. E.............. ............... Provisional crown............ ........... ........... ........... ........... ........... D2910................. E.............. ............... Dental recement inlay........ ........... ........... ........... ........... ........... D2915................. E.............. ............... Recement cast or prefab post. ........... ........... ........... ........... ........... D2920................. E.............. ............... Dental recement crown........ ........... ........... ........... ........... ...........

[[Page 50839]]

D2930................. E.............. ............... Prefab stnlss steel crwn pri. ........... ........... ........... ........... ........... D2931................. E.............. ............... Prefab stnlss steel crown pe. ........... ........... ........... ........... ........... D2932................. E.............. ............... Prefabricated resin crown.... ........... ........... ........... ........... ........... D2933................. E.............. ............... Prefab stainless steel crown. ........... ........... ........... ........... ........... D2934................. E.............. ............... Prefab steel crown primary... ........... ........... ........... ........... ........... D2940................. E.............. ............... Dental sedative filling...... ........... ........... ........... ........... ........... D2950................. E.............. ............... Core build-up incl any pins.. ........... ........... ........... ........... ........... D2951................. E.............. ............... Tooth pin retention.......... ........... ........... ........... ........... ........... D2952................. E.............. ............... Post and core cast + crown... ........... ........... ........... ........... ........... D2953................. E.............. ............... Each addtnl cast post........ ........... ........... ........... ........... ........... D2954................. E.............. ............... Prefab post/core + crown..... ........... ........... ........... ........... ........... D2955................. E.............. ............... Post removal................. ........... ........... ........... ........... ........... D2957................. E.............. ............... Each addtnl prefab post...... ........... ........... ........... ........... ........... D2960................. E.............. ............... Laminate labial veneer....... ........... ........... ........... ........... ........... D2961................. E.............. ............... Lab labial veneer resin...... ........... ........... ........... ........... ........... D2962................. E.............. ............... Lab labial veneer porcelain.. ........... ........... ........... ........... ........... D2971................. E.............. ............... Add proc construct new crown. ........... ........... ........... ........... ........... D2975................. E.............. ............... Coping....................... ........... ........... ........... ........... ........... D2980................. E.............. ............... Crown repair................. ........... ........... ........... ........... ........... D2999................. S.............. ............... Dental unspec restorative pr.

0330 7.1756 $425.82 ........... $85.16 D3110................. E.............. ............... Pulp cap direct.............. ........... ........... ........... ........... ........... D3120................. E.............. ............... Pulp cap indirect............ ........... ........... ........... ........... ........... D3220................. E.............. ............... Therapeutic pulpotomy........ ........... ........... ........... ........... ........... D3221................. E.............. ............... Gross pulpal debridement..... ........... ........... ........... ........... ........... D3230................. E.............. ............... Pulpal therapy anterior prim. ........... ........... ........... ........... ........... D3240................. E.............. ............... Pulpal therapy posterior pri. ........... ........... ........... ........... ........... D3310................. E.............. ............... Anterior..................... ........... ........... ........... ........... ........... D3320................. E.............. ............... Root canal therapy 2 canals.. ........... ........... ........... ........... ........... D3330................. E.............. ............... Root canal therapy 3 canals.. ........... ........... ........... ........... ........... D3331................. E.............. ............... Non-surg tx root canal obs... ........... ........... ........... ........... ........... D3332................. E.............. ............... Incomplete endodontic tx..... ........... ........... ........... ........... ........... D3333................. E.............. ............... Internal root repair......... ........... ........... ........... ........... ........... D3346................. E.............. ............... Retreat root canal anterior.. ........... ........... ........... ........... ........... D3347................. E.............. ............... Retreat root canal bicuspid.. ........... ........... ........... ........... ........... D3348................. E.............. ............... Retreat root canal molar..... ........... ........... ........... ........... ........... D3351................. E.............. ............... Apexification/recalc initial. ........... ........... ........... ........... ........... D3352................. E.............. ............... Apexification/recalc interim. ........... ........... ........... ........... ........... D3353................. E.............. ............... Apexification/recalc final... ........... ........... ........... ........... ........... D3410................. E.............. ............... Apicoect/perirad surg anter.. ........... ........... ........... ........... ........... D3421................. E.............. ............... Root surgery bicuspid........ ........... ........... ........... ........... ........... D3425................. E.............. ............... Root surgery molar........... ........... ........... ........... ........... ........... D3426................. E.............. ............... Root surgery ea add root..... ........... ........... ........... ........... ........... D3430................. E.............. ............... Retrograde filling........... ........... ........... ........... ........... ........... D3450................. E.............. ............... Root amputation.............. ........... ........... ........... ........... ........... D3460................. S.............. ............... Endodontic endosseous implan.

0330 7.1756 $425.82 ........... $85.16 D3470................. E.............. ............... Intentional replantation..... ........... ........... ........... ........... ........... D3910................. E.............. ............... Isolation- tooth w rubb dam.. ........... ........... ........... ........... ........... D3920................. E.............. ............... Tooth splitting.............. ........... ........... ........... ........... ........... D3950................. E.............. ............... Canal prep/fitting of dowel.. ........... ........... ........... ........... ........... D3999................. S.............. ............... Endodontic procedure.........

0330 7.1756 $425.82 ........... $85.16 D4210................. E.............. ............... Gingivectomy/plasty per quad. ........... ........... ........... ........... ........... D4211................. E.............. ............... Gingivectomy/plasty per toot. ........... ........... ........... ........... ........... D4240................. E.............. ............... Gingival flap proc w/ planin. ........... ........... ........... ........... ........... D4241................. E.............. ............... Gngvl flap w rootplan 1-3 th. ........... ........... ........... ........... ........... D4245................. E.............. ............... Apically positioned flap..... ........... ........... ........... ........... ........... D4249................. E.............. ............... Crown lengthen hard tissue... ........... ........... ........... ........... ........... D4260................. S.............. ............... Osseous surgery per quadrant.

0330 7.1756 $425.82 ........... $85.16 D4261................. E.............. ............... Osseous surgl-3teethperquad.. ........... ........... ........... ........... ........... D4263................. S.............. ............... Bone replce graft first site.

0330 7.1756 $425.82 ........... $85.16 D4264................. S.............. ............... Bone replce graft each add...

0330 7.1756 $425.82 ........... $85.16 D4265................. E.............. ............... Bio mtrls to aid soft/os reg. ........... ........... ........... ........... ........... D4266................. E.............. ............... Guided tiss regen resorble... ........... ........... ........... ........... ........... D4267................. E.............. ............... Guided tiss regen nonresorb.. ........... ........... ........... ........... ........... D4268................. S.............. ............... Surgical revision procedure..

0330 7.1756 $425.82 ........... $85.16 D4270................. S.............. ............... Pedicle soft tissue graft pr.

0330 7.1756 $425.82 ........... $85.16 D4271................. S.............. ............... Free soft tissue graft proc..

0330 7.1756 $425.82 ........... $85.16

[[Page 50840]]

D4273................. S.............. ............... Subepithelial tissue graft...

0330 7.1756 $425.82 ........... $85.16 D4274................. E.............. ............... Distal/proximal wedge proc... ........... ........... ........... ........... ........... D4275................. E.............. ............... Soft tissue allograft........ ........... ........... ........... ........... ........... D4276................. E.............. ............... Con tissue w dble ped graft.. ........... ........... ........... ........... ........... D4320................. E.............. ............... Provision splnt intracoronal. ........... ........... ........... ........... ........... D4321................. E.............. ............... Provisional splint extracoro. ........... ........... ........... ........... ........... D4341................. E.............. ............... Periodontal scaling & root... ........... ........... ........... ........... ........... D4342................. E.............. ............... Periodontal scaling 1-3teeth. ........... ........... ........... ........... ........... D4355................. S.............. ............... Full mouth debridement.......

0330 7.1756 $425.82 ........... $85.16 D4381................. S.............. ............... Localized chemo delivery.....

0330 7.1756 $425.82 ........... $85.16 D4910................. E.............. ............... Periodontal maint procedures. ........... ........... ........... ........... ........... D4920................. E.............. ............... Unscheduled dressing change.. ........... ........... ........... ........... ........... D4999................. E.............. ............... Unspecified periodontal proc. ........... ........... ........... ........... ........... D5110................. E.............. ............... Dentures complete maxillary.. ........... ........... ........... ........... ........... D5120................. E.............. ............... Dentures complete mandible... ........... ........... ........... ........... ........... D5130................. E.............. ............... Dentures immediat maxillary.. ........... ........... ........... ........... ........... D5140................. E.............. ............... Dentures immediat mandible... ........... ........... ........... ........... ........... D5211................. E.............. ............... Dentures maxill part resin... ........... ........... ........... ........... ........... D5212................. E.............. ............... Dentures mand part resin..... ........... ........... ........... ........... ........... D5213................. E.............. ............... Dentures maxill part metal... ........... ........... ........... ........... ........... D5214................. E.............. ............... Dentures mandibl part metal.. ........... ........... ........... ........... ........... D5225................. E.............. ............... Maxillary part denture flex.. ........... ........... ........... ........... ........... D5226................. E.............. ............... Mandibular part denture flex. ........... ........... ........... ........... ........... D5281................. E.............. ............... Removable partial denture.... ........... ........... ........... ........... ........... D5410................. E.............. ............... Dentures adjust cmplt maxil.. ........... ........... ........... ........... ........... D5411................. E.............. ............... Dentures adjust cmplt mand... ........... ........... ........... ........... ........... D5421................. E.............. ............... Dentures adjust part maxill.. ........... ........... ........... ........... ........... D5422................. E.............. ............... Dentures adjust part mandbl.. ........... ........... ........... ........... ........... D5510................. E.............. ............... Dentur repr broken compl bas. ........... ........... ........... ........... ........... D5520................. E.............. ............... Replace denture teeth complt. ........... ........... ........... ........... ........... D5610................. E.............. ............... Dentures repair resin base... ........... ........... ........... ........... ........... D5620................. E.............. ............... Rep part denture cast frame.. ........... ........... ........... ........... ........... D5630................. E.............. ............... Rep partial denture clasp.... ........... ........... ........... ........... ........... D5640................. E.............. ............... Replace part denture teeth... ........... ........... ........... ........... ........... D5650................. E.............. ............... Add tooth to partial denture. ........... ........... ........... ........... ........... D5660................. E.............. ............... Add clasp to partial denture. ........... ........... ........... ........... ........... D5670................. E.............. ............... Replc tth&acrlc on mtl frmwk. ........... ........... ........... ........... ........... D5671................. E.............. ............... Replc tth&acrlc mandibular... ........... ........... ........... ........... ........... D5710................. E.............. ............... Dentures rebase cmplt maxil.. ........... ........... ........... ........... ........... D5711................. E.............. ............... Dentures rebase cmplt mand... ........... ........... ........... ........... ........... D5720................. E.............. ............... Dentures rebase part maxill.. ........... ........... ........... ........... ........... D5721................. E.............. ............... Dentures rebase part mandbl.. ........... ........... ........... ........... ........... D5730................. E.............. ............... Denture reln cmplt maxil ch.. ........... ........... ........... ........... ........... D5731................. E.............. ............... Denture reln cmplt mand chr.. ........... ........... ........... ........... ........... D5740................. E.............. ............... Denture reln part maxil chr.. ........... ........... ........... ........... ........... D5741................. E.............. ............... Denture reln part mand chr... ........... ........... ........... ........... ........... D5750................. E.............. ............... Denture reln cmplt max lab... ........... ........... ........... ........... ........... D5751................. E.............. ............... Denture reln cmplt mand lab.. ........... ........... ........... ........... ........... D5760................. E.............. ............... Denture reln part maxil lab.. ........... ........... ........... ........... ........... D5761................. E.............. ............... Denture reln part mand lab... ........... ........... ........... ........... ........... D5810................. E.............. ............... Denture interm cmplt maxill.. ........... ........... ........... ........... ........... D5811................. E.............. ............... Denture interm cmplt mandbl.. ........... ........... ........... ........... ........... D5820................. E.............. ............... Denture interm part maxill... ........... ........... ........... ........... ........... D5821................. E.............. ............... Denture interm part mandbl... ........... ........... ........... ........... ........... D5850................. E.............. ............... Denture tiss conditn maxill.. ........... ........... ........... ........... ........... D5851................. E.............. ............... Denture tiss condtin mandbl.. ........... ........... ........... ........... ........... D5860................. E.............. ............... Overdenture complete......... ........... ........... ........... ........... ........... D5861................. E.............. ............... Overdenture partial.......... ........... ........... ........... ........... ........... D5862................. E.............. ............... Precision attachment......... ........... ........... ........... ........... ........... D5867................. E.............. ............... Replacement of precision att. ........... ........... ........... ........... ........... D5875................. E.............. ............... Prosthesis modification...... ........... ........... ........... ........... ........... D5899................. E.............. ............... Removable prosthodontic proc. ........... ........... ........... ........... ........... D5911................. S.............. ............... Facial moulage sectional.....

0330 7.1756 $425.82 ........... $85.16 D5912................. S.............. ............... Facial moulage complete......

0330 7.1756 $425.82 ........... $85.16 D5913................. E.............. ............... Nasal prosthesis............. ........... ........... ........... ........... ........... D5914................. E.............. ............... Auricular prosthesis......... ........... ........... ........... ........... ...........

[[Page 50841]]

D5915................. E.............. ............... Orbital prosthesis........... ........... ........... ........... ........... ........... D5916................. E.............. ............... Ocular prosthesis............ ........... ........... ........... ........... ........... D5919................. E.............. ............... Facial prosthesis............ ........... ........... ........... ........... ........... D5922................. E.............. ............... Nasal septal prosthesis...... ........... ........... ........... ........... ........... D5923................. E.............. ............... Ocular prosthesis interim.... ........... ........... ........... ........... ........... D5924................. E.............. ............... Cranial prosthesis........... ........... ........... ........... ........... ........... D5925................. E.............. ............... Facial augmentation implant.. ........... ........... ........... ........... ........... D5926................. E.............. ............... Replacement nasal prosthesis. ........... ........... ........... ........... ........... D5927................. E.............. ............... Auricular replacement........ ........... ........... ........... ........... ........... D5928................. E.............. ............... Orbital replacement.......... ........... ........... ........... ........... ........... D5929................. E.............. ............... Facial replacement........... ........... ........... ........... ........... ........... D5931................. E.............. ............... Surgical obturator........... ........... ........... ........... ........... ........... D5932................. E.............. ............... Postsurgical obturator....... ........... ........... ........... ........... ........... D5933................. E.............. ............... Refitting of obturator....... ........... ........... ........... ........... ........... D5934................. E.............. ............... Mandibular flange prosthesis. ........... ........... ........... ........... ........... D5935................. E.............. ............... Mandibular denture prosth.... ........... ........... ........... ........... ........... D5936................. E.............. ............... Temp obturator prosthesis.... ........... ........... ........... ........... ........... D5937................. E.............. ............... Trismus appliance............ ........... ........... ........... ........... ........... D5951................. E.............. ............... Feeding aid.................. ........... ........... ........... ........... ........... D5952................. E.............. ............... Pediatric speech aid......... ........... ........... ........... ........... ........... D5953................. E.............. ............... Adult speech aid............. ........... ........... ........... ........... ........... D5954................. E.............. ............... Superimposed prosthesis...... ........... ........... ........... ........... ........... D5955................. E.............. ............... Palatal lift prosthesis...... ........... ........... ........... ........... ........... D5958................. E.............. ............... Intraoral con def inter plt.. ........... ........... ........... ........... ........... D5959................. E.............. ............... Intraoral con def mod palat.. ........... ........... ........... ........... ........... D5960................. E.............. ............... Modify speech aid prosthesis. ........... ........... ........... ........... ........... D5982................. E.............. ............... Surgical stent............... ........... ........... ........... ........... ........... D5983................. S.............. ............... Radiation applicator.........

0330 7.1756 $425.82 ........... $85.16 D5984................. S.............. ............... Radiation shield.............

0330 7.1756 $425.82 ........... $85.16 D5985................. S.............. ............... Radiation cone locator.......

0330 7.1756 $425.82 ........... $85.16 D5986................. E.............. ............... Fluoride applicator.......... ........... ........... ........... ........... ........... D5987................. S.............. ............... Commissure splint............

0330 7.1756 $425.82 ........... $85.16 D5988................. E.............. ............... Surgical splint.............. ........... ........... ........... ........... ........... D5999................. E.............. ............... Maxillofacial prosthesis..... ........... ........... ........... ........... ........... D6010................. E.............. ............... Odontics endosteal implant... ........... ........... ........... ........... ........... D6040................. E.............. ............... Odontics eposteal implant.... ........... ........... ........... ........... ........... D6050................. E.............. ............... Odontics transosteal implnt.. ........... ........... ........... ........... ........... D6053................. E.............. ............... Implnt/abtmnt spprt remv dnt. ........... ........... ........... ........... ........... D6054................. E.............. ............... Implnt/abtmnt spprt remvprtl. ........... ........... ........... ........... ........... D6055................. E.............. ............... Implant connecting bar....... ........... ........... ........... ........... ........... D6056................. E.............. ............... Prefabricated abutment....... ........... ........... ........... ........... ........... D6057................. E.............. ............... Custom abutment.............. ........... ........... ........... ........... ........... D6058................. E.............. ............... Abutment supported crown..... ........... ........... ........... ........... ........... D6059................. E.............. ............... Abutment supported mtl crown. ........... ........... ........... ........... ........... D6060................. E.............. ............... Abutment supported mtl crown. ........... ........... ........... ........... ........... D6061................. E.............. ............... Abutment supported mtl crown. ........... ........... ........... ........... ........... D6062................. E.............. ............... Abutment supported mtl crown. ........... ........... ........... ........... ........... D6063................. E.............. ............... Abutment supported mtl crown. ........... ........... ........... ........... ........... D6064................. E.............. ............... Abutment supported mtl crown. ........... ........... ........... ........... ........... D6065................. E.............. ............... Implant supported crown...... ........... ........... ........... ........... ........... D6066................. E.............. ............... Implant supported mtl crown.. ........... ........... ........... ........... ........... D6067................. E.............. ............... Implant supported mtl crown.. ........... ........... ........... ........... ........... D6068................. E.............. ............... Abutment supported retainer.. ........... ........... ........... ........... ........... D6069................. E.............. ............... Abutment supported retainer.. ........... ........... ........... ........... ........... D6070................. E.............. ............... Abutment supported retainer.. ........... ........... ........... ........... ........... D6071................. E.............. ............... Abutment supported retainer.. ........... ........... ........... ........... ........... D6072................. E.............. ............... Abutment supported retainer.. ........... ........... ........... ........... ........... D6073................. E.............. ............... Abutment supported retainer.. ........... ........... ........... ........... ........... D6074................. E.............. ............... Abutment supported retainer.. ........... ........... ........... ........... ........... D6075................. E.............. ............... Implant supported retainer... ........... ........... ........... ........... ........... D6076................. E.............. ............... Implant supported retainer... ........... ........... ........... ........... ........... D6077................. E.............. ............... Implant supported retainer... ........... ........... ........... ........... ........... D6078................. E.............. ............... Implnt/abut suprtd fixd dent. ........... ........... ........... ........... ........... D6079................. E.............. ............... Implnt/abut suprtd fixd dent. ........... ........... ........... ........... ........... D6080................. E.............. ............... Implant maintenance.......... ........... ........... ........... ........... ........... D6090................. E.............. ............... Repair implant............... ........... ........... ........... ........... ...........

[[Page 50842]]

D6094................. E.............. ............... Abut support crown titanium.. ........... ........... ........... ........... ........... D6095................. E.............. ............... Odontics repr abutment....... ........... ........... ........... ........... ........... D6100................. E.............. ............... Removal of implant........... ........... ........... ........... ........... ........... D6190................. E.............. ............... Radio/surgical implant index. ........... ........... ........... ........... ........... D6194................. E.............. ............... Abut support retainer titani. ........... ........... ........... ........... ........... D6199................. E.............. ............... Implant procedure............ ........... ........... ........... ........... ........... D6205................. E.............. ............... Pontic-indirect resin based.. ........... ........... ........... ........... ........... D6210................. E.............. ............... Prosthodont high noble metal. ........... ........... ........... ........... ........... D6211................. E.............. ............... Bridge base metal cast....... ........... ........... ........... ........... ........... D6212................. E.............. ............... Bridge noble metal cast...... ........... ........... ........... ........... ........... D6214................. E.............. ............... Pontic titanium.............. ........... ........... ........... ........... ........... D6240................. E.............. ............... Bridge porcelain high noble.. ........... ........... ........... ........... ........... D6241................. E.............. ............... Bridge porcelain base metal.. ........... ........... ........... ........... ........... D6242................. E.............. ............... Bridge porcelain nobel metal. ........... ........... ........... ........... ........... D6245................. E.............. ............... Bridge porcelain/ceramic..... ........... ........... ........... ........... ........... D6250................. E.............. ............... Bridge resin w/high noble.... ........... ........... ........... ........... ........... D6251................. E.............. ............... Bridge resin base metal...... ........... ........... ........... ........... ........... D6252................. E.............. ............... Bridge resin w/noble metal... ........... ........... ........... ........... ........... D6253................. E.............. ............... Provisional pontic........... ........... ........... ........... ........... ........... D6545................. E.............. ............... Dental retainr cast metl..... ........... ........... ........... ........... ........... D6548................. E.............. ............... Porcelain/ceramic retainer... ........... ........... ........... ........... ........... D6600................. E.............. ............... Porcelain/ceramic inlay 2srf. ........... ........... ........... ........... ........... D6601................. E.............. ............... Porc/ceram inlay >= 3 surfac. ........... ........... ........... ........... ........... D6602................. E.............. ............... Cst hgh nble mtl inlay 2 srf. ........... ........... ........... ........... ........... D6603................. E.............. ............... Cst hgh nble mtl inlay >=3sr. ........... ........... ........... ........... ........... D6604................. E.............. ............... Cst bse mtl inlay 2 surfaces. ........... ........... ........... ........... ........... D6605................. E.............. ............... Cst bse mtl inlay >= 3 surfa. ........... ........... ........... ........... ........... D6606................. E.............. ............... Cast noble metal inlay 2 sur. ........... ........... ........... ........... ........... D6607................. E.............. ............... Cst noble mtl inlay >=3 surf. ........... ........... ........... ........... ........... D6608................. E.............. ............... Onlay porc/crmc 2 surfaces... ........... ........... ........... ........... ........... D6609................. E.............. ............... Onlay porc/crmc >=3 surfaces. ........... ........... ........... ........... ........... D6610................. E.............. ............... Onlay cst hgh nbl mtl 2 srfc. ........... ........... ........... ........... ........... D6611................. E.............. ............... Onlay cst hgh nbl mtl >=3srf. ........... ........... ........... ........... ........... D6612................. E.............. ............... Onlay cst base mtl 2 surface. ........... ........... ........... ........... ........... D6613................. E.............. ............... Onlay cst base mtl >=3 surfa. ........... ........... ........... ........... ........... D6614................. E.............. ............... Onlay cst nbl mtl 2 surfaces. ........... ........... ........... ........... ........... D6615................. E.............. ............... Onlay cst nbl mtl >=3 surfac. ........... ........... ........... ........... ........... D6624................. E.............. ............... Inlay titanium............... ........... ........... ........... ........... ........... D6634................. E.............. ............... Onlay titanium............... ........... ........... ........... ........... ........... D6710................. E.............. ............... Crown-indirect resin based... ........... ........... ........... ........... ........... D6720................. E.............. ............... Retain crown resin w hi nble. ........... ........... ........... ........... ........... D6721................. E.............. ............... Crown resin w/base metal..... ........... ........... ........... ........... ........... D6722................. E.............. ............... Crown resin w/noble metal.... ........... ........... ........... ........... ........... D6740................. E.............. ............... Crown porcelain/ceramic...... ........... ........... ........... ........... ........... D6750................. E.............. ............... Crown porcelain high noble... ........... ........... ........... ........... ........... D6751................. E.............. ............... Crown porcelain base metal... ........... ........... ........... ........... ........... D6752................. E.............. ............... Crown porcelain noble metal.. ........... ........... ........... ........... ........... D6780................. E.............. ............... Crown 3/4 high noble metal... ........... ........... ........... ........... ........... D6781................. E.............. ............... Crown 3/4 cast based metal... ........... ........... ........... ........... ........... D6782................. E.............. ............... Crown 3/4 cast noble metal... ........... ........... ........... ........... ........... D6783................. E.............. ............... Crown 3/4 porcelain/ceramic.. ........... ........... ........... ........... ........... D6790................. E.............. ............... Crown full high noble metal.. ........... ........... ........... ........... ........... D6791................. E.............. ............... Crown full base metal cast... ........... ........... ........... ........... ........... D6792................. E.............. ............... Crown full noble metal cast.. ........... ........... ........... ........... ........... D6793................. E.............. ............... Provisional retainer crown... ........... ........... ........... ........... ........... D6794................. E.............. ............... Crown titanium............... ........... ........... ........... ........... ........... D6920................. S.............. ............... Dental connector bar.........

0330 7.1756 $425.82 ........... $85.16 D6930................. E.............. ............... Dental recement bridge....... ........... ........... ........... ........... ........... D6940................. E.............. ............... Stress breaker............... ........... ........... ........... ........... ........... D6950................. E.............. ............... Precision attachment......... ........... ........... ........... ........... ........... D6970................. E.............. ............... Post & core plus retainer.... ........... ........... ........... ........... ........... D6971................. E.............. ............... Cast post bridge retainer.... ........... ........... ........... ........... ........... D6972................. E.............. ............... Prefab post & core plus reta. ........... ........... ........... ........... ........... D6973................. E.............. ............... Core build up for retainer... ........... ........... ........... ........... ........... D6975................. E.............. ............... Coping metal................. ........... ........... ........... ........... ........... D6976................. E.............. ............... Each addtnl cast post........ ........... ........... ........... ........... ...........

[[Page 50843]]

D6977................. E.............. ............... Each addtl prefab post....... ........... ........... ........... ........... ........... D6980................. E.............. ............... Bridge repair................ ........... ........... ........... ........... ........... D6985................. E.............. ............... Pediatric partial denture fx. ........... ........... ........... ........... ........... D6999................. E.............. ............... Fixed prosthodontic proc..... ........... ........... ........... ........... ........... D7111................. S.............. ............... Coronal remnants deciduous t.

0330 7.1756 $425.82 ........... $85.16 D7140................. S.............. ............... Extraction erupted tooth/exr.

0330 7.1756 $425.82 ........... $85.16 D7210................. S.............. ............... Rem imp tooth w mucoper flp..

0330 7.1756 $425.82 ........... $85.16 D7220................. S.............. ............... Impact tooth remov soft tiss.

0330 7.1756 $425.82 ........... $85.16 D7230................. S.............. ............... Impact tooth remov part bony.

0330 7.1756 $425.82 ........... $85.16 D7240................. S.............. ............... Impact tooth remov comp bony.

0330 7.1756 $425.82 ........... $85.16 D7241................. S.............. ............... Impact tooth rem bony w/comp.

0330 7.1756 $425.82 ........... $85.16 D7250................. S.............. ............... Tooth root removal...........

0330 7.1756 $425.82 ........... $85.16 D7260................. S.............. ............... Oral antral fistula closure..

0330 7.1756 $425.82 ........... $85.16 D7261................. S.............. ............... Primary closure sinus perf...

0330 7.1756 $425.82 ........... $85.16 D7270................. E.............. ............... Tooth reimplantation......... ........... ........... ........... ........... ........... D7272................. E.............. ............... Tooth transplantation........ ........... ........... ........... ........... ........... D7280................. E.............. ............... Exposure impact tooth orthod. ........... ........... ........... ........... ........... D7282................. E.............. ............... Mobilize erupted/malpos toot. ........... ........... ........... ........... ........... D7283................. B.............. ............... Place device impacted tooth.. ........... ........... ........... ........... ........... D7285................. E.............. ............... Biopsy of oral tissue hard... ........... ........... ........... ........... ........... D7286................. E.............. ............... Biopsy of oral tissue soft... ........... ........... ........... ........... ........... D7287................. E.............. ............... Cytology sample collection... ........... ........... ........... ........... ........... D7288................. B.............. ............... Brush biopsy................. ........... ........... ........... ........... ........... D7290................. E.............. ............... Repositioning of teeth....... ........... ........... ........... ........... ........... D7291................. S.............. ............... Transseptal fiberotomy.......

0330 7.1756 $425.82 ........... $85.16 D7310................. E.............. ............... Alveoplasty w/ extraction.... ........... ........... ........... ........... ........... D7311................. E.............. ............... Alveoloplasty w/extract 1-3.. ........... ........... ........... ........... ........... D7320................. E.............. ............... Alveoplasty w/o extraction... ........... ........... ........... ........... ........... D7321................. B.............. ............... Alveoloplasty not w/extracts. ........... ........... ........... ........... ........... D7340................. E.............. ............... Vestibuloplasty ridge extens. ........... ........... ........... ........... ........... D7350................. E.............. ............... Vestibuloplasty exten graft.. ........... ........... ........... ........... ........... D7410................. E.............. ............... Rad exc lesion up to 1.25 cm. ........... ........... ........... ........... ........... D7411................. E.............. ............... Excision benign lesion>1.25c. ........... ........... ........... ........... ........... D7412................. E.............. ............... Excision benign lesion compl. ........... ........... ........... ........... ........... D7413................. E.............. ............... Excision malig lesion ........... ........... ........... ........... ........... 1.25cm. D7415................. E.............. ............... Excision malig les complicat. ........... ........... ........... ........... ........... D7440................. E.............. ............... Malig tumor exc to 1.25 cm... ........... ........... ........... ........... ........... D7441................. E.............. ............... Malig tumor > 1.25 cm........ ........... ........... ........... ........... ........... D7450................. E.............. ............... Rem odontogen cyst to 1.25cm. ........... ........... ........... ........... ........... D7451................. E.............. ............... Rem odontogen cyst > 1.25 cm. ........... ........... ........... ........... ........... D7460................. E.............. ............... Rem nonodonto cyst to 1.25cm. ........... ........... ........... ........... ........... D7461................. E.............. ............... Rem nonodonto cyst > 1.25 cm. ........... ........... ........... ........... ........... D7465................. E.............. ............... Lesion destruction........... ........... ........... ........... ........... ........... D7471................. E.............. ............... Rem exostosis any site....... ........... ........... ........... ........... ........... D7472................. E.............. ............... Removal of torus palatinus... ........... ........... ........... ........... ........... D7473................. E.............. ............... Remove torus mandibularis.... ........... ........... ........... ........... ........... D7485................. E.............. ............... Surg reduct osseoustuberosit. ........... ........... ........... ........... ........... D7490................. E.............. ............... Mandible resection........... ........... ........... ........... ........... ........... D7510................. E.............. ............... I&d absc intraoral soft tiss. ........... ........... ........... ........... ........... D7511................. B.............. ............... Incision/drain abscess intra. ........... ........... ........... ........... ........... D7520................. E.............. ............... I&d abscess extraoral........ ........... ........... ........... ........... ........... D7521................. B.............. ............... Incision/drain abscess extra. ........... ........... ........... ........... ........... D7530................. E.............. ............... Removal fb skin/areolar tiss. ........... ........... ........... ........... ........... D7540................. E.............. ............... Removal of fb reaction....... ........... ........... ........... ........... ........... D7550................. E.............. ............... Removal of sloughed off bone. ........... ........... ........... ........... ........... D7560................. E.............. ............... Maxillary sinusotomy......... ........... ........... ........... ........... ........... D7610................. E.............. ............... Maxilla open reduct simple... ........... ........... ........... ........... ........... D7620................. E.............. ............... Clsd reduct simpl maxilla fx. ........... ........... ........... ........... ........... D7630................. E.............. ............... Open red simpl mandible fx... ........... ........... ........... ........... ........... D7640................. E.............. ............... Clsd red simpl mandible fx... ........... ........... ........... ........... ........... D7650................. E.............. ............... Open red simp malar/zygom fx. ........... ........... ........... ........... ........... D7660................. E.............. ............... Clsd red simp malar/zygom fx. ........... ........... ........... ........... ........... D7670................. E.............. ............... Closd rductn splint alveolus. ........... ........... ........... ........... ........... D7671................. E.............. ............... Alveolus open reduction...... ........... ........... ........... ........... ........... D7680................. E.............. ............... Reduct simple facial bone fx. ........... ........... ........... ........... ...........

[[Page 50844]]

D7710................. E.............. ............... Maxilla open reduct compound. ........... ........... ........... ........... ........... D7720................. E.............. ............... Clsd reduct compd maxilla fx. ........... ........... ........... ........... ........... D7730................. E.............. ............... Open reduct compd mandble fx. ........... ........... ........... ........... ........... D7740................. E.............. ............... Clsd reduct compd mandble fx. ........... ........... ........... ........... ........... D7750................. E.............. ............... Open red comp malar/zygma fx. ........... ........... ........... ........... ........... D7760................. E.............. ............... Clsd red comp malar/zygma fx. ........... ........... ........... ........... ........... D7770................. E.............. ............... Open reduc compd alveolus fx. ........... ........... ........... ........... ........... D7771................. E.............. ............... Alveolus clsd reduc stblz te. ........... ........... ........... ........... ........... D7780................. E.............. ............... Reduct compnd facial bone fx. ........... ........... ........... ........... ........... D7810................. E.............. ............... Tmj open reduct-dislocation.. ........... ........... ........... ........... ........... D7820................. E.............. ............... Closed tmp manipulation...... ........... ........... ........... ........... ........... D7830................. E.............. ............... Tmj manipulation under anest. ........... ........... ........... ........... ........... D7840................. E.............. ............... Removal of tmj condyle....... ........... ........... ........... ........... ........... D7850................. E.............. ............... Tmj meniscectomy............. ........... ........... ........... ........... ........... D7852................. E.............. ............... Tmj repair of joint disc..... ........... ........... ........... ........... ........... D7854................. E.............. ............... Tmj excisn of joint membrane. ........... ........... ........... ........... ........... D7856................. E.............. ............... Tmj cutting of a muscle...... ........... ........... ........... ........... ........... D7858................. E.............. ............... Tmj reconstruction........... ........... ........... ........... ........... ........... D7860................. E.............. ............... Tmj cutting into joint....... ........... ........... ........... ........... ........... D7865................. E.............. ............... Tmj reshaping components..... ........... ........... ........... ........... ........... D7870................. E.............. ............... Tmj aspiration joint fluid... ........... ........... ........... ........... ........... D7871................. E.............. ............... Lysis + lavage w catheters... ........... ........... ........... ........... ........... D7872................. E.............. ............... Tmj diagnostic arthroscopy... ........... ........... ........... ........... ........... D7873................. E.............. ............... Tmj arthroscopy lysis adhesn. ........... ........... ........... ........... ........... D7874................. E.............. ............... Tmj arthroscopy disc reposit. ........... ........... ........... ........... ........... D7875................. E.............. ............... Tmj arthroscopy synovectomy.. ........... ........... ........... ........... ........... D7876................. E.............. ............... Tmj arthroscopy discectomy... ........... ........... ........... ........... ........... D7877................. E.............. ............... Tmj arthroscopy debridement.. ........... ........... ........... ........... ........... D7880................. E.............. ............... Occlusal orthotic appliance.. ........... ........... ........... ........... ........... D7899................. E.............. ............... Tmj unspecified therapy...... ........... ........... ........... ........... ........... D7910................. E.............. ............... Dent sutur recent wnd to 5cm. ........... ........... ........... ........... ........... D7911................. E.............. ............... Dental suture wound to 5 cm.. ........... ........... ........... ........... ........... D7912................. E.............. ............... Suture complicate wnd > 5 cm. ........... ........... ........... ........... ........... D7920................. E.............. ............... Dental skin graft............ ........... ........... ........... ........... ........... D7940................. S.............. ............... Reshaping bone orthognathic..

0330 7.1756 $425.82 ........... $85.16 D7941................. E.............. ............... Bone cutting ramus closed.... ........... ........... ........... ........... ........... D7943................. E.............. ............... Cutting ramus open w/graft... ........... ........... ........... ........... ........... D7944................. E.............. ............... Bone cutting segmented....... ........... ........... ........... ........... ........... D7945................. E.............. ............... Bone cutting body mandible... ........... ........... ........... ........... ........... D7946................. E.............. ............... Reconstruction maxilla total. ........... ........... ........... ........... ........... D7947................. E.............. ............... Reconstruct maxilla segment.. ........... ........... ........... ........... ........... D7948................. E.............. ............... Reconstruct midface no graft. ........... ........... ........... ........... ........... D7949................. E.............. ............... Reconstruct midface w/graft.. ........... ........... ........... ........... ........... D7950................. E.............. ............... Mandible graft............... ........... ........... ........... ........... ........... D7953................. E.............. ............... Bone replacement graft....... ........... ........... ........... ........... ........... D7955................. E.............. ............... Repair maxillofacial defects. ........... ........... ........... ........... ........... D7960................. E.............. ............... Frenulectomy/frenulotomy..... ........... ........... ........... ........... ........... D7963................. E.............. ............... Frenuloplasty................ ........... ........... ........... ........... ........... D7970................. E.............. ............... Excision hyperplastic tissue. ........... ........... ........... ........... ........... D7971................. E.............. ............... Excision pericoronal gingiva. ........... ........... ........... ........... ........... D7972................. E.............. ............... Surg redct fibrous tuberosit. ........... ........... ........... ........... ........... D7980................. E.............. ............... Sialolithotomy............... ........... ........... ........... ........... ........... D7981................. E.............. ............... Excision of salivary gland... ........... ........... ........... ........... ........... D7982................. E.............. ............... Sialodochoplasty............. ........... ........... ........... ........... ........... D7983................. E.............. ............... Closure of salivary fistula.. ........... ........... ........... ........... ........... D7990................. E.............. ............... Emergency tracheotomy........ ........... ........... ........... ........... ........... D7991................. E.............. ............... Dental coronoidectomy........ ........... ........... ........... ........... ........... D7995................. E.............. ............... Synthetic graft facial bones. ........... ........... ........... ........... ........... D7996................. E.............. ............... Implant mandible for augment. ........... ........... ........... ........... ........... D7997................. E.............. ............... Appliance removal............ ........... ........... ........... ........... ........... D7999................. E.............. ............... Oral surgery procedure....... ........... ........... ........... ........... ........... D8010................. E.............. ............... Limited dental tx primary.... ........... ........... ........... ........... ........... D8020................. E.............. ............... Limited dental tx transition. ........... ........... ........... ........... ........... D8030................. E.............. ............... Limited dental tx adolescent. ........... ........... ........... ........... ........... D8040................. E.............. ............... Limited dental tx adult...... ........... ........... ........... ........... ........... D8050................. E.............. ............... Intercep dental tx primary... ........... ........... ........... ........... ...........

[[Page 50845]]

D8060................. E.............. ............... Intercep dental tx transitn.. ........... ........... ........... ........... ........... D8070................. E.............. ............... Compre dental tx transition.. ........... ........... ........... ........... ........... D8080................. E.............. ............... Compre dental tx adolescent.. ........... ........... ........... ........... ........... D8090................. E.............. ............... Compre dental tx adult....... ........... ........... ........... ........... ........... D8210................. E.............. ............... Orthodontic rem appliance tx. ........... ........... ........... ........... ........... D8220................. E.............. ............... Fixed appliance therapy habt. ........... ........... ........... ........... ........... D8660................. E.............. ............... Preorthodontic tx visit...... ........... ........... ........... ........... ........... D8670................. E.............. ............... Periodic orthodontc tx visit. ........... ........... ........... ........... ........... D8680................. E.............. ............... Orthodontic retention........ ........... ........... ........... ........... ........... D8690................. E.............. ............... Orthodontic treatment........ ........... ........... ........... ........... ........... D8691................. E.............. ............... Repair ortho appliance....... ........... ........... ........... ........... ........... D8692................. E.............. ............... Replacement retainer......... ........... ........... ........... ........... ........... D8999................. E.............. ............... Orthodontic procedure........ ........... ........... ........... ........... ........... D9110................. N.............. ............... Tx dental pain minor proc.... ........... ........... ........... ........... ........... D9210................. E.............. ............... Dent anesthesia w/o surgery.. ........... ........... ........... ........... ........... D9211................. E.............. ............... Regional block anesthesia.... ........... ........... ........... ........... ........... D9212................. E.............. ............... Trigeminal block anesthesia.. ........... ........... ........... ........... ........... D9215................. E.............. ............... Local anesthesia............. ........... ........... ........... ........... ........... D9220................. E.............. ............... General anesthesia........... ........... ........... ........... ........... ........... D9221................. E.............. ............... General anesthesia ea ad 15m. ........... ........... ........... ........... ........... D9230................. N.............. ............... Analgesia.................... ........... ........... ........... ........... ........... D9241................. E.............. ............... Intravenous sedation......... ........... ........... ........... ........... ........... D9242................. E.............. ............... IV sedation ea ad 30 m....... ........... ........... ........... ........... ........... D9248................. N.............. ............... Sedation (non-iv)............ ........... ........... ........... ........... ........... D9310................. E.............. ............... Dental consultation.......... ........... ........... ........... ........... ........... D9410................. E.............. ............... Dental house call............ ........... ........... ........... ........... ........... D9420................. E.............. ............... Hospital call................ ........... ........... ........... ........... ........... D9430................. E.............. ............... Office visit during hours.... ........... ........... ........... ........... ........... D9440................. E.............. ............... Office visit after hours..... ........... ........... ........... ........... ........... D9450................. E.............. ............... Case presentation tx plan.... ........... ........... ........... ........... ........... D9610................. E.............. ............... Dent therapeutic drug inject. ........... ........... ........... ........... ........... D9630................. S.............. ............... Other drugs/medicaments......

0330 7.1756 $425.82 ........... $85.16 D9910................. E.............. ............... Dent appl desensitizing med.. ........... ........... ........... ........... ........... D9911................. E.............. ............... Appl desensitizing resin..... ........... ........... ........... ........... ........... D9920................. E.............. ............... Behavior management.......... ........... ........... ........... ........... ........... D9930................. S.............. ............... Treatment of complications...

0330 7.1756 $425.82 ........... $85.16 D9940................. S.............. ............... Dental occlusal guard........

0330 7.1756 $425.82 ........... $85.16 D9941................. E.............. ............... Fabrication athletic guard... ........... ........... ........... ........... ........... D9942................. E.............. ............... Repair/reline occlusal guard. ........... ........... ........... ........... ........... D9950................. S.............. ............... Occlusion analysis...........

0330 7.1756 $425.82 ........... $85.16 D9951................. S.............. ............... Limited occlusal adjustment..

0330 7.1756 $425.82 ........... $85.16 D9952................. S.............. ............... Complete occlusal adjustment.

0330 7.1756 $425.82 ........... $85.16 D9970................. E.............. ............... Enamel microabrasion......... ........... ........... ........... ........... ........... D9971................. E.............. ............... Odontoplasty 1-2 teeth....... ........... ........... ........... ........... ........... D9972................. E.............. ............... Extrnl bleaching per arch.... ........... ........... ........... ........... ........... D9973................. E.............. ............... Extrnl bleaching per tooth... ........... ........... ........... ........... ........... D9974................. E.............. ............... Intrnl bleaching per tooth... ........... ........... ........... ........... ........... D9999................. E.............. ............... Adjunctive procedure......... ........... ........... ........... ........... ........... E0100................. Y.............. ............... Cane adjust/fixed with tip... ........... ........... ........... ........... ........... E0105................. Y.............. ............... Cane adjust/fixed quad/3 pro. ........... ........... ........... ........... ........... E0110................. Y.............. ............... Crutch forearm pair.......... ........... ........... ........... ........... ........... E0111................. Y.............. ............... Crutch forearm each.......... ........... ........... ........... ........... ........... E0112................. Y.............. ............... Crutch underarm pair wood.... ........... ........... ........... ........... ........... E0113................. Y.............. ............... Crutch underarm each wood.... ........... ........... ........... ........... ........... E0114................. Y.............. ............... Crutch underarm pair no wood. ........... ........... ........... ........... ........... E0116................. Y.............. ............... Crutch underarm each no wood. ........... ........... ........... ........... ........... E0117................. Y.............. ............... Underarm springassist crutch. ........... ........... ........... ........... ........... E0118................. E.............. ............... Crutch substitute............ ........... ........... ........... ........... ........... E0130................. Y.............. ............... Walker rigid adjust/fixed ht. ........... ........... ........... ........... ........... E0135................. Y.............. ............... Walker folding adjust/fixed.. ........... ........... ........... ........... ........... E0140................. Y.............. ............... Walker w trunk support....... ........... ........... ........... ........... ........... E0141................. Y.............. ............... Rigid wheeled walker adj/fix. ........... ........... ........... ........... ........... E0143................. Y.............. ............... Walker folding wheeled w/o s. ........... ........... ........... ........... ........... E0144................. Y.............. ............... Enclosed walker w rear seat.. ........... ........... ........... ........... ........... E0147................. Y.............. ............... Walker variable wheel resist. ........... ........... ........... ........... ........... E0148................. Y.............. ............... Heavyduty walker no wheels... ........... ........... ........... ........... ...........

[[Page 50846]]

E0149................. Y.............. ............... Heavy duty wheeled walker.... ........... ........... ........... ........... ........... E0153................. Y.............. ............... Forearm crutch platform atta. ........... ........... ........... ........... ........... E0154................. Y.............. ............... Walker platform attachment... ........... ........... ........... ........... ........... E0155................. Y.............. ............... Walker wheel attachment,pair. ........... ........... ........... ........... ........... E0156................. Y.............. ............... Walker seat attachment....... ........... ........... ........... ........... ........... E0157................. Y.............. ............... Walker crutch attachment..... ........... ........... ........... ........... ........... E0158................. Y.............. ............... Walker leg extenders set of4. ........... ........... ........... ........... ........... E0159................. Y.............. ............... Brake for wheeled walker..... ........... ........... ........... ........... ........... E0160................. Y.............. ............... Sitz type bath or equipment.. ........... ........... ........... ........... ........... E0161................. Y.............. ............... Sitz bath/equipment w/faucet. ........... ........... ........... ........... ........... E0162................. Y.............. ............... Sitz bath chair.............. ........... ........... ........... ........... ........... E0163................. Y.............. ............... Commode chair stationry fxd.. ........... ........... ........... ........... ........... E0164................. Y.............. ............... Commode chair mobile fixed a. ........... ........... ........... ........... ........... E0166................. Y.............. ............... Commode chair mobile detach.. ........... ........... ........... ........... ........... E0167................. Y.............. ............... Commode chair pail or pan.... ........... ........... ........... ........... ........... E0168................. Y.............. ............... Heavyduty/wide commode chair. ........... ........... ........... ........... ........... E0169................. Y.............. ............... Seatlift incorp commodechair. ........... ........... ........... ........... ........... E0175................. Y.............. ............... Commode chair foot rest...... ........... ........... ........... ........... ........... E0180................. Y.............. ............... Press pad alternating w pump. ........... ........... ........... ........... ........... E0181................. Y.............. ............... Press pad alternating w/ pum. ........... ........... ........... ........... ........... E0182................. Y.............. ............... Pressure pad alternating pum. ........... ........... ........... ........... ........... E0184................. Y.............. ............... Dry pressure mattress........ ........... ........... ........... ........... ........... E0185................. Y.............. ............... Gel pressure mattress pad.... ........... ........... ........... ........... ........... E0186................. Y.............. ............... Air pressure mattress........ ........... ........... ........... ........... ........... E0187................. Y.............. ............... Water pressure mattress...... ........... ........... ........... ........... ........... E0188................. Y.............. ............... Synthetic sheepskin pad...... ........... ........... ........... ........... ........... E0189................. Y.............. ............... Lambswool sheepskin pad...... ........... ........... ........... ........... ........... E0190................. E.............. ............... Positioning cushion.......... ........... ........... ........... ........... ........... E0191................. Y.............. ............... Protector heel or elbow...... ........... ........... ........... ........... ........... E0193................. Y.............. ............... Powered air flotation bed.... ........... ........... ........... ........... ........... E0194................. Y.............. ............... Air fluidized bed............ ........... ........... ........... ........... ........... E0196................. Y.............. ............... Gel pressure mattress........ ........... ........... ........... ........... ........... E0197................. Y.............. ............... Air pressure pad for mattres. ........... ........... ........... ........... ........... E0198................. Y.............. ............... Water pressure pad for mattr. ........... ........... ........... ........... ........... E0199................. Y.............. ............... Dry pressure pad for mattres. ........... ........... ........... ........... ........... E0200................. Y.............. ............... Heat lamp without stand...... ........... ........... ........... ........... ........... E0202................. Y.............. ............... Phototherapy light w/ photom. ........... ........... ........... ........... ........... E0203................. E.............. ............... Therapeutic lightbox tabletp. ........... ........... ........... ........... ........... E0205................. Y.............. ............... Heat lamp with stand......... ........... ........... ........... ........... ........... E0210................. Y.............. ............... Electric heat pad standard... ........... ........... ........... ........... ........... E0215................. Y.............. ............... Electric heat pad moist...... ........... ........... ........... ........... ........... E0217................. Y.............. ............... Water circ heat pad w pump... ........... ........... ........... ........... ........... E0218................. Y.............. ............... Water circ cold pad w pump... ........... ........... ........... ........... ........... E0220................. Y.............. ............... Hot water bottle............. ........... ........... ........... ........... ........... E0221................. E.............. ............... Infrared heating pad system.. ........... ........... ........... ........... ........... E0225................. Y.............. ............... Hydrocollator unit........... ........... ........... ........... ........... ........... E0230................. Y.............. ............... Ice cap or collar............ ........... ........... ........... ........... ........... E0231................. E.............. ............... Wound warming device......... ........... ........... ........... ........... ........... E0232................. E.............. ............... Warming card for NWT......... ........... ........... ........... ........... ........... E0235................. Y.............. ............... Paraffin bath unit portable.. ........... ........... ........... ........... ........... E0236................. Y.............. ............... Pump for water circulating p. ........... ........... ........... ........... ........... E0238................. Y.............. ............... Heat pad non-electric moist.. ........... ........... ........... ........... ........... E0239................. Y.............. ............... Hydrocollator unit portable.. ........... ........... ........... ........... ........... E0240................. E.............. ............... Bath/shower chair............ ........... ........... ........... ........... ........... E0241................. E.............. ............... Bath tub wall rail........... ........... ........... ........... ........... ........... E0242................. E.............. ............... Bath tub rail floor.......... ........... ........... ........... ........... ........... E0243................. E.............. ............... Toilet rail.................. ........... ........... ........... ........... ........... E0244................. E.............. ............... Toilet seat raised........... ........... ........... ........... ........... ........... E0245................. E.............. ............... Tub stool or bench........... ........... ........... ........... ........... ........... E0246................. E.............. ............... Transfer tub rail attachment. ........... ........... ........... ........... ........... E0247................. E.............. ............... Trans bench w/wo comm open... ........... ........... ........... ........... ........... E0248................. E.............. ............... HDtrans bench w/wo comm open. ........... ........... ........... ........... ........... E0249................. Y.............. ............... Pad water circulating heat u. ........... ........... ........... ........... ........... E0250................. Y.............. ............... Hosp bed fixed ht w/ mattres. ........... ........... ........... ........... ........... E0251................. Y.............. ............... Hosp bed fixd ht w/o mattres. ........... ........... ........... ........... ........... E0255................. Y.............. ............... Hospital bed var ht w/ mattr. ........... ........... ........... ........... ...........

[[Page 50847]]

E0256................. Y.............. ............... Hospital bed var ht w/o matt. ........... ........... ........... ........... ........... E0260................. Y.............. ............... Hosp bed semi-electr w/ matt. ........... ........... ........... ........... ........... E0261................. Y.............. ............... Hosp bed semi-electr w/o mat. ........... ........... ........... ........... ........... E0265................. Y.............. ............... Hosp bed total electr w/ mat. ........... ........... ........... ........... ........... E0266................. Y.............. ............... Hosp bed total elec w/o matt. ........... ........... ........... ........... ........... E0270................. E.............. ............... Hospital bed institutional t. ........... ........... ........... ........... ........... E0271................. Y.............. ............... Mattress innerspring......... ........... ........... ........... ........... ........... E0272................. Y.............. ............... Mattress foam rubber......... ........... ........... ........... ........... ........... E0273................. E.............. ............... Bed board.................... ........... ........... ........... ........... ........... E0274................. E.............. ............... Over-bed table............... ........... ........... ........... ........... ........... E0275................. Y.............. ............... Bed pan standard............. ........... ........... ........... ........... ........... E0276................. Y.............. ............... Bed pan fracture............. ........... ........... ........... ........... ........... E0277................. Y.............. ............... Powered pres-redu air mattrs. ........... ........... ........... ........... ........... E0280................. Y.............. ............... Bed cradle................... ........... ........... ........... ........... ........... E0290................. Y.............. ............... Hosp bed fx ht w/o rails w/m. ........... ........... ........... ........... ........... E0291................. Y.............. ............... Hosp bed fx ht w/o rail w/o.. ........... ........... ........... ........... ........... E0292................. Y.............. ............... Hosp bed var ht w/o rail w/o. ........... ........... ........... ........... ........... E0293................. Y.............. ............... Hosp bed var ht w/o rail w/.. ........... ........... ........... ........... ........... E0294................. Y.............. ............... Hosp bed semi-elect w/ mattr. ........... ........... ........... ........... ........... E0295................. Y.............. ............... Hosp bed semi-elect w/o matt. ........... ........... ........... ........... ........... E0296................. Y.............. ............... Hosp bed total elect w/ matt. ........... ........... ........... ........... ........... E0297................. Y.............. ............... Hosp bed total elect w/o mat. ........... ........... ........... ........... ........... E0300................. Y.............. ............... Enclosed ped crib hosp grade. ........... ........... ........... ........... ........... E0301................. Y.............. ............... HD hosp bed, 350-600 lbs..... ........... ........... ........... ........... ........... E0302................. Y.............. ............... Ex hd hosp bed > 600 lbs..... ........... ........... ........... ........... ........... E0303................. Y.............. ............... Hosp bed hvy dty xtra wide... ........... ........... ........... ........... ........... E0304................. Y.............. ............... Hosp bed xtra hvy dty x wide. ........... ........... ........... ........... ........... E0305................. Y.............. ............... Rails bed side half length... ........... ........... ........... ........... ........... E0310................. Y.............. ............... Rails bed side full length... ........... ........... ........... ........... ........... E0315................. E.............. ............... Bed accessory brd/tbl/supprt. ........... ........... ........... ........... ........... E0316................. Y.............. ............... Bed safety enclosure......... ........... ........... ........... ........... ........... E0325................. Y.............. ............... Urinal male jug-type......... ........... ........... ........... ........... ........... E0326................. Y.............. ............... Urinal female jug-type....... ........... ........... ........... ........... ........... E0350................. E.............. ............... Control unit bowel system.... ........... ........... ........... ........... ........... E0352................. E.............. ............... Disposable pack w/bowel syst. ........... ........... ........... ........... ........... E0370................. E.............. ............... Air elevator for heel........ ........... ........... ........... ........... ........... E0371................. Y.............. ............... Nonpower mattress overlay.... ........... ........... ........... ........... ........... E0372................. Y.............. ............... Powered air mattress overlay. ........... ........... ........... ........... ........... E0373................. Y.............. ............... Nonpowered pressure mattress. ........... ........... ........... ........... ........... E0424................. Y.............. ............... Stationary compressed gas 02. ........... ........... ........... ........... ........... E0425................. E.............. ............... Gas system stationary compre. ........... ........... ........... ........... ........... E0430................. E.............. ............... Oxygen system gas portable... ........... ........... ........... ........... ........... E0431................. Y.............. ............... Portable gaseous 02.......... ........... ........... ........... ........... ........... E0434................. Y.............. ............... Portable liquid 02........... ........... ........... ........... ........... ........... E0435................. E.............. ............... Oxygen system liquid portabl. ........... ........... ........... ........... ........... E0439................. Y.............. ............... Stationary liquid 02......... ........... ........... ........... ........... ........... E0440................. E.............. ............... Oxygen system liquid station. ........... ........... ........... ........... ........... E0441................. Y.............. ............... Oxygen contents, gaseous..... ........... ........... ........... ........... ........... E0442................. Y.............. ............... Oxygen contents, liquid...... ........... ........... ........... ........... ........... E0443................. Y.............. ............... Portable 02 contents, gas.... ........... ........... ........... ........... ........... E0444................. Y.............. ............... Portable 02 contents, liquid. ........... ........... ........... ........... ........... E0445................. A.............. ............... Oximeter non-invasive........ ........... ........... ........... ........... ........... E0450................. Y.............. ............... Volume vent stationary/porta. ........... ........... ........... ........... ........... E0455................. Y.............. ............... Oxygen tent excl croup/ped t. ........... ........... ........... ........... ........... E0457................. Y.............. ............... Chest shell.................. ........... ........... ........... ........... ........... E0459................. Y.............. ............... Chest wrap................... ........... ........... ........... ........... ........... E0460................. Y.............. ............... Neg press vent portabl/statn. ........... ........... ........... ........... ........... E0461................. Y.............. ............... Vol vent noninvasive interfa. ........... ........... ........... ........... ........... E0462................. Y.............. ............... Rocking bed w/ or w/o side r. ........... ........... ........... ........... ........... E0463................. Y.............. ............... Press supp vent invasive int. ........... ........... ........... ........... ........... E0464................. Y.............. ............... Press supp vent noninv int... ........... ........... ........... ........... ........... E0470................. Y.............. ............... RAD w/o backup non-inv intfc. ........... ........... ........... ........... ........... E0471................. Y.............. ............... RAD w/backup non inv intrfc.. ........... ........... ........... ........... ........... E0472................. Y.............. ............... RAD w backup invasive intrfc. ........... ........... ........... ........... ........... E0480................. Y.............. ............... Percussor elect/pneum home m. ........... ........... ........... ........... ........... E0481................. E.............. ............... Intrpulmnry percuss vent sys. ........... ........... ........... ........... ...........

[[Page 50848]]

E0482................. Y.............. ............... Cough stimulating device..... ........... ........... ........... ........... ........... E0483................. Y.............. ............... Chest compression gen system. ........... ........... ........... ........... ........... E0484................. Y.............. ............... Non-elec oscillatory pep dvc. ........... ........... ........... ........... ........... E0500................. Y.............. ............... Ippb all types............... ........... ........... ........... ........... ........... E0550................. Y.............. ............... Humidif extens supple w ippb. ........... ........... ........... ........... ........... E0555................. Y.............. ............... Humidifier for use w/ regula. ........... ........... ........... ........... ........... E0560................. Y.............. ............... Humidifier supplemental w/ i. ........... ........... ........... ........... ........... E0561................. Y.............. ............... Humidifier nonheated w PAP... ........... ........... ........... ........... ........... E0562................. Y.............. ............... Humidifier heated used w PAP. ........... ........... ........... ........... ........... E0565................. Y.............. ............... Compressor air power source.. ........... ........... ........... ........... ........... E0570................. Y.............. ............... Nebulizer with compression... ........... ........... ........... ........... ........... E0571................. Y.............. ............... Aerosol compressor for svneb. ........... ........... ........... ........... ........... E0572................. Y.............. ............... Aerosol compressor adjust pr. ........... ........... ........... ........... ........... E0574................. Y.............. ............... Ultrasonic generator w svneb. ........... ........... ........... ........... ........... E0575................. Y.............. ............... Nebulizer ultrasonic......... ........... ........... ........... ........... ........... E0580................. Y.............. ............... Nebulizer for use w/ regulat. ........... ........... ........... ........... ........... E0585................. Y.............. ............... Nebulizer w/ compressor & he. ........... ........... ........... ........... ........... E0590................. Y.............. ............... Dispensing fee dme neb drug.. ........... ........... ........... ........... ........... E0600................. Y.............. ............... Suction pump portab hom modl. ........... ........... ........... ........... ........... E0601................. Y.............. ............... Cont airway pressure device.. ........... ........... ........... ........... ........... E0602................. Y.............. ............... Manual breast pump........... ........... ........... ........... ........... ........... E0603................. A.............. ............... Electric breast pump......... ........... ........... ........... ........... ........... E0604................. A.............. ............... Hosp grade elec breast pump.. ........... ........... ........... ........... ........... E0605................. Y.............. ............... Vaporizer room type.......... ........... ........... ........... ........... ........... E0606................. Y.............. ............... Drainage board postural...... ........... ........... ........... ........... ........... E0607................. Y.............. ............... Blood glucose monitor home... ........... ........... ........... ........... ........... E0610................. Y.............. ............... Pacemaker monitr audible/vis. ........... ........... ........... ........... ........... E0615................. Y.............. ............... Pacemaker monitr digital/vis. ........... ........... ........... ........... ........... E0616................. N.............. ............... Cardiac event recorder....... ........... ........... ........... ........... ........... E0617................. Y.............. ............... Automatic ext defibrillator.. ........... ........... ........... ........... ........... E0618................. A.............. ............... Apnea monitor................ ........... ........... ........... ........... ........... E0619................. A.............. ............... Apnea monitor w recorder..... ........... ........... ........... ........... ........... E0620................. Y.............. ............... Cap bld skin piercing laser.. ........... ........... ........... ........... ........... E0621................. Y.............. ............... Patient lift sling or seat... ........... ........... ........... ........... ........... E0625................. E.............. ............... Patient lift bathroom or toi. ........... ........... ........... ........... ........... E0627................. Y.............. ............... Seat lift incorp lift-chair.. ........... ........... ........... ........... ........... E0628................. Y.............. ............... Seat lift for pt furn-electr. ........... ........... ........... ........... ........... E0629................. Y.............. ............... Seat lift for pt furn-non-el. ........... ........... ........... ........... ........... E0630................. Y.............. ............... Patient lift hydraulic....... ........... ........... ........... ........... ........... E0635................. Y.............. ............... Patient lift electric........ ........... ........... ........... ........... ........... E0636................. Y.............. ............... PT support & positioning sys. ........... ........... ........... ........... ........... E0637................. E.............. ............... Sit-stand w seatlift wheeled. ........... ........... ........... ........... ........... E0638................. E.............. ............... Standing frame sys wheeled... ........... ........... ........... ........... ........... E0639................. E.............. ............... Moveable patient lift system. ........... ........... ........... ........... ........... E0640................. E.............. ............... Fixed patient lift system.... ........... ........... ........... ........... ........... E0650................. Y.............. ............... Pneuma compresor non-segment. ........... ........... ........... ........... ........... E0651................. Y.............. ............... Pneum compressor segmental... ........... ........... ........... ........... ........... E0652................. Y.............. ............... Pneum compres w/cal pressure. ........... ........... ........... ........... ........... E0655................. Y.............. ............... Pneumatic appliance half arm. ........... ........... ........... ........... ........... E0660................. Y.............. ............... Pneumatic appliance full leg. ........... ........... ........... ........... ........... E0665................. Y.............. ............... Pneumatic appliance full arm. ........... ........... ........... ........... ........... E0666................. Y.............. ............... Pneumatic appliance half leg. ........... ........... ........... ........... ........... E0667................. Y.............. ............... Seg pneumatic appl full leg.. ........... ........... ........... ........... ........... E0668................. Y.............. ............... Seg pneumatic appl full arm.. ........... ........... ........... ........... ........... E0669................. Y.............. ............... Seg pneumatic appli half leg. ........... ........... ........... ........... ........... E0671................. Y.............. ............... Pressure pneum appl full leg. ........... ........... ........... ........... ........... E0672................. Y.............. ............... Pressure pneum appl full arm. ........... ........... ........... ........... ........... E0673................. Y.............. ............... Pressure pneum appl half leg. ........... ........... ........... ........... ........... E0675................. Y.............. ............... Pneumatic compression device. ........... ........... ........... ........... ........... E0691................. Y.............. ............... Uvl pnl 2 sq ft or less...... ........... ........... ........... ........... ........... E0692................. Y.............. ............... Uvl sys panel 4 ft........... ........... ........... ........... ........... ........... E0693................. Y.............. ............... Uvl sys panel 6 ft........... ........... ........... ........... ........... ........... E0694................. Y.............. ............... Uvl md cabinet sys 6 ft...... ........... ........... ........... ........... ........... E0700................. E.............. ............... Safety equipment............. ........... ........... ........... ........... ........... E0701................. Y.............. ............... Helmet w face guard prefab... ........... ........... ........... ........... ........... E0710................. E.............. ............... Restraints any type.......... ........... ........... ........... ........... ...........

[[Page 50849]]

E0720................. Y.............. ............... Tens two lead................ ........... ........... ........... ........... ........... E0730................. Y.............. ............... Tens four lead............... ........... ........... ........... ........... ........... E0731................. Y.............. ............... Conductive garment for tens/. ........... ........... ........... ........... ........... E0740................. Y.............. ............... Incontinence treatment systm. ........... ........... ........... ........... ........... E0744................. Y.............. ............... Neuromuscular stim for scoli. ........... ........... ........... ........... ........... E0745................. Y.............. ............... Neuromuscular stim for shock. ........... ........... ........... ........... ........... E0746................. E.............. ............... Electromyograph biofeedback.. ........... ........... ........... ........... ........... E0747................. Y.............. ............... Elec osteogen stim not spine. ........... ........... ........... ........... ........... E0748................. Y.............. ............... Elec osteogen stim spinal.... ........... ........... ........... ........... ........... E0749................. N.............. ............... Elec osteogen stim implanted. ........... ........... ........... ........... ........... E0752................. B.............. ............... Neurostimulator electrode.... ........... ........... ........... ........... ........... E0754................. A.............. ............... Pulsegenerator pt programmer. ........... ........... ........... ........... ........... E0755................. E.............. ............... Electronic salivary reflex s. ........... ........... ........... ........... ........... E0756................. B.............. ............... Implantable pulse generator.. ........... ........... ........... ........... ........... E0757................. N.............. ............... Implantable RF receiver...... ........... ........... ........... ........... ........... E0758................. A.............. ............... External RF transmitter...... ........... ........... ........... ........... ........... E0759................. A.............. ............... Replace rdfrquncy transmittr. ........... ........... ........... ........... ........... E0760................. Y.............. ............... Osteogen ultrasound stimltor. ........... ........... ........... ........... ........... E0761................. E.............. ............... Nontherm electromgntc device. ........... ........... ........... ........... ........... E0765................. Y.............. ............... Nerve stimulator for tx n&v.. ........... ........... ........... ........... ........... E0769................. B.............. ............... Electric wound treatment dev. ........... ........... ........... ........... ........... E0776................. Y.............. ............... Iv pole...................... ........... ........... ........... ........... ........... E0779................. Y.............. ............... Amb infusion pump mechanical. ........... ........... ........... ........... ........... E0780................. Y.............. ............... Mech amb infusion pump =250lb. ........... ........... ........... ........... ........... E1050................. A.............. ............... Whelchr fxd full length arms. ........... ........... ........... ........... ........... E1060................. A.............. ............... Wheelchair detachable arms... ........... ........... ........... ........... ........... E1070................. A.............. ............... Wheelchair detachable foot r. ........... ........... ........... ........... ........... E1083................. A.............. ............... Hemi-wheelchair fixed arms... ........... ........... ........... ........... ........... E1084................. A.............. ............... Hemi-wheelchair detachable a. ........... ........... ........... ........... ........... E1085................. A.............. ............... Hemi-wheelchair fixed arms... ........... ........... ........... ........... ........... E1086................. A.............. ............... Hemi-wheelchair detachable a. ........... ........... ........... ........... ........... E1087................. A.............. ............... Wheelchair lightwt fixed arm. ........... ........... ........... ........... ........... E1088................. A.............. ............... Wheelchair lightweight det a. ........... ........... ........... ........... ........... E1089................. A.............. ............... Wheelchair lightwt fixed arm. ........... ........... ........... ........... ...........

[[Page 50851]]

E1090................. A.............. ............... Wheelchair lightweight det a. ........... ........... ........... ........... ........... E1092................. A.............. ............... Wheelchair wide w/ leg rests. ........... ........... ........... ........... ........... E1093................. A.............. ............... Wheelchair wide w/ foot rest. ........... ........... ........... ........... ........... E1100................. A.............. ............... Whchr s-recl fxd arm leg res. ........... ........... ........... ........... ........... E1110................. A.............. ............... Wheelchair semi-recl detach.. ........... ........... ........... ........... ........... E1130................. A.............. ............... Whlchr stand fxd arm ft rest. ........... ........... ........... ........... ........... E1140................. A.............. ............... Wheelchair standard detach a. ........... ........... ........... ........... ........... E1150................. Y.............. ............... Wheelchair standard w/ leg r. ........... ........... ........... ........... ........... E1160................. A.............. ............... Wheelchair fixed arms........ ........... ........... ........... ........... ........... E1161................. A.............. ............... Manual adult wc w tiltinspac. ........... ........... ........... ........... ........... E1170................. A.............. ............... Whlchr ampu fxd arm leg rest. ........... ........... ........... ........... ........... E1171................. A.............. ............... Wheelchair amputee w/o leg r. ........... ........... ........... ........... ........... E1172................. A.............. ............... Wheelchair amputee detach ar. ........... ........... ........... ........... ........... E1180................. A.............. ............... Wheelchair amputee w/ foot r. ........... ........... ........... ........... ........... E1190................. A.............. ............... Wheelchair amputee w/ leg re. ........... ........... ........... ........... ........... E1195................. A.............. ............... Wheelchair amputee heavy dut. ........... ........... ........... ........... ........... E1200................. A.............. ............... Wheelchair amputee fixed arm. ........... ........... ........... ........... ........... E1210................. Y.............. ............... Whlchr moto ful arm leg rest. ........... ........... ........... ........... ........... E1211................. Y.............. ............... Wheelchair motorized w/ det.. ........... ........... ........... ........... ........... E1212................. A.............. ............... Wheelchair motorized w full.. ........... ........... ........... ........... ........... E1213................. A.............. ............... Wheelchair motorized w/ det.. ........... ........... ........... ........... ........... E1220................. A.............. ............... Whlchr special size/constrc.. ........... ........... ........... ........... ........... E1221................. A.............. ............... Wheelchair spec size w foot.. ........... ........... ........... ........... ........... E1222................. A.............. ............... Wheelchair spec size w/ leg.. ........... ........... ........... ........... ........... E1223................. A.............. ............... Wheelchair spec size w foot.. ........... ........... ........... ........... ........... E1224................. A.............. ............... Wheelchair spec size w/ leg.. ........... ........... ........... ........... ........... E1225................. Y.............. ............... Wheelchair spec sz semi-recl. ........... ........... ........... ........... ........... E1226................. B.............. ............... W/C access fully reclineback. ........... ........... ........... ........... ........... E1227................. Y.............. ............... Wheelchair spec sz spec ht a. ........... ........... ........... ........... ........... E1228................. Y.............. ............... Wheelchair spec sz spec ht b. ........... ........... ........... ........... ........... E1229................. Y.............. ............... Pediatric wheelchair NOS..... ........... ........... ........... ........... ........... E1230................. Y.............. ............... Power operated vehicle....... ........... ........... ........... ........... ........... E1231................. Y.............. ............... Rigid ped w/c tilt-in-space.. ........... ........... ........... ........... ........... E1232................. Y.............. ............... Folding ped wc tilt-in-space. ........... ........... ........... ........... ........... E1233................. Y.............. ............... Rig ped wc tltnspc w/o seat.. ........... ........... ........... ........... ........... E1234................. Y.............. ............... Fld ped wc tltnspc w/o seat.. ........... ........... ........... ........... ........... E1235................. Y.............. ............... Rigid ped wc adjustable...... ........... ........... ........... ........... ........... E1236................. Y.............. ............... Folding ped wc adjustable.... ........... ........... ........... ........... ........... E1237................. Y.............. ............... Rgd ped wc adjstabl w/o seat. ........... ........... ........... ........... ........... E1238................. Y.............. ............... Fld ped wc adjstabl w/o seat. ........... ........... ........... ........... ........... E1239................. Y.............. ............... Ped power wheelchair NOS..... ........... ........... ........... ........... ........... E1240................. A.............. ............... Whchr litwt det arm leg rest. ........... ........... ........... ........... ........... E1250................. A.............. ............... Wheelchair lightwt fixed arm. ........... ........... ........... ........... ........... E1260................. A.............. ............... Wheelchair lightwt foot rest. ........... ........... ........... ........... ........... E1270................. A.............. ............... Wheelchair lightweight leg r. ........... ........... ........... ........... ........... E1280................. A.............. ............... Whchr h-duty det arm leg res. ........... ........... ........... ........... ........... E1285................. A.............. ............... Wheelchair heavy duty fixed.. ........... ........... ........... ........... ........... E1290................. A.............. ............... Wheelchair hvy duty detach a. ........... ........... ........... ........... ........... E1295................. A.............. ............... Wheelchair heavy duty fixed.. ........... ........... ........... ........... ........... E1296................. Y.............. ............... Wheelchair special seat heig. ........... ........... ........... ........... ........... E1297................. Y.............. ............... Wheelchair special seat dept. ........... ........... ........... ........... ........... E1298................. Y.............. ............... Wheelchair spec seat depth/w. ........... ........... ........... ........... ........... E1300................. E.............. ............... Whirlpool portable........... ........... ........... ........... ........... ........... E1310................. Y.............. ............... Whirlpool non-portable....... ........... ........... ........... ........... ........... E1340................. Y.............. ............... Repair for DME, per 15 min... ........... ........... ........... ........... ........... E1353................. Y.............. ............... Oxygen supplies regulator.... ........... ........... ........... ........... ........... E1355................. Y.............. ............... Oxygen supplies stand/rack... ........... ........... ........... ........... ........... E1372................. Y.............. ............... Oxy suppl heater for nebuliz. ........... ........... ........... ........... ........... E1390................. Y.............. ............... Oxygen concentrator.......... ........... ........... ........... ........... ........... E1391................. Y.............. ............... Oxygen concentrator, dual.... ........... ........... ........... ........... ........... E1399................. N.............. ............... Durable medical equipment mi. ........... ........... ........... ........... ........... E1405................. Y.............. ............... O2/water vapor enrich w/heat. ........... ........... ........... ........... ........... E1406................. Y.............. ............... O2/water vapor enrich w/o he. ........... ........... ........... ........... ........... E1500................. A.............. ............... Centrifuge................... ........... ........... ........... ........... ........... E1510................. A.............. ............... Kidney dialysate delivry sys. ........... ........... ........... ........... ........... E1520................. A.............. ............... Heparin infusion pump........ ........... ........... ........... ........... ...........

[[Page 50852]]

E1530................. A.............. ............... Replacement air bubble detec. ........... ........... ........... ........... ........... E1540................. A.............. ............... Replacement pressure alarm... ........... ........... ........... ........... ........... E1550................. A.............. ............... Bath conductivity meter...... ........... ........... ........... ........... ........... E1560................. A.............. ............... Replace blood leak detector.. ........... ........... ........... ........... ........... E1570................. A.............. ............... Adjustable chair for esrd pt. ........... ........... ........... ........... ........... E1575................. A.............. ............... Transducer protect/fld bar... ........... ........... ........... ........... ........... E1580................. A.............. ............... Unipuncture control system... ........... ........... ........... ........... ........... E1590................. A.............. ............... Hemodialysis machine......... ........... ........... ........... ........... ........... E1592................. A.............. ............... Auto interm peritoneal dialy. ........... ........... ........... ........... ........... E1594................. A.............. ............... Cycler dialysis machine...... ........... ........... ........... ........... ........... E1600................. A.............. ............... Deli/install chrg hemo equip. ........... ........... ........... ........... ........... E1610................. A.............. ............... Reverse osmosis h2o puri sys. ........... ........... ........... ........... ........... E1615................. A.............. ............... Deionizer H2O puri system.... ........... ........... ........... ........... ........... E1620................. A.............. ............... Replacement blood pump....... ........... ........... ........... ........... ........... E1625................. A.............. ............... Water softening system....... ........... ........... ........... ........... ........... E1630................. A.............. ............... Reciprocating peritoneal dia. ........... ........... ........... ........... ........... E1632................. A.............. ............... Wearable artificial kidney... ........... ........... ........... ........... ........... E1634................. B.............. ............... Peritoneal dialysis clamp.... ........... ........... ........... ........... ........... E1635................. A.............. ............... Compact travel hemodialyzer.. ........... ........... ........... ........... ........... E1636................. A.............. ............... Sorbent cartridges per 10.... ........... ........... ........... ........... ........... E1637................. A.............. ............... Hemostats for dialysis, each. ........... ........... ........... ........... ........... E1639................. A.............. ............... Dialysis scale............... ........... ........... ........... ........... ........... E1699................. A.............. ............... Dialysis equipment noc....... ........... ........... ........... ........... ........... E1700................. Y.............. ............... Jaw motion rehab system...... ........... ........... ........... ........... ........... E1701................. Y.............. ............... Repl cushions for jaw motion. ........... ........... ........... ........... ........... E1702................. Y.............. ............... Repl measr scales jaw motion. ........... ........... ........... ........... ........... E1800................. Y.............. ............... Adjust elbow ext/flex device. ........... ........... ........... ........... ........... E1801................. Y.............. ............... SPS elbow device............. ........... ........... ........... ........... ........... E1802................. Y.............. ............... Adjst forearm pro/sup device. ........... ........... ........... ........... ........... E1805................. Y.............. ............... Adjust wrist ext/flex device. ........... ........... ........... ........... ........... E1806................. Y.............. ............... SPS wrist device............. ........... ........... ........... ........... ........... E1810................. Y.............. ............... Adjust knee ext/flex device.. ........... ........... ........... ........... ........... E1811................. Y.............. ............... SPS knee device.............. ........... ........... ........... ........... ........... E1815................. Y.............. ............... Adjust ankle ext/flex device. ........... ........... ........... ........... ........... E1816................. Y.............. ............... SPS ankle device............. ........... ........... ........... ........... ........... E1818................. Y.............. ............... SPS forearm device........... ........... ........... ........... ........... ........... E1820................. Y.............. ............... Soft interface material...... ........... ........... ........... ........... ........... E1821................. Y.............. ............... Replacement interface SPSD... ........... ........... ........... ........... ........... E1825................. Y.............. ............... Adjust finger ext/flex devc.. ........... ........... ........... ........... ........... E1830................. Y.............. ............... Adjust toe ext/flex device... ........... ........... ........... ........... ........... E1840................. Y.............. ............... Adj shoulder ext/flex device. ........... ........... ........... ........... ........... E1841................. Y.............. ............... Static str shldr dev rom adj. ........... ........... ........... ........... ........... E1902................. A.............. ............... AAC non-electronic board..... ........... ........... ........... ........... ........... E2000................. Y.............. ............... Gastric suction pump hme mdl. ........... ........... ........... ........... ........... E2100................. Y.............. ............... Bld glucose monitor w voice.. ........... ........... ........... ........... ........... E2101................. Y.............. ............... Bld glucose monitor w lance.. ........... ........... ........... ........... ........... E2120................. Y.............. ............... Pulse gen sys tx endolymp fl. ........... ........... ........... ........... ........... E2201................. Y.............. ............... Man w/ch acc seat w>=20/8min 20min 40 min...... ........... ........... ........... ........... ........... E2508................. Y.............. ............... SGD spelling phys contact.... ........... ........... ........... ........... ........... E2510................. Y.............. ............... SGD w multi methods msg/accs. ........... ........... ........... ........... ........... E2511................. Y.............. ............... SGD sftwre prgrm for PC/PDA.. ........... ........... ........... ........... ........... E2512................. Y.............. ............... SGD accessory, mounting sys.. ........... ........... ........... ........... ........... E2599................. Y.............. ............... SGD accessory noc............ ........... ........... ........... ........... ........... E2601................. Y.............. ............... Gen w/c cushion wdth =22 in. ........... ........... ........... ........... ........... E2603................. Y.............. ............... Skin protect wc cus wd =22in. ........... ........... ........... ........... ........... E2605................. Y.............. ............... Position wc cush wdth =22 in. ........... ........... ........... ........... ........... E2607................. Y.............. ............... Skin pro/pos wc cus wd =22in. ........... ........... ........... ........... ........... E2609................. Y.............. ............... Custom fabricate w/c cushion. ........... ........... ........... ........... ........... E2610................. B.............. ............... Powered w/c cushion.......... ........... ........... ........... ........... ........... E2611................. Y.............. ............... Gen use back cush wdth =22in. ........... ........... ........... ........... ........... E2613................. Y.............. ............... Position back cush wd =22in.. ........... ........... ........... ........... ........... E2615................. Y.............. ............... Pos back post/lat wdth =22in. ........... ........... ........... ........... ........... E2617................. Y.............. ............... Custom fab w/c back cushion.. ........... ........... ........... ........... ........... E2618................. Y.............. ............... Wc acc solid seat supp base.. ........... ........... ........... ........... ........... E2619................. Y.............. ............... Replace cover w/c seat cush.. ........... ........... ........... ........... ........... E2620................. Y.............. ............... WC planar back cush wd =22in. ........... ........... ........... ........... ........... E8000................. E.............. ............... Posterior gait trainer....... ........... ........... ........... ........... ........... E8001................. E.............. ............... Upright gait trainer......... ........... ........... ........... ........... ........... E8002................. E.............. ............... Anterior gait trainer........ ........... ........... ........... ........... ........... G0008................. X.............. ............... Admin influenza virus vac....

0350 0.3954 $23.46

$0.00

$0.00 G0009................. X.............. ............... Admin pneumococcal vaccine...

0350 0.3954 $23.46

$0.00

$0.00 G0010................. B.............. ............... Admin hepatitis b vaccine.... ........... ........... ........... ........... ........... G0027................. A.............. ............... Semen analysis............... ........... ........... ........... ........... ........... G0101................. V.............. ............... CA screen pelvic/breast exam.

0600 0.8688 $51.56 ........... $10.31 G0102................. N.............. ............... Prostate ca screening dre.... ........... ........... ........... ........... ........... G0103................. A.............. ............... Psa, total screening......... ........... ........... ........... ........... ........... G0104................. S.............. ............... CA screen flexi sigmoidscope.

0159 3.1455 $186.66 ........... $46.67

[[Page 50854]]

G0105................. T.............. ............... Colorectal scrn hi risk ind..

0158 7.6588 $454.50 ........... $113.63 G0106................. S.............. ............... Colon CA screen barium enema.

0157 2.2904 $135.92 ........... $27.18 G0107................. A.............. ............... CA screen fecal blood test... ........... ........... ........... ........... ........... G0108................. A.............. ............... Diab manage trn per indiv.... ........... ........... ........... ........... ........... G0109................. A.............. ............... Diab manage trn ind/group.... ........... ........... ........... ........... ........... G0110................. A.............. ............... Nett pulm-rehab educ ind..... ........... ........... ........... ........... ........... G0111................. A.............. ............... Nett pulm-rehab educ group... ........... ........... ........... ........... ........... G0112................. A.............. ............... Nett nutrition guid, initial. ........... ........... ........... ........... ........... G0113................. A.............. ............... Nett nutrition guid,subseqnt. ........... ........... ........... ........... ........... G0114................. A.............. ............... Nett psychosocial consult.... ........... ........... ........... ........... ........... G0115................. A.............. ............... Nett psychological testing... ........... ........... ........... ........... ........... G0116................. A.............. ............... Nett psychosocial counsel.... ........... ........... ........... ........... ........... G0117................. S.............. ............... Glaucoma scrn hgh risk direc.

0230 0.7858 $46.63 $14.97

$9.33 G0118................. S.............. ............... Glaucoma scrn hgh risk direc.

0230 0.7858 $46.63 $14.97

$9.33 G0120................. S.............. ............... Colon ca scrn barium enema...

0157 2.2904 $135.92 ........... $27.18 G0121................. T.............. ............... Colon ca scrn not hi rsk ind.

0158 7.6588 $454.50 ........... $113.63 G0122................. E.............. ............... Colon ca scrn barium enema... ........... ........... ........... ........... ........... G0123................. A.............. ............... Screen cerv/vag thin layer... ........... ........... ........... ........... ........... G0124................. A.............. ............... Screen c/v thin layer by MD.. ........... ........... ........... ........... ........... G0127................. T.............. ............... Trim nail(s).................

0009

0.668 $39.64

$8.34

$7.93 G0128................. B.............. ............... CORF skilled nursing service. ........... ........... ........... ........... ........... G0129................. P.............. ............... Partial hosp prog service....

0033 4.0708 $241.57 ........... $48.31 G0130................. X.............. ............... Single energy x-ray study....

0260 0.7555 $44.83 $17.93

$8.97 G0141................. E.............. ............... Scr c/v cyto,autosys and md.. ........... ........... ........... ........... ........... G0143................. A.............. ............... Scr c/v cyto,thinlayer,rescr. ........... ........... ........... ........... ........... G0144................. A.............. ............... Scr c/v cyto,thinlayer,rescr. ........... ........... ........... ........... ........... G0145................. A.............. ............... Scr c/v cyto,thinlayer,rescr. ........... ........... ........... ........... ........... G0147................. A.............. ............... Scr c/v cyto, automated sys.. ........... ........... ........... ........... ........... G0148................. A.............. ............... Scr c/v cyto, autosys, rescr. ........... ........... ........... ........... ........... G0151................. B.............. ............... HHCP-serv of pt,ea 15 min.... ........... ........... ........... ........... ........... G0152................. B.............. ............... HHCP-serv of ot,ea 15 min.... ........... ........... ........... ........... ........... G0153................. B.............. ............... HHCP-svs of s/l path,ea 15mn. ........... ........... ........... ........... ........... G0154................. B.............. ............... HHCP-svs of rn,ea 15 min..... ........... ........... ........... ........... ........... G0155................. B.............. ............... HHCP-svs of csw,ea 15 min.... ........... ........... ........... ........... ........... G0156................. B.............. ............... HHCP-svs of aide,ea 15 min... ........... ........... ........... ........... ........... G0166................. T.............. ............... Extrnl counterpulse, per tx..

0678 1.7276 $102.52 ........... $20.50 G0168................. N.............. ............... Wound closure by adhesive.... ........... ........... ........... ........... ........... G0173................. S.............. ............... Linear acc stereo radsur com.

1528 ........... $5,250.00 ........... $1,050.00 G0175................. V.............. ............... OPPS Service,sched team conf.

0602 1.4284 $84.77 ........... $16.95 G0176................. P.............. ............... OPPS/PHP activity therapy....

0033 4.0708 $241.57 ........... $48.31 G0177................. P.............. ............... OPPS/PHP train & educ serv...

0033 4.0708 $241.57 ........... $48.31 G0179................. E.............. ............... MD recertification HHA PT.... ........... ........... ........... ........... ........... G0180................. E.............. ............... MD certification HHA patient. ........... ........... ........... ........... ........... G0181................. E.............. ............... Home health care supervision. ........... ........... ........... ........... ........... G0182................. E.............. ............... Hospice care supervision..... ........... ........... ........... ........... ........... G0186................. T.............. ............... Dstry eye lesn,fdr vssl tech.

0235 4.6593 $276.50 $67.40 $55.30 G0202................. A.............. ............... Screeningmammographydigital.. ........... ........... ........... ........... ........... G0204................. A.............. ............... Diagnosticmammographydigital. ........... ........... ........... ........... ........... G0206................. A.............. ............... Diagnosticmammographydigital. ........... ........... ........... ........... ........... G0219................. E.............. ............... PET img whbd ring noncov ind. ........... ........... ........... ........... ........... G0235................. E.............. ............... PET not otherwise specified.. ........... ........... ........... ........... ........... G0237................. S.............. ............... Therapeutic procd strg endur.

0411 0.3869 $22.96 ...........

$4.59 G0238................. S.............. ............... Oth resp proc, indiv.........

0411 0.3869 $22.96 ...........

$4.59 G0239................. S.............. ............... Oth resp proc, group.........

0411 0.3869 $22.96 ...........

$4.59 G0243................. S.............. ............... Multisour photon stero treat.

1528 ........... $5,250.00 ........... $1,050.00 G0244................. B.............. ............... Observ care by facility topt. ........... ........... ........... ........... ........... G0245................. V.............. ............... Initial Foot Exam PTLOPS.....

0600 0.8688 $51.56 ........... $10.31 G0246................. V.............. ............... Followup eval of foot pt lop.

0600 0.8688 $51.56 ........... $10.31 G0247................. T.............. ............... Routine footcare pt w lops...

0009

0.668 $39.64

$8.34

$7.93 G0248................. S.............. ............... Demonstrate use home inr mon.

1503 ........... $150.00 ........... $30.00 G0249................. S.............. ............... Provide test material,equipm.

1503 ........... $150.00 ........... $30.00 G0250................. E.............. ............... MD review interpret of test.. ........... ........... ........... ........... ........... G0251................. S.............. ............... Linear acc based stero radio.

1513 ........... $1,150.00 ........... $230.00 G0252................. E.............. ............... PET imaging initial dx....... ........... ........... ........... ........... ........... G0255................. E.............. ............... Current percep threshold tst. ........... ........... ........... ........... ........... G0257................. S.............. ............... Unsched dialysis ESRD pt hos.

0170 5.8994 $350.09 ........... $70.02

[[Page 50855]]

G0258................. X.............. ............... IV infusion during obs stay..

0340 0.6384 $37.88 ...........

$7.58 G0259................. N.............. ............... Inject for sacroiliac joint.. ........... ........... ........... ........... ........... G0260................. T.............. ............... Inj for sacroiliac jt anesth.

0206

5.492 $325.91 $75.55 $65.18 G0263................. B.............. ............... Adm with CHF, CP, asthma..... ........... ........... ........... ........... ........... G0264................. B.............. ............... Assmt otr CHF, CP, asthma.... ........... ........... ........... ........... ........... G0265................. A.............. ............... Cryopresevation Freeze+stora. ........... ........... ........... ........... ........... G0266................. A.............. ............... Thawing + expansion froz cel. ........... ........... ........... ........... ........... G0267................. S.............. ............... Bone marrow or psc harvest...

0110 3.6594 $217.16 ........... $43.43 G0268................. X.............. ............... Removal of impacted wax md...

0340 0.6384 $37.88 ...........

$7.58 G0269................. N.............. ............... Occlusive device in vein art. ........... ........... ........... ........... ........... G0270................. A.............. ............... MNT subs tx for change dx.... ........... ........... ........... ........... ........... G0271................. A.............. ............... Group MNT 2 or more 30 mins.. ........... ........... ........... ........... ........... G0275................. N.............. ............... Renal angio, cardiac cath.... ........... ........... ........... ........... ........... G0278................. N.............. ............... Iliac art angio,cardiac cath. ........... ........... ........... ........... ........... G0279................. A.............. ............... Excorp shock tx, elbow epi... ........... ........... ........... ........... ........... G0280................. A.............. ............... Excorp shock tx other than... ........... ........... ........... ........... ........... G0281................. A.............. ............... Elec stim unattend for press. ........... ........... ........... ........... ........... G0282................. E.............. ............... Elect stim wound care not pd. ........... ........... ........... ........... ........... G0283................. A.............. ............... Elec stim other than wound... ........... ........... ........... ........... ........... G0288................. S.............. ............... Recon, CTA for pre & post su.

0417

4.075 $241.82 ........... $48.36 G0289................. N.............. ............... Arthro, loose body + chondro. ........... ........... ........... ........... ........... G0290................. T.............. ............... Drug-eluting stents, single..

0656 109.9237 $6,523.20 ........... $1,304.64 G0291................. T.............. ............... Drug-eluting stents,each add.

0656 109.9237 $6,523.20 ........... $1,304.64 G0293................. S.............. ............... Non-cov surg proc,clin trial.

1505 ........... $350.00 ........... $70.00 G0294................. S.............. ............... Non-cov proc, clinical trial.

1502 ........... $75.00 ........... $15.00 G0295................. E.............. ............... Electromagnetic therapy onc.. ........... ........... ........... ........... ........... G0297................. T.............. ............... Insert single chamber/cd.....

0107 260.0295 $15,430.93 $3,103.22 $3,086.19 G0298................. T.............. ............... Insert dual chamber/cd.......

0107 260.0295 $15,430.93 $3,103.22 $3,086.19 G0299................. T.............. ............... Inser/repos single icd+leads.

0108 349.1681 $20,720.68 ........... $4,144.14 G0300................. T.............. ............... Insert reposit lead dual+gen.

0108 349.1681 $20,720.68 ........... $4,144.14 G0302................. S.............. ............... Pre-op service LVRS complete.

1509 ........... $750.00 ........... $150.00 G0303................. S.............. ............... Pre-op service LVRS 10-15dos.

507 ........... $550.00 ........... $110.00 G0304................. S.............. ............... Pre-op service LVRS 1-9 dos..

1504 ........... $250.00 ........... $50.00 G0305................. S.............. ............... Post op service LVRS min 6...

1504 ........... $250.00 ........... $50.00 G0306................. A.............. ............... CBC/diffwbc w/o platelet..... ........... ........... ........... ........... ........... G0307................. A.............. ............... CBC without platelet......... ........... ........... ........... ........... ........... G0308................. A.............. ............... ESRD related svc 4+mo8hrs pu. ........... ........... ........... ........... ........... G0362................. M.............. ............... each add sequential infusion. ........... ........... ........... ........... ........... G0363................. M.............. ............... irrigate implanted venous de. ........... ........... ........... ........... ........... G0364................. X.............. ............... Bone marrow aspirate & biops.

0342

0.156

$9.26

$3.70

$1.85 G0365................. S.............. ............... Vessel mapping hemo access...

0267 2.6327 $156.23 $62.18 $31.25 G0366................. B.............. ............... EKG for initial prevent exam. ........... ........... ........... ........... ........... G0367................. S.............. ............... EKG tracing for initial prev.

0099 0.3821 $22.67 ...........

$4.53 G0368................. M.............. ............... EKG interpret & report preve. ........... ........... ........... ........... ........... G0369................. M.............. ............... Pharm fee 1st month transpla. ........... ........... ........... ........... ........... G0370................. M.............. ............... Pharmacy fee oral cancer etc. ........... ........... ........... ........... ........... G0371................. M.............. ............... Pharm dispense inhalation 30. ........... ........... ........... ........... ........... G0374................. M.............. ............... Pharm dispense inhalation 90. ........... ........... ........... ........... ........... G0375................. S.............. ............... Smoke/Tobacco counseling 3-1.

1491 ...........

$5.00 ...........

$1.00 G0376................. S.............. ............... Smoke/Tobacco counseling >10.

1491 ...........

$5.00 ...........

$1.00 G3001................. S.............. ............... Admin + supply, tositumomab..

1522 ........... $2,250.00 ........... $450.00 G9001................. B.............. ............... MCCD, initial rate........... ........... ........... ........... ........... ........... G9002................. B.............. ............... MCCD,maintenance rate........ ........... ........... ........... ........... ........... G9003................. B.............. ............... MCCD, risk adj hi, initial... ........... ........... ........... ........... ........... G9004................. B.............. ............... MCCD, risk adj lo, initial... ........... ........... ........... ........... ........... G9005................. B.............. ............... MCCD, risk adj, maintenance.. ........... ........... ........... ........... ........... G9006................. B.............. ............... MCCD, Home monitoring........ ........... ........... ........... ........... ........... G9007................. B.............. ............... MCCD, sch team conf.......... ........... ........... ........... ........... ........... G9008................. B.............. ............... Mccd,phys coor-care ovrsght.. ........... ........... ........... ........... ........... G9009................. E.............. ............... MCCD, risk adj, level 3...... ........... ........... ........... ........... ........... G9010................. E.............. ............... MCCD, risk adj, level 4...... ........... ........... ........... ........... ........... G9011................. E.............. ............... MCCD, risk adj, level 5...... ........... ........... ........... ........... ........... G9012................. E.............. ............... Other Specified Case Mgmt.... ........... ........... ........... ........... ........... G9013................. E.............. ............... ESRD demo bundle level I..... ........... ........... ........... ........... ........... G9014................. E.............. ............... ESRD demo bundle-level II.... ........... ........... ........... ........... ........... G9016................. E.............. ............... Demo-smoking cessation coun.. ........... ........... ........... ........... ........... G9017................. A.............. ............... Amantadine HCL,oral.......... ........... ........... ........... ........... ........... G9018................. A.............. ............... Zanamivir, inh pwdr.......... ........... ........... ........... ........... ........... G9019................. A.............. ............... Oseltamivir phosp............ ........... ........... ........... ........... ........... G9020................. A.............. ............... Rimantadine HCL.............. ........... ........... ........... ........... ........... G9021................. M.............. ............... Chemo assess nausea vomit L1. ........... ........... ........... ........... ........... G9022................. M.............. ............... Chemo assess nausea vomit L2. ........... ........... ........... ........... ........... G9023................. M.............. ............... Chemo assess nausea vomit L3. ........... ........... ........... ........... ........... G9024................. M.............. ............... Chemo assess nausea vomit L4. ........... ........... ........... ........... ........... G9025................. M.............. ............... Chemo assessment pain level1. ........... ........... ........... ........... ........... G9026................. M.............. ............... Chemo assessment pain level2. ........... ........... ........... ........... ........... G9027................. M.............. ............... Chemo assessment pain level3. ........... ........... ........... ........... ........... G9028................. M.............. ............... Chemo assessment pain level4. ........... ........... ........... ........... ........... G9029................. M.............. ............... Chemo assess for fatigue L1.. ........... ........... ........... ........... ........... G9030................. M.............. ............... Chemo assess for fatigue L2.. ........... ........... ........... ........... ........... G9031................. M.............. ............... Chemo assess for fatigue L3.. ........... ........... ........... ........... ........... G9032................. M.............. ............... Chemo assess for fatigue L4.. ........... ........... ........... ........... ........... G9033................. A.............. ............... Amantadine HCL, oral, brand.. ........... ........... ........... ........... ........... G9034................. A.............. ............... Zanamivir, inh pwdr, brand... ........... ........... ........... ........... ........... G9035................. A.............. ............... Oseltamivir phosp, brand..... ........... ........... ........... ........... ........... G9036................. A.............. ............... Rimantadine HCL, brand....... ........... ........... ........... ........... ........... G9041................. A.............. ............... Low vision serv occupational. ........... ........... ........... ........... ........... G9042................. A.............. ............... Low vision orient/mobility... ........... ........... ........... ........... ...........

[[Page 50857]]

G9043................. A.............. ............... Low vision rehab therapist... ........... ........... ........... ........... ........... G9044................. A.............. ............... Low vision rehab teacher..... ........... ........... ........... ........... ........... J0120................. N.............. ............... Tetracyclin injection........ ........... ........... ........... ........... ........... J0128................. G.............. ............... Abarelix injection...........

9216 ........... $66.96 ........... $13.39 J0130................. K.............. ............... Abciximab injection..........

1605 ........... $450.60 ........... $90.12 J0135................. K.............. ............... Adalimumab injection.........

1083 ........... $300.10 ........... $60.02 J0150................. K.............. ............... Injection adenosine 6 MG.....

0379 ........... $33.45 ...........

$6.69 J0152................. K.............. ............... Adenosine injection..........

0917 ........... $71.53 ........... $14.31 J0170................. N.............. ............... Adrenalin epinephrin inject.. ........... ........... ........... ........... ........... J0180................. K.............. ............... Agalsidase beta injection....

9208 ........... $123.35 ........... $24.67 J0190................. N.............. ............... Inj biperiden lactate/5 mg... ........... ........... ........... ........... ........... J0200................. N.............. ............... Alatrofloxacin mesylate...... ........... ........... ........... ........... ........... J0205................. K.............. ............... Alglucerase injection........

0900 ........... $39.94 ...........

$7.99 J0207................. K.............. ............... Amifostine...................

7000 ........... $436.01 ........... $87.20 J0210................. K.............. ............... Methyldopate hcl injection...

2210 ...........

$9.58 ...........

$1.92 J0215................. B.............. ............... Alefacept.................... ........... ........... ........... ........... ........... J0256................. K.............. ............... Alpha 1 proteinase inhibitor.

0901 ...........

$3.30 ...........

$0.66 J0270................. B.............. ............... Alprostadil for injection.... ........... ........... ........... ........... ........... J0275................. B.............. ............... Alprostadil urethral suppos.. ........... ........... ........... ........... ........... J0280................. N.............. ............... Aminophyllin 250 MG inj...... ........... ........... ........... ........... ........... J0282................. N.............. ............... Amiodarone HCl............... ........... ........... ........... ........... ........... J0285................. K.............. ............... Amphotericin B...............

9030 ........... $30.70 ...........

$6.14 J0287................. K.............. ............... Amphotericin b lipid complex.

9024 ........... $11.95 ...........

$2.39 J0288................. K.............. ............... Ampho b cholesteryl sulfate..

0735 ........... $12.24 ...........

$2.45 J0289................. K.............. ............... Amphotericin b liposome inj..

0736 ........... $21.91 ...........

$4.38 J0290................. N.............. ............... Ampicillin 500 MG inj........ ........... ........... ........... ........... ........... J0295................. N.............. ............... Ampicillin sodium per 1.5 gm. ........... ........... ........... ........... ........... J0300................. N.............. ............... Amobarbital 125 MG inj....... ........... ........... ........... ........... ........... J0330................. N.............. ............... Succinycholine chloride inj.. ........... ........... ........... ........... ........... J0350................. N.............. ............... Injection anistreplase 30 u.. ........... ........... ........... ........... ........... J0360................. N.............. ............... Hydralazine hcl injection.... ........... ........... ........... ........... ........... J0380................. N.............. ............... Inj metaraminol bitartrate... ........... ........... ........... ........... ........... J0390................. N.............. ............... Chloroquine injection........ ........... ........... ........... ........... ........... J0395................. K.............. ............... Arbutamine HCl injection.....

9031 ........... $163.15 ........... $32.63 J0456................. N.............. ............... Azithromycin................. ........... ........... ........... ........... ........... J0460................. N.............. ............... Atropine sulfate injection... ........... ........... ........... ........... ........... J0470................. N.............. ............... Dimecaprol injection......... ........... ........... ........... ........... ........... J0475................. K.............. ............... Baclofen 10 MG injection.....

9032 ........... $188.01 ........... $37.60 J0476................. B.............. ............... Baclofen intrathecal trial... ........... ........... ........... ........... ........... J0500................. N.............. ............... Dicyclomine injection........ ........... ........... ........... ........... ........... J0515................. N.............. ............... Inj benztropine mesylate..... ........... ........... ........... ........... ........... J0520................. N.............. ............... Bethanechol chloride inject.. ........... ........... ........... ........... ........... J0530................. N.............. ............... Penicillin g benzathine inj.. ........... ........... ........... ........... ........... J0540................. N.............. ............... Penicillin g benzathine inj.. ........... ........... ........... ........... ........... J0550................. N.............. ............... Penicillin g benzathine inj.. ........... ........... ........... ........... ........... J0560................. N.............. ............... Penicillin g benzathine inj.. ........... ........... ........... ........... ........... J0570................. N.............. ............... Penicillin g benzathine inj.. ........... ........... ........... ........... ........... J0580................. K.............. ............... Penicillin g benzathine inj..

0880 ........... $72.26 ........... $14.45 J0583................. N.............. ............... Bivalirudin.................. ........... ........... ........... ........... ........... J0585................. K.............. ............... Botulinum toxin a per unit...

0902 ...........

$4.80 ...........

$0.96 J0587................. K.............. ............... Botulinum toxin type B.......

9018 ...........

$7.89 ...........

$1.58 J0592................. N.............. ............... Buprenorphine hydrochloride.. ........... ........... ........... ........... ........... J0595................. N.............. ............... Butorphanol tartrate 1 mg.... ........... ........... ........... ........... ........... J0600................. K.............. ............... Edetate calcium disodium inj.

0892 ........... $40.34 ...........

$8.07 J0610................. N.............. ............... Calcium gluconate injection.. ........... ........... ........... ........... ........... J0620................. N.............. ............... Calcium glycer & lact/10 ML.. ........... ........... ........... ........... ........... J0630................. K.............. ............... Calcitonin salmon injection..

0893 ........... $35.68 ...........

$7.14 J0636................. N.............. ............... Inj calcitriol per 0.1 mcg... ........... ........... ........... ........... ........... J0637................. K.............. ............... Caspofungin acetate..........

9019 ........... $32.35 ...........

$6.47 J0640................. N.............. ............... Leucovorin calcium injection. ........... ........... ........... ........... ........... J0670................. N.............. ............... Inj mepivacaine HCL/10 ml.... ........... ........... ........... ........... ........... J0690................. N.............. ............... Cefazolin sodium injection... ........... ........... ........... ........... ........... J0692................. N.............. ............... Cefepime HCl for injection... ........... ........... ........... ........... ........... J0694................. N.............. ............... Cefoxitin sodium injection... ........... ........... ........... ........... ........... J0696................. N.............. ............... Ceftriaxone sodium injection. ........... ........... ........... ........... ........... J0697................. N.............. ............... Sterile cefuroxime injection. ........... ........... ........... ........... ...........

[[Page 50858]]

J0698................. N.............. ............... Cefotaxime sodium injection.. ........... ........... ........... ........... ........... J0702................. N.............. ............... Betamethasone acet&sod phosp. ........... ........... ........... ........... ........... J0704................. N.............. ............... Betamethasone sod phosp/4 MG. ........... ........... ........... ........... ........... J0706................. K.............. ............... Caffeine citrate injection...

0876 ...........

$3.34 ...........

$0.67 J0710................. N.............. ............... Cephapirin sodium injection.. ........... ........... ........... ........... ........... J0713................. N.............. ............... Inj ceftazidime per 500 mg... ........... ........... ........... ........... ........... J0715................. N.............. ............... Ceftizoxime sodium / 500 MG.. ........... ........... ........... ........... ........... J0720................. N.............. ............... Chloramphenicol sodium injec. ........... ........... ........... ........... ........... J0725................. N.............. ............... Chorionic gonadotropin/1000u. ........... ........... ........... ........... ........... J0735................. K.............. ............... Clonidine hydrochloride......

0935 ........... $57.47 ........... $11.49 J0740................. K.............. ............... Cidofovir injection..........

9033 ........... $782.98 ........... $156.60 J0743................. N.............. ............... Cilastatin sodium injection.. ........... ........... ........... ........... ........... J0744................. N.............. ............... Ciprofloxacin iv............. ........... ........... ........... ........... ........... J0745................. N.............. ............... Inj codeine phosphate /30 MG. ........... ........... ........... ........... ........... J0760................. N.............. ............... Colchicine injection......... ........... ........... ........... ........... ........... J0770................. N.............. ............... Colistimethate sodium inj.... ........... ........... ........... ........... ........... J0780................. N.............. ............... Prochlorperazine injection... ........... ........... ........... ........... ........... J0800................. K.............. ............... Corticotropin injection......

1280 ........... $95.44 ........... $19.09 J0835................. K.............. ............... Inj cosyntropin per 0.25 MG..

0835 ........... $69.27 ........... $13.85 J0850................. K.............. ............... Cytomegalovirus imm IV /vial.

0903 ........... $683.07 ........... $136.61 J0878................. G.............. ............... Daptomycin injection.........

9124 ...........

$0.30 ...........

$0.06 J0880................. E.............. ............... Darbepoetin alfa injection... ........... ........... ........... ........... ........... J0895................. K.............. ............... Deferoxamine mesylate inj....

0895 ........... $14.91 ...........

$2.98 J0900................. N.............. ............... Testosterone enanthate inj... ........... ........... ........... ........... ........... J0945................. N.............. ............... Brompheniramine maleate inj.. ........... ........... ........... ........... ........... J0970................. N.............. ............... Estradiol valerate injection. ........... ........... ........... ........... ........... J1000................. N.............. ............... Depo-estradiol cypionate inj. ........... ........... ........... ........... ........... J1020................. N.............. ............... Methylprednisolone 20 MG inj. ........... ........... ........... ........... ........... J1030................. N.............. ............... Methylprednisolone 40 MG inj. ........... ........... ........... ........... ........... J1040................. N.............. ............... Methylprednisolone 80 MG inj. ........... ........... ........... ........... ........... J1051................. N.............. ............... Medroxyprogesterone inj...... ........... ........... ........... ........... ........... J1055................. E.............. ............... Medrxyprogester acetate inj.. ........... ........... ........... ........... ........... J1056................. E.............. ............... MA/EC contraceptiveinjection. ........... ........... ........... ........... ........... J1060................. N.............. ............... Testosterone cypionate 1 ML.. ........... ........... ........... ........... ........... J1070................. N.............. ............... Testosterone cypionat 100 MG. ........... ........... ........... ........... ........... J1080................. N.............. ............... Testosterone cypionat 200 MG. ........... ........... ........... ........... ........... J1094................. N.............. ............... Inj dexamethasone acetate.... ........... ........... ........... ........... ........... J1100................. N.............. ............... Dexamethasone sodium phos.... ........... ........... ........... ........... ........... J1110................. K.............. ............... Inj dihydroergotamine mesylt.

1210 ........... $27.82 ...........

$5.56 J1120................. N.............. ............... Acetazolamid sodium injectio. ........... ........... ........... ........... ........... J1160................. N.............. ............... Digoxin injection............ ........... ........... ........... ........... ........... J1165................. N.............. ............... Phenytoin sodium injection... ........... ........... ........... ........... ........... J1170................. N.............. ............... Hydromorphone injection...... ........... ........... ........... ........... ........... J1180................. K.............. ............... Dyphylline injection.........

9166 ...........

$7.74 ...........

$1.55 J1190................. K.............. ............... Dexrazoxane HCl injection....

0726 ........... $216.39 ........... $43.28 J1200................. N.............. ............... Diphenhydramine hcl injectio. ........... ........... ........... ........... ........... J1205................. N.............. ............... Chlorothiazide sodium inj.... ........... ........... ........... ........... ........... J1212................. N.............. ............... Dimethyl sulfoxide 50% 50 ML. ........... ........... ........... ........... ........... J1230................. N.............. ............... Methadone injection.......... ........... ........... ........... ........... ........... J1240................. N.............. ............... Dimenhydrinate injection..... ........... ........... ........... ........... ........... J1245................. N.............. ............... Dipyridamole injection....... ........... ........... ........... ........... ........... J1250................. N.............. ............... Inj dobutamine HCL/250 mg.... ........... ........... ........... ........... ........... J1260................. K.............. ............... Dolasetron mesylate..........

0750 ...........

$6.55 ...........

$1.31 J1270................. N.............. ............... Injection, doxercalciferol... ........... ........... ........... ........... ........... J1320................. N.............. ............... Amitriptyline injection...... ........... ........... ........... ........... ........... J1325................. N.............. ............... Epoprostenol injection....... ........... ........... ........... ........... ........... J1327................. K.............. ............... Eptifibatide injection.......

1607 ........... $12.73 ...........

$2.55 J1330................. K.............. ............... Ergonovine maleate injection.

1330 0.5263 $31.23 ...........

$6.25 J1335................. N.............. ............... Ertapenem injection.......... ........... ........... ........... ........... ........... J1364................. N.............. ............... Erythro lactobionate /500 MG. ........... ........... ........... ........... ........... J1380................. N.............. ............... Estradiol valerate 10 MG inj. ........... ........... ........... ........... ........... J1390................. N.............. ............... Estradiol valerate 20 MG inj. ........... ........... ........... ........... ........... J1410................. K.............. ............... Inj estrogen conjugate 25 MG.

9038 ........... $57.77 ........... $11.55 J1435................. N.............. ............... Injection estrone per 1 MG... ........... ........... ........... ........... ........... J1436................. K.............. ............... Etidronate disodium inj......

1436 ........... $68.69 ........... $13.74 J1438................. K.............. ............... Etanercept injection.........

1608 ........... $152.11 ........... $30.42

[[Page 50859]]

J1440................. K.............. ............... Filgrastim 300 mcg injection.

0728 ........... $178.39 ........... $35.68 J1441................. K.............. ............... Filgrastim 480 mcg injection.

7049 ........... $282.29 ........... $56.46 J1450................. N.............. ............... Fluconazole.................. ........... ........... ........... ........... ........... J1452................. K.............. ............... Intraocular Fomivirsen na....

9040 ........... $203.93 ........... $40.79 J1455................. N.............. ............... Foscarnet sodium injection... ........... ........... ........... ........... ........... J1457................. K.............. ............... Gallium nitrate injection....

1085 ...........

$1.30 ...........

$0.26 J1460................. N.............. ............... Gamma globulin 1 CC inj...... ........... ........... ........... ........... ........... J1470................. B.............. ............... Gamma globulin 2 CC inj...... ........... ........... ........... ........... ........... J1480................. B.............. ............... Gamma globulin 3 CC inj...... ........... ........... ........... ........... ........... J1490................. B.............. ............... Gamma globulin 4 CC inj...... ........... ........... ........... ........... ........... J1500................. B.............. ............... Gamma globulin 5 CC inj...... ........... ........... ........... ........... ........... J1510................. B.............. ............... Gamma globulin 6 CC inj...... ........... ........... ........... ........... ........... J1520................. B.............. ............... Gamma globulin 7 CC inj...... ........... ........... ........... ........... ........... J1530................. B.............. ............... Gamma globulin 8 CC inj...... ........... ........... ........... ........... ........... J1540................. B.............. ............... Gamma globulin 9 CC inj...... ........... ........... ........... ........... ........... J1550................. B.............. ............... Gamma globulin 10 CC inj..... ........... ........... ........... ........... ........... J1560................. B.............. ............... Gamma globulin > 10 CC inj... ........... ........... ........... ........... ........... J1563................. E.............. ............... IV immune globulin........... ........... ........... ........... ........... ........... J1564................. E.............. ............... Immune globulin 10 mg........ ........... ........... ........... ........... ........... J1565................. K.............. ............... RSV-ivig.....................

0906 ........... $15.56 ...........

$3.11 J1570................. N.............. ............... Ganciclovir sodium injection. ........... ........... ........... ........... ........... J1580................. N.............. ............... Garamycin gentamicin inj..... ........... ........... ........... ........... ........... J1590................. N.............. ............... Gatifloxacin injection....... ........... ........... ........... ........... ........... J1595................. N.............. ............... Injection glatiramer acetate. ........... ........... ........... ........... ........... J1600................. N.............. ............... Gold sodium thiomaleate inj.. ........... ........... ........... ........... ........... J1610................. K.............. ............... Glucagon hydrochloride/1 MG..

9042 ........... $62.16 ........... $12.43 J1620................. K.............. ............... Gonadorelin hydroch/ 100 mcg.

7005 ........... $173.44 ........... $34.69 J1626................. K.............. ............... Granisetron HCl injection....

0764 ...........

$7.24 ...........

$1.45 J1630................. N.............. ............... Haloperidol injection........ ........... ........... ........... ........... ........... J1631................. N.............. ............... Haloperidol decanoate inj.... ........... ........... ........... ........... ........... J1642................. N.............. ............... Inj heparin sodium per 10 u.. ........... ........... ........... ........... ........... J1644................. N.............. ............... Inj heparin sodium per 1000u. ........... ........... ........... ........... ........... J1645................. N.............. ............... Dalteparin sodium............ ........... ........... ........... ........... ........... J1650................. N.............. ............... Inj enoxaparin sodium........ ........... ........... ........... ........... ........... J1652................. N.............. ............... Fondaparinux sodium.......... ........... ........... ........... ........... ........... J1655................. K.............. ............... Tinzaparin sodium injection..

1655 ...........

$2.53 ...........

$0.51 J1670................. K.............. ............... Tetanus immune globulin inj..

1670 ........... $76.90 ........... $15.38 J1700................. N.............. ............... Hydrocortisone acetate inj... ........... ........... ........... ........... ........... J1710................. N.............. ............... Hydrocortisone sodium ph inj. ........... ........... ........... ........... ........... J1720................. N.............. ............... Hydrocortisone sodium succ i. ........... ........... ........... ........... ........... J1730................. K.............. ............... Diazoxide injection..........

1740 ........... $113.86 ........... $22.77 J1742................. K.............. ............... Ibutilide fumarate injection.

9044 ........... $243.34 ........... $48.67 J1745................. K.............. ............... Infliximab injection.........

7043 ........... $54.20 ........... $10.84 J1750................. K.............. ............... Iron dextran.................

9045 ........... $11.43 ...........

$2.29 J1756................. K.............. ............... Iron sucrose injection.......

9046 ...........

$0.38 ...........

$0.08 J1785................. K.............. ............... Injection imiglucerase /unit.

0916 ...........

$3.98 ...........

$0.80 J1790................. N.............. ............... Droperidol injection......... ........... ........... ........... ........... ........... J1800................. N.............. ............... Propranolol injection........ ........... ........... ........... ........... ........... J1810................. E.............. ............... Droperidol/fentanyl inj...... ........... ........... ........... ........... ........... J1815................. N.............. ............... Insulin injection............ ........... ........... ........... ........... ........... J1817................. N.............. ............... Insulin for insulin pump use. ........... ........... ........... ........... ........... J1825................. E.............. ............... Interferon beta-1a........... ........... ........... ........... ........... ........... J1830................. K.............. ............... Interferon beta-1b / .25 MG..

0910 ........... $81.95 ........... $16.39 J1835................. K.............. ............... Itraconazole injection.......

9047 ........... $36.93 ...........

$7.39 J1840................. N.............. ............... Kanamycin sulfate 500 MG inj. ........... ........... ........... ........... ........... J1850................. N.............. ............... Kanamycin sulfate 75 MG inj.. ........... ........... ........... ........... ........... J1885................. N.............. ............... Ketorolac tromethamine inj... ........... ........... ........... ........... ........... J1890................. N.............. ............... Cephalothin sodium injection. ........... ........... ........... ........... ........... J1931................. K.............. ............... Laronidase injection.........

9209 ........... $23.16 ...........

$4.63 J1940................. N.............. ............... Furosemide injection......... ........... ........... ........... ........... ........... J1950................. K.............. ............... Leuprolide acetate /3.75 MG..

0800 ........... $441.78 ........... $88.36 J1955................. B.............. ............... Inj levocarnitine per 1 gm... ........... ........... ........... ........... ........... J1956................. N.............. ............... Levofloxacin injection....... ........... ........... ........... ........... ........... J1960................. N.............. ............... Levorphanol tartrate inj..... ........... ........... ........... ........... ........... J1980................. N.............. ............... Hyoscyamine sulfate inj...... ........... ........... ........... ........... ........... J1990................. N.............. ............... Chlordiazepoxide injection... ........... ........... ........... ........... ...........

[[Page 50860]]

J2001................. N.............. ............... Lidocaine injection.......... ........... ........... ........... ........... ........... J2010................. N.............. ............... Lincomycin injection......... ........... ........... ........... ........... ........... J2020................. K.............. ............... Linezolid injection..........

9001 ........... $24.15 ...........

$4.83 J2060................. N.............. ............... Lorazepam injection.......... ........... ........... ........... ........... ........... J2150................. N.............. ............... Mannitol injection........... ........... ........... ........... ........... ........... J2175................. N.............. ............... Meperidine hydrochl /100 MG.. ........... ........... ........... ........... ........... J2180................. N.............. ............... Meperidine/promethazine inj.. ........... ........... ........... ........... ........... J2185................. N.............. ............... Meropenem.................... ........... ........... ........... ........... ........... J2210................. N.............. ............... Methylergonovin maleate inj.. ........... ........... ........... ........... ........... J2250................. N.............. ............... Inj midazolam hydrochloride.. ........... ........... ........... ........... ........... J2260................. N.............. ............... Inj milrinone lactate / 5 MG. ........... ........... ........... ........... ........... J2270................. N.............. ............... Morphine sulfate injection... ........... ........... ........... ........... ........... J2271................. N.............. ............... Morphine so4 injection 100mg. ........... ........... ........... ........... ........... J2275................. N.............. ............... Morphine sulfate injection... ........... ........... ........... ........... ........... J2280................. N.............. ............... Inj, moxifloxacin 100 mg..... ........... ........... ........... ........... ........... J2300................. N.............. ............... Inj nalbuphine hydrochloride. ........... ........... ........... ........... ........... J2310................. N.............. ............... Inj naloxone hydrochloride... ........... ........... ........... ........... ........... J2320................. N.............. ............... Nandrolone decanoate 50 MG... ........... ........... ........... ........... ........... J2321................. N.............. ............... Nandrolone decanoate 100 MG.. ........... ........... ........... ........... ........... J2322................. N.............. ............... Nandrolone decanoate 200 MG.. ........... ........... ........... ........... ........... J2324................. K.............. ............... Nesiritide...................

9114 ........... $75.19 ........... $15.04 J2353................. K.............. ............... Octreotide injection, depot..

1207 ........... $87.40 ........... $17.48 J2354................. N.............. ............... Octreotide inj, non-depot.... ........... ........... ........... ........... ........... J2355................. K.............. ............... Oprelvekin injection.........

7011 ........... $249.06 ........... $49.81 J2357................. G.............. ............... Omalizumab injection.........

9300 ........... $15.98 ...........

$3.20 J2360................. N.............. ............... Orphenadrine injection....... ........... ........... ........... ........... ........... J2370................. N.............. ............... Phenylephrine hcl injection.. ........... ........... ........... ........... ........... J2400................. N.............. ............... Chloroprocaine hcl injection. ........... ........... ........... ........... ........... J2405................. K.............. ............... Ondansetron hcl injection....

0768 ...........

$3.80 ...........

$0.76 J2410................. N.............. ............... Oxymorphone hcl injection.... ........... ........... ........... ........... ........... J2430................. K.............. ............... Pamidronate disodium /30 MG..

0730 ........... $58.42 ........... $11.68 J2440................. N.............. ............... Papaverin hcl injection...... ........... ........... ........... ........... ........... J2460................. N.............. ............... Oxytetracycline injection.... ........... ........... ........... ........... ........... J2469................. K.............. ............... Palonosetron HCl.............

9210 ........... $18.42 ...........

$3.68 J2501................. N.............. ............... Paricalcitol................. ........... ........... ........... ........... ........... J2505................. K.............. ............... Injection, pegfilgrastim 6mg.

9119 ........... $2,178.28 ........... $435.66 J2510................. N.............. ............... Penicillin g procaine inj.... ........... ........... ........... ........... ........... J2515................. N.............. ............... Pentobarbital sodium inj..... ........... ........... ........... ........... ........... J2540................. N.............. ............... Penicillin g potassium inj... ........... ........... ........... ........... ........... J2543................. N.............. ............... Piperacillin/tazobactam...... ........... ........... ........... ........... ........... J2545................. Y.............. ............... Pentamidine isethionte/300mg. ........... ........... ........... ........... ........... J2550................. N.............. ............... Promethazine hcl injection... ........... ........... ........... ........... ........... J2560................. N.............. ............... Phenobarbital sodium inj..... ........... ........... ........... ........... ........... J2590................. N.............. ............... Oxytocin injection........... ........... ........... ........... ........... ........... J2597................. N.............. ............... Inj desmopressin acetate..... ........... ........... ........... ........... ........... J2650................. N.............. ............... Prednisolone acetate inj..... ........... ........... ........... ........... ........... J2670................. N.............. ............... Totazoline hcl injection..... ........... ........... ........... ........... ........... J2675................. N.............. ............... Inj progesterone per 50 MG... ........... ........... ........... ........... ........... J2680................. N.............. ............... Fluphenazine decanoate 25 MG. ........... ........... ........... ........... ........... J2690................. N.............. ............... Procainamide hcl injection... ........... ........... ........... ........... ........... J2700................. N.............. ............... Oxacillin sodium injeciton... ........... ........... ........... ........... ........... J2710................. N.............. ............... Neostigmine methylslfte inj.. ........... ........... ........... ........... ........... J2720................. N.............. ............... Inj protamine sulfate/10 MG.. ........... ........... ........... ........... ........... J2725................. N.............. ............... Inj protirelin per 250 mcg... ........... ........... ........... ........... ........... J2730................. K.............. ............... Pralidoxime chloride inj.....

2730 ........... $76.68 ........... $15.34 J2760................. N.............. ............... Phentolaine mesylate inj..... ........... ........... ........... ........... ........... J2765................. N.............. ............... Metoclopramide hcl injection. ........... ........... ........... ........... ........... J2770................. K.............. ............... Quinupristin/dalfopristin....

2770 ........... $105.48 ........... $21.10 J2780................. N.............. ............... Ranitidine hydrochloride inj. ........... ........... ........... ........... ........... J2783................. G.............. ............... Rasburicase..................

0738 ........... $109.18 ........... $21.84 J2788................. K.............. ............... Rho d immune globulin 50 mcg.

9023 ........... $25.08 ...........

$5.02 J2790................. K.............. ............... Rho d immune globulin inj....

0884 ........... $113.91 ........... $22.78 J2792................. K.............. ............... Rho(D) immune globulin h, sd.

1609 ........... $12.04 ...........

$2.41 J2794................. G.............. ............... Risperidone, long acting.....

9125 ...........

$4.71 ...........

$0.94 J2795................. N.............. ............... Ropivacaine HCl injection.... ........... ........... ........... ........... ........... J2800................. N.............. ............... Methocarbamol injection...... ........... ........... ........... ........... ...........

[[Page 50861]]

J2810................. N.............. ............... Inj theophylline per 40 MG... ........... ........... ........... ........... ........... J2820................. K.............. ............... Sargramostim injection.......

0731 ........... $21.11 ...........

$4.22 J2910................. N.............. ............... Aurothioglucose injeciton.... ........... ........... ........... ........... ........... J2912................. N.............. ............... Sodium chloride injection.... ........... ........... ........... ........... ........... J2916................. N.............. ............... Na ferric gluconate complex.. ........... ........... ........... ........... ........... J2920................. N.............. ............... Methylprednisolone injection. ........... ........... ........... ........... ........... J2930................. N.............. ............... Methylprednisolone injection. ........... ........... ........... ........... ........... J2940................. K.............. ............... Somatrem injection...........

2940 ........... $43.14 ...........

$8.63 J2941................. K.............. ............... Somatropin injection.........

7034 ........... $42.93 ...........

$8.59 J2950................. N.............. ............... Promazine hcl injection...... ........... ........... ........... ........... ........... J2993................. K.............. ............... Reteplase injection..........

9005 ........... $898.81 ........... $179.76 J2995................. K.............. ............... Inj streptokinase /250000 IU.

0911 ........... $83.36 ........... $16.67 J2997................. K.............. ............... Alteplase recombinant........

7048 ........... $30.65 ...........

$6.13 J3000................. N.............. ............... Streptomycin injection....... ........... ........... ........... ........... ........... J3010................. N.............. ............... Fentanyl citrate injeciton... ........... ........... ........... ........... ........... J3030................. K.............. ............... Sumatriptan succinate / 6 MG.

3030 ........... $51.03 ........... $10.21 J3070................. N.............. ............... Pentazocine hcl injection.... ........... ........... ........... ........... ........... J3100................. K.............. ............... Tenecteplase injection.......

9002 ........... $2,052.77 ........... $410.55 J3105................. N.............. ............... Terbutaline sulfate inj...... ........... ........... ........... ........... ........... J3110................. B.............. ............... Teriparatide injection....... ........... ........... ........... ........... ........... J3120................. N.............. ............... Testosterone enanthate inj... ........... ........... ........... ........... ........... J3130................. N.............. ............... Testosterone enanthate inj... ........... ........... ........... ........... ........... J3140................. N.............. ............... Testosterone suspension inj.. ........... ........... ........... ........... ........... J3150................. N.............. ............... Testosteron propionate inj... ........... ........... ........... ........... ........... J3230................. N.............. ............... Chlorpromazine hcl injection. ........... ........... ........... ........... ........... J3240................. K.............. ............... Thyrotropin injection........

9108 ........... $712.58 ........... $142.52 J3246................. K.............. ............... Tirofiban HCl................

7041 ...........

$7.89 ...........

$1.58 J3250................. N.............. ............... Trimethobenzamide hcl inj.... ........... ........... ........... ........... ........... J3260................. N.............. ............... Tobramycin sulfate injection. ........... ........... ........... ........... ........... J3265................. N.............. ............... Injection torsemide 10 mg/ml. ........... ........... ........... ........... ........... J3280................. N.............. ............... Thiethylperazine maleate inj. ........... ........... ........... ........... ........... J3301................. N.............. ............... Triamcinolone acetonide inj.. ........... ........... ........... ........... ........... J3302................. N.............. ............... Triamcinolone diacetate inj.. ........... ........... ........... ........... ........... J3303................. N.............. ............... Triamcinolone hexacetonl inj. ........... ........... ........... ........... ........... J3305................. K.............. ............... Inj trimetrexate glucoronate.

7045 ........... $139.85 ........... $27.97 J3310................. N.............. ............... Perphenazine injeciton....... ........... ........... ........... ........... ........... J3315................. K.............. ............... Triptorelin pamoate..........

9122 ........... $369.98 ........... $74.00 J3320................. N.............. ............... Spectinomycn di-hcl inj...... ........... ........... ........... ........... ........... J3350................. K.............. ............... Urea injection...............

9051 1.0454 $62.04 ........... $12.41 J3360................. N.............. ............... Diazepam injection........... ........... ........... ........... ........... ........... J3364................. N.............. ............... Urokinase 5000 IU injection.. ........... ........... ........... ........... ........... J3365................. K.............. ............... Urokinase 250,000 IU inj.....

7036 ........... $415.69 ........... $83.14 J3370................. N.............. ............... Vancomycin hcl injection..... ........... ........... ........... ........... ........... J3396................. K.............. ............... Verteporfin injection........

1203 ...........

$9.16 ...........

$1.83 J3400................. N.............. ............... Triflupromazine hcl inj...... ........... ........... ........... ........... ........... J3410................. N.............. ............... Hydroxyzine hcl injection.... ........... ........... ........... ........... ........... J3411................. N.............. ............... Thiamine hcl 100 mg.......... ........... ........... ........... ........... ........... J3415................. N.............. ............... Pyridoxine hcl 100 mg........ ........... ........... ........... ........... ........... J3420................. N.............. ............... Vitamin b12 injection........ ........... ........... ........... ........... ........... J3430................. N.............. ............... Vitamin k phytonadione inj... ........... ........... ........... ........... ........... J3465................. K.............. ............... Injection, voriconazole......

1052 ...........

$4.63 ...........

$0.93 J3470................. N.............. ............... Hyaluronidase injection...... ........... ........... ........... ........... ........... J3475................. N.............. ............... Inj magnesium sulfate........ ........... ........... ........... ........... ........... J3480................. N.............. ............... Inj potassium chloride....... ........... ........... ........... ........... ........... J3485................. N.............. ............... Zidovudine................... ........... ........... ........... ........... ........... J3486................. N.............. ............... Ziprasidone mesylate......... ........... ........... ........... ........... ........... J3487................. K.............. ............... Zoledronic acid..............

9115 ........... $202.41 ........... $40.48 J3490................. N.............. ............... Drugs unclassified injection. ........... ........... ........... ........... ........... J3520................. E.............. ............... Edetate disodium per 150 mg.. ........... ........... ........... ........... ........... J3530................. N.............. ............... Nasal vaccine inhalation..... ........... ........... ........... ........... ........... J3535................. E.............. ............... Metered dose inhaler drug.... ........... ........... ........... ........... ........... J3570................. E.............. ............... Laetrile amygdalin vit B17... ........... ........... ........... ........... ........... J3590................. N.............. ............... Unclassified biologics....... ........... ........... ........... ........... ........... J7030................. N.............. ............... Normal saline solution infus. ........... ........... ........... ........... ........... J7040................. N.............. ............... Normal saline solution infus. ........... ........... ........... ........... ........... J7042................. N.............. ............... 5% dextrose/normal saline.... ........... ........... ........... ........... ...........

[[Page 50862]]

J7050................. N.............. ............... Normal saline solution infus. ........... ........... ........... ........... ........... J7051................. N.............. ............... Sterile saline/water......... ........... ........... ........... ........... ........... J7060................. N.............. ............... 5% dextrose/water............ ........... ........... ........... ........... ........... J7070................. N.............. ............... D5w infusion................. ........... ........... ........... ........... ........... J7100................. N.............. ............... Dextran 40 infusion.......... ........... ........... ........... ........... ........... J7110................. N.............. ............... Dextran 75 infusion.......... ........... ........... ........... ........... ........... J7120................. N.............. ............... Ringers lactate infusion..... ........... ........... ........... ........... ........... J7130................. N.............. ............... Hypertonic saline solution... ........... ........... ........... ........... ........... J7190................. K.............. ............... Factor viii..................

0925 ...........

$0.51 ...........

$0.10 J7191................. K.............. ............... Factor VIII (porcine)........

0926 ...........

$1.75 ...........

$0.35 J7192................. K.............. ............... Factor viii recombinant......

0927 ...........

$0.94 ...........

$0.19 J7193................. K.............. ............... Factor IX non-recombinant....

0931 ...........

$0.75 ...........

$0.15 J7194................. K.............. ............... Factor ix complex............

0928 ...........

$0.52 ...........

$0.10 J7195................. K.............. ............... Factor IX recombinant........

0932 ...........

$0.86 ...........

$0.17 J7197................. N.............. ............... Antithrombin iii injection... ........... ........... ........... ........... ........... J7198................. K.............. ............... Anti-inhibitor...............

0929 ...........

$1.12 ...........

$0.22 J7199................. B.............. ............... Hemophilia clot factor noc... ........... ........... ........... ........... ........... J7300................. E.............. ............... Intraut copper contraceptive. ........... ........... ........... ........... ........... J7302................. E.............. ............... Levonorgestrel iu contracept. ........... ........... ........... ........... ........... J7303................. E.............. ............... Contraceptive vaginal ring... ........... ........... ........... ........... ........... J7304................. E.............. ............... Contraceptive hormone patch.. ........... ........... ........... ........... ........... J7308................. K.............. ............... Aminolevulinic acid hcl top..

7308 ........... $96.79 ........... $19.36 J7310................. K.............. ............... Ganciclovir long act implant.

0913 ........... $4,318.68 ........... $863.74 J7317................. K.............. ............... Sodium hyaluronate injection.

7316 ........... $110.65 ........... $22.13 J7320................. K.............. ............... Hylan G-F 20 injection.......

1611 ........... $203.15 ........... $40.63 J7330................. B.............. ............... Cultured chondrocytes implnt. ........... ........... ........... ........... ........... J7340................. E.............. ............... Metabolic active D/E tissue.. ........... ........... ........... ........... ........... J7342................. K.............. ............... Metabolically active tissue..

9054 ........... $15.69 ...........

$3.14 J7343................. B.............. ............... Nonmetabolic act d/e tissue.. ........... ........... ........... ........... ........... J7344................. K.............. ............... Nonmetabolic active tissue...

9156 ........... $53.76 ........... $10.75 J7350................. K.............. ............... Injectable human tissue......

9055 ...........

$3.54 ...........

$0.71 J7500................. N.............. ............... Azathioprine oral 50mg....... ........... ........... ........... ........... ........... J7501................. K.............. ............... Azathioprine parenteral......

0887 ........... $47.40 ...........

$9.48 J7502................. K.............. ............... Cyclosporine oral 100 mg.....

0888 ...........

$3.94 ...........

$0.79 J7504................. K.............. ............... Lymphocyte immune globulin...

0890 ........... $290.30 ........... $58.06 J7505................. K.............. ............... Monoclonal antibodies........

7038 ........... $885.36 ...........

77.07 J7506................. N.............. ............... Prednisone oral.............. ........... ........... ........... ........... ........... J7507................. K.............. ............... Tacrolimus oral per 1 MG.....

0891 ...........

$3.37 ...........

$0.67 J7509................. N.............. ............... Methylprednisolone oral...... ........... ........... ........... ........... ........... J7510................. N.............. ............... Prednisolone oral per 5 mg... ........... ........... ........... ........... ........... J7511................. K.............. ............... Antithymocyte globuln rabbit.

9104 ........... $299.47 ........... $59.89 J7513................. K.............. ............... Daclizumab, parenteral.......

1612 ........... $381.48 ........... $76.30 J7515................. K.............. ............... Cyclosporine oral 25 mg......

7515 ...........

$1.00 ...........

$0.20 J7516................. N.............. ............... Cyclosporin parenteral 250mg. ........... ........... ........... ........... ........... J7517................. K.............. ............... Mycophenolate mofetil oral...

9015 ...........

$2.50 ...........

$0.50 J7518................. G.............. ............... Mycophenolic acid............

9219 ...........

$2.47 ...........

$0.49 J7520................. K.............. ............... Sirolimus, oral..............

9020 ...........

$6.85 ...........

$1.37 J7525................. K.............. ............... Tacrolimus injection.........

9006 ........... $126.61 ........... $25.32 J7599................. N.............. ............... Immunosuppressive drug noc... ........... ........... ........... ........... ........... J7608................. Y.............. ............... Acetylcysteine inh sol u d... ........... ........... ........... ........... ........... J7611................. Y.............. ............... Albuterol concentrated form.. ........... ........... ........... ........... ........... J7612................. Y.............. ............... Levalbuterol concentrated.... ........... ........... ........... ........... ........... J7613................. Y.............. ............... Albuterol unit dose.......... ........... ........... ........... ........... ........... J7614................. Y.............. ............... Levalbuterol unit dose....... ........... ........... ........... ........... ........... J7616................. Y.............. ............... Albuterol compound solution.. ........... ........... ........... ........... ........... J7617................. Y.............. ............... Levalbuterol compounded sol.. ........... ........... ........... ........... ........... J7622................. A.............. ............... Beclomethasone inhalatn sol.. ........... ........... ........... ........... ........... J7624................. A.............. ............... Betamethasone inhalation sol. ........... ........... ........... ........... ........... J7626................. A.............. ............... Budesonide inhalation sol.... ........... ........... ........... ........... ........... J7628................. Y.............. ............... Bitolterol mes inhal sol con. ........... ........... ........... ........... ........... J7629................. Y.............. ............... Bitolterol mes inh sol u d... ........... ........... ........... ........... ........... J7631................. Y.............. ............... Cromolyn sodium inh sol u d.. ........... ........... ........... ........... ........... J7633................. N.............. ............... Budesonide concentrated sol.. ........... ........... ........... ........... ........... J7635................. Y.............. ............... Atropine inhal sol con....... ........... ........... ........... ........... ........... J7636................. Y.............. ............... Atropine inhal sol unit dose. ........... ........... ........... ........... ........... J7637................. Y.............. ............... Dexamethasone inhal sol con.. ........... ........... ........... ........... ...........

[[Page 50863]]

J7638................. Y.............. ............... Dexamethasone inhal sol u d.. ........... ........... ........... ........... ........... J7639................. Y.............. ............... Dornase alpha inhal sol u d.. ........... ........... ........... ........... ........... J7641................. A.............. ............... Flunisolide, inhalation sol.. ........... ........... ........... ........... ........... J7642................. Y.............. ............... Glycopyrrolate inhal sol con. ........... ........... ........... ........... ........... J7643................. Y.............. ............... Glycopyrrolate inhal sol u d. ........... ........... ........... ........... ........... J7644................. Y.............. ............... Ipratropium brom inh sol u d. ........... ........... ........... ........... ........... J7648................. Y.............. ............... Isoetharine hcl inh sol con.. ........... ........... ........... ........... ........... J7649................. Y.............. ............... Isoetharine hcl inh sol u d.. ........... ........... ........... ........... ........... J7658................. Y.............. ............... Isoproterenolhcl inh sol con. ........... ........... ........... ........... ........... J7659................. Y.............. ............... Isoproterenol hcl inh sol ud. ........... ........... ........... ........... ........... J7668................. Y.............. ............... Metaproterenol inh sol con... ........... ........... ........... ........... ........... J7669................. Y.............. ............... Metaproterenol inh sol u d... ........... ........... ........... ........... ........... J7674................. N.............. ............... Methacholine chloride, neb... ........... ........... ........... ........... ........... J7680................. Y.............. ............... Terbutaline so4 inh sol con.. ........... ........... ........... ........... ........... J7681................. Y.............. ............... Terbutaline so4 inh sol u d.. ........... ........... ........... ........... ........... J7682................. Y.............. ............... Tobramycin inhalation sol.... ........... ........... ........... ........... ........... J7683................. Y.............. ............... Triamcinolone inh sol con.... ........... ........... ........... ........... ........... J7684................. Y.............. ............... Triamcinolone inh sol u d.... ........... ........... ........... ........... ........... J7699................. Y.............. ............... Inhalation solution for DME.. ........... ........... ........... ........... ........... J7799................. Y.............. ............... Non-inhalation drug for DME.. ........... ........... ........... ........... ........... J8499................. E.............. ............... Oral prescrip drug non chemo. ........... ........... ........... ........... ........... J8501................. G.............. ............... Oral aprepitant..............

0868 ...........

$4.75 ...........

$0.95 J8510................. K.............. ............... Oral busulfan................

7015 ...........

$1.98 ...........

$0.40 J8520................. K.............. ............... Capecitabine, oral, 150 mg...

7042 ...........

$3.30 ...........

$0.66 J8521................. E.............. ............... Capecitabine, oral, 500 mg... ........... ........... ........... ........... ........... J8530................. N.............. ............... Cyclophosphamide oral 25 MG.. ........... ........... ........... ........... ........... J8560................. K.............. ............... Etoposide oral 50 MG.........

0802 ........... $41.12 ...........

$8.22 J8565................. E.............. ............... Gefitinib oral............... ........... ........... ........... ........... ........... J8600................. N.............. ............... Melphalan oral 2 MG.......... ........... ........... ........... ........... ........... J8610................. N.............. ............... Methotrexate oral 2.5 MG..... ........... ........... ........... ........... ........... J8700................. K.............. ............... Temozolomide.................

1086 ...........

$7.28 ...........

$1.46 J8999................. B.............. ............... Oral prescription drug chemo. ........... ........... ........... ........... ........... J9000................. N.............. ............... Doxorubic hcl 10 MG vl chemo. ........... ........... ........... ........... ........... J9001................. K.............. ............... Doxorubicin hcl liposome inj.

7046 ........... $365.64 ........... $73.13 J9010................. K.............. ............... Alemtuzumab injection........

9110 ........... $516.87 ........... $103.37 J9015................. K.............. ............... Aldesleukin/single use vial..

0807 ........... $701.76 ........... $140.35 J9017................. K.............. ............... Arsenic trioxide.............

9012 ........... $33.76 ...........

$6.75 J9020................. K.............. ............... Asparaginase injection.......

0814 ........... $55.42 ........... $11.08 J9031................. K.............. ............... Bcg live intravesical vac....

0809 ........... $121.74 ........... $24.35 J9035................. G.............. ............... Bevacizumab injection........

9214 ........... $58.17 ........... $11.63 J9040................. K.............. ............... Bleomycin sulfate injection..

0857 ........... $54.18 ........... $10.84 J9041................. K.............. ............... Bortezomib injection.........

9207 ........... $28.90 ...........

$5.78 J9045................. K.............. ............... Carboplatin injection........

0811 ........... $77.16 ........... $15.43 J9050................. K.............. ............... Carmus bischl nitro inj......

0812 ........... $141.29 ........... $28.26 J9055................. G.............. ............... Cetuximab injection..........

9215 ........... $50.59 ........... $10.12 J9060................. N.............. ............... Cisplatin 10 MG injection.... ........... ........... ........... ........... ........... J9062................. B.............. ............... Cisplatin 50 MG injection.... ........... ........... ........... ........... ........... J9065................. K.............. ............... Inj cladribine per 1 MG......

0858 ........... $39.37 ...........

$7.87 J9070................. N.............. ............... Cyclophosphamide 100 MG inj.. ........... ........... ........... ........... ........... J9080................. B.............. ............... Cyclophosphamide 200 MG inj.. ........... ........... ........... ........... ........... J9090................. B.............. ............... Cyclophosphamide 500 MG inj.. ........... ........... ........... ........... ........... J9091................. B.............. ............... Cyclophosphamide 1.0 grm inj. ........... ........... ........... ........... ........... J9092................. B.............. ............... Cyclophosphamide 2.0 grm inj. ........... ........... ........... ........... ........... J9093................. N.............. ............... Cyclophosphamide lyophilized. ........... ........... ........... ........... ........... J9094................. B.............. ............... Cyclophosphamide lyophilized. ........... ........... ........... ........... ........... J9095................. B.............. ............... Cyclophosphamide lyophilized. ........... ........... ........... ........... ........... J9096................. B.............. ............... Cyclophosphamide lyophilized. ........... ........... ........... ........... ........... J9097................. B.............. ............... Cyclophosphamide lyophilized. ........... ........... ........... ........... ........... J9098................. K.............. ............... Cytarabine liposome..........

1166 ........... $366.43 ........... $73.29 J9100................. N.............. ............... Cytarabine hcl 100 MG inj.... ........... ........... ........... ........... ........... J9110................. B.............. ............... Cytarabine hcl 500 MG inj.... ........... ........... ........... ........... ........... J9120................. N.............. ............... Dactinomycin actinomycin d... ........... ........... ........... ........... ........... J9130................. K.............. ............... Dacarbazine 100 mg inj.......

0819 ...........

$6.20 ...........

$1.24 J9140................. B.............. ............... Dacarbazine 200 MG inj....... ........... ........... ........... ........... ........... J9150................. K.............. ............... Daunorubicin.................

0820 ........... $35.28 ...........

$7.06 J9151................. K.............. ............... Daunorubicin citrate liposom.

0821 ........... $57.56 ........... $11.51

[[Page 50864]]

J9160................. K.............. ............... Denileukin diftitox, 300 mcg.

1084 ........... $1,235.33 ........... $247.07 J9165................. N.............. ............... Diethylstilbestrol injection. ........... ........... ........... ........... ........... J9170................. K.............. ............... Docetaxel....................

0823 ........... $301.17 ........... $60.23 J9178................. K.............. ............... Inj, epirubicin hcl, 2 mg....

1167 ........... $25.15 ...........

$5.03 J9181................. N.............. ............... Etoposide 10 MG inj.......... ........... ........... ........... ........... ........... J9182................. B.............. ............... Etoposide 100 MG inj......... ........... ........... ........... ........... ........... J9185................. K.............. ............... Fludarabine phosphate inj....

0842 ........... $262.41 ........... $52.48 J9190................. N.............. ............... Fluorouracil injection....... ........... ........... ........... ........... ........... J9200................. K.............. ............... Floxuridine injection........

0827 ........... $60.17 ........... $12.03 J9201................. K.............. ............... Gemcitabine HCl..............

0828 ........... $117.45 ........... $23.49 J9202................. K.............. ............... Goserelin acetate implant....

0810 ........... $196.25 ........... $39.25 J9206................. K.............. ............... Irinotecan injection.........

0830 ........... $129.08 ........... $25.82 J9208................. K.............. ............... Ifosfomide injection.........

0831 ........... $53.54 ........... $10.71 J9209................. K.............. ............... Mesna injection..............

0732 ........... $13.68 ...........

$2.74 J9211................. K.............. ............... Idarubicin hcl injection.....

0832 ........... $314.00 ........... $62.80 J9212................. K.............. ............... Interferon alfacon-1.........

0912 ...........

$3.91 ...........

$0.78 J9213................. K.............. ............... Interferon alfa-2a inj.......

0834 ........... $31.75 ...........

$6.35 J9214................. K.............. ............... Interferon alfa-2b inj.......

0836 ........... $13.22 ...........

$2.64 J9215................. K.............. ............... Interferon alfa-n3 inj.......

0865 ...........

$8.77 ...........

$1.75 J9216................. K.............. ............... Interferon gamma 1-b inj.....

0838 ........... $277.79 ........... $55.56 J9217................. K.............. ............... Leuprolide acetate suspnsion.

9217 ........... $230.87 ........... $46.17 J9218................. K.............. ............... Leuprolide acetate injeciton.

0861 ........... $10.96 ...........

$2.19 J9219................. K.............. ............... Leuprolide acetate implant...

7051 ........... $2,262.19 ........... $452.44 J9230................. N.............. ............... Mechlorethamine hcl inj...... ........... ........... ........... ........... ........... J9245................. K.............. ............... Inj melphalan hydrochl 50 MG.

0840 ........... $523.22 ........... $104.64 J9250................. N.............. ............... Methotrexate sodium inj...... ........... ........... ........... ........... ........... J9260................. B.............. ............... Methotrexate sodium inj...... ........... ........... ........... ........... ........... J9263................. B.............. ............... Oxaliplatin.................. ........... ........... ........... ........... ........... J9265................. K.............. ............... Paclitaxel injection.........

0863 ........... $19.11 ...........

$3.82 J9266................. K.............. ............... Pegaspargase/singl dose vial.

0843 ........... $1,528.80 ........... $305.76 J9268................. K.............. ............... Pentostatin injection........

0844 ........... $1,868.91 ........... $373.78 J9270................. K.............. ............... Plicamycin (mithramycin) inj.

0860 ........... $80.54 ........... $16.11 J9280................. K.............. ............... Mitomycin 5 MG inj...........

0862 ........... $26.36 ...........

$5.27 J9290................. B.............. ............... Mitomycin 20 MG inj.......... ........... ........... ........... ........... ........... J9291................. B.............. ............... Mitomycin 40 MG inj.......... ........... ........... ........... ........... ........... J9293................. K.............. ............... Mitoxantrone hydrochl / 5 MG.

0864 ........... $329.69 ........... $65.94 J9300................. K.............. ............... Gemtuzumab ozogamicin........

9004 ........... $2,245.04 ........... $449.01 J9305................. G.............. ............... Pemetrexed injection.........

9213 ........... $41.29 ...........

$8.26 J9310................. K.............. ............... Rituximab cancer treatment...

0849 ........... $447.97 ........... $89.59 J9320................. K.............. ............... Streptozocin injection.......

0850 ........... $153.33 ........... $30.67 J9340................. K.............. ............... Thiotepa injection...........

0851 ........... $44.55 ...........

$8.91 J9350................. K.............. ............... Topotecan....................

0852 ........... $755.51 ........... $151.10 J9355................. K.............. ............... Trastuzumab..................

1613 ........... $53.98 ........... $10.80 J9357................. K.............. ............... Valrubicin, 200 mg...........

9167 ........... $376.87 ........... $75.37 J9360................. N.............. ............... Vinblastine sulfate inj...... ........... ........... ........... ........... ........... J9370................. N.............. ............... Vincristine sulfate 1 MG inj. ........... ........... ........... ........... ........... J9375................. B.............. ............... Vincristine sulfate 2 MG inj. ........... ........... ........... ........... ........... J9380................. B.............. ............... Vincristine sulfate 5 MG inj. ........... ........... ........... ........... ........... J9390................. K.............. ............... Vinorelbine tartrate/10 mg...

0855 ........... $62.85 ........... $12.57 J9395................. K.............. ............... Injection, Fulvestrant.......

9120 ........... $82.90 ........... $16.58 J9600................. K.............. ............... Porfimer sodium..............

0856 ........... $2,457.97 ........... $491.59 J9999................. N.............. ............... Chemotherapy drug............ ........... ........... ........... ........... ........... K0001................. Y.............. ............... Standard wheelchair.......... ........... ........... ........... ........... ........... K0002................. Y.............. ............... Stnd hemi (low seat) whlchr.. ........... ........... ........... ........... ........... K0003................. Y.............. ............... Lightweight wheelchair....... ........... ........... ........... ........... ........... K0004................. Y.............. ............... High strength ltwt whlchr.... ........... ........... ........... ........... ........... K0005................. Y.............. ............... Ultralightweight wheelchair.. ........... ........... ........... ........... ........... K0006................. Y.............. ............... Heavy duty wheelchair........ ........... ........... ........... ........... ........... K0007................. Y.............. ............... Extra heavy duty wheelchair.. ........... ........... ........... ........... ........... K0009................. Y.............. ............... Other manual wheelchair/base. ........... ........... ........... ........... ........... K0010................. Y.............. ............... Stnd wt frame power whlchr... ........... ........... ........... ........... ........... K0011................. Y.............. ............... Stnd wt pwr whlchr w control. ........... ........... ........... ........... ........... K0012................. Y.............. ............... Ltwt portbl power whlchr..... ........... ........... ........... ........... ........... K0014................. Y.............. ............... Other power whlchr base...... ........... ........... ........... ........... ........... K0015................. Y.............. ............... Detach non-adjus hght armrst. ........... ........... ........... ........... ........... K0017................. Y.............. ............... Detach adjust armrest base... ........... ........... ........... ........... ...........

[[Page 50865]]

K0018................. Y.............. ............... Detach adjust armrst upper... ........... ........... ........... ........... ........... K0019................. Y.............. ............... Arm pad each................. ........... ........... ........... ........... ........... K0020................. Y.............. ............... Fixed adjust armrest pair.... ........... ........... ........... ........... ........... K0037................. Y.............. ............... High mount flip-up footrest.. ........... ........... ........... ........... ........... K0038................. Y.............. ............... Leg strap each............... ........... ........... ........... ........... ........... K0039................. Y.............. ............... Leg strap h style each....... ........... ........... ........... ........... ........... K0040................. Y.............. ............... Adjustable angle footplate... ........... ........... ........... ........... ........... K0041................. Y.............. ............... Large size footplate each.... ........... ........... ........... ........... ........... K0042................. Y.............. ............... Standard size footplate each. ........... ........... ........... ........... ........... K0043................. Y.............. ............... Ftrst lower extension tube... ........... ........... ........... ........... ........... K0044................. Y.............. ............... Ftrst upper hanger bracket... ........... ........... ........... ........... ........... K0045................. Y.............. ............... Footrest complete assembly... ........... ........... ........... ........... ........... K0046................. Y.............. ............... Elevat legrst low extension.. ........... ........... ........... ........... ........... K0047................. Y.............. ............... Elevat legrst up hangr brack. ........... ........... ........... ........... ........... K0050................. Y.............. ............... Ratchet assembly............. ........... ........... ........... ........... ........... K0051................. Y.............. ............... Cam relese assem ftrst/lgrst. ........... ........... ........... ........... ........... K0052................. Y.............. ............... Swingaway detach footrest.... ........... ........... ........... ........... ........... K0053................. Y.............. ............... Elevate footrest articulate.. ........... ........... ........... ........... ........... K0056................. Y.............. ............... Seat ht =21 ltwt wc.. ........... ........... ........... ........... ........... K0064................. Y.............. ............... Zero pressure tube flat free. ........... ........... ........... ........... ........... K0065................. Y.............. ............... Spoke protectors............. ........... ........... ........... ........... ........... K0066................. Y.............. ............... Solid tire any size each..... ........... ........... ........... ........... ........... K0067................. Y.............. ............... Pneumatic tire any size each. ........... ........... ........... ........... ........... K0068................. Y.............. ............... Pneumatic tire tube each..... ........... ........... ........... ........... ........... K0069................. Y.............. ............... Rear whl complete solid tire. ........... ........... ........... ........... ........... K0070................. Y.............. ............... Rear whl compl pneum tire.... ........... ........... ........... ........... ........... K0071................. Y.............. ............... Front castr compl pneum tire. ........... ........... ........... ........... ........... K0072................. Y.............. ............... Frnt cstr cmpl sem-pneum tir. ........... ........... ........... ........... ........... K0073................. Y.............. ............... Caster pin lock each......... ........... ........... ........... ........... ........... K0074................. Y.............. ............... Pneumatic caster tire each... ........... ........... ........... ........... ........... K0075................. Y.............. ............... Semi-pneumatic caster tire... ........... ........... ........... ........... ........... K0076................. Y.............. ............... Solid caster tire each....... ........... ........... ........... ........... ........... K0077................. Y.............. ............... Front caster assem complete.. ........... ........... ........... ........... ........... K0078................. Y.............. ............... Pneumatic caster tire tube... ........... ........... ........... ........... ........... K0090................. Y.............. ............... Rear tire power wheelchair... ........... ........... ........... ........... ........... K0091................. Y.............. ............... Rear tire tube power whlchr.. ........... ........... ........... ........... ........... K0092................. Y.............. ............... Rear assem cmplt powr whlchr. ........... ........... ........... ........... ........... K0093................. Y.............. ............... Rear zero pressure tire tube. ........... ........... ........... ........... ........... K0094................. Y.............. ............... Wheel tire for power base.... ........... ........... ........... ........... ........... K0095................. Y.............. ............... Wheel tire tube each base.... ........... ........... ........... ........... ........... K0096................. Y.............. ............... Wheel assem powr base complt. ........... ........... ........... ........... ........... K0097................. Y.............. ............... Wheel zero presure tire tube. ........... ........... ........... ........... ........... K0098................. Y.............. ............... Drive belt power wheelchair.. ........... ........... ........... ........... ........... K0099................. Y.............. ............... Pwr wheelchair front caster.. ........... ........... ........... ........... ........... K0102................. Y.............. ............... Crutch and cane holder....... ........... ........... ........... ........... ........... K0104................. Y.............. ............... Cylinder tank carrier........ ........... ........... ........... ........... ........... K0105................. Y.............. ............... Iv hanger.................... ........... ........... ........... ........... ........... K0106................. Y.............. ............... Arm trough each.............. ........... ........... ........... ........... ........... K0108................. Y.............. ............... W/c component-accessory NOS.. ........... ........... ........... ........... ........... K0195................. Y.............. ............... Elevating whlchair leg rests. ........... ........... ........... ........... ........... K0415................. B.............. ............... RX antiemetic drg, oral NOS.. ........... ........... ........... ........... ........... K0416................. B.............. ............... Rx antiemetic drg,rectal NOS. ........... ........... ........... ........... ........... K0452................. Y.............. ............... Wheelchair bearings.......... ........... ........... ........... ........... ........... K0455................. Y.............. ............... Pump uninterrupted infusion.. ........... ........... ........... ........... ........... K0462................. Y.............. ............... Temporary replacement eqpmnt. ........... ........... ........... ........... ........... K0552................. Y.............. ............... Supply/Ext inf pump syr type. ........... ........... ........... ........... ........... K0600................. Y.............. ............... Functional neuromuscularstim. ........... ........... ........... ........... ........... K0601................. Y.............. ............... Repl batt silver oxide 1.5 v. ........... ........... ........... ........... ........... K0602................. Y.............. ............... Repl batt silver oxide 3 v... ........... ........... ........... ........... ........... K0603................. Y.............. ............... Repl batt alkaline 1.5 v..... ........... ........... ........... ........... ........... K0604................. Y.............. ............... Repl batt lithium 3.6 v...... ........... ........... ........... ........... ........... K0605................. Y.............. ............... Repl batt lithium 4.5 v...... ........... ........... ........... ........... ........... K0606................. Y.............. ............... AED garment w/elec analysis.. ........... ........... ........... ........... ........... K0607................. Y.............. ............... Repl batt for AED............ ........... ........... ........... ........... ........... K0608................. Y.............. ............... Repl garment for AED......... ........... ........... ........... ........... ........... K0609................. Y.............. ............... Repl electrode for AED....... ........... ........... ........... ........... ...........

[[Page 50866]]

K0618................. A.............. ............... TLSO 2 piece rigid shell..... ........... ........... ........... ........... ........... K0619................. A.............. ............... TLSO 3 piece rigid shell..... ........... ........... ........... ........... ........... K0620................. A.............. ............... Tubular elastic dressing..... ........... ........... ........... ........... ........... K0628................. Y.............. ............... Mult dens insert direct form. ........... ........... ........... ........... ........... K0629................. Y.............. ............... Mult dens insert custom mold. ........... ........... ........... ........... ........... K0630................. Y.............. ............... SIO flex pelvisacral prefab.. ........... ........... ........... ........... ........... K0631................. Y.............. ............... SIO flex pelvisacral custom.. ........... ........... ........... ........... ........... K0632................. Y.............. ............... SIO panel prefab............. ........... ........... ........... ........... ........... K0633................. Y.............. ............... SIO panel custom............. ........... ........... ........... ........... ........... K0634................. Y.............. ............... LO flexibl L1 - below L5 pre. ........... ........... ........... ........... ........... K0635................. Y.............. ............... LO sag stays/panels pre-fab.. ........... ........... ........... ........... ........... K0636................. Y.............. ............... LO sagitt rigid panel prefab. ........... ........... ........... ........... ........... K0637................. Y.............. ............... LO flex w/o rigid stays pre.. ........... ........... ........... ........... ........... K0638................. Y.............. ............... LSO flex w/rigid stays cust.. ........... ........... ........... ........... ........... K0639................. Y.............. ............... LSO post rigid panel pre..... ........... ........... ........... ........... ........... K0640................. Y.............. ............... LSO sag-coro rigid frame pre. ........... ........... ........... ........... ........... K0641................. Y.............. ............... LSO sag-cor rigid frame cust. ........... ........... ........... ........... ........... K0642................. Y.............. ............... LSO flexion control prefab... ........... ........... ........... ........... ........... K0643................. Y.............. ............... LSO flexion control custom... ........... ........... ........... ........... ........... K0644................. Y.............. ............... LSO sagit rigid panel prefab. ........... ........... ........... ........... ........... K0645................. Y.............. ............... LSO sagittal rigid panel cus. ........... ........... ........... ........... ........... K0646................. Y.............. ............... LSO sag-coronal panel prefab. ........... ........... ........... ........... ........... K0647................. Y.............. ............... LSO sag-coronal panel custom. ........... ........... ........... ........... ........... K0648................. Y.............. ............... LSO s/c shell/panel prefab... ........... ........... ........... ........... ........... K0649................. Y.............. ............... LSO s/c shell/panel custom... ........... ........... ........... ........... ........... K0669................. Y.............. ............... W/c seat/back no CVR SADMERC. ........... ........... ........... ........... ........... K0670................. A.............. ............... Stance phase only............ ........... ........... ........... ........... ........... K0671................. Y.............. ............... Portable oxygen concentrator. ........... ........... ........... ........... ........... L0100................. A.............. ............... Cranial orthosis/helmet mold. ........... ........... ........... ........... ........... L0110................. A.............. ............... Cranial orthosis/helmet nonm. ........... ........... ........... ........... ........... L0112................. A.............. ............... Cranial cervical orthosis.... ........... ........... ........... ........... ........... L0120................. A.............. ............... Cerv flexible non-adjustable. ........... ........... ........... ........... ........... L0130................. A.............. ............... Flex thermoplastic collar mo. ........... ........... ........... ........... ........... L0140................. A.............. ............... Cervical semi-rigid adjustab. ........... ........... ........... ........... ........... L0150................. A.............. ............... Cerv semi-rig adj molded chn. ........... ........... ........... ........... ........... L0160................. A.............. ............... Cerv semi-rig wire occ/mand.. ........... ........... ........... ........... ........... L0170................. A.............. ............... Cervical collar molded to pt. ........... ........... ........... ........... ........... L0172................. A.............. ............... Cerv col thermplas foam 2 pi. ........... ........... ........... ........... ........... L0174................. A.............. ............... Cerv col foam 2 piece w thor. ........... ........... ........... ........... ........... L0180................. A.............. ............... Cer post col occ/man sup adj. ........... ........... ........... ........... ........... L0190................. A.............. ............... Cerv collar supp adj cerv ba. ........... ........... ........... ........... ........... L0200................. A.............. ............... Cerv col supp adj bar & thor. ........... ........... ........... ........... ........... L0210................. A.............. ............... Thoracic rib belt............ ........... ........... ........... ........... ........... L0220................. A.............. ............... Thor rib belt custom fabrica. ........... ........... ........... ........... ........... L0430................. A.............. ............... Dewall posture protector..... ........... ........... ........... ........... ........... L0450................. A.............. ............... TLSO flex prefab thoracic.... ........... ........... ........... ........... ........... L0452................. A.............. ............... tlso flex custom fab thoraci. ........... ........... ........... ........... ........... L0454................. A.............. ............... TLSO flex prefab sacrococ-T9. ........... ........... ........... ........... ........... L0456................. A.............. ............... TLSO flex prefab............. ........... ........... ........... ........... ........... L0458................. A.............. ............... TLSO 2Mod symphis-xipho pre.. ........... ........... ........... ........... ........... L0460................. A.............. ............... TLSO2Mod symphysis-stern pre. ........... ........... ........... ........... ........... L0462................. A.............. ............... TLSO 3Mod sacro-scap pre..... ........... ........... ........... ........... ........... L0464................. A.............. ............... TLSO 4Mod sacro-scap pre..... ........... ........... ........... ........... ........... L0466................. A.............. ............... TLSO rigid frame pre soft ap. ........... ........... ........... ........... ........... L0468................. A.............. ............... TLSO rigid frame prefab pelv. ........... ........... ........... ........... ........... L0470................. A.............. ............... TLSO rigid frame pre subclav. ........... ........... ........... ........... ........... L0472................. A.............. ............... TLSO rigid frame hyperex pre. ........... ........... ........... ........... ........... L0480................. A.............. ............... TLSO rigid plastic custom fa. ........... ........... ........... ........... ........... L0482................. A.............. ............... TLSO rigid lined custom fab.. ........... ........... ........... ........... ........... L0484................. A.............. ............... TLSO rigid plastic cust fab.. ........... ........... ........... ........... ........... L0486................. A.............. ............... TLSO rigidlined cust fab two. ........... ........... ........... ........... ........... L0488................. A.............. ............... TLSO rigid lined pre one pie. ........... ........... ........... ........... ........... L0490................. A.............. ............... TLSO rigid plastic pre one... ........... ........... ........... ........... ........... L0700................. A.............. ............... Ctlso a-p-l control molded... ........... ........... ........... ........... ........... L0710................. A.............. ............... Ctlso a-p-l control w/ inter. ........... ........... ........... ........... ........... L0810................. A.............. ............... Halo cervical into jckt vest. ........... ........... ........... ........... ...........

[[Page 50867]]

L0820................. A.............. ............... Halo cervical into body jack. ........... ........... ........... ........... ........... L0830................. A.............. ............... Halo cerv into milwaukee typ. ........... ........... ........... ........... ........... L0860................. A.............. ............... Magnetic resonanc image comp. ........... ........... ........... ........... ........... L0861................. A.............. ............... Halo repl liner/interface.... ........... ........... ........... ........... ........... L0960................. E.............. ............... Post surgical support pads... ........... ........... ........... ........... ........... L0970................. A.............. ............... Tlso corset front............ ........... ........... ........... ........... ........... L0972................. A.............. ............... Lso corset front............. ........... ........... ........... ........... ........... L0974................. A.............. ............... Tlso full corset............. ........... ........... ........... ........... ........... L0976................. A.............. ............... Lso full corset.............. ........... ........... ........... ........... ........... L0978................. A.............. ............... Axillary crutch extension.... ........... ........... ........... ........... ........... L0980................. A.............. ............... Peroneal straps pair......... ........... ........... ........... ........... ........... L0982................. A.............. ............... Stocking supp grips set of f. ........... ........... ........... ........... ........... L0984................. A.............. ............... Protective body sock each.... ........... ........... ........... ........... ........... L0999................. A.............. ............... Add to spinal orthosis NOS... ........... ........... ........... ........... ........... L1000................. A.............. ............... Ctlso milwauke initial model. ........... ........... ........... ........... ........... L1005................. A.............. ............... Tension based scoliosis orth. ........... ........... ........... ........... ........... L1010................. A.............. ............... Ctlso axilla sling........... ........... ........... ........... ........... ........... L1020................. A.............. ............... Kyphosis pad................. ........... ........... ........... ........... ........... L1025................. A.............. ............... Kyphosis pad floating........ ........... ........... ........... ........... ........... L1030................. A.............. ............... Lumbar bolster pad........... ........... ........... ........... ........... ........... L1040................. A.............. ............... Lumbar or lumbar rib pad..... ........... ........... ........... ........... ........... L1050................. A.............. ............... Sternal pad.................. ........... ........... ........... ........... ........... L1060................. A.............. ............... Thoracic pad................. ........... ........... ........... ........... ........... L1070................. A.............. ............... Trapezius sling.............. ........... ........... ........... ........... ........... L1080................. A.............. ............... Outrigger.................... ........... ........... ........... ........... ........... L1085................. A.............. ............... Outrigger bil w/ vert extens. ........... ........... ........... ........... ........... L1090................. A.............. ............... Lumbar sling................. ........... ........... ........... ........... ........... L1100................. A.............. ............... Ring flange plastic/leather.. ........... ........... ........... ........... ........... L1110................. A.............. ............... Ring flange plas/leather mol. ........... ........... ........... ........... ........... L1120................. A.............. ............... Covers for upright each...... ........... ........... ........... ........... ........... L1200................. A.............. ............... Furnsh initial orthosis only. ........... ........... ........... ........... ........... L1210................. A.............. ............... Lateral thoracic extension... ........... ........... ........... ........... ........... L1220................. A.............. ............... Anterior thoracic extension.. ........... ........... ........... ........... ........... L1230................. A.............. ............... Milwaukee type superstructur. ........... ........... ........... ........... ........... L1240................. A.............. ............... Lumbar derotation pad........ ........... ........... ........... ........... ........... L1250................. A.............. ............... Anterior asis pad............ ........... ........... ........... ........... ........... L1260................. A.............. ............... Anterior thoracic derotation. ........... ........... ........... ........... ........... L1270................. A.............. ............... Abdominal pad................ ........... ........... ........... ........... ........... L1280................. A.............. ............... Rib gusset (elastic) each.... ........... ........... ........... ........... ........... L1290................. A.............. ............... Lateral trochanteric pad..... ........... ........... ........... ........... ........... L1300................. A.............. ............... Body jacket mold to patient.. ........... ........... ........... ........... ........... L1310................. A.............. ............... Post-operative body jacket... ........... ........... ........... ........... ........... L1499................. A.............. ............... Spinal orthosis NOS.......... ........... ........... ........... ........... ........... L1500................. A.............. ............... Thkao mobility frame......... ........... ........... ........... ........... ........... L1510................. A.............. ............... Thkao standing frame......... ........... ........... ........... ........... ........... L1520................. A.............. ............... Thkao swivel walker.......... ........... ........... ........... ........... ........... L1600................. A.............. ............... Abduct hip flex frejka w cvr. ........... ........... ........... ........... ........... L1610................. A.............. ............... Abduct hip flex frejka covr.. ........... ........... ........... ........... ........... L1620................. A.............. ............... Abduct hip flex pavlik harne. ........... ........... ........... ........... ........... L1630................. A.............. ............... Abduct control hip semi-flex. ........... ........... ........... ........... ........... L1640................. A.............. ............... Pelv band/spread bar thigh c. ........... ........... ........... ........... ........... L1650................. A.............. ............... HO abduction hip adjustable.. ........... ........... ........... ........... ........... L1652................. A.............. ............... HO bi thighcuffs w sprdr bar. ........... ........... ........... ........... ........... L1660................. A.............. ............... HO abduction static plastic.. ........... ........... ........... ........... ........... L1680................. A.............. ............... Pelvic & hip control thigh c. ........... ........... ........... ........... ........... L1685................. A.............. ............... Post-op hip abduct custom fa. ........... ........... ........... ........... ........... L1686................. A.............. ............... HO post-op hip abduction..... ........... ........... ........... ........... ........... L1690................. A.............. ............... Combination bilateral HO..... ........... ........... ........... ........... ........... L1700................. A.............. ............... Leg perthes orth toronto typ. ........... ........... ........... ........... ........... L1710................. A.............. ............... Legg perthes orth newington.. ........... ........... ........... ........... ........... L1720................. A.............. ............... Legg perthes orthosis trilat. ........... ........... ........... ........... ........... L1730................. A.............. ............... Legg perthes orth scottish r. ........... ........... ........... ........... ........... L1750................. A.............. ............... Legg perthes sling........... ........... ........... ........... ........... ........... L1755................. A.............. ............... Legg perthes patten bottom t. ........... ........... ........... ........... ........... L1800................. A.............. ............... Knee orthoses elas w stays... ........... ........... ........... ........... ........... L1810................. A.............. ............... Ko elastic with joints....... ........... ........... ........... ........... ...........

[[Page 50868]]

L1815................. A.............. ............... Elastic with condylar pads... ........... ........... ........... ........... ........... L1820................. A.............. ............... Ko elas w/ condyle pads & jo. ........... ........... ........... ........... ........... L1825................. A.............. ............... Ko elastic knee cap.......... ........... ........... ........... ........... ........... L1830................. A.............. ............... Ko immobilizer canvas longit. ........... ........... ........... ........... ........... L1831................. A.............. ............... Knee orth pos locking joint.. ........... ........... ........... ........... ........... L1832................. A.............. ............... KO adj jnt pos rigid support. ........... ........... ........... ........... ........... L1834................. A.............. ............... Ko w/0 joint rigid molded to. ........... ........... ........... ........... ........... L1836................. A.............. ............... Rigid KO wo joints........... ........... ........... ........... ........... ........... L1840................. A.............. ............... Ko derot ant cruciate custom. ........... ........... ........... ........... ........... L1843................. A.............. ............... KO single upright custom fit. ........... ........... ........... ........... ........... L1844................. A.............. ............... Ko w/adj jt rot cntrl molded. ........... ........... ........... ........... ........... L1845................. A.............. ............... Ko w/ adj flex/ext rotat cus. ........... ........... ........... ........... ........... L1846................. A.............. ............... Ko w adj flex/ext rotat mold. ........... ........... ........... ........... ........... L1847................. A.............. ............... KO adjustable w air chambers. ........... ........... ........... ........... ........... L1850................. A.............. ............... Ko swedish type.............. ........... ........... ........... ........... ........... L1855................. A.............. ............... Ko plas doub upright jnt mol. ........... ........... ........... ........... ........... L1858................. A.............. ............... Ko polycentric pneumatic pad. ........... ........... ........... ........... ........... L1860................. A.............. ............... Ko supracondylar socket mold. ........... ........... ........... ........... ........... L1870................. A.............. ............... Ko doub upright lacers molde. ........... ........... ........... ........... ........... L1880................. A.............. ............... Ko doub upright cuffs/lacers. ........... ........... ........... ........... ........... L1900................. A.............. ............... Afo sprng wir drsflx calf bd. ........... ........... ........... ........... ........... L1901................. A.............. ............... Prefab ankle orthosis........ ........... ........... ........... ........... ........... L1902................. A.............. ............... Afo ankle gauntlet........... ........... ........... ........... ........... ........... L1904................. A.............. ............... Afo molded ankle gauntlet.... ........... ........... ........... ........... ........... L1906................. A.............. ............... Afo multiligamentus ankle su. ........... ........... ........... ........... ........... L1907................. A.............. ............... AFO supramalleolar custom.... ........... ........... ........... ........... ........... L1910................. A.............. ............... Afo sing bar clasp attach sh. ........... ........... ........... ........... ........... L1920................. A.............. ............... Afo sing upright w/ adjust s. ........... ........... ........... ........... ........... L1930................. A.............. ............... Afo plastic.................. ........... ........... ........... ........... ........... L1932................. A.............. ............... Afo rig ant tib prefab TCF/=. ........... ........... ........... ........... ........... L1940................. A.............. ............... Afo molded to patient plasti. ........... ........... ........... ........... ........... L1945................. A.............. ............... Afo molded plas rig ant tib.. ........... ........... ........... ........... ........... L1950................. A.............. ............... Afo spiral molded to pt plas. ........... ........... ........... ........... ........... L1951................. A.............. ............... AFO spiral prefabricated..... ........... ........... ........... ........... ........... L1960................. A.............. ............... Afo pos solid ank plastic mo. ........... ........... ........... ........... ........... L1970................. A.............. ............... Afo plastic molded w/ankle j. ........... ........... ........... ........... ........... L1971................. A.............. ............... AFO w/ankle joint, prefab.... ........... ........... ........... ........... ........... L1980................. A.............. ............... Afo sing solid stirrup calf.. ........... ........... ........... ........... ........... L1990................. A.............. ............... Afo doub solid stirrup calf.. ........... ........... ........... ........... ........... L2000................. A.............. ............... Kafo sing fre stirr thi/calf. ........... ........... ........... ........... ........... L2005................. A.............. ............... KAFO sng/dbl mechanical act.. ........... ........... ........... ........... ........... L2010................. A.............. ............... Kafo sng solid stirrup w/o j. ........... ........... ........... ........... ........... L2020................. A.............. ............... Kafo dbl solid stirrup band/. ........... ........... ........... ........... ........... L2030................. A.............. ............... Kafo dbl solid stirrup w/o j. ........... ........... ........... ........... ........... L2035................. A.............. ............... KAFO plastic pediatric size.. ........... ........... ........... ........... ........... L2036................. A.............. ............... Kafo plas doub free knee mol. ........... ........... ........... ........... ........... L2037................. A.............. ............... Kafo plas sing free knee mol. ........... ........... ........... ........... ........... L2038................. A.............. ............... Kafo w/o joint multi-axis an. ........... ........... ........... ........... ........... L2039................. A.............. ............... KAFO,plstic,medlat rotat con. ........... ........... ........... ........... ........... L2040................. A.............. ............... Hkafo torsion bil rot straps. ........... ........... ........... ........... ........... L2050................. A.............. ............... Hkafo torsion cable hip pelv. ........... ........... ........... ........... ........... L2060................. A.............. ............... Hkafo torsion ball bearing j. ........... ........... ........... ........... ........... L2070................. A.............. ............... Hkafo torsion unilat rot str. ........... ........... ........... ........... ........... L2080................. A.............. ............... Hkafo unilat torsion cable... ........... ........... ........... ........... ........... L2090................. A.............. ............... Hkafo unilat torsion ball br. ........... ........... ........... ........... ........... L2106................. A.............. ............... Afo tib fx cast plaster mold. ........... ........... ........... ........... ........... L2108................. A.............. ............... Afo tib fx cast molded to pt. ........... ........... ........... ........... ........... L2112................. A.............. ............... Afo tibial fracture soft..... ........... ........... ........... ........... ........... L2114................. A.............. ............... Afo tib fx semi-rigid........ ........... ........... ........... ........... ........... L2116................. A.............. ............... Afo tibial fracture rigid.... ........... ........... ........... ........... ........... L2126................. A.............. ............... Kafo fem fx cast thermoplas.. ........... ........... ........... ........... ........... L2128................. A.............. ............... Kafo fem fx cast molded to p. ........... ........... ........... ........... ........... L2132................. A.............. ............... Kafo femoral fx cast soft.... ........... ........... ........... ........... ........... L2134................. A.............. ............... Kafo fem fx cast semi-rigid.. ........... ........... ........... ........... ........... L2136................. A.............. ............... Kafo femoral fx cast rigid... ........... ........... ........... ........... ........... L2180................. A.............. ............... Plas shoe insert w ank joint. ........... ........... ........... ........... ...........

[[Page 50869]]

L2182................. A.............. ............... Drop lock knee............... ........... ........... ........... ........... ........... L2184................. A.............. ............... Limited motion knee joint.... ........... ........... ........... ........... ........... L2186................. A.............. ............... Adj motion knee jnt lerman t. ........... ........... ........... ........... ........... L2188................. A.............. ............... Quadrilateral brim........... ........... ........... ........... ........... ........... L2190................. A.............. ............... Waist belt................... ........... ........... ........... ........... ........... L2192................. A.............. ............... Pelvic band & belt thigh fla. ........... ........... ........... ........... ........... L2200................. A.............. ............... Limited ankle motion ea jnt.. ........... ........... ........... ........... ........... L2210................. A.............. ............... Dorsiflexion assist each joi. ........... ........... ........... ........... ........... L2220................. A.............. ............... Dorsi & plantar flex ass/res. ........... ........... ........... ........... ........... L2230................. A.............. ............... Split flat caliper stirr & p. ........... ........... ........... ........... ........... L2232................. A.............. ............... Rocker bottom, contact AFO... ........... ........... ........... ........... ........... L2240................. A.............. ............... Round caliper and plate atta. ........... ........... ........... ........... ........... L2250................. A.............. ............... Foot plate molded stirrup at. ........... ........... ........... ........... ........... L2260................. A.............. ............... Reinforced solid stirrup..... ........... ........... ........... ........... ........... L2265................. A.............. ............... Long tongue stirrup.......... ........... ........... ........... ........... ........... L2270................. A.............. ............... Varus/valgus strap padded/li. ........... ........... ........... ........... ........... L2275................. A.............. ............... Plastic mod low ext pad/line. ........... ........... ........... ........... ........... L2280................. A.............. ............... Molded inner boot............ ........... ........... ........... ........... ........... L2300................. A.............. ............... Abduction bar jointed adjust. ........... ........... ........... ........... ........... L2310................. A.............. ............... Abduction bar-straight....... ........... ........... ........... ........... ........... L2320................. A.............. ............... Non-molded lacer............. ........... ........... ........... ........... ........... L2330................. A.............. ............... Lacer molded to patient mode. ........... ........... ........... ........... ........... L2335................. A.............. ............... Anterior swing band.......... ........... ........... ........... ........... ........... L2340................. A.............. ............... Pre-tibial shell molded to p. ........... ........... ........... ........... ........... L2350................. A.............. ............... Prosthetic type socket molde. ........... ........... ........... ........... ........... L2360................. A.............. ............... Extended steel shank......... ........... ........... ........... ........... ........... L2370................. A.............. ............... Patten bottom................ ........... ........... ........... ........... ........... L2375................. A.............. ............... Torsion ank & half solid sti. ........... ........... ........... ........... ........... L2380................. A.............. ............... Torsion straight knee joint.. ........... ........... ........... ........... ........... L2385................. A.............. ............... Straight knee joint heavy du. ........... ........... ........... ........... ........... L2390................. A.............. ............... Offset knee joint each....... ........... ........... ........... ........... ........... L2395................. A.............. ............... Offset knee joint heavy duty. ........... ........... ........... ........... ........... L2397................. A.............. ............... Suspension sleeve lower ext.. ........... ........... ........... ........... ........... L2405................. A.............. ............... Knee joint drop lock ea jnt.. ........... ........... ........... ........... ........... L2415................. A.............. ............... Knee joint cam lock each joi. ........... ........... ........... ........... ........... L2425................. A.............. ............... Knee disc/dial lock/adj flex. ........... ........... ........... ........... ........... L2430................. A.............. ............... Knee jnt ratchet lock ea jnt. ........... ........... ........... ........... ........... L2492................. A.............. ............... Knee lift loop drop lock rin. ........... ........... ........... ........... ........... L2500................. A.............. ............... Thi/glut/ischia wgt bearing.. ........... ........... ........... ........... ........... L2510................. A.............. ............... Th/wght bear quad-lat brim m. ........... ........... ........... ........... ........... L2520................. A.............. ............... Th/wght bear quad-lat brim c. ........... ........... ........... ........... ........... L2525................. A.............. ............... Th/wght bear nar m-l brim mo. ........... ........... ........... ........... ........... L2526................. A.............. ............... Th/wght bear nar m-l brim cu. ........... ........... ........... ........... ........... L2530................. A.............. ............... Thigh/wght bear lacer non-mo. ........... ........... ........... ........... ........... L2540................. A.............. ............... Thigh/wght bear lacer molded. ........... ........... ........... ........... ........... L2550................. A.............. ............... Thigh/wght bear high roll cu. ........... ........... ........... ........... ........... L2570................. A.............. ............... Hip clevis type 2 posit jnt.. ........... ........... ........... ........... ........... L2580................. A.............. ............... Pelvic control pelvic sling.. ........... ........... ........... ........... ........... L2600................. A.............. ............... Hip clevis/thrust bearing fr. ........... ........... ........... ........... ........... L2610................. A.............. ............... Hip clevis/thrust bearing lo. ........... ........... ........... ........... ........... L2620................. A.............. ............... Pelvic control hip heavy dut. ........... ........... ........... ........... ........... L2622................. A.............. ............... Hip joint adjustable flexion. ........... ........... ........... ........... ........... L2624................. A.............. ............... Hip adj flex ext abduct cont. ........... ........... ........... ........... ........... L2627................. A.............. ............... Plastic mold recipro hip & c. ........... ........... ........... ........... ........... L2628................. A.............. ............... Metal frame recipro hip & ca. ........... ........... ........... ........... ........... L2630................. A.............. ............... Pelvic control band & belt u. ........... ........... ........... ........... ........... L2640................. A.............. ............... Pelvic control band & belt b. ........... ........... ........... ........... ........... L2650................. A.............. ............... Pelv & thor control gluteal.. ........... ........... ........... ........... ........... L2660................. A.............. ............... Thoracic control thoracic ba. ........... ........... ........... ........... ........... L2670................. A.............. ............... Thorac cont paraspinal uprig. ........... ........... ........... ........... ........... L2680................. A.............. ............... Thorac cont lat support upri. ........... ........... ........... ........... ........... L2750................. A.............. ............... Plating chrome/nickel pr bar. ........... ........... ........... ........... ........... L2755................. A.............. ............... Carbon graphite lamination... ........... ........... ........... ........... ........... L2760................. A.............. ............... Extension per extension per.. ........... ........... ........... ........... ........... L2768................. A.............. ............... Ortho sidebar disconnect..... ........... ........... ........... ........... ........... L2770................. A.............. ............... Low ext orthosis per bar/jnt. ........... ........... ........... ........... ...........

[[Page 50870]]

L2780................. A.............. ............... Non-corrosive finish......... ........... ........... ........... ........... ........... L2785................. A.............. ............... Drop lock retainer each...... ........... ........... ........... ........... ........... L2795................. A.............. ............... Knee control full kneecap.... ........... ........... ........... ........... ........... L2800................. A.............. ............... Knee cap medial or lateral p. ........... ........... ........... ........... ........... L2810................. A.............. ............... Knee control condylar pad.... ........... ........... ........... ........... ........... L2820................. A.............. ............... Soft interface below knee se. ........... ........... ........... ........... ........... L2830................. A.............. ............... Soft interface above knee se. ........... ........... ........... ........... ........... L2840................. A.............. ............... Tibial length sock fx or equ. ........... ........... ........... ........... ........... L2850................. A.............. ............... Femoral lgth sock fx or equa. ........... ........... ........... ........... ........... L2860................. A.............. ............... Torsion mechanism knee/ankle. ........... ........... ........... ........... ........... L2999................. A.............. ............... Lower extremity orthosis NOS. ........... ........... ........... ........... ........... L3000................. B.............. ............... Ft insert ucb berkeley shell. ........... ........... ........... ........... ........... L3001................. B.............. ............... Foot insert remov molded spe. ........... ........... ........... ........... ........... L3002................. B.............. ............... Foot insert plastazote or eq. ........... ........... ........... ........... ........... L3003................. B.............. ............... Foot insert silicone gel eac. ........... ........... ........... ........... ........... L3010................. B.............. ............... Foot longitudinal arch suppo. ........... ........... ........... ........... ........... L3020................. B.............. ............... Foot longitud/metatarsal sup. ........... ........... ........... ........... ........... L3030................. B.............. ............... Foot arch support remov prem. ........... ........... ........... ........... ........... L3031................. E.............. ............... Foot lamin/prepreg composite. ........... ........... ........... ........... ........... L3040................. B.............. ............... Ft arch suprt premold longit. ........... ........... ........... ........... ........... L3050................. B.............. ............... Foot arch supp premold metat. ........... ........... ........... ........... ........... L3060................. B.............. ............... Foot arch supp longitud/meta. ........... ........... ........... ........... ........... L3070................. B.............. ............... Arch suprt att to sho longit. ........... ........... ........... ........... ........... L3080................. B.............. ............... Arch supp att to shoe metata. ........... ........... ........... ........... ........... L3090................. B.............. ............... Arch supp att to shoe long/m. ........... ........... ........... ........... ........... L3100................. B.............. ............... Hallus-valgus nght dynamic s. ........... ........... ........... ........... ........... L3140................. B.............. ............... Abduction rotation bar shoe.. ........... ........... ........... ........... ........... L3150................. B.............. ............... Abduct rotation bar w/o shoe. ........... ........... ........... ........... ........... L3160................. B.............. ............... Shoe styled positioning dev.. ........... ........... ........... ........... ........... L3170................. B.............. ............... Foot plastic heel stabilizer. ........... ........... ........... ........... ........... L3201................. B.............. ............... Oxford w supinat/pronat inf.. ........... ........... ........... ........... ........... L3202................. B.............. ............... Oxford w/ supinat/pronator c. ........... ........... ........... ........... ........... L3203................. B.............. ............... Oxford w/ supinator/pronator. ........... ........... ........... ........... ........... L3204................. B.............. ............... Hightop w/ supp/pronator inf. ........... ........... ........... ........... ........... L3206................. B.............. ............... Hightop w/ supp/pronator chi. ........... ........... ........... ........... ........... L3207................. B.............. ............... Hightop w/ supp/pronator jun. ........... ........... ........... ........... ........... L3208................. B.............. ............... Surgical boot each infant.... ........... ........... ........... ........... ........... L3209................. B.............. ............... Surgical boot each child..... ........... ........... ........... ........... ........... L3211................. B.............. ............... Surgical boot each junior.... ........... ........... ........... ........... ........... L3212................. B.............. ............... Benesch boot pair infant..... ........... ........... ........... ........... ........... L3213................. B.............. ............... Benesch boot pair child...... ........... ........... ........... ........... ........... L3214................. B.............. ............... Benesch boot pair junior..... ........... ........... ........... ........... ........... L3215................. B.............. ............... Orthopedic ftwear ladies oxf. ........... ........... ........... ........... ........... L3216................. B.............. ............... Orthoped ladies shoes dpth i. ........... ........... ........... ........... ........... L3217................. B.............. ............... Ladies shoes hightop depth i. ........... ........... ........... ........... ........... L3219................. B.............. ............... Orthopedic mens shoes oxford. ........... ........... ........... ........... ........... L3221................. B.............. ............... Orthopedic mens shoes dpth i. ........... ........... ........... ........... ........... L3222................. B.............. ............... Mens shoes hightop depth inl. ........... ........... ........... ........... ........... L3224................. A.............. ............... Womans shoe oxford brace..... ........... ........... ........... ........... ........... L3225................. A.............. ............... Mans shoe oxford brace....... ........... ........... ........... ........... ........... L3230................. B.............. ............... Custom shoes depth inlay..... ........... ........... ........... ........... ........... L3250................. B.............. ............... Custom mold shoe remov prost. ........... ........... ........... ........... ........... L3251................. B.............. ............... Shoe molded to pt silicone s. ........... ........... ........... ........... ........... L3252................. B.............. ............... Shoe molded plastazote cust.. ........... ........... ........... ........... ........... L3253................. B.............. ............... Shoe molded plastazote cust.. ........... ........... ........... ........... ........... L3254................. B.............. ............... Orth foot non-stndard size/w. ........... ........... ........... ........... ........... L3255................. B.............. ............... Orth foot non-standard size/. ........... ........... ........... ........... ........... L3257................. B.............. ............... Orth foot add charge split s. ........... ........... ........... ........... ........... L3260................. B.............. ............... Ambulatory surgical boot eac. ........... ........... ........... ........... ........... L3265................. B.............. ............... Plastazote sandal each....... ........... ........... ........... ........... ........... L3300................. B.............. ............... Sho lift taper to metatarsal. ........... ........... ........... ........... ........... L3310................. B.............. ............... Shoe lift elev heel/sole neo. ........... ........... ........... ........... ........... L3320................. B.............. ............... Shoe lift elev heel/sole cor. ........... ........... ........... ........... ........... L3330................. B.............. ............... Lifts elevation metal extens. ........... ........... ........... ........... ........... L3332................. B.............. ............... Shoe lifts tapered to one-ha. ........... ........... ........... ........... ........... L3334................. B.............. ............... Shoe lifts elevation heel /i. ........... ........... ........... ........... ...........

[[Page 50871]]

L3340................. B.............. ............... Shoe wedge sach.............. ........... ........... ........... ........... ........... L3350................. B.............. ............... Shoe heel wedge.............. ........... ........... ........... ........... ........... L3360................. B.............. ............... Shoe sole wedge outside sole. ........... ........... ........... ........... ........... L3370................. B.............. ............... Shoe sole wedge between sole. ........... ........... ........... ........... ........... L3380................. B.............. ............... Shoe clubfoot wedge.......... ........... ........... ........... ........... ........... L3390................. B.............. ............... Shoe outflare wedge.......... ........... ........... ........... ........... ........... L3400................. B.............. ............... Shoe metatarsal bar wedge ro. ........... ........... ........... ........... ........... L3410................. B.............. ............... Shoe metatarsal bar between.. ........... ........... ........... ........... ........... L3420................. B.............. ............... Full sole/heel wedge btween.. ........... ........... ........... ........... ........... L3430................. B.............. ............... Sho heel count plast reinfor. ........... ........... ........... ........... ........... L3440................. B.............. ............... Heel leather reinforced...... ........... ........... ........... ........... ........... L3450................. B.............. ............... Shoe heel sach cushion type.. ........... ........... ........... ........... ........... L3455................. B.............. ............... Shoe heel new leather standa. ........... ........... ........... ........... ........... L3460................. B.............. ............... Shoe heel new rubber standar. ........... ........... ........... ........... ........... L3465................. B.............. ............... Shoe heel thomas with wedge.. ........... ........... ........... ........... ........... L3470................. B.............. ............... Shoe heel thomas extend to b. ........... ........... ........... ........... ........... L3480................. B.............. ............... Shoe heel pad & depress for.. ........... ........... ........... ........... ........... L3485................. B.............. ............... Shoe heel pad removable for.. ........... ........... ........... ........... ........... L3500................. B.............. ............... Ortho shoe add leather insol. ........... ........... ........... ........... ........... L3510................. B.............. ............... Orthopedic shoe add rub insl. ........... ........... ........... ........... ........... L3520................. B.............. ............... O shoe add felt w leath insl. ........... ........... ........... ........... ........... L3530................. B.............. ............... Ortho shoe add half sole..... ........... ........... ........... ........... ........... L3540................. B.............. ............... Ortho shoe add full sole..... ........... ........... ........... ........... ........... L3550................. B.............. ............... O shoe add standard toe tap.. ........... ........... ........... ........... ........... L3560................. B.............. ............... O shoe add horseshoe toe tap. ........... ........... ........... ........... ........... L3570................. B.............. ............... O shoe add instep extension.. ........... ........... ........... ........... ........... L3580................. B.............. ............... O shoe add instep velcro clo. ........... ........... ........... ........... ........... L3590................. B.............. ............... O shoe convert to sof counte. ........... ........... ........... ........... ........... L3595................. B.............. ............... Ortho shoe add march bar..... ........... ........... ........... ........... ........... L3600................. B.............. ............... Trans shoe calip plate exist. ........... ........... ........... ........... ........... L3610................. B.............. ............... Trans shoe caliper plate new. ........... ........... ........... ........... ........... L3620................. B.............. ............... Trans shoe solid stirrup exi. ........... ........... ........... ........... ........... L3630................. B.............. ............... Trans shoe solid stirrup new. ........... ........... ........... ........... ........... L3640................. B.............. ............... Shoe dennis browne splint bo. ........... ........... ........... ........... ........... L3649................. B.............. ............... Orthopedic shoe modifica NOS. ........... ........... ........... ........... ........... L3650................. A.............. ............... Shlder fig 8 abduct restrain. ........... ........... ........... ........... ........... L3651................. A.............. ............... Prefab shoulder orthosis..... ........... ........... ........... ........... ........... L3652................. A.............. ............... Prefab dbl shoulder orthosis. ........... ........... ........... ........... ........... L3660................. A.............. ............... Abduct restrainer canvas&web. ........... ........... ........... ........... ........... L3670................. A.............. ............... Acromio/clavicular canvas&we. ........... ........... ........... ........... ........... L3675................. A.............. ............... Canvas vest SO............... ........... ........... ........... ........... ........... L3677................. E.............. ............... SO hard plastic stabilizer... ........... ........... ........... ........... ........... L3700................. A.............. ............... Elbow orthoses elas w stays.. ........... ........... ........... ........... ........... L3701................. A.............. ............... Prefab elbow orthosis........ ........... ........... ........... ........... ........... L3710................. A.............. ............... Elbow elastic with metal joi. ........... ........... ........... ........... ........... L3720................. A.............. ............... Forearm/arm cuffs free motio. ........... ........... ........... ........... ........... L3730................. A.............. ............... Forearm/arm cuffs ext/flex a. ........... ........... ........... ........... ........... L3740................. A.............. ............... Cuffs adj lock w/ active con. ........... ........... ........... ........... ........... L3760................. A.............. ............... EO withjoint, Prefabricated.. ........... ........... ........... ........... ........... L3762................. A.............. ............... Rigid EO wo joints........... ........... ........... ........... ........... ........... L3800................. A.............. ............... Whfo short opponen no attach. ........... ........... ........... ........... ........... L3805................. A.............. ............... Whfo long opponens no attach. ........... ........... ........... ........... ........... L3807................. A.............. ............... WHFO,no joint, prefabricated. ........... ........... ........... ........... ........... L3810................. A.............. ............... Whfo thumb abduction bar..... ........... ........... ........... ........... ........... L3815................. A.............. ............... Whfo second m.p. abduction a. ........... ........... ........... ........... ........... L3820................. A.............. ............... Whfo ip ext asst w/ mp ext s. ........... ........... ........... ........... ........... L3825................. A.............. ............... Whfo m.p. extension stop..... ........... ........... ........... ........... ........... L3830................. A.............. ............... Whfo m.p. extension assist... ........... ........... ........... ........... ........... L3835................. A.............. ............... Whfo m.p. spring extension a. ........... ........... ........... ........... ........... L3840................. A.............. ............... Whfo spring swivel thumb..... ........... ........... ........... ........... ........... L3845................. A.............. ............... Whfo thumb ip ext ass w/ mp.. ........... ........... ........... ........... ........... L3850................. A.............. ............... Action wrist w/ dorsiflex as. ........... ........... ........... ........... ........... L3855................. A.............. ............... Whfo adj m.p. flexion contro. ........... ........... ........... ........... ........... L3860................. A.............. ............... Whfo adj m.p. flex ctrl & i.. ........... ........... ........... ........... ........... L3890................. B.............. ............... Torsion mechanism wrist/elbo. ........... ........... ........... ........... ........... L3900................. A.............. ............... Hinge extension/flex wrist/f. ........... ........... ........... ........... ...........

[[Page 50872]]

L3901................. A.............. ............... Hinge ext/flex wrist finger.. ........... ........... ........... ........... ........... L3902................. E.............. ............... Whfo ext power compress gas.. ........... ........... ........... ........... ........... L3904................. A.............. ............... Whfo electric custom fitted.. ........... ........... ........... ........... ........... L3906................. A.............. ............... Wrist gauntlet molded to pt.. ........... ........... ........... ........... ........... L3907................. A.............. ............... Whfo wrst gauntlt thmb spica. ........... ........... ........... ........... ........... L3908................. A.............. ............... Wrist cock-up non-molded..... ........... ........... ........... ........... ........... L3909................. A.............. ............... Prefab wrist orthosis........ ........... ........... ........... ........... ........... L3910................. A.............. ............... Whfo swanson design.......... ........... ........... ........... ........... ........... L3911................. A.............. ............... Prefab hand finger orthosis.. ........... ........... ........... ........... ........... L3912................. A.............. ............... Flex glove w/elastic finger.. ........... ........... ........... ........... ........... L3914................. A.............. ............... WHO wrist extension cock-up.. ........... ........... ........... ........... ........... L3916................. A.............. ............... Whfo wrist extens w/ outrigg. ........... ........... ........... ........... ........... L3917................. A.............. ............... Prefab metacarpl fx orthosis. ........... ........... ........... ........... ........... L3918................. A.............. ............... HFO knuckle bender........... ........... ........... ........... ........... ........... L3920................. A.............. ............... Knuckle bender with outrigge. ........... ........... ........... ........... ........... L3922................. A.............. ............... Knuckle bend 2 seg to flex j. ........... ........... ........... ........... ........... L3923................. A.............. ............... HFO, no joint, prefabricated. ........... ........... ........... ........... ........... L3924................. A.............. ............... Oppenheimer.................. ........... ........... ........... ........... ........... L3926................. A.............. ............... Thomas suspension............ ........... ........... ........... ........... ........... L3928................. A.............. ............... Finger extension w/ clock sp. ........... ........... ........... ........... ........... L3930................. A.............. ............... Finger extension with wrist.. ........... ........... ........... ........... ........... L3932................. A.............. ............... Safety pin spring wire....... ........... ........... ........... ........... ........... L3934................. A.............. ............... Safety pin modified.......... ........... ........... ........... ........... ........... L3936................. A.............. ............... Palmer....................... ........... ........... ........... ........... ........... L3938................. A.............. ............... Dorsal wrist................. ........... ........... ........... ........... ........... L3940................. A.............. ............... Dorsal wrist w/ outrigger at. ........... ........... ........... ........... ........... L3942................. A.............. ............... Reverse knuckle bender....... ........... ........... ........... ........... ........... L3944................. A.............. ............... Reverse knuckle bend w/ outr. ........... ........... ........... ........... ........... L3946................. A.............. ............... HFO composite elastic........ ........... ........... ........... ........... ........... L3948................. A.............. ............... Finger knuckle bender........ ........... ........... ........... ........... ........... L3950................. A.............. ............... Oppenheimer w/ knuckle bend.. ........... ........... ........... ........... ........... L3952................. A.............. ............... Oppenheimer w/ rev knuckle 2. ........... ........... ........... ........... ........... L3954................. A.............. ............... Spreading hand............... ........... ........... ........... ........... ........... L3956................. A.............. ............... Add joint upper ext orthosis. ........... ........... ........... ........... ........... L3960................. A.............. ............... Sewho airplan desig abdu pos. ........... ........... ........... ........... ........... L3962................. A.............. ............... Sewho erbs palsey design abd. ........... ........... ........... ........... ........... L3963................. A.............. ............... Molded w/ articulating elbow. ........... ........... ........... ........... ........... L3964................. Y.............. ............... Seo mobile arm sup att to wc. ........... ........... ........... ........... ........... L3965................. Y.............. ............... Arm supp att to wc rancho ty. ........... ........... ........... ........... ........... L3966................. Y.............. ............... Mobile arm supports reclinin. ........... ........... ........... ........... ........... L3968................. Y.............. ............... Friction dampening arm supp.. ........... ........... ........... ........... ........... L3969................. Y.............. ............... Monosuspension arm/hand supp. ........... ........... ........... ........... ........... L3970................. Y.............. ............... Elevat proximal arm support.. ........... ........... ........... ........... ........... L3972................. Y.............. ............... Offset/lat rocker arm w/ ela. ........... ........... ........... ........... ........... L3974................. Y.............. ............... Mobile arm support supinator. ........... ........... ........... ........... ........... L3980................. A.............. ............... Upp ext fx orthosis humeral.. ........... ........... ........... ........... ........... L3982................. A.............. ............... Upper ext fx orthosis rad/ul. ........... ........... ........... ........... ........... L3984................. A.............. ............... Upper ext fx orthosis wrist.. ........... ........... ........... ........... ........... L3985................. A.............. ............... Forearm hand fx orth w/ wr h. ........... ........... ........... ........... ........... L3986................. A.............. ............... Humeral rad/ulna wrist fx or. ........... ........... ........... ........... ........... L3995................. A.............. ............... Sock fracture or equal each.. ........... ........... ........... ........... ........... L3999................. A.............. ............... Upper limb orthosis NOS...... ........... ........... ........... ........... ........... L4000................. A.............. ............... Repl girdle milwaukee orth... ........... ........... ........... ........... ........... L4002................. A.............. ............... Replace strap, any orthosis.. ........... ........... ........... ........... ........... L4010................. A.............. ............... Replace trilateral socket br. ........... ........... ........... ........... ........... L4020................. A.............. ............... Replace quadlat socket brim.. ........... ........... ........... ........... ........... L4030................. A.............. ............... Replace socket brim cust fit. ........... ........... ........... ........... ........... L4040................. A.............. ............... Replace molded thigh lacer... ........... ........... ........... ........... ........... L4045................. A.............. ............... Replace non-molded thigh lac. ........... ........... ........... ........... ........... L4050................. A.............. ............... Replace molded calf lacer.... ........... ........... ........... ........... ........... L4055................. A.............. ............... Replace non-molded calf lace. ........... ........... ........... ........... ........... L4060................. A.............. ............... Replace high roll cuff....... ........... ........... ........... ........... ........... L4070................. A.............. ............... Replace prox & dist upright.. ........... ........... ........... ........... ........... L4080................. A.............. ............... Repl met band kafo-afo prox.. ........... ........... ........... ........... ........... L4090................. A.............. ............... Repl met band kafo-afo calf/. ........... ........... ........... ........... ........... L4100................. A.............. ............... Repl leath cuff kafo prox th. ........... ........... ........... ........... ...........

[[Page 50873]]

L4110................. A.............. ............... Repl leath cuff kafo-afo cal. ........... ........... ........... ........... ........... L4130................. A.............. ............... Replace pretibial shell...... ........... ........... ........... ........... ........... L4205................. A.............. ............... Ortho dvc repair per 15 min.. ........... ........... ........... ........... ........... L4210................. A.............. ............... Orth dev repair/repl minor p. ........... ........... ........... ........... ........... L4350................. A.............. ............... Ankle control orthosi prefab. ........... ........... ........... ........... ........... L4360................. A.............. ............... Pneumati walking boot prefab. ........... ........... ........... ........... ........... L4370................. A.............. ............... Pneumatic full leg splint.... ........... ........... ........... ........... ........... L4380................. A.............. ............... Pneumatic knee splint........ ........... ........... ........... ........... ........... L4386................. A.............. ............... Non-pneum walk boot prefab... ........... ........... ........... ........... ........... L4392................. A.............. ............... Replace AFO soft interface... ........... ........... ........... ........... ........... L4394................. A.............. ............... Replace foot drop spint...... ........... ........... ........... ........... ........... L4396................. A.............. ............... Static AFO................... ........... ........... ........... ........... ........... L4398................. A.............. ............... Foot drop splint recumbent... ........... ........... ........... ........... ........... L5000................. A.............. ............... Sho insert w arch toe filler. ........... ........... ........... ........... ........... L5010................. A.............. ............... Mold socket ank hgt w/ toe f. ........... ........... ........... ........... ........... L5020................. A.............. ............... Tibial tubercle hgt w/ toe f. ........... ........... ........... ........... ........... L5050................. A.............. ............... Ank symes mold sckt sach ft.. ........... ........... ........... ........... ........... L5060................. A.............. ............... Symes met fr leath socket ar. ........... ........... ........... ........... ........... L5100................. A.............. ............... Molded socket shin sach foot. ........... ........... ........... ........... ........... L5105................. A.............. ............... Plast socket jts/thgh lacer.. ........... ........... ........... ........... ........... L5150................. A.............. ............... Mold sckt ext knee shin sach. ........... ........... ........... ........... ........... L5160................. A.............. ............... Mold socket bent knee shin s. ........... ........... ........... ........... ........... L5200................. A.............. ............... Kne sing axis fric shin sach. ........... ........... ........... ........... ........... L5210................. A.............. ............... No knee/ankle joints w/ ft b. ........... ........... ........... ........... ........... L5220................. A.............. ............... No knee joint with artic ali. ........... ........... ........... ........... ........... L5230................. A.............. ............... Fem focal defic constant fri. ........... ........... ........... ........... ........... L5250................. A.............. ............... Hip canad sing axi cons fric. ........... ........... ........... ........... ........... L5270................. A.............. ............... Tilt table locking hip sing.. ........... ........... ........... ........... ........... L5280................. A.............. ............... Hemipelvect canad sing axis.. ........... ........... ........... ........... ........... L5301................. A.............. ............... BK mold socket SACH ft endo.. ........... ........... ........... ........... ........... L5311................. A.............. ............... Knee disart, SACH ft, endo... ........... ........... ........... ........... ........... L5321................. A.............. ............... AK open end SACH............. ........... ........... ........... ........... ........... L5331................. A.............. ............... Hip disart canadian SACH ft.. ........... ........... ........... ........... ........... L5341................. A.............. ............... Hemipelvectomy canadian SACH. ........... ........... ........... ........... ........... L5400................. A.............. ............... Postop dress & 1 cast chg bk. ........... ........... ........... ........... ........... L5410................. A.............. ............... Postop dsg bk ea add cast ch. ........... ........... ........... ........... ........... L5420................. A.............. ............... Postop dsg & 1 cast chg ak/d. ........... ........... ........... ........... ........... L5430................. A.............. ............... Postop dsg ak ea add cast ch. ........... ........... ........... ........... ........... L5450................. A.............. ............... Postop app non-wgt bear dsg.. ........... ........... ........... ........... ........... L5460................. A.............. ............... Postop app non-wgt bear dsg.. ........... ........... ........... ........... ........... L5500................. A.............. ............... Init bk ptb plaster direct... ........... ........... ........... ........... ........... L5505................. A.............. ............... Init ak ischal plstr direct.. ........... ........... ........... ........... ........... L5510................. A.............. ............... Prep BK ptb plaster molded... ........... ........... ........... ........... ........... L5520................. A.............. ............... Perp BK ptb thermopls direct. ........... ........... ........... ........... ........... L5530................. A.............. ............... Prep BK ptb thermopls molded. ........... ........... ........... ........... ........... L5535................. A.............. ............... Prep BK ptb open end socket.. ........... ........... ........... ........... ........... L5540................. A.............. ............... Prep BK ptb laminated socket. ........... ........... ........... ........... ........... L5560................. A.............. ............... Prep AK ischial plast molded. ........... ........... ........... ........... ........... L5570................. A.............. ............... Prep AK ischial direct form.. ........... ........... ........... ........... ........... L5580................. A.............. ............... Prep AK ischial thermo mold.. ........... ........... ........... ........... ........... L5585................. A.............. ............... Prep AK ischial open end..... ........... ........... ........... ........... ........... L5590................. A.............. ............... Prep AK ischial laminated.... ........... ........... ........... ........... ........... L5595................. A.............. ............... Hip disartic sach thermopls.. ........... ........... ........... ........... ........... L5600................. A.............. ............... Hip disart sach laminat mold. ........... ........... ........... ........... ........... L5610................. A.............. ............... Above knee hydracadence...... ........... ........... ........... ........... ........... L5611................. A.............. ............... Ak 4 bar link w/fric swing... ........... ........... ........... ........... ........... L5613................. A.............. ............... Ak 4 bar ling w/hydraul swig. ........... ........... ........... ........... ........... L5614................. A.............. ............... 4-bar link above knee w/swng. ........... ........... ........... ........... ........... L5616................. A.............. ............... Ak univ multiplex sys frict.. ........... ........... ........... ........... ........... L5617................. A.............. ............... AK/BK self-aligning unit ea.. ........... ........... ........... ........... ........... L5618................. A.............. ............... Test socket symes............ ........... ........... ........... ........... ........... L5620................. A.............. ............... Test socket below knee....... ........... ........... ........... ........... ........... L5622................. A.............. ............... Test socket knee disarticula. ........... ........... ........... ........... ........... L5624................. A.............. ............... Test socket above knee....... ........... ........... ........... ........... ........... L5626................. A.............. ............... Test socket hip disarticulat. ........... ........... ........... ........... ........... L5628................. A.............. ............... Test socket hemipelvectomy... ........... ........... ........... ........... ...........

[[Page 50874]]

L5629................. A.............. ............... Below knee acrylic socket.... ........... ........... ........... ........... ........... L5630................. A.............. ............... Syme typ expandabl wall sckt. ........... ........... ........... ........... ........... L5631................. A.............. ............... Ak/knee disartic acrylic soc. ........... ........... ........... ........... ........... L5632................. A.............. ............... Symes type ptb brim design s. ........... ........... ........... ........... ........... L5634................. A.............. ............... Symes type poster opening so. ........... ........... ........... ........... ........... L5636................. A.............. ............... Symes type medial opening so. ........... ........... ........... ........... ........... L5637................. A.............. ............... Below knee total contact..... ........... ........... ........... ........... ........... L5638................. A.............. ............... Below knee leather socket.... ........... ........... ........... ........... ........... L5639................. A.............. ............... Below knee wood socket....... ........... ........... ........... ........... ........... L5640................. A.............. ............... Knee disarticulat leather so. ........... ........... ........... ........... ........... L5642................. A.............. ............... Above knee leather socket.... ........... ........... ........... ........... ........... L5643................. A.............. ............... Hip flex inner socket ext fr. ........... ........... ........... ........... ........... L5644................. A.............. ............... Above knee wood socket....... ........... ........... ........... ........... ........... L5645................. A.............. ............... Bk flex inner socket ext fra. ........... ........... ........... ........... ........... L5646................. A.............. ............... Below knee cushion socket.... ........... ........... ........... ........... ........... L5647................. A.............. ............... Below knee suction socket.... ........... ........... ........... ........... ........... L5648................. A.............. ............... Above knee cushion socket.... ........... ........... ........... ........... ........... L5649................. A.............. ............... Isch containmt/narrow m-l so. ........... ........... ........... ........... ........... L5650................. A.............. ............... Tot contact ak/knee disart s. ........... ........... ........... ........... ........... L5651................. A.............. ............... Ak flex inner socket ext fra. ........... ........... ........... ........... ........... L5652................. A.............. ............... Suction susp ak/knee disart.. ........... ........... ........... ........... ........... L5653................. A.............. ............... Knee disart expand wall sock. ........... ........... ........... ........... ........... L5654................. A.............. ............... Socket insert symes.......... ........... ........... ........... ........... ........... L5655................. A.............. ............... Socket insert below knee..... ........... ........... ........... ........... ........... L5656................. A.............. ............... Socket insert knee articulat. ........... ........... ........... ........... ........... L5658................. A.............. ............... Socket insert above knee..... ........... ........... ........... ........... ........... L5661................. A.............. ............... Multi-durometer symes........ ........... ........... ........... ........... ........... L5665................. A.............. ............... Multi-durometer below knee... ........... ........... ........... ........... ........... L5666................. A.............. ............... Below knee cuff suspension... ........... ........... ........... ........... ........... L5668................. A.............. ............... Socket insert w/o lock lower. ........... ........... ........... ........... ........... L5670................. A.............. ............... Bk molded supracondylar susp. ........... ........... ........... ........... ........... L5671................. A.............. ............... BK/AK locking mechanism...... ........... ........... ........... ........... ........... L5672................. A.............. ............... Bk removable medial brim sus. ........... ........... ........... ........... ........... L5673................. A.............. ............... Socket insert w lock mech.... ........... ........... ........... ........... ........... L5676................. A.............. ............... Bk knee joints single axis p. ........... ........... ........... ........... ........... L5677................. A.............. ............... Bk knee joints polycentric p. ........... ........... ........... ........... ........... L5678................. A.............. ............... Bk joint covers pair......... ........... ........... ........... ........... ........... L5679................. A.............. ............... Socket insert w/o lock mech.. ........... ........... ........... ........... ........... L5680................. A.............. ............... Bk thigh lacer non-molded.... ........... ........... ........... ........... ........... L5681................. A.............. ............... Intl custm cong/latyp insert. ........... ........... ........... ........... ........... L5682................. A.............. ............... Bk thigh lacer glut/ischia m. ........... ........... ........... ........... ........... L5683................. A.............. ............... Initial custom socket insert. ........... ........... ........... ........... ........... L5684................. A.............. ............... Bk fork strap................ ........... ........... ........... ........... ........... L5685................. A.............. ............... Below knee sus/seal sleeve... ........... ........... ........... ........... ........... L5686................. A.............. ............... Bk back check................ ........... ........... ........... ........... ........... L5688................. A.............. ............... Bk waist belt webbing........ ........... ........... ........... ........... ........... L5690................. A.............. ............... Bk waist belt padded and lin. ........... ........... ........... ........... ........... L5692................. A.............. ............... Ak pelvic control belt light. ........... ........... ........... ........... ........... L5694................. A.............. ............... Ak pelvic control belt pad/l. ........... ........... ........... ........... ........... L5695................. A.............. ............... Ak sleeve susp neoprene/equa. ........... ........... ........... ........... ........... L5696................. A.............. ............... Ak/knee disartic pelvic join. ........... ........... ........... ........... ........... L5697................. A.............. ............... Ak/knee disartic pelvic band. ........... ........... ........... ........... ........... L5698................. A.............. ............... Ak/knee disartic silesian ba. ........... ........... ........... ........... ........... L5699................. A.............. ............... Shoulder harness............. ........... ........... ........... ........... ........... L5700................. A.............. ............... Replace socket below knee.... ........... ........... ........... ........... ........... L5701................. A.............. ............... Replace socket above knee.... ........... ........... ........... ........... ........... L5702................. A.............. ............... Replace socket hip........... ........... ........... ........... ........... ........... L5704................. A.............. ............... Custom shape cover BK........ ........... ........... ........... ........... ........... L5705................. A.............. ............... Custom shape cover AK........ ........... ........... ........... ........... ........... L5706................. A.............. ............... Custom shape cvr knee disart. ........... ........... ........... ........... ........... L5707................. A.............. ............... Custom shape cvr hip disart.. ........... ........... ........... ........... ........... L5710................. A.............. ............... Kne-shin exo sng axi mnl loc. ........... ........... ........... ........... ........... L5711................. A.............. ............... Knee-shin exo mnl lock ultra. ........... ........... ........... ........... ........... L5712................. A.............. ............... Knee-shin exo frict swg & st. ........... ........... ........... ........... ........... L5714................. A.............. ............... Knee-shin exo variable frict. ........... ........... ........... ........... ........... L5716................. A.............. ............... Knee-shin exo mech stance ph. ........... ........... ........... ........... ...........

[[Page 50875]]

L5718................. A.............. ............... Knee-shin exo frct swg & sta. ........... ........... ........... ........... ........... L5722................. A.............. ............... Knee-shin pneum swg frct exo. ........... ........... ........... ........... ........... L5724................. A.............. ............... Knee-shin exo fluid swing ph. ........... ........... ........... ........... ........... L5726................. A.............. ............... Knee-shin ext jnts fld swg e. ........... ........... ........... ........... ........... L5728................. A.............. ............... Knee-shin fluid swg & stance. ........... ........... ........... ........... ........... L5780................. A.............. ............... Knee-shin pneum/hydra pneum.. ........... ........... ........... ........... ........... L5781................. A.............. ............... Lower limb pros vacuum pump.. ........... ........... ........... ........... ........... L5782................. A.............. ............... HD low limb pros vacuum pump. ........... ........... ........... ........... ........... L5785................. A.............. ............... Exoskeletal bk ultralt mater. ........... ........... ........... ........... ........... L5790................. A.............. ............... Exoskeletal ak ultra-light m. ........... ........... ........... ........... ........... L5795................. A.............. ............... Exoskel hip ultra-light mate. ........... ........... ........... ........... ........... L5810................. A.............. ............... Endoskel knee-shin mnl lock.. ........... ........... ........... ........... ........... L5811................. A.............. ............... Endo knee-shin mnl lck ultra. ........... ........... ........... ........... ........... L5812................. A.............. ............... Endo knee-shin frct swg & st. ........... ........... ........... ........... ........... L5814................. A.............. ............... Endo knee-shin hydral swg ph. ........... ........... ........... ........... ........... L5816................. A.............. ............... Endo knee-shin polyc mch sta. ........... ........... ........... ........... ........... L5818................. A.............. ............... Endo knee-shin frct swg & st. ........... ........... ........... ........... ........... L5822................. A.............. ............... Endo knee-shin pneum swg frc. ........... ........... ........... ........... ........... L5824................. A.............. ............... Endo knee-shin fluid swing p. ........... ........... ........... ........... ........... L5826................. A.............. ............... Miniature knee joint......... ........... ........... ........... ........... ........... L5828................. A.............. ............... Endo knee-shin fluid swg/sta. ........... ........... ........... ........... ........... L5830................. A.............. ............... Endo knee-shin pneum/swg pha. ........... ........... ........... ........... ........... L5840................. A.............. ............... Multi-axial knee/shin system. ........... ........... ........... ........... ........... L5845................. A.............. ............... Knee-shin sys stance flexion. ........... ........... ........... ........... ........... L5848................. A.............. ............... Knee-shin sys hydraul stance. ........... ........... ........... ........... ........... L5850................. A.............. ............... Endo ak/hip knee extens assi. ........... ........... ........... ........... ........... L5855................. A.............. ............... Mech hip extension assist.... ........... ........... ........... ........... ........... L5856................. A.............. ............... Elec knee-shin swing/stance.. ........... ........... ........... ........... ........... L5857................. A.............. ............... Elec knee-shin swing only.... ........... ........... ........... ........... ........... L5910................. A.............. ............... Endo below knee alignable sy. ........... ........... ........... ........... ........... L5920................. A.............. ............... Endo ak/hip alignable system. ........... ........... ........... ........... ........... L5925................. A.............. ............... Above knee manual lock....... ........... ........... ........... ........... ........... L5930................. A.............. ............... High activity knee frame..... ........... ........... ........... ........... ........... L5940................. A.............. ............... Endo bk ultra-light material. ........... ........... ........... ........... ........... L5950................. A.............. ............... Endo ak ultra-light material. ........... ........... ........... ........... ........... L5960................. A.............. ............... Endo hip ultra-light materia. ........... ........... ........... ........... ........... L5962................. A.............. ............... Below knee flex cover system. ........... ........... ........... ........... ........... L5964................. A.............. ............... Above knee flex cover system. ........... ........... ........... ........... ........... L5966................. A.............. ............... Hip flexible cover system.... ........... ........... ........... ........... ........... L5968................. A.............. ............... Multiaxial ankle w dorsiflex. ........... ........... ........... ........... ........... L5970................. A.............. ............... Foot external keel sach foot. ........... ........... ........... ........... ........... L5972................. A.............. ............... Flexible keel foot........... ........... ........... ........... ........... ........... L5974................. A.............. ............... Foot single axis ankle/foot.. ........... ........... ........... ........... ........... L5975................. A.............. ............... Combo ankle/foot prosthesis.. ........... ........... ........... ........... ........... L5976................. A.............. ............... Energy storing foot.......... ........... ........... ........... ........... ........... L5978................. A.............. ............... Ft prosth multiaxial ankl/ft. ........... ........... ........... ........... ........... L5979................. A.............. ............... Multi-axial ankle/ft prosth.. ........... ........... ........... ........... ........... L5980................. A.............. ............... Flex foot system............. ........... ........... ........... ........... ........... L5981................. A.............. ............... Flex-walk sys low ext prosth. ........... ........... ........... ........... ........... L5982................. A.............. ............... Exoskeletal axial rotation u. ........... ........... ........... ........... ........... L5984................. A.............. ............... Endoskeletal axial rotation.. ........... ........... ........... ........... ........... L5985................. A.............. ............... Lwr ext dynamic prosth pylon. ........... ........... ........... ........... ........... L5986................. A.............. ............... Multi-axial rotation unit.... ........... ........... ........... ........... ........... L5987................. A.............. ............... Shank ft w vert load pylon... ........... ........... ........... ........... ........... L5988................. A.............. ............... Vertical shock reducing pylo. ........... ........... ........... ........... ........... L5990................. A.............. ............... User adjustable heel height.. ........... ........... ........... ........... ........... L5995................. A.............. ............... Lower ext pros heavyduty fea. ........... ........... ........... ........... ........... L5999................. A.............. ............... Lowr extremity prosthes NOS.. ........... ........... ........... ........... ........... L6000................. A.............. ............... Par hand robin-aids thum rem. ........... ........... ........... ........... ........... L6010................. A.............. ............... Hand robin-aids little/ring.. ........... ........... ........... ........... ........... L6020................. A.............. ............... Part hand robin-aids no fing. ........... ........... ........... ........... ........... L6025................. A.............. ............... Part hand disart myoelectric. ........... ........... ........... ........... ........... L6050................. A.............. ............... Wrst MLd sck flx hng tri pad. ........... ........... ........... ........... ........... L6055................. A.............. ............... Wrst mold sock w/exp interfa. ........... ........... ........... ........... ........... L6100................. A.............. ............... Elb mold sock flex hinge pad. ........... ........... ........... ........... ........... L6110................. A.............. ............... Elbow mold sock suspension t. ........... ........... ........... ........... ...........

[[Page 50876]]

L6120................. A.............. ............... Elbow mold doub splt soc ste. ........... ........... ........... ........... ........... L6130................. A.............. ............... Elbow stump activated lock h. ........... ........... ........... ........... ........... L6200................. A.............. ............... Elbow mold outsid lock hinge. ........... ........... ........... ........... ........... L6205................. A.............. ............... Elbow molded w/ expand inter. ........... ........... ........... ........... ........... L6250................. A.............. ............... Elbow inter loc elbow forarm. ........... ........... ........... ........... ........... L6300................. A.............. ............... Shlder disart int lock elbow. ........... ........... ........... ........... ........... L6310................. A.............. ............... Shoulder passive restor comp. ........... ........... ........... ........... ........... L6320................. A.............. ............... Shoulder passive restor cap.. ........... ........... ........... ........... ........... L6350................. A.............. ............... Thoracic intern lock elbow... ........... ........... ........... ........... ........... L6360................. A.............. ............... Thoracic passive restor comp. ........... ........... ........... ........... ........... L6370................. A.............. ............... Thoracic passive restor cap.. ........... ........... ........... ........... ........... L6380................. A.............. ............... Postop dsg cast chg wrst/elb. ........... ........... ........... ........... ........... L6382................. A.............. ............... Postop dsg cast chg elb dis/. ........... ........... ........... ........... ........... L6384................. A.............. ............... Postop dsg cast chg shlder/t. ........... ........... ........... ........... ........... L6386................. A.............. ............... Postop ea cast chg & realign. ........... ........... ........... ........... ........... L6388................. A.............. ............... Postop applicat rigid dsg on. ........... ........... ........... ........... ........... L6400................. A.............. ............... Below elbow prosth tiss shap. ........... ........... ........... ........... ........... L6450................. A.............. ............... Elb disart prosth tiss shap.. ........... ........... ........... ........... ........... L6500................. A.............. ............... Above elbow prosth tiss shap. ........... ........... ........... ........... ........... L6550................. A.............. ............... Shldr disar prosth tiss shap. ........... ........... ........... ........... ........... L6570................. A.............. ............... Scap thorac prosth tiss shap. ........... ........... ........... ........... ........... L6580................. A.............. ............... Wrist/elbow bowden cable mol. ........... ........... ........... ........... ........... L6582................. A.............. ............... Wrist/elbow bowden cbl dir f. ........... ........... ........... ........... ........... L6584................. A.............. ............... Elbow fair lead cable molded. ........... ........... ........... ........... ........... L6586................. A.............. ............... Elbow fair lead cable dir fo. ........... ........... ........... ........... ........... L6588................. A.............. ............... Shdr fair lead cable molded.. ........... ........... ........... ........... ........... L6590................. A.............. ............... Shdr fair lead cable direct.. ........... ........... ........... ........... ........... L6600................. A.............. ............... Polycentric hinge pair....... ........... ........... ........... ........... ........... L6605................. A.............. ............... Single pivot hinge pair...... ........... ........... ........... ........... ........... L6610................. A.............. ............... Flexible metal hinge pair.... ........... ........... ........... ........... ........... L6615................. A.............. ............... Disconnect locking wrist uni. ........... ........... ........... ........... ........... L6616................. A.............. ............... Disconnect insert locking wr. ........... ........... ........... ........... ........... L6620................. A.............. ............... Flexion/extension wrist unit. ........... ........... ........... ........... ........... L6623................. A.............. ............... Spring-ass rot wrst w/ latch. ........... ........... ........... ........... ........... L6625................. A.............. ............... Rotation wrst w/ cable lock.. ........... ........... ........... ........... ........... L6628................. A.............. ............... Quick disconn hook adapter o. ........... ........... ........... ........... ........... L6629................. A.............. ............... Lamination collar w/ couplin. ........... ........... ........... ........... ........... L6630................. A.............. ............... Stainless steel any wrist.... ........... ........... ........... ........... ........... L6632................. A.............. ............... Latex suspension sleeve each. ........... ........... ........... ........... ........... L6635................. A.............. ............... Lift assist for elbow........ ........... ........... ........... ........... ........... L6637................. A.............. ............... Nudge control elbow lock..... ........... ........... ........... ........... ........... L6638................. A.............. ............... Elec lock on manual pw elbow. ........... ........... ........... ........... ........... L6640................. A.............. ............... Shoulder abduction joint pai. ........... ........... ........... ........... ........... L6641................. A.............. ............... Excursion amplifier pulley t. ........... ........... ........... ........... ........... L6642................. A.............. ............... Excursion amplifier lever ty. ........... ........... ........... ........... ........... L6645................. A.............. ............... Shoulder flexion-abduction j. ........... ........... ........... ........... ........... L6646................. A.............. ............... Multipo locking shoulder jnt. ........... ........... ........... ........... ........... L6647................. A.............. ............... Shoulder lock actuator....... ........... ........... ........... ........... ........... L6648................. A.............. ............... Ext pwrd shlder lock/unlock.. ........... ........... ........... ........... ........... L6650................. A.............. ............... Shoulder universal joint..... ........... ........... ........... ........... ........... L6655................. A.............. ............... Standard control cable extra. ........... ........... ........... ........... ........... L6660................. A.............. ............... Heavy duty control cable..... ........... ........... ........... ........... ........... L6665................. A.............. ............... Teflon or equal cable lining. ........... ........... ........... ........... ........... L6670................. A.............. ............... Hook to hand cable adapter... ........... ........... ........... ........... ........... L6672................. A.............. ............... Harness chest/shlder saddle.. ........... ........... ........... ........... ........... L6675................. A.............. ............... Harness figure of 8 sing con. ........... ........... ........... ........... ........... L6676................. A.............. ............... Harness figure of 8 dual con. ........... ........... ........... ........... ........... L6680................. A.............. ............... Test sock wrist disart/bel e. ........... ........... ........... ........... ........... L6682................. A.............. ............... Test sock elbw disart/above.. ........... ........... ........... ........... ........... L6684................. A.............. ............... Test socket shldr disart/tho. ........... ........... ........... ........... ........... L6686................. A.............. ............... Suction socket............... ........... ........... ........... ........... ........... L6687................. A.............. ............... Frame typ socket bel elbow/w. ........... ........... ........... ........... ........... L6688................. A.............. ............... Frame typ sock above elb/dis. ........... ........... ........... ........... ........... L6689................. A.............. ............... Frame typ socket shoulder di. ........... ........... ........... ........... ........... L6690................. A.............. ............... Frame typ sock interscap-tho. ........... ........... ........... ........... ........... L6691................. A.............. ............... Removable insert each........ ........... ........... ........... ........... ...........

[[Page 50877]]

L6692................. A.............. ............... Silicone gel insert or equal. ........... ........... ........... ........... ........... L6693................. A.............. ............... Lockingelbow forearm cntrbal. ........... ........... ........... ........... ........... L6694................. A.............. ............... Elbow socket ins use w/lock.. ........... ........... ........... ........... ........... L6695................. A.............. ............... Elbow socket ins use w/o lck. ........... ........... ........... ........... ........... L6696................. A.............. ............... Cus elbo skt in for con/atyp. ........... ........... ........... ........... ........... L6697................. A.............. ............... Cus elbo skt in not con/atyp. ........... ........... ........... ........... ........... L6698................. A.............. ............... Below/above elbow lock mech.. ........... ........... ........... ........... ........... L6700................. A.............. ............... Terminal device model 3. L6705................. A.............. ............... Terminal device model 5. L6710................. A.............. ............... Terminal device model 5x. L6715................. A.............. ............... Terminal device model 5xa. L6720................. A.............. ............... Terminal device model 6. L6725................. A.............. ............... Terminal device model 7. L6730................. A.............. ............... Terminal device model 7lo. L6735................. A.............. ............... Terminal device model 8. L6740................. A.............. ............... Terminal device model 8x. L6745................. A.............. ............... Terminal device model 88x. L6750................. A.............. ............... Terminal device model 10p. L6755................. A.............. ............... Terminal device model 10x. L6765................. A.............. ............... Terminal device model 12p. L6770................. A.............. ............... Terminal device model 99x. L6775................. A.............. ............... Terminal device model 555. L6780................. A.............. ............... Terminal device model ss555. L6790................. A.............. ............... Hooks-accu hook or equal..... ........... ........... ........... ........... ........... L6795................. A.............. ............... Hooks-2 load or equal........ ........... ........... ........... ........... ........... L6800................. A.............. ............... Hooks-aprl vc or equal....... ........... ........... ........... ........... ........... L6805................. A.............. ............... Modifier wrist flexion unit.. ........... ........... ........... ........... ........... L6806................. A.............. ............... Trs grip vc or equal......... ........... ........... ........... ........... ........... L6807................. A.............. ............... Term device grip1/2 or equal. ........... ........... ........... ........... ........... L6808................. A.............. ............... Term device infant or child.. ........... ........... ........... ........... ........... L6809................. A.............. ............... Trs super sport passive...... ........... ........... ........... ........... ........... L6810................. A.............. ............... Pincher tool otto bock or eq. ........... ........... ........... ........... ........... L6825................. A.............. ............... Hands dorrance vo............ ........... ........... ........... ........... ........... L6830................. A.............. ............... Hand aprl vc................. ........... ........... ........... ........... ........... L6835................. A.............. ............... Hand sierra vo............... ........... ........... ........... ........... ........... L6840................. A.............. ............... Hand becker imperial......... ........... ........... ........... ........... ........... L6845................. A.............. ............... Hand becker lock grip........ ........... ........... ........... ........... ........... L6850................. A.............. ............... Term dvc-hand becker plylite. ........... ........... ........... ........... ........... L6855................. A.............. ............... Hand robin-aids vo........... ........... ........... ........... ........... ........... L6860................. A.............. ............... Hand robin-aids vo soft...... ........... ........... ........... ........... ........... L6865................. A.............. ............... Hand passive hand............ ........... ........... ........... ........... ........... L6867................. A.............. ............... Hand detroit infant hand..... ........... ........... ........... ........... ........... L6868................. A.............. ............... Passive inf hand steeper/hos. ........... ........... ........... ........... ........... L6870................. A.............. ............... Hand child mitt.............. ........... ........... ........... ........... ........... L6872................. A.............. ............... Hand nyu child hand.......... ........... ........... ........... ........... ........... L6873................. A.............. ............... Hand mech inf steeper or equ. ........... ........... ........... ........... ........... L6875................. A.............. ............... Hand bock vc................. ........... ........... ........... ........... ........... L6880................. A.............. ............... Hand bock vo................. ........... ........... ........... ........... ........... L6881................. A.............. ............... Autograsp feature ul term dv. ........... ........... ........... ........... ........... L6882................. A.............. ............... Microprocessor control uplmb. ........... ........... ........... ........... ........... L6890................. A.............. ............... Production glove............. ........... ........... ........... ........... ........... L6895................. A.............. ............... Custom glove................. ........... ........... ........... ........... ........... L6900................. A.............. ............... Hand restorat thumb/1 finger. ........... ........... ........... ........... ........... L6905................. A.............. ............... Hand restoration multiple fi. ........... ........... ........... ........... ........... L6910................. A.............. ............... Hand restoration no fingers.. ........... ........... ........... ........... ........... L6915................. A.............. ............... Hand restoration replacmnt g. ........... ........... ........... ........... ........... L6920................. A.............. ............... Wrist disarticul switch ctrl. ........... ........... ........... ........... ........... L6925................. A.............. ............... Wrist disart myoelectronic c. ........... ........... ........... ........... ........... L6930................. A.............. ............... Below elbow switch control... ........... ........... ........... ........... ........... L6935................. A.............. ............... Below elbow myoelectronic ct. ........... ........... ........... ........... ........... L6940................. A.............. ............... Elbow disarticulation switch. ........... ........... ........... ........... ........... L6945................. A.............. ............... Elbow disart myoelectronic c. ........... ........... ........... ........... ........... L6950................. A.............. ............... Above elbow switch control... ........... ........... ........... ........... ........... L6955................. A.............. ............... Above elbow myoelectronic ct. ........... ........... ........... ........... ........... L6960................. A.............. ............... Shldr disartic switch contro. ........... ........... ........... ........... ........... L6965................. A.............. ............... Shldr disartic myoelectronic. ........... ........... ........... ........... ...........

[[Page 50878]]

L6970................. A.............. ............... Interscapular-thor switch ct. ........... ........... ........... ........... ........... L6975................. A.............. ............... Interscap-thor myoelectronic. ........... ........... ........... ........... ........... L7010................. A.............. ............... Hand otto back steeper/eq sw. ........... ........... ........... ........... ........... L7015................. A.............. ............... Hand sys teknik village swit. ........... ........... ........... ........... ........... L7020................. A.............. ............... Electronic greifer switch ct. ........... ........... ........... ........... ........... L7025................. A.............. ............... Electron hand myoelectronic.. ........... ........... ........... ........... ........... L7030................. A.............. ............... Hand sys teknik vill myoelec. ........... ........... ........... ........... ........... L7035................. A.............. ............... Electron greifer myoelectro.. ........... ........... ........... ........... ........... L7040................. A.............. ............... Prehensile actuator hosmer s. ........... ........... ........... ........... ........... L7045................. A.............. ............... Electron hook child michigan. ........... ........... ........... ........... ........... L7170................. A.............. ............... Electronic elbow hosmer swit. ........... ........... ........... ........... ........... L7180................. A.............. ............... Electronic elbow utah myoele. ........... ........... ........... ........... ........... L7181................. A.............. ............... Electronic elbo simultaneous. ........... ........... ........... ........... ........... L7185................. A.............. ............... Electron elbow adolescent sw. ........... ........... ........... ........... ........... L7186................. A.............. ............... Electron elbow child switch.. ........... ........... ........... ........... ........... L7190................. A.............. ............... Elbow adolescent myoelectron. ........... ........... ........... ........... ........... L7191................. A.............. ............... Elbow child myoelectronic ct. ........... ........... ........... ........... ........... L7260................. A.............. ............... Electron wrist rotator otto.. ........... ........... ........... ........... ........... L7261................. A.............. ............... Electron wrist rotator utah.. ........... ........... ........... ........... ........... L7266................. A.............. ............... Servo control steeper or equ. ........... ........... ........... ........... ........... L7272................. A.............. ............... Analogue control unb or equa. ........... ........... ........... ........... ........... L7274................. A.............. ............... Proportional ctl 12 volt uta. ........... ........... ........... ........... ........... L7360................. A.............. ............... Six volt bat otto bock/eq ea. ........... ........... ........... ........... ........... L7362................. A.............. ............... Battery chrgr six volt otto.. ........... ........... ........... ........... ........... L7364................. A.............. ............... Twelve volt battery utah/equ. ........... ........... ........... ........... ........... L7366................. A.............. ............... Battery chrgr 12 volt utah/e. ........... ........... ........... ........... ........... L7367................. A.............. ............... Replacemnt lithium ionbatter. ........... ........... ........... ........... ........... L7368................. A.............. ............... Lithium ion battery charger.. ........... ........... ........... ........... ........... L7499................. A.............. ............... Upper extremity prosthes NOS. ........... ........... ........... ........... ........... L7500................. A.............. ............... Prosthetic dvc repair hourly. ........... ........... ........... ........... ........... L7510................. A.............. ............... Prosthetic device repair rep. ........... ........... ........... ........... ........... L7520................. A.............. ............... Repair prosthesis per 15 min. ........... ........... ........... ........... ........... L7900................. A.............. ............... Male vacuum erection system.. ........... ........... ........... ........... ........... L8000................. A.............. ............... Mastectomy bra............... ........... ........... ........... ........... ........... L8001................. A.............. ............... Breast prosthesis bra & form. ........... ........... ........... ........... ........... L8002................. A.............. ............... Brst prsth bra & bilat form.. ........... ........... ........... ........... ........... L8010................. A.............. ............... Mastectomy sleeve............ ........... ........... ........... ........... ........... L8015................. A.............. ............... Ext breastprosthesis garment. ........... ........... ........... ........... ........... L8020................. A.............. ............... Mastectomy form.............. ........... ........... ........... ........... ........... L8030................. A.............. ............... Breast prosthesis silicone/e. ........... ........... ........... ........... ........... L8035................. A.............. ............... Custom breast prosthesis..... ........... ........... ........... ........... ........... L8039................. A.............. ............... Breast prosthesis NOS........ ........... ........... ........... ........... ........... L8040................. A.............. ............... Nasal prosthesis............. ........... ........... ........... ........... ........... L8041................. A.............. ............... Midfacial prosthesis......... ........... ........... ........... ........... ........... L8042................. A.............. ............... Orbital prosthesis........... ........... ........... ........... ........... ........... L8043................. A.............. ............... Upper facial prosthesis...... ........... ........... ........... ........... ........... L8044................. A.............. ............... Hemi-facial prosthesis....... ........... ........... ........... ........... ........... L8045................. A.............. ............... Auricular prosthesis......... ........... ........... ........... ........... ........... L8046................. A.............. ............... Partial facial prosthesis.... ........... ........... ........... ........... ........... L8047................. A.............. ............... Nasal septal prosthesis...... ........... ........... ........... ........... ........... L8048................. A.............. ............... Unspec maxillofacial prosth.. ........... ........... ........... ........... ........... L8049................. A.............. ............... Repair maxillofacial prosth.. ........... ........... ........... ........... ........... L8100................. E.............. ............... Compression stocking BK18-30. ........... ........... ........... ........... ........... L8110................. A.............. ............... Compression stocking BK30-40. ........... ........... ........... ........... ........... L8120................. A.............. ............... Compression stocking BK40-50. ........... ........... ........... ........... ........... L8130................. E.............. ............... Gc stocking thighlngth 18-30. ........... ........... ........... ........... ........... L8140................. E.............. ............... Gc stocking thighlngth 30-40. ........... ........... ........... ........... ........... L8150................. E.............. ............... Gc stocking thighlngth 40-50. ........... ........... ........... ........... ........... L8160................. E.............. ............... Gc stocking full lngth 18-30. ........... ........... ........... ........... ........... L8170................. E.............. ............... Gc stocking full lngth 30-40. ........... ........... ........... ........... ........... L8180................. E.............. ............... Gc stocking full lngth 40-50. ........... ........... ........... ........... ........... L8190................. E.............. ............... Gc stocking waistlngth 18-30. ........... ........... ........... ........... ........... L8195................. E.............. ............... Gc stocking waistlngth 30-40. ........... ........... ........... ........... ........... L8200................. E.............. ............... Gc stocking waistlngth 40-50. ........... ........... ........... ........... ........... L8210................. E.............. ............... Gc stocking custom made...... ........... ........... ........... ........... ........... L8220................. E.............. ............... Gc stocking lymphedema....... ........... ........... ........... ........... ...........

[[Continued on page 50879]]

From the Federal Register Online via GPO Access [wais.access.gpo.gov] ]

[[pp. 50879-50886]] Medicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates; Correction

[[Continued from page 50878]]

[[Page 50879]]

L8230................. E.............. ............... Gc stocking garter belt...... ........... ........... ........... ........... ........... L8239................. E.............. ............... G compression stocking NOS... ........... ........... ........... ........... ........... L8300................. A.............. ............... Truss single w/ standard pad. ........... ........... ........... ........... ........... L8310................. A.............. ............... Truss double w/ standard pad. ........... ........... ........... ........... ........... L8320................. A.............. ............... Truss addition to std pad wa. ........... ........... ........... ........... ........... L8330................. A.............. ............... Truss add to std pad scrotal. ........... ........... ........... ........... ........... L8400................. A.............. ............... Sheath below knee............ ........... ........... ........... ........... ........... L8410................. A.............. ............... Sheath above knee............ ........... ........... ........... ........... ........... L8415................. A.............. ............... Sheath upper limb............ ........... ........... ........... ........... ........... L8417................. A.............. ............... Pros sheath/sock w gel cushn. ........... ........... ........... ........... ........... L8420................. A.............. ............... Prosthetic sock multi ply BK. ........... ........... ........... ........... ........... L8430................. A.............. ............... Prosthetic sock multi ply AK. ........... ........... ........... ........... ........... L8435................. A.............. ............... Pros sock multi ply upper lm. ........... ........... ........... ........... ........... L8440................. A.............. ............... Shrinker below knee.......... ........... ........... ........... ........... ........... L8460................. A.............. ............... Shrinker above knee.......... ........... ........... ........... ........... ........... L8465................. A.............. ............... Shrinker upper limb.......... ........... ........... ........... ........... ........... L8470................. A.............. ............... Pros sock single ply BK...... ........... ........... ........... ........... ........... L8480................. A.............. ............... Pros sock single ply AK...... ........... ........... ........... ........... ........... L8485................. A.............. ............... Pros sock single ply upper l. ........... ........... ........... ........... ........... L8499................. A.............. ............... Unlisted misc prosthetic ser. ........... ........... ........... ........... ........... L8500................. A.............. ............... Artificial larynx............ ........... ........... ........... ........... ........... L8501................. A.............. ............... Tracheostomy speaking valve.. ........... ........... ........... ........... ........... L8505................. A.............. ............... Artificial larynx, accessory. ........... ........... ........... ........... ........... L8507................. A.............. ............... Trach-esoph voice pros pt in. ........... ........... ........... ........... ........... L8509................. A.............. ............... Trach-esoph voice pros md in. ........... ........... ........... ........... ........... L8510................. A.............. ............... Voice amplifier.............. ........... ........... ........... ........... ........... L8511................. A.............. ............... Indwelling trach insert...... ........... ........... ........... ........... ........... L8512................. A.............. ............... Gel cap for trach voice pros. ........... ........... ........... ........... ........... L8513................. A.............. ............... Trach pros cleaning device... ........... ........... ........... ........... ........... L8514................. A.............. ............... Repl trach puncture dilator.. ........... ........... ........... ........... ........... L8515................. A.............. ............... Gel cap app device for trach. ........... ........... ........... ........... ........... L8600................. N.............. ............... Implant breast silicone/eq... ........... ........... ........... ........... ........... L8603................. N.............. ............... Collagen imp urinary 2.5 ml.. ........... ........... ........... ........... ........... L8606................. N.............. ............... Synthetic implnt urinary 1ml. ........... ........... ........... ........... ........... L8610................. N.............. ............... Ocular implant............... ........... ........... ........... ........... ........... L8612................. N.............. ............... Aqueous shunt prosthesis..... ........... ........... ........... ........... ........... L8613................. N.............. ............... Ossicular implant............ ........... ........... ........... ........... ........... L8614................. N.............. ............... Cochlear device/system....... ........... ........... ........... ........... ........... L8615................. A.............. ............... Coch implant headset replace. ........... ........... ........... ........... ........... L8616................. A.............. ............... Coch implant microphone repl. ........... ........... ........... ........... ........... L8617................. A.............. ............... Coch implant trans coil repl. ........... ........... ........... ........... ........... L8618................. A.............. ............... Coch implant tran cable repl. ........... ........... ........... ........... ........... L8619................. A.............. ............... Replace cochlear processor... ........... ........... ........... ........... ........... L8620................. A.............. ............... Repl lithium ion battery..... ........... ........... ........... ........... ........... L8621................. A.............. ............... Repl zinc air battery........ ........... ........... ........... ........... ........... L8622................. A.............. ............... Repl alkaline battery........ ........... ........... ........... ........... ........... L8630................. N.............. ............... Metacarpophalangeal implant.. ........... ........... ........... ........... ........... L8631................. N.............. ............... MCP joint repl 2 pc or more.. ........... ........... ........... ........... ........... L8641................. N.............. ............... Metatarsal joint implant..... ........... ........... ........... ........... ........... L8642................. N.............. ............... Hallux implant............... ........... ........... ........... ........... ........... L8658................. N.............. ............... Interphalangeal joint spacer. ........... ........... ........... ........... ........... L8659................. N.............. ............... Interphalangeal joint repl... ........... ........... ........... ........... ........... L8670................. N.............. ............... Vascular graft, synthetic.... ........... ........... ........... ........... ........... L8699................. N.............. ............... Prosthetic implant NOS....... ........... ........... ........... ........... ........... L9900................. A.............. ............... O&P supply/accessory/service. ........... ........... ........... ........... ........... M0064................. X.............. ............... Visit for drug monitoring....

0374 1.0414 $61.80 ........... $12.36 M0075................. E.............. ............... Cellular therapy............. ........... ........... ........... ........... ........... M0076................. E.............. ............... Prolotherapy................. ........... ........... ........... ........... ........... M0100................. E.............. ............... Intragastric hypothermia..... ........... ........... ........... ........... ........... M0300................. E.............. ............... IV chelationtherapy.......... ........... ........... ........... ........... ........... M0301................. E.............. ............... Fabric wrapping of aneurysm.. ........... ........... ........... ........... ........... P2028................. A.............. ............... Cephalin floculation test.... ........... ........... ........... ........... ........... P2029................. A.............. ............... Congo red blood test......... ........... ........... ........... ........... ........... P2031................. E.............. ............... Hair analysis................ ........... ........... ........... ........... ........... P2033................. A.............. ............... Blood thymol turbidity....... ........... ........... ........... ........... ........... P2038................. A.............. ............... Blood mucoprotein............ ........... ........... ........... ........... ...........

[[Page 50880]]

P3000................. A.............. ............... Screen pap by tech w md supv. ........... ........... ........... ........... ........... P3001................. B.............. ............... Screening pap smear by phys.. ........... ........... ........... ........... ........... P7001................. E.............. ............... Culture bacterial urine...... ........... ........... ........... ........... ........... P9010................. K.............. ............... Whole blood for transfusion..

0950 2.0123 $119.42 ........... $23.88 P9011................. K.............. ............... Blood split unit.............

0967 1.2698 $75.35 ........... $15.07 P9012................. K.............. ............... Cryoprecipitate each unit....

0952 0.7395 $43.88 ...........

$8.78 P9016................. K.............. ............... RBC leukocytes reduced.......

0954 2.7370 $162.42 ........... $32.48 P9017................. K.............. ............... Plasma 1 donor frz w/in 8 hr.

9508 1.2038 $71.44 ........... $14.29 P9019................. K.............. ............... Platelets, each unit.........

0957 0.8317 $49.36 ...........

$9.87 P9020................. K.............. ............... Plaelet rich plasma unit.....

0958 5.1815 $307.49 ........... $61.50 P9021................. K.............. ............... Red blood cells unit.........

0959 2.0301 $120.47 ........... $24.09 P9022................. K.............. ............... Washed red blood cells unit..

0960 2.9707 $176.29 ........... $35.26 P9023................. K.............. ............... Frozen plasma, pooled, sd....

0949 1.1956 $70.95 ........... $14.19 P9031................. K.............. ............... Platelets leukocytes reduced.

1013 1.6023 $95.09 ........... $19.02 P9032................. K.............. ............... Platelets, irradiated........

9500 1.3589 $80.64 ........... $16.13 P9033................. K.............. ............... Platelets leukoreduced irrad.

0968 2.3639 $140.28 ........... $28.06 P9034................. K.............. ............... Platelets, pheresis..........

9507 6.8988 $409.40 ........... $81.88 P9035................. K.............. ............... Platelet pheres leukoreduced.

9501 8.1495 $483.62 ........... $96.72 P9036................. K.............. ............... Platelet pheresis irradiated.

9502 5.1895 $307.96 ........... $61.59 P9037................. K.............. ............... Plate pheres leukoredu irrad.

1019 9.5131 $564.54 ........... $112.91 P9038................. K.............. ............... RBC irradiated...............

9505 2.3876 $141.69 ........... $28.34 P9039................. K.............. ............... RBC deglycerolized...........

9504 6.4314 $381.66 ........... $76.33 P9040................. K.............. ............... RBC leukoreduced irradiated..

0969 3.6451 $216.31 ........... $43.26 P9041................. K.............. ............... Albumin (human),5%, 50ml.....

0961 0.5119 $30.38 ...........

$6.08 P9043................. K.............. ............... Plasma protein fract,5%,50ml.

0956 1.1226 $66.62 ........... $13.32 P9044................. K.............. ............... Cryoprecipitatereducedplasma.

1009 1.3062 $77.51 ........... $15.50 P9045................. K.............. ............... Albumin (human), 5%, 250 ml..

0963 1.3869 $82.30 ........... $16.46 P9046................. K.............. ............... Albumin (human), 25%, 20 ml..

0964 0.4878 $28.95 ...........

$5.79 P9047................. K.............. ............... Albumin (human), 25%, 50ml...

0965 1.1117 $65.97 ........... $13.19 P9048................. K.............. ............... Plasmaprotein fract,5%,250ml.

0966 4.9564 $294.13 ........... $58.83 P9050................. K.............. ............... Granulocytes, pheresis unit..

9506 15.6155 $926.67 ........... $185.33 P9051................. K.............. ............... Blood, l/r, cmv-neg..........

1010 2.9692 $176.20 ........... $35.24 P9052................. K.............. ............... Platelets, hla-m, l/r, unit..

1011 10.9690 $650.93 ........... $130.19 P9053................. K.............. ............... Plt, pher, l/r cmv-neg, irr..

1020 10.1551 $602.63 ........... $120.53 P9054................. K.............. ............... Blood, l/r, froz/degly/wash..

1016 5.2631 $312.33 ........... $62.47 P9055................. K.............. ............... Plt, aph/pher, l/r, cmv-neg..

1017 8.5998 $510.34 ........... $102.07 P9056................. K.............. ............... Blood, l/r, irradiated.......

1018 2.8004 $166.18 ........... $33.24 P9057................. K.............. ............... RBC, frz/deg/wsh, l/r, irrad.

1021 4.8787 $289.52 ........... $57.90 P9058................. K.............. ............... RBC, l/r, cmv-neg, irrad.....

1022 4.2901 $254.59 ........... $50.92 P9059................. K.............. ............... Plasma, frz between 8-24hour.

0955 1.2934 $76.75 ........... $15.35 P9060................. K.............. ............... Fr frz plasma donor retested.

9503 1.6241 $96.38 ........... $19.28 P9603................. A.............. ............... One-way allow prorated miles. ........... ........... ........... ........... ........... P9604................. A.............. ............... One-way allow prorated trip.. ........... ........... ........... ........... ........... P9612................. N.............. ............... Catheterize for urine spec... ........... ........... ........... ........... ........... P9615................. N.............. ............... Urine specimen collect mult.. ........... ........... ........... ........... ........... Q0035................. X.............. ............... Cardiokymography.............

0100 2.4968 $148.17 $41.44 $29.63 Q0081................. B.............. ............... Infusion ther other than che. ........... ........... ........... ........... ........... Q0083................. B.............. ............... Chemo by other than infusion. ........... ........... ........... ........... ........... Q0084................. B.............. ............... Chemotherapy by infusion..... ........... ........... ........... ........... ........... Q0085................. B.............. ............... Chemo by both infusion and o. ........... ........... ........... ........... ........... Q0091................. T.............. ............... Obtaining screen pap smear...

0191

0.167

$9.91

$2.78

$1.98 Q0092................. N.............. ............... Set up port xray equipment... ........... ........... ........... ........... ........... Q0111................. A.............. ............... Wet mounts/ w preparations... ........... ........... ........... ........... ........... Q0112................. A.............. ............... Potassium hydroxide preps.... ........... ........... ........... ........... ........... Q0113................. A.............. ............... Pinworm examinations......... ........... ........... ........... ........... ........... Q0114................. A.............. ............... Fern test.................... ........... ........... ........... ........... ........... Q0115................. A.............. ............... Post-coital mucous exam...... ........... ........... ........... ........... ........... Q0136................. K.............. ............... Non esrd epoetin alpha inj...

0733 ...........

$9.99 ...........

$2.00 Q0137................. K.............. ............... Darbepoetin alfa, non esrd...

0734 ...........

$3.28 ...........

$0.66 Q0144................. E.............. ............... Azithromycin dihydrate, oral. ........... ........... ........... ........... ........... Q0163................. N.............. ............... Diphenhydramine HCl 50mg..... ........... ........... ........... ........... ........... Q0164................. N.............. ............... Prochlorperazine maleate 5mg. ........... ........... ........... ........... ........... Q0165................. B.............. ............... Prochlorperazine maleate10mg. ........... ........... ........... ........... ........... Q0166................. K.............. ............... Granisetron HCl 1 mg oral....

0765 ........... $33.51 ...........

$6.70 Q0167................. N.............. ............... Dronabinol 2.5mg oral........ ........... ........... ........... ........... ........... Q0168................. B.............. ............... Dronabinol 5mg oral.......... ........... ........... ........... ........... ...........

[[Page 50881]]

Q0169................. N.............. ............... Promethazine HCl 12.5mg oral. ........... ........... ........... ........... ........... Q0170................. B.............. ............... Promethazine HCl 25 mg oral.. ........... ........... ........... ........... ........... Q0171................. Na............. ............... Chlorpromazine HCl 10mg oral. ........... ........... ........... ........... ........... Q0172................. B.............. ............... Chlorpromazine HCl 25mg oral. ........... ........... ........... ........... ........... Q0173................. N.............. ............... Trimethobenzamide HCl 250mg.. ........... ........... ........... ........... ........... Q0174................. N.............. ............... Thiethylperazine maleate10mg. ........... ........... ........... ........... ........... Q0175................. N.............. ............... Perphenazine 4mg oral........ ........... ........... ........... ........... ........... Q0176................. B.............. ............... Perphenazine 8mg oral........ ........... ........... ........... ........... ........... Q0177................. N.............. ............... Hydroxyzine pamoate 25mg..... ........... ........... ........... ........... ........... Q0178................. B.............. ............... Hydroxyzine pamoate 50mg..... ........... ........... ........... ........... ........... Q0179................. K.............. ............... Ondansetron HCl 8mg oral.....

0769 ........... $32.02 ...........

$6.40 Q0180................. K.............. ............... Dolasetron mesylate oral.....

0763 ........... $48.54 ...........

$9.71 Q0181................. E.............. ............... Unspecified oral anti-emetic. ........... ........... ........... ........... ........... Q0187................. K.............. ............... Factor viia recombinant......

1409 ........... $1,080.11 ........... $216.02 Q1001................. N.............. ............... Ntiol category 1............. ........... ........... ........... ........... ........... Q1002................. N.............. ............... Ntiol category 2............. ........... ........... ........... ........... ........... Q1003................. N.............. ............... Ntiol category 3............. ........... ........... ........... ........... ........... Q1004................. N.............. ............... Ntiol category 4............. ........... ........... ........... ........... ........... Q1005................. N.............. ............... Ntiol category 5............. ........... ........... ........... ........... ........... Q2001................. E.............. ............... Oral cabergoline 0.5 mg...... ........... ........... ........... ........... ........... Q2002................. N.............. ............... Elliotts b solution per ml... ........... ........... ........... ........... ........... Q2003................. K.............. ............... Aprotinin, 10,000 kiu........

7019 ...........

$2.20 ...........

$0.44 Q2004................. N.............. ............... Bladder calculi irrig sol.... ........... ........... ........... ........... ........... Q2005................. K.............. ............... Corticorelin ovine triflutat.

7024 ........... $386.53 ........... $77.31 Q2006................. K.............. ............... Digoxin immune fab (ovine)...

7025 ........... $552.18 ........... $110.44 Q2007................. K.............. ............... Ethanolamine oleate 100 mg...

7026 ........... $64.53 ........... $12.91 Q2008................. K.............. ............... Fomepizole, 15 mg............

7027 ........... $12.31 ...........

$2.46 Q2009................. K.............. ............... Fosphenytoin, 50 mg..........

7028 ...........

$5.19 ...........

$1.04 Q2011................. K.............. ............... Hemin, per 1 mg..............

7030 ...........

$6.51 ...........

$1.30 Q2012................. K.............. ............... Pegademase bovine, 25 iu.....

9168 ........... $161.16 ........... $32.23 Q2013................. K.............. ............... Pentastarch 10% solution.....

7040 ........... $12.45 ...........

$2.49 Q2014................. N.............. ............... Sermorelin acetate, 0.5 mg... ........... ........... ........... ........... ........... Q2017................. K.............. ............... Teniposide, 50 mg............

7035 ........... $266.23 ........... $53.25 Q2018................. K.............. ............... Urofollitropin, 75 iu........

7037 ........... $44.74 ...........

$8.95 Q2019................. K.............. ............... Basiliximab..................

1615 ........... $1,473.57 ........... $294.71 Q2020................. E.............. ............... Histrelin acetate............ ........... ........... ........... ........... ........... Q2021................. K.............. ............... Lepirudin....................

9057 ........... $128.17 ........... $25.63 Q2022................. K.............. ............... VonWillebrandFactrCmplxperIU.

1618 ...........

$0.74 ...........

$0.15 Q3000................. H.............. ............... Rubidium-Rb-82...............

9025 ........... ........... ........... ........... Q3001................. B.............. ............... Brachytherapy Radioelements.. ........... ........... ........... ........... ........... Q3002................. H.............. ............... Gallium ga 67................

1619 ........... ........... ........... ........... Q3003................. H.............. ............... Technetium tc99m bicisate....

1620 ........... ........... ........... ........... Q3004................. N.............. ............... Xenon xe 133................. ........... ........... ........... ........... ........... Q3005................. H.............. ............... Technetium tc99m mertiatide..

1622 ........... ........... ........... ........... Q3006................. H.............. ............... Technetium tc99m glucepatate.

9154 ........... ........... ........... ........... Q3007................. H.............. ............... Sodium phosphate p32.........

1624 ........... ........... ........... ........... Q3008................. H.............. ............... Indium 111-in pentetreotide..

1625 ........... ........... ........... ........... Q3009................. N.............. ............... Technetium tc99m oxidronate.. ........... ........... ........... ........... ........... Q3010................. H.............. ............... Technetium tc99m labeledrbcs.

9155 ........... ........... ........... ........... Q3011................. H.............. ............... Chromic phosphate p32........

1628 ........... ........... ........... ........... Q3012................. N.............. ............... Cyanocobalamin cobalt co57... ........... ........... ........... ........... ........... Q3014................. A.............. ............... Telehealth facility fee...... ........... ........... ........... ........... ........... Q3019................. A.............. ............... ALS emer trans no ALS serv... ........... ........... ........... ........... ........... Q3020................. A.............. ............... ALS nonemer trans no ALS se.. ........... ........... ........... ........... ........... Q3025................. K.............. ............... IM inj interferon beta 1-a...

9022 ........... $89.10 ........... $17.82 Q3026................. E.............. ............... Subc inj interferon beta-1a.. ........... ........... ........... ........... ........... Q3031................. N.............. ............... Collagen skin test........... ........... ........... ........... ........... ........... Q4001................. B.............. ............... Cast sup body cast plaster... ........... ........... ........... ........... ........... Q4002................. B.............. ............... Cast sup body cast fiberglas. ........... ........... ........... ........... ........... Q4003................. B.............. ............... Cast sup shoulder cast plstr. ........... ........... ........... ........... ........... Q4004................. B.............. ............... Cast sup shoulder cast fbrgl. ........... ........... ........... ........... ........... Q4005................. B.............. ............... Cast sup long arm adult plst. ........... ........... ........... ........... ........... Q4006................. B.............. ............... Cast sup long arm adult fbrg. ........... ........... ........... ........... ........... Q4007................. B.............. ............... Cast sup long arm ped plster. ........... ........... ........... ........... ........... Q4008................. B.............. ............... Cast sup long arm ped fbrgls. ........... ........... ........... ........... ........... Q4009................. B.............. ............... Cast sup sht arm adult plstr. ........... ........... ........... ........... ...........

[[Page 50882]]

Q4010................. B.............. ............... Cast sup sht arm adult fbrgl. ........... ........... ........... ........... ........... Q4011................. B.............. ............... Cast sup sht arm ped plaster. ........... ........... ........... ........... ........... 012............. B.............. ............... Cast sup sht arm ped fbrglas. ........... ........... ........... ........... ........... Q4013................. B.............. ............... Cast sup gauntlet plaster.... ........... ........... ........... ........... ........... Q4014................. B.............. ............... Cast sup gauntlet fiberglass. ........... ........... ........... ........... ........... Q4015................. B.............. ............... Cast sup gauntlet ped plster. ........... ........... ........... ........... ........... Q4016................. B.............. ............... Cast sup gauntlet ped fbrgls. ........... ........... ........... ........... ........... Q4017................. B.............. ............... Cast sup lng arm splint plst. ........... ........... ........... ........... ........... Q4018................. B.............. ............... Cast sup lng arm splint fbrg. ........... ........... ........... ........... ........... Q4019................. B.............. ............... Cast sup lng arm splnt ped p. ........... ........... ........... ........... ........... Q4020................. B.............. ............... Cast sup lng arm splnt ped f. ........... ........... ........... ........... ........... Q4021................. B.............. ............... Cast sup sht arm splint plst. ........... ........... ........... ........... ........... Q4022................. B.............. ............... Cast sup sht arm splint fbrg. ........... ........... ........... ........... ........... Q4023................. B.............. ............... Cast sup sht arm splnt ped p. ........... ........... ........... ........... ........... Q4024................. B.............. ............... Cast sup sht arm splnt ped f. ........... ........... ........... ........... ........... Q4025................. B.............. ............... Cast sup hip spica plaster... ........... ........... ........... ........... ........... Q4026................. B.............. ............... Cast sup hip spica fiberglas. ........... ........... ........... ........... ........... Q4027................. B.............. ............... Cast sup hip spica ped plstr. ........... ........... ........... ........... ........... Q4028................. B.............. ............... Cast sup hip spica ped fbrgl. ........... ........... ........... ........... ........... Q4029................. B.............. ............... Cast sup long leg plaster.... ........... ........... ........... ........... ........... Q4030................. B.............. ............... Cast sup long leg fiberglass. ........... ........... ........... ........... ........... Q4031................. B.............. ............... Cast sup lng leg ped plaster. ........... ........... ........... ........... ........... Q4032................. B.............. ............... Cast sup lng leg ped fbrgls.. ........... ........... ........... ........... ........... Q4033................. B.............. ............... Cast sup lng leg cylinder pl. ........... ........... ........... ........... ........... Q4034................. B.............. ............... Cast sup lng leg cylinder fb. ........... ........... ........... ........... ........... Q4035................. B.............. ............... Cast sup lngleg cylndr ped p. ........... ........... ........... ........... ........... Q4036................. B.............. ............... Cast sup lngleg cylndr ped f. ........... ........... ........... ........... ........... Q4037................. B.............. ............... Cast sup shrt leg plaster.... ........... ........... ........... ........... ........... Q4038................. B.............. ............... Cast sup shrt leg fiberglass. ........... ........... ........... ........... ........... Q4039................. B.............. ............... Cast sup shrt leg ped plster. ........... ........... ........... ........... ........... Q4040................. B.............. ............... Cast sup shrt leg ped fbrgls. ........... ........... ........... ........... ........... Q4041................. B.............. ............... Cast sup lng leg splnt plstr. ........... ........... ........... ........... ........... Q4042................. B.............. ............... Cast sup lng leg splnt fbrgl. ........... ........... ........... ........... ........... Q4043................. B.............. ............... Cast sup lng leg splnt ped p. ........... ........... ........... ........... ........... Q4044................. B.............. ............... Cast sup lng leg splnt ped f. ........... ........... ........... ........... ........... Q4045................. B.............. ............... Cast sup sht leg splnt plstr. ........... ........... ........... ........... ........... Q4046................. B.............. ............... Cast sup sht leg splnt fbrgl. ........... ........... ........... ........... ........... Q4047................. B.............. ............... Cast sup sht leg splnt ped p. ........... ........... ........... ........... ........... Q4048................. B.............. ............... Cast sup sht leg splnt ped f. ........... ........... ........... ........... ........... Q4049................. B.............. ............... Finger splint, static........ ........... ........... ........... ........... ........... Q4050................. B.............. ............... Cast supplies unlisted....... ........... ........... ........... ........... ........... Q4051................. B.............. ............... Splint supplies misc......... ........... ........... ........... ........... ........... Q4054................. A.............. ............... Darbepoetin alfa, esrd use... ........... ........... ........... ........... ........... Q4055................. A.............. ............... Epoetin alfa, esrd use....... ........... ........... ........... ........... ........... Q4075................. N.............. ............... Acyclovir, 5 mg.............. ........... ........... ........... ........... ........... Q4076................. N.............. ............... Dopamine hcl, 40 mg.......... ........... ........... ........... ........... ........... Q4077................. K.............. ............... Treprostinil, 1 mg...........

1082 ........... $55.02 ........... $11.00 Q4079................. G.............. ............... Injection, natalizumab.......

9126 ...........

$6.51 ...........

$1.30 Q9941................. K.............. ............... IVIG lyophil 1g..............

0869 ........... $39.46 ...........

$7.89 Q9942................. K.............. ............... IVIG lyophil 10 mg...........

0870 ...........

$0.40 ...........

$0.08 Q9943................. K.............. ............... IVIG non-lyophil 1g..........

0871 ........... $57.26 ........... $11.45 Q9944................. K.............. ............... IVIG non-lyophil 10 mg.......

0872 ...........

$0.57 ...........

$0.11 Q9945................. K.............. ............... LOCM = 400 mg/ml iodine,1ml.

19163 ...........

$0.20 ...........

$0.04 Q9952................. K.............. ............... Inj Gad-base MR contrast, ml.

9164 ...........

$3.01 ...........

$0.60 Q9953................. N.............. ............... Inj Fe-based MR contrast, ml. ........... ........... ........... ........... ........... Q9954................. K.............. ............... Oral MR contrast, 100 ml.....

9165 ...........

$9.01 ...........

$1.80 Q9955................. K.............. ............... Inj perflexane lip micros, m.

9203 ........... $13.49 ...........

$2.70 Q9956................. K.............. ............... Inj octafluoropropane mic,ml.

9202 ........... $41.42 ...........

$8.28 Q9957................. K.............. ............... Inj perflutren lip micros, m.

9112 ........... $63.51 ........... $12.70 R0070................. N.............. ............... Transport portable x-ray..... ........... ........... ........... ........... ...........

[[Page 50883]]

R0075................. N.............. ............... Transport port x-ray multipl. ........... ........... ........... ........... ........... R0076................. N.............. ............... Transport portable EKG....... ........... ........... ........... ........... ........... V2020................. A.............. ............... Vision svcs frames purchases. ........... ........... ........... ........... ........... V2025................. E.............. ............... Eyeglasses delux frames...... ........... ........... ........... ........... ........... V2100................. A.............. ............... Lens spher single plano 4.00. ........... ........... ........... ........... ........... V2101................. A.............. ............... Single visn sphere 4.12-7.00. ........... ........... ........... ........... ........... V2102................. A.............. ............... Singl visn sphere 7.12-20.00. ........... ........... ........... ........... ........... V2103................. A.............. ............... Spherocylindr 4.00d/12-2.00d. ........... ........... ........... ........... ........... V2104................. A.............. ............... Spherocylindr 4.00d/2.12-4d.. ........... ........... ........... ........... ........... V2105................. A.............. ............... Spherocylinder 4.00d/4.25-6d. ........... ........... ........... ........... ........... V2106................. A.............. ............... Spherocylinder 4.00d/>6.00d.. ........... ........... ........... ........... ........... V2107................. A.............. ............... Spherocylinder 4.25d/12-2d... ........... ........... ........... ........... ........... V2108................. A.............. ............... Spherocylinder 4.25d/2.12-4d. ........... ........... ........... ........... ........... V2109................. A.............. ............... Spherocylinder 4.25d/4.25-6d. ........... ........... ........... ........... ........... V2110................. A.............. ............... Spherocylinder 4.25d/over 6d. ........... ........... ........... ........... ........... V2111................. A.............. ............... Spherocylindr 7.25d/.25-2.25. ........... ........... ........... ........... ........... V2112................. A.............. ............... Spherocylindr 7.25d/2.25-4d.. ........... ........... ........... ........... ........... V2113................. A.............. ............... Spherocylindr 7.25d/4.25-6d.. ........... ........... ........... ........... ........... V2114................. A.............. ............... Spherocylinder over 12.00d... ........... ........... ........... ........... ........... V2115................. A.............. ............... Lens lenticular bifocal...... ........... ........... ........... ........... ........... V2118................. A.............. ............... Lens aniseikonic single...... ........... ........... ........... ........... ........... V2121................. A.............. ............... Lenticular lens, single...... ........... ........... ........... ........... ........... V2199................. A.............. ............... Lens single vision not oth c. ........... ........... ........... ........... ........... V2200................. A.............. ............... Lens spher bifoc plano 4.00d. ........... ........... ........... ........... ........... V2201................. A.............. ............... Lens sphere bifocal 4.12-7.0. ........... ........... ........... ........... ........... V2202................. A.............. ............... Lens sphere bifocal 7.12-20.. ........... ........... ........... ........... ........... V2203................. A.............. ............... Lens sphcyl bifocal 4.00d/.1. ........... ........... ........... ........... ........... V2204................. A.............. ............... Lens sphcy bifocal 4.00d/2.1. ........... ........... ........... ........... ........... V2205................. A.............. ............... Lens sphcy bifocal 4.00d/4.2. ........... ........... ........... ........... ........... V2206................. A.............. ............... Lens sphcy bifocal 4.00d/ove. ........... ........... ........... ........... ........... V2207................. A.............. ............... Lens sphcy bifocal 4.25-7d/.. ........... ........... ........... ........... ........... V2208................. A.............. ............... Lens sphcy bifocal 4.25-7/2.. ........... ........... ........... ........... ........... V2209................. A.............. ............... Lens sphcy bifocal 4.25-7/4.. ........... ........... ........... ........... ........... V2210................. A.............. ............... Lens sphcy bifocal 4.25-7/ov. ........... ........... ........... ........... ........... V2211................. A.............. ............... Lens sphcy bifo 7.25-12/.25-. ........... ........... ........... ........... ........... V2212................. A.............. ............... Lens sphcyl bifo 7.25-12/2.2. ........... ........... ........... ........... ........... V2213................. A.............. ............... Lens sphcyl bifo 7.25-12/4.2. ........... ........... ........... ........... ........... V2214................. A.............. ............... Lens sphcyl bifocal over 12.. ........... ........... ........... ........... ........... V2215................. A.............. ............... Lens lenticular bifocal...... ........... ........... ........... ........... ........... V2218................. A.............. ............... Lens aniseikonic bifocal..... ........... ........... ........... ........... ........... V2219................. A.............. ............... Lens bifocal seg width over.. ........... ........... ........... ........... ........... V2220................. A.............. ............... Lens bifocal add over 3.25d.. ........... ........... ........... ........... ........... V2221................. A.............. ............... Lenticular lens, bifocal..... ........... ........... ........... ........... ........... V2299................. A.............. ............... Lens bifocal speciality...... ........... ........... ........... ........... ........... V2300................. A.............. ............... Lens sphere trifocal 4.00d... ........... ........... ........... ........... ........... V2301................. A.............. ............... Lens sphere trifocal 4.12-7.. ........... ........... ........... ........... ........... V2302................. A.............. ............... Lens sphere trifocal 7.12-20. ........... ........... ........... ........... ........... V2303................. A.............. ............... Lens sphcy trifocal 4.0/.12-. ........... ........... ........... ........... ........... V2304................. A.............. ............... Lens sphcy trifocal 4.0/2.25. ........... ........... ........... ........... ........... V2305................. A.............. ............... Lens sphcy trifocal 4.0/4.25. ........... ........... ........... ........... ........... V2306................. A.............. ............... Lens sphcyl trifocal 4.00/>6. ........... ........... ........... ........... ........... V2307................. A.............. ............... Lens sphcy trifocal 4.25-7/.. ........... ........... ........... ........... ........... V2308................. A.............. ............... Lens sphc trifocal 4.25-7/2.. ........... ........... ........... ........... ........... V2309................. A.............. ............... Lens sphc trifocal 4.25-7/4.. ........... ........... ........... ........... ........... V2310................. A.............. ............... Lens sphc trifocal 4.25-7/>6. ........... ........... ........... ........... ........... V2311................. A.............. ............... Lens sphc trifo 7.25-12/.25-. ........... ........... ........... ........... ........... V2312................. A.............. ............... Lens sphc trifo 7.25-12/2.25. ........... ........... ........... ........... ........... V2313................. A.............. ............... Lens sphc trifo 7.25-12/4.25. ........... ........... ........... ........... ........... V2314................. A.............. ............... Lens sphcyl trifocal over 12. ........... ........... ........... ........... ........... V2315................. A.............. ............... Lens lenticular trifocal..... ........... ........... ........... ........... ........... V2318................. A.............. ............... Lens aniseikonic trifocal.... ........... ........... ........... ........... ........... V2319................. A.............. ............... Lens trifocal seg width > 28. ........... ........... ........... ........... ........... V2320................. A.............. ............... Lens trifocal add over 3.25d. ........... ........... ........... ........... ........... V2321................. A.............. ............... Lenticular lens, trifocal.... ........... ........... ........... ........... ........... V2399................. A.............. ............... Lens trifocal speciality..... ........... ........... ........... ........... ........... V2410................. A.............. ............... Lens variab asphericity sing. ........... ........... ........... ........... ...........

[[Page 50884]]

V2430................. A.............. ............... Lens variable asphericity bi. ........... ........... ........... ........... ........... V2499................. A.............. ............... Variable asphericity lens.... ........... ........... ........... ........... ........... V2500................. A.............. ............... Contact lens pmma spherical.. ........... ........... ........... ........... ........... V2501................. A.............. ............... Cntct lens pmma-toric/prism.. ........... ........... ........... ........... ........... V2502................. A.............. ............... Contact lens pmma bifocal.... ........... ........... ........... ........... ........... V2503................. A.............. ............... Cntct lens pmma color vision. ........... ........... ........... ........... ........... V2510................. A.............. ............... Cntct gas permeable sphericl. ........... ........... ........... ........... ........... V2511................. A.............. ............... Cntct toric prism ballast.... ........... ........... ........... ........... ........... V2512................. A.............. ............... Cntct lens gas permbl bifocl. ........... ........... ........... ........... ........... V2513................. A.............. ............... Contact lens extended wear... ........... ........... ........... ........... ........... V2520................. A.............. ............... Contact lens hydrophilic..... ........... ........... ........... ........... ........... V2521................. A.............. ............... Cntct lens hydrophilic toric. ........... ........... ........... ........... ........... V2522................. A.............. ............... Cntct lens hydrophil bifocl.. ........... ........... ........... ........... ........... V2523................. A.............. ............... Cntct lens hydrophil extend.. ........... ........... ........... ........... ........... V2530................. A.............. ............... Contact lens gas impermeable. ........... ........... ........... ........... ........... V2531................. A.............. ............... Contact lens gas permeable... ........... ........... ........... ........... ........... V2599................. A.............. ............... Contact lens/es other type... ........... ........... ........... ........... ........... V2600................. A.............. ............... Hand held low vision aids.... ........... ........... ........... ........... ........... V2610................. A.............. ............... Single lens spectacle mount.. ........... ........... ........... ........... ........... V2615................. A.............. ............... Telescop/othr compound lens.. ........... ........... ........... ........... ........... V2623................. A.............. ............... Plastic eye prosth custom.... ........... ........... ........... ........... ........... V2624................. A.............. ............... Polishing artifical eye...... ........... ........... ........... ........... ........... V2625................. A.............. ............... Enlargemnt of eye prosthesis. ........... ........... ........... ........... ........... V2626................. A.............. ............... Reduction of eye prosthesis.. ........... ........... ........... ........... ........... V2627................. A.............. ............... Scleral cover shell.......... ........... ........... ........... ........... ........... V2628................. A.............. ............... Fabrication & fitting........ ........... ........... ........... ........... ........... V2629................. A.............. ............... Prosthetic eye other type.... ........... ........... ........... ........... ........... V2630................. N.............. ............... Anter chamber intraocul lens. ........... ........... ........... ........... ........... V2631................. N.............. ............... Iris support intraoclr lens.. ........... ........... ........... ........... ........... V2632................. N.............. ............... Post chmbr intraocular lens.. ........... ........... ........... ........... ........... V2700................. A.............. ............... Balance lens................. ........... ........... ........... ........... ........... V2702................. E.............. ............... Deluxe lens feature.......... ........... ........... ........... ........... ........... V2710................. A.............. ............... Glass/plastic slab off prism. ........... ........... ........... ........... ........... V2715................. A.............. ............... Prism lens/es................ ........... ........... ........... ........... ........... V2718................. A.............. ............... Fresnell prism press-on lens. ........... ........... ........... ........... ........... V2730................. A.............. ............... Special base curve........... ........... ........... ........... ........... ........... V2744................. A.............. ............... Tint photochromatic lens/es.. ........... ........... ........... ........... ........... V2745................. A.............. ............... Tint, any color/solid/grad... ........... ........... ........... ........... ........... V2750................. A.............. ............... Anti-reflective coating...... ........... ........... ........... ........... ........... V2755................. A.............. ............... UV lens/es................... ........... ........... ........... ........... ........... V2756................. E.............. ............... Eye glass case............... ........... ........... ........... ........... ........... V2760................. A.............. ............... Scratch resistant coating.... ........... ........... ........... ........... ........... V2761................. B.............. ............... Mirror coating............... ........... ........... ........... ........... ........... V2762................. A.............. ............... Polarization, any lens....... ........... ........... ........... ........... ........... V2770................. A.............. ............... Occluder lens/es............. ........... ........... ........... ........... ........... V2780................. A.............. ............... Oversize lens/es............. ........... ........... ........... ........... ........... V2781................. B.............. ............... Progressive lens per lens.... ........... ........... ........... ........... ........... V2782................. A.............. ............... Lens, 1.54-1.65 p/1.60-1.79g. ........... ........... ........... ........... ........... V2783................. A.............. ............... Lens, >= 1.66 p/>=1.80 g..... ........... ........... ........... ........... ........... V2784................. A.............. ............... Lens polycarb or equal....... ........... ........... ........... ........... ........... V2785................. F.............. ............... Corneal tissue processing.... ........... ........... ........... ........... ........... V2786................. A.............. ............... Occupational multifocal lens. ........... ........... ........... ........... ........... V2790................. N.............. ............... Amniotic membrane............ ........... ........... ........... ........... ........... V2797................. A.............. ............... Vis item/svc in other code... ........... ........... ........... ........... ........... V2799................. A.............. ............... Miscellaneous vision service. ........... ........... ........... ........... ........... V5008................. E.............. ............... Hearing screening............ ........... ........... ........... ........... ........... V5010................. E.............. ............... Assessment for hearing aid... ........... ........... ........... ........... ........... V5011................. E.............. ............... Hearing aid fitting/checking. ........... ........... ........... ........... ........... V5014................. E.............. ............... Hearing aid repair/modifying. ........... ........... ........... ........... ........... V5020................. E.............. ............... Conformity evaluation........ ........... ........... ........... ........... ........... V5030................. E.............. ............... Body-worn hearing aid air.... ........... ........... ........... ........... ........... V5040................. E.............. ............... Body-worn hearing aid bone... ........... ........... ........... ........... ........... V5050................. E.............. ............... Hearing aid monaural in ear.. ........... ........... ........... ........... ........... V5060................. E.............. ............... Behind ear hearing aid....... ........... ........... ........... ........... ........... V5070................. E.............. ............... Glasses air conduction....... ........... ........... ........... ........... ........... V5080................. E.............. ............... Glasses bone conduction...... ........... ........... ........... ........... ...........

[[Page 50885]]

V5090................. E.............. ............... Hearing aid dispensing fee... ........... ........... ........... ........... ........... V5095................. E.............. ............... Implant mid ear hearing pros. ........... ........... ........... ........... ........... V5100................. E.............. ............... Body-worn bilat hearing aid.. ........... ........... ........... ........... ........... V5110................. E.............. ............... Hearing aid dispensing fee... ........... ........... ........... ........... ........... V5120................. E.............. ............... Body-worn binaur hearing aid. ........... ........... ........... ........... ........... V5130................. E.............. ............... In ear binaural hearing aid.. ........... ........... ........... ........... ........... V5140................. E.............. ............... Behind ear binaur hearing ai. ........... ........... ........... ........... ........... V5150................. E.............. ............... Glasses binaural hearing aid. ........... ........... ........... ........... ........... V5160................. E.............. ............... Dispensing fee binaural...... ........... ........... ........... ........... ........... V5170................. E.............. ............... Within ear cros hearing aid.. ........... ........... ........... ........... ........... V5180................. E.............. ............... Behind ear cros hearing aid.. ........... ........... ........... ........... ........... V5190................. E.............. ............... Glasses cros hearing aid..... ........... ........... ........... ........... ........... V5200................. E.............. ............... Cros hearing aid dispens fee. ........... ........... ........... ........... ........... V5210................. E.............. ............... In ear bicros hearing aid.... ........... ........... ........... ........... ........... V5220................. E.............. ............... Behind ear bicros hearing ai. ........... ........... ........... ........... ........... V5230................. E.............. ............... Glasses bicros hearing aid... ........... ........... ........... ........... ........... V5240................. E.............. ............... Dispensing fee bicros........ ........... ........... ........... ........... ........... V5241................. E.............. ............... Dispensing fee, monaural..... ........... ........... ........... ........... ........... V5242................. E.............. ............... Hearing aid, monaural, cic... ........... ........... ........... ........... ........... V5243................. E.............. ............... Hearing aid, monaural, itc... ........... ........... ........... ........... ........... V5244................. E.............. ............... Hearing aid, prog, mon, cic.. ........... ........... ........... ........... ........... V5245................. E.............. ............... Hearing aid, prog, mon, itc.. ........... ........... ........... ........... ........... V5246................. E.............. ............... Hearing aid, prog, mon, ite.. ........... ........... ........... ........... ........... V5247................. E.............. ............... Hearing aid, prog, mon, bte.. ........... ........... ........... ........... ........... V5248................. E.............. ............... Hearing aid, binaural, cic... ........... ........... ........... ........... ........... V5249................. E.............. ............... Hearing aid, binaural, itc... ........... ........... ........... ........... ........... V5250................. E.............. ............... Hearing aid, prog, bin, cic.. ........... ........... ........... ........... ........... V5251................. E.............. ............... Hearing aid, prog, bin, itc.. ........... ........... ........... ........... ........... V5252................. E.............. ............... Hearing aid, prog, bin, ite.. ........... ........... ........... ........... ........... V5253................. E.............. ............... Hearing aid, prog, bin, bte.. ........... ........... ........... ........... ........... V5254................. E.............. ............... Hearing id, digit, mon, cic.. ........... ........... ........... ........... ........... V5255................. E.............. ............... Hearing aid, digit, mon, itc. ........... ........... ........... ........... ........... V5256................. E.............. ............... Hearing aid, digit, mon, ite. ........... ........... ........... ........... ........... V5257................. E.............. ............... Hearing aid, digit, mon, bte. ........... ........... ........... ........... ........... V5258................. E.............. ............... Hearing aid, digit, bin, cic. ........... ........... ........... ........... ........... V5259................. E.............. ............... Hearing aid, digit, bin, itc. ........... ........... ........... ........... ........... V5260................. E.............. ............... Hearing aid, digit, bin, ite. ........... ........... ........... ........... ........... V5261................. E.............. ............... Hearing aid, digit, bin, bte. ........... ........... ........... ........... ........... V5262................. E.............. ............... Hearing aid, disp, monaural.. ........... ........... ........... ........... ........... V5263................. E.............. ............... Hearing aid, disp, binaural.. ........... ........... ........... ........... ........... V5264................. E.............. ............... Ear mold/insert.............. ........... ........... ........... ........... ........... V5265................. E.............. ............... Ear mold/insert, disp........ ........... ........... ........... ........... ........... V5266................. E.............. ............... Battery for hearing device... ........... ........... ........... ........... ........... V5267................. E.............. ............... Hearing aid supply/accessory. ........... ........... ........... ........... ........... V5268................. E.............. ............... ALD Telephone Amplifier...... ........... ........... ........... ........... ........... V5269................. E.............. ............... Alerting device, any type.... ........... ........... ........... ........... ........... V5270................. E.............. ............... ALD, TV amplifier, any type.. ........... ........... ........... ........... ........... V5271................. E.............. ............... ALD, TV caption decoder...... ........... ........... ........... ........... ........... V5272................. E.............. ............... Tdd.......................... ........... ........... ........... ........... ........... V5273................. E.............. ............... ALD for cochlear implant..... ........... ........... ........... ........... ........... V5274................. E.............. ............... ALD unspecified.............. ........... ........... ........... ........... ........... V5275................. E.............. ............... Ear impression............... ........... ........... ........... ........... ........... V5298................. E.............. ............... Hearing aid noc.............. ........... ........... ........... ........... ........... V5299................. B.............. ............... Hearing service.............. ........... ........... ........... ........... ........... V5336................. E.............. ............... Repair communication device.. ........... ........... ........... ........... ........... V5362................. E.............. ............... Speech screening............. ........... ........... ........... ........... ........... V5363................. E.............. ............... Language screening........... ........... ........... ........... ........... ........... V5364................. E.............. ............... Dysphagia screening.......... ........... ........... ........... ........... ...........

* Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved.

[[Page 50886]]

(Catalog of Federal Domestic Assistance Program No. 93.773, Medicare--Hospital Insurance; and Program No. 93.774, Medicare-- Supplementary Medical Insurance Program)

Dated: August 17, 2005 Ann C. Agnew, Executive Secretary to the Department

[FR Doc. 05-16699 Filed 8-18-05; 2:44 pm]

BILLING CODE 4120-01-P