Separate Parts In This Issue Part III Health and Human Services Department, Centers for Medicare & Medicaid Services,

[Federal Register: November 7, 2003 (Volume 68, Number 216)]

[Rules and Regulations]

[Page 63397-63690]

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

[DOCID:fr07no03-15]

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Part III

Department of Health and Human Services

Centers for Medicare & Medicaid Services

42 CFR Parts 410 and 419

Medicare Program; Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2004 Payment Rates; Final Rule

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 410 and 419

[CMS-1471-FC]

RIN 0938-AL19

Medicare Program; Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2004 Payment Rates

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

ACTION: Final rule with comment period.

SUMMARY: This final rule with comment period revises the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. In addition, it describes changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2004. Finally, this rule responds to public comments received on the August 12, 2003 proposed rule for revisions to the hospital outpatient prospective payment system and payment rates (68 FR 47966).

DATES: Effective date: This final rule is effective January 1, 2004.

Comment date: We will consider comments on the ambulatory payment classification assignments of Healthcare Common Procedure Coding System codes identified in Addendum B with new interim (NI) condition codes, if we receive them at the appropriate address, as provided below, no later than 5 p.m. on January 6, 2004.

ADDRESSES: In commenting, please refer to file code CMS-1471-FC. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission or e-mail.

Mail written comments (one original and two copies) to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1471-FC, P.O. Box 8018, Baltimore, MD 21244-8018.

Please allow sufficient time for mailed comments to be timely received in the event of delivery delays.

If you prefer, you may deliver (by hand or courier) your written comments (one original and two copies) to one of the following addresses: Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201, or Room C5-14-03, 7500 Security Boulevard, Baltimore, MD 21244-1850.

(Because access to the interior of the HHH Building is not readily available to persons without Federal Government identification, commenters are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp-in clock is available for persons wishing to retain a proof of filing by stamping in and retaining an extra copy of the comments being filed.)

Comments mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and could be considered late.

For information on viewing public comments, see the beginning of the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT: Dana Burley, (410) 786-0378-- outpatient prospective payment issues; Suzanne Asplen, (410) 786-4558 or Jana Petze, (410) 786-9374--partial hospitalization and community mental health centers issues.

SUPPLEMENTARY INFORMATION:

Inspection of Public Comments: Comments received timely will be available for public inspection as they are received, generally beginning approximately 3 weeks after publication of a document, at the headquarters of the Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 a.m. to 4 p.m. To schedule an appointment to view public comments, call (410) 786-7195.

Availability of Copies and Electronic Access

Copies: To order copies of the Federal Register containing this document, send your request to: New Orders, Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. Specify the date of the issue requested and enclose a check or money order payable to the Superintendent of Documents, or enclose your Visa or Master Card number and expiration date. Credit card orders can also be placed by calling the order desk at (202) 512-1800 (or toll-free at 1-888-293- 6498) or by faxing to (202) 512-2250. The cost for each copy is $10. As an alternative, you can view and photocopy the Federal Register document at most libraries designated as Federal Depository Libraries and at many other public and academic libraries throughout the country that receive the Federal Register.

This Federal Register document is also available from the Federal Register online database through GPO Access, a service of the U.S. Government Printing Office. The web site address is: http://www.access.gpo.gov/nara/index.html .

To assist readers in referencing sections contained in this document, we are providing the following table of contents.

Outline of Contents

I. Background

A. Authority for the Outpatient Prospective Payment System

B. Summary of Rulemaking for the Outpatient Prospective Payment System

C. Summary of Changes in the August 12, 2003 Proposed Rule

1. Changes Required by Statute

2. Additional Changes to OPPS

D. Public Comments and Responses to the August 12, 2003 Proposed Rule II. Changes to the Ambulatory Payment Classification (APC) Groups and Relative Weights

A. Recommendations of the Advisory Panel on APC Groups

1. Establishment of the Advisory Panel on APC Groups

2. August 2003 Meeting

3. Recommendations of the Advisory Panel and Our Responses

B. Other Changes Affecting the APCs

1. Limit on Variation of Costs of Services Classified Within an APC Group

2. Procedures Moved From New Technology APCs to Clinically Appropriate APCs

3. Revision of Cost Bands and Payment Amounts for New Technology APCs

4. Creation of APCs for Combinations of Device Procedures III. Recalibration of APC Weights for CY 2004

A. Data Issues

1. Period of Claims Data Used

2. Treatment of ``Multiple Procedure'' Claims

B. Description of Our Calculation of Weights for CY 2004

C. Discussion of Relative Weights for Specific Procedural APCs IV. Transitional Pass-Through and Related Payment Issues

A. Background

B. Discussion of Pro Rata Reduction V. Payment for Devices

A. Pass-Through Devices

B. Expiration of Transitional Pass-Through Payments in CY 2004

C. Reinstitution of C Codes for Expired Device Categories

D. Other Policy Issues Relating to Pass-Through Device Categories

1. Reducing Transitional Pass-Through Device Categories To Offset Costs Packaged Into APC Groups

2. Multiple Procedure Reduction for Devices VI. Payment for Drugs, Biologicals, Radiopharmaceutical Agents, Blood, and Blood Products

A. Pass-Through Drugs and Biologicals

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B. Drugs, Biologicals, and Radiopharmaceuticals Without Pass- Through Status

1. Background

2. Criteria for Packaging Payment for Drugs, Biologicals, and Radiopharmaceuticals

3. Payment for Drugs, Biologicals, and Radiopharmaceuticals That Are Not Packaged

4. Payment for Drug Administration

5. Generic Drugs and Radiopharmaceuticals

6. Orphan Drugs

7. Vaccines

8. Blood and Blood Products

9. Intravenous Immune Globulin

10. Payment for Split Unit of Blood

11. Other Issues VII. Wage Index Changes for CY 2004 VIII. Copayment for CY 2004 IX. Conversion Factor Update for CY 2004 X. Outlier Policy and Elimination of Transitional Corridor Payments for CY 2004

A. Outlier Policy for CY 2004

B. Elimination of Transitional Corridor Payments for CY 2004 XI. Other Policy Decisions and Changes

A. Hospital Coding for Evaluation and Management (E/M) Services

B. Status Indicators and Issues Related to OCE Editing

C. Observation Services

D. Procedures That Will Be Paid Only As Inpatient Procedures

E. Partial Hospitalization Payment Methodology

1. Background

2. PHP APC Update for CY 2004

3. Outlier Payments to CMHCs XII. General Data, Billing, and Coding Issues XIII. Provisions of the Final Rule With Comment Period for 2004

A. Changes Required by Statute

B. Additional Changes

C. Major Changes From the Proposed Rule XIV. Collection of Information Requirements XV. Response to Public Comments XVI. Regulatory Impact Analysis

A. General

B. Changes in This Final Rule

C. Limitations of Our Analysis

D. Estimated Impacts of This Final Rule on Hospitals

E. Projected Distribution of Outlier Payments

F. Estimated Impacts of This Final Rule on Beneficiaries

Addenda

Addendum A--List of Ambulatory Payment Classifications (APCs) with Status Indicators, Relative Weights, Payment Rates, and Copayment Amounts Addendum B--Payment Status by HCPCS Code, and Related Information Addendum C--Hospital Outpatient Payment for Procedures by APC: Displayed on Web Site Only Addendum D--Payment Status Indicators for the Hospital Outpatient Prospective Payment System Addendum E--CPT Codes That Would Be Paid Only As Inpatient Procedures Addendum H--Wage Index for Urban Areas Addendum I--Wage Index for Rural Areas Addendum J--Wage Index for Hospitals That Are Reclassified Addendum L--Packaged Nonchemotherapy Infusion Drugs Addendum M--Separately Paid Nonchemotherapy Infusion Drugs Addendum N--Packaged Chemotherapy Drugs Other Than Infusion Addendum O--Separately Paid Chemotherapy Drugs Other Than Infusion Addendum P--Packaged Chemotherapy Drugs Infusion Only Addendum Q--Separately Paid Chemotherapy Drugs Infusion Only

Alphabetical List of Acronyms Appearing in This Final Rule With Comment Period

ACEP American College of Emergency Physicians AHA American Hospital Association AHIMA American Health Information Management Association AMA American Medical Association APC Ambulatory payment classification ASC Ambulatory surgical center AWP Average wholesale price BBA Balanced Budget Act of 1997 BIPA Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 BBRA Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 CAH Critical access hospital CCR Cost center specific cost-to-charge ratio CMHC Community mental health center CMS Centers for Medicare & Medicaid Services (Formerly known as the Health Care Financing Administration) CPT [Physicians'] Current Procedural Terminology, Fourth Edition, 2002, copyrighted by the American Medical Association CY Calendar year DMEPOS Durable medical equipment, prosthetics, orthotics, and supplies DRG Diagnosis-related group DSH Disproportionate Share Hospital EACH Essential Access Community Hospital E/M Evaluation and management ESRD End-stage renal disease FACA Federal Advisory Committee Act FDA Food and Drug Administration FI Fiscal intermediary FSS Federal Supply Schedule FY Federal fiscal year HCPCS Healthcare Common Procedure Coding System HCRIS Hospital Cost Report Information System HHA Home health agency HIPAA Health Insurance Portability and Accountability Act of 1996 ICD-9-CM International Classification of Diseases, Ninth Edition, Clinical Modification IME Indirect Medical Education IPPS (Hospital) inpatient prospective payment system IVIG Intravenous Immune Globulin LTC Long Term Care MedPAC Medicare Payment Advisory Commission MDH Medicare Dependent Hospital MSA Metropolitan statistical area NECMA New England County Metropolitan Area OCE Outpatient code editor OMB Office of Management and Budget OPD (Hospital) outpatient department OPPS (Hospital) outpatient prospective payment system PHP Partial hospitalization program PM Program memorandum PPS Prospective payment system PPV Pneumococcal pneumonia (virus) PRA Paperwork Reduction Act RFA Regulatory Flexibility Act RRC Rural Referral Center SBA Small Business Administration SCH Sole Community Hospital SDP Single drug pricer SI Status Indicator TEFRA Tax Equity and Fiscal Responsibility Act TOPS Transitional outpatient payments USPDI United States Pharmacopoeia Drug Information

I. Background

A. Authority for the Outpatient Prospective Payment System

When the Medicare statute was originally enacted, Medicare payment for hospital outpatient services was based on hospital-specific costs. In an effort to ensure that Medicare and its beneficiaries pay appropriately for services and to encourage more efficient delivery of care, the Congress mandated replacement of the cost-based payment methodology with a prospective payment system (PPS). The Balanced Budget Act of 1997 (BBA) (Pub. L. 105-33), enacted on August 5, 1997, added section 1833(t) to the Social Security Act (the Act) authorizing implementation of a PPS for hospital outpatient services. The Balanced Budget Refinement Act of 1999 (BBRA) (Pub. L. 106-113), enacted on November 29, 1999, made major changes that affected the hospital outpatient PPS (OPPS). The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) (Pub. L. 106-554), enacted on December 21, 2000, made further changes in the OPPS. The OPPS was first implemented for services furnished on or after August 1, 2000.

B. Summary of Rulemaking for the Outpatient Prospective Payment System

[sbull] On September 8, 1998, we published a proposed rule (63 FR 47552) to establish in regulations a PPS for hospital outpatient services, to eliminate the formula-driven overpayment for certain hospital outpatient services, and to extend reductions in payment for costs of hospital outpatient services.

[sbull] On April 7, 2000, we published a final rule with comment period (65 FR

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18434) that addressed the provisions of the PPS for hospital outpatient services scheduled to be effective for services furnished on or after July 1, 2000. Under this system, Medicare payment for hospital outpatient services included in the PPS is made at a predetermined, specific rate. These outpatient services are classified according to a list of ambulatory payment classifications (APCs). The April 7, 2000 final rule with comment period also established requirements for provider departments and provider-based entities and prohibited Medicare payment for nonphysician services furnished to a hospital outpatient by a provider or supplier other than a hospital unless the services are furnished under arrangement. In addition, this rule extended reductions in payment for costs of hospital outpatient services as required by the BBA and amended by the BBRA. Medicare regulations governing the hospital OPPS are set forth at 42 CFR part 419. Subsequently, we announced a delay in implementation of the OPPS from July 1, 2000 to August 1, 2000.

[sbull] On August 3, 2000, we published an interim final rule with comment period (65 FR 47670) that modified criteria that we use to determine which medical devices are eligible for transitional pass- through payments. The rule also corrected and clarified certain provider-based provisions included in the April 7, 2000 rule.

[sbull] On November 13, 2000, we published an interim final rule with comment period (65 FR 67798) to provide the annual update to the amounts and factors for OPPS payment rates effective for services furnished on or after January 1, 2001. We implemented the 2001 OPPS on January 1, 2001. We also responded to public comments on those portions of the April 7, 2000 final rule that implemented related provisions of the BBRA and public comments on the August 3, 2000 rule.

[sbull] On November 2, 2001, we published a final rule (66 FR 55857) that announced the Medicare OPPS conversion factor for calendar year (CY) 2002. It also described the Secretary s estimate of the total amount of the transitional pass-through payments for CY 2002 and the implementation of a uniform reduction in each of the pass-through payments for that year.

[sbull] On November 2, 2001, we also published an interim final rule with comment period (66 FR 55850) that set forth the criteria the Secretary will use to establish new categories of medical devices eligible for transitional pass-through payments under Medicare's OPPS.

[sbull] On November 30, 2001, we published a final rule (66 FR 59856) that revised the Medicare OPPS to implement applicable statutory requirements, including relevant provisions of BIPA, and changes resulting from continuing experience with this system. In addition, it described the CY 2002 payment rates for Medicare hospital outpatient services paid under the PPS. This final rule also announced a uniform reduction of 68.9 percent to be applied to each of the transitional pass-through payments for certain categories of medical devices and drugs and biologicals.

[sbull] On December 31, 2001, we published a final rule (66 FR 67494) that delayed, until no later than April 1, 2002, the effective date of CY 2002 payment rates and the uniform reduction of transitional pass-through payments that were announced in the November 30, 2001 final rule. In addition, this final rule indefinitely delayed certain related regulatory provisions.

[sbull] On March 1, 2002, we published a final rule (67 FR 9556) that corrected technical errors that affected the amounts and factors used to determine the payment rates for services paid under the Medicare OPPS and corrected the uniform reduction to be applied to transitional pass-through payments for CY 2002 as published in the November 30, 2001 final rule. These corrections and the regulatory provisions that had been delayed became effective on April 1, 2002.

[sbull] On November 1, 2002, we published a final rule (67 FR 66718) that revised the Medicare OPPS to update the payment weights and conversion factor for services payable under the 2003 OPPS on the basis of data from claims for services furnished from April 1, 2001 through March 31, 2002. The rule also removed from pass-through status most drugs and devices that had been paid under pass-through provisions in 2002 as required by the applicable provisions of law governing the duration of pass-through payment.

[sbull] On August 12, 2003, we published a proposed rule (68 FR 47966) that proposed the Medicare OPPS conversion factor for CY 2004. In addition, it described proposed changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system.

C. Summary of Changes in the August 12, 2003 Proposed Rule

On August 12, 2003, we published a proposed rule (68 FR 47966) that proposed changes to the Medicare hospital OPPS and CY 2004 payment rates including proposed changes used to determine these payment rates. The following is a summary of the major changes that we proposed and the issues we addressed in the August 12, 2003 proposed rule. 1. Changes Required by Statute

We proposed the following changes to implement statutory requirements:

[sbull] Add APCs, delete APCs, and modify the composition of some existing APCs.

[sbull] Recalibrate the relative payment weights of the APCs.

[sbull] Update the conversion factor and the wage index.

[sbull] Revise the APC payment amounts to reflect the APC reclassifications, the recalibration of payment weights, and the other required updates and adjustments.

[sbull] Cease transitional pass-through payments for drugs and biologicals and devices that will have been paid under the transitional pass-through methodology for at least 2 years by January 1, 2004.

[sbull] Cease transitional outpatient payments (TOPS payments) for all hospitals paid under OPPS except for cancer hospitals and children s hospitals. 2. Additional Changes to OPPS

We proposed the following additional changes to the OPPS:

[sbull] Adjust payment to moderate the effects of decreased median costs for non-pass-through drugs, biologicals, and radiopharmaceuticals.

[sbull] Implement a new method for paying for drug administration.

[sbull] Create new evaluation and management service codes for outpatient clinic and emergency department encounters.

[sbull] Change status indicators for Healthcare Common Procedure Coding System (HCPCS) codes.

[sbull] List midyear and proposed HCPCS codes that are paid under OPPS.

[sbull] Allocate a portion of the outlier percentage target amount to community mental health centers (CMHCs) and create a separate threshold for outlier payments for partial hospitalization services.

[sbull] Create methodology and payment rates for separately payable drugs and radiopharmaceuticals for 2004.

[sbull] Make several changes in our current payment policy with regard to payment

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for Q0081, Q0083, Q0084, and Q0085 to facilitate accurate payments for drugs and drug administration.

[sbull] Change the status indicator and payment amount for P9010 by assigning it to APC 0957 (Platelet concentrate) with a payment rate of $37.30.

[sbull] Establish new payment bands for new technology APCs.

D. Public Comments and Responses to the August 12, 2003 Proposed Rule

We received approximately 876 timely items of correspondence containing multiple comments on the August 12, 2003 proposed rule. Summaries of the public comments and our responses to those comments are set forth below under the appropriate section heading of this final rule with comment period.

We received comments from various sources including but not limited to health care facilities, physicians, drug and device manufacturers, and beneficiaries. Hospital associations and the Medicare Payment Advisory Commission (MedPAC) generally supported our proposed approach to revising the relative weights for APCs. Pharmaceutical and medical device manufacturers and some individual hospitals that furnish particular devices or drugs were concerned with the proposed reductions in payment for medical devices and drugs. We received many thoughtful comments from a wide range of commenters with regard to methodological issues in OPPS. In addition, several comments provided external data to support their assertions. The following are the major issues addressed by the commenters:

[sbull] The proposal to use $150 as the packaging threshold for separate payment of drugs.

[sbull] The proposal to pay for orphan drugs within the OPPS, basing payment on claims data.

[sbull] The proposal to pay for generic drugs at 43 percent of average wholesale prices (AWP) beginning with the time of the generic drug's Food and Drug Administration (FDA) approval.

[sbull] The proposed payments for blood and blood products under OPPS.

[sbull] The proposal to establish a separate outlier pool for community mental health centers(CMHCs).The proposal to apply an adjustment to increase payment to small rural hospitals' clinic and emergency room (ER) visit rates to ameliorate the effect of the sunsetting of the transitional corridor payments.

[sbull] The proposal to reinstitute drug and device coding requirements.

[sbull] Propose APC assignments and status indicators for numerous services.

In addition to comments regarding the policy proposals in the August 12, 2003 proposed rule, we received comments about the publication date of the proposed rule and the comment period.

Comment: Some commenters objected to the use of the date on which the August 12, 2003 proposed rule was made public by web posting and by public display at the Office of the Federal Register as the beginning of the comment period. They indicated that we should start the comment period only on the publication of the proposed rule in the Federal Register because that is where subscribers look for it. They objected to what they view as a 55-day comment period if it were to start on the date of Federal Register publication (August 12, 2003). Some commenters objected to the publication of the proposed rule so late in the year. They indicated that our publication on August 9 resulted in the comment period ending so close to the publication deadline for the final rule that they believed that their comments could not be fully analyzed and used and would not be as effective as if the proposed rule were published in June or early July. They urged us to publish the proposed rule in late spring. Some commenters objected to the scheduling of the APC Panel meeting so soon after the issuance of the proposed rule because they felt that it gave them inadequate time to prepare their presentations for the Panel.

Response: The comment period on a proposed rule begins on the day that the proposed rule is available for public comment. We believe that putting the document on display at the Office of the Federal Register and also making it available on the CMS Web site meets the test of being publicly available and that, therefore, is the start of the comment period. The publication of the proposed rule on the internet makes it available to many more people than routinely access the Federal Register or can visit the Office of the Federal Register where the display copy is located. The public had 60 days to comment on the proposed rule. This is the standard amount of time generally allowed for comment on notices of proposed rulemaking. Therefore, we do not believe the public was at a disadvantage or limited in the amount of time available to make public comments.

Our review of the public comments is extensive, with the comments being read and considered carefully, often by many staff. We agree that it is preferable, when possible, to issue the proposed rule as early as possible. However, the important issue is whether we have sufficient time to carefully and thoughtfully consider all comments in development of the final rule, rather than the amount of time between the end of the comment period and the publication of the final rule.

II. Changes to the Ambulatory Payment Classification (APC) Groups and Relative Weights

Under the OPPS, we pay for hospital outpatient services on a rate- per-service basis that varies according to the APC group to which the service is assigned. Each APC weight represents the median hospital cost of the services included in that APC relative to the median hospital cost of the services included in APC 0601, Mid-Level Clinic Visits. The APC weights are scaled to APC 0601 because a mid-level clinic visit is one of the most frequently performed services in the outpatient setting.

Section 1833(t)(9)(A) of the Act requires the Secretary to review the components of the OPPS not less often than annually and to revise the groups, relative payment weights, and other adjustments to take into account changes in medical practice, changes in technology, and the addition of new services, new cost data, and other relevant information and factors. Section 1833(t)(9)(A) of the Act requires the Secretary, beginning in 2001, to consult with an outside panel of experts to review the APC groups and the relative payment weights.

Finally, section 1833(t)(2) of the Act provides that, subject to certain exceptions, the items and services within an APC group cannot be considered comparable with respect to the use of resources if the highest median (or mean cost, if elected by the Secretary) for an item or service in the group is more than 2 times greater than the lowest median cost for an item or service within the same group (referred to as the ``2 times rule'').

We use the median cost of the item or service in implementing this provision. The statute authorizes the Secretary to make exceptions to the 2 times rule ``in unusual cases, such as low volume items and services.''

For purposes of the proposed rule and this final rule we analyzed the APC groups within this statutory framework.

A. Recommendations of the Advisory Panel on APC Groups

1. Establishment of the Advisory Panel on APC Groups

Section 1833(t)(9)(A) of the Social Security Act (the Act) requires that we consult with an outside panel of experts, the Panel, to review the clinical integrity of the APC groups and their

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weights. The Act specifies that the Panel will act in an advisory capacity. This expert panel, which is to be composed of representatives of providers subject to the OPPS (currently employed full-time, in their respective areas of expertise), reviews and advises us about the clinical integrity of the APC groups and their weights. The Panel is not restricted to using our data and may use data collected or developed by organizations outside the Department in conducting its review.

On November 21, 2000, the Secretary signed the charter establishing an ``Advisory Panel on APC Groups.'' The Panel is technical in nature and is governed by the provisions of the Federal Advisory Committee Act (FACA) as amended (Pub. L. 92-463).

On November 1, 2002, the Secretary renewed the charter. The new charter indicates that the Panel continues to be technical in nature, is governed by the provisions of the FACA, may convene ``up to three meetings per year,'' and is chaired by a Federal official.

To establish the Panel, we solicited members in a notice published in the Federal Register on December 5, 2000 (65 FR 75943). We received applications from more than 115 individuals nominating either a colleague or themselves. After carefully reviewing the applications, we chose 15 highly qualified individuals to serve on the Panel.

Because of the loss of 6 Panel members in March 2003 due to the expiration of terms of office, retirement, and a career change, a Federal Register notice was published on February 28, 2003 (68 FR 9671), requesting nominations of Panel members. From the 40 nominations we received, 6 new members have been chosen and have been identified on the CMS web site.

We received one comment regarding our selection of Panel members.

Comment: One commenter stated that Community Mental Health Centers (CMHCs) have not been represented on the APC Panel even though the names of qualified nominees have been submitted. The commenter went on to say that the Federal Register (February 28, 2003, at 68 FR 9671 through 9672) specifically states, ``Qualified nominees will meet those requirements necessary to be a Panel member. Panel members must be representatives of Medicare providers (including Community Mental Health Centers) subject to the OPPS * * * [therefore,] I feel that it is imperative to have a freestanding CMHC representative on the Panel.''

Response: The Federal Register notice on the APC Panel to which the commenter referred, states in section II, Criteria for Nominees, the following: ``The Panel shall consist of up to 15 members selected by the Secretary, or designee, from among representatives of Medicare providers (including Community Mental Health Centers) subject to the OPPS.'' The language does not mandate that a CMHC representative will be on the Panel. In the regulation, we simply identified representatives from CMHCs--or any other organizations--as possible nominees.

This year, when we requested nominations for the APC Panel, the list of nominees was long, prestigious, and included representatives from all aspects of the health care industry: Doctors, nurses, hospital administrators, coders, etc. Therefore, our choices were difficult; however, since there are definite Federal guidelines governing our selections, and specific Panel and Agency needs to address, given the clinical range of services paid under the OPPS, we were able to identify the most qualified individuals. Since the needs of the Agency and the Panel change due to members leaving, we invite all concerned Medicare providers to continue to nominate qualified individuals when the need arises.

The Panel's biannual meetings are forums to discuss APCs and representatives from the CMCHs--and other organizations--are invited to attend Panel meetings and to make presentations to the Panel on relevant agenda items.

Comment: The commenter also stated that the APC Panel sets the payment rates for the outpatient services.

Response: While the Panel is an advisory committee mandated by law to review the APC groups, and their associated weights, and to advise the Secretary of Health and Human Services and the Administrator of the Centers for Medicare & Medicaid Services concerning the clinical integrity of the APC groups and their weights, the APC Panel does not set payment rates for outpatient services. The advice provided by the Panel is considered by us in our development of the annual rulemaking to update the hospital OPPS. The APC Panel's activities most often address whether or not the HCPCS codes within the APCs are comparable clinically and with respect to resource use, assigning new codes to new or existing APCs, reassigning codes to different APCs, and the configuring of existing APCs into new APCs. 2. August 2003 Meeting

The APC Panel met on August 22, 2003 to discuss issues presented in the proposed rule of August 12. We announced the meeting in the Federal Register on July 25 and invited the public to make presentations to the Panel on issues discussed in the proposed rule. In this section, we summarize the issues discussed by the Panel, their recommendations on those issues, and our decisions with respect to their recommendations.

a. Blood and Blood Products

The Panel heard testimony by suppliers of blood and blood products and their representatives who expressed significant concerns about the proposed payment rates, particularly in light of new safety and testing requirements. These presenters to the Panel recommended that we exclude blood and blood products from the OPPS and pay for them at reasonable cost. After listening to the testimony, reviewing the median costs and proposed payments rate from our hospital claims data, and deliberating the issue, the Panel recommended that we continue to pay for blood and blood products within the OPPS. However, the Panel further recommended that we freeze the payment rates for blood and blood products at 2003 levels for 2004 and 2005 while we undertake further analysis of the cost data. The Panel also recommended that hospitals be educated on the proper billing for blood and blood products.

As discussed elsewhere in this final rule, we will accept the Panel's recommendation with respect to 2004. We will freeze the payment rates for blood and blood products at the 2003 payment levels. However, we are not making a decision with respect to 2005 at this time. Any proposals regarding our 2005 payment rates or policies for these items will be discussed in our proposed rule for the CY 2005 update. The Panel also recommended that the APCs for blood and blood products be on the agenda for the winter 2004 meeting in time for consideration of the 2005 payment rates. We agree to place this item on the agenda for the next APC Panel meeting.

b. Nuclear Medicine, Brachytherapy, and Radiosurgery Services

(1) Nuclear Medicine APCs and Radiopharmaceuticals

The Panel heard testimony on and considered the proposed restructuring of the nuclear medicine APCs discussed in the August 12, 2003 proposed rule. The Panel recommended that we move forward with the categorization system in the proposed OPPS 2004 rule absent strong, reasoned opposition from provider groups. If strong opposition was revealed in the public comments,

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the Panel recommended that we maintain the classification system that is in place for 2003. The Panel also recommended that we change the HCPCS code descriptors for radiopharmaceuticals to be on a ``per-dose'' basis--not on a ``per-unit'' basis.

We have accepted the Panel's recommendation that we move forward with the proposed restructuring, after considering public comments on this issue. As discussed in section II.A.3 of this final rule, we will implement the restructuring with certain changes to the proposed reclassification based on our review of the public comments. For reasons discussed in section VI.B.3 of this final rule, we are not accepting the Panel's recommendation to change the HCPCS code descriptors at this time.

The Panel further recommended that APCs for radiopharmaceuticals be on the agenda for the January 2004 meeting. In preparation for that meeting, the Panel recommended that our staff analyze the claims for the nuclear medicine APCs and do the following: Itemize the costs, determine what proportion of the median cost can be attributed to radiopharmaceuticals, and present the data at the Panel's January 2004 meeting. The Panel recommended that the issue of packaging the costs of radiopharmaceuticals under the 2003 threshold of $150 be placed on the agenda for the Panel's winter 2004 meeting.

We will consider this topic for placement on the agenda for the Panel's 2004 meeting. As discussed in section VI.B.3 of this rule, however, we are revising our threshold for packaging radiopharmaceuticals from $150 to $50. (2) Brachytherapy Services

The Panel recommended that we review whether the codes for needles and catheters were included in the payment rate proposed for APC 0313. The Panel also recommended that we consider outside data presented by commenters in establishing payment rates for APCs 312 and 651 to arrive at an appropriate payment rate. See our discussion, below, regarding APCs 312, 313, and 651 and our considerations concerning the claims used to set the relative weights for these APCs.

The Panel further recommended that we discontinue use of G codes for prostate brachytherapy and use appropriate Current Procedural Terminology (CPT) codes paid in clinical APCs when making payment for these services. The Panel recommended we pay separately for brachytherapy sources for the treatment of prostate cancer in the same manner by which we are paying separately for the brachytherapy sources for the treatment of other types of cancer. We have accepted the Panel's recommendation. As discussed in section II.B.4 of this final rule, we will discontinue use of the special G codes for prostate brachytherapy and allow separate payment for the sources used in these treatments. (3) Radiation Therapy and Radiosurgery APC Issues

The APC Panel heard testimony concerning radiation treatment delivery codes CPT 77412 through 77416, which we proposed to assign to APC 0301 and CPT 77417, assigned to APC 0260. The presenter stated that many hospital billing departments had not updated their charge masters since the inception of OPPS to reflect the costs of newer technology, specifically with respect to the use of x-ray guidance during external beam radiation treatment delivery. The APC Panel recommended that we review whether the use of x-ray guidance (as opposed to CT or ultrasound guidance) for radiation therapy is being properly reported and included in the payment rates for the radiation treatment delivery codes. We agree that we should review these issues further and will do so in preparation for the 2005 update. However, we did not receive sufficient or convincing information upon which to base a change for 2004. Therefore, we encourage interested parties to submit any additional information on the use of these codes and cost of providing these services in the outpatient hospital setting in response to this final rule with comment period.

The APC Panel also heard testimony concerning the proposed payment rate for CPT 77418, assigned to APC 0412 (IMRT treatment delivery). The presenter stated that the proposed amount was too low. However, the APC Panel supported the proposal in the absence of compelling evidence that the rate derived from the claims data is wrong. We concur with the APC Panel's recommendation and will retain CPT 77418 in APC 0412. We used approximately 113,000 claims to set the weight for this procedure, which we believe is a sufficiently robust set of data.

During this section of the APC Panel's August 22 meeting, the Panel members also heard testimony concerning HCPCS codes G0251 and G0173 used to report stereotactic radiosurgery. The APC Panel supported the proposed payment rates for these codes until more data become available. The APC Panel also asked to review this issue further at its winter 2004 meeting. We discuss stereotactic radiosurgery in further detail below. We have decided to make certain changes to the payment for these procedures. However, the APC assignment for these codes for 2004 is interim final. We solicit comments on the 2004 assignments, and we will also include this on the APC Panel's agenda for its winter 2004 meeting.

The final topic in this section of the APC Panel's August 22 meeting pertained to HCPCS codes G0242 and G0243 (multi source photon stereotactic planning). The APC Panel was requested to recommend that we combine the coding for these procedures under one code, with the payment for the new code derived by adding the payment for G0242 and G0243 together. The information presented to the APC Panel stated that the services represented by the two G codes represent one continuous procedure, that it is a surgical procedure, and the cost center mapping should be to a surgical cost center. The APC Panel will review this request at its winter 2004 meeting. The APC Panel is interested in receiving comments on this topic from professional societies representing neurosurgeons, radiation oncologists and others concerning this proposal.

c. Payment and Coding for Drug Administration and for Certain Drugs, Biologicals, and Radiopharmaceuticals

The APC Panel heard testimony and discussed the proposals described in the August 12, 2003 proposed rule on payment for drug administration and the packaging of the costs of drugs, biologicals, and radiopharmaceuticals. The APC Panel recommended that:

[sbull] We continue to use the current ``Q'' codes for drug administration and not institute new ``G'' codes to represent the administration of either packaged or separately paid drugs.

[sbull] We allow billing of Q0081 on a per-visit basis, rather than on a per-day basis as proposed.

[sbull] We delete Q0085 and allow hospitals to use both Q0083 and Q0084 when billing for chemotherapy administered by both infusion and other techniques in a given visit.

[sbull] That we consider adopting the final option among the three new methods of paying for drug administration that we proposed, as options to the current policy, in the August 12, 2003 proposed rule.

[sbull] That we look further at hospital pharmacies' costs for preparing drugs and radiopharmaceuticals and this issue be examined more closely by the Panel during its winter 2004 meeting.

The APC Panel also expressed serious concern about the dollar threshold for

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the packaging of drugs and the adequacy of payment for separately paid drugs. However, in the absence of alternative proposals by us, the APC Panel did not make further recommendations on that issue. The APC Panel requested that we present alternative options during the winter 2004 meeting, including a new APC structure for drugs and radiopharmaceuticals. As for specific drug issues, after hearing testimony concerning the codes for Baclofin refill kits, the APC Panel recommended that we delete code C9010 and retain the other codes for this product used in the treatment of Parkinson's disease and spasticity.

We have carefully considered each of the APC Panel's recommendations along with comments on the subject of drug administration and payment for drugs, biologicals, and radiopharmaceuticals. For the reasons discussed more fully elsewhere in this final rule, we have decided to accept the APC Panel's recommendations that we continue using Q0081 through Q0084 in 2004; that we continue to define these codes on a per-visit, rather than per- day basis; that we delete code Q0085; and that we delete code C9010. We have decided to continue paying for the drug administration ``Q'' codes according to our current rules and discuss that decision further in section VI.B.4 of this final rule. We will consider the Panel's recommendation that we investigate other approaches for paying for drugs and radiopharmaceuticals. However, for 2004, we have determined that we will pay separately under their own APCs for drugs, biologicals and radiopharmaceuticals for which the median per day costs are in excess of $50. (4) Device-Related Procedures

The APC Panel heard testimony from the device manufacturing community and others concerning payment for procedures that involve the implantation of devices. The presenters discussed concerns that affected such procedures in general, such as the absence of a proposal to limit payment reductions for such procedures between 2003 and 2004 and issues related to the hospital claims for these procedures. Presentations to the APC Panel also discussed inadequacies in the claims data or our methodology for using the claims data to set relative weights for specific device-related APCs (APCs 0046, 0107, 0108, 0222, 0225, 0385, and 0386. Presenters urged that the APC Panel advise us to use the best external data possible, including proprietary data that would be held confidential. Presentations to the APC Panel also addressed the multiple surgical reduction with respect to device- related APCs.

The APC Panel recommended:

[sbull] That we use credible external data that can be made publicly available for establishing the median costs for APCs 0107 and 0386.

[sbull] That we change the status indicator for CPT 61885 so that it is not subject to the multiple procedure discounting.

[sbull] That we assign the new CPT codes for central venous access devices into appropriate APCs, either clinical APCs or new technology APCs.

[sbull] That the APC assignments of the new central venous access devices be reviewed by the APC Panel at its next meeting.

[sbull] That we provide the APC Panel with median cost data for all APCs in spreadsheet format for its consideration in advance of and during its next meeting.

[sbull] That we review the presenter's suggestions with respect to APC 0046 and make recommendations for any changes to this APC to the APC Panel at its next meeting.

[sbull] That we change the status indicator for CPT 93571 and 93572 from ``N'' (packaged status) to an appropriate indicator that allows separate payment under the APC.

We considered the final set of recommendations from the APC Panel's August 2003 meeting and have accepted several of them. Specifically, we decided to use external data in setting the median cost for 2004 for APC 0107. We have not used external data for APC 0386. Each of these decisions is discussed in greater detail elsewhere in this final rule. We accepted the Panel's recommendation to change the status indicator for CPT 61885. In order to do so, we moved this code into its own APC, 0039, Implant neurostim, one array. We have assigned the new CPT codes for central venous access devices to New Technology APCs as displayed in Addendum B. The range of new CPT codes is 36555 through 36597, and the new APC assignments include APCs 0032, 0115, 0109, 0187, and 1541.

The assignment of these codes is subject to public comment and will be placed on the APC Panel's agenda for its next meeting. During that meeting, we will also provide the APC Panel with spreadsheet data on the median costs of all APCs. With respect to APC 0046, we are sympathetic to the presenter's concerns. However, we were not provided with data that we considered sufficient to assess whether a new coding structure with increased payment rates is warranted for the treatment of bone fractures with external fixation devices. However, we would support the specialty societies' efforts to request changes to the existing CPT coding structure. For reasons discussed elsewhere, we have not accepted the Panel's recommendation with respect to CPT codes 93571 and 93572.

Comment: An association voiced concern that the Panel meeting on August 22, 2003 came too soon after the publication of the August 12, 2003 proposed rule for its members to prepare adequately for presentation to the Panel.

Response: The agency must schedule the Panel meetings sufficiently in advance of the meeting in order to provide ample notice to the public of the meeting and to allow sufficient time for the Panel members to arrange their schedules. We attempted to balance those needs with the goal of conducting the first mid-year meeting of the Panel during the comment period so that issues discussed in the August 12, 2003 proposed rule could be topics for the Panel's consideration and interested parties' testimony before the Panel. The July 25, 2003 Federal Register notice (68 FR 44089) announced the second 2003 meeting of the APC Panel, which we believe provided sufficient advance notice of the meeting.

While it is true that the proposed rule was placed on display on August 6, published on August 12, and the meeting was held on August 22, 2003, many interested parties attended the meeting and presented thoughtful comments on most issues discussed in the proposed rule. Nevertheless, we will take this comment into consideration for future planning of APC Panel meetings.

Comment: Several commenters expressed concern about the length of the meeting and time allotted on the agenda to particular issues. One commenter stated that scheduling only [1] day for Panel deliberations was inadequate. A commenter was concerned that device-related issues were relegated to the last hour, that presenters were given only 2 minutes, and that there was little time for Panel discussion and consideration of the issues presented.

Response: We appreciate the commenter's interest in ensuring that adequate time be allowed for the public to present issues for the Panel's consideration and for the Panel to have sufficient time for their discussion and deliberation.

Although the device issues were scheduled for the last hour of the meeting, the Panel members received the written presentations beforehand, and had an opportunity to review them

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before the meeting. Placing a limit on presentations is a prerogative of the Panel Chair and must at times be done in order to allow all interested parties to make presentations on agenda items. However, we will take all of the concerns into consideration when scheduling future meetings. 3. Recommendations of the Advisory Panel and Our Responses

January 2003 Meeting

In this section, we consider the Panel's recommendations affecting specific APCs. The Panel based its recommendations on claims data for the period April 1, 2002 through September 30, 2002. This data set comprises a portion of the data that will be used to set 2004 payment rates. APC titles in this discussion are those that existed when the APC Panel met in January 2003. In a few cases, APC titles have been changed for this final rule, and, therefore, some APCs do not have the same title in Addendum A as they have in this section.

The Panel's agenda included APCs that our staff believed violated the 2 times rule as well as APCs for which comments were submitted. As discussed below, the Panel sometimes declined to recommend a change in an APC even though the APC appeared to violate the 2 times rule. In section II.B of the August 12, 2003 proposed rule, we discuss our proposals regarding the 2 times rule based on the April 1 through December 31, 2002 data that we used to determine the final 2004 APC relative weights. Section II.B (68 FR 47977) of the August 12, 2003 proposed rule also details the criteria we used when deciding to propose exceptions to the 2 times rule.

Unless otherwise specified in each of the following discussions of the APC Panel's recommendations, our proposed actions are finalized in this final rule.

a. Debridement and Destruction

APC 0012: Level I Debridement & Destruction

APC 0013: Level II Debridement & Destruction

We expressed concern to the Panel that APCs 0012 and 0013 appear to violate the 2 times rule. In order to remedy these violations, we asked the Panel to consider the following changes:

(1) Move the following codes from APC 0013 to APC 0012:

HCPCS

Description

11001..................................... Debride infected skin add- on. 11302..................................... Shave skin lesion. 15786..................................... Abrasion, lesion, single. 15793..................................... Chemical peel, nonfacial. 15851..................................... Removal of sutures. 16000..................................... Initial treatment of burn(s). 16025..................................... Treatment of burn(s).

(2) Move code 11057 (Trim skin lesions, over 4) from APC 0012 to APC 0013.

The Panel agreed with our staff and recommended that we make these changes. We proposed to accept the Panel's recommendation.

However, we received comments from a group of hospitals concerning the proposed change for CPT code 15851, removal of sutures under anesthesia (other than local), same surgeon. In their comments, the hospitals noted that the descriptor for CPT codes 15851 and 15850 (removal of sutures under anesthesia (other than local), other surgeon, were virtually identical with the exception of which surgeon performs the suture removal. The commenters did not believe that the identity of the surgeon could result in a significant difference in resource costs to the hospital. Our clinical staff agree and believe that the difference in hospital median costs derived from our claims data may be due to a misunderstanding about the coding. For 2004, we have decided that we will place both CPT codes for suture remove under anesthesia in APC 0016.

b. Excision/Biopsy

APC 0019: Level I Excision/Biopsy

APC 0020: Level II Excision/Biopsy

APC 0021: Level III Excision/Biopsy

We expressed concern to the Panel that APCs 0019 and 0020 appear to violate the 2 times rule. In order to remedy these violations, we asked the Panel to consider the following changes:

(1) Move the following HCPCS codes from APC 0019 to a new APC:

HCPCS

Description

11755..................................... Biopsy, nail unit. 11976..................................... Removal of contraceptive cap. 24200..................................... Removal of arm foreign body. 28190..................................... Removal of foot foreign body. 56605..................................... Biopsy of vulva/perineum. 56606..................................... Biopsy of vulva/perineum. 69100..................................... Biopsy of external ear.

The APC Panel recommended that we make these changes, and we proposed to do so in our August 12, 2003 proposed rule.

(2) Move the following HCPCS codes from APC 0020 to APC 0021:

HCPCS

Description

11404..................................... Removal of skin lesion. 11423..................................... Removal of skin lesion. 11604..................................... Removal of skin lesion. 11623..................................... Removal of skin lesion.

The Panel recommended that we not change the structure of APCs 0019, 0020, and 0021 at this time in the interest of preserving clinical homogeneity. In August, we proposed to accept the Panel's recommendation that we make no changes to the structure of these APCs for 2004. However, following our review of the median costs developed for the final rule, using a more complete set of claims for services from April through December 2002, we determined that CPT codes 11404 and 11623 should be moved to APC 0021. We plan to place these APCs on the Panel's agenda for the 2005 update.

c. Thoracentesis/Lavage Procedures and Endoscopies

APC 0071: Level I Endoscopy Upper Airway

APC 0072: Level II Endoscopy Upper Airway

APC 0073: Level III Endoscopy Upper Airway

We expressed concern to the Panel that APCs 0071 and 0072 appear to violate the 2 times rule. In order to remedy these violations, we asked the Panel to consider the changes below.

Move the following HCPCS codes as described below:

Table 1.--HCPCS Codes Final to be Redistributed From APCs 0071 and 0072 to APCs 0071, 0072, and 0073

2003 2004 HCPCS

Description

APC APC

31505............................. Diagnostic

0072 0071 laryngoscopy. 31575............................. Diagnostic

0071 0072 laryngoscopy. 31720............................. Clearance of airways 0072 0073

The Panel recommended that we make the above changes. We proposed to accept the Panel's recommendation, with the exception of CPT code 31720. After reviewing an additional quarter of claims data that were not available at the time the Panel convened, placement of CPT code 31720 into APC 0072 better reflects its resource consumption. Therefore, we proposed to keep CPT code 31720 in APC 0072.

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d. Cardiac and Ambulatory Blood Pressure Monitoring

APC 0097: Cardiac and Ambulatory Blood Pressure Monitoring

We expressed concern to the Panel that APC 0097 appears to violate the 2 times rule. We asked the Panel to recommend options for resolving this violation and suggested splitting APC 0097 into two APCs. The Panel recommended that the structure of APC 0097 should not be changed at this time based on clinical homogeneity considerations. We proposed to accept the Panel's recommendation that we make no changes to APC 0097 for 2004. We received no comments disagreeing with this proposal, and we will adopt it for 2004. We also plan to place this APC on the Panel's agenda for the 2005 update.

e. Electrocardiograms

APC 0099: Electrocardiograms

APC 0340: Minor Ancillary Procedures

We expressed concern to the Panel that APC 0099 appears to violate the 2 times rule. We asked the Panel to recommend options for resolving this violation, and suggested moving CPT code 93701 (Bioimpedance, thoracic) from APC 0099 to APC 0340. The Panel believed, however, that the structure of APC 0099 should not be changed at this time based on clinical homogeneity considerations. We proposed to accept the Panel's recommendation that we make no changes to APC 0099 for 2004. We plan to place this APC on the Panel's agenda for the 2005 update.

f. Cardiac Stress Tests

APC 0100: Cardiac Stress Tests

A presenter to the Panel, who represented a device manufacturer, requested that we move CPT code 93025 (Microvolt t-wave assessment) out of APC 0100. The presenter believes that the actual cost for this procedure is significantly higher than for other procedures in the same APC. Since this technology is often billed in conjunction with other procedures (for example, stress tests, CPT code 93017), few single-APC claims were available to evaluate the presenter's contention.

The Panel believed the data presented are insufficient to merit moving the code and recommended that CPT code 93025 remain in APC 0100 until more data are available for review. We proposed to accept the Panel's recommendation that CPT code 93025 remain in APC 0100 until more claims data become available for review. We will adopt this proposal for 2004.

g. Revision/Removal of Pacemakers or Automatic Implantable Cardioverter Defibrillators

APC 0105: Revision/Removal of Pacemakers, AICD, or Vascular

We asked the Panel to review the codes within APC 0105 for an apparent violation of the 2 times rule, stating that we believe the apparent violation is a result of incorrectly coded claims. The Panel agreed and recommended no changes to APC 0105 at this time. We proposed to accept the Panel's recommendation that we make no changes to APC 0105 until more accurate claims data become available and support the need for a change. We will adopt this proposal for 2004.

h. Sigmoidoscopy

APC 0146: Level I Sigmoidoscopy

APC 0147: Level II Sigmoidoscopy

We expressed concern to the Panel that relatively simple procedures such as anoscopy and rigid sigmoidoscopy have higher median costs than more complex procedures such as flexible sigmoidoscopy. Panel members suggested the high costs may be due to the need to perform an otherwise minor office procedure in a hospital setting (for example, due to the clinical condition of the patient). Panel members also suggested that claims may be incorrectly coded because coding instructions do not clearly state how to code when the procedure performed is not as extensive as the procedure planned (for example, when a colonoscopy is planned but only a sigmoidoscopy is performed). In these cases, coding instructions are unclear as to whether the planned procedure should be reported with a modifier for reduced services or with the code for the actual procedure performed.

The Panel recommended that we make no changes to APCs 0146 and 0147 at this time. We proposed to accept the Panel's recommendation that we make no changes to APCs 0146 and 0147. We will adopt this proposal for 2004. However, we plan to place this APC on the Panel's agenda for the 2005 update.

i. Anal/Rectal Procedures

APC 0148: Level I Anal/Rectal Procedure

APC 0149: Level III Anal/Rectal Procedure

APC 0155: Level II Anal/Rectal Procedure

We expressed concern to the Panel that APCs 0148 and 0149 appear to violate the 2 times rule. We asked the Panel to recommend options for resolving these violations, and suggested rearranging some of the CPT codes within APCs 0148, 0149, and 0155. The Panel recommended that we move CPT code 46040 (Incision of rectal abscess) from APC 0155 to APC 0149. We proposed to accept the Panel's recommendation, and we will adopt it for 2004.

j. Insertion of Penile Prosthesis

APC 0179: Urinary Incontinence Procedures

APC 0182: Insertion of Penile Prosthesis

A presenter to the Panel representing manufacturers and providers requested that APC 0182 be split into two APCs, based on whether the procedure used inflatable or non-inflatable penile prostheses. The presenter stated that the complexity of the procedure, the cost of the devices, and related resources were all significantly higher with inflatable prostheses.

The Panel recommended that we eliminate APCs 0179 and 0182 and create two new APCs, 0385 and 0386, that contain the following CPT codes:

APC 0385

HCPCS

Description

52282..................................... Cystoscopy, implant stent. 53440..................................... Correct bladder function. 53444..................................... Insert tandem cuff. 54400..................................... Insert semi-rigid prosthesis. 54416..................................... Remv/repl penis contain prosthesis.

APC 0386

HCPCS

Description

53445..................................... Insert uro/ves nck sphincter. 53447..................................... Remove/replace ur sphincter. 54401..................................... Insert self-contained prosthesis. 54405..................................... Insert multi-comp penis prosthesis. 54410..................................... Remove/replace penis prosthesis.

We proposed to accept the Panel's recommendation to eliminate APCs 0179 and 0182 and create two new APCs, 0385 and 0386, containing the above CPT code configurations.

k. Surgical Hysteroscopy

APC 0190: Surgical Hysteroscopy

A presenter to the Panel, who represented a device manufacturer, requested that we move CPT code 58563 (Hysteroscopy, ablation) from APC 0190 to a higher paying APC. The presenter noted that endometrial cryoablation is included in a new technology APC, while a thermal ablation system is included with older, less costly

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techniques. The presenter expressed concern that cryoablation may be reimbursed at a higher rate than the thermal ablation system, giving its manufacturers an unfair competitive advantage.

Panel members agreed that new, more expensive technologies that prove to be more effective merit review for a higher payment rate. Without substantial evidence of greater effectiveness, however, the Panel was reluctant to create APCs that provide an incentive to use a more expensive device. In its discussion of whether or not to recommend moving CPT code 58563 to a higher paying APC, the Panel recommended that we take into account different methods of endometrial ablation associated with hysteroscopy, adequately reflect the resources used for the various procedures, avoid creating a competitive advantage or disadvantage, and collect data needed to track costs on the type of technologies used for this procedure.

After consulting with experts in the field, we proposed to split APC 0190 (Surgical Hysteroscopy) into two APCs that are more clinically homogeneous. We proposed to change the description for APC 0190 from ``Surgical Hysteroscopy'' to ``Level I Hysteroscopy'' and keep the following HCPCS codes in APC 0190:

HCPCS

Description

58558..................................... Hysteroscopy, biopsy. 58559..................................... Hysteroscopy, lysis. 58562..................................... Hysteroscopy, remove fb. 58579..................................... Hysteroscope procedure.

We also proposed to move the following HCPCS codes from APC 0190 to newly created APC 0387 titled ``Level II Hysteroscopy'':

HCPCS

Description

58560..................................... Hysteroscopy, resect septum. 58561..................................... Hysteroscopy, remove myoma. 58563..................................... Hysteroscopy, ablation.

In addition, we proposed to move the following HCPCS codes as described below:

Table 2.--HCPCS Codes to be Redistributed to APCs 0130, 0195, and 0190

2003 2004 HCPCS

Description

APC APC

58578............................. Laparoscopic

0190 0130 procedure, uterus. 58353............................. Endometrial ablate, 0193 0195 thermal. 58555............................. Hysteroscopy,

0194 0190 diagnostic, sep. procedure.

We believe these final changes take into account the different technologies used to perform these procedures while maintaining the clinical comparability of these APCs as well as improving their homogeneity in terms of resource consumption. 1. Female Reproductive Procedures

APC 0195: Level VII Female Reproductive Proc

APC 0202: Level VIII Female Reproductive Proc

A commenter requested that we place CPT code 57288 (Repair bladder defect) in its own APC because it requires the use of a device. Our staff suggested that CPT codes 57288 and 57287 remain in APC 0202, while the remaining codes in APC 0202 be moved to APC 0195:

HCPCS

Description

57109..................................... Vaginectomy partial w/nodes. 58920..................................... Partial removal of ovary(s). 58925..................................... Removal of ovarian cyst(s).

The Panel agreed with our staff, and we proposed to accept the Panel's recommendation to move CPT codes 57109, 58920, and 58925 from APC 0202 to APC 0195. We will adopt the Panel's recommendation for 2004.

m. Nerve Injections

APC 0203: Level IV Nerve Injections

APC 0204: Level I Nerve Injections

APC 0206: Level II Nerve Injections

APC 0207: Level III Nerve Injections

Several commenters suggested changes in the configuration of APCs 0203, 0204, 0206, and 0207 because of concerns that the current classifications result in payment rates that are too low relative to the resource costs associated with certain procedures in these APCs. Several of these APCs include procedures associated with drugs or devices for which pass-through payments are scheduled to expire in 2003.

We requested the Panel's input regarding whether or not these APCs should be restructured. The Panel stated that the current configuration of APCs 0203, 0204, 0206, and 0207 is more clinically cohesive than the previous year's configuration and that more data should be collected before making any changes. We proposed to accept the Panel's recommendation that we make no changes to the structure of these APCs until more data become available for review. We will adopt the Panel's recommendation for 2004.

n. Laminotomies and Laminectomies; Implantation of Pain Management Device

APC 0208: Laminotomies and Laminectomies

APC 0223: Implantation of Pain Management Device

A presenter to the Panel, who represented a device manufacturer, requested that we move CPT code 62351 (Implant spinal canal catheter) from APC 0208 to APC 0223 to better capture the device cost that may be involved with the procedure. The Panel believed the data were insufficient to merit moving the code and recommended that CPT code 62351 remain in APC 0208 until more data are available for review. We proposed to accept the Panel's recommendation that CPT code 62351 remain in APC 0208 until more claims data become available for review. We will adopt the Panel's recommendation for 2004.

o. Extended EEG Studies and Sleep Studies; Electroencephalogram

APC 0209: Extended EEG Studies and Sleep Studies, Level II

APC 0213: Extended EEG Studies and Sleep Studies, Level I

APC 0214: Electroencephalogram

We expressed concern to the Panel that APC 0213 appears to minimally violate the 2 times rule. In order to remedy this violation, we asked the Panel to consider a commenter's suggestion that we move CPT code 95955 (EEG during surgery) from APC 0214 to APC 0213. The Panel agreed with the commenter's suggestion. We proposed to accept the Panel's recommendation to move CPT code 95955 from APC 0214 to APC 0213.

p. Nerve and Muscle Tests

APC 0215: Level I Nerve and Muscle Tests

APC 0216: Level III Nerve and Muscle Tests APC 0218:

Level II Nerve and Muscle Tests

We expressed concern to the Panel that APC 0218 appears to violate the 2 times rule. In order to remedy this violation, one commenter requested that we move CPT codes 95921 (Autonomic nerve function test) and 95922 (Autonomic nerve function test) from APC 0218 to APC 0216, while another

[[Page 63408]]

commenter requested that we move CPT code 95904 (Sensory nerve conduction test) from APC 0215 to APC 0218. Alternatively, our staff suggested to the Panel that the following CPT codes be moved from APC 0218 to APC 0215.

HCPCS

Description

95858..................................... Tensilon test & myogram. 95870..................................... Muscle test, nonparaspinal. 95900..................................... Motor nerve conduction test. 95903..................................... Motor nerve conduction test.

After considering all of the above proposals, the Panel recommended that we move CPT codes 95858, 95870, 95900, and 95903 from APC 0218 to APC 0215. We proposed to accept the Panel's recommendation.

q. Implantation of Drug Infusion Device

APC 0227: Implantation of Drug Infusion Device

APC 0227 contains only two CPT codes: Implantation of programmable spine infusion pumps, 62362, and Implantation of non-programmable spine infusion pumps, 62361. A commenter requested that we split APC 0227 into two APCs to recognize the cost difference between CPT code 62361 and CPT code 62362. However, since our cost data do not show a significant cost difference between the two devices and APC 0227 does not violate the 2 times rule, the Panel recommended that CPT codes 62361 and 62362 remain in APC 0227. We proposed to accept the Panel's recommendation, which we will adopt for 2004.

r. Ophthalmologic APCs

APC 0230: Level I Eye Tests & Treatments

APC 0235: Level I Posterior Segment Eye Procedures

APC 0236: Level II Posterior Segment Eye Procedures

APC 0698: Level II Eye Tests & Treatments

We advised the Panel that APCs 0230 and 0235 violate the 2 times rule but that the current configuration of these APCs reflects the Panel's previous recommendations. A presenter to the Panel, who represented a device manufacturer, expressed concern that the pass- through device category ``New Technology: Intraocular Lens'' was discontinued and these devices are now packaged. The presenter asked the Panel to recommend that future new intraocular lens devices be considered for a new pass-through category.

To remedy the violations to the 2 times rule, we asked the Panel to consider moving CPT code 67820 (Revise eyelashes) from APC 0230 to APC 0698 and CPT code 67110 (Repair detached retina) from APC 0235 to APC 0236. The Panel recommended that we make these changes. We proposed to accept the Panel's recommendation and monitor the data for APC 0235 for possible review next year. We will adopt this recommendation for 2004. The Panel also acknowledged that making recommendations concerning pass-through categories is beyond their purview.

s. Skin Tests and Miscellaneous Red Blood Cell Tests; Transfusion Laboratory Procedures

APC 0341: Skin Tests and Miscellaneous Red Blood Cell Tests

APC 0345: Level I Transfusion Laboratory Procedures We advised the Panel that APCs 0341 and 0345 minimally violate the 2 times rule and suggested moving several CPT codes within these APCs into a new APC because a commenter expressed concern over the combination of skin tests and miscellaneous red blood cell tests in APC 0341, asserting that services within this APC cannot be considered comparable with respect to resource usage.

In order to remedy these violations to the 2 times rule, we suggested moving CPT code 86901 (Blood typing, Rh (D)) from APC 0345 to a new APC along with the following CPT codes from APC 0341:

HCPCS

Description

86880..................................... Coombs test, direct. 86885..................................... Coombs test, indirect, qualitative. 86886..................................... Coombs test, indirect, titer. 86900..................................... Blood typing, ABO.

The Panel recommended that we make the above changes. We proposed to accept the Panel's recommendation to move HCPCS codes 86880, 86885, 86886, and 86900 from APC 0341 to new APC 0409 and to move CPT code 86901 (Blood typing, Rh (D)) from APC 0345 to new APC 0409. We will adopt the Panel's recommendation for 2004.

t. Otorhinolaryngologic Function Tests

APC 0363: Level I Otorhinolaryngologic Function Tests

APC 0660: Level II Otorhinolaryngologic Function Tests

We expressed concern to the Panel that APC 0660 appears to violate the 2 times rule and suggested moving CPT codes 92543 (Caloric vestibular test) and 92588 (Evoked auditory test) from APC 0660 to APC 0363. The Panel recommended that we make these CPT code changes. We proposed to accept the Panel's recommendation to move CPT codes 92543 and 92588 from APC 0660 to APC 0363, and we will adopt the proposal for 2004.

u. Tube Changes and Repositioning

APC 0121: Level I Tube changes and Repositioning

APC 0122: Level II Tube changes and Repositioning

We expressed concern to the Panel that APC 0121 appears to violate the 2 times rule. In order to remedy this violation, we suggested moving the following CPT codes from APC 0121 to APC 0122:

HCPCS

Description

47530..................................... Revise/reinsert bile tube. 50688..................................... Change of ureter tube. 51710..................................... Change of bladder tube. 62225..................................... Replace/irrigate catheter.

The Panel recommended that we make these CPT code changes. We proposed to accept the Panel's recommendation to move CPT codes 47530, 50688, 51710, and 62225 from APC 0121 to APC 0122. We will adopt the proposal for 2004.

v. Myelography

APC 0274: Myelography

We advised the Panel that APC 0274 minimally violates the 2 times rule and suggested moving CPT codes 72285 (X-ray c/t spine disk) and 72295 (X-ray c/t spine disk) from APC 0274 to a new APC. A presenter, from an organization representing radiologists, agreed with our proposal. The Panel recommended that we make these CPT code changes. We proposed to accept the Panel's recommendation to move CPT codes 72285 and 72295 from APC 0274 to new APC 0388. We will adopt the recommendation for 2004.

w. Therapeutic Radiologic Procedures

APC 0296: Level I Therapeutic Radiologic Procedures

APC 0297: Level II Therapeutic Radiologic Procedures

We advised the Panel that APCs 0296 and 0297 appear to minimally violate the 2 times rule as a result of changes recommended by the Panel and adopted by us last year. The Panel recommended that no changes be made to APCs 0296 and 0297 in the interest of preserving the clinical homogeneity of these APCs. We proposed to accept the Panel's recommendation that we make no CPT code changes to APCs 0296 and 0297, and we are adopting the proposal for 2004.

x. Vascular Procedures; Cannula/Access Device Procedures

APC 0103: Miscellaneous Vascular Procedures

[[Page 63409]]

APC 0115: Cannula/Access Device Procedures

A commenter requested that we move CPT code 36860 (External cannula declotting) from APC 0103 to APC 0115, asserting that this procedure is more similar to other procedures in APC 0115 and does not fit well in its current miscellaneous APC. The Panel found that the claims data were insufficient to support moving CPT code 36860 from APC 0103 to the higher paying APC 0115 and recommended that CPT code 36860 remain in APC 0103 until more data are available for review. We proposed to accept the Panel's recommendation that CPT code 36860 remain in APC 0103 until more claims data become available for review. We will adopt this proposal for 2004.

y. Angiography and Venography Except Extremity

APC 0279: Level II Angiography and Venography except Extremity

APC 0280: Level III Angiography and Venography except Extremity

APC 0668: Level I Angiography and Venography except Extremity

A commenter requested that we move CPT code 75978 (Repair venous blockage) from APC 0668 to APC 0280 and that we move CPT code 75774 (Artery x-ray, each vessel) from APC 0668 to APC 0279. A presenter to the Panel testified that CPT code 75978 is commonly used for dialysis patients and often requires multiple intraoperative attempts to succeed; thus, it should be paid under APC 0280. The Panel believed that APCs 0279, 0280, and 0668 were clinically homogenous and recommended that we only make changes after consulting with experts in the field. We proposed to accept the Panel's recommendation to make no changes to APCs 0279, 0280, and 0668 until we have consulted with experts in the field. We plan to place these APCs on the Panel's agenda for the 2005 update.

z. Computed Tomography (CT), Magnetic Resonance (MR), and Ultrasound Guidance Procedures Currently Packaged

APC 0332: Computerized Axial Tomography and Computerized Angiography without Contrast Material

APC 0335: Magnetic Resonance Imaging, Miscellaneous

APC 0268: Ultrasound Guidance Procedures

A presenter to the Panel expressed concern that the packaging of guidance procedures for tissue ablation does not recognize the significant difference in cost and time required to perform each procedure (for example, MRI vs. CT). This presenter believed that hospitals needed more education on the appropriate application of these codes. Another commenter requested that CPT codes 76362, 76394, and 76490 be changed from a status indicator of N to a status indicator of S and be included in an appropriate clinical or new technology APC.

The Panel agreed with the above comments and stated that the packaging of these three procedures made it difficult for hospitals to track their use for the purpose of allocating funds. The Panel recommended changing the following CPT codes from a packaged status (N status indicator) to a separately payable status (S status indicator) within the indicated APCs:

Table 3.--HCPCS Codes To Be Designated as Separately Payable

2004 2004 HCPCS

Description 2003 SI SI APC

76362........................ CT scan for N...... S..... 0332 tissue ablation. 76394........................ MRI for tissue N...... S..... 0335 ablation. 76490........................ US for tissue N...... S..... 0268 ablation.

We proposed to accept the Panel's recommendation to change HCPCS codes 76362, 76394, and 76490 from a packaged status to a separately payable status as indicated above. HCPCS 76490 has been deleted for 2004. However, we will pay for it under APC 0268 during the grace period from January through March 2004.

aa. Magnetic Resonance Imaging and Magnetic Resonance Angiography Without Contrast

APC 0336: Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast

A commenter requested that we change CPT code 76393 (MR guidance for needle placement) from a packaged status to a separately payable status within APC 0336. Based on clinical homogeneity considerations, the Panel agreed with the commenter and recommended that CPT code 76393 be changed from a status indicator of N to a status indicator of S and placed in APC 0335. We proposed to accept the Panel's recommendation.

bb. Plain Film Except Teeth; Plain Film Except Teeth Including Bone Density Measurement

APC 0260: Level I Plain Film Except Teeth

APC 0261: Level II Plain Film Except Teeth Including Bone Density Measurement

APC 0272: Level I Fluoroscopy

A commenter requested that we move CPT codes 76120 (Cine/video x- rays) and 76125 (Cine/video x-rays add-on) from APC 0260 to APC 0261. However, a presenter to the Panel argued that these CPT codes are fluoroscopic procedures that should not be grouped with Level I radiography procedures. The Panel recommended that we move CPT code 76120 from APC 0260 to APC 0272 and that CPT code 76125 remain in APC 0260. This change makes the APCs more clinically coherent. We proposed to accept the Panel's recommendation, and we will adopt the proposal for 2004.

cc. Chemotherapy Administration by Other Technique Except Infusion

APC 0116: Chemotherapy Administration by Other Technique Except Infusion

A presenter to the Panel requested that we split APC 0116 into three APCs according to the method of administration: (a) Subcutaneous or intramuscular administration (CPT code 96400); (b) ``push'' administration (CPT code 96408); and (c) central nervous system administration (CPT code 96450). The presenter also requested that existing CPT codes should replace the more nonspecific Q codes for administration of chemotherapy because the CPT codes will provide more detailed data on methods of chemotherapy administration, which could be used for future payment policy decisions. Another presenter agreed with this request and stated that CPT codes are preferable to Q codes because other payers require CPT codes.

The Panel agreed with the above suggestions to split APC 0116 into 3 APCs according to the method of

[[Page 63410]]

administration. The Panel recommended that we require hospitals to use the existing CPT codes (for example, 96400, 96408, and 96450) for administration of chemotherapy and map them to APCs 0116, 0117, and 0118, as appropriate. The Panel also recommended that payment rates be based on current Q code cost data until cost data for the CPT codes are available. These cost data will be used to determine whether to change the APC structure for chemotherapy administration.

We proposed not to accept the Panel's recommendations to split APC 0116 into three APCs and to use CPT codes for administration of chemotherapy. We will consider such a split in the future but would like to first address the administration of drugs issue. Based on the comments we received on our proposed drug administration coding, we believe that making a change in APC 0116 will be too complicated and burdensome for hospitals at this time. (See a full discussion of this in section VI.B.4 of this final rule.)

We will consider such a split for APC 0116 for CY 2005. We also believe the use of CPT codes will be burdensome to hospitals, will require extensive education, and will result in a significant amount of miscoding. The CPT codes for infusion therapy are based on the service furnished per hour. We do not believe that all hospitals routinely record the start and stop time for infusion therapy and that doing so in order to be able to bill the proper number of hours of infusion therapy could be very burdensome for them. Moreover, the historic cost data on which we base the payment for the service are reported on a per visit basis (much easier to cull from the record than the number of hours of service) and if we changed to CPT codes for these services, we will be unable to convert the charge/cost data now on a per visit basis to a per hour basis (as required by the CPT code) for budget neutrality purposes. See section VI of this final rule for further discussion on payments for drugs and drug administration.

dd. Capturing the Costs of Drugs, Biologicals and Radiopharmaceuticals Packaged Into APCs

APC 0290: Level I Diagnostic Nuclear Medicine Excluding Myocardial Scans

APC 0291: Level II Diagnostic Nuclear Medicine Excluding Myocardial Scans

APC 0292: Level III Diagnostic Nuclear Medicine Excluding Myocardial Scans

APC 0294: Level II Therapeutic Nuclear Medicine

APC 0666: Myocardial Add-on Scans

At the January 2003 meeting, we told the Panel that APCs 0290 and 0291 appear to violate the 2 times rule. Several presenters to the Panel expressed concern that our cost data are inadequate because of confusion over coding due to changes in codes and coding instructions for these procedures, poor hospital reporting of radiopharmaceutical use, and the use of single (not multiple) claims in determining costs. One presenter claimed that the current cost data used for CPT code 78122 (Whole blood volume determination) underestimated real costs because of confusion about whether to code radiopharmaceuticals on a ``per dose'' basis or ``per millicurie'' basis. This presenter requested that we move CPT code 78122 from APC 0290 to the higher paying APC 0292.

Other presenters agreed with these concerns and stated they were applicable to payments for all drugs, not just radiopharmaceuticals. These commenters were also concerned about the loss of drug-specific data due to packaging because hospitals will have no incentive to code, and thereby identify, packaged drugs.

Pass-through payments for 236 drugs, biologicals, and radiopharmaceuticals expired as of 2003, were then paid either separately or packaged with the procedures with which they are associated. Drugs and radiopharmaceuticals with median costs for administration of $150 or less were packaged. Beginning in 2003, claims data do not provide specific cost information for packaged items. We requested input from the Panel on methods for determining drug costs in the future.

Panel members were concerned that packaging the costs of radiopharmaceuticals into procedures would result in underpayments for the service because we lack adequate data on the cost of radiopharmaceuticals. They were also concerned about creating incentives to use radiopharmaceuticals based on cost rather than clinical efficacy. The Panel recommended that we consider grouping drugs and radiopharmaceuticals into new APCs taking into account both their cost and clinical use. The Panel further recommended that, if new APCs for radionuclides are created, the descriptors should be as simple as possible and use of confusing units of measure should be limited.

Due to the packaging of radiopharmaceuticals into the APC payments for nuclear medicine procedures, we, along with commenters have expressed concern to the Panel regarding whether the current nuclear medicine APC structure is homogeneous in terms of resource consumption. We have reviewed information about the use and cost of various radiopharmaceuticals and believe that restructuring the APCs for nuclear medicine will result in greater clinical and resource homogeneity. Therefore, we proposed to eliminate APCs 0286, 0290, 0291, 0292, 0294, and 0666 and create 20 new APCs for nuclear medicine.

Comment: We received many comments about the proposed nuclear medicine APCs. Generally, commenters supported our proposal for the new APCs but had suggestions for modifications to improve clinical and resource use homogeneity. The suggested modifications are:

[sbull] Split APC 0398 into three levels to account for differences in the number of sessions provided and type and amount of radiopharmaceutical used with these procedures.

[sbull] Split APC 0401 into two levels to account for the different number of sessions, type and amount of radiopharmaceuticals used, and whether or not ventilation imaging and perfusion imaging are part of the procedure.

[sbull] Delete codes G0273 and G0274 and use the newly created CPT codes 78804 and 79403. They recommended that we assign 78804 to a new APC 0406T, Tumor/Infection Imaging Level II and that we assign 79403 to the new APC for Radionucliide Therapy APC, created by combining proposed APCs 0407 and 0408.

[sbull] Move codes 78015, 78016, and 78018 from APC 0390 to APC 0406 because they are for metastatic tumor imaging rather than for one organ system.

[sbull] Move all of the nuclear medicine ``add-on'' codes into one APC to be named ``Nuclear Medicine Add-On Imaging.'' Three of the codes, 78478, Heart wall motion add-on, 78480 Heart function add-on, and 78496, Heart function first pass add-on, are assigned to proposed APC 0399. They recommended moving the remaining add-on code, 78020, Thyroid carcinoma metastases uptake, to proposed APC 0399 with the other three add-on codes, to create an APC comprised of add-on codes with a status indicator ``X.''

[sbull] Move each of the codes in the series of codes, 78X99 into the appropriate APCs based on the organ system to be consistent with the proposed APC structure.

[sbull] Reassign codes 78270, 78271, and 78272 to APC 0389 because they are

[[Page 63411]]

non-imaging nuclear medicine procedures with resource use more similar to the procedures in APC 0389.

[sbull] Combine APCs 0390, 0391, and 0392 to create two new APCs composed of thyroid, parathyroid, and adrenal systems. They suggest that the codes should be reassigned to two levels of endocrine imaging based on the number of sessions and radiopharmaceuticals used in the procedure. The titles suggested for the new APCs are ``Endocrine Level I'' and ``Endocrine Level II.''

[sbull] Combine proposed APCs 0407 and 0408 into one APC because hospital claims data do not reflect any logical division between the two proposed APCs. Further, they request that all of the nuclear medicine therapy codes in the new APC should be paid separately since they know of no nuclear medicine therapeutic radiopharmaceutical that has costs below the proposed $150 threshold for packaging.

[sbull] Collapse and redistribute code assignments in APCs 0404 and 0405 to create two new APCs for Level I and Level II Renal and Genitourinary Studies. They recommended assigning only one code, 78709, Kidney imaging, multiple studies, with and without pharmaceutical intervention, to the Level II APC.

Response: After careful review of the recommendations, with one exception, we concur with the commenters that their recommended modifications to the proposed APC classifications improve clinical homogeneity and payment equity. The shifts in median cost that result from the adjustments are minor in most cases and overall, the increased cost is not significant.

The one exception to our agreement with the commenters' recommendation is regarding the assignment of 78708, Kidney imaging with vascular flow and function, single study. Commenters recommended that it be assigned to APC 0404. We believe that it is more appropriately assigned to APC 0405 based on both clinical and resource use considerations.

Although we do not disagree with the commenters' suggestions, we also will not assign the new code 78804, pre-treatment planning, non- Hodgkins to the APC suggested by the commenters. Instead, we will assign it to new technology APC 1508. A detailed discussion of this assignment and other issues related to Zevalin is below in section VI.B.

Thus, we will finalize the nuclear medicine APCs as shown below.

APC 0376: Cardiac Imaging Level II

HCPCS

Description

78473..................................... Gated heart, multiple. 78483..................................... Heart first pass, multiple.

APC 0377: Cardiac Imaging Level III

HCPCS

Description

78461..................................... Heart muscle blood, multiple. 78465..................................... Heart image (3D), multiple.

APC 0378: Pulmonary Imaging Level II

HCPCS

Description

78584..................................... Lung V/Q image gas, single breath. 78585..................................... Lung V/Q imaging gas. 78588..................................... Lung V/Q imaging aerosol. 78596..................................... Lung differential function.

APC 0389: Non-Imaging Nuclear Medicine

HCPCS

Description

78000..................................... Thyroid, single uptake. 78001..................................... Thyroid, multiple uptakes. 78003..................................... Thyroid suppress/stimuli. 78190..................................... Platelet survival, kinetics. 78191..................................... Platelet survival. 78270..................................... Vitamin B-12 absorption exam. 78271..................................... Vitamin B-12 absorp. exam, intrin. Fac. 78272..................................... Vitamin B-12 absorp, combined. 78725..................................... Kidney function study.

APC 0390: Endocrine Level I

HCPCS

Description

78006..................................... Thyroid imaging with uptake. 78010..................................... Thyroid imaging. 78011..................................... Thyroid imaging with flow. 78099..................................... Endocrine nuclear procedure.

APC 0391: Endocrine Level II

HCPCS

Description

78007..................................... Thyroid image, mult uptakes. 78070..................................... Parathyroid nuclear imaging. 78075..................................... Adrenal nuclear imaging.

APC 0393: Red Cell/Plasma Studies

HCPCS

Description

78110..................................... Plasma volume, single. 78111..................................... Plasma volume, multiple. 78120..................................... Red cell mass, single. 78121..................................... Red cell mass, multiple. 78122..................................... Blood volume. 78130..................................... Red cell survival study. 78135..................................... Red cell survival kinetics. 78140..................................... Red cell sequestration. 78160..................................... Plasma iron turnover. 78162..................................... Radioiron absorption exam. 78170..................................... Red cell iron utilization. 78172..................................... Total body iron estimation.

APC 0394: Hepatobiliary Imaging

HCPCS

Description

78201..................................... Liver imaging. 78202..................................... Liver imaging with flow. 78205..................................... Liver imaging (3D). 78206..................................... Liver image (3D) with flow. 78215..................................... Liver and spleen imaging. 78216..................................... Liver & spleen image/flow. 78220..................................... Liver function study. 78223..................................... Hepatobiliary imaging.

APC 0395: Gastrointestinal Imaging

HCPCS

Description

78230..................................... Salivary gland imaging. 78231..................................... Serial salivary imaging. 78232..................................... Salivary gland function exam. 78258..................................... Esophageal motility study. 78261..................................... Gastric mucosa imaging. 78262..................................... Gastroesophageal reflux exam. 78264..................................... Gastric emptying study. 78278..................................... Acute GI blood loss imaging. 78282..................................... GI protein loss exam. 78290..................................... Meckel's divert exam. 78291..................................... Leveen/shunt patency exam. 78299..................................... GI nuclear procedure.

APC 0396: Bone Imaging

HCPCS

Description

78300..................................... Bone imaging, limited area. 78305..................................... Bone imaging, multiple areas. 78306..................................... Bone imaging, whole body. 78315..................................... Bone imaging, 3 phase. 78320..................................... Bone imaging (3D). 78399..................................... Musculoskeletal nuclear exam.

APC 0397: Vascular Imaging

HCPCS

Description

78445..................................... Venous thrombosis study. 78455..................................... Venous thrombosis study.

[[Page 63412]]

78456..................................... Acute venous thrombus image. 78457..................................... Venous thrombosis imaging. 78458..................................... Ven thrombosis images, bilat.

APC 0398: Cardiac Imaging Level I

HCPCS

Description

78414..................................... Non-imaging heart function. 78428..................................... Cardiac shunt imaging. 78460..................................... Heart muscle blood, single. 78464..................................... Heart image (3D), single. 78466..................................... Heart infarct image. 78468..................................... Heart infarct image (ef). 78469..................................... Heart infarct image (3D). 78472..................................... Gated heart, planar, single. 78481..................................... Heart first pass, single. 78494..................................... Heart image, spect. 78499..................................... Unlisted cardiovascular.

APC 0399: Nuclear Medicine Add-On Imaging

HCPCS

Description

78020..................................... Thyroid met uptake. 78478..................................... Heart wall motion add-on. 78480..................................... Heart function add-on. 78496..................................... Heart first pass add-on.

APC 0400: Hematopoietic Imaging

HCPCS

Description

78102..................................... Bone marrow imaging, ltd. 78103..................................... Bone marrow imaging, mult. 78104..................................... Bone marrow imaging, body. 78185..................................... Spleen imaging. 78195..................................... Lymph system imaging. 78199..................................... Blood/lymph nuclear exam.

APC 0401: Pulmonary Imaging, Level 1

HCPCS

Description

78580..................................... Lung perfusion imaging. 78586..................................... Aerosol lung image, single. 78587..................................... Aerosol lung image, multiple. 78591..................................... Vent image, 1 breath, 1 proj. 78593..................................... Vent image, 1 proj, gas. 78594..................................... Vent image, mult proj, gas. 78599..................................... Respiratory Nuclear Exam.

APC 0402: Brain Imaging

HCPCS

Description

78600..................................... Brain imaging, ltd static. 78601..................................... Brain imaging, ltd w/flow. 78605..................................... Brain imaging, complete. 78606..................................... Brain imaging, compl w/flow. 78607..................................... Brain imaging (3D). 78610..................................... Brain flow imaging only. 78615..................................... Cerebral vascular flow image. 78699..................................... Nervous system nuclear exam.

APC 0403: CSF Imaging

HCPCS

Description

78630..................................... Cerebrospinal fluid scan. 78635..................................... CSF ventriculography. 78645..................................... CSF shunt evaluation. 78647..................................... Cerebrospinal fluid scan. 78650..................................... CSF leakage imaging. 78660..................................... Nuclear exam of tear flow.

APC 0404: Renal & Genitourinary Studies Level I

HCPCS

Description

78700..................................... Kidney imaging, static. 78701..................................... Kidney imaging with flow. 78704..................................... Imaging renogram. 78707..................................... Kidney flow/function image. 78710..................................... Kidney imaging (3D). 78715..................................... Renal vascular flow exam.

APC 0405: Renal & Genitourinary Studies Level II

HCPCS

Description

78708..................................... Kidney flow/function image. 78709..................................... Kidney flow/function image.

APC 0406: Tumor/Infection Imaging

HCPCS

Description

78015..................................... Thyroid metastases imaging. 78016..................................... Thyroid metastases imaging/ studies. 78018..................................... Thyroid metastases imaging/ body. 78800..................................... Tumor imaging, limited area. 78801..................................... Tumor imaging, mult areas. 78802..................................... Tumor imaging, whole body. 78803..................................... Tumor imaging, whole body. 78805..................................... Abscess imaging, ltd area. 78806..................................... Abscess imaging, whole body. 78807..................................... Nuclear localization/ abscess.

APC 0407: Radionucliide Therapy

HCPCS

Description

79000..................................... Init hyperthyroid therapy. 79001..................................... Repeat hyperthyroid therapy. 79020..................................... Thyroid ablation. 79030..................................... Thyroid ablation, carcinoma. 79035..................................... Thyroid metastatic therapy. 79100..................................... Hematopoetic nuclear therapy. 79200..................................... Intracavitary nuclear treatment. 79300..................................... Interstitial nuclear therapy. 79400..................................... Nonhemato nuclear therapy. 79420..................................... Intravascular nuclear therapy. 79440..................................... Nuclear joint therapy. 79999..................................... Nuclear medicine therapy.

APC 1507: New Technology Level VII ($500-$600)

79403..................................... Hematopoetic nuclear therapy.

APC 1508: Tumor/Infection Imaging Level II

HCPCS

Description

78804..................................... Pre-tx planning, non- Hodgkins.

We believe that the final APC structure, which takes into account the organ(s) being examined (or treated) as well as the type and complexity of the procedure, is more homogeneous both clinically and in terms of resource consumption than the current APC structure.

ee. Endoscopy Lower Airway

APC 0076: Endoscopy Lower Airway

A presenter to the Panel expressed concern that APC 0076 apparently violates the 2 times rule and requested that we move CPT code 31631 (bronchoscopy with tracheal stent placement) from APC 0076 and into a new APC.

The Panel suggested that a new APC comprised of the four most costly procedures in APC 0076 will result in a more homogenous grouping, and recommended that we move the following CPT codes from APC 0076 and into newly created APC 0415.

HCPCS

Description

31630........................ Bronchoscopy dilate/fracture reduction. 31631........................ Bronchoscopy, dilate w/stent. 31640........................ Bronchoscopy w/tumor excise. 31641........................ Bronchoscopy, treat blockage.

We proposed to accept the Panel's recommendation that we move CPT codes 31630, 31631, 31640, and 31641 from APC 0076 to new APC 0415. We

[[Page 63413]]

received no comments disagreeing with this proposal and will adopt this recommendation for 2004.

ff. Gastrointestinal Endoscopic Stenting Procedures

APC 0141: Upper GI Procedures APC 0142: Small Intestine Endoscopy APC 0143: Lower GI Endoscopy APC 0147: Level II Sigmoidoscopy

A commenter requested that we create a new APC that will be comprised of all the gastrointestinal endoscopic stent codes. The Panel agreed with the commenter's suggestion because the resource requirements for all gastrointestinal endoscopic stents appear to be similar. The Panel recommended that we move the following CPT codes from their 2003 APCs to newly created APC 0384 for 2004:

Table 4.--HCPCS Codes to be Moved Into New APC 0384

HCPCS

Description

2003 APC 2004 APC

43219............................... Esophagus endoscopy.............................

0141

0384 43256............................... Upper GI endoscopy w/stent......................

0141

0384 44370............................... Small bowel endoscopy w/stent...................

0142

0384 44379............................... Small bowel endoscopy w/stent...................

0142

0384 44383............................... Small bowel endoscopy...........................

0142

0384 44397............................... Colonoscopy w/stent.............................

0143

0384 45387............................... Colonoscopy w/stent.............................

0143

0384 45327............................... Proctosigmoidoscopy w/stent.....................

0147

0384 45345............................... Sigmoidoscopy w/stent...........................

0147

0384

We proposed to accept the Panel's recommendation to move the following gastrointestinal endoscopic stent CPT codes into newly created APC 0384: 43219, 43256 (from APC 0141); 44370, 44379, 44383 (from APC 0142); 44397, 45387 (from APC 0143); 45327, 45345 (from APC 0147). We received no comments disagreeing with this proposal, and we will adopt it for 2004.

gg. Capturing the Costs of Devices That Are Packaged Into APCs

APC 0081: Non-Coronary Angioplasty or Atherectomy APC 0083: Coronary Angioplasty and Percutaneous Valvuloplasty APC 0104: Transcatheter Placement of Intracoronary Stents APC 0222: Implantation of Neurological Device APC 0223: Implantation of Pain Management Device APC 0227: Implantation of Drug Infusion Device APC 0229: Transcatheter Placement of Intravascular Shunts

Several commenters requested that the status indicators for the above APCs (all of which include high-cost devices) be changed from T (multiple-procedure discount applies) to S (multiple-procedure discount does not apply). Two presenters to the Panel stated that hospitals do not pay less for devices when they are used in the context of a multiple-procedure claim and suggested that we apply the multiple- procedure reduction to the non-device portion of the claim only. Alternatively, these presenters recommended that we apply the discount policy only when the device cost is below a predetermined proportion of the APC cost. Another presenter to the Panel requested that APCs 0222, 0223, and 0227 be exempt from the multiple-procedure discount policy because the cost of the devices used in these procedures makes up more than 50 percent of the APC cost.

We sought the Panel's input as to whether there are situations in which we should not apply our multiple procedure discount policy. The Panel recommended no changes to the status indicators for any of the device-related APCs discussed because they were concerned that exemptions from the discount policy could result in incentives to use more devices than necessary. However, the Panel asked that we analyze our data to determine if we may be underpaying for devices when the multiple procedure discounting policy is applied and recommended that we develop some methodology to track device costs. In section II.B of this preamble, we discuss the issue of device costs and multiple procedure reductions and our progress to date in developing ``combination APCs'' to address the Panel's concern.

hh. Discussion of Ways To Increase the Use of Multiple Claims To Set APC Payment Rates

A presenter to the Panel suggested that we use dates of service on multiple procedure claims to increase the number of claims we use to set payment rates. Another presenter suggested that we could further increase the number of multiple procedure claims that could be used to set payment rates by ignoring codes with status indicator K. Other suggestions were to exclude from consideration those APCs with small dollar values and to create a new code or APC specifically for the insertion and removal of devices.

The Panel recommended that our staff explore ways to increase the number of claims used to set payment rates, including the following methodologies: sort multiple claims by date of service; exclude codes with K status indicator from evaluation; exclude those APCs with nominal costs (the definition of ``nominal'' can be determined by modeling a variety of possible dollar amounts). In addition, the Panel recommended that we not create G codes as part of the effort to use multiple procedure claims for developing relative weights. If new codes are needed, the Panel suggested that our staff work with the American Medical Association's CPT Board to identify possible new codes.

B. Other Changes Affecting the APCs

1. Limit on Variation of Costs of Services Classified Within an APC Group

Section 1833(t)(2) of the Act provides that the items and services within an APC group cannot be considered comparable with respect to the use of resources if the highest cost item or service within an APC group is more than 2 times greater than the lowest cost item or service within the same group. However, the statute authorizes the Secretary to make exceptions to this limit on the variation of costs within each APC group in unusual cases such as low volume items and services. No exception may be made in the case of a drug or biological that has been designated as an orphan drug under section 526 of the Federal Food, Drug, and Cosmetic Act.

Taking into account the proposed APC changes discussed in relation to the APC Panel recommendations in section II.A.4 of this preamble and the use of 2002 claims data to calculate the

[[Page 63414]]

median cost of procedures classified to APCs, we reviewed all the APCs to determine which of them would not meet the 2 times limit. We use the following criteria when deciding whether to make exceptions to the 2 times rule for affected APCs:

[sbull] Resource homogeneity.

[sbull] Clinical homogeneity.

[sbull] Hospital concentration.

[sbull] Frequency of service (volume).

[sbull] Opportunity for upcoding and code fragmentation. For a detailed discussion of these criteria, refer to the April 7, 2000 final rule (65 FR 18457).

The following table contains the final list of APCs that we exempt from the 2 times rule based on the criteria cited above. In cases in which a recommendation of the APC Panel appeared to result in or allow a violation of the 2 times rule, we generally accepted the Panel recommendation because Panel recommendations were based on explicit consideration of resource use, clinical homogeneity, hospital specialization, and the quality of the data used to determine payment rates.

The median cost for hospital outpatient services for these and all other APCs can be found at Web site: http://www.cms.hhs.gov.

Table 5.--APCS Exempted From 2 Times Rule

Final Rule APC

Description

0006........................................ Level I Incision & Drainage. 0012........................................ Level I Debridement & Destruction. 0018........................................ Biopsy of Skin/Puncture of Lesion. 0019........................................ Level I Excision/Biopsy. 0020........................................ Level II Excision/Biopsy. 0043........................................ Closed Treatment Fracture Finger/Toe/Trunk. 0046........................................ Open/Percutaneous Treatment Fracture or Dislocation. 0058........................................ Level I Strapping and Cast Application. 0060........................................ Manipulation Therapy. 0071........................................ Level I Endoscopy Upper Airway. 0074........................................ Level IV Endoscopy Upper Airway. 0084........................................ Level I Electrophysiologic Evaluation. 0093........................................ Vascular Reconstruction/Fistula Repair without Device. 0097........................................ Cardiac and Ambulatory Blood Pressure Monitoring. 0099........................................ Electrocardiograms. 0103........................................ Miscellaneous Vascular Procedures. 0105........................................ Revision/Removal of Pacemakers, AICD, or Vascular. 0109........................................ Removal of Implanted Devices. 0130........................................ Level I Laparoscopy. 0147........................................ Level II Sigmoidoscopy. 0148........................................ Level I Anal/Rectal Procedure. 0155........................................ Level II Anal/Rectal Procedure. 0165........................................ Level III Urinary and Anal Procedures. 0192........................................ Level IV Female Reproductive Proc. 0203........................................ Level IV Nerve Injections. 0204........................................ Level I Nerve Injections. 0207........................................ Level III Nerve Injections. 0213........................................ Extended EEG Studies and Sleep Studies, Level I. 0214........................................ Electroencephalogram. 0218........................................ Level II Nerve and Muscle Tests. 0231........................................ Level III Eye Tests & Treatments. 0233........................................ Level II Anterior Segment Eye Procedures. 0235........................................ Level I Posterior Segment Eye Procedures. 0239........................................ Level II Repair and Plastic Eye Procedures. 0245........................................ Level I Cataract Procedures without IOL Insert. 0252........................................ Level II ENT Procedures. 0262........................................ Plain Film of Teeth. 0266........................................ Level II Diagnostic Ultrasound Except Vascular. 0274........................................ Myelography. 0279........................................ Level II Angiography and Venography except Extremity. 0297........................................ Level II Therapeutic Radiologic Procedures. 0303........................................ Treatment Device Construction. 0314........................................ Hyperthermic Therapies. 0323........................................ Extended Individual Psychotherapy. 0340........................................ Minor Ancillary Procedures. 0341........................................ Skin Tests. 0344........................................ Level III Pathology. 0355........................................ Level III Immunizations. 0356........................................ Level IV Immunizations. 0363........................................ Level I Otorhinolaryngologic Function Tests. 0364........................................ Level I Audiometry. 0367........................................ Level I Pulmonary Test. 0368........................................ Level II Pulmonary Tests. 0370........................................ Allergy Tests. 0373........................................ Neuropsychological Testing. 0397........................................ Vascular Imaging. 0398........................................ Level I Cardiac Imaging. 0402........................................ Brain Imaging. 0404........................................ Renal and Genitourinary Studies Level I.

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0407........................................ Radionuclide Therapy. 0409........................................ Red Blood Cell Tests. 0688........................................ Revision/Removal of Neurostimulator Pulse Generator Receiver. 0692........................................ Electronic Analysis of Neurostimulator Pulse Generators. 0698........................................ Level II Eye Tests & Treatments. 0699........................................ Level IV Eye Tests & Treatments. 1528........................................ New Technology--Level XXVIII ($5000-$5500).

2. Procedures Moved From New Technology APCs to Clinically Appropriate APCs

In the November 30, 2001 final rule (66 FR 59903), we made final our proposal to change the period of time during which a service may be paid under a new technology APC. Beginning in 2002, the policy is to retain a service within a new technology APC group until we have acquired adequate data that allow us to assign the service to a clinically appropriate APC. This policy allows us to move a service from a new technology APC in less than 2 years if sufficient data are available, and it also allows us to retain a service in a new technology APC for more than 3 years if sufficient data upon which to base a decision for reassignment have not been collected.

In the context of new technology procedures, we create HCPCS codes for services only. We do not create HCPCS codes for equipment that is used in the course of providing an item or service (except in the case of ``C'' codes for devices that meet the criteria for transitional pass-through payments). Equipment that is used to provide an item or service is not separately coded because it is a resource required to furnish the service. Like other resources that are required to furnish a service (for example, cost of a room, cost of staff, cost of supplies), the hospital should show charges either as part of its charge for the procedure or with a revenue code.

As described below, we proposed to delete four HCPCS codes that are currently paid in new technology APCs. We believed that these four HCPCS codes do not conform to our current policy to not create HCPCS codes for equipment used to provide a service. In addition, we stated that there soon would exist, CPT codes to describe all of the services being furnished, including any equipment that is needed to perform them, so we believe it is appropriate at this time to delete the HCPCS codes. The HCPCS codes which we proposed to delete effective January 1, 2004 were:

C1088; Laser Optic Treatment System, Indigo Laseroptic Treatment System C9701; Stretta System C9703; Bard Endoscopic Suturing System, and C9711; H.E.L.P. Apheresis System.

A full description of these HCPCS is available in the proposed rule (67 FR 47978).

We received no comments in response to this proposal. However, we have determined that our proposal to delete codes C9701 and C9703 was in error. Upon further review of this issue, we have determined that these codes were in fact established to represent complete procedures. Therefore, we will retain codes C9701 and C9703.

Comment: A provider of treatment planning software submitted several comments regarding this service. In their first set of comments on the 2003 OPPS final rule with comment, the commenter agreed with our decision to create a new G-code, G0288, for their product, Preview, and other similar treatment planning software and to assign this service to new technology APC 0975. G0288 was created and assigned to new technology APC 0975 for the 2003 final rule and was subject to comment after its publication. In their comments in response to the 2003 final rule with comment, they indicated that the $625 payment rate associated with new technology APC 0975 appropriately reflected the costs of Preview to providers. However, this party recommended that we pay for G0288 under certain circumstances. These included payment only for treatment planning imaging services that are FDA approved; that is, to follow FDA's determinations concerning which imaging software programs are sufficiently comprehensive and accurate. Further, the commenter recommended that we pay for both pre-surgical and post-surgical imaging, claiming optimum effectiveness of the related endovascular repair procedures only occurs when imaging studies are performed both before and after surgery. Third, this party recommended that we use G0288 in the OPPS but not in other Medicare payment systems until cost data were more complete. The commenter believed that we should encourage use of the CPT process to develop codes that describe a wide range of applications for the treatment planning imaging that may develop.

The commenter also commented on our August 12, 2003 proposed rule, in which we proposed assigning G0288 to new APC 0414, with a payment rate of $260.65. This commenter stated that the proposed payment is inadequate and based on flawed, imputed cost data. It also asserted that the descriptors for APC 0414 and G0288 do not restrict the use of this code to services that meet the ``recognized standards and specifications'' for three-dimensional computer-aided measurement planning simulation (``3D-CAMPS'') services and recommended that we revise the proposed payment for APC 0414 based on hospital acquisition cost data that they provided. The commenter also recommended that we create a revenue code specifically for APC 0414 to enable more rational charge determination for the service and that we revise the descriptors for APC 0414 and G0288 to ensure that the codes only are used for the 3D-CAMPS systems, and to clarify that the service may be applied pre- or post-surgically. The recommended descriptor is: ``Three-dimensional computer-aided measurement simulation (3D-CAMPS) services for pre- surgical and post-surgical imaging.''

Response: We proposed to move G0288 from new technology APC 0975 to APC 0414 because we believe that we had sufficient 2002 claims data for our analysis. The predecessor C-code for Preview, C9708, was reported approximately 1,300 times in 2002, with a median cost of $272.48. However, we have reviewed the hospital cost data that the commenting party provided, and believe that there may be some claims in our data that understate the cost of the treatment planning software. We have decided to give equal weight to the median cost based on our claims data and the median cost of $625 provided by the commenter, based on its analysis. Therefore, we are establishing the appropriate cost

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amount as $448.74. As a result, we are assigning G0288 to new technology service APC 1506, for a payment rate of $450.00. We are continuing the assignment of G0288 to a new technology APC because this is still a relatively new procedure and we still have concerns regarding our cost data.

We agree that this can be used for treatment planning prior to surgery and for post-surgical monitoring and have revised the code descriptor to clarify this point. The descriptor for this code is revised as follows: G0288 Reconstruction, computed tomographic angiography of aorta for preoperative planning and evaluation post vascular surgery. We assume that hospitals providing this service will abide by the FDA labeling requirements for equipment used in providing this service. 3. Revision of Cost Bands and Payment Amounts for New Technology APCs

We proposed to implement a comprehensive restructuring of all the new technology APCs. First, the cost intervals in the current new technology APCs are inconsistent, ranging from $50 to $1,500. Secondly, as the number of procedures assigned to new technology APCs increases, we believe that narrower cost bands are required to avoid inaccurate payment for new technology services. The increased number of new technology APCs that would result from narrowing the cost bands cannot be accommodated within the current sequence of available APC numbers. Therefore, we proposed to dedicate two new series of APC numbers to the restructured new technology APCs, which would allow us to narrow the cost bands and also afford us flexibility in creating additional bands as future needs may dictate.

We proposed to establish cost bands from $0 to $100 in increments of $50, from $100 through $2,000 in intervals of $100, and from $2,000 through $6,000 in intervals of $500. We believe that these intervals would allow us to price new technology services more appropriately and consistently. We also propose to retain two parallel sets of new technology APCs, one with status indicator ``S'' and the other with status indicator ``T.'' We solicited comments on the hierarchy of cost levels of the restructured new technology APCs.

The final list of restructured new technology APCs is in Addendum A.

We received a number of comments in support of this proposal to restructure the new technology APC bands. Therefore, we will finalize our proposal. 4. Creation of APCs for Combinations of Device Procedures

In the August 12, 2003 proposed rule, we discussed data development that we had undertaken to create median costs for combinations of HCPCS codes in different APCs that we believed were frequently performed on the same day. We focused our work on pairs of APCs, one of which contained a service that required an expensive device. See 68 FR 47979 for a complete description of the data development. We undertook this activity to see if creating larger classification groups of this type might increase the number of multiple procedure claims that we could use to set payment rates for these services. We also thought that the analysis might yield useful information regarding the appropriateness of the multiple procedure reduction for combinations of services that include at least one APC with an expensive device, that are commonly performed on the same date. In many cases, we found that the combination APC medians closely approximated the median that results under the current policy (that is, the sum of single medians for each APC, reducing the median for the lower cost procedure by 50 percent). In other cases, the data revealed combination APC median costs that were considerably higher or lower than under our current policy.

We concluded in the proposed rule that the results of the study provided no compelling reason to change our payment policy. We asked for comment on all aspects of the methodology, analysis, and payment options. We also asked for discussion of how we could use more multiple procedure claims were we not to create combination APCs and for an explanation of why external data should be used in lieu of our single or multiple procedure claims data to set median costs for APCs with large device costs. However, we did not propose to create combination APCs or to make payment based on the combination APC medians for 2004.

We received only a few comments on the combination APC methodology and these were in the context of why we should not apply multiple procedure reductions to specific combinations of APCs. See the discussion of multiple procedure reduction in V.D.2 for a summary of these comments and our responses.

III. Recalibration of APC Weights for CY 2004

Section 1833(t)(9)(A) of the Act requires that the Secretary review and revise the relative payment weights for APCs at least annually, beginning in 2001. In the April 7, 2000 final rule (65 FR 18482), we explained in detail how we calculated the relative payment weights that were implemented on August 1, 2000 for each APC group. Except for some reweighting due to APC changes, these relative weights continued to be in effect for CY 2001. (See the November 13, 2000 interim final rule (65 FR 67824 to 67827)).

To recalibrate the relative APC weights for services furnished on or after January 1, 2004 and before January 1, 2005, we used the same basic methodology that we described in the April 7, 2000 final rule. That is, we recalibrated the weights based on claims and cost report data for outpatient services. We used the most recent available data to construct the database for calculating APC group weights. For the purpose of recalibrating APC relative weights for CY 2004, the most recent available claims data are the approximately 127 million final action claims for hospital outpatient department services furnished on or after April 1, 2002 and before January 1, 2003. We eliminated 2.6 million claims for bill types other than OPPS bill types and claims for services furnished in Maryland, Guam, and the Virgin Islands. We matched the remaining claims that were paid under the OPPS to the most recent cost report filed by the individual hospitals represented in our claims data. We were left with about 75 million claims for which we could identify cost report data. The APC relative weights continue to be based on the median hospital costs for services in the APC groups.

A. Data Issues

1. Period of Claims Data Used

We used claims for the period beginning April 1, 2002 through and including December 31, 2002 as the basis for the CY 2004 OPPS. The statute requires that we take into account new cost data and other relevant information and factors in reviewing and revising the weights, and we believe that this period will give us the most recent costs. We chose not to include the claims for the period beginning on January 1, 2002 through March 31, 2002 because they were used to set the payment rates for the 2003 OPPS and we believe that the most recent 9 months of claims data will result in payment rates that are most representative of the current relative costs of hospital outpatient services.

Comment: Some commenters supported our use of claims for this 9- month period for setting the weights for

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the 2004 OPPS. Other commenters wanted us to use external data in lieu of claims data for specified APCs because they believed that the payments that result from the median costs developed using claims data were inadequate. Other commenters objected to the use of 2002 claims data because they stated that 2002 costs would not be an appropriate proxy for the relative costs of drugs, biologicals, and radiopharmaceuticals in 2004 and they urged us to use hospital acquisition costs instead of claims data.

Response: We used 2002 claims data for services furnished from April 1, 2002 through December 31, 2002 as the basis for the relative weights used to create payment amounts for the 2004 OPPS. Our established policy is to use the most recent claims data available. For the August 12, 2003 proposed rule and this final rule, those data are for services in the last 3 quarters of 2002. These data are used to calculate median costs upon which to base our relative weights. The OPPS seeks and uses relative costs to create weights that are used to distribute a fixed amount of Medicare payment for OPPS services appropriately among hospitals. Therefore, the accuracy of the relativity is more important than whether the median costs derived from the claims data accurately reflect the costs of the services. See section III.B for our discussion of the use of external data. 2. Treatment of ``Multiple Procedure'' Claims

Since the inception of the OPPS, we have received many requests asking that we ensure that the data from claims that contain charges for multiple procedures are included in the data from which we calculate the OPPS relative payment weights. Those making the requests believe that relying solely on single-procedure claims to recalibrate APC weights fails to take into account data for many frequently performed and complex procedures, particularly those commonly performed in combination with other procedures.

We agree that it is desirable to use the data from as many claims as possible to recalibrate the relative payment weights, including those with multiple procedures. For CY 2003, we identified a number of multiple-procedure claims that could be treated as single-procedure claims, enabling us to greatly increase the number of claims used to develop the APC payment weights. However, there remain several inherent features of multiple procedure claims that prevent us from using all of them to recalibrate the payment weights. We discussed these obstacles in detail in the August 9, 2002 proposed rule (67 FR 52092, 52108 through 52111), and the November 1, 2002 final rule (67 FR 66718, 66743 through 66746).

To enable us to use more claims in the creation of median costs upon which our payment weights and rates are based, we proposed several changes to how we use claims data for the CY 2004 OPPS. Specifically, we proposed to expand the number of HCPCS codes that we ``ignore'' for the purpose of creating pseudo single claims from claims that contain other separately payable HCPCS codes. We also looked at dates of service on packaged HCPCS codes and packaged revenue centers, and proposed where possible, to attribute the charges to major, separately payable HCPCS codes based on the codes' dates of service. We also considered creating combination APCs for procedures that have a significant device component. Our complete discussion of the use of data to set the weights for CY 2004 OPPS follows in section III.B of this preamble.

Expansion of the List of Codes To Be Ignored in Creation of Single Claims

For CY 2003 OPPS, we ignored the presence of HCPCS codes 93005, 71010, and 71020 to create pseudo-single claims where there was only one remaining separately paid, major HCPCS code on the claim. Ignoring these codes enabled us to attribute the costs of packaged HCPCS codes and packaged revenue centers to the remaining separately paid, major HCPCS codes and, thereby, create a useable psuedo single claim. We did this because we believed that the charges found in the packaged HCPCS or packaged revenue centers would be appropriately associated with the only other separately payable HCPCS that remained on the claim once the ignored codes were bypassed.

For CY 2004 OPPS, we proposed to expand the list of HCPCS codes to be ignored for purposes of creating pseudo-single claims. On claims that contain other separately payable HCPCS, we proposed to bypass the HCPCS codes in the APCs identified in Table 6. As with the previously ignored HCPCS codes 93005, 71010, and 71020, we believe that there are additional codes that are highly unlikely to have charges that are found in packaged HCPCS or in packaged revenue centers. Therefore, we believe that they also can be ignored for the purpose of creating pseudo-single claims from the remaining charges on the claim. We solicited comments on the proposed methodology to create pseudo-single claims, on the list of codes that we proposed to ignore (Table 6), and whether there are other low-cost services that we could ignore using this methodology. We also requested comments on whether we should use the charges for the codes in the APCs in Table 6 to create pseudo singles for these codes from these claims.

Use of Dates of Service To Create Single Claims

For CY 2004, we used dates of service on HCPCS codes and on packaged revenue centers to attribute charges to a major payable HCPCS code where the dates of service match. We could only use this approach where there are different dates of service for the separately payable major HCPCS codes. Where there are multiple major payable HCPCS codes on a claim with the same date, we could not use this approach because there was no way to tell to which major payable HCPCS code the charges from the packaged HCPCS or packaged revenue center belonged. Moreover, where the hospital did not provide dates for all packaged revenue centers, we could not attribute charges based on the date of service.

Use of Single Procedure Claims

Comment: Some commenters objected to the use of single procedure claims as the basis for setting weights for all APCs. The commenters are concerned that even with the changes we made to use more claims for 2004 OPPS, some of the APCs had medians based on less than 10 percent of their true claims volume. They believe that this methodology results in the use of claims only for simple, low-cost cases from small, relatively non-busy centers with low levels of technological complexity and inappropriately low costs and charges. They urged us to use external data, whether proprietary or not, in place of the claims- derived medians when the medians would otherwise be based on a small number of claims.

Some commenters urged us to ignore codes for procedures performed on the same day as procedures of interest to them and to package all revenue center charges and charges for packaged HCPCS codes into the code for which they were seeking a median. Some commenters gave us relatively elaborate strategies for creating pseduo-single claims out of multiple procedure claims for particular services or groups of services that were of interest to them. Some of these related to special packaging for chemotherapy services and nuclear medicine services. The commenters urged us to model our data for the 2005 OPPS according to the specifications they provided.

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Response: We would certainly prefer to use all claims in the setting of weights for APCs, if it were possible to do so validly. However, we continue to be plagued by our inability to allocate revenue center charges when there are multiple major procedure codes for services performed on the same day. We are unable to determine how to accurately split some costs (for example, recovery room time) among the major procedures. We have received no comments that offer alternatives that would enable us to do so with confidence.

We did not accept the service-specific strategies for acquiring more single claims that were submitted in comments because none of them could be generalized to the entire claims population in such a way that we could be sure that they would not distort the relativity of all services. We set weights for hundreds of APCs in this system and we think it is important that the same rules governing creation of pseudo single claims from multiple procedure claims be applied across all services so that packaging occurs uniformly and the relativity of services is maintained. It is a practical impossibility to have different strategies for creating pseudo singles for each category of services.

We did not use the line items that were ignored in the calculation of medians for the APC into which they would fall because we lacked confidence that they would accurately represent the full cost of the service. We asked for comments on this in the proposed rule. Based on the comments that indicate that the data for these line items should be used in median setting, we expect to use these line items for median setting for the 2005 proposed rule.

APCs to be Ignored To Create More Single Claims

Comment: Commenters supported the expansion of the list of APCs that we ignored to create single procedure claims from multiple procedure claims to enable us to use more claims data in weight setting. A commenter asked that we confirm that the line items that were ignored to create pseudo-single claims (See Table 6) are used in the weight setting process. A commenter asked that we implement the combination APC approach as a way of using more claims data for multiple procedure claims. One commenter asked that we add evaluation and management codes to the list of codes ignored for purposes of creating pseudo-singles. Other commenters provided lists of additional codes that could be ignored to create more pseudo-single claims.

Commenters also supported the use of dates of service on lines with revenue code charges where they could be used to attribute charges to HCPCS codes for weight setting. Some commenters advised that we should use the date of service aggregation at the beginning of the pseudo- single claim creation to achieve the best effects. Some commenters asked that we require all hospitals to use dates of service on all lines (but not before July 1, 2004), even where only revenue codes are on the lines, so that more claims could be used in future years.

Several commenters asked that we eliminate the requirement for series bills for certain services if we require a date of service for each line because the claim will grow in size as charges for multiple dates of service that are now combined on a single line with no date of service will now have to be split into multiple lines to show the date of service. The commenters fear that the increase in the lines on the claim may result in errors on the claim and there may be cashflow problems if more claims are returned to the provider. The commenters indicated that delays in payment for series bills covering 30 days of service are significant.

Response: For the 2004 OPPS, we did make progress in using more claims by looking to the dates on revenue center charges, where they exist, to assign them to a single major procedure on the same date. We applied the date of service criteria before we ignored APCs to create single claims. Moreover, we were able to create more single procedure claims by ignoring procedures for which we thought no revenue center charges or packaged HCPCS charges would be appropriately assigned. We appreciate the information provided in comments and hope that the public will continue to furnish us with an expanded list of codes that they believe can be considered ``stand alone'' codes, which we could properly ignore in creating pseudo single claims from claims containing multiple major procedures. We did not add evaluation and management service codes to the list because we believe that drugs and supplies are often used during such services and that it would not be correct to assume that all of the supply and drug charges on the claim were for items and services used with the procedure that also is billed also on the same claim. We would like to further explore the issue of which claims to ignore for pseudo single creation with the APC Panel in its winter meeting and to seek the Panel's views on the specific code to be added to the list of codes to be ignored for this purpose.

While we did not apply the combination APC approach, we expect to continue to explore whether this would, upon further refinement, have value in establishing correct weights for procedures performed in combination with one another. We hope to improve both of these processes next year and to develop other methods of using multiple procedure claims.

We did not use the line items for the HCPCS codes we ignored in the calculation of medians for those HCPCS codes. We asked for public comment on the issue. In view of the public comments supporting the concept of ignoring certain codes for creation of pseudo singles and supporting the validity of using these line items in the median setting for these codes, we will propose to use them for median setting for the 2005 proposed rule.

Our requirement for series bills creates efficiencies in claims processing that enable us to provide better provider service. In view of the decision to not implement the drug administration option, which would have required coding of all drugs, and seemed to be the impetus for the comment, we do not expect to revise our series bill policy.

B. Description of Our Calculation of Weights for CY 2004

The methodology we followed to calculate the APC relative payment weights proposed for CY 2004 is as follows:

[sbull] We excluded from the data claims for those bill and claim types that would not be paid under the OPPS (for example, bill type 72X for dialysis services for patients with end-stage renal disease (ESRD)).

[sbull] We eliminated claims from hospitals located in Maryland, Guam, and the U.S. Virgin Islands.

[sbull] Using the most recent available cost report from each hospital, we converted billed charges to costs and aggregated them to the procedure or visit level first by identifying the cost-to-charge ratio specific to each hospital's cost centers (``cost center specific cost-to-charge ratios'' or CCRs) and then by matching the CCRs to revenue centers used on the hospital's CY 2001 outpatient bills. The CCRs include operating and capital costs but exclude items paid on a reasonable cost basis.

[sbull] We eliminated from the hospital CCR data 287 hospitals that we identified as having reported charges on their cost reports that were not actual charges (for example, a uniform charge applied to all services). Of these, 206 hospitals had claims data.

[sbull] We eliminated from our data claims for critical access hospitals that are not

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paid under OPPS and whose claims are therefore not suitable for use in setting weights for services paid under OPPS.

[sbull] We calculated the geometric mean of the total operating CCRs of hospitals remaining in the CCR data. We removed from the CCR data 56 hospitals whose total operating CCR deviated from the geometric mean by more than three standard deviations.

[sbull] We excluded from our data approximately 3.11 million claims submitted by the hospitals that we removed or trimmed from the hospital CCR data.

[sbull] We matched revenue centers from the remaining universe of claims to hospital CCRs.

[sbull] We separated the remaining claims that we had matched with a cost report into the following three distinct groups: (1) Single- procedure claims; (2) multiple-procedure claims; and (3) claims on which we could not identify at least one OPPS covered service. Single- procedure claims are those that include only one HCPCS code (other than laboratory and incidentals such as packaged drugs and venipuncture) that could be grouped to an APC. Multiple-procedure claims include more than one HCPCS code that could be mapped to an APC. Dividing the claims yielded approximately 24.43 million single-procedure claims and 16.86 million multiple-procedure claims.

We converted 9.833 million multiple-procedure claims to single- procedure claims using the following criteria: (1) If a multiple- procedure claim contained lines with a HCPCS code in the pathology series (that is, CPT 80000 series of codes), we treated each of those lines as a single claim. (2) For multiple-procedure claims with a packaged HCPCS code (status indicator ``N'') on the claim, we ignored line items for preoperative procedures and for those services in the APCs identified in Table 6. These are services with payment amounts below $50 (under the CY 2003 OPPS) for which we believe the charge represents the totality of the charges associated with the service (that is, that there are no packaged HCPCS or packaged revenue centers attributable to the service). If only one procedure (other than HCPCS codes in Table 6) existed on the claim, we treated it as a single- procedure claim. (3) If the claim had no packaged HCPCS codes and if there were no packaged revenue centers on the claim, we treated each line with a procedure as a single-procedure claim if billed with single units. (4) If the claim had no packaged HCPCS codes but had packaged revenue centers for the procedure, we ignored the line item for codes in the APCs identified in Table 6. If only one HCPCS code remained, we treated the claim as a single-procedure claim.

Table 6.--APCS That Were Ignored To Create Pseudo Single Procedure Claims

APC

APC Description

Status indicator

0001............................... Level I Photochemotherapy....................................................... S 0060............................... Manipulation Therapy............................................................ S 0077............................... Level I Pulmonary Treatment..................................................... S 0099............................... Electrocardiograms.............................................................. S 0215............................... Level I Nerve and Muscle Tests.................................................. S 0215............................... Level I Nerve and Muscle Tests.................................................. S 0230............................... Level I Eye Tests & Treatments.................................................. S 0260............................... Level I Plain Film Except Teeth................................................. X 0262............................... Plain Film of Teeth............................................................. X 0271............................... Mammography..................................................................... S 0341............................... Skin Tests and Miscellaneous Red Blood Cell Tests............................... X 0342............................... Level I Pathology............................................................... X 0343............................... Level II Pathology.............................................................. X 0344............................... Level III Pathology............................................................. X 0345............................... Level I Transfusion Laboratory Procedures....................................... X 0364............................... Level I Audiometry.............................................................. X 0367............................... Level I Pulmonary Test.......................................................... X 0669............................... Digital Mammography............................................................. S 0690............................... Electronic Analysis of Pacemakers and other Cardiac Devices..................... S 0706............................... New Technology--Level I ($0-$50)................................................ S

In addition, we assessed the dates of service for HCPCS codes and packaged revenue centers on each claim that contained more than one major code. Where it was possible to attribute charges for packaged HCPCS and packaged revenue centers to HCPCS codes for major procedures by matching unique dates of service, we did this and created single claims by packaging charges into the charge for the major service on the same date. We were only able to do this if the multiple major procedures had different dates of service and if there were dates of service on all of the packaged revenue centers. Dates of service on revenue centers are not required and, therefore, only claims from hospitals that submitted dates of service on revenue centers in CY 2002 could be used in this process for maximizing the number of single- procedure claims to be used for weight setting.

[sbull] To calculate median costs for services within an APC, we used only single-procedure bills and those multiple-procedure bills that we converted into single claims. If a claim had a single code with a zero charge (that would have been considered a single-procedure claim), we did not use it. As we discussed in section III.A.2 of this final rule, we did not use multiple-procedure claims that billed more than one separately payable HCPCS code with charges for packaged items and services such as anesthesia, recovery room, or supplies that could not be reliably allocated or apportioned among the primary HCPCS codes on the claim. We have not yet developed what we regard as an acceptable method of using multiple procedure bills to recalibrate APC weights that minimizes the risk of improperly assigning charges to the wrong procedure or visit.

For APCs in Table 7, we required that there be a C code on the claim for the claim to be used. These APCs require the use of a device in the provision of the service. Moreover, in 2002, hospitals were required to bill the C code in order for the device to receive pass- through

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payment for the device. Therefore, if no C code was billed on the claim, we presumed that the claim was incorrectly coded, and we did not use it. For some of these APCs, we further required that specific devices be on the claim.

Table 7.--APCS for Which a HCPCS for a Device Was Required To Be on a Claim Used for Weight Setting

APC

APC Description

Status

0032................................. Insertion of Central Venous/Arterial Catheter....... T 0039................................. Implant Neurostim, One Array........................ S 0048................................. Arthroplasty with Prosthesis........................ T 0080................................. Diagnostic Cardiac Catheterization.................. T 0081................................. Non-Coronary Angioplasty or Atherectomy............. T 0082................................. Coronary Atherectomy................................ T 0083................................. Coronary Angioplasty and Percutaneous Valvuloplasty. T 0085................................. Level II Electrophysiologic Evaluation.............. T 0086................................. Ablate Heart Dysrhythm Focus........................ T 0087................................. Cardiac Electrophysiologic Recording/Mapping........ T 0089................................. Insertion/Replacement of Permanent Pacemaker and T Electrodes. 0090................................. Insertion/Replacement of Pacemaker Pulse Generator.. T 0104................................. Transcatheter Placement of Intracoronary Stents..... T 0106................................. Insertion/Replacement/Repair of Pacemaker and/or T Electrodes. 0107................................. Insertion of Cardioverter-Defibrillator............. T 0108................................. Insertion/Replacement/Repair of Cardioverter-

T Defibrillator Leads. 0115................................. Cannula/Access Device Procedures.................... T 0119................................. Implantation of Devices............................. T 0122................................. Level II Tube Changes and Repositioning............. T 0167................................. Level III Urethral Procedures....................... T 0202................................. Level VIII Female Reproductive Proc................. T 0222................................. Implantation of Neurological Device................. T 0225................................. Implantation of Neurostimulator Electrodes.......... S 0226................................. Implantation of Drug Infusion Reservoir............. T 0227................................. Implantation of Drug Infusion Device................ T 0229................................. Transcatheter Placement of Intravascular Shunts..... T 0259................................. Level VI ENT Procedures............................. T 0313................................. Brachytherapy....................................... S 0384................................. GI Procedures with Stents........................... T 0385................................. Level I Prosthetic Urological Procedures............ T 0386................................. Level II Prosthetic Urological Procedures........... T 0648................................. Breast Reconstruction with Prosthesis............... T 0652................................. Insertion of Intraperitoneal Catheters.............. T 0653................................. Vascular Reconstruction/Fistula Repair with Device.. T 0654................................. Insertion/Replacement of a Permanent Dual Chamber T Pacemaker. 0655................................. Insertion/Replacement/Conversion of a Permanent Dual T Chamber Pacemaker. 0670................................. Intravenous and Intracardiac Ultrasound............. S 0674................................. Prostate Cryoablation............................... T 0680................................. Insertion of Patient Activated Event Recorders...... S 0681................................. Knee Arthroplasty................................... T

[sbull] For each single-procedure claim, we calculated a cost for every billed line item charge by multiplying each revenue center charge by the appropriate hospital-specific CCR. We used the most recent settled or submitted cost reports. Using the most recent ``submitted to settled ratio,'' we adjusted CCRs for the submitted cost reports but not the settled ones. If an appropriate cost center did not exist for a given hospital, we crosswalked the revenue center to a secondary cost center when possible, or used the hospital's overall CCR for outpatient department services. We excluded from this calculation all charges associated with HCPCS codes previously defined as not paid under the OPPS (for example, laboratory, ambulance, and therapy services). We included all charges associated with HCPCS codes that are designated as packaged services (that is, HCPCS codes with the status indicator of ``N'').

[sbull] To calculate per-service costs, we used the charges shown in revenue centers that contained items integral to performing services. Table 8 contains a list of the revenue centers that we packaged into major HCPCS codes when they appeared on the same claim. This is a change to the packaging of revenue centers by category of service that had been done since the inception of the OPPS in the April 7, 2000 final rule (65 FR 18457). In all prior years of the OPPS, we had specific subsets of revenue centers that we packaged into major HCPCS codes based on the type of service we assigned to the HCPCS code for this purpose. For example, we had a set of revenue centers that could be packaged into visit codes and a different, but overlapping, set of revenue centers that could be packaged into surgery codes. For 2004 OPPS, we converted these categories to a single set of revenue codes (see Table 8) that would be packaged into the major HCPCS code with which it appears on a claim. We believe that this will increase the likelihood that the total charge for the major HCPCS code will capture all of the costs attributed to the services furnished. Table 8 lists packaged services by revenue center that we are proposing to use to calculate per-service costs for outpatient services furnished in CY 2004.

TABLE 8.--Packaged Services by Revenue Code

Revenue code

Description

250....................................... Pharmacy. 251....................................... Generic. 252....................................... Nongeneric.

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254....................................... Pharmacy Incident to Other Diagnostic. 255....................................... Pharmacy Incident to Radiology. 257....................................... Nonprescription Drugs. 258....................................... IV Solutions. 259....................................... Other Pharmacy. 260....................................... IV Therapy, General Class. 262....................................... IV Therapy/Pharmacy Services. 263....................................... Supply/Delivery. 264....................................... IV Therapy/Supplies. 269....................................... Other IV Therapy. 270....................................... M&S Supplies. 271....................................... Nonsterile Supplies. 272....................................... Sterile Supplies. 274....................................... Prosthetic/Orthotic Devices. 275....................................... Pacemaker Drug. 276....................................... Intraocular Lens Source Drug. 278....................................... Other Implants. 279....................................... Other M&S Supplies. 280....................................... Oncology. 289....................................... Other Oncology. 290....................................... Durable Medical Equipment. 370....................................... Anesthesia. 371....................................... Anesthesia Incident to Radiology. 372....................................... Anesthesia Incident to Other Diagnostic. 379....................................... Other Anesthesia. 390....................................... Blood Storage and Processing. 399....................................... Other Blood Storage and Processing. 560....................................... Medical Social Services. 569....................................... Other Medical Social Services. 621....................................... Supplies Incident to Radiology. 622....................................... Supplies Incident to Other Diagnostic. 624....................................... Investigational Device (IDE). 630....................................... Drugs Requiring Specific Identification, General Class. 631....................................... Single Source. 632....................................... Multiple. 633....................................... Restrictive Prescription. 637....................................... Self-Administered Drug (Insulin Admin. in Emergency Diabetic. COMA) . 700....................................... Cast Room. 709....................................... Other Cast Room. 710....................................... Recovery Room. 719....................................... Other Recovery Room. 720....................................... Labor Room. 721....................................... Labor. 762....................................... Observation Room. 810....................................... Organ Acquisition. 819....................................... Other Organ Acquisition. 942....................................... Education/Training.

[sbull] We standardized costs for geographic wage variation by dividing the labor-related portion of the operating and capital costs for each billed item by the proposed FY 2004 hospital inpatient prospective payment system (IPPS) wage index published in the Federal Register on May 9, 2002 (67 FR 31602). We used 60 percent to represent our estimate of that portion of costs attributable, on average, to labor. We have used this estimate since the inception of the OPPS and continue to believe that it is appropriate. (See the April 7, 2000 final rule (65 FR 18496) for a complete description of how we derived this percentage).

[sbull] We summed the standardized labor-related cost and the nonlabor-related cost component for each billed item to derive the total standardized cost for each procedure or medical visit.

[sbull] We removed extremely unusual costs that appeared to be errors in the data using a trimming methodology analogous to what we use in calculating the diagnosis-related group (DRG) weights for the hospital IPPS. That is, we eliminated any bills with costs outside of three standard deviations from the geometric mean.

[sbull] After trimming the procedure and visit level costs, we mapped each procedure or visit cost to its assigned APC, including, to the extent possible, the proposed APC changes.

[sbull] We calculated the median cost for each APC.

To develop the median cost for observation (APC 339, HCPCS code G0244), we selected claims containing HCPCS code G0244 (Observation care provided by a facility to a patient with CHF, chest pain, or asthma, minimum eight hours, maximum forty-eight hours) that also showed one or more of the ICD-9 (International Classification of Diseases, Ninth Edition) diagnosis codes required for payment of APC 339. We ignored other separately payable codes so that the claims with G0244 would not be excluded for having multiple major procedures on a single claim. We packaged the costs of allowable revenue centers and HCPCS codes with status indicator ``N'' into the cost of G0244, and trimmed as was done for the calculation of the median costs for other APCs.

[sbull] Using the median APC costs, we calculated the relative payment weights for each APC. As in prior years, we scaled all the relative payment weights to APC 0601, Mid-level clinic visit, because it is one of the most frequently performed services in the hospital outpatient setting. We assigned APC 0601 a relative payment weight of 1.00 and divided the median cost for each APC by the median cost for APC 0601 to derive the relative payment weight for each APC. Using 2002 data, the median cost for APC 0601 is $58.78.

Section 1833(t)(9)(B) of the Act requires that APC revisions, relative payment weight revisions, and wage index and other adjustments be made in a manner that ensures that estimated aggregate payments under the OPPS for 2004 are neither greater than nor less than the estimated aggregate payments that would have been made without the changes. To comply with this requirement concerning the APC changes, we compared aggregate payments using the CY 2003 relative weights to aggregate payments using the CY 2004 proposed weights. Based on this comparison, we made an adjustment of 0.981635942 to the weights. The weights that we developed for 2004 OPPS, which incorporate the recalibration adjustments explained in this section, are listed in Addendum A and Addendum B.

Impact of Allocation of Equipment and Capital Costs

Comment: Several commenters indicated that the weight setting methodology may have a disproportionately adverse effect on procedures performed in departments with higher medical equipment and capital costs such as radiology and nuclear medicine. The commenters indicated that the capital costs incurred by these departments are generally spread among all hospital departments on a square foot or other basis, rather than being specifically allocated to the departments that incur the costs involved. This would distort the cost to charge ratios for these departments, resulting in under-weighting of the APCs for the services they furnish. Commenters indicated that we recognized this in the preamble to the 2000 OPPS rule (65 FR 18485, April 7, 2002) but indicated that it did not have the data necessary to make the appropriate adjustment due to hospital reporting processes. The commenter indicated that it would be appropriate for us to re-evaluate mechanisms that could be used to ameliorate the distortion.

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Response: We recognize that the allocation of capital and equipment costs to revenue centers that do not use the equipment could distort cost to charge ratios for the revenue centers that use the equipment (and presumably whose charges reflect those costs). It is not clear how cost to charge ratios could be adjusted for such allocations. However, for the 2005 OPPS, we hope to explore the effect and impact of basing relative weights on relative hospital charges, rather than costs. If weights are based on relative charges, then presumably, the charges for services with high cost equipment and capital expenses would reflect those costs relative to other services without such costs.

Dates of Service on Revenue Code Lines

Comment: Commenters supported requiring dates of service on lines with revenue code charges but asked that the requirement not be enforced until June 2004 to enable hospitals to have sufficient time to adjust their systems to provide this information.

Response: Subsequent to the proposed rule, we learned that the X 12N 837 standard transaction with which covered entities had to be in compliance on October 16, 2003, requires a date of service on each line item containing a charge.

Single Revenue Code List for Packaging

Comment: One commenter supported the use of a single revenue code list for packaging costs into separately paid HCPCS codes. The commenter indicated that this change would result in more accurately attributing costs to services. Another commenter objected to our proposed changes for packaging revenue centers. This commenter is concerned that the use of a single set of revenue codes for packaging into the major procedure on a claim may inappropriately allocate charges not associated with the major service on the claim. For example, the commenter stated that revenue code 254 and revenue code 255 should continue to map to a radiological APC, and charges in these revenue centers should not be assigned to a major non-radiological procedure.

Response: We proposed to combine the multiple lists of revenue codes into one because there was significant overlap in them and our physicians believed that the risk of not picking up appropriate charges was greater than the risk of picking up charges that were not appropriate. In the case cited by the commenter, we are depending on hospital billing and our reliance on single procedure claims to preclude us from packaging a charge for a radiological service into a HCPCS code for a non-radiological service. We have never had a complaint that we have packaged more costs than were appropriate into a HCPCS code, although we frequently are told that we neglected to pick up all related charges. For the final rule, we retained the single set of revenue codes for packaging into separately payable major HCPCS codes.

Need for Stability in Relative Weights

Comment: Commenters stated that significant changes in weights for services from year to year are difficult for hospitals because not all hospitals provide all services and if the APC rates fall for the particular service mix the hospital furnishes, this can mean significant shifts in total payment for outpatient services from Medicare from year to year. Commenters indicated that we should adjust medians derived from claims data to limit the amount of change that occurs from year to year. Commenters indicated that hospitals are limiting availability of services based on declining Medicare OPPS revenues and that once a service is curtailed or eliminated, it is not likely to be reintroduced again because the hospital will cease monitoring the costs of the device and equipment needed to offer the service once it is no longer provided in the hospital and, therefore, even if it would be cost effective to reintroduce the service, it is not likely to occur. Commenters indicated that the pattern of revenue changes is a factor in hospital decisions regarding whether to acquire state-of-the-art equipment. Therefore, reductions in payments for equipment-intense services discourage hospitals from acquiring the equipment necessary to provide state-of-the-art services to Medicare beneficiaries. Commenters also indicated that the cumulative effects of the reductions from 2002 payment rates, particularly for procedures to implant medical devices, have resulted in significant payment cuts for many of these procedures and will discourage acquisition of the items necessary to provide the highest quality care.

A commenter stated that we should stabilize the APC rate when a device comes off of pass-through status. Several commenters stated that the proposed rates reverse the progress that was made in 2002 by using the manufacturer prices in the setting of medians for 2002. Commenters indicated that we should adjust the medians from claims data to ensure that no APC's median falls more than 5 percent compared to the medians used for payment in 2003. A commenter suggested that we adjust the medians whenever there is more than a 20 percent reduction from one year to the next. Another commenter indicated that all APCs that decline more than 10 percent compared to 2003 adjusted medians should be adjusted in the same way that we proposed to adjust medians for drugs, biologicals and radiopharmaceuticals and that these adjustments also should apply to brachytherapy sources.

Another commenter asked that we let no median cost used in weight setting fall more than half the difference between the loss and 15 percent because this methodology offers a buffer for hospitals to minimize annual changes. Another commenter indicated that we should freeze the 2003 payment rates, particularly for brachytherapy services and should educate providers to show all of the charges for all of the ancillary services on the claim so that they will be included in the development of relative weights for future years.

Response: We are sympathetic with the concerns of hospitals that the OPPS should be sufficiently stable that hospitals would have the capacity to plan and budget for future years. We recognize that the early years of a payment system may result in shifts in payment across services. However, a prospective payment system is a system of averaging in which the payment to the hospital becomes an overall amount that the hospital has at its disposal to use in the way it finds to be most efficient and effective. The payments for individual services are the means by which the amount of money to be spent on OPPS is distributed among hospitals but the hospitals have the right to use that payment as they choose across all services they choose to furnish. The OPPS is a system that attempts to calibrate payments for a service or procedure to best approximate the costs that an efficient provider would incur in providing the service or procedure in order to give providers incentives for efficient procurement and service delivery.

As we indicated in the proposed rule, for 2004, some of the same services had significant declines in median costs compared to the 2003 adjusted median but not compared to the 2003 median before adjustment. We did not propose to adjust the 2004 medians for procedural APCs compared to the 2003 adjusted median. Instead, we indicated that we would consider using external data that could be made publicly available if we were convinced that the medians for 2004 would result in payment rates that were grossly aberrant in the context of the service.

[[Page 63423]]

After reviewing the comments, and our final claims data for 2004, we decided that we would not adjust the medians for procedural APCs but that we would adjust medians for certain APCs for which we were given external data that could be made public because we were convinced that the medians from our claims data resulted in median costs that were grossly variant. We adjusted the medians for the following APCs using external data: APC 0107 (insertion of cardioverter-defibrilator), APC 0108 (Insertion/replacement/repair of cardioverter defibrillator leads and insertion of pulse generator), APC 0222 (implantation of neurostimulator), APC 0039 (which was broken out of APC 0222) and APC 0674 (prostate cryoablation). For each of these APCs we calculated an adjusted device portion of the median by taking one part of the device cost from our data and one part of the device cost supplied by external data. We added the adjusted device median to the nondevice median from our data to acquire the adjusted median. In the case of APC 0108, we used the external device cost data that was used to set the median for the 2003 OPPS because we received no outside data for the 2004 OPPS for this APC and because the proposed median of $28,685.30 set forth in the proposed rule was considerably higher than the final rule data median of $23,944.80, which resulted when additional claims were used to calculate the median cost. In other cases, we found that corrections in the APC assignment or splitting an APC into two APCs resulted in more accurate median costs.

For 2004, we will adjust median costs for drugs, biologicals and radiopharmaceuticals as proposed for reasons discussed in section VI.B.3. We will freeze payments for blood and blood products at the 2003 rates for reasons discussed in section VI.B.8. We will pay single indication orphan drugs at 88 percent AWP for reasons discussed in section VI.B.6.

Comparison of Procedural APC Medians for the 2004 OPPS to Adjusted Medians for 2003 OPPS

Using the data available to us at the time we developed the proposed rule, we identified APCs that showed decreases in median cost of more than 10 percent compared to the adjusted medians on which their payments were based for 2003. We discussed specific APC medians to the extent that we understood the reason for the decreases or were particularly puzzled by the change. We requested comments on the medians and provided a set of criteria for external data that could be used to supplement the median costs derived from our claims data. The criteria we provided regarding the use of external data included a stipulation that the data must not be confidential because any data we use must be available to the public. We also provided a list of preferred (but not required) criteria that addressed our preferences for characteristics of the data. We indicated that to be of optimal use, the external data should represent a divergent group of hospitals by location and type, identify the number of devices billed to Medicare as well as rebates or reductions for bulk purchases, identify the HCPCS codes with which the devices would be used, identify the source of the data and include both charges and costs for each hospital by quarter for the last 3 quarters of 2002 (68 FR 47987). We did not propose to adjust the medians for procedural APCs in the manner that they were adjusted for the 2003 OPPS. For 2004 we did not apply a systematic adjustment to all medians that declined more than a specified percentage in comparison with the medians for 2003. Instead, as discussed previously, we adjusted the medians of 5 APCs based on external data where we thought it was necessary and we have split some APCs where we thought doing so would result in more accurate relative weights.

Use of External Data

Comment: Some commenters opposed the use of external data on the basis that they believe that they will result in unfair imbalances in payment. They recognized that the application of cost-to-charge ratios will not result in amounts that are equal to full acquisition costs but they believe that as long as the same standard methodology is used across all services, the relative payments will be correct. They indicated that in a system of averaging, it is not necessary or even expected that each item and service will be paid at acquisition cost. They encouraged us to remain faithful to the averaging process inherent in a prospective payment system and not to rely on external data. Some commenters opposed use of external data and supported the requirement that they be publicly disclosable. Other commenters stated that we should use our claims data to set weights because they accurately reflect the relative hospital costs of providing outpatient services. However, these commenters were concerned with how different rates for some services in the 2004 proposed rule are from the rates for the same services in 2003.

Some commenters said that we should use external data that are proprietary and maintain the confidentiality of such data. Several commenters indicated that the prices for medical devices are often covered by agreements that preclude the parties from disclosing the price of the device and that we should use the data to set prices, notwithstanding that they cannot be made available for inspection by the parties whose payments may be reduced by their use. Several commenters stated that we used external data that were proprietary for setting of 2002 weights, and for some 2003 weights and that we should do so again because data from manufacturer price lists and invoices more accurately reflect the costs attained by applying the cost-to- charge ratios for hospital departments to the charges for the devices to get costs to package into the APC medians. These commenters stated that external data should be used more widely than data based on the criteria that were used for the 2003 OPPS for the use of external data (that is, that the device-cost portion of the APC exceeded 80 percent of the total APC cost for external data to be used). These commenters stated that external data should be used for all APCs that show significant reductions since the 2002 OPPS. In particular, they cited the APC Panel recommendation that outside data be used to set the median cost for APC 107.

Some commenters had specific comments on the criteria we provided for use of external data. One commenter stated that its members did not have and could not easily acquire the data that would ensure that the data represent a diverse group of hospitals by location and type nor could they identify specific hospitals that used their devices. The commenter also stated that its members could not provide the information on discounts and rebates against their price lists that we requested. The commenter indicated that its members did not want to provide the HCPCS codes in which their products were used but instead, wanted us to require the typical applications that they feel are most appropriate. The commenters agreed that they could provide the source of the data. The commenters stated that its members could not provide data that corresponded with the same period of time being used to set the relative weights for all APCs.

Response: In the proposed rule, we indicated that external data should cover services furnished during the last 3 quarters of 2002 (68 FR 47987). We appreciate that manufacturers and wholesalers would not want to disclose negotiated prices for 2003 or 2004 for competitive reasons. However, we fail to

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understand how they could be harmed by publicly disclosing prices that were applicable in 2002 but have now been obsolete for a year. Moreover, since upward adjustment of any median cost results in reduction of payments for all other items and services, we believe that, in a governmental payment program, the parties whose payments are reduced by the use of external data should be able to examine all elements of the payment system.

We do not believe that widespread use of external data to set median costs for selected APCs is appropriate in a system that relies on relativity to establish payment amounts. We are sympathetic with the concerns of some commenters that widespread use of external data will result in payment inequities rather than appropriate payments to hospitals based on the relative weights of the services they furnish. However, we are also concerned about circumstances in which we are convinced that the payment amounts that would result from the medians from our data will discourage hospitals to provide access to needed care. Therefore, in the case of several APCs as discussed elsewhere, we used external data to adjust the medians. In general, however, we continue to have confidence in the integrity of our claims data with respect to the procedural APCs. For the future, we prefer to seek ways to refine the methodologies that we apply to our own data, such as the use of a greater percentage of claims to set the weights for certain APCs.

Comment: Several commenters stated that we should work with them to set the methodology for the 2005 medians in view of the absence of device codes in the 2003 data and should pursue a study of the acquisition costs of devices in particular, so that there will be valid device related data for setting the 2005 OPPS.

Response: We are always interested in hearing the proposals of outside parties with regard to our methodology for setting OPPS weights. We recognize the concern that the absence of device codes for 2003 claims may lead to median costs that fail to fully incorporate the costs of the devices used in the applicable APCs and we are interested in all ideas for preventing this problem. Our proposed methodology will be presented in the proposed rule for the 2005 OPPS and will be open to public comment.

General Comments About Payment

Comment: A commenter asked that we base the relative weights on the geometric mean that we use for trimming the data. The commenter indicated that the use of the geometric mean is the industry standard for both trimming aberrant data, as we use it, and also for calculating relative weights when costs are not distributed symmetrically. The commenter stated that the use of the geometric mean is particularly useful in circumstances that mirror those of OPPS: the first years of a new system and with low-volume high-cost services. The commenter noted that we agreed to move forward with analyses to look at the use of a mean versus median cost for weight setting in the November 1, 2002 final rule published in the Federal Register, but believes that not much analysis is needed since the use of the geometric mean is an industry standard for setting relative weights.

Response: We appreciate the thoughtful comments on this issue and other suggestions on how we might improve our rate setting methodology. We will continue to explore these options in 2004. Our efforts in 2003 were limited to creating unscaled weights from the means used for the 2003 OPPS and comparing them to the unscaled weights for medians for 2003 OPPS. Our preliminary comparison revealed that there would be many swings in payments. Hence, for the 2004 OPPS, we continued our use of the median cost.

In preparation for 2005 OPPS, we hope to calculate OPPS amounts using the mean costs, and also mean and median charges (to circumvent the effects of cost-to-charge ratios), and the 2004 OPPS conversion factor. This should give us a more complete view of the impact of revising our methodology in this way.

Charge Compression and Cost Finding

Comment: A commenter indicated that the use of cost to charge ratios is consistent with the concept of averaging that underpins a prospective payment system and that the system should not seek to micro-cost individual items or services but rather should rely upon the hospital charging patterns irrespective of Medicare policy to base relativity. The commenter indicated that while some items have different markups than others, the use of a standardized methodology to establish relative weights for all services should result in appropriate relative payments. The commenter strongly objected to any additional burdens that would be imposed in order to fine tune the pass-through payment system or weights at the expense of all other APC payments. The commenter specifically objected to CMS overriding the claims data to alter the ratio for new technology devices because the commenter believes that such adjustments will make the OPPS unduly administratively complex and create unfair imbalances in payment.

Other commenters opposed the use of cost-to-charge ratios applied to charges to acquire cost data. They indicated that in many cases, we had to use overall hospital cost-to-charge ratios that had no relevance to the costs of the services being determined and therefore resulted in invalid representations of median costs. They also indicated that both the departmental and the hospital specific cost-to-charge ratios were derived in part from costs that are commingled between inpatient and outpatient services and therefore are not necessarily representative of a ratio that could be applied to outpatient services alone, as we do. Some commenters indicated that we ignore studies that demonstrate that charges are compressed, with low-cost services being marked up more than high-cost services, thus resulting in systematic underpayment of high-cost items and diminishing beneficiary access to high-cost services. A commenter suggested that, for drugs, biologicals and radiopharmaceuticals, we set a minimum payment based on the Federal Supply Schedule price plus a percentage markup to ensure that payment for drugs, biologicals, and radiopharmaceuticals was sufficient to make them available to Medicare beneficiaries who need them.

Several commenters indicated that the application of hospital specific cost-to-charge ratios at the department level where available, otherwise at the hospital level will always result in incorrect costs because hospitals do not have a consistent markup for all items and services within a department. They indicated that hospitals markup low- cost items more than high-cost items and that therefore, the application of a cost-to-charge ratio, even at the department level, will never result in the hospital acquisition cost for an item. They indicated that there is no easy adjustment to correct for charge compression and they urge us to explore using external data, developing surveys or doing studies to acquire hospital cost data that can be used in place of the median costs acquired from claims data.

Response: We recognize that the application of cost-to-charge ratios to charges for individual items as needed to develop median costs for APCs is imperfect. However, the only means at our disposal for determining costs from the charges on the claims was to calculate a cost-to-charge ratio using the cost report data that we believe is

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applicable to the OPD (for example, excluding room and board). We acknowledge that this system for determining relative values is imperfect, but we believe that it continues to be preferable to total reliance for particular items on external data which could inappropriately inflate Medicare payments for those items to the detriment of general hospital services. As indicated above, we hope to explore use of mean costs, and mean and median charges in preparation for the 2005 OPPS to determine if such a change would result in better relative weights and less instability in OPPS payments for particular services from year to year. However for 2004, we based relative weights on median costs derived through the application of a cost-to-charge ratio to the charges for the services.

General Concerns About Decreases

Comment: We received many comments objecting to proposed decreases in the proposed payment rates for specific services. These commenters indicated that the service has become more expensive rather than less expensive over the year, or indicated that the payment for the service declined for 2003 and should not decline for 2004. In some cases, the comments indicated that the payment should remain at the 2003 rate so that hospitals will not consider discontinuing the service.

Response: The OPPS is a relative payment system based upon the relative median costs of services. We calculate the costs of services by applying a cost to charge ratio to the charges for the services and then packaging the costs together for major HCPCS codes. We then calculate the median of the array of costs across all claims for HCPCS codes in an APC. There are many factors that can affect whether the cost of services rises or falls from one year to the next. In general, for the 2004 OPPS, about half the APC median costs increased and about half decreased compared to the 2003 median costs. In most cases, the changes were modest and such changes from year to year are to be expected as hospitals find ways to reduce costs for some services and incur higher costs for others. Because we do not expect the mix of services furnished in hospitals to vary hugely from year to year across the universe of hospitals, we do not expect that the changes in relative costs to create enormous impacts either.

Disparity in Payments for Overhead Costs for the Same Service

Comment: A commenter indicated that OPPS provides disparate payment for the overhead costs associated with services that are furnished both in physician offices and in hospital outpatient departments. As an example, the commenter indicated that CMS attributes $25.36 in physician practice expense to CPT code 99213 (office or outpatient mid level evaluation and management service for an established patient) but pays a hospital $54.46 (the amount set forth in the proposed rule) for the overhead for the same service and indicated that for other services the OPPS payment is as much as 4 times the amount paid to physicians for practice expense for the same service. The commenter asked that CMS establish payment equity for the same service furnished in these respective settings.

Response: The method for calculating payment for physicians' practice expenses under the Medicare physician fee schedule is established by law, as is the method we use for the outpatient setting. The application of the different methodologies results in different payment amounts in the two settings.

Comments and responses on payment amounts for specific APCs are included in section II.B.

Source of Data for Weight Setting

Comment: One commenter stated that we should conduct a study to establish a source for cost data other than claims data on which to base APC weights. Another commenter strongly objected to use of survey data because the commenter did not believe that it could ever fully capture all hospital costs for services and that therefore, the survey data would be used only for items and would have to be integrated with claims data for services. The commenter did not believe that the two could be integrated in a way that would properly reflect the relative costs.

Response: We believe that relative weights should generally be based on claims data because, notwithstanding the weaknesses, claims data are the most complete and accurate source of information about all services furnished by all providers paid under OPPS. We believe that it would be unreasonably expensive to acquire survey data that would be representative of the entire population of Medicare hospitals and all OPPS services furnished in them. We do not support the idea of using only selected hospitals and/or selected services because we think data from a limited survey would not be representative of the whole population of Medicare hospitals and services and would not be accurate to reflect relative costs of all services.

Incomplete Hospital Bills

Comment: Commenters indicated that when OPPS was implemented, hospitals no longer had a payment incentive to ensure that all charges were shown on the claim because there was no longer a direct relationship between the amount of charges on the claim and the interim payment they would receive for services. Therefore they ceased to complete the claim as fully as when the charges were directly related to the Medicare interim payment. Several commenters indicated that in some cases, hospitals went as far as to remove items from the chargemaster so that a charge was no longer created when an item or service was used, particularly if the item or service were from a department other than the department billing the CPT code. A commenter said that in many cases, hospitals ceased to bill all charges for services if the completion of the claim with all charges would delay the submission of the claim to Medicare and therefore delay the Medicare payment to the hospital. Commenters indicated that hospitals did this particularly for services like brachytherapy in which the services were furnished from multiple departments of the hospital and the claim could be delayed significantly to accumulate all charges. Commenters indicated that the absence of all charges for services could result in poor data and instability in median costs from year to year, particularly when we use only single procedure claims.

Response: We encourage hospitals to report all charges for all services on claims for Medicare payment so that the data on which relative weights are set will fully reflect the relative costs of all services. However, where all charges are not included on the claim but the costs exist in the cost centers, the cost-to-charge ratios would increase and, to some extent, offset the effect of the absence of charges. Hence, while we would prefer that hospitals bill all charges for the services they furnish, where they do not do so, it does not necessarily mean that the costs derived from applying the hospital's cost-to-charge ratio to charges would result in improper relative weights for the services.

C. Discussion of Relative Weights for Specific Procedural APCs

New APC for Antepartum Care

We proposed rule to split APC 0199, Obstetrical Care Service, into two APCs.

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For this final rule, new APC 0700, Antepartum Care Service, was created and 59412 (external cephalic version) was assigned to it. The two remaining HCPCS code 59409 (vaginal delivery only) and 59612 (vaginal delivery only, after previous cesarean delivery) will remain in APC 0199, Obstetrical Care Service. We received no comments about this APC and will finalize our proposal.

Implantation of Neurostimulators and Implantation of Neurostimulator Leads (APCs 0222 and 225)

Comment: Commenters encouraged us to use a ``dampening'' approach to increase the median costs for these APCs and to use external data to set the payment weights for APCs 0222 and 0225. Commenters indicated that the proposed payment amounts do not cover the cost of the device, much less the hospital services to furnish it. Commenters indicated that our policy of calculating median weights based on single claims or pseudo single claims disadvantages these services by resulting in the use of only the simplest and lowest cost services. A commenter indicated that these services have had relative weights that were too low since the inception of OPPS and that the cumulative effect of multiple years of payment reductions will cause hospitals to cease to provide these services to Medicare beneficiaries. A commenter suggested that we split these APCs to reflect the different resources used in implanting one device versus another device in the same APC. A commenter also asked that we establish a separate APC for the NeuroCybernetic Prosthesis System.

Response: We also are concerned that the median costs for these APCs appear to be so low relative to other OPPS median costs. Both of these APCs are ones for which we require that selected C codes be on the claims that are used in calculation of the median to increase the likelihood that we are using correctly coded claims for these services. We recognize that the need to use single procedure claims and the need to further select claims that appear to be correctly coded reduce the number of claims used in median calculation. However, if we did not require that selected C codes were on the claims used, the median costs would be even lower than those calculated. Hence, using more single procedure claims would, in this case, result in even lower median costs.

For 2004, we have made changes to both of these APCs. In the case of APC 0222, we removed HCPCS code 61885 from APC 0222 and we placed it in its own APC 0039 because the APC Panel recommended that its status indicator be changed from a ``T'' to an ``S'' in order to not apply the multiple procedure reduction when two devices are implanted, as is often the case. Moreover, for both APC 0222 and APC 0039, we accepted external data for the device cost and used one part external data and one part claims data for the device portion of the APC's median cost to which we added the nondevice portion of the median cost. This increased the median cost for APC 0222 from a final data median of $11,050.90 to an adjusted median cost of $13,383.79. This increased the median cost for APC 0039 from a final data median cost of $10,741.66 to an adjusted median cost of $13,555.80. We believe that this more accurately reflects the relative cost of these services to other OPPS services.

In the case of APC 0225, we split the APC into two APCs, (APC 0225) and (APC 0040). APC 0225 contains CPT codes 63655, 64553, 64573, 64580 and 64577 and for this final rule, has a median cost of $11,873.72. APC 0040 contains CPT codes 64560, 64555, 63650, 64561, 64575, 64581, and 64565 and, for this final rule, has a median cost of $3,002.98. Both APCs have a status indicator ``S'' (to which multiple procedure discounts do not apply).

We believe that these changes will result in more appropriate relative weights for these services in relation to other OPPS services. Brachytherapy Issues

High Dose Rate Brachytherapy (APC 0313)

Comment: Commenters objected to the proposed payment amounts for this APC and indicated that the costs of the procedure could not be fully included in it. Commenters indicated that they did not believe that hospitals were billing for both the needles and the catheters. These commenters recommended that we use only claims that contain the primary procedure code, the HDR Iridium source code, and codes for catheters and needles. A commenter indicated that the direct costs for the practice expense in physician offices for the codes in this APC average $1,130.16 and that it is inconceivable to the commenter that hospital costs could be any less. The commenter believes that the faulty data are attributable to hospital billing errors and urged us to educate hospitals regarding how to bill the service properly. A commenter asked us to issue a program instruction requiring hospitals to report both the cost of the HDR source and the needles or catheters needed to administer the treatment by date of service to facilitate setting of a correct median cost. The commenter is concerned that the actual cost of brachytherapy needles and catheters has not been captured and is not incorporated into any of the related APCs. Commenters also indicated that the discussion of the APC in the August 12, 2003 proposed rule was confusing and did not fit the services furnished in this APC.

Response: Upon receipt of comments and after listening to the concerns of outside groups during the comment period, we explored the circumstances surrounding the development of the median cost for the APC that resulted in the weights and payments in the August 12, 2003 proposed rule. We found that, while the APC was on the list of APCs for which claims were required to contain C codes and although the criteria required that there be both a brachytherapy source (C1717) and either needles (C1715) or catheters (C1728), no claims that met all of those criteria were found among the single procedure claims for that APC. Therefore, the system defaulted to using all single procedure claims, for which there were no sources or needles/catheters on the claim. Hence, APC 0313 was erroneously included in Table 7 as an APC for which C codes were required. Moreover, our discussion of the median for the APC was in error to say that there had been sources packaged into the payment for 2002 and that this accounted for the reduction in proposed payment for 2003.

For the final rule, we acquired more single procedure claims but again, none of the single procedure claims contained both sources and needles or catheters. We then revised our criteria to require only that the claims must contain sources (C1717). This gave us 27 single procedure claims that we used to acquire a median cost of $936.52, a significant increase over the median for all claims of $795.83.

In the course of discussions regarding this APC, some parties suggested that we ignore other procedure codes, such as dosimetry codes, that are typically found on claims for these services because the commenters believe that no charges billed under packaged revenue codes or packaged HCPCS should be allocated to those other procedures. We plan to explore the expansion of the codes we ignore for selection of single procedure claims for the 2005 OPPS. However, we did not believe we had sufficient information or data to make such a change for the final rule for 2004. We again note that it is important for

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hospitals to include charges for all services they furnish on the claim so that we can better ensure that the relative weights are based on the most accurate data possible.

Low Dose Rate Brachytherapy (APCs 312 and 651)

Comment: We received several comments regarding payment for low dose, non-prostate brachytherapy (APCs 312 and 651). Commenters cited the proposed reduction in payment for APC 0312 and expressed concern that our methodology that excludes a number of multiple procedure bills results in our use of data from atypical encounters such as those in small centers with minimal technological complexity and inappropriate costs and charges. Commenters indicated that typically other services would be furnished on the same day and that the presence of these services on the claim would likely result in the claim not being used. Commenters indicated that the resources used for the services in these APCs are highly variable depending on the part of the body being treated and the nature of the equipment involved. They indicated that some hospitals ceased billing charges for all of the services furnished when OPPS was implemented because showing the charges on the claim would no longer result in more payment but showing all charges on the claim was costly, burdensome, and slowed billing. Commenters indicated that we should educate providers in the correct way to bill for the catheters, needles, and sources used for this service and that in the absence of acceptable median costs, we should adjust the medians to result in reasonable payments for the service. Commenters indicated that we should select only claims that contain device costs and ignore claims that do not contain such costs, setting the median cost on the subset of selected claims.

Response: We used the medians from our final data to set the relative weights on which the payments will be based for 2004. We were not convinced by comments that the data did not reflect a median cost that was appropriate relative to the costs of other OPPS services. We recognize that our methodology excludes a large number of claims because there were multiple procedures on the claim and as we indicated in the discussion of multiple procedure claims, we are continuing to work on ways to use more claims data. We will closely examine expanding the list of CPT and HCPCS codes that could be ignored to create pseudo single claims for use in calculating median costs to set relative weights. For future years, we will consider whether to impose criteria for correctly coded claims, such as requiring that the claims contain either any C code or specified C codes for brachytherapy sources and needles or catheters that are necessary to insert the sources. We were not able to do this for the 2004 OPPS. For the 2005 OPPS, we will use the claims data from 2003, for which there is no coding of brachytherapy needles or catheters, although there is coding of sources that can be used to select correctly coded claims.

As we previously indicated, for the 2004 OPPS, we will pay for prostate brachytherapy using the CPT codes and the HCPCS codes for brachytherapy sources used. We expect that the majority of the CPT codes billed will be 77778 (APC 0651) and 55859 (APC 0163) and that the HCPCS codes billed will be C1718 (brachytherapy source, iodine 125) or C1720 (brachy source, palladium 103). When we calculate the total median cost on which the payment to the hospital for the services involved in prostate brachytherapy will be based, we determine that paying under APC 0651 and APC 0163 with separate payment for the sources (APC 1718 or APC 1720) will result in more payment than would be the case under the packaged payment we proposed. For example, if we assume that 100 sources are implanted during a prostate brachytherapy procedure, we would expect the hospital to bill 77778, 55859, and 100 units of either C1718 or C1720. The sum of the applicable medians will be $6,486.54 if using iodine sources and $7,261.54 if using palladium sources. This is a considerable increase over the payments in 2003, which were $5,154.34 with iodine sources and $5,998.24 with palladium sources. We believe that this circumstance will be the predominant use of APC 0651 and that the total median for the service will result in appropriate relative weights on which to set the payments.

APC 0312 was billed just over 850 times for the 9 months of data used in the final rule. Of the five CPT codes in this APC, four have median costs for the CPT code of less than $400 and one code, 77776, Interstitial radiation source application, simple has a median of $2,218.18. However, that code does not meet the test of being significant, which we define as having a frequency greater than 1,000 or a frequency lower than 99 and a percentage of larger than or equal to 2 percent. Therefore, we have not moved it from the APC.

Separate Payment for All Brachytherapy Sources

Comment: Commenters indicated that we should provide separate payment for all brachytherapy sources but that the current payment structure and amounts are inadequate. Commenters indicated that we should create two new permanent separate brachytherapy source APCs for high activity iodine 125 and high activity palladium 103 sources that should be paid on a per source, per patient basis in addition to the procedure code. Commenters indicated that the proposed rates for iodine 125 and palladium 103 sources do not capture the costs of loose low dose seeds, much less the costs of high activity sources, which typically cost in excess of $150 per source.

Response: For 2004, we will pay separately for implantable brachytherapy sources based on the median costs from our claims data. We were not convinced by comments that the relative weights that will result from these median costs are inappropriate.

Prostate Brachytherapy

Comment: Commenters indicated that the creation of the new G codes (G0256 and G0261) for prostate brachytherapy imposes an unneeded burden on hospitals and that it conflict with the reporting of the service by other payers. Additionally, commenters stated that the use of the codes will preclude us from capturing the costs of the service in the future. The commenters encouraged us to eliminate the G codes and pay using the CPT codes for the procedures and the HCPCS codes for the sources on a per source, per case basis. They indicated that this would allow us to capture the true costs of the procedures to set rates in the future and that this approach is consistent with the APC Panel recommendation to us. A commenter requested that we eliminate APC 0649 (Prostate Brachytherapy Palladium Seeds) and APC 0684 (Prostate Brachytherapy Iodine Seeds) and reinstate the previous policy that allowed hospitals to bill the prostate brachytherapy procedures with two separate APCs; one for urology CPT code 55859 and one for the radiation oncology CPT code 77778. The commenter stated that this elimination would be consistent with our decision to pay for the sources on an individual basis. The commenter believed that creation of the G codes has caused unnecessary confusion for hospitals. The procedure is now described with a single G code; however, only one revenue center can be selected, causing confusion since these APCs have both a

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urology CPT code as well as a radiation oncology CPT code. The commenter requested that we eliminate these two APC groups and institute a system that would allow the two procedures to be reported in separate APC groups.

Response: We agree and have deleted the alphanumeric HCPCS codes for packaged prostate brachytherapy and will pay using CPT codes for the procedures and the HCPCS codes for the sources. We have deleted the G codes (G0256 and G0261) and APCs 0649 and 0684; and for 2004, we will pay prostate brachytherapy procedures under APCs 0163 and 0651. Brachytherapy sources used for prostate brachytherapy will be paid on a per source basis using APCs 1718 (iodine) and 1720 (palladium).

Cryoablation of the Prostate (APC 0674)

Comment: Commenters indicated that the proposed payment was too low to pay for both the hospital services and the cost of the probes used in the procedure. They indicated that 92 percent of the procedures use 6 or more probes (64 percent use 6 probes and 28 percent use more than 6 probes). They indicated that a kit of 6 probes costs $5,000 and asked that we set a payment amount no less than the minimum cost a hospital incurs to provide the service, which they stated is $6,750. Commenters indicated that charges for this new technology were not properly reported by hospitals and that therefore the data do not properly reflect the costs of the service.

Response: We recognize that with the device being paid as a pass- through for the first time effective April 1, 2001, it is likely that there are irregularities in the claims data regarding the number of units of the device that have probably led to a median cost that is not representative of the relative cost of the procedure with the device packaged. Therefore, for 2004, we used one part of the acquisition cost of 6 probes ($5,000 for 6 probes which are used in 64 percent of the procedures) and one part of the device cost from our claims data to create an adjusted device cost median to which we added the nondevice cost from our claims data to acquire an adjusted median of $6,915.08 on which we based the relative weight for the 2004 OPPS. This compares favorably to the median of $5,925.41 on which the August 12, 2003 proposed rule was based and also compares favorably to the final rule data median of $6,283.49 on which the payment weights would have been based had we not used external data to adjust the device portion of the median.

Payment for Cesium-131

A new brachytherapy source, Cesium-131, came to our attention during the latter part of this year, through the pass-through device application process. We reached a decision on this application after publication of the August 12, 2003 proposed rule. We determined that this source did not meet our criteria for creation of a new pass- through category for devices. However, we believe that separate payment for a substantially equivalent new brachytherapy source is warranted, since we pay separately for other sources. The indications presented to us for Cesium-131 were substantially the same as those for Palladium- 103 and Iodine-125. As such, the reasons for separate payment of brachytherapy sources, for example, variation in the number of seeds or other source forms make packaging into a clinical APC an undesirable option. Therefore, we have decided to create a separate APC so that the costs of this new source may be tracked like those of other brachytherapy sources. The payment rate for this source is $44.67 per seed. This payment rate is close to the reported price of the Cesium- 131 seed and equal to our payment rate based on claims for Palladium- 103, a source that is used for similar clinical indications.

Cardiopulmonary Resuscitation

Comment: A commenter indicated that a 28 percent drop in payment for this service is unwarranted because of the number of people and the level of training needed when this service is furnished.

Response: We were not convinced that the relative weight that would result from the use of the median cost for this APC would be inappropriate in relation to other OPPS services. Therefore, we will use the median cost from the final rule data to set the weight for this APC.

Computer Aided Detection for Diagnostic Mammography

Comment: A commenter expressed concern about our proposal to reassign Computer-Aided Detection for Diagnostic Mammography from a New Technology APC to APC 0410. The commenter stated that the proposed reassignment is premature and would result in a reduced payment rate that would be approximately half of the payment rate for the technical component of procedures performed in other settings. The commenter recommended that we retain this procedure in New Technology APC 1501 until we have greater claims experience.

Response: The alphanumeric HCPCS code for this service (G0236) is being replaced by a CPT code for the same service for 2004 (CPT code 76082). We found over 43,000 claims for this service in the 2002 data on which we are basing the 2004 relative weights. We believe that this volume of services is sufficient to justify setting a relative weight based on cost information rather than keeping the service in a new technology APC. Moreover, the practice expense portion of payment for this service is not relevant to the setting of relative weights for OPPS services, in which the relativity is established within the context of services paid under OPPS and not with regard to the practice expense for services under the Medicare physician fee schedule.

Orthopedic Fracture Fixation Procedures

Comment: Commenters stated that APCs 0043, 0046, 0047, 0048, 0049, and 0050 are not clinically similar and they violate the 2 times rule. They asked that we separate out the more costly procedures that involve fracture fixation devices because they involve additional time, resources, and significant costs of fixation devices. They recommended that we either create two new APCs with corresponding HCPCS codes for upper (at a payment of approximately $2,000) and lower fracture fixation devices (at a payment of approximately $3,000) or create two code modifiers (for upper and lower fixation devices) and multiple new APCs.

Response: For the 2004 OPPS, services that require an external fixation device will continue to be paid in APCs that also provide payment for fractures that do not require external fixation devices. While we are sympathetic to the commenters' concerns, we are not able to identify CPT codes that always require use of an external fixation device or the extent to which such devices are required for other codes. Nor did the information we received from the commenters provide a convincing breakdown of the differences in costs for procedures using external fixation devices. To create new APCs or new APC relative weights to provide additional payment for external fixation devices where such APCs would also contain procedures that do not routinely require use of an external fixation device, would result in overpayment of those procedures. Moreover, since most services in these APCs do not require an external fixation device, it may be appropriate to continue to pay for them in these APCs to encourage hospitals to use them only when required. Furthermore, we would be reluctant to

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impose an additional burden on hospitals by establishing ``G'' codes or modifiers to use in reporting procedures with or without external fixation devices. However, as we state elsewhere, we would support interested specialty societies' decisions to request the CPT to consider this coding issue.

APC 0680 Reveal ILR

Comment: A commenter indicated that the proposed payment rate is about 95 percent of the hospital acquisition cost of the device, leaving the hospital at an immediate loss if it implants this device. The commenter indicated that it is the only manufacturer of the device and therefore the only source of acquisition cost for the device. They indicated that in 2002, the cost was $3,495 and recommended that we re- evaluate and re-price the APC to provide sufficient payment that beneficiaries will have access to the device when needed. They indicated that the predominant site of service is in the hospital outpatient department and that if payment is below hospital cost, beneficiary access will eventually be limited.

Response: The final rule data for APC 0680 reveals a median cost of $3,691.15 for this APC, on which the relative weights for 2004 are based. We were not convinced by comments that this median cost would result in a relative weight that would be inappropriate relative to the payments for other services under OPPS.

Fractional Flow Reserve (FFR)

Comment: A commenter indicated that fractional flow reserve (CPT codes 93571, Intravascular doppler velocity and/or pressure derived coronary flow reserve measurement * * * during coronary angiography, initial vessel and 93572, each additional vessel) should be paid separately in addition to the procedure with which they are performed, rather than being packaged into the payment for the primary procedure. The commenter indicated that FFR should be paid separately because it is an expensive service with higher device and equipment costs and takes more time and staff than if it is not used. They also indicated that we pay separately for Intravascular ultrasound (IVUS) which is also deployed via guidewires. They stated that the principal difference is that IVUS describes the anatomy of the vessels while FFR describes the blood flow through the vessels. They indicated that it is inequitable to treat them differently. Payment for IVUS but not FFR creates inappropriate financial incentives for hospitals in determining which procedures to provide.

Response: Currently, where FFR is provided, the costs for it are packaged with the principal service to which FFR is an addition, which we expect to be coronary angiography. If we were to pay separately for this service, we would need to remove the costs for this service from the cost for services with which it was packaged (that is, coronary arteriography), which would reduce the medians on which the payments for those services are based. This would reduce the median and therefore the payment for coronary angiography. We are concerned with the circumstances under which this service would be appropriately paid under Medicare and will consider development of a national coverage decision regarding when it is medically necessary to treat illness or injury. After such a coverage decision is made, we will reconsider whether it is appropriate to pay separately for the service.

Cataract Surgery With IOL Implantation (APC 0246)

Comment: A manufacturer of intraocular lenses was concerned that on claims for the procedures in APC 246, the median charge of claims for which no charge is reported using revenue code 276 (Intraocular lens) is one-third lower than the median charge of claims where a charge is reported using revenue code 276. The commenter believes that when charges are not listed in revenue center 0276, they are omitted from the claim altogether, rather than being placed in a different revenue center. The commenter recommended that we adopt a policy of using only claims for APC 0246 that report charges for revenue code 276, which would be consistent with our proposal to calculate relative weights for certain device-related APCs using only claims that included a separate and correctly coded charge for a device.

Response: For the 2004 OPPS, payment for cataract surgery with IOL insertion is based on the median cost for the procedure from the final data. A review of the 2002 claims for procedures in APC 246, which includes CPT code 66984, one of the highest volume outpatient surgical procedures paid under the OPPS, indicates that the vast majority are billed with revenue code 276. Long-standing instructions require hospitals to report the IOL charge under revenue code 276 when billing for a procedure in APC 246.

In our implementing instructions for the 2004 OPPS update, we will remind hospitals and the contractors who process OPPS claims that, in order to receive payment for a procedure in APC 246, hospitals are required to report the associated IOL charge under revenue code 276. We will also consider for the 2005 OPPS update the commenter's recommendation that we use only claims with revenue code 276 to recalibrate the relative payment weight for APC 246. Our data are extremely robust for this APC (with a frequency of nearly 520,000), and they indicate that the preponderance of the claims used to establish the 2004 median does include revenue code 276.

Transcatheter Placement of Intracoronary Drug-Eluting Stent Procedures (APC 0656)

Comment: One commenter supported our recognition of the new drug- eluting stent technology through the creation of two ``G'' codes (G0290 and G0291) and their placement in new APC 0656. However, the commenter questioned how we calculated the proposed payment rate for 2004. The commenter stated that some patients classically considered at higher risk for percutaneous interventions, including diabetics and patients with multi-vessel disease, are being referred for drug-eluting stent procedures. The commenter stated that the clinical disposition of these patients makes them more complex and more resource-intensive than the average patient. The commenter further noted that, while the reporting of a second main coronary vessel procedure would result in a second, reduced APC payment, that our payment for the single vessel should be based on an average of 1.7 stents per vessel. Finally, the commenter recommended that we add APC 0656 to the list of APCs for which a device was required to be on the claim for weight setting.

Response: For the 2004 OPPS, we will continue to base the payment for transcatheter placement of intracoronary drug eluting stents on the median for APC 0104, transcatheter placement of intracoronary stents. We increased the median for APC 0104 ($4,765.05) by $1,200 to acquire the median we used for APC 0656. We are using the same adjustment amount used for a single stent in the inpatient prospective payment system. We received no comments that are sufficiently compelling to convince us that more than one stent per vessel typically will be used when this service is furnished in the outpatient department or that the adjustment amount of $1,200 per stent is inappropriate. We will consider including this on the agenda for the next APC Panel meeting.

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With respect to the comment that we should add APC 0656 to the list of APCs for which a device was required to be on the claim for weight setting, we believe it would be inappropriate to do so for the 2004 OPPS. This is because the drug-eluting stent was not approved by the FDA until 2003, and, therefore, it did not appear in the 2002 data. Moreover, since there are no device codes for coronary stents for use on claims in 2003, the 2003 data will not contain the device codes that would be needed to create a subset of stent device claims to use for the 2005 OPPS. However, in view of the reinstitution of device coding for 2004, we will consider this comment in our work to develop the 2006 OPPS. Moreover, as we indicated above, we based the payment for APC 0656 on the median for APC 0104, which was calculated from claims that contained C codes for stents.

Cardioverter Defibrillator (APC 0107)

Comment: Commenters indicated that the proposed payment for this APC was too low to pay for the device, much less the cost of the services to implant it. They indicated that the cost of the device in 2002 varied between $19,160 and $21,410 among major group purchasers, considerably more than the proposed payment of $15,773.28. They asked that we use the external data to set the device portion of the hospital cost.

Response: We reviewed the data for this APC and considered the comments of the APC Panel at its August 2003 meeting on the August 12, 2003 proposed rule. We were convinced that the median for this device is too low to be appropriate relative to other median costs. We used external data that had been presented to the APC Panel to calculate a mean external acquisition cost and used one part external cost to one part median cost from our claims data to acquire an adjusted cost for the device. We then added the nondevice median from our claims data to the adjusted device acquisition cost to acquire an adjusted median that we used to set the relative weight for this APC. Effective for October 1, 2003, we established codes to be used for reporting the services assigned to APCs 107 and 108. Specifically, CPT code 33240 (Insertion of cardioverter defibrillator) is no longer recognized as a valid code for OPPS. Instead, hospitals now report either G0297 (Insertion of single chamber pacing cardioverter defibrillator pulse generator) or G0298 (Insertion of dual chamber pacing cardioverter defibrillator pulse generator). Also effective for October 1, 2003, CPT code 33249 (Insertion/replacement/repair of cardioverter defibrillator and insertion of pulse generator) is no longer recognized as a valid code for OPPS. Instead, hospitals will report either G0299 (Insertion or repositioning of electrode lead for single chamber pacing cardioverter defibrillator and insertion of pulse generator) or G0300 (Insertion or repositioning of electrode lead for dual chamber pacing cardioverter defibrillator and insertion of pulse generator). These codes were created to capture differential costs related to single and dual chamber cardioverter defibrillators. Claims containing the CPT codes we no longer recognize for OPPS (CPT codes 33240 and 33249) are being returned to providers to be coded correctly and resubmitted.

Insertion of Pacemaker Dual Chamber (APC 0655) and Insertion of Pacemaker Single Chamber (APC 0089)

Comment: A commenter indicated that the proposed payment rates for these APCs are only slightly more than the lowest median hospital acquisition cost of the device leaving a hospital little or no payment for the services to implant it. They asked that we re-evaluate and price these APCs at a level that pays the full cost of the device and services.

Response: We carefully reviewed the data for these APCs. We were not convinced that there was a need to adjust the median for either of these APCs. The median cost for APC 0655 is about 12 percent higher than the adjusted median on which the 2003 payment weights were based (2003 adjusted median of $7,298.52 versus the final rule median of $8,225.23). The median cost for APC 0089 is slightly higher than the adjusted median on which the 2003 weights were based (2003 adjusted median of $6,686.16 versus the final rule median of $6,754.63). The comment was not convincing that these median costs were inappropriate in relation to the other median costs that will be used to set the relative weights. Moreover, since median costs for both APCs rose above the amounts achieved by upward adjustments for these APCs in 2003, we believe that the medians are appropriately relative to the costs for other services that will be used to set the relative weights.

Insertion of Pacemaker, Dual Chamber Generator Only (APC 0654)

Comment: A commenter indicated that the proposed payment rate is about 95 percent of the hospital acquisition cost of the device, leaving the hospital at an immediate loss if it implants this device. They asked that we re-evaluate and price these APCs at a level that pays the full cost of the device and services.

Response: The median cost for this APC is about 19 percent higher than the adjusted median on which the 2003 payment weight was based (2003 adjusted median of $5,456.63 versus the final rule median of $6,495.61). We saw no reason to further adjust the median on which the relative weights for 2004 are based. The comment was not convincing that these median costs were inappropriate in relation to the other median costs that will be used to set the relative weights. Moreover, since the median cost for the APC rose above the amounts achieved by upward adjustments for the APC in 2003, we believe that the median is appropriately relative to the costs for other services that will be used to set the relative weights.

INTEGRA Wound Products and Other Wound Products

Comment: We received a comment concerning INTEGRA Dermal Regeneration Template and INTEGRA Bilayer Wound Matrix in which the commenter stated that there is a payment disparity between the INTEGRA products and APLIGRAF, DERMAGRAFT and TRANSCYTE, which are eligible for separate payment as biologicals. The commenter noted that hospitals that use APLIGRAF, DERMAGRAFT, and TRANSCYTE receive an extra payment in the form of a pass-through or other separately paid APC payment in addition to the APC payment for the skin repair procedures (APC 0025), while users of the aforementioned INTEGRA products receive only the regular payment associated with skin repair CPT codes. The commenter stated that this payment differentiation provides a financial incentive to hospitals to use the other skin replacement products, and places INTEGRA at a competitive disadvantage. The commenter recommended that we create a product-specific APC for INTEGRA to provide comparable payment for ``this class of products.'' Alternatively, the commenter recommended that we establish a single APC that includes the cost of all or most skin replacement technologies. The manufacturer noted that hospitals using INTEGRA would receive only $340.41 under our proposed rate for APC 0025, while total payments for APC 0025 plus the product- specific codes for APLIGRAF, DERMAGRAFT, and TRANSCYTE would be between $770.86 and $1,072.86.

Response: TRANSCYTE was approved for transitional pass-through

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payment as a biological as of July 1, 2003; DERMAGRAFT continues in pass-through status through 2004; and APLIGRAF is a former pass-through biological proposed to be paid separately as non-pass-through biological, that is, status indicator ``K.'' Since no party has yet applied for transitional pass-through payment for INTEGRA along with relevant documentation in order to evaluate Integra as a biological for pass-through payment, we have not been able to evaluate pass-through payment status as a biological for this product. We are sympathetic to the commenter's concern, and we find merit in the recommendation to group a class of skin replacement products into the same APC. However, we do not believe that we have sufficient information at present upon which to determine the appropriate payment rate for such an APC. Furthermore, we would want to allow the public an opportunity to provide input on such a proposal. Therefore, we will consider the recommendation of a common APC for skin repair using new skin replacement technologies for 2005. We will also consider referring this issue for consideration by the APC Panel at its next meeting. Meanwhile, we invite public comment on the concept of grouping payment for skin repair procedures using new skin repair technologies such as INTEGRA, DERMAGRAFT, and APLIGRAF into a common APC.

Stereotactic Radiosurgery

Comment: A commenter urged that we continue to consider stereotactic radiosurgery (SRS) to be a radiation procedure and that we not reopen the revenue code of surgery for SRS, stating that a radiation oncologist is a critical component to the delivery of SRS. The commenter expressed concern for unintended consequences that may result from unbundling of services associated with this procedure.

Response: We appreciate the commenter's concern for accurately capturing the costs of stereotactic radiosurgery. As a matter of policy, however, we do not generally mandate the reporting of services under specific revenue centers but leave that decision up to the hospitals.

Comment: We received several comments regarding stereotactic radiosurgery (SRS). Commenters were concerned that the current G code descriptors do not appropriately recognize the differences among the various forms of SRS. Commenters explained that there are two basic methods in which SRS can be delivered to patients, linear accelerator- based treatment (often referred to as ``Linac'') and multi-source photon-based treatment (often referred to as Cobalt 60). Advances in technology have further distinguished these treatment modalities. Linear accelerator-based treatment can be performed using various types of SRS systems, two of which include gantry-based systems and image- guided robotic SRS systems. Commenters stated that the existing G codes do not accurately describe the unique differences among these services and therefore do not accurately capture the costs involved in providing these services.

For example, several commenters expressed concern regarding the limitation imposed by the code descriptor for HCPCS code G0242, which restricts its use to planning for Cobalt 60-based treatment. While some commenters stated that planning costs for linear accelerator-based treatment and Cobalt 60-based treatment are identical, other commenters asserted that planning costs for these services differ significantly.

Commenters recommended the following options to resolve the issue:

(1) Create another G code to distinguish between linear accelerator-based SRS and Cobalt 60-based SRS, which would be consistent with the two G codes (G0173 for linear accelerator-based and G0243 for Cobalt 60-based) for SRS treatment delivery; or

(2) Modify the descriptor for HCPCS code G0242 to describe treatment planning for both linear accelerator-based and Cobalt 60- based SRS treatments. For clarification purposes, the current G codes for SRS treatment delivery services are as follows:

G codes for linear accelerator-based SRS treatment delivery:

HCPCS code G0173--Stereotactic radiosurgery, complete course of therapy in one session.

HCPCS code G0251--Linear accelerator-based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, maximum 5 sessions per course of treatment.

G code for Cobalt 60-based SRS treatment delivery:

HCPCS code G0243--Multi-source photon stereotactic radiosurgery, delivery including collimator changes and custom plugging, complete course of treatment, all lesions. The current G code for Cobalt 60- based SRS treatment planning is as follows:

HCPCS code G0242--Multi-source photon stereotactic radiosurgery (Cobalt 60 multi-source converging beams) plan, including dose volume histograms for target and critical structure tolerances, plan optimization performed for highly conformal distributions, plan positional accuracy and dose verification, all lesions treated, per course of treatment.

Response: We agree with commenters that the current description for HCPCS code G0242 is limited to the planning of Cobalt 60-based SRS treatment and does not account for the planning of linear accelerator- based SRS treatment. To be consistent with the two G codes we created for treatment delivery, we will create a new G code (G0338) to distinguish linear accelerator-based SRS treatment planning from Cobalt 60-based SRS treatment planning. We will place G0338 in APC 1516 at a payment rate of $1,450. The new G code for linear accelerator-based SRS treatment planning will be as follows:

HCPCS code G0338--Linear-accelerator-based stereotactic radiosurgery plan, including dose volume histograms for target and critical structure tolerances, plan optimization performed for highly conformal distributions, plan positional accuracy and dose verification, all lesions treated, per course of treatment.

Comment: Several commenters expressed concern that our current code descriptors for HCPCS codes G0173 and G0251 do not distinguish between the various types of linear accelerator-based SRS treatment. Currently, image-guided robotic linear accelerator-based SRS systems are grouped with other forms of linear accelerator-based SRS systems using HCPCS codes G0173 and G0251. Commenters requested that we modify the code descriptors to distinguish image-guided robotic systems from other forms of linear accelerator-based SRS systems to account for the wide cost variation in delivering these services.

Response: We agree with commenters that the descriptors for HCPCS codes G0173 and G0251 do not distinguish image-guided robotic SRS systems from other forms of linear accelerator-based SRS systems to account for the cost variation of delivering these services. To more accurately capture the true costs of these services, we will create two new G codes (G0339 and G0340) to describe complete and fractionated image-guided robotic linear accelerator-based SRS treatment. Please see response to below comment for code descriptors.

Comment: Commenters urged that we modify the code descriptor for the delivery of image-guided robotic SRS to include both complete and fractionated courses of therapy in one code, resulting in the same payment amount for both types of therapy. Commenters explained

[[Page 63432]]

that the per-session costs of delivering image-guided robotic linear accelerator-based SRS are the same, regardless of whether the patient's disease requires one treatment or multiple treatments.

Response: Our claims data do not support the assertion that the per-session costs of delivering image-guided robotic linear accelerator-based SRS is equal to the costs of delivering a complete course of image-guided robotic linear accelerator-based SRS treatment. However, we acknowledge the possibility that claims data for G0173 and G0251 may include both image-guided robotic linear accelerator-based SRS treatments as well as other forms of linear accelerator-based SRS treatments and, as a result, the median cost may not accurately reflect the true costs of delivering image-guided robotic linear accelerator- based SRS therapy. As stated in our response to the above comment, we will create two new G codes (G0339 and G0340) to distinguish complete and fractionated image-guided robotic linear accelerator-based SRS treatment from other forms of complete and fractionated linear accelerator-based SRS treatment. We will place HCPCS code G0339 (complete session) in APC 1528 at a payment rate of $5250. The APC placement of HCPCS code G0340 is discussed below.

While we recognize the costs to provide multi-session image-guided robotic SRS therapy may be greater than the current payment rate for HCPCS code G0251, we received no convincing cost data supporting commenters' claims that the costs of performing each additional session subsequent to the first session of a fractionated treatment is equivalent to the costs of performing a complete session. Rather, we believe that certain economies of scale are realized when performing each additional session subsequent to the first session of a fractionated treatment. That is, based on our understanding of the therapy, we do not believe that the same exact amount of hospital resources would be utilized for each subsequent session.

Statements provided by various interested parties indicate that the costs of providing each session of a fractionated treatment range from $2700 to $9000. However, we received no convincing data to substantiate these statements. We have estimated that approximately 75 percent of the costs of a complete session would be required to provide each additional session subsequent to the first session of a fractionated treatment. Therefore, we will place HCPCS code G0340 in new technology APC 1525, which covers procedures ranging from $3500 to $4000 in payment and which pays $3750. This new technology APC range pays approximately seventy-five percent of the payment for HCPCS code G0339. We will modify the descriptor for HCPCS code 0340 to describe additional sessions (second through fifth sessions) subsequent to the first session of a fractionated treatment. In addition, we will expand the descriptor for a complete session (HCPCS code G0339) to include the first session of a multi-session treatment. To further clarify, when providers perform multi-session image-guided robotic SRS therapy, they should bill using HCPCS code G0339 for the first session. For each additional session subsequent to the first session, providers should bill using only HCPCS code G0340 up to a maximum of five sessions.

Although we received no clinical data to substantiate the use of a single session versus multiple fractionations up to five sessions, a few commenters stated that a maximum of five sessions may be utilized to treat certain conditions; therefore, we will continue to pay for the delivery of multi-session therapy (HCPCS code G0340) up to a maximum of five sessions per course of treatment. When additional data is submitted, we may reconsider this payment decision.

As described above, we will create the following new G codes to identify image-guided robotic linear accelerator-based SRS treatment delivery:

HCPCS code G0339--Image-guided robotic linear accelerator-based stereotactic radiosurgery, complete course of therapy in one session, or first session of fractionated treatment.

HCPCS code G0340--Image-guided robotic linear accelerator-based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, second through fifth sessions, maximum five sessions per course of treatment.

SIRTeX Medical (RE: SIR-Spheres Brachytherapy Source)

Comment: The manufacturer of a brachytherapy source to treat liver cancer commented that our proposed payment of $8,870.88 for APC 2616 was inadequate to pay for its product, which it reported costs $14,000 per treatment dose. This commenter stated that there are only two products that would fit this APC, which is for Yttrium-90 brachytherapy source. Moreover, this party claimed that there were significant clinical differences between its product and another Yttrium-90 source, and that these differences necessitated the price differential between the two products. The commenter requested establishment of a separate alpha-numeric HCPCS code for its product, in order to account for the cost differences between the two Yttrium-90 products and to set more equitable payment rates for the two products.

Response: We appreciate the concerns of the commenter. We would first note that payment to APC 2616 has increased to $9,615.50 per dose compared to the 2003 payment of $6,485.37. The information provided in the comment did not convince us that the payment rate resulting from the 2002 claims data is inadequate to pay hospitals for the Yttrium-90 products. We are uncertain whether or not there are other Yttrium-90 sources in addition to the two discussed in this comment that would need to be considered in any analysis of the relative costs of the products. Therefore, until we have additional data, we believe that code C2616 and APC 2616 adequately describes and pays for Yttrium-90 brachytherapy sources.

Low Osmolar Contrast Media

Comment: A radiology specialty society expressed disappointment because we did not address payment for low osmolar contrast media (LOCM) in the proposed rule. The commenter believes that the variability in usage and Medicare's restricted coverage of LOCM warrant payment in a separate APC in the 2004 final rule. The commenter recommends that we increase the relative weights of APCs that include codes that involve the use of LOCM agents to reflect the additional costs of these agents if we do not establish a separate APC to pay for LOCM.

Response: We issued a program memorandum on November 22, 2002 (Transmittal A-02-120, Change Request 2185) in which we removed all requirements differentiating payment between high osmolar contrast material and LOCM as well as restrictions that would limit payment for LOCM only to patients with specific diagnoses. In that program memorandum, we instructed our contractors to discontinue any edits that would prohibit payment for LOCM if specific diagnoses were not reflected on the claim, effective for services furnished on or after January 1, 2003. We further directed contractors to instruct hospitals to include charges for LOCM in the charge for the diagnostic procedure or, if LOCM is billed as a separate charge, to use revenue code 254 or 255 as appropriate. These instructions applied only to hospitals subject to the OPPS.

We disagree with the commenter's recommendation that a separate APC

[[Page 63433]]

should be established to bill for LOCM for several reasons. Prior to issuance of Transmittal A-02-120, covered LOCM costs would have been reflected either in an appropriate revenue code or within the hospital's charge for a diagnostic procedure or in a charge with an appropriate HCPCS code (A4644, A4645, or A4646). To the extent that hospitals submitted covered charges for LOCM in 2002, those costs are packaged into the cost of the procedure with which the LOCM was used. We expect that claims for services involving the use of LOCM furnished during CY 2003 will reflect even more fully costs associated with LOCM in light of the instructions that were issued in Transmittal A-02-120. These costs will be reflected in the 2005 update of the OPPS. Finally, without verifiable information that demonstrates the actual market- based price that a broadly based national sample of hospitals are routinely required to pay in order to procure LOCM, we have no data upon which to base a determination that a separate APC for LOCM would be appropriate.

Prosthetic Urology

Comment: Several commenters supported the proposed restructuring of the prosthetic urology procedures into APCs 385 and 386. However, the commenters urged us to consider further refinements to increase the payment rates for these APCs. The commenters expressed concern about the use of a single departmental cost-to-charge ratio for devices and recommended for calendar year 2005 that we implement edits in our development of median costs to benchmark cost data for device procedures so that charges for expensive devices are not reduced below a designated point. The commenters also stated that hospitals charged for only one component of a prosthetic urology device for multi- component prosthetic urology devices. The commenters believe this resulted in under-reporting of charges for the entire procedure. The commenters recommended that we use external data to adjust the level of payment for multi-component devices and exclude claims with device costs less than $5,000 from the rate-setting database. Commenters stated that hospitals in the States of California, Colorado, Florida, Illinois, North Dakota, New York, and Oklahoma have closed their prosthetic urology programs because Medicare OPPS payments are too low.

Response: APCs 385 and 386 were created by splitting APC 0182 into two APCs for higher cost and lower cost devices (penile prostheses and urinary sphincters). The payment for these procedures in 2003 is $4,975.96. As a result of splitting former APC 0182 into two APCs, the payment amount for 2004 is $3,663.93 for APC 0385 and $6,342.07 for APC 0386. This is a relatively small reduction for APC 0385 with the lower cost devices and a very significant increase for APC 0386, with the higher cost devices. Moreover, as discussed in more detail elsewhere, we decided to change the status indicator for these APCs from ``T'' to an ``S'' so that the multiple procedure reduction will not apply to them (or other procedures with a ``T'' status indicator) on the same day. These changes together result in significantly more payment for these services in 2004 than in 2003. Therefore, we did not use external data to further adjust the median cost on which the payment was based.

Intensity Modulation Radiation Therapy

Comment: Commenters urged that we withdraw our proposal to move intensity modulation radiation therapy (IMRT) treatment planning (CPT code 77301) from new technology APC 1510 (previously APC 0712 in 2003) to APC 0413 and IMRT treatment delivery (CPT code 77418) from new technology APC 1506 (previously APC 0710 in 2003) to APC 0412. Commenters indicated that the payments proposed for APCs 0412 and 0413 are too low to adequately compensate hospitals for the costs of the services. One commenter further explained that part of the problem behind the low median cost may be that, according to CMS PM A-02-26, hospitals are precluded from billing for all of the services involved in this treatment. The commenter indicated that hospitals should be able to bill and be paid for the simulations (CPT codes 77280-77295), dosimetry calculations (CPT code 77300), an isodose plan (CPT codes 77305-77315), special teletherapy port plan (CPT code 77321), continuing medical physics (CPT code 77336) and special medical physics (CPT code 77370). Commenters requested that CPT codes 77301 and 77418 be retained in their current new technology APCs (APCs 1510 and 1506, respectively) for another year to provide additional time for provider education about the proper coding of these services and to enable the data to mature.

Response: We agree with commenters that the payment rate for APC 0413 does not adequately cover the costs of providing IMRT treatment planning (CPT code 77301). As noted by one commenter, PM A-02-26 instructs that services identified by CPT codes 77280 through 77295, 77300, and 77305 through 77321, 77336, and 77370 are included in the APC payment for IMRT and SR planning. The low median for CPT code 77301 appears to be a result of miscoding. Therefore, we will retain CPT code 77301 in new technology APC 1510 to allow additional time for provider education and to enable the data to mature. We believe, however, that the significant volume of single claims (93 percent of total claims) used to set the payment rate for IMRT treatment delivery (CPT code 77418) accurately reflects the costs hospitals are reporting for this service. Based on this robust claims data, we will move CPT 77418 from new technology APC 1506 (previously APC 0710 in 2003) to APC 0412 (IMRT Treatment Delivery).

Comment: One commenter requested that we allow the use of existing IMRT CPT codes 77301 and 77418 for compensator-based IMRT technology in the hospital outpatient setting. The commenter states that Medicare beneficiaries may be denied access to compensator-based IMRT as a result of inadequate payment for this service.

Response: We do not prohibit the use of existing IMRT CPT codes 77301 and 77418 to be billed for compensator-based IMRT technology in the hospital outpatient setting. Rather, we believe the confusion may pertain to billing instructions for CPT codes 77301 and 77334 billed on the same day. CMS PM A-02-26 instructs that ``payment for IMRT and SR planning does not include payment for services described by CPT codes 77332 through 77334. When provided, these services should be billed in addition to the IMRT and SR planning codes 77301 and G0242.'' Providers billing for both CPT codes 77301 (IMRT treatment planning) and 77334 (design and construction of complex treatment devices) on the same day should append a 59 modifier to receive accurate payment. Proton Beam Therapy

Comment: Several commenters indicated that proton beam therapy, intermediate and complex should be moved from APC 0650 to a new technology APC (as it appears in Addendum B). However, commenters stated that these two codes should not be placed in the same APC due to a significant difference in resource utilization. We received several other comments supporting our proposal to maintain simple proton beam therapy (CPT codes 77520 and 77522) in APC 0664 and intermediate and complex proton beam therapies (CPT codes 77523 and 77525, respectively) in APC 1511 (previously APC 0712 in 2003).

Response: We agree with commenters that codes for simple proton beam

[[Page 63434]]

radiation therapy (CPT codes 77520 and 77522) should be placed in a different APC than codes for intermediary (CPT code 77523) and complex (CPT code 77525) radiation therapy. As we stated in the correction notice of February 10, 2003 (68 FR 6636), we also agree with commenters that it would be inappropriate to return codes for simple proton beam therapy to a new technology APC due to having sufficient claims data to integrate these codes into the OPPS. We continue to believe that the placement of these codes in APC 0664 is appropriate based on having used 98 percent of total claims for simple proton beam therapy to set the 2004 median for APC 0664. Therefore, CPT codes 77520 and 77522 will remain in APC 0664.

The placement of intermediate (CPT code 77523) and complex (CPT code 77525) proton beam therapies in APC 650 in the November 1, 2002 final rule (67 FR 66718) for the 2003 OPPS was an error that was corrected in the correction notice of February 10, 2003 (68 FR 6636). We clarified in the correction notice that these CPT codes were placed in new technology APC 0712 for CY 2003 because they lacked sufficient cost data to confidently move these codes out of a new technology APC. We continue to lack sufficient cost data to move these codes into a clinical APC; therefore, we will crosswalk CPT codes 77523 and 77525 from new technology APC 0712 to the corresponding new technology APC 1511 for CY 2004. Once sufficient data is available, we will be able to determine whether intermediate and complex proton beam therapies should be placed in the same APC.

FDG PET Procedures

Comment: Several commenters commended us for our proposed rates for FDG PET procedures. They were pleased that the proposed 2004 rates for the FDG PET procedure and the radiopharmaceutical when combined are nearly identical to the rates for the combined procedure and radiopharmaceutical for 2003. Commenters stated that the retention of FDG PET procedures in a new technology APC will allow providers an additional year to improve their reporting practices, while providing us with another year of more accurate claims data.

Response: We agree with commenters that the retention of FDG PET procedures in a new technology APC for an additional year will allow providers a reasonable amount of time to improve their reporting practices, while providing us with another year of claims experience. Therefore, we will retain FDG PET procedures in new technology APC 1516.

Comment: One commenter expressed concern that HCPCS code G0296 did not appear in Addendum B of the August 12, 2003 proposed rule. The commenter urged us to place this new code in APC 1516 with other FDG PET procedures.

Response: We thank the commenter for bringing to our attention the absence of HCPCS code G0296 from addendum B of the proposed rule. We agree with the commenter's recommendation to place this code in the same APC as other FDG PET procedures. Therefore, we will place HCPCS code G0296 in new technology APC 1516.

Comment: One commenter recommended the establishment of a revenue code dedicated solely to PET procedures.

Response: Revenue codes exist for hospital accounting purposes and, in general we do not require that particular services be billed with particular revenue codes. We are not convinced that adding specific requirements for revenue coding or expanding the revenue codes to acquire more specific information will result in better data or that the end result would be cost effective in terms of its potential effect on hospital operations.

IV. Transitional Pass-Through and Related Payment Issues

A. Background

Section 1833(t)(6) of the Act provides for temporary additional payments or ``transitional pass-through payments'' for certain medical devices, drugs, and biological agents. As originally enacted by the BBRA, this provision required the Secretary to make additional payments to hospitals for current orphan drugs, as designated under section 526 of the Federal Food, Drug, and Cosmetic Act, Pub. L. 107-186; current drugs, biological agents, and brachytherapy devices used for the treatment of cancer; and current drugs and biological products.

For those drugs, biological agents, and devices referred to as ``current,'' the transitional pass-through payment began on the first date the hospital OPPS was implemented (before enactment of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act (BIPA), Pub. L. 106-554, enacted December 21, 2000).

Transitional pass-through payments are also required for certain ``new'' medical devices, drugs, and biological agents that were not being paid for as a hospital outpatient service as of December 31, 1996 and whose cost is ``not insignificant'' in relation to the OPPS payment for the procedures or services associated with the new device, drug, or biological. Under the statute, transitional pass-through payments can be made for at least 2 years but not more than 3 years.

Section 1833(t)(6)(B)(i) of the Act required that we establish by April 1, 2001, initial categories to be used for purposes of determining which medical devices are eligible for transitional pass- through payments. Section 1833(t)(6)(B)(i)(II) of the Act explicitly authorized us to establish initial categories by program memorandum (PM). On March 22, 2001, we issued two PMs, Transmittals A-01-40 and A- 01-41 that established the initial categories. We posted them on our Web site at: http://www.hcfa.gov/pubforms/transmit/A0140.pdf and http://www .hcfa.gov/pubforms/transmit/A0141.pdf, respectively.

Transmittal A-01-41 includes a list of the initial device categories, a crosswalk of all the item-specific codes for individual devices that were approved for transitional pass-through payments, and the initial category code by which the cross-walked individual device was to be billed beginning April 1, 2001. Items eligible for transitional pass-through payments are generally coded using a Level II HCPCS code with an alpha prefix of ``C.'' Pass-through device categories are identified by status indicator ``H'' and pass-through drugs and biological agents are identified by status indicator ``G.'' Subsequently, we added a number of additional categories, retired 95 categories effective January 1, 2003, and made clarifications to some of the categories' long descriptors found in various program transmittals. A list of current device category codes can be found below, in Table 10.

Section 1833(t)(6)(B)(ii) of the Act also requires us to establish, through rulemaking, criteria that will be used to create additional device categories for transitional pass-through payment. The criteria for new categories were the subject of a separate interim final rule with comment period published in the Federal Register on November 2, 2001 (66 FR 55850) and made final in the November 1, 2002 Federal Register (67 FR 66781) announcing the 2003 update to the OPPS.

Transitional pass-through categories are for devices only; they do not apply to drugs or biological agents. The regulations at Sec. 419.64 governing transitional pass-through payments for eligible drugs and biological agents are unaffected by the creation of categories.

[[Page 63435]]

The process to apply for transitional pass-through payment for eligible drugs and biological agents or for additional device categories can be found on respective pages on our Web site at http://www.cms.gov. If we revise the application instructions in any way, we will post the revisions on our Web site and submit the changes for approval by the Office of Management and Budget (OMB) as required under the Paperwork Reduction Act (PRA). Notification of new drug, biological, or device category application processes is generally posted on the OPPS Web site at http://www.cms.gov.

B. Discussion of Pro Rata Reduction

Section 1833(t)(6)(E) of the Act limits the total projected amount of transitional pass-through payments for a given year to an ``applicable percentage'' of projected total Medicare and beneficiary payments under the hospital OPPS. For a year before 2004, the applicable percentage is 2.5 percent; for 2004 and subsequent years, we specify the applicable percentage up to 2.0 percent. We proposed to set the percentage at 2.0 percent for the 2004 OPPS.

If we estimate before the beginning of the calendar year that the total amount of pass-through payments in that year would exceed the applicable percentage, section 1833(t)(6)(E)(iii) of the Act requires a prospective uniform reduction in the amount of each of the transitional pass-through payments made in that year to ensure that the limit is not exceeded. We make an estimate of pass-through spending to determine not only whether payment exceeds the applicable percentage but also to determine the appropriate reduction to the conversion factor.

In the August 12, 2003 proposed rule, we described in the detail the methodology we used to make an estimate of pass-through spending in 2004 (68 FR 47992). In general, we specified that after using the respective methodologies described in the proposed rule, to determine projected 2004 pass-through spending for the groups of devices, drugs, and biological agents, we would calculate total projected 2004 pass- through spending as a percentage of the total projected payments (Medicare and beneficiary payments) under OPPS to determine if the pro rata reduction would be required.

Table 9 shows our current estimate of 2004 pass-through spending for known pass-through drugs, biologicals, and devices based on information available at the time this table was developed. We specified in the proposed rule that we were uncertain whether estimated pass-through spending in 2004 would exceed $456 million (2.0 percent of total estimated OPPS spending) because we had not yet completed the estimate of pass-through spending for a number of drugs and devices. In particular, we did not have estimates for those drugs still under agency review for additional pass-through payments beginning October 2003 or the changes in pass-through spending that could result from quarterly rather than annual updates of AWP for pass-through drugs. Finally, we would incorporate an estimate of pass-through spending for items for which pass-through payment becomes effective later in 2004 (that is, April 1, 2004; July 1, 2004; and October 1, 2004) based on estimates of items that become eligible for pass-through payment on October 1, 2003 and January 1, 2004. Specifically, we would assume a proportionate amount of spending for items that become eligible later in the year while making an adjustment to account for the fact that items made eligible later in the year will not receive pass-through payments for the entire year. We invited comments on the methodology we proposed and the estimates for utilization that appeared in Table 12 of the August 12, 2003 proposed rule. We received several comments on this proposal, which are summarized below along with our responses.

Table 9.--Estimate of Pass-Through Spending in 2004

2004 pass-

2004 through 2004 estimated anticipated HCPC

APC

Drug biological

payment utilization pass-through portion

payments

Existing Pass-through Drugs/biologicals J0583................ 9111

Injectin Bivalrudin, per

$0.40 $5,278,000 $2,111,200 1 mg. C9112................ 9112

Injection, Perflutren

37.44

67,000 2,508,480 lipid microsphere, per 2 ml. C9113................ 9113

Injection, Pantoprazole

6.34

20,000

126,800 sodium, per vial. J1335................ 9116

Injection, Ertapenum

6.00

14,400

86,400 sodium, per 500 mg. J2505................ 9119

Injection,

708.00

110,344 78,123,329 Pegfilgrastim, per 6 mg single dose vial. J9395................ 9120

Injection, Fluvestrant,

22.13

274,156 6,067,072 per 25 mg. C9121................ 9121

Injection, Argatroban,

4.13

50,000

206,500 per 5 mg. C9200................ 9200

Orcel, per 36 cm2.......

286.80

1,000

286,800 C9123................ 9123

Transcyte, per 247 sq cm

194.76

100

19,476 C9203................ 9203

Injection Perflexane

36.00

82,400 2,966,400 lipid microspheres, per 10 ml vial. J2324................ 9114

Injection, Nesiritide,

38.30

60,000 2,298,000 per 0.5 mg vial. J3315................ 9122

Injection, Triptorelin

100.70

307,440 30,959,208 pamoate, per 3.75 mg. J3487................ 9115

Injection, Zoledronic

54.93

539,000 29,607,270 acid, per 1 mg. J3486................ 9204

Injectionm Ziprasidone

5.25

234,286 1,230,000 mesylate, per 10 mg. C9205................ 9205

Injection, Oxaliplatin,

23.86

280,756 6,698,845 per 5 mg. C9208................ 9208

Injection, IV,

31.27

194,533 6,083,040 Agalsidase beta, per 1 mg. C9201................ 9201

Dermagraft, per 37.5

145.92

9,264 1,351,803 square centimeters. C9209................ 9209

Injection, IV,

162.72

2,612

425,092 Laronidase, per 2.9 mg. Pass-through Drugs/ Biologicals Effective January 2004 C9207................ 9207

Injection, IV,

262.66

102,680 26,970,000 Bortezomib, per 3.5 mg. C9210................ 9210

Injection, IV,

77.76

37,500 2,916,000 Palonosetron HCI, per 0.25 mg (250 micrograms). C9211................ 9211

Injection, alefacept,

168.00

13,775 2,314,200 for intravenous use, per 7.5 mg. C9212................ 9212

Injection, alefacept,

119.40

27,550 3,289,470 for intramuscular use, per 7.5 mg. Existing Pass-through Devices C1783................ 1783

Ocular implant, aqueous ..............

324

160,250 drainage assist device. C1814................ 1814

Retinal tamponade

..............

35,173 13,675,262 device, silicone oil. C1884................ 1884

Embolization Protective ..............

25,000 38,601,544 System. C1888................ 1888

Catheter, ablation, non- ..............

215

129,731 cardiac, endovascular (implantable).

[[Page 63436]]

C1900................ 1900

Lead, left ventricular ..............

2,095 2,819,912 coronary venous system. C2614................ 2614

Probe, percutaneous ..............

901 1,752,445 lumbar discectomy. C2632................ 2632

Brachytherapy solution, ..............

225 1,890,000 iodine--125, per mCi. C1818................ 1818

Integrated

..............

4

27,800 keratoprosthesis. Pass-through Devices Effective January 2004 C1819................ 1819

Tissue localization- ..............

9,858 1,823,730 excision dev. Other Items Expected To

.............. .............. Be Determined Eligible for 2004 Spending for future .............. .............. 22,466,959 approved drugs. Spending for future .............. .............. 12,791,197 approved devices. Total Spending for Pass- .............. .............. 302,784,216 through Drugs/ biologicals, and devices 2004.

Comment: Several commenters objected to the methods used to project pass-through drug spending, especially those techniques used to estimate future products that are first eligible for pass-through payments beginning in April 2004 or later in the year. They are concerned that pass-through expenditures in 2004 will exceed the statutory cap and cause us to impose a pro rata reduction. Several hospital associations propose that we limit the funds allocated for the pass-through pool to one percent and use the remaining 1.0 percent to fund all other APCs. They suggest that we over-estimate pass-through spending, which results in the reduction of payment rates for other critical care services.

Response: Section 1833(t)(6)(E)(i) of the Act requires that the Secretary estimate the total pass-through payments to be made for the forthcoming year (which allows us to determine the amount of the conversion factor for the forthcoming year) and to the extent the estimate exceeds the statutory limit, reduce the amount of each pass- through payment. For 2004, the statutory limit is 2.0 percent of total estimated program payments. In the August 12, 2003 proposed rule, we provided our best estimate at that time of pass-through payments for the drugs and devices for which we expected to make pass-through payments in 2004, and we explained our methodology for determining the estimate for the final rule. We provided a list of the devices and drugs we either knew would be paid under pass-through next year or which we believed may be paid as pass-through items in 2004.

We finalized our estimate of 2004 pass-through spending and, for the reasons discussed below, we have determined that no pro rata reduction will be required in 2004. As discussed below the estimate falls under the statutory limit of 2.0 percent. Therefore, the conversion factor has been increased correspondingly from the proposed rule by 0.7 percent.

Pass-Through Devices Effective January 2004

Comment: One commenter recommended that we not impose a pro rata reduction on pass-through devices if the estimated pass-through expenditures increase appreciably. A device manufacturers' association was concerned that new drugs will take an increasing share of the pass- through pool. They suggested that the shift to more pass-through spending on drugs will increase under the easier qualifications for drug pass-through payments and encouraged us to reconsider the issue to determine how to ensure that devices maintain an ``adequate'' share of the pass-through pool.

Response: Section 1833(t)(6)(E)(iii) of the Act requires a prospective uniform reduction (pro rata) of the amount of each of the transitional pass-through payments made in that year, if it is expected that pass-through payments will exceed the cap set for OPPS pass- through expenditures. Therefore, if any pro rata reduction applies, we are required to apply it to pass-through devices as well as drugs and biological agents. For 2004, we do not expect the total payments for pass-through drugs and devices to exceed the statutory limit. Therefore, as discussed elsewhere, we will not impose a pro rata adjustment on any pass-through items in 2004.

V. Payment for Devices

A. Pass-Through Devices

Section 1833(t)(6)(B)(iii) of the Act requires that a category of devices be eligible for transitional pass-through payments for at least 2, but not more than 3, years. This period begins with the first date on which a transitional pass-through payment is made for any medical device that is described by the category. We proposed that two device categories currently in effect would expire effective January 1, 2004. Our proposed payment methodology for devices that have been paid by means of pass-through categories, and for which pass-through status would expire effective January 1, 2004, is discussed in the section below.

Although the device category codes became effective April 1, 2001, most of the item-specific ``C'' codes for pass-through devices that were crosswalked to the new category codes were approved for pass- through payment in CY 2000 and as of January 1, 2001. (The crosswalk for item-specific ``C'' codes to category codes was issued in Transmittals A-01-41 and A-01-97). We based the expiration dates for the category codes listed in Table 10, on when a category was first created, or when the item-specific devices that are described by, and included in, the initial categories were first paid as pass-through devices, before the implementation of device categories. The device category expiration dates are listed in Table 10. We proposed to base the expiration date for a device category on the earliest effective date of pass-through payment status of the devices that populate that category. There are two categories for devices that will have been eligible for pass-through payments for more than 2\1/2\ years as of December 31, 2003, and we proposed that they would not be eligible for pass-through payments effective January 1, 2004. The two categories we proposed for expiration are C1765 and C2618, as indicated in Table 10. Each category includes devices for which pass-through payment was first made under OPPS in 2000 or 2001.

A comprehensive list of all currently effective pass-through device categories is displayed in Table 10. Also displayed

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are the dates the devices described by the category were populated and their respective expiration dates. For devices continuing on pass- through status after 2003, expiration dates were set forth in the August 12, proposed rule and are finalized here. Newly added code C1819 is first announced in this final rule and is given a December 31, 2005 expiration date.

The methodology used to base expiration of a device category is the same as that used to determine the 95 initial categories that expired as of January 1, 2003. A list including those 95 categories that expired as of January 1, 2003 (as well as 5 categories that continued to be paid in 2003) is found in the November 1, 2002 final rule (67 FR 66761 through 66763).

Table 10.--List of Current Pass--Through Device Categories With Expiration Dates

Category long

Expiration HCPCS codes

descriptor

Date(s) populated date

C1765........... Adhesion Barrier.... 10/1/00-3/31/01; 7/1/ 12/31/03 01. C2618........... Probe, cryoblation.. 4/1/01.............. 12/31/03 C1888........... Catheter, ablation, 7/1/02.............. 12/31/04 non-cardiac, endovascular (implantable). C1900........... Lead, left

7/1/02.............. 12/31/04 ventricular coronary venous system. C1783........... Ocular implant, 7/1/02.............. 12/31/04 aqueous drainage assist device. C1884........... Embolization

1/1/03.............. 12/31/04 protective system. C2614........... Probe, percutaneous 1/1/03.............. 12/31/04 lumbar discectomy. C2632........... Brachytherapy

1/1/03.............. 12/31/04 solution, iodine- 125, per mCi. C1814........... Retinal tamponade 4/1/03.............. 12/31/05 device, silicone oil. C1818........... Integrated

7/1/03.............. 12/31/05 keratoprosthesis. C1819........... Tissue localization 1/1/04.............. 12/31/05 excision device.

We received several comments on this proposal, which are summarized below along with our responses.

Comment: A few parties provided comments on our criteria for eligibility for a new device category for pass-through payment as published in the November 1, 2002 Federal Register (67 FR 66781).

Response: We made no proposal to modify our criteria for establishment of a new category for transitional pass-through payment, so the criteria were not subject to comment in this rulemaking period. However, we will take note of these comments as considerations in our ongoing evaluation of the new device category process.

New Technology Treatment for New Devices for Brachytherapy Catheters and Needles

Comment: A commenter asked that we consider pass-through payment or new technology payment for new devices of brachytherapy catheters and needles when they are approved by FDA for new indications and treatment protocols.

Response: We have a process for applying for pass-through new technology APC status. See http://www.cms.hhs.gov for instructions. If a provider or other party believes that an item or service meets the criteria for pass-through or new technology status, the interested party should submit an application, and we will then make a judgement based on the individual circumstances described in the application.

B. Expiration of Transitional Pass-Through Payments in CY 2004

In the November 1, 2002 final rule, we established a policy for payment of devices included in pass-through categories that are due to expire (67 FR 66763). We stated that we would package the costs of the devices no longer eligible for pass-through payments in 2003 into the costs of the clinical APCs with which the devices were billed in 2001. There were very few exceptions to the policy (for example, brachytherapy sources for other than prostate brachytherapy), and we proposed to make no changes. Therefore, we proposed that payment for the devices that populate C1765 and C2618, which we proposed would cease to be eligible for pass-through payment on January 1, 2004, would be made as part of the payment for the APCs with which they are billed.

The methodology that we proposed to use to package expiring pass- through device costs is consistent with the packaging methodology that we describe in section II.B.5. For the codes in APCs displayed in Table 10 of the proposed rule, we proposed to use only those claims on which the hospital included the ``C'' code and to discard the claims on which no ``C'' code is billed. We proposed to limit our analysis to the claims with ``C'' codes because we are not confident that the claims for the relevant APCs include the charges for the devices unless the ``C'' codes are specifically billed.

To calculate the total cost for a service on a per-service basis, we included all charges billed with the service in a revenue center in addition to packaged HCPCS codes with status indicator ``N.'' We also packaged the costs of devices that we proposed would no longer be eligible for pass-through payment in 2004 into the HCPCS codes with which the devices were billed.

We received several comments on this proposal, which are summarized below along with our responses.

Comment: A commenter supported packaging the cost of expiring pass- through codes C2618 and CC1765 into the payment for the procedure in which they are used because they believe that packaging minimizes payment incentive to use these devices over other appropriate devices. The commenter urged CMS to release the crosswalk it will use to assign pass-through device costs to specific APCs so that they can confirm the appropriateness of the assignment.

Response: There is no such crosswalk. Devices and packaged drugs (that is, those with a per day median cost of $50 or less) are packaged into the HCPCS code on the single procedure claim (natural single or pseudo single) with which they are billed. The packaging is controlled solely by what the hospital bills on the claim. To determine what drugs and devices were packaged into an APC, one would need to undertake an extensive analysis of all single and pseudo single claims used in weight setting. The only time that judgment was used to attribute a device to an APC was not for purposes of packaging charges into APCs but rather was in the setting of median costs for 5 APCs in which external data on acquisition costs was used in a one to one proportion

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with claims data to set the device cost for an APC as discussed above.

C. Reinstitution of C Codes for Expired Device Categories

Comment: Some commenters strongly objected to reinstatement of the C codes for devices because of the burden that it would impose on hospitals without a corresponding benefit in immediate payment. They indicated that charges for devices are included in the revenue code charges for the services furnished and that using C codes will increase administrative costs significantly without any benefit to patient care or hospital revenues. They indicated that hospital staffs would not be able to differentiate between devices that should be reported and those that should not. One commenter said that widespread confusion over what device to code and what device to not code is the reason that the claims for services that require pass-through devices often do not show codes for the devices. The commenter indicates that most hospitals could not comply with this requirement by January 1, 2004 in any case because of extensive changes to chargemasters that would be needed. Moreover, given that many hospitals did not comply even when the use of the code would have resulted in separate payment is a strong indication that they would be unlikely to comply when no additional payment will result from coding devices. Commenters indicated that reintroducing C codes for devices will result in continuation of improper coding and will lead to a false sense of confidence in the data for procedures that require devices. A commenter said that if CMS decided to reintroduce C codes for devices, CMS should reinstate the same C codes that were used for device coding in 2002 because it would minimize confusion.

Other commenters said that CMS should reinstate the C codes for reporting of devices so that CMS and others can ensure that only correctly coded claims are used to set medians for APCs into which device costs are packaged. They said that coding for devices is needed so that CMS can be assured that the costs of the devices are packaged into the costs for the procedure when the medians for the procedure are set. They urged us to continue to use the presence of an appropriate device code as a criterion for claims used to set medians for devices.

Response: For 2004, we are reactivating the C codes for device categories as they existed on December 31, 2002. The use of the code is not required and will not be enforced. However, hospitals should understand that providing complete and accurate information on the claims about the services that were furnished and the charges for those services is fundamental to our establishment of relative weights on which the payment for their services is based.

Comment: Commenters that supported the reinstitution of C codes for devices said that CMS should continue to restrict the claims used for APCs with a device to claims that contain the charges for the devices used in the APC. In particular, a commenter said that the median for APC 0246 (Cataract removal with intraocular lens) should be based only on claims that contain charges under revenue center 0276 and that claims for APC 0246 that do not contain charges in revenue center 0276 should not be used to set the median. In the case of this APC, the commenter asked that we adopt the 2004 proposed payment at a minimum. Other commenters opposed the reinstitution of C codes for devices, which would preclude us from restricting claims used to set weights for device APCs to claims containing such codes.

Response: We restricted the claims used to set the medians for the APCs contained in Table 7 to claims for which there was a line item containing a device category code that was in use for services furnished on April 1, 2002 through and including December 31, 2002. We believed that restricting the claims used to set median costs to those that met this criterion resulted in median costs that more accurately reflected relative costs of these services. Moreover, for the APCs in Table 7 we required that the claim not only contain a device code that was valid during the period specified but we also required that the claim must have a particular device code or combination of device codes.

For APC 0313 (high dose rate brachytherapy), we attempted to require both brachytherapy sources HDR Iridium 192 (C1717) and either a catheter (C1728) or needle (C1715) but we found that no single procedure claims met those criteria. Hence, the median for APC 0313 that appeared in the 2003 OPPS final rule was the median for claims that did not meet the specified criteria and it was mistakenly included in Table 10 in the NPRM. For this final rule, we again began by applying the criteria including source and needle or catheter codes, but still no claims met the criteria. Therefore, we sought only single procedure claims that contained brachytherapy sources. We found 27 single procedure claims that met the revised criteria and we used the median cost of $936.52 that resulted from those claims.

D. Other Policy Issues Relating to Pass-Through Device Categories

1. Reducing Transitional Pass-Through Payments To Offset Costs Packaged Into APC Groups

In the November 30, 2001 final rule, we explained the methodology we used to estimate the portion of each APC rate that could reasonably be attributed to the cost of associated devices that are eligible for pass-through payments (66 FR 59904). Beginning with the implementation of the 2002 OPPS update (April 1, 2002), we deduct from the pass- through payments for the identified devices an amount that offsets the portion of the APC payment amount that we determine is associated with the device, as required by section 1833(t)(6)(D)(ii) of the Act. In the November 1, 2002 final rule, we published the applicable offset amounts for 2003 (67 FR 66801).

For the 2002 and 2003 OPPS updates, we estimated the portion of each APC rate that could reasonably be attributed to the cost of an associated pass-through device that is eligible for pass-through payment using claims data from the period used for recalibration of the APC rates. Using these claims, we calculated a median cost for every APC without packaging the costs of associated C codes for device categories that were billed with the APC. We then calculated a median cost for every APC with the costs of associated device category C codes that were billed with the APC packaged into the median. Comparing the median APC cost minus device packaging to the median APC cost including device packaging enables us to determine the percentage of the median APC cost that is attributable to associated pass-through devices. By applying these percentages to final APC rates, we determined the applicable offset amount. We included any APC on the offset list for which the device cost was at least 1 percent of the APC's cost.

As we discussed in our November 1, 2002 final rule (67 FR 66801), the listed offsets are those that may potentially be used because we do not know which procedures would be billed with newly created categories.

After publication of the November 1, 2002 final rule, we received a comment indicating that in some cases it may be inappropriate to apply an offset to a new device category because the device category is not replacing any device whose costs have been packaged into the APC. We agree with this comment

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and proposed to modify our policy for applying offsets. Specifically, we proposed to apply an offset to a new device category only when we can determine that an APC contains costs associated with the device. We specified in the proposed rule that we would continue our existing methodology for determining the offset amount, described above. However, we solicited comments for alternative methodologies for determining the offset amounts that potentially could be applied to the payment amounts for new device categories.

We added that we could use this methodology to establish the device offset amounts for the 2004 OPPS because we are using 2002 claims on which device codes are reported. However, for the 2005 update to OPPS, we proposed to use 2003 claims that would not include device coding. Thus, for 2005, we are considering whether or not to use the charges from lines on the claim having no HCPCS code but have charges under revenue codes 272, 275, 276, 278, 279, 280, 289, and 624 as proxies for the device charges that would have been billed with HCPCS codes for these devices in previous years. We are also considering the reinstitution of the C codes for expired device categories and requiring hospitals to use one or more newly created C codes for identification of devices and costs on claims. See section VI.B of this final rule for further discussion.

We proposed to review each new device category on a case-by-case basis to determine whether device costs associated with the new category are packaged into the existing APC structure.

We reviewed the device categories eligible for continuing pass- through payment in 2004 to determine whether the costs associated with the device categories are packaged into the existing APCs. For the categories existing as of publication of the proposed rule, we determined that there are no close or identifiable costs associated with the devices in our data related to the respective APCs that are normally billed with those devices. Therefore, for these categories we proposed to set the offset to $0 for 2004.

If we create a new device category and determine that our data contain identifiable costs associated with the devices in any APC, we would apply an offset. We proposed, if any offsets apply, for new categories, to announce the offsets in a transmittal that announces the information regarding the new category.

We received several comments on the proposal, which are summarized below along with our responses.

Comment: Device manufacturers and associations generally supported our proposal to modify our policy in applying offsets to only those device categories where we can determine that an APC contains costs associated with the device category. One commenter also recommended that we not apply offsets to those categories that do not replace current devices found in the APC costs.

Response: We will apply an offset to a new device category only when we are able to determine that an APC contains costs associated with the new device. We will also continue our existing methodology for determining any offset amount, if we find that device costs associated with a new device category are packaged into the APCs. We will include information about any applicable offset in the transmittal we issue to announce information regarding the new category.

We also will publish the device percentages related to APCs on our web site. We believe this information is useful to the public even if we do not use the information to apply any particular offset to new device categories, because we use this information to apply the tests of ``not insignificant cost'' to a proposed new device category application. A transitional pass-through device category must have an average cost that is not insignificant in relation to the OPD fee schedule amount, according to section 1833(t)(6)(A)(iv)(II) of the Act. 2. Multiple Procedure Reduction for Devices

In our discussion in the proposed rule of recommendations of the Advisory Panel, we noted that the Panel asked us to analyze our data to determine if we may be underpaying for devices when the multiple procedure policy is applied (68 FR 47976). We made no proposal to change our policy regarding the multiple procedure reduction for device-related APCs, but we did receive a number of comments on the topic.

Comment: Commenters stated that we should change the status indicator (SI) from ``T'' to ``S'' for APCs with packaged device costs so that the multiple procedure discount will not adversely affect the payment for APCs that contain high cost devices. One commenter indicated that no APC for which the device percentage is 50 percent or more should be subjected to a multiple procedure reduction because any such reduction would reduce the Medicare payment below the hospital's cost for the device. The commenter offered to work with us to develop a list of device percentages of APC payments that would not be subject to the multiple procedure reduction. Another commenter suggested that we create a modifier that could be used to override the multiple procedure reduction for certain codes with SI ``T''. Some commenters said that any code that is not subject to the multiple procedure modifier under the Medicare physician fee schedule should be subjected to a multiple procedure modifier under OPPS.

Response: We are concerned that the application of the multiple procedure reduction has been a recurring theme among commenters with regard to APCs that contain significant device costs. We continue to believe that for most cases, including many cases with devices, the payment reductions for the second and subsequent payments are appropriate. This is particularly true given that there must be two procedures with SI=T for the reduction to occur. Hence, if a device procedure is performed with a non-device procedure, the non-device procedure will not be reduced if the device procedure has an SI=S, even if the non-device procedure is less costly because it was done at the same time as the device intense procedure. We are reluctant to change the SIs for device procedures because of the increase that will occur for non-device procedures. The shift in median costs will be picked up in the scaling of relative weights for budget neutrality and will result in some reduction for all services, shifting payment to procedures and away from other services types (for example, E&M, diagnostic tests).

Decisions regarding the application of the multiple procedure SIs are made independently for the Medicare physician fee schedule and the OPPS. The physician fee schedule decision is heavily dependent upon the work performed by the physician and the OPPS decision is made only with regard to the resources the hospital supplies for the service to be performed. There is no reason to believe that a decision to reduce or not reduce for multiple procedures in one system would necessarily justify that same decision in the other system.

For 2004 OPPS we have not changed the policy. However, as we did for 2003 OPPS, we have changed the SI for certain APCs for which we were convinced that the application of the multiple procedure reduction would result in inappropriate payment. For 2005, we hope to analyze the effects of a more systematic approach to determining when we should apply the

[[Page 63440]]

multiple procedure reduction to APCs with high device costs. We hope to develop these possible approaches and discuss them with the APC Panel at its winter meeting.

Prosthetic Urology (APCs 0385 and 0386)

Comment: Commenters said that APCs 0385 and 0386 should be changed from SI=S to SI=T and that the APC Panel agreed and recommended these changes in its August 22, 2003 meeting. The commenters indicated that when a penile prosthesis and a urinary sphincter are both implanted at the same time, while there is some cost efficiency (for example, OR time, recovery room time, drugs, supplies), the cost of the prostheses are such a large part of the cost of the APC that the reduction of the second APC by 50 percent results in less than cost being paid.

Response: For the 2004 OPPS, we have changed the SI for these APCs from T to S, so that when both the prosthesis and sphincter are implanted on the same date, the multiple procedure reduction will not apply to the second device. These APCs each contain a combination of penile prostheses and sphincters. Our data analysis shows that it is not a rare occurrence for both to be implanted on the same day and that each APC has a device percentage in excess of 60 percent. For these reasons, we have changed the SI for these APCs to ``S'' for 2004.

Electrophysiology APCs (APCs 0085, 0086 and 0087)

Comment: Commenters said that APCs 0085, 0086, and 0087 should not be subject to the multiple procedure reduction because the devices used in these procedures are not less costly when the second procedure is done on the same day. Commenters said that these procedures have become so advanced that they now are commonly done on the same day and that the multiple procedure reduction significantly reduces the payments below what they were paid when they were done on subsequent days. A commenter suggested that we should create a combination APC for APCs 0085, 0086 and 0087 or for APCs 0085 and 0086 since these are often performed on the same day and the commenter believes that the multiple procedure reduction improperly reduces payment for them.

Response: We have not changed the SI for these APCs because we do not believe that such a change is warranted. Although devices are integral to these APCs, the device portion of the median is not very significant. Each has a device percent lower than 35 percent (APC 0085 = 25.61 percent, APC 0086=34.77 percent, APC 0087= 30 percent). Moreover, we believe that there is efficiency in performing these procedures on the same day in the outpatient setting, which is why hospital practice has changed. Therefore, we are retaining these procedures as SI=T for 2004.

Implantation or Revision of Pain Management Catheter; Implantation of Drug Infusion Device (APCs 0223 and 0227)

Comment: A commenter indicated that the same rationale that applies to implantation of neurostimulators (discussed immediately preceding) applies to APCs 0223 and 0227 and that therefore, the multiple procedure reduction should not apply.

Response: We are not convinced by the comment that it would be appropriate to change the SI for APCs 0223 and 0227 from ``T'' to ``S''. We believe that there are economies of scale that cause these procedures to allow for appropriate payment when they are performed with other procedures.

Left Ventricular Leads (APCs 0105, 1547 and 1550)

Comment: A commenter indicated that placement of a Left ventricular lead (CPT code 33224, 33225, and 33226, APCs 0105, 1547 and 1550 respectively) should not be subjected to the multiple procedure reduction.

Response: We have reviewed the codes contained in these APCs and we are not convinced that it would be appropriate to change the SI for these APCs.

VI. Payment for Drugs, Biologicals, Radiopharmaceutical Agents, Blood, and Blood Products

A. Pass-Through Drugs and Biologicals

In the proposed rule, we expressed concern about the extent to which Medicare pays more for pass-through drugs than other payers and more than the market-based price of drugs. To address this problem of how to pay appropriately for drugs that are priced using the AWP, we are developing regulations that would revise the current payment methodology for Part B covered drugs paid under section 1842(o) of the Act. We proposed to adopt and apply the provisions of the final AWP rule to establish the AWP of pass-through drugs payable under the OPPS. If implementation of the AWP final rule necessitates mid-year changes in the 2004 OPPS payment rates for pass-through drugs, we proposed to make those changes on a prospective payment basis through our regular OPPS Transmittal process and PRICER quarterly updates. We further proposed to issue instructions by program memorandum regarding implementation of the provisions of the AWP final rule to set payment rates for pass-through drugs under the OPPS.

We stated that if the AWP final rule is not issued in time to permit us to apply its provisions to price pass-through drugs furnished on or after January 1, 2004, we proposed to use 95 percent of the AWP listed in the most recent quarterly update of the Single Drug Pricer (SDP). If a drug with pass-through status is not included in the SDP, we proposed to forward to the SDP contractor the AWP information submitted as part of the pass-through application for calculation of an allowed payment amount.

Because the January SDP would not be available in time, we proposed to announce the January 1, 2004 prices for pass-through drugs in our January 2004 OPPS implementing instructions to fiscal intermediaries and in the January 2004 OPPS PRICER rather than in the 2004 final rule, which is to be published in the Federal Register by November 1, 2003. We further proposed to update the AWP for pass-through drugs paid under the OPPS on a quarterly basis in accordance with the quarterly updates of the SDP. The updated rates for pass-through drugs and biologicals would also be issued through our quarterly OPPS program memoranda and PRICER updates.

Comment: A national hospital association supported our proposal to use the SDP to determine the payment amount for pass-through drugs and biologicals. However, the same commenter expressed concern about not having accurate 2004 information on AWP until after the 2004 OPPS is implemented, which would make it impossible to predict pass-through spending and not give hospitals enough time to update their billing systems. The commenter also opposed our proposal to update the AWP for pass-through drugs on a quarterly basis because it would result in increased confusion and burden on hospitals to make quarterly price changes and could result in CMS having to make quarterly adjustments to the pass-through pool to recalculate the relative payment weights for all APCs.

A provider expressed reservations about the impact of the AWP rule, which could precipitate a shift in care from physicians' offices to hospitals. This commenter recommended that we determine pass-through payment

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amounts using market applications by drug manufacturers and acquisition data solicited from the hospital industry through group purchasing organizations and individual hospitals and systems. The same commenter encouraged us to delay changes in pass-through payments pending an assessment of the impact of the AWP rule on physician practices.

Response: We wish to clarify how our use of the SDP to price pass- through drugs will affect the OPPS in 2004. The payment rates for pass- through drugs and biologicals that are shown in Addendum B are based on the April 1, 2003 SDP, which was the update that was available when we recalibrated the relative payment weights for this final rule. We also used these payment rates as the basis for estimating pass-through spending in 2004, which is discussed in section IV of this preamble.

We have carefully considered the commenter's concern about the confusion that could result if we were to revise the payment amounts for pass-through drugs and biologicals by installing prices from the January 2004 update of the SDP in the OPPS PRICER for implementation beginning January 1, 2004. We agree with the commenter that, because of the timing, this proposal could create operational problems both for providers and for our claims processing systems. Therefore, we will retain the payment amounts published in this final rule as the payment amounts for pass-through drugs effective January 1, 2004.

Further, to keep quarterly changes to a minimum, we have decided not to implement at this time our proposal to update the AWP for pass- through drugs paid under the OPPS on a quarterly basis in accordance with quarterly SDP updates.

At this time, we are not implementing the AWP rule. Therefore, we are not making final the OPPS changes we proposed that would have resulted from the AWP rule.

Comment: Several commenters were concerned about the delay in processing pass-through applications and assigning c-codes for new drugs and biologicals. Commenters believed that the lack of immediate payment under OPPS for new FDA-approved drugs and biologicals may drive hospitals to discontinue providing innovative life-saving therapies to Medicare beneficiaries until pass-through payments are established. Another commenter suggested that CMS create and regularly update a central on-line listing of all current codes for pass-through drugs, biologicals, and devices. The Web site should also list all pass- through drug and device applications under review, and their status in the review process.

Response: We understand the concerns expressed by commenters about the impact of the time gap from FDA approval to our c-code assignment and payment for new pass-through items; however, our position on this issue remains the same as that described in the November 1, 2002 final rule (67 FR 66780-81).

B. Drugs, Biologicals, and Radiopharmaceuticals Without Pass-Through Status

1. Background

Under the OPPS, we currently pay for radiopharmaceuticals, drugs, and biologicals including blood, and blood products, which do not have pass-through status, in one of three ways: packaged payment, separate payment (individual APCs), and reasonable cost. As we explained in the April 7, 2000 final rule (65 FR 18450), we generally package the cost of drugs and radiopharmaceuticals into the APC payment rate for the procedure or treatment with which the products are usually furnished. Hospitals do not receive separate payment from Medicare for packaged items and supplies, and hospitals may not bill beneficiaries separately for any such packaged items and supplies whose costs are recognized and paid for within the national OPPS payment rate for the associated procedure or service. (Transmittal A-01-133, a Program Memorandum issued to Intermediaries on November 20, 2001, explains in greater detail the rules regarding separate payment for packaged services). As we explained in the November 1, 2002 final rule (67 FR 66757), we do not classify diagnostic and therapeutic radiopharmaceutical agents as drugs or biologicals as described in section 1861(t) of the Act.

Comment: Several trade associations and manufacturers urged CMS to revise its policy that radiopharmaceuticals are not drugs. They emphasized that radiopharmaceuticals go through the same FDA approval process as drugs, are approved for inclusion in the United States Pharmacopoeia Drug Indication, and have historically been considered drugs under OPPS. They indicated that Congress is considering a legislative clarification that under OPPS radiopharmaceuticals will continue to be treated and paid as drugs.

Response: We appreciate the comments on this issue. We do not intend, by our designation of radiopharmaceuticals for purposes of determining which items are eligible for pass-through status, to imply that radiopharmaceuticals are not considered drugs under the Food, Drug, and Cosmetic Act or that they are not subject to the same FDA approval process as those items that we have designated as drugs. However, we will continue to consider radiopharmaceuticals as neither a drug nor biological. Our reasons were set forth in the November 1, 2002 final rule (67 FR 66757). In that rule, we stated that a careful reading of the statutory language in section 1861(t)(1) convinces us that inclusion of an item in, for example, the USPDI, does not necessarily mean that the item is a drug or biological. Inclusion in such a reference (or approval by a hospital committee) is a necessary condition for us to call a product a drug or biological, but it is not enough. CMS must make its own determination that a product is a drug or biological for OPPS purposes under its governing statutes, and this determination is different from and does not affect FDA's determination that a product is a drug or biological under the Food, Drug, and Cosmetic Act.

While we have determined that radiopharmaceuticals are not drugs under the OPPS, we have chosen to establish separate payment for radiopharmaceuticals under the same packaging threshold policy that we apply to drugs and biologicals. We have also determined that we will apply the same adjustments to the median costs for radiopharmaceuticals that will apply to non-pass-through, separately paid drugs and biologicals.

Payment for New Radionucliide Therapy for Certain Forms of Non-Hodgkins Lymphoma

Currently, payment for the radiopharmaceutical Zevalin (Ibritumomab Tiuxetan) is packaged into the payment for HCPCS codes G0273 (Pretx planning, non-Hodgkins) and G0274 (Radiopharm tx, non-Hodgkins). To ensure consistency with our payment policy for other radiopharmaceuticals (that is, making separate payment for radiopharmaceuticals whose costs are greater than $150 per episode of care), we proposed to make payment for Zevalin (ibritumomab tiuxetan) separately from payment for the procedures with which Zevalin (ibritumomab tiuxetan) is used.

We proposed to use HCPCS A9522 (Indium 111 ibritumomab tiuxetan) to report the use of In-111 Zevalin (In-111 Ibritumomab Tiuxetan) and HCPCS A9523 (Yttrium 90 ibritumomab tiuxetan) to report the use of Y90 Zevalin (Y90 Ibritumomab Tiuxetan). We proposed to place HCPCS A9522 in

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APC 9118 with a payment amount of $2,084.55 and HCPCS A9523 in APC 9117 with a payment amount of $18,066.09. We note that payment rates for radiopharmaceuticals are not subject to wage index adjustments because no portion of the payment is attributed to labor-related costs.

Because we proposed that payment for G0273 and G0274 no longer include payment for Zevalin, we also proposed to place G0273 into newly created APC 0406 and G0274 into newly created APC 0408. These APCs include procedures that are similar clinically and in terms of resource consumption to G0274 and G0273, respectively.

Zevalin (ibritumomab tiuxetan) is a radioimmunotherapy that is used to treat patients with certain forms of non-Hodgkin's lymphoma (NHL). Medicare began payment under the OPPS for Zevalin services furnished on or after October 1, 2002.

On June 27, 2003, the FDA approved the manufacture and sale of Bexxar (tositumomab and Iodine I 131 tositumomab), which is another radioimmunotherapy used to treat patients with certain forms of non- Hodgkin's lymphoma. Both Zevalin and Bexxar are therapeutic regimens administered in two separate steps: The first step is diagnostic to determine radiopharmaceutical biodistribution of radiolabeled antibodies; the second step is the therapeutic administration of targeted radiolabeled antibodies.

On September 8, 2003, we issued a One Time Notification (Transmittal 1, Change Request 2914) to implement payment for Bexxar effective for services furnished on or after July 1, 2003. We instructed hospitals to bill for Bexxar using HCPCS codes G0273 (Pretx planning, non-Hodgkins), G0274 (Radiopharm tx, non-Hodgkins), and G3001 (Administration and supply of tositumomab, 450mg). Publication deadlines precluded our being able to address payment for Bexxar in the August 12, 2003 proposed rule.

Comment: A major hospital association, a nuclear medicine specialty organization, several providers that treat cancer patients, and two radiopharmaceutical manufacturers submitted comments regarding the changes we proposed to the coding and payment for Zevalin (ibritumomab tiuxetan) under the 2004 OPPS. The commenters agree with our proposal to separate payment for Zevalin from the payment for the procedure and to pay for Zevalin using HCPCS codes A9522 and A9523, which would not be subject to a wage index adjustment. One commenter noted that the HCPCS descriptors for A9522 and A9523 define the unit of service as ``per millicurie,'' but that the payment we proposed for these two codes appeared to be a total payment amount rather than a per millicurie rate. Several commenters recommended that the code descriptors for A9522 and A9523 be revised to read ``per dose'' rather than ``per millicurie.''

Response: We appreciate the commenters'' support of our proposal to pay for Zevalin separately from its administration. We also agree with the commenter who suggested that the payment rate proposed for A9522 and A9523 was incorrectly shown as a total payment amount rather than a per millicure rate, and we have made certain that the final payment amounts implemented in the 2004 update are consistent with the code descriptor for the service. We further agree with the recommendation of commenters that the HCPCS descriptors for Indium 111 ibritumomab tiuxetan and Yttrium 90 ibritumomab tiuxetan would be less confusing if expressed in terms of dose rather than millicuries. However, the descriptors for A9522 and A9523 were established by the HCPCS National Panel through the process described on our Web site at http://www.cms.hhs.gov/medicare/hcpcs/ , and such a descriptor change could not be applied for in time for January 1, 2004 implementation of the OPPS. Therefore, we are establishing two temporary C-codes for hospitals to use to bill under the OPPS for Indium 111 ibritumomab tiuxetan and Yttrium 90 ibritumomab tiuxetan, for services furnished beginning January 1, 2004, as follows:

C1082, Supply of radiopharmaceutical diagnostic imaging agent, indium-111 ibritumomab tiuxetan, per dose

C1083, Supply of radiopharmaceutical therapeutic imaging agent, Yttrium 90 ibritumomab tiuxetan, per dose

Comment: One commenter recommended that we create separate codes that parallel A9522 and A9523 to bill for Bexxar (tositumomab and I-131 tositumomab).

Response: We are establishing two temporary C-codes for hospitals to use to bill under the OPPS for I-131 tositumomab for services furnished beginning January 1, 2004, as follows:

C1080, Supply of radiopharmaceutical diagnostic imaging agent, I- 131 tositumomab, per dose

C1081, Supply of radiopharmaceutical therapeutic imaging agent, I- 131 tositumomab, per dose

Comment: Several commenters recommended that we discontinue use of HCPCS codes G0273 and G0274 to describe the administration of Zevalin and that, instead, we instruct hospitals to report new CPT code 78804, Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent(s); whole body, requiring two or more days imaging, and new CPT code 79403, Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion. One commenter expressed concern about our proposal to assign G0273 for pre-treatment planning and administration of the diagnostic dose to APC 0406, Tumor/ Infection Imaging because the payment rate proposed for APC 0406 ($258.10) is inadequate to pay for the cost of the scans required to measure the distribution of the radiopharmaceutical agent. The same commenter agreed with our proposal to assign G0274 for administration of the therapeutic dose to APC 0408, with a proposed payment rate of $217.16.

Response: We agree with the commenters' recommendations that we replace HCPCS codes G0273 and G0274 with CPT codes 78804 and 79403, respectively. We will direct our contractors to instruct hospitals to use CPT code 78804 to report administration of the diagnostic dose of ibritumomab tiuxetan and I-131 tositumomab and to report CPT code 79403 to report administration of the therapeutic dose of ibritumomab tiuxetan and I-131 tositumomab. We also agree with the concern of commenters that the payment amount for APC 0406 in the final rule is insufficient for administration of the diagnostic radiolabeled antibodies plus the imaging required to determine radiopharmaceutical localization of tumor(s) and distribution of the radiopharmaceutical agent. Therefore, we are assigning CPT code 78804 to New Technology APC 1508, which has a payment rate of $650. After we have had an opportunity to collect claims data that indicate hospital costs for this procedure, we will re-evaluate its APC assignment. Further, there are several additional expenses associated with these innovative radioimmunotherapies used to treat patients with certain forms of non- Hodgkin's lymphoma, which we discuss below. We are therefore assigning CPT code 70403 to New Technology APC 1507, until we have collected sufficient data to confirm the appropriate clinical APC for this service.

Comment: Several commenters expressed concern that our proposed payment for Zevalin ($2,084.55 for the diagnostic dose of indium and $18,066.09 for the therapeutic dose of

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yttrium) would be approximately $2,000 less than what it costs a hospital to purchase Zevalin from a nuclear pharmacy, thereby jeopardizing beneficiary access to this therapy. One commenter submitted information from a nuclear pharmacy attesting that it has dispensed 2,068 patient-specific doses of Zevalin nationwide (1,071 Indium doses and 997 Yttrium doses) and that its current charges are $2,260 per dose of Indium-111 Zevalin and $19,565 per dose of Yttrium- 90 Zevalin. The commenter stated that this represents nearly 80 percent of all Zevalin doses dispensed between product launch in April 2002 through June 30, 2003.

Another commenter expressed concern about the adverse impact that the proposed reduction in payments for Zevalin could have on payment for Bexxar in 2004. The commenter urged us not to base payment for Bexxar on what we proposed for Zevalin but, rather, on hospital acquisition costs for Bexxar, which approximate the wholesale acquisition cost (WAC) of $2,250 for the diagnostic dose and $19,500 for the therapeutic dose.

Response: Although we established a code to enable hospitals to bill for and receive separate payment for Zevalin effective October 1, 2002, hospitals could only report this code through December 31, 2002. (Effective January 1, 2003, we combined payment for Zevalin with its administration, using HCPCS codes G0273 and G0274.) Our 2002 claims data are insufficient to allow us to calculate a median cost for Zevalin. Because Bexxar was approved by the FDA in June 2003, it was not billed at all in 2002. Therefore, we cannot determine payment rates for either radiopharmaceutical based on the standard methodology that we use to calculate the other APC relative payment weights and rates. In instances where we lack adequate data upon which to base a payment rate, we have relied wholly or in part on external data as the basis for rate setting. For example, in the absence of claims data, we use data submitted in applications for new technology status to enable us to assign a service to an appropriate new technology APC. Elsewhere in this final rule, we discuss how we are using external data to set 2004 payment rates for certain other services and procedures.

We received information consistent with our request for verifiable data (68 FR 47998) that indicates the payment amounts we proposed for A9522 and A9523 in the proposed rule do not reflect the price for Zevalin that is widely available to the hospital market.

Therefore, we are making final the following payments, effective for services furnished on or after January 1, 2004:

For HCPCS code C1080 (APC 1080) the payment is $2,260;

For HCPCS code C1081 (APC 1081) the payment is $19,565; For HCPCS code C1082 (APC 9118) the payment is $2,260;

For HCPCS code C1083 (APC 9117) the payment is $19,565.

Comment: One commenter expressed concern about the inadequacy of the 2003 payment rate ($2,159) that we established for HCPCS code G3001, Administration and supply of tositumomab, 450mg. The commenter noted that the WAC for unlabeled tositumomab is $2,125, and that a payment amount of $2,159 is not sufficient to pay hospitals for both the acquisition of unlabeled tositumomab and its administration. The commenter was also concerned that packaging the unlabeled antibody tositumomab with its administration and assigning it to an APC that is subject to wage adjustment would result in large payment differences across the country. The commenter noted that the unlabeled antibody rituximab, which is used with Zevalin therapy, is a separately payable drug and therefore not subject to wage index adjustments. The commenter recommended that we either increase the payment rate for G3001 and exempt it from wage adjustment or that we create a new code for unlabeled tositumomab, assign a payment rate that reflects its acquisition cost, and pay separately for its administration using HCPCS code Q0084.

Response: After carefully reviewing the commenter's concerns, we have assigned HCPCS code G3001 to New Technology APC 1522, which has a payment rate of $2,250. Unlabeled tositumomab is not approved as either a drug or a radiopharmaceutical, but is a supply that is required as part of the Bexxar treatment regimen. Therefore, we do not agree with the commenter's recommendation that we assign a separate new code to unlabeled tositumomab. Moreover, administration of unlabeled tositumomab is a complete service that qualifies it for assignment to a New Technology APC. We believe that the increased payment resulting from assignment of G3001 to New Technology APC 1522 will be sufficient to enable hospitals to acquire and administer unlabeled tositumomab, notwithstanding application of a wage adjustment.

Comment: One commenter recommended that we modify the payment amounts for the existing codes used to bill for Bexxar or that we establish new codes to recognize the costs of patient evaluation, education, and clearance for radiation safety purposes as well as the costs of compounding Bexxar by radiopharmacies. The same commenter suggested that, as an alternative to establishing a new code for the costs associated with the procedures required for patient safety and education when Bexxar is used, we allow hospitals to report an appropriate Evaluation and Management code for patient evaluation, education, and clearance when receiving diagnostic or therapeutic services involving radioisotopes.

Response: We disagree with the commenter's recommendation that an additional code is needed to pay for radiopharmacy compounding costs or that an allowance of $1,000 should be added to the payment for the both diagnostic and therapeutic doses of Bexxar to offset these costs. We believe that the rates we are implementing in this final rule, as discussed above, provide sufficient payment for radiopharmacy compounding or delivery costs that hospitals may incur when using Bexxar or Zevalin. We have carefully considered the commenter's recommendation that hospitals be allowed to bill an appropriate evaluation and management code for patient evaluation, education, and clearance following procedures involving radioisotopes. We recognize that special requirements may have to be met before releasing a patient following exposure to a high dose of radiation. We would expect the patient's physician to provide, and bill for separately with appropriate documentation, a significant portion of the preparation and education needed by a patient being treated with Zevalin or Bexxar. However, to the extent that qualified hospital staff are required to provide additional face-to-face patient education and instructions before the patient's release following radioimmunotherapy, the hospital may bill an appropriate evaluation and management code as long as the medical record documents that the services are medically necessary and that they constitute a distinct, separately identifiable evaluation and management service that is consistent with the hospital's criteria for that service.

Drugs and Biologicals for Which Pass-Through Status Will Expire in 2004

Section 1833(t)(6)(C)(i) of the Act specifies that the duration of transitional pass-through payments for drugs and biologicals must be no less

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than 2 years nor any longer than 3 years. The drugs and biologicals that are due to expire on December 31, 2003 meet that criterion. Table 11 lists the drugs and biologicals for which pass-through status will expire on December 31, 2003.

Table 11.--List of Drugs and Biologicals for Which Pass-Through Status Expires CY 2004

Pass-through HCPCS

APC

Long descriptor

Trade name

expiration date

C9202............ 9202 Injection, suspension of microspheres of human Optison (single

12-31-03 serum albumin with octafluoropropane, per 3ml. source). J0587............ 9018 Injection, Botulinum toxin, type B, per 100 Myobloc (single

12-31-03 units.

source). J0637............ 9019 Injection, Caspofungin acetate, 5 mg.......... Cancidas (single

12-31-03 source). J7517............ 9015 Mycophenolate mofetil, oral per 250 mg........ CellCept (single

12-31-03 source). J9010............ 9110 Injection, Alemtuzumab, per 10 mg............. Campath (single

12-31-03 source). J9017............ 9012 Injection, Arsenic trioxide, per 1 mg......... Trisenox (single

12-31-03 source). J9219............ 7051 Implant, Leuprolide acetate, per 65 mg implant Viadur (single

12-31-03 source).

Comment: A commenter requested that we maintain transitional pass- through status for this biological through calendar year 2004. The commenter indicated that Dermagraft was approved as a pass-through device effective October 1, 2000 through March 31, 2001, by which time CMS had concluded that Dermagraft should be classified as a biological for payment purposes. Dermagraft later re-qualified for pass-through status as a biological effective April 1, 2002. The commenter stated that CMS should not count the time Dermagraft was on the pass-through list as a device to determine whether this product received a minimum of 2 years under pass-through status.

Response: We agree with the commenter and will retain Dermagraft in pass-through status through December 2004.

Comment: The manufacturer of an ultrasound contrast agent, Optison (APC 9202, C9202), expressed concern about our decision to retire their product from pass-through status on December 31, 2003. The manufacturer indicated that two of Optison's competitors, Definity (C9112) and Imagent (C9203) will remain pass-throughs in 2004 and receive higher payments, while payment for Optison will be based on median cost calculated from hospital claims data. The commenter was concerned about differential OPPS payments to hospitals for clinically similar products and recommended that we should either allow all of these agents to remain on pass-through status until December 31, 2004, or remove them and use claims data to establish a uniform payment rate for 2004.

Response: As stated above, section 1833(t)(6)(C)(i) of the Act specifies that transitional pass-through payments for drugs and biologicals must be made for at least for 2 years but not more than 3 years. Pass-through payment for Optison was established on April 1, 2001, while Definity and Imagent received pass-through status on April 1, 2002 and April 1, 2003, respectively. Since hospitals have been billing for and receiving pass-through payments for Optison for at least 2 years, we have the statutory authority to remove this item from pass-through status. Since pass-through payments for Definity and Imagent have not exceeded the minimum 2-year period yet, these products will retain their special status in 2004. In the absence of verifiable external data, the 2004 payment rate for Optison was calculated using hospital claims data from April through December 2002 and was eligible for dampening. 2. Criteria for Packaging Payment for Drugs, Biologicals, and Radiopharmaceuticals

To the maximum extent possible, our intention is to package into the APC payment the costs of any items and supplies that are furnished with an outpatient procedure. For 2004, we proposed to continue with our policy of paying separately for drugs and radiopharmaceuticals whose median cost per day exceeds $150 and packaging the cost of drugs and radiopharmaceuticals with median cost per day of less than $150 into the procedures with which they are billed. In the proposed rule, we set forth the methodology we used to calculate the median cost per day for drugs, biologicals, and radiopharmaceuticals (68 FR 47996- 47997).

We proposed to provide an exception in 2004 to the packaging rule for drugs and radiopharmaceuticals whose payment status would change as a result of using newer data. For 2004, we proposed that:

[sbull] Currently packaged drugs and radiopharmaceuticals with median costs per day at or above $150 would receive separate payment in 2004.

[sbull] Currently separately payable drugs and radiopharmaceuticals with median costs per day under $150 would continue to receive separate payment in CY 2004.

[sbull] Drugs whose pass-through status would expire on December 31, 2003, and whose median costs per day are under $150 would receive separate payment in 2004.

[sbull] Currently packaged drugs and radiopharmaceuticals with median costs per day below $150 would remain packaged in 2004.

We requested comments on the methodology we used to determine the median cost per day, on the threshold we proposed to use for packaging drugs and radiopharmaceuticals, and on the proposal to pay separately for drugs and radiopharmaceuticals whose payment status would change based on use of recent claims data and our proposed methodology. We also requested comments on alternatives to packaging.

We received many comments on our proposals, which are summarized below along with our responses.

Comment: We received many comments from patient advocates, individual clinicians, physician and nursing professional associations, individual hospitals, and manufacturers and their representatives that expressed significant concerns over our proposal to continue the 2003 policy under which we package the cost of most drugs, biologicals and radiopharmaceuticals that cost $150 or less. We also received several comments from major provider groups in support of the packaging proposal and recommending a higher threshold. One such organization recommends that we study this issue further to develop a more appropriate long-term solution.

Commenters who disagreed with the proposal to package drugs, biologicals and radiopharmaceuticals costing $150 or less believe that the proposed rates for the drug administration codes do not adequately address the costs of hospitals to administer these drugs. Several commenters conducted their own analyses of this issue in conjunction

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with the proposals for drug administration discussed elsewhere in this final rule. For many of these commenters, the issues of packaging, drug payment rates and our discussion of drug administration in the proposed rule were intertwined. Some commenters that disagreed with our $150 packaging threshold asserted that most visits involve delivery of drugs that had been designated as packaged and that overpayment for visits with no packaged drugs is small compared to the overall underpayment of both packaged and separately payable drugs. Particular concern was expressed about the packaging of cancer chemotherapy drugs. One commenter stated that the dosages may vary significantly, and where given in high doses the cost for a single drug alone may exceed the total packaged payment. Also, commenters stated that several packaged drugs are often administered during a single infusion, and where the cost of a single packaged drug may be less than $150 the cost of multiple packaged drugs is often greater than $150.

Several commenters indicated that the methodology and cost data we used to calculate the median cost per day for drugs and radiopharmaceuticals were based on incorrectly coded claims where the wrong number of units were reported and a very limited number of single claims were captured which failed to portray the hospitals' charges appropriately. Therefore, certain high cost items fell below the $150 threshold.

Commenters expressed concern about patient access to effective but lower cost drugs and the disincentive we may create by paying separately for those over $150 per day. One organization stated that cancer centers have reported that they have taken or are considering steps to restrict patient access to those drugs that we have packaged. One hospital estimated that it would lose approximately $490 per visit for a patient receiving chemotherapy due to the $150 packaging rule and the proposed reductions in payments for certain drugs. While some commenters expressed general concerns about packaging the costs of any drugs, biologicals or radiopharmaceuticals, other commenters recommended that we apply a $50 threshold in lieu of the proposed $150 threshold in determining which items to pay for separately. Some of the commenters recommending a $50 threshold cited statutory changes under consideration by Congress that would mandate a $50 threshold.

Response: For 2004, we have established a $50 median cost per day threshold in determining whether drugs, biologicals and radiopharmaceuticals will be packaged. Those items that fall below the threshold will be packaged into the costs of the service or procedure with which they are billed; those items with median costs above the threshold will be paid for separately in 2004.

We analyzed our data in determining our final drug administration coding and payment policy, as discussed elsewhere in this final rule, and reviewed the median costs of all APCs under both a $150 and a $50 packaging rule. We concluded that there was not a sufficient difference in the median costs under those two scenarios, resulting in inadequate payment when drugs, biologicals and radiopharmaceuticals costing between $50 and $150 would be used by the hospital. Therefore, we agree with the majority of commenters that, for 2004, the appropriate threshold should be $50.

We also recognize, as several commenters did, that packaging creates incentives for hospital efficiencies and will continue to apply that concept to devices, most supplies and equipment associated with a procedural APC, and low cost drugs. However, we are convinced that under our current methodology for establishing relative weights, that packaging drugs, biologicals and radiopharmaceuticals costing in excess of the $50 threshold per patient per day would not provide adequate payment in 2004 and could adversely affect beneficiary access to important therapies. Nevertheless, our final decision for 2004 does not mean that a change in our methodology for establishing relative weights in the future could not cause us to revisit our packaging policy in the future. Since we have lowered the packaging threshold from $150 to $50, we will not adopt the proposal to provide an exception to the packaging rule for drugs and radiopharmaceuticals whose payment status would change from 2003 to 2004 as a result of using newer 2002 data.

However, we note several exceptions to our policy of packaging drugs, biologicals and radiopharmaceuticals for which the median per day cost is less than the $50 threshold. As discussed elsewhere in this final rule, we will allow separate payment under the OPPS for all blood and blood products and for single indication orphan drugs. We will also allow separate payment for hepatitis B vaccine under the OPPS. While the median per day costs for several hepatitis B vaccine codes fell below the $50 threshold using the final rule data, we believe that continued separate payment for these codes is warranted given the special, separate benefit category established by Congress. Separate payment for influenza and pneumococcal vaccines will continue to be made outside of the OPPS on a reasonable cost basis. 3. Payment for Drugs, Biologicals, and Radiopharmaceuticals That Are Not Packaged

In order to establish payment rates for separately payable drugs and radiopharmaceuticals for the 2004 OPPS, we first determined median cost for each drug and radiopharmaceutical per unit. When we compared the median cost per unit used for determining the 2003 payment rate (for example, the true or dampened median cost) for separately payable drugs and radiopharmaceuticals with their 2004 median cost per unit, we found fluctuations in costs from 2003 to 2004.

We solicited comments concerning the reasons for the fluctuations in median costs from 2003 to 2004. We stated our interest in determining whether these fluctuations reflect changes in the market prices of these drugs and radiopharmaceuticals or problems in the hospital claims data (for example, inaccurate coding, improper charges) that we use for setting payment rates.

In the proposed rule, we discussed in detail several options we considered to address the fluctuations in median costs for separately payable drugs and radiopharmaceuticals (68 FR 47997-47998). The option that we proposed for 2004 was a variation of the methodology used for the 2003 OPPS. For separately payable drugs and radiopharmaceuticals whose 2004 median costs decreased by more than 15 percent from the applicable 2003 median cost, we proposed to limit the reduction in median costs to one fourth of the difference between the value derived from claims data and a 15 percent reduction (for example, for a drug whose cost decreased by 35 percent from the applicable 2003 median cost, the allowed reduction from 2003 to 2004 would be 15 percent + (\1/4\ times 35 - 15) percent = 20 percent). For separately payable drugs and radiopharmaceuticals whose median costs decreased by less than 15 percent from 2003 to 2004, we proposed to establish their payment rates using the median costs derived from the 2002 claims data. We stated that, based on more complete claims data we expected to have for the final rule and on the comments from the public, we would re- evaluate the appropriateness of adjusting median costs for drugs for which median costs would decline in 2004.

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We also proposed a separate payment policy for drugs, biologicals, and radiopharmaceuticals for which generic alternatives have been approved by the Food and Drug Administration (FDA) between October 2001 and December 2002.

We solicited comment on both our proposed methodology and payment rates for separately payable drugs and radiopharmaceuticals for 2004. We requested that commenters who disagree with the proposed rate for a drug or radiopharmaceutical submit verifiable information to support their opinions that the proposed rate is inaccurate and does not reflect the price that is widely available to the hospital market.

We received a number of comments on our payment methodology options for separately payable drugs, biologicals, and radiopharmaceuticals. Those comments are summarized below along with our responses.

Comment: We received a number of comments noting disagreement with the proposed payment rates for separately paid drugs, biologicals and radiopharmaceuticals overall. Many of these comments were included in the comments on our packaging proposal, summarized above, and expressed some of the same concerns, such as restrictions to patient access, particularly to cancer chemotherapy drugs. One hospital commenting on the proposed rates stated that, as with most hospitals, they continually attempt to leverage buying power to reduce the costs of drugs but, like most hospitals, have been unable to do so for certain drugs. Commenters asked that we critically review the data used to establish the payment rates including consideration of the charge compression issue. Commenters stated that the proposed payments would not cover the direct acquisition costs of certain items.

A number of commenters objecting to our proposed payment rates stated that the hospital data that we use to calculate those rates are flawed and that the methodology we employ to convert hospital claims data to relative weights is problematic. Commenters attributed these concerns to issues such as hospital billing practices that result in inaccurate reporting of units or charges, HCPCS coding changes, and the use of cost-to-charge ratios across all products regardless of whether an item is high or low cost.

We received numerous comments on alternatives to our proposed policies for separately payable drugs and radiopharmaceuticals. One commenter suggested that we pay the amount of the hospital's acquisition cost plus an additional 25 percent to pay for costs of receiving, processing and storing the items. Other comments suggested that we limit the decreases for all separately paid drugs to a reduction of 10 percent in the payment rates, as we proposed for blood and blood products, instead of our proposed policy of limiting reductions in median costs for those separately paid items with median costs with reductions greater than 15 percent. Another suggestion was that we establish a payment rate floor for a product that could be raised if a manufacturer submitted information demonstrating that the rate should be higher than the floor.

Several commenters indicated that we should use only claims that have the appropriate administration or procedure code and the HCPCS code for a particular drug or radiopharmaceutical when determining the median cost for that drug or radiopharmaceutical. One commenter recommended that we pay for drugs and biologicals at 95% AWP to standardize payments for drugs and biologicals across different practice settings. Another commenter requested that we establish payment floors that are equal to those in the pending Congressional Medicare legislation (for example, certain sole source drugs would be paid at least 88 percent of AWP in 2004); whereas another drug manufacturer recommended that we use the Federal Supply Schedule price plus a certain percentage (for example, 12.5 percent) as an absolute minimum payment amount for drugs and radiopharmaceuticals.

In addition to the comments regarding our proposed payment rates for drugs, biologicals and radiopharmaceuticals overall, we received comments concerning the proposed rate for specific items. For a few of those items, we received external cost data that met the preferred criteria we set forth in our proposed rule (for example, non- proprietary data that demonstrates actual, market-based prices at which a broadly-based national sample of hospitals were able to procure the item). Several commenters suggested that we substitute external data on hospital acquisition cost for median costs calculated from our claims data when determining the payment rate for drugs and radiopharmaceuticals for which we have received such data. Others recommended that we use external data to benchmark payment for drugs and radiopharmaceuticals and make appropriate adjustments to the proposed 2004 payment levels. Even though most commenters supported the use of external data in place of hospital claims data, a national hospital association expressed concern about the use of external data in OPPS. The commenter indicated that if external data is used for rate setting in 2004, then we may have to continue to collect data on acquisition cost for future years to be able to continue to adjust the weights. Instead, the commenter was supportive of using claims data to set payment rates without the use of external data and urged us to remain committed to the averaging process inherent in the prospective payment system.

Response: We have decided to adopt the general principle proposed in our August 12, 2003 proposed rule limiting the reduction in median costs to one-fourth of the difference between the value derived from our claims data and a 15 percent reduction. For example, a drug whose median cost decreased by 35 percent from the median cost used to establish the separate payment rate for 2003 would be 15 percent + (\1/ 4\ times 35-15) percent, or 20 percent. However, we will not apply this methodology to the medians of those drugs, biologicals and radiopharmaceuticals that are packaged in 2003 but for which we will allow separate payment in 2004. Payment for drugs, biologicals and radiopharmaceuticals that emerge from packaged status in 2004 because their median per day costs are greater than $50 per day will be based on the unadjusted median cost derived from our April-December 2002 claims data. Since these items are packaged in 2003, we did not calculate any adjusted medians on which to base their payments on for 2003. Thus, we are unable to determine the extent to which their median costs fluctuate from 2003 to 2004.

As discussed in our proposed rule and elsewhere in this final rule, we used a more complete set of claims for the April-December 2002 claims period and the most recently submitted cost report data to calculate median costs for all currently separately paid drugs, biologicals and radiopharmaceuticals. Our analysis of the later and more complete data revealed that a number of these items continued to experience a decline of more than 15% in median cost. We again considered several options to address the fluctuations in medians, which for some items would result in wide fluctuations in payments to hospitals. One option was to do nothing to adjust for the fluctuations; another option was to apply a more modest give-back (for example, 50 percent instead of 75 percent, after allowing for the 15 percent reduction.) We also considered the comments we received on drug payments in general and for specific items.

[[Continued on page 63447]]

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

[[pp. 63447-63496]] Medicare Program; Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2004 Payment Rates

[[Continued from page 63446]]

[[Page 63447]]

We did not adopt the options that would allow no adjustments for items separately paid in 2003 where the costs declined because we were convinced by the many commenters on this topic that such fluctuations create problems for the hospitals. We were also convinced by the commenters that a less generous give-back, such as 50 percent, would not adequately address the very real concerns about patient access to some of these drugs, particularly for cancer chemotherapy. We believe that, for the majority of items paid separately in 2003 for which the more recent hospital data indicates a reduction in excess of 15 percent, the adjustment methodology we proposed and that we are adopting for this final rule provides an adequate buffer for the hospitals against dramatic fluctuations in payment amounts while at the same time not significantly affecting the budget neutrality scalar applied to the relative weights for all services.

We believe that either the use of our unadjusted medians or, where applicable, a median adjusted to limit reductions greater than 15 percent methodology, will not adversely impact beneficiary access. However, we were convinced by the external data meeting our preferred criteria and the related comments that we received for several items, the payment rates resulting from our data alone could provide a disincentive for hospitals to provide these particular therapies. Therefore, we have determined that we will use this credible and relevant external data to establish a median cost for the following items listed in table 15. For these items, as with the few device- related APCs for which we are considering external data, we have calculated an adjusted median cost by blending the median cost derived from our dampening methodology with the cost data from the external sources on a one-to-one ratio.

Table 12.--List of Drugs, Biologicals, and Radiopharmaceuticals for Which Blended Data Were Used to Determine 2004 Payment Rates

2004 adjusted

External 2004 1:1 Blended APC

HCPCS

Short descriptor

median cost acquisition cost median cost

0909.......................... J1825............ Interferon beta-1a..........................

$159.16

$231.25

$195.21 9022.......................... Q3025............ IM inj interferon beta-1a...................

53.05

77.08

65.07 0902.......................... J0585............ Botulinum toxin a...........................

2.86

3.92

3.39 7000.......................... J0207............ Amifostine..................................

241.95

369.49

305.72 1624.......................... Q3007............ Sodium phosphate p32........................

49.18

100.00

74.59 1625.......................... Q3008............ Indium 111-in pentetreotide.................

400.41

550.00

475.21 1305.......................... C1305............ Apligraf....................................

659.55

1,077.57

868.56

We note that we also received external data for other items, which we did not use for rate setting. In those cases, we determined the data was not reliable because the data did not meet the preferred criteria set forth in the August 12, 2003 proposed rule.

Comment: One commenter raised a concern about our proposal to limit reductions in the median costs of non-pass-through drugs and biologicals to one-fourth of the difference between the actual decline and 15% less than the 2003 adjusted median. While expressing support for an initiative that reduces significant fluctuation in APC payment rates from one year to the next, the commenter expressed uncertainty about the size of the reduction limitation and suggested that CMS consider a less generous dampening approach since the budget-neutral dampening would negatively affect other APCs.

Response: While we believe that a general limitation on reductions in payments for certain drugs and biologicals is warranted for reasons discussed elsewhere in this final rule, we also recognize the commenter's concerns about the effect that such a policy would have on other APCs. We have decided to address the commenter's concern by placing an upper limit on adjustments to the median costs used to calculate the 2004 payment rates. We believe that it is reasonable to place such an upper limit on the dampening so that the resulting adjusted median is no greater than 95 percent of AWP or the 2004 unadjusted median. We reviewed the drugs, biologicals, and radiopharmaceuticals whose median costs decreased by more than 15 percent from 2003 to 2004. We then compared the adjusted median (after dampening) to 95 percent of AWP for each of the items. In cases where 95 percent of AWP was higher than the adjusted median, we capped the adjusted median at a value that was the higher of 95 percent of AWP or the 2004 unadjusted median. The 95 percent of AWPs for these drugs and radiopharmaceuticals were calculated using AWP values from the Redbook that were effective as of April 1, 2003. We reviewed the drugs, biologicals, and radiopharmaceuticals whose median costs decreased by more than 15 percent from 2003 to 2004. We then compared the adjusted median (after dampening) to 95 percent of AWP for each of the items. In cases where 95 percent of AWP was higher than the adjusted median, we capped the adjusted median at a value that was the higher of 95 percent of the AWP or the 2004 unadjusted median. The drugs, biologicals, and radiopharmaceuticals affected by this policy are listed in the table below.

Table 13.--Items Whose 2004 Adjusted Medians are Capped at the Higher of 95 Percent of AWP or Their 2004 Unadjusted Median

2004 adjusted

2004 unadjusted APC

Description

median

95% AWP

median

1095.......................................... Technetium TC 99m depreotide...................

$216.26

$40.00

$17.18 0820.......................................... Daunorubicin...................................

89.80

78.14

65.81 0961.......................................... Albumin (human), 5%, 50 ml.....................

41.86

15.31

16.15 0963.......................................... Albumin (human), 5%, 250 ml....................

204.03

58.00

62.83 0964.......................................... Albumin (human), 25%, 20 ml....................

46.10

15.31

21.86 0965.......................................... Albumin (human), 25%, 50 ml....................

114.36

30.63

51.12

[[Page 63448]]

4. Payment for Drug Administration

In order to facilitate accurate payments for drugs and drug administration, we considered whether to make several changes in our current payment policy with regard to payment for Q0081, Q0083, Q0084, and Q0085.

We proposed to continue our current policy of packaging drugs and radiopharmaceuticals that cost less than $150 per episode of care into the APC with which they are associated (for example, nuclear medicine scans, drug administration).

In the proposed rule, we presented data that showed that paying based on a median cost for the APC for each of the four current codes generally results in underpayment when packaged drugs are billed on the claim and overpayment when separately paid drugs are billed on the claim. In the proposed rule we discussed our data analysis in detail. We also discussed four alternatives to the current codes and APC payments in detail (68 FR 47999-48003). In summary, the 4 alternatives presented were:

1. Maintain the current codes and APCs with payments based on the median costs of all claims in the APC.

2. Eliminate the four current codes and create eight new codes to enable hospitals to report that they administered a packaged drug or a separately paid drug. We would pay a different APC amount for each of the eight new codes. The new code descriptors would parallel those of the current codes. This would retain the concept of using one code rather than two when both ``infusion'' and administration of chemotherapy by ``other than infusion'' occurred (as exists under the current codes). Coders would have to look up the drugs administered to know which code to bill.

3. Eliminate the four current codes and create six new codes to enable hospitals to report that they administered a packaged drug or separately paid drug and pay a different APC amount for each of the six new codes. In this option, no code equivalent to Q0085 would exist. Therefore, when administering chemotherapy by ``infusion'' or ``other than infusion,'' hospitals would report two codes, one for administration by ``infusion'' and one for administration by ``other than infusion.'' This would eliminate the need to use one code when both infusion and another method of administration of chemotherapy occurred. Coders would have to look up the drugs administered to know which code to bill.

4. Retain three of the current codes (Q0081, Q0083, and Q0084) but delete Q0085 (infusion and other administration of chemotherapy) and modify the OCE to use the drugs billed on the claim to assign an APC for packaged drugs or an APC for separately paid drugs. No drug administration code could be paid without a drug also being reported on the claim. We solicited comments on each of the options in the proposed rule.

For 2004 OPPS we will continue the use of Q0081, Q0083 and Q0084 to pay for drug administration, for both packaged drugs and separately paid drugs. These drug administration codes will continue to describe the administration of drugs per visit. As recommended by the APC Panel, we will cease to make payment under OPPS for Q0085 and will instead permit the services described by Q0085 to be billed using both Q0083 and Q0084. We believe that this will result in appropriate payment for drug administration because for 2004 OPPS we will pay separately for drugs for which the per day median cost is in excess of $50 per day.

Comment: Commenters stated that appropriate payment for drug administration is very important but the options provided for making changes would be extremely burdensome and cannot be done for 2004, if ever. They indicated that the risk of incorrect coding and the adverse consequences of incorrect coding for options 2, 3 or 4 are severe and that the payment changes do not justify the change in codes or policy. Commenters indicated that options 2-4 would increase operational costs that would eliminate any benefit from higher payments; decrease accuracy of coding for drug administration; increase improper payments due to decreased accuracy of coding; increase inaccuracies in claims data due to decreased accuracy of coding. The commenters indicated that they believe that there were many errors in the addenda (Addenda L, M, N, O, P, and Q) in the proposed rule that would be used for option 4 and that it would be virtually impossible to create mutually exclusive lists of drugs as would be required to implement option 4.

Commenters indicated that they believed the options as presented in the NPRM would violate the HIPAA requirements that the same service be coded the same way for all payers. They urged CMS to eliminate the Q codes for drug administration and in favor of use of the CPT codes to code drugs administration. Commenters asked that CMS engage the APC Panel in a discussion of the best way to code drug administration.

One of the commenters indicated that its analysis showed that options 2, 3 or 4 have considerable financial risk for Medicare. Specifically, the commenter indicated that its analysis revealed that option 2 would result in additional payments of $107.1 million for 2004. A commenter asked that CMS create a task force to study the most appropriate methodology for payment for drug administration and for setting payment rates. A commenter supported option 4, which would continue the current coding and map the combination of a drug administration code and drug codes to the appropriate APC. One commenter suggested that we continue the current coding for drug administration, set payment rates at the packaged drug rate for the APC but offset the payment by the difference if no appropriate drug is billed for the same date of service. The commenter indicated that this would simplify the coding and the payment for drug administration and should result in greater accuracy of payment. A commenter supported options 2 or 3 as the most accurate for payment of drugs furnished in the emergency department.

Response: For the reasons discussed earlier in this section, for 2004, CMS will continue use of Q0081, Q0083 and Q0084. Q0085 will not be recognized as a valid OPPS code for 2004. Instead, when a hospital furnishes chemotherapy infusion and chemotherapy via another route, the hospital will bill and be paid for both Q0083 and Q0084. Coding for drug administration is discussed in greater detail below in the context of other comments.

As discussed in elsewhere in this final rule, for 2004, CMS will pay separately for all drugs, biologicals and radiopharmaceuticals that have a per day median cost in excess of $50. Therefore, only drugs, biologicals and radiopharmaceuticals that have a per day median cost of $50 or less will be packaged into the payment for the services. Therefore, the payment for drug administration codes Q0081, Q0083 and Q0084 will be based on the median costs for drug administration with only drugs having a median per day cost of $50 or less packaged into the cost of the administration code. We believe that separate payment for drugs with a median cost in excess of $50 will result in the drug administration codes being paid more accurately and will result in more equitable payment for both the drugs and their administration.

[[Page 63449]]

Edits To Ensure Correct Billing for Drugs

Comment: A commenter asked that CMS create a series of edits in the OCE that would facilitate the collection of better data on drug costs and drug administration. Specifically, the commenter wants the OCE to edit out claims where a drug administration code is billed with no drug code on the claim; where a chemotherapy drug administration code is billed with a revenue code 25X and no specific HCPS code; and where multiple units of a drug administration code are billed on the same line.

Response: We will consider what edits may be appropriate for inclusion in the OCE with regard to drug administration to facilitate collection of better data. However, we are concerned that edits of the type requested by the commenter may both impose greater billing burden on hospitals and create complexities that could delay claims processing.

Discounting of Non-Chemotherapy Administration

Comment: Commenters indicated that no multiple procedure reduction should be applied to Q0081 (infusion of drugs other than chemotherapy) or its successor codes under any of the options. They indicated that payment is already too low to cover the cost of the infusion and that reducing it further when there are more costly procedures on the claim will only further under pay the service.

Response: We have retained the status indicator of ``T'' for Q0081. This status indicator means that the code will be reduced by 50 percent if it is the lower priced service on the same claim with another procedure with the status indicator ``T''. In most cases, we expect that this reduction would occur when there is a separate procedure performed on the same day as the infusion and that there will be significant efficiencies in administering an infusion. If the infusion is performed by itself or with a visit, or with a service with status code ``S'', the multiple procedure reduction will not apply.

Payment for Drug Administration on a Per Day Versus a Per Visit Basis

Comment: Commenters indicated that it would be incorrect to revise the definition of the drug administration codes to be per day instead of per visit, as they are currently defined. They referred to many cases in which it is necessary for a patient to have more than one administration of non-chemotherapy drugs in a day and that hospitals should be able to bill multiple units of the applicable code when that occurs. They noted that the APC Panel supported this view with regard to Q0081, infusion of non-chemotherapy drugs. They asked that CMS provide explicit instructions regarding billing for drug administration and ensure that fiscal intermediaries are bound to comply with the national instructions. One commenter asked that CMS create modifiers or specific HCPCS codes to reflect administration of multiple chemotherapy agents during a single session and that CMS permit payment for more than one chemotherapy administration on the same day of service, with a new modifier to reflect truly separate administrations.

Response: We acknowledge the commenters' concerns about our proposal to change the drug administration codes from a per visit basis to a per day basis and have not revised the definition of the drug administration codes from per day to per visit.

CPT Codes for Drug Administration

Comment: Many commenters suggested that CMS should delete the HCPCS alphanumeric codes for drug administration and should use existing CPT codes. They indicated that the APC Panel supports this change and that it would be less burdensome for providers than using the HCPCS alphanumeric codes. One commenter presented a crosswalk that could be used to pay under the current drug administration APCs while permitting hospitals to bill using CPT codes. A commenter indicated that hospitals already maintain start and stop times for infusion therapies and that, therefore, the use of CPT codes for infusion would not be more burdensome than the current HCPCS codes.

Response: For the reasons discussed earlier in this section, for 2004 OPPS, administration of infusion of non-chemotherapy drugs, infusion of chemotherapy drugs and administration of chemotherapy by other than infusion, will continue to be billed and paid based on Q0081, Q0083 and Q0084. However, we take seriously the requests of the commenters and the APC Panel that we should use the CPT codes to pay for drug administration. We will seriously consider the crosswalk submitted and will discuss it with the APC Panel at its winter meeting. We also will pursue a means by which the existing data from 2003 hospital claims, which exist only for the Q codes, which are per visit, can be used to pay for services billed under the CPT infusion codes, which are on a per hour basis.

Elimination of Q0085 Chemotherapy Administration by Both Infusion and Other Technique

Comment: Several commenters supported elimination of Q0085 and the continued use of Q0083 and Q0084 in place of Q0085.

Response: As indicated above, we will no longer recognize Q0085 for payment of drug administration services for 2004. The code could not be deleted from HCPCS because the 2004 HCPCS was complete before the NPRM comment period closed. Instead, hospitals will bill and be paid for both Q0083 and Q0084 when they furnish chemotherapy by both infusion and another route.

Charge Compression Reduction Through Revenue Code Requirements and Expansion of Revenue Codes

Comment: A commenter indicated that CMS could reduce charge compression effects by requiring hospitals to do detailed coding of drugs using the most specific categories of revenue codes. The commenter indicated that CMS would also need to create additional revenue codes to collect more specific information. The commenter indicated that collection of drug charge information at such detailed levels would both reduce charge compression and give CMS more information when determining which drugs to package to specific drug administration services.

Response: CMS will not require that specific revenue codes be used for drugs and will not ask the National Uniform Billing Committee to create additional revenue codes to collect more specific information. Revenue codes exist for hospital accounting purposes and, in general CMS does not require that particular services be billed with particular revenue codes. We are not convinced that adding specific requirements for revenue coding or expanding the revenue codes to acquire more specific information will result in better data or that the end result would be cost effective in terms of its potential effect on hospital operations. We believe that such requests to the NUBC should be generated by the provider community if it believes such changes would be in their overall best interest.

Request for Clarification of Instructions

Comment: Commenters said that CMS needs to develop and issue clear national instructions on how drug administration in the OPD should be billed and to ensure that fiscal intermediaries all comply uniformly with the instructions. They said that in the absence of national instructions,

[[Page 63450]]

fiscal intermediary medical directors have developed and enforced local medical review policies that vary considerably from one another, resulting in very different interpretations of how services should be billed and of the amount of payment for the same set of circumstances. They specifically recommend that we address issues including how often drug administration codes can be billed in a day, billing for piggyback infusions, how to bill units of service, billing for pain control pump services, double infusions, and use of chemotherapy administration codes for patients with non-cancer diagnoses. The commenter also asked for clarification of the use of 90782 (IM injection) and 90784 (IVP injection) when used for sedation before surgery, Q0081 when used to keep a vein open, and Q0083 with regard to whether it should be billed each time a chemotherapy drug is administered. A commenter also asked that CMS clarify whether HCCPS codes Q0081, Q0083, Q0084 and Q0085, CPT codes 90783, 90784 and 90788 may be billed more than once per visit. The commenter indicated that CMS previously said that CPT codes 90782- 90788 may be billed separately for each injection and asked if this is a change to CMS policy in this regard.

Response: CMS will develop program instructions regarding how the drug administration codes should be used. We will attempt to address the specific questions identified in the comments in the course of developing those instructions. When the instructions are issued, they will be binding on all Medicare fiscal intermediaries under their contract with CMS. In the absence of national instructions, Medicare fiscal intermediaries have authority to develop local medical review policies governing billing, coverage and payment.

With regard to the issue of how often in a day Q0081, Q0083 and Q0084 may be billed, each of these codes is to be used to report all services in a single visit, regardless of the number of drugs administered during that visit. Therefore, if two chemotherapy drugs are administered by intravenous injection and 3 chemotherapy drugs are administered by infusion, the hospital would bill 1 unit of Q0083 and 1 unit of Q0084. A second unit of either code would only be billed if the patient left the OPD after completion of the first administration and then returned later for a separate encounter for administration of another chemotherapy drug. If the patient leaves the OPD and returns later in the day suffering from dehydration and requires infusion of fluids and infusion of antiemetics, the hospital would bill Q0081 for those services. If the patient returns later in the same day for another infusion of one or more chemotherapy drugs that could not be administered at the earlier infusion for medical reasons, the hospital may bill 2 units of Q0084.

CPT codes 90782-90788 each represent an injection and as such, one unit of the code may be billed each time there is a separate injection that meets the definition of the code.

As indicated above, drugs for which the median cost per day is greater than $50 are paid separately and are not packaged into the payment for the drug administration codes with which they are billed. See Addendum B for the 2004 OPPS payment amount for separately paid drugs, which are indicated with both payment amounts and status indicator ``K.''

Proposed Payment Rates for Drug Administration

Comment: Commenters indicated that the proposed payment rates for drug administration are too low to adequately compensate hospitals for the costs of packaged drugs. They indicated that there is some confusion over the resultant decrease in drug administration medians after low cost drugs ($50-$150) were packaged into the drug administration codes. The expectation was that the addition of the drug costs would result in increases. Moreover, they stated that the payment rates for drug administration services that include drugs that cost $50 to $150 per day, are so low that none of the rates are adequate to cover cases for which multiple drugs of $100 each are administered.

A commenter who is particularly concerned with immunosuppressive drugs that are needed by beneficiaries following organ transplants, indicated that in 2000, Congress directed the Secretary of HHS to prepare a report to Congress containing recommendations regarding a cost effective way of providing coverage for immunosuppressive drugs to promote the objectives of improving health outcomes by decreasing transplant rejection rates attributable to failure to comply with immunosuppressive drug therapy and to achieve Medicare cost savings by preventing the need for secondary transplants and other care related to post transplant complications (Pub. L. 106-113). The commenter believes that packaging transplant drugs into the payment for drug administration and the proposal of such a low amount of payment defeats Congress's stated intention in this case and will decrease beneficiary access to immunosuppressive drug therapy following transplant surgery.

Response: We believe that making separate payment for both the procedure and drugs for which there is a median per day cost in excess of $50, will result in appropriate payment for the procedure with which the drug is billed. In the case of the HCPCS codes for administration of drugs per visit (Q0081, Q0083 and Q0084), compared to the proposed payments published in the NPRM, payments for the procedures do not decline by much when calculated without packaged drugs that have medians of $50 to $150. Therefore, we believe that total payments will be more appropriate for these drugs in 2004.

With respect to post-transplant immunosuppressive drugs, we would note that take-home supplies of such drugs are billed to the Durable Medical Equipment Regional Carriers and paid for separately outside of the OPPS. To the extent that such drugs fall below the $50 median cost per day, we expect the frequency of administration in the hospital outpatient setting to be low.

Coding for Drugs

Comment: A trade association representing drug manufacturers supported our proposal to require hospitals to report individual codes for all drugs, including those that are packaged, on the grounds that it would improve the quality of our data. Most commenters representing hospitals and hospital associations opposed the proposal. They indicated that the operational impact on hospitals would be significant, if we were to implement such a requirement. It would take a year or more to update chargemasters and train staff, and many more codes would have to be established for drugs that are administered but not identified in the current HCPCS. Hospitals and hospital groups did not support detailed reporting of routine, low cost drugs and supplies that are currently reported only using a packaged revenue code. A commenter stated that if CMS were to choose to require drug and/or device coding, CMS should give hospitals at least a year to prepare to implement the requirement and work with hospitals to identify all drugs and devices that would require codes, develop HCPCS codes with dosage descriptions that match the administered or purchased dose, assign HCPS to all administered drugs, clarify reporting of self-administered drugs and drugs considered integral to a procedure under OPPS, and identify applicable drugs and devices in hospital

[[Page 63451]]

chargemasters. Commenters indicated that the use of ``unclassified drugs'' and ``unclassified biologicals'' would increase if hospitals are required to bill all drugs and that such a requirement would result in less reliable data for CMS at great cost to hospitals, with no measurable benefit. Some commenters indicated that the use of unclassified codes would create significantly more work for hospital staff and Medicare contractors. One commenter was concerned that this requirement would force hospitals to contort internal ordering and billing systems in order to match HCPCS codes to unrelated packaged dosage amounts, thereby significantly increasing the potential for error in the administration of drugs and putting patient safety at risk.

Response: Because we are not implementing any of the new drug administration coding requirements that we proposed, the need for more detailed drug coding is removed. Therefore, we are not requiring hospitals to report with a HCPCS code every drug that is administered to a patient. However, in order to receive payment for a drug for which a separate payment is provided, hospitals will have to continue to bill for the drug using revenue code 636, ``Drugs requiring detail coding,'' and report the appropriate HCPCS code for the drug. Drugs for which separate payment is allowed are designated by status indicator ``K'' in Addendum B. Hospitals should continue to bill for packaged drugs, which are assigned status indicator ``N,'' using any of the drug revenue codes that are packaged revenue codes under the OPPS: 250, 251, 252, 254, 255, 257, 258, 259, 631, 632, or 633. Hospitals are not required to use HCPCS codes when billing for packaged drugs, unless revenue code 636 is used. Although we are not requiring hospitals to report HCPCS codes for packaged drugs, it is essential that hospitals continue to bill charges for packaged drugs by including the charge for packaged drugs in the charge for the procedure or service with which the drug is used, or as a separate drug charge (whether or not it is separately payable). Reporting charges for packaged drugs is critical because packaged drug costs are used for calculating outlier payments and are also identified when we calculate hospital costs for the procedures and services with which the drugs are used in the course of the annual OPPS updates.

Comment: Several commenters recommended that CMS establish a unique revenue code for radiopharmaceuticals that hospitals would be required to use when reporting all radiopharmaceuticals, whether packaged or separately payable. They indicated that establishing a unique revenue code would assist CMS in tracking costs for the radiopharmaceuticals and contribute to more accurate cost data collection.

Response: We do not establish revenue codes. Rather, the National Uniform Billing Committee (NUBC) receives and considers such requests from multiple sources, including providers and other members of the public. While we continue to examine cost-to-charge and cost compression issues, we will consider whether such an approach would assist CMS in refining our methods of establishing relative weights. We would also note that the commenters and other interested parties may also request that the NUBC consider the creation of new revenue codes.

Comment: Several commenters expressed concern about the frequent coding changes implemented for radiopharmaceuticals over the past two years. They recommended that CMS revise the HCPCS coding descriptors for products that do not currently have ``per dose'' or ``per study'' descriptors to reflect the products as they are administered to the patient. They emphasized that creating these new descriptors and corresponding payment rates will improve data collection and help to ensure equitable payment to hospitals.

Response: We recognize the concerns expressed by these commenters. However, we are striving to achieve stability in descriptor changes, and we believe that in changing descriptors to ``per dose'', we will lose specificity with respect to the data we will receive from hospitals. We are not convinced that there is a programmatic need to change the radiopharmaceutical code descriptors to ``per dose'' and that our claims data are problematic for setting payment rates for these products; however, we will continue to work with industry representatives to ensure that the current HCPCS descriptors are appropriate and review this issue in the future, if needed. Furthermore, we stress the importance of proper coding by providers so that we can get accurate data for future rate setting.

Comment: One drug manufacturer urged CMS to advise hospitals that it is appropriate for them to set charges for drugs submitted to Medicare for OPPS services so that the charges reflect actual product costs when charges are multiplied by hospital and cost-center-specific ratios of cost-to-charges. The commenter also requested CMS to not rely on data obtained in the absence of such advice. A comment from a national hospital organization, however, advised CMS to permit hospitals to continue to establish their charge structures and mark-up policies separate and apart from CMS's payment policies. The commenter indicated that only in this manner would prospective payments appropriately reflect general trends in charges and mark-ups across all hospitals.

Response: We do not regulate what hospitals charge for hospital services and will not advise hospitals regarding how to determine the charge for an item or service. Hospital charges have fundamental uses and the use of charges to determine relative costs for OPPS should not be the determining factor in how a hospital sets its charge for any item or service. The OPPS is a system based upon the relative costs of services and these costs are developed by applying the hospital's most recent cost to charge ratio to the charges of the hospital for the item. While we recognize that the system is imperfect, we believe that on average, it results in appropriate relative weights. However we recognize that on occasion, this is not true and therefore, as discussed elsewhere, we have used external data where we believe that the median derived from claims data does not appropriately reflect the relative cost of the item or service.

Comment: One commenter requested that we change the status indicator for HCPCS code J7599 (Immunosuppressive drug, not otherwise classified) from ``E'' to ``N'' so that new immunosuppresives can be identified on claims forms as a separate line item until a unique pass- through ``C'' code can be assigned to the product.

Response: We agree that the status indicator for J7599 should be ``N'' and have made that change for CY 2004. As for other new drugs and biologicals, interested parties may submit an application for pass- through status for new immunosuppressives.

Coding for Drugs Billed as Supplies

Comment: Commenters said that CMS significantly complicated the issue of billing for drugs when it indicated that drugs that are an integral part of the procedure should be billed as supplies (revenue code 270) rather than as pharmaceuticals (revenue code 250).

Response: We did not issue instructions to require that drugs that are an integral part of a surgical procedure be billed using revenue code 270 (supplies) rather than revenue code 250 (pharmaceuticals). Rather, we instructed hospitals to report drugs that are treated as supplies because they are

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an integral part of a procedure or treatment under the revenue code associated with the cost center under which the hospital accumulates the costs for the drugs. (See section XXIV.D of Transmittal A-02-129, issued on January 3, 2003.)

In general, supplies that are an integral component of a procedure or treatment are not reported with a HCPCS code. The charges for such supplies are typically reflected either in the charges on the line for the HCPCS for the procedure or on another line with a revenue code that will result in the charges being assigned to the same cost center to which the cost of those services are assigned in the cost report.

Correct Coding Initiative Edits

5. Generic Drugs, and Radiopharmaceuticals

In general, hospital acquisition costs for drugs, biologicals, and radiopharmaceutical agents with generic competitors are lower than the acquisition costs for sole source or multi-source drugs. In order to ensure that Medicare recognizes these lower costs in a timely manner, we proposed a new method of calculating payment amounts for drugs, biologicals, and radiopharmaceuticals that are separately paid under the OPPS and for which the Food and Drug Administration (FDA) has recently approved generic alternatives.

Because many hospitals have long term purchasing arrangements for drugs and radiopharmaceuticals, we believe that there is generally a 12-month lag between the time that generic items are made available and when our claims data will accurately reflect the costs associated with the availability of the generic alternative. Therefore, during the interval between FDA approval of a generic item and the time when we would reasonably expect claims data to reflect the cost of generic alternatives, we proposed to adopt the following methodology to price the affected drugs, biologicals, and radiopharmaceuticals under the OPPS.

We proposed to identify items approved for generic availability by the FDA during the 6 months before the first day of the claims period we use as the basis for an annual OPPS update. Where we determine that our claims data do not reflect the costs of generic alternatives for a separately payable drug, biological, or radiopharmaceutical, we proposed to base our payment rate on 43 percent of the AWP for the drug, biological, or radiopharmaceutical.

To apply this payment methodology to the 2004 OPPS update, we reviewed FDA approvals for generic drugs, biologicals, and radiopharmaceuticals issued between October 2001 and December 2002. We found six drugs, which we proposed to be separately paid under the 2004 OPPS that had generic alternatives approved during that time. These drugs are: Daunorubicin, Bleomycin, Pamidronate, Paclitaxel, Ifosfomide, and Idarubicin. Table 21 shows the dates when the FDA approved generic alternatives for these drugs.

We solicited comments on this proposed method of calculating payment for drugs, biologicals, and radiopharmaceuticals for which generic alternatives have recently been approved. Specifically, we were interested in comments concerning our proposed methodology for identifying these items, whether we properly identified all the items, and whether our proposed payment policy for these generic alternatives is appropriate.

We received many comments on our proposal regarding generic drugs and radiopharmaceuticals, which are summarized below along with our responses.

Comment: One commenter applauded CMS's efforts to lower payment for generic products to an amount more closely aligned with hospital acquisition cost. However, the commenter indicated that payment for generic cancer products would continue to be excessive and contribute to an environment where hospitals may offer treatments using less effective chemotherapy products. Alternatively, comments from a national hospital association and numerous manufacturers stated that the presence of generic alternatives in the market does not necessarily result in cost savings for hospitals. They indicated that established multi-year contracts may prevent providers from switching immediately to generic alternatives. As a result, providers would not realize any cost savings from buying the generic products until the conclusion of their existing contract, which in some cases may be a few years after the generics are available in the market. Commenters also indicated that it is quite common for shortages of generic equivalents to occur when they first appear in the market. Thus, there is no guarantee that sufficient quantities of generic alternatives will be available in the marketplace for all providers to purchase them. Furthermore, adoption of generic drugs by hospitals is also affected by whether the providers determine they are safe to use in comparison to the brand name products. One commenter recommended that CMS continue to use its 2002 claims data to set the payment rated for these drugs.

Response: We appreciate these insightful comments and agree with the commenters that the time it takes for hospitals to realize cost savings (or price decreases) from purchasing generic products is longer than we initially expected because of the various reasons described by the commenters. Further research on this issue also shows that cost savings due to competition between generic and name brand drugs can vary. One reason is that in some cases regulations allow the first generic marketed to compete with a name brand drug to have a period of exclusivity during which time no other generics may come on the market. This period of exclusivity may mean that cost savings during this period of exclusivity are less than cost savings that occur once more than one generic is put on the market. For 2004, we believe that calculating payment rates for generics according to the methodology discussed above would not sufficiently take into consideration the true costs incurred by hospitals for purchasing generic products. Therefore, we believe that it is appropriate to calculate the payment rates for generics according to the same methodology used for other separately payable drugs and radiopharmaceuticals. 6. Orphan Drugs

In the proposed rule we stated that we no longer believe that paying for orphan drugs at reasonable cost, outside of OPPS is appropriate, and we proposed the following payment policy:

[sbull] We proposed to continue using the same criteria to identify single indication orphan drugs (67 FR 66772).

[sbull] We proposed to discontinue retrospective cost payments and to make prospective payments under the OPPS for those identified single indication orphan drugs.

[sbull] We proposed to base payments on the same methodology we use to pay for other drugs including any limitation on payment reductions (as described above).

[sbull] We proposed to make separate payment for the single indication orphan drugs and place them in APCs.

The 11 single indication orphan drugs that would be affected by our proposal are: (J0205 Injection, alglucerase, per 10 units; J0256 Injection, alpha 1-proteinase inhibitor, 10 mg; J9300 Gemtuzumab ozogamicin, 5 mg; and J1785 Injection, imiglucerase, per unit); J2355 Injection, oprelvekin, 5 mg; J3240 Injection, thyrotropin alpha, 0.9 mg;

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J7513 Daclizumab parenteral, 25 mg; J9015 Aldesleukin, per vial; J9160 Denileukin diftitox, 300 mcg; J9216 Interferon, gamma 1-b, 3 million units; and Q2019 Injection, basiliximab, 20 mg.

We solicited comments on these proposals and requested that commenters submit information meeting the same criteria as comments for other drugs (as discussed above). We received numerous comments, all of which were in opposition to our proposals regarding payment for orphan drugs.

Comment: Every commenter who commented on the changes we proposed regarding payments for single indication orphan drugs opposed our proposal to discontinue payment for orphan drugs on a reasonable cost basis and to instead use the same methodology to set payment amounts for the single indication orphan drugs that we use to set rates for other drugs. Commenters stated that doing so would create serious access problems for patients who rely on an orphan drug for treatment of a rare disease because hospitals would no longer be able to afford to treat them. A number of commenters were particularly concerned by the decreased payment rate proposed for alpha-1-proteinase inhibitor. Some pointed out that the data we used to calculate payments for orphan drugs are especially flawed because of the low volume, high cost characteristics of orphan drugs, complicated by errors in the way hospitals bill for drugs generally. Recommendations from commenters included: applying the dampening rule to limit decreases to 10% of reasonable cost payments in 2003; establishing a payment floor; and, continuing to pay for orphan drugs on a reasonable cost basis.

Response: We carefully reviewed commenters' concerns about the impact our proposal would have on patient access to orphan drugs. We do not dispute that orphan drugs used solely to treat an orphan condition are generally expensive and, by definition, are rarely used. We also recognize that coding changes may have resulted in questionable billing data. However, we believe that it is important to balance these concerns with maintaining a consistent payment system for hospital outpatient department services overall, and to limit to the maximum possible extent payment for services or items outside the OPPS. We also discussed in the August 12 proposed rule our concerns about the increased number of drugs that meet our criteria for special payment status as single indication orphan drugs and the resulting increase in the number of hospital outpatient services that would be paid outside the OPPS were we to continue to pay for these drugs on a reasonable cost basis. It was in light of these factors that we proposed to discontinue payment for single indication orphan drugs on a reasonable cost basis outside the OPPS and to use our claims data as the basis for setting payment rates for those drugs that we have identified as meeting our criteria for special payment status as single indication orphan drugs. We also proposed to pay separately for the single indication orphan drugs and to assign each of them to an APC.

Having weighed the concerns raised by commenters and our concerns about the increasing number of outpatient services that would be paid outside the OPPS were we to continue the current policy of paying for single indication orphan drugs on a reasonable cost basis, we have decided that beneficiaries, hospitals, and the Medicare program will be best served over the long term by our making payment for the single indication orphan drugs under the OPPS at 88 percent of the AWP. We arrived at 88 percent based on our analysis of claims data, and our intent that payment be sufficient to ensure that all beneficiaries have access to needed drugs. Among the 11 orphan drugs, the highest median cost in the claims data was approximately 78 percent of the AWP. After considering comments we received on the proposed rule, we were concerned that merely adopting the existing highest percentage of the AWP may not ensure that a sufficient payment amount is established in all cases prospectively. We therefore have provided for an additional margin of ten percentage points to account for possible future increases, and ensure sufficient payment. This results in the percentage of 88 percent that we have adopted in this final rule.

However, we received information consistent with our request for verifiable data (68 FR 47998) that indicates the payment amounts we proposed for alpha-1 proteinase inhibitor, for imiglucerase, and for alglucerase do not reflect the price at which these drugs are widely available to the hospital market. This information, combined with the concerns expressed by commenters generally that the payment amounts we proposed for the 11 drugs that meet our criteria for special payment as single indication orphan drugs are too low and may threaten beneficiary access to the drugs, have persuaded us to make final one modification to the method we proposed for setting payment rates for drugs that are paid as single indication orphan drugs under the OPPS. That is, rather than using claims data to calculate payment rates for single indication orphan drugs that meet our criteria for special payment under the OPPS, we are setting payment for all but two of these drugs at 88 percent of their AWP as established in the April 1, 2003 single drug pricer (SDP). As discussed above, we received information about the widely available market price for imiglucerase and alglucerase, and, based on that information, we have priced these two drugs at 94 percent of their AWP.

We believe that this policy is a reasonable compromise. It enables us to set a prospective payment amount under the OPPS for qualified single indication orphan drugs. But, by increasing payment levels for these low volume drugs, we minimize the risk of compromising beneficiary access to treatment for life-threatening, rare diseases.

Therefore, we have set payment rates for single indication orphan drugs in accordance with the following policy, effective January 1, 2004:

[sbull] We are using the same criteria that we implemented in CY 2003 to identify single indication orphan drugs used solely for an orphan condition for special payment under the OPPS;

[sbull] We are discontinuing payment on a reasonable cost basis for single indication orphan drugs furnished in the outpatient department of hospital that is subject to the OPPS;

[sbull] We are making separate payment for single indication orphan drugs and assigning them to APCs;

[sbull] We are setting payment under the 2004 OPPS for single indication orphan drugs at 88 percent of the AWP listed for these drugs in the April 1, 2003 single drug pricer unless we are presented with verifiable information that shows that our payment rate does not reflect the price that is widely available to the hospital market.

Comment: Several commenters objected to our special treatment for only 11 orphan drugs, rather than including all of the drugs that the FDA designates as having orphan status. A few commenters recommended that we set the criteria for special treatment based on claims volume instead of our current criteria. That is, CMS would set a criterion for ``high volume'' drugs based on a threshold of 30,000 or more claims per year. Then, any FDA-designated orphan drug with less than the threshold volume of claims would be subject to special payment under the OPPS as an orphan drug.

Response: Using the statutory authority at section 1833(t)(1)(B)(i) of

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the Act, which gives the Secretary broad authority to designate covered OPD services under the OPPS, we have established criteria which distinguish these 11 drugs from other drugs designated as orphan drugs by the FDA under the Orphan Drug Act. Our determination under this authority to provide special payment for a subset of FDA-designated orphan drugs does not affect FDA's classification of drugs under the Orphan Drug Act. Because these 11 drugs have a low volume of patient use, lack other indications, and have no other source of payment, we allow special treatment of them so beneficiaries can continue to have access to them. Because these 11 drugs are used solely to treat an orphan condition that affects a relatively low number of beneficiaries, hospitals receive payment for a low volume of cases by definition, and the cost of the drug is not spread across other uses. We are concerned that if we were to adopt the commenter's recommendation that we qualify all FDA-designated orphan drugs under a particular volume threshold for special payment under the OPPS, we could be expanding this special payment provision, which is meant to target the small number of orphan drugs that are used solely to treat rare diseases, to drugs that are used for other conditions and indications, for which hospitals would also be receiving payment. Therefore, we are not adding a volume threshold to our criteria for identifying orphan drugs that receive special payment under the OPPS in 2004. 7. Vaccines

Outpatient hospital departments administer large amounts of the vaccines for influenza (flu) and pneumococcal pneumonia (PPV), typically by participating in immunization programs. In recent years, the availability and cost of some vaccines (particularly the flu vaccine) have fluctuated considerably. As discussed in the November 1, 2002 final rule (67 FR 66718), we were advised by providers that OPPS payment was insufficient to cover the costs of the flu vaccine and that access of Medicare beneficiaries to flu vaccines might be limited. They cited the timing of updates to OPPS rates as a major concern. They said that our update methodology, which uses 2-year-old claims data to recalibrate payment rates would never be able to take into account yearly fluctuations in the cost of the flu vaccine. We agreed and decided to pay hospitals for influenza and pneumococcal pneumonia vaccines based on a reasonable cost methodology. As a result of this change, hospitals, home health agencies (HHAs), and hospices were paid at reasonable cost for these vaccines in 2003. We are aware that access concerns continue to exist for these vaccines; therefore, we proposed to continue paying for influenza and pneumococcal pneumonia vaccines under reasonable cost methodology.

We received no comments regarding our payment proposal for vaccines, and finalize our proposal in this rule. 8. Blood and Blood Products

Since the OPPS was first implemented in August 2000, separate payment has been made for blood and blood products in APCs rather than packaging them into payment for the procedures with which they were administered. We proposed to continue to pay separately for blood and blood products.

The list of APCs containing blood and blood products can be found in the November 1, 2002 final rule (67 FR 66750). We note that the APCs for these products are intended to make payment for the costs of the products. Costs for storage and other administrative expenses are packaged into the APCs for the procedures with which the products are used.

As described in the November 1, 2002 final rule (67 FR 66773), we applied a special dampening option to blood and blood products that had significant reductions in payment rates from 2002 to 2003. For 2003, we limited the decrease in payment rates for blood and blood products to approximately 15 percent.

After careful comparison of the 2003 dampened medians with the 2004 medians from our claims data, we determined that establishing payment rates based on the 2004 median costs would, for many blood and blood products, result in payments that are significantly lower than hospital acquisition costs. In order to mitigate any significant payment reductions and to minimize any compromise in access of beneficiaries to these products, we proposed a 10 percent limit to decreases in payment rates for blood and blood products from 2003 to 2004.

We solicited comment on this proposal, especially from hospitals. Specifically, we solicited comments that include verifiable information about the widely available acquisition cost of commonly used blood and blood products.

We received several comments on this proposal, which are summarized below along with our responses.

Comment: Several hospital groups supported the recommendation made by the APC Panel at its August 22, 2003 meeting and urged us to consider freezing 2004 payment rates for blood and blood products at the 2003 levels. A few commenters recommended that CMS use data provided by suppliers of blood and blood products to help set payment rates for 2004. Two commenters stated that major blood organizations are prepared to share the data for verification with CMS. Another commenter recommended that CMS base payments on either reasonable cost or external data.

Response: After carefully reviewing the concerns expressed by commenters and analyzing the further reductions in payment that would result from using our 2002 claims data, even with the 10 percent limit on payment decreases that we proposed, we are convinced that our payments would be considerably lower than what it costs hospitals to acquire blood and blood products. Further, we are mindful of the increasing number of tests required to ensure the safety of the nation's blood supply, which is adding to the cost of processing blood and blood products. Therefore, in order to ensure that our beneficiaries have uninterrupted access to safe blood and blood products, we agree with the recommendation of commenters and the APC Panel that we freeze payments for blood and blood products in 2004 at 2003 payment levels rather than implement our proposal to limit payment decreases to 10 percent. This will enable us to undertake further study of the issues raised by commenters and by presenters at the August APC Panel meeting, without putting beneficiary access to blood and blood products at risk. Therefore, effective for services furnished on or after January 1, 2004, the payment rates for blood and blood products will not change from their 2003 levels.

Comment: One commenter was concerned that while autologous blood and directed donor blood do not have separate CPT codes, hospitals' costs to obtain them are different. Hospitals can only report charges for the autologous blood unit if the patient receives it; otherwise, hospitals must absorb the cost of the autologous donation. The same commenter also suggested that CMS research the issue of whether providing blood to patients with special needs would increase hospital costs. The commenter stated that hospitals do not receive additional payment when conducting national searches to meet special blood needs. Another commenter was concerned that drugs and biologicals were dampened to a

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lesser extent than blood and blood products. The commenter requested that CMS discontinue the differential dampening and apply the dampening rule equally.

Response: The commenter's concerns about rules governing payment for autologous blood and the costs associated with procuring blood for patients with special needs fall outside the scope of our proposed rule. These questions require further analysis and study, which we cannot undertake in time for implementation of the 2004 update of the OPPS. However, as we examine the current policies that affect payment for blood and blood products under the OPPS, we will consider both of the commenter's concerns.

As for the comment regarding adoption of a uniform dampening policy for both separately payable drugs as well as blood and blood products, this concern is no longer an issue because of our decision to freeze payment rates for blood and blood products at their 2003 levels for 2004.

Comment: Several commenters requested that CMS provide and promote guidance on correct coding and billing for blood and blood products to hospitals and other providers.

Response: We acknowledge the need for comprehensive billing and coding guidelines for hospitals and other providers. This is an area we expect to address in the near future. 9. Intravenous Immune Globulin

In the proposed rule, we discussed public comments suggesting that we reclassify intravenous immune globulin (IVIG) as a blood and blood product. We stated that after a review of claims data, we believe that payment for these products is appropriate using the methodology we proposed to implement for other drugs and biologicals. Therefore, we proposed to continue to classify IVIG as a biologic. We solicited comments on this proposal.

We received several comments on this proposal, which are summarized below along with our responses.

Comment: Several trade associations, manufacturers, patient organizations and individual commenters urged CMS to classify intravenous immune globulin (IVIG) under the ``blood and blood product category.'' They indicated that IVIG is derived from plasma fractionation similar to other products categorized as a blood and blood product by CMS; and, furthermore, IVIG falls within the FDA's definition of ``blood and blood product.'' Some of the commenters expressed concern about the potential negative impact on patient access as a result of our proposed payment policy. Another commenter requested that we consider all plasma-derived products and their recombinant analogs as blood products.

Response: We appreciate these comments. However, we continue to believe that IVIG and other plasma-derived therapies and their recombinant analogs are comparable to other drugs and biologicals, and they do not have the same access concerns as other blood and blood products. Our policy regarding IVIG and plasma therapies were described in the November 1, 2002 final rule (67 FR 66774). For 2004, IVIG will be a separately payable item, and its payment rate will be based on approximately 26,500 claims for approximately 1.5 million services. As mentioned in the August 12, 2003 proposed rule (68 FR 48005), analysis of the claims data indicated that hospital costs and billing practices for IVIG have been consistent over the past two years. Therefore, we believe that the 2002 claims data contain a sufficiently robust set of claims for IVIG on which to base the payment rate for this item using the methodology that will be used for other separately payable non- pass-through drugs, biologicals, and radiopharmaceuticals. 10. Payment for Split Unit of Blood

Since implementation of the OPPS, we have assigned status indicator ``E'' to HCPCS code P9011, blood (split unit). Status indicator ``E'' designates services for which payment is not allowed under the OPPS or services that are not covered by Medicare. P9011 was created to identify situations where one unit of red blood cells or whole blood, for example, is split and half of the unit is transfused to one patient and the other half to another patient. Because use of split units is not uncommon, we proposed to change the status indicator for P9011 from ``E'' to ``K'' and assign it to a blood and blood product APC that pays approximately 50 percent of the payment for the whole unit of blood. We proposed to assign P9011 to APC 0957 (Platelet concentrate) with a payment rate of $37.30. We invited comments on this proposed change in the status indicator and payment amount for P9011.

We received a few comments on this proposal, which are summarized below along with our responses.

Comment: Commenters pointed out that there was a typographical error in the proposed rule in which we referred to the split unit of blood as P9010 rather than P9011.

Response: We agree this was an error and have corrected it in this preamble and are making final our proposal to assign P9011 to APC 0957 (platelet concentrate). 11. Other Issues

We proposed to continue our payment policy for Procrit and Aranesp for calendar year 2004. As explained in detail in the November 1, 2002 final rule (67 FR 66758), Aranesp and Procrit are in separate APCs, and are paid at equivalent rates with the application of a ratio to convert the dosage units of Aranesp into units of Procrit. We indicated that we might refine the conversion ratio as soon as feasible based on information not available at the time we established the current conversion ratio.

We have continued to gather information regarding an appropriate conversion ratio by reviewing recent published studies and data from alternative sources. In the proposed rule, we stated that we remain open to establishing a different conversion ratio in the final rule if we conclude that a change is warranted based on public comments and information submitted during the public comment period and/or any other information we consider in developing the final rule. Therefore, we proposed to continue with the current policy regarding payment for Procrit and Aranesp, including the current conversion ratio. We solicited comments on this issue and we stated that we would base any changes to our current payment policy for these two drugs only on data that we could make available to the public.

We received several comments on this proposal, which are summarized below along with our responses.

Comment: We received several comments concerning payment under the OPPS for erythropoietin and an erythropoietin-like product. Specifically, the comments pertained to payment for AranespTM(marketed by Amgen) and Procrit TM (marketed by Ortho Biotech) under the OPPS and the decision we made for 2003 with respect to an appropriate conversion ratio to ensure that these products, which use the same biological mechanism to produce the same results, are paid at the same rate .

Response: Erythropoietin, a protein produced by the kidney, stimulates the bone marrow to produce red blood cells. In severe kidney disease, the kidney is not able to produce normal amounts of erythropoietin and this leads to the anemia. Additionally, certain chemotherapeutic agents used in the treatment of some cancers suppress the bone marrow and cause anemia. Treatment with exogenous erythropoietin can increase red blood

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cell production in these patients and thus treat their anemia.

In the late 1980's, scientists used recombinant DNA technology to produce an erythropoietin-like protein called epoetin alfa. Epoetin alfa has exactly the same amino acid structure as the erythropoietin humans produce naturally and, when given to patients with anemia, stimulates red blood cell production.

Two commercial epoetin-alfa products are currently marketed in the United States: EpogenTM(marketed by Amgen) and Procrit TM(marketed by Ortho Biotech). These products are exactly the same but are marketed under two different trade names. Both EpogenTMand Procrit TMare approved by the FDA for marketing for the following conditions: (1) Treatment of anemia related to chronic renal failure (including patients on and not on dialysis), (2) treatment of Zidovudine-related anemia in HIV patients, (3) treatment of anemia in cancer patients on chemotherapy, and (4) treatment of anemia related to allogenic blood transfusions in surgery patients. Both products are given either intravenously or subcutaneously up to three times a week.

Amgen developed a new erythropoietin-like product, darbepoetin alfa, which it markets as AranespTM. Also produced by recombinant DNA technology, darbepoetin alfa differs from epoetin alfa by the addition of two carbohydrate chains. The addition of these two carbohydrate chains affects the biologic half-life of the compound. This change, in turn, affects how often the biological can be administered, which yields a decreased dosing schedule for darbepoetin alfa by comparison to epoetin alfa. Amgen has received FDA approval to market AranespTMfor treatment of anemia related to chronic renal failure (including patients on and not on dialysis) and for treatment of chemotherapy-related anemia in cancer patients.

Because darbepoetin alfa has two additional carbohydrate side- chains, it is not structurally identical to epoetin alfa. However, the two products use the same biological mechanism to produce the same clinical results--stimulation of the bone marrow to produce red blood cells.

These biologicals are dosed in different units. Epoetin alfa is dosed in Units per kilogram (U/kg) of patient weight and darbepoetin alfa in micrograms per kilogram (mcg/kg). The difference in dosing metric is due to changes in the accepted convention at the time of each product's development. At the time epoetin alfa was developed, biologicals (such as those developed through recombinant DNA) were typically dosed in International Units (IU or Units for short), a measure of the product's biologic activity. They were not dosed by weight (for example, micrograms) because of a concern that weight might not accurately reflect their standard biologic activity. The biologic activity of such products can now be accurately predicted by weight, however, and manufacturers have begun specifying the doses of such biologicals by weight. No standard formula exists for converting amounts of a biologic dosed in Units to amounts of a drug dosed by weight.

In the clinical management of individual patients, CMS recognizes that no precise method of converting an epoetin alfa dose to a darbepoetin alfa dose has yet been established for any of the approved clinical uses. There are general guidelines for conversion and clinicians modify the dose based on the patient's hematopoietic response after the start of treatment with the new biological. For the purpose of developing a payment policy, however, it is feasible to establish a method of converting the dose of each of these drugs to the other. This payment methodology is intended to reflect average dosing requirements for the entire Medicare target population, and is not intended to serve as a guide for dosing individual patients.

As part of the process to define and further refine a payment conversion ratio between these biologicals, CMS held a series of meetings with representatives from both Amgen and Ortho Biotech. Both companies provided substantial new data, both published and unpublished. We also reviewed the Food and Drug Administration labeling for each product (EpogenTM, ProcritTM, and AranespTM), hired an independent contractor to review the available clinical evidence, and performed an internal review of this evidence as well. CMS took into consideration both published and unpublished studies as well as abstracts, conference reports, clinical guidelines, marketing material, and other reports and materials provided by Amgen and Ortho Biotech.

As noted in the OPPS final rule for 2003, CMS was interested in having a ``head-to-head'' comparison of epoetin alfa to darbepoetin alfa either in patients with chronic kidney disease or in cancer patients with chemotherapy-induced anemia, and in which appropriate outcome measures were used. Because no head-to-head study has yet been completed, CMS also considered clinical studies that either compared both products to each other or that linked the dose of a particular product with an appropriate health outcome measure. For the 2003 OPPS, we held a series of meetings with both Amgen and Ortho Biotech. We examined the written and published information provided by both companies, reviewed the FDA labeling for each product, hired an independent contractor to review available clinical evidence and performed an internal review of the evidence as well. In our review, we placed the greatest emphasis on published, high quality clinical studies and looked for the best possible estimates based on an evaluation of the dosing of each product that, on average, produced the same clinical response. Based on our own review of the evidence, our consultation with the independent contractor who also reviewed the evidence, and our discussions with each company, we established a conversion ratio for purposes of payment in 2003 of 260 International Units of epoetin alfa to one microgram of darbepoetin alfa (260:1).

Since publication of the OPPS final rule for 2003, we have continued to review and refine our analysis of the appropriate conversion ratio between these biologicals. In order to facilitate analysis of the non-peer reviewed materials submitted by Amgen and Ortho Biotech, we initiated a process in July 2003, in which each company shared with CMS, our contractor, and each other, a detailed description of the methods used in each of their unpublished clinical studies. Each company was then asked to submit to us their comments as well as the responses to questions raised by the other company's review. Finally, based on our analysis of this information, CMS submitted questions to each company to clarify their views. The final payment conversion ratio is based on our analysis of the information submitted during the process described above, as well as claims analysis, and other publicly available information.

Chemotherapy-induced anemia: The articles submitted by the manufacturers regarding treatment of chemotherapy-induced anemia (CIA) were all observational, retrospective, cohort studies. Several of these studies were conducted with a high degree of attention to minimizing avoidable bias and maximizing data integrity. Observational studies are, however, unavoidably subject to patient selection bias since study subjects are not randomly assigned to the groups being compared. It is not possible to eliminate the possibility that the choice of

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erythropoetic agent was somehow systematically linked to characteristics of the patients treated. Similarities or differences in clinical response may reflect either baseline patient characteristics or the effects of the therapy being studied.

Another major limitation of observational studies is that the researcher typically has no control over the manner in which the intervention under study has been delivered. In this instance, an additional difficulty with using observational studies to assess the equivalence of dosages of epoetin alfa and darbepoetin alfa in chemotherapy-induced anemia in cancer patients is that the response to these drugs may be disease-driven, dosage-driven, or both (depending for example, among other factors, on the individual cancer patient's level of endogenous erythropoietin). A large range of dosages of both epoetin alfa and darbepoetin alfa may show similar effects in any given patient and higher than necessary dosages may not be reflected in greater elevations of hemoglobin. More generally, the populations in the reported studies may show different results due to differences in demographics, health status, types of cancer, and cancer treatments.

Beyond these methodological concerns, the question of what constitutes the best indicator of drug effect remains unsettled. Studies in the literature have used one or more of the following end- points to analyze the effects of erythropoietic drugs:

1. Hemoglobin response--an increase from baseline of 2 g/dL (usually in the absence of transfusion in the preceding 28 days) 2. Hematopoietic response--Hemoglobin increase of 2g/dL from baseline or a hemoglobin 12g/dL 3. Mean change in hemoglobin `` the mean increase in hemoglobin from baseline (usually in the absence of transfusion in the preceding 28 days) 4. Transfusions of red blood cells `` the number (percent) of patients requiring transfusion measured at various time intervals.

Studies submitted by one of the manufacturers proposed additional measures such as ``early hemoglobin response'' (the hemoglobin rise from baseline at 4 or 5 weeks) and the ``area under the curve'' defined by hemoglobin increases from baseline. The FDA has not used these measures as criteria for registration (i.e., market approval) and they do not appear to be regularly used in the peer reviewed literature of erythropoietic drugs and their use either in kidney disease or in oncology. Therefore, their clinical significance is unclear at this time. They do, however, raise the question of how hemoglobin response patterns affect symptoms that matter most to patients. Both companies are conducting additional clinical studies to address further the potential importance of front-loaded regimens that provide high initial doses of erythropoietic drugs in order to stimulate a more rapid clinical response.

During the process of exchanging and critiquing study methods, Amgen and Ortho-Biotech each raised significant methodological concerns about the study designs used to obtain new data. In addition to the overall concern about the observational methodology and selection of the outcome chosen for purposes of comparison, the following concerns were raised:

--the use of survival curves to analyze clinical data in this context --the possible effect of patient functional status on erythropoietic response --the technique for calculating mean values for drug dosages (arithmetic vs geometric means) --the strategy for deciding how to handle data from patients who received transfusions --the significance of an early rise in hemoglobin, and/or the significance of measures of hemoglobin response over the entire 12-16 week treatment interval

Each company provided extensive and compelling discussions of these and other issues, highlighting the fact that conclusions regarding the relative potency of these products are inherently limited by the nature and quality of the clinical data that currently exist. Despite the limitations of the available studies, CMS believes that it has sufficient data to establish a reasonable conversion ratio for payment purposes.

Amgen submitted several observational studies, including one community-based study and three medication use evaluations (MUE). While interim results from two of these studies have been published in peer- reviewed journals, final results have not yet been subjected to full peer review. In one study (Vadhan-Raj, 2003), patients were started on darbepoetin at 3 mcg/kg every other week (QOW). The patients received up to 8 doses (16 weeks). The patients had hemoglobin (Hgb) responses comparable to that seen with epoetin 40,000-60,000 IU per week. The protocol allowed a dose increase and 43 percent of participants had their darbepoetin dose increased to 5 mcg/kg/QOW per the protocol. Virtually all of the Amgen studies produced results that suggested a conversion ratio of 400:1.

Ortho Biotech submitted early unpublished results from a multicenter head-to-head trial of 40,000 IU of epoetin weekly compared to 200 mcg of darbepoetin every other week. The primary end-point is the change in Hgb from baseline at week 5, and initial results show significantly greater increase in Hgb for patients treated with epoetin. Ortho Biotech also submitted data from several retrospective analyses of medical charts and electronic medial records, totaling several thousand patients. None of these studies have yet been peer- reviewed or published. All of the Ortho-sponsored studies provide results suggesting that the appropriate conversion ratio is 260:1 or less.

In the observational studies that directly compare Aranesp and Procrit for the treatment of CIA, and report total dose per patient per episode of both epoetin and darbepoetin, the ratio of mean total doses is 341:1 and the ratio of median total doses is 352:1. However, selection bias may affect the validity of these studies. CMS therefore believes that the above-mentioned ratios may still overestimate, at least modestly, the potency of darbepoetin alfa relative to epoetin alfa. An analysis of Medicare claims data from 2002 and 2003 determined that the ratio of utilization of Procrit to Aranesp in Medicare patients was 330:1 (units:mcg).

As noted above, a conversion ratio between the dosages of these two products is not meant to guide what should be done for individual patients in clinical practice. In addition, by using a conversion ratio CMS is not attempting to establish a lower or upper limit on the amount of either biological a physician can prescribe to a patient. CMS expects that physicians will continue to prescribe these biologicals based on their own clinical judgment of the needs of individual patients.

Based on our own review of the evidence, our consultation with the independent contactor who also reviewed the evidence, and our discussions with Amgen and Ortho Biotech, CMS concludes that an appropriate conversion ratio for the purposes of a payment policy is 330 International Units of epoetin alfa to one microgram of darbepoetin alfa (330:1) for the purpose of treating chemotherapy-induced anemia.

Chronic Kidney Disease without dialysis: It is well established that as a patient progresses through the stages of chronic kidney disease (CKD), erythropoietin levels decline and anemia tends to develop. Furthermore,

[[Page 63458]]

CKD patients are a very heterogeneous population, and it is likely that they will need varying doses of erythropoietic drugs as their CKD progresses to ESRD. At the present time there are no head-to-head randomized controlled clinical trials that look at erythropoietic drug needs across the spectrum of CKD.

Amgen presented studies that examined the effect of darbepoetin on hemoglobin in this population. Two studies showed a dose conversion ratio (DCR) range between 215-330. These were observational studies similarly affected by the methodological weaknesses of this study design previously discussed for chemotherapy-induced anemia. A third study submitted by Amgen showed a DCR of 168:1 and is the only study that prospectively looked at darbepoetin and epoetin.

We estimate that no more than 10 percent of the Medicare patients who receive darbepoetin in the hospital outpatient setting receive it solely because of CKD. As a result, at this time, we believe that it could be confusing and burdensome for hospitals as well as the Medicare claims processing systems to use different HCPCS codes assigned to different APCs in order to distinguish and pay different amounts for darbepoetin used by patients with CIA from darbepoetin used by patients with CKD. Therefore, given the heterogeneity of the population, the general paucity of scientific evidence on CKD, the estimated low incidence of CKD-only indications in the OPPS population, and the potential burden on providers of requiring different codes for different indications, we are not establishing a different payment rate for darbepoetin for CKD at this time. However, CMS invites the submission of peer reviewed clinical data to further illuminate the issue. Therefore, we are going to use a 330:1 conversion ratio for CKD also and, therefore, a single APC payment rate for darbepoetin alfa, in 2004.

VII. Wage Index Changes for CY 2004

Section 1833(t)(2)(D) of the Act requires that we determine a wage adjustment factor to adjust for geographic wage differences, in a budget neutral manner, that portion of the OPPS payment rate and copayment amount that is attributable to labor and labor-related costs.

We used the proposed Federal fiscal year (FY) 2004 hospital inpatient PPS wage index to make wage adjustments in determining the proposed payment rates set forth in the proposed rule. We also proposed to use the final FY 2004 hospital inpatient wage index to calculate the final CY 2004 payment rates and coinsurance amounts for OPPS. Therefore, we have used the corrected final FY 2004 hospital inpatient wage index to make wage adjustments in determining the final payments rates set forth in this final rule. The corrected final FY 2004 hospital inpatient wage index published as Tables 4A, 4B, and 4C in the October 6, 2003 Federal Register (68 FR 57732 through 57758) is reprinted in this final rule as Addendum H--Wage Index for Urban Areas; Addendum I--Wage Index for Rural Areas; and Addendum J--Wage Index for Hospitals That Are Reclassified. We used the corrected final FY 2004 hospital inpatient wage index to calculate the payment rates and coinsurance amounts published in this final rule to implement the OPPS for CY 2004. We note however, that from time to time, there are mid- year corrections to these wage indices and that our contractors will adopt and implement the mid-year changes for OPPS in the same manner that they make mid-year changes for inpatient hospital prospective payment.

We received several comments on how we apply the wage index in setting rates.

Comment: Commenters stated that we should exempt the device portion of the median cost from wage adjustment. They indicated that the wage index reflects the variation in wages and that applying it to 60 percent of an APC payment where part of that payment is for devices, to which the wage index is not applicable, results in inappropriately low payments in rural areas and discourages the expansion of state of the art technologies to rural hospitals. A commenter indicated that we should work with the commenter to calculate and publish a list of the device percentages for each APC and that the wage index adjustment should not be applied to that portion of the APC.

Response: To apply the wage index only to the non-device portion of the APC payment will mean a significant revision to the methodology used to calculate the relative weights and the conversion factor as well as changes to the system that applies the wage index on individual claims. When we calculate median costs, we divide 60 percent of the cost by the wage index for the hospital to neutralize the cost for the effects of the wage index. In addition, when we determine the conversion factor, we calculate a wage adjustment scalar to adjust for any increase or decrease that may occur to total payments from changes in the wage index. Moreover, it cannot be assumed that not applying the wage index to the device portion of the APC payment will result in increased payment for APCs that require devices. In localities that have high wage indices, this change could result in reductions in payments for device APCs. For example, if the wage index is 1.5 and the national APC payment is $10,000, the wage index applied to 60 percent of the APC increases the payment to the high wage index hospital to $13,000. If the wage index is 0.9, the wage index applied to 60 percent of the APC decreases the payment to the hospital to $9,400. However, if the wage index is applied only to 20 percent of the APC payment because 80 percent of the cost of the APC is for the device, the hospital in the high wage index area will now get $11,000 (a $2,000 loss) and the hospital in the low wage index area will now get $9,800 (a $400 gain).

Also, because the wage index is used to neutralize costs derived from charges and is a factor in the conversion factor, the $10,000 payment in the example may change. To gauge the full impact of such a change, we would have to undertake significant statistical analysis. We will continue to apply the wage index to 60 percent of the APC for 2004. However, we recognize the need to reassess whether this percentage is correct in view of the packaging of high cost devices into APCs and will make every effort to do a reassessment for 2005 OPPS proposed rule. If we determine that a change to the percentage might be appropriate, we will propose it in the 2005 OPPS NPRM.

VIII. Copayment for CY 2004

In the November 30, 2001 final rule (66 FR 59887), we adopted a methodology that applied five rules for calculating APC copayment amounts when payments for APC groups change because the APCs' relative weights are recalibrated or when individual services are reclassified from one APC group to another. In calculating the unadjusted copayment amounts for 2004, we encountered circumstances that the methodology in the November 30, 2001 final rule either did not address or whose applicability was ambiguous. Therefore, we proposed to revise and clarify the methodology we would follow to calculate unadjusted copayment amounts, including situations in which recalibration of the relative payment weight of an existing APC results in a change in the APC payment; situations in which reclassification of HCPCS codes from an existing APC to another APC results in a change in the APC payment; and situations in which newly created APCs are comprised of HCPCS codes from existing APCs.

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As we stated in the August 12, 2003 proposed rule, as a general rule, we would seek to lower the coinsurance rate for the services in an APC from the prior year. This principle is consistent with section 1833(t)(8)(C)(ii) of the Act, which accelerates the reduction in the national unadjusted coinsurance rate so that beneficiary liability will eventually equal 20 percent of the OPPS payment rate for all OPPS services and with section 1833(t)(3)(B), which indicates the congressional goal of achieving 20 percent coinsurance when fully phased in and gives the Secretary the authority to set rules for determining copayment amounts to new services. However, in no event is the proposed 2004 unadjusted coinsurance amount for an APC group lower than 20 percent or greater than 50 percent of the payment rate.

We proposed to determine copayment amounts in 2004 and subsequent years in accordance with the following rules.

1. When an APC group consists solely of HCPCS codes that were not paid under the OPPS the prior year because they were packaged or excluded or are new codes, the unadjusted copayment amount would be 20 percent of the APC payment rate.

2. If a new APC that did not exist during the prior year is created and consists of HCPCS codes previously assigned to other APCs, the copayment amount is calculated as the product of the APC payment rate and the lowest coinsurance percentage of the codes comprising the new APC.

3. If no codes are added to or removed from an APC and, after recalibration of its relative payment weight, the new payment rate is equal to or greater than the prior year's rate, the copayment amount remains constant (unless the resulting coinsurance percentage is less than 20 percent).

4. If no codes are added to or removed from an APC and, after recalibration of its relative payment weight, the new payment rate is less than the prior year's rate, the copayment amount is calculated as the product of the new payment rate and the prior year's coinsurance percentage.

5. If HCPCS codes are added to or deleted from an APC, and, after recalibrating its relative payment weight, holding its unadjusted copayment amount constant results in a decrease in the coinsurance percentage for the reconfigured APC, the copayment amount would not change (unless retaining the copayment amount would result in a coinsurance rate less than 20 percent).

6. If HCPCS codes are added to an APC, and, after recalibrating its relative payment weight, holding its unadjusted copayment amount constant results in an increase in the coinsurance percentage for the reconfigured APC, the copayment amount would be calculated as the product of the payment rate of the reconfigured APC and the lowest coinsurance percentage of the codes being added to the reconfigured APC.

We stated in the proposed rule that this methodology would, in general, reduce the beneficiary coinsurance rate and copayment amount for APCs for which the payment rate changes as the result of the reconfiguration of APCs and/or the recalibration of relative payment weights. We received no comments from the public on our proposal for the calculation of beneficiary copayment amounts.

The unadjusted copayment amounts for services payable under the OPPS effective January 1, 2004 are shown in Addendum A and Addendum B.

IX. Conversion Factor Update for CY 2004

Section 1833(t)(3)(C)(ii) of the Act requires us to update the conversion factor used to determine payment rates under the OPPS on an annual basis.

Section 1833(t)(3)(C)(iv) of the Act provides that for 2004, the update is equal to the hospital inpatient market basket percentage increase applicable to hospital discharges under section 1886(b)(3)(B)(iii) of the Act.

The forecast of the hospital market basket increase for FY 2004 published in the inpatient PPS proposed rule on May 19, 2003 was 3.5 percent. To set the proposed OPPS conversion factor for 2004, we increased the 2003 conversion factor of $52.151 (the figure from the November 1, 2002 final rule (67 FR 66788) by 3.5 percent.

In accordance with section 1833(t)(9)(B) of the Act, we further adjusted the proposed conversion factor for 2004 to ensure that the revisions we proposed to update by means of the wage index are made on a budget-neutral basis. We calculated a budget neutrality factor of 1.003 for wage index changes by comparing total payments from our simulation model using the proposed FY 2004 hospital inpatient PPS wage index values to those payments using the current (FY 2003) wage index values. In addition, for CY 2004, allowed pass-through payments have decreased to 2 percent of total OPPS payments, down from 2.3 percent in CY 2003. The 0.3 percent was also used to adjust the conversion factor.

The proposed market basket increase factor of 3.5 percent for 2004, the required wage index budget neutrality adjustment of approximately 1.003, and the 0.3 percent adjustment to the pass-through estimate, resulted in a proposed conversion factor for 2004 of $54.289.

For purposes of updating the CY 2003 conversion factor to determine a final conversion factor for CY 2004 we applied an update factor based on the final hospital inpatient market basket increase for FY 2004 of 3.4 percent, as published in the final rule for IPPS on August 1, 2003. We further adjusted the conversion factor by applying a budget neutrality factor of 1.001 for wage index changes based on final FY 2004 hospital inpatient PPS wage index values as published in a correction notice to the IPPS final rule on October 6, 2003. In addition, for CY 2004, estimated pass-through payments have decreased to 1.3 percent of total OPPS payments, down from 2.3 percent in CY 2003. The conversion factor was further adjusted by the difference in estimated pass-through payments of 1.0 percent.

The increase factor of 3.4 percent for 2004, the required wage index budget neutrality adjustment of slightly more than 1.001 and the 1.0 percent adjustment to the pass-through estimate, result in a final conversion factor for 2004 of $54.561.

We received several comments concerning the conversion factor update for 2004, which are summarized below.

Comment: Several commenters stated that the OPPS has been underfunded since its inception. One commenter stated that the OPPS conversion factor has increased by less than the full market basket increase and urged that we work with Congress to enact an annual outpatient update for 2005 that corrects for the funding gap. Other commenters, noting the preliminary estimate of pass-through spending in our proposed rule of August 12 of 1.0 percent of total OPPS payments, strongly urged us to return the remaining 1.0 percent to the conversion factor to help fund all other APCs.

Response: As described elsewhere in this final rule, we have completed our estimate of pass-through spending for 2004. By statute, we are authorized to spend only 2.0 percent of total estimated OPPS payments on pass-through spending for 2004. According to the best information available to us at this time, we estimate the total pass- through spending to be 1.3 percent of total OPPS spending for 2004. For 2003, we estimated the total pass-through spending to be 2.3 percent of total. Thus, we have returned the additional 1.0 percent to the conversion factor.

[[Page 63460]]

X. Outlier Policy and Elimination of Transitional Corridor Payments for CY 2004

A. Outlier Policy for CY 2004

For OPPS services furnished between August 1, 2000 and April 1, 2002, we calculated outlier payments in the aggregate for all OPPS services that appear on a bill in accordance with section 1833(t)(5)(D) of the Act. In the November 30, 2001 final rule (66 FR 59856, 59888), we specified that beginning with 2002, we would calculate outlier payments based on each individual OPPS service. We revised the aggregate method that we had used to calculate outlier payments and began to determine outliers on a service-by-service basis.

As explained in the April 7, 2000 final rule (65 FR 18498), we set a target for outlier payments at 2.0 percent of total payments. For purposes of simulating payments to calculate outlier thresholds, we proposed to continue to set the target for outlier payments at 2.0 percent. For 2003, the outlier threshold is met when costs of furnishing a service or procedure exceed 2.75 times the APC payment amount, and the current outlier payment percentage is 45 percent of the amount of costs in excess of the threshold.

For the reasons discussed in detail in section XI.E of this preamble, we proposed to establish two separate outlier thresholds, one for community mental health centers (CMHCs) and one for hospitals. For CY 2004, we proposed to continue to set the target for outlier payments at 2.0 percent of total OPPS payments (a portion of that 2.0 percent, 0.36 percent, would be allocated to CMHCs for PHP services). Based on our simulations for 2004, we proposed to set the hospital threshold for 2004 at 2.75 times the APC payment amount, and the proposed 2004 payment percentage applicable to costs over the threshold at 50 percent. We proposed to set the threshold for CMHCs for 2004 at 11.75 times the APC payment amount and the 2004 outlier payment percentage applicable to costs over the threshold at 50 percent. In this final rule, we are setting the target amount for outlier payments at 2.6 times the APC payment for hospitals and 3.65 times the APC payment for CMHCs. For 2004, the hospital outlier threshold is met when costs of furnishing a service or procedure exceed 2.6 times the APC payment amount and the outlier payment percentage is 50 percent of the amount of costs in excess of the threshold. Similarly, for CMHCs the threshold is met when costs of furnishing a service or procedure exceed 3.65 times the APC payment amount and the outlier payment percentage is 50 percent of the amount of costs in excess of the threshold.

We received several comments concerning our proposal to establish two separate outlier pools, one for hospitals and another for CMHCs, and to determine eligibility for outlier payments by applying an outlier threshold of 2.75 times the APC payment for hospitals and 11.75 times the APC payment for CMHCs. The comments we received concerning that proposal are summarized in section XI E.3 along with our responses. Comments we received pertaining to other aspects of our proposal for outlier payments are summarized below:

Comment: One hospital association contended that outpatient services that qualify for outlier payments should receive 80 percent of their costs above the threshold, rather than the proposed level of 50 percent. The association stated that an increased payment level would help to ameliorate the level of losses incurred by hospitals, such as teaching hospitals, that provide complex outpatient services and would make OPPS policy consistent with the policy under the IPPS. The association also pointed out that because we apply an outlier threshold that is a multiple of the APC payment, rather than a fixed dollar amount, hospitals that provide certain costlier services must absorb significantly more costs before even qualifying for outlier payments, making it even more important to increase the outlier payment percentage. The association recognized that increasing the payment percentage would require additional funds and recommended that we seriously consider increasing the outlier payment pool from its current level of 2.0 percent of total OPPS payments to 3.0 percent, the maximum allowed by law for 2004 and beyond.

Response: Although we acknowledge the importance of outlier payments to providers, those payments are intended to ensure that the Medicare program shares, to some extent, in the extraordinarily high costs a provider may incur in caring for specific patients in unusual circumstances. Outlier payments are not intended to be paid on a routine or regular basis for treating the majority of Medicare beneficiaries. The APC payments are developed to be reasonable and adequate payment for all but the most extraordinary cases. At this time, we do not believe that it would be appropriate to shift additional funds from APC payments in order to increase the outlier payment percentage. Increasing the outlier pool would result in reduced payments for the majority of services providers furnish in order to make increased payments for the rare, extraordinarily high cost cases a provider may treat.

Comment: A hospital association commented that we have furnished very little data on actual outlier payments under the OPPS, so hospitals have no way of knowing whether actual payments were higher or lower than estimated outlier payments and are unable to comment on the proper outlier threshold for OPPS. The association pointed out that we have historically furnished data on actual outlier payments in the IPPS rule and recommended that we furnish data on OPPS outlier payments so that hospitals may be able to make informed comments on the proper threshold.

Response: Based on hospital and CMHC claims submitted for the period April 1, 2002 through December 31, 2002, outlier payments for that period amounted to 1.78 percent of total OPPS payments. The outlier target we were trying to achieve for that period was 1.5 percent of total OPPS payments. Outlier payments to hospitals alone amounted to 1.54 percent of total OPPS payments to hospitals, while outlier payments to CMHCs amounted to 49.8 percent of their total OPPS payments.

B. Elimination of Transitional Corridor Payments for CY 2004

Since the inception of the OPPS, providers have been eligible to receive additional transitional payments if the payments they received under the OPPS were less than the payments they would have received for the same services under the payment system in effect before the OPPS. Under 1833(t)(7) of the Act, most hospitals that realize lower payments under the OPPS received transitional corridor payments based on a percent of the decrease in payments. However, rural hospitals having 100 or fewer beds, as well as cancer hospitals and children's hospitals described in section 1886(d)(1)(B)(iii) and (v) of the Act, were held harmless under this provision and paid the full amount of the decrease in payments under the OPPS.

Transitional corridor payments were intended to be temporary payments to ease providers' transition from the prior cost-based payment system to the prospective payment system. Beginning January 1, 2004, in accordance with section 1833(t)(7) of the Act, transitional corridor payments will no longer be paid to providers other than cancer hospitals and children's hospitals. Cancer hospitals and children's hospitals are held harmless permanently

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under the transitional corridor provisions of the statute.

Since small rural hospitals may not be able to achieve the same level of operating efficiencies as larger rural hospitals and urban hospitals, we were concerned that the possible decrease in payments to these hospitals resulting from the elimination of the transitional corridor payments could result in these hospitals having to decrease or altogether cease to provide certain outpatient services. A reduction of services could have consequences for Medicare beneficiaries and their continued access to care in rural areas. In light of these concerns, we stated in the August 12, 2003 proposed rule that one thing we could do is to provide increased APC payments for clinic and emergency room visits furnished by rural hospitals having 100 or fewer beds. Any adjustment to payments for these hospitals would be made under the authority granted to the Secretary under section 1833(t)(2)(E) of the Act, to establish in a budget neutral manner adjustments as determined to be necessary to ensure equitable payments, such as adjustments for certain classes of hospitals. In the August 12, 2003 proposed rule, we invited comments on whether we should provide an adjustment, such as the one described above, for small rural hospitals.

We received a few comments regarding the elimination of transitional corridor payments, which are summarized below along with our responses.

Comment: Two commenters stated that the loss of transitional corridor payments would dramatically affect revenues for rural hospitals; therefore, they supported increased payments to rural hospitals for clinic and emergency room visits. One hospital association recommended that we provide appropriate payment protections for small rural hospitals that provide emergency services to safeguard them from any adverse consequences stemming from the elimination of transitional corridor payments and to avoid life-threatening consequences by protecting beneficiaries' timely access to emergency services. Two additional commenters contended that our proposal would be inadequate and that to avoid curtailing services to Medicare beneficiaries relief is needed for small rural hospitals, sole community hospitals, and rural referral centers. They recommended that we continue transitional corridor payments using the authority we have to make adjustments under section 1833(t)(2)(E) of the Act. One commenter stated that our proposal failed to address other outpatient services that will be underpaid and suggested that transitional corridor payments be continued for a year while a more broad based payment methodology is developed for small rural hospitals. Another commenter recommended a rural APC add-on adjustment for all APCs paid to rural hospitals to acknowledge that these hospitals cannot achieve the same level of operating efficiencies as larger rural and urban hospitals. Another commenter argued that termination of transitional corridor payments was detrimental to all hospitals and recommended retaining transitional corridor payments for all hospitals.

One commenter opposed shifting payments from larger hospitals in order to increase payments to small rural hospitals. The commenter stated that all hospitals, regardless of size and location, struggle with gaining operating efficiencies under the OPPS. One hospital association indicated that transitional corridor payments have been a critical source of financial support for many teaching hospitals and payments to these hospitals deserve further analyses by us, which would likely result in the conclusion that a teaching hospital adjustment is warranted. Several hospital associations expressed concern about our proposal to create differential payment rates between urban and rural hospitals for clinic and emergency room visits, and one questioned our legal authority to pay differently for the same service. One of the associations added that as a preferred alternative, it is urging the Congress to allocate additional resources to extend the transitional corridor and hold harmless provisions to all providers as well as urging the Congress to increase payments for clinic and emergency room visits for all hospitals. Another of the hospital associations stated that it does not support a budget neutral, redistributive adjustment through regulation, but is instead urging the Congress to allocate additional resources to assist rural hospitals by increasing payment rates for clinic and emergency room visits for all hospitals.

The Medicare Payment Advisory Commission (MedPAC) commented that the August 12, 2003 proposed rule failed to provide a rationale for proposing increased payments for emergency room and clinic visits as a means of supporting small rural hospitals and recognized that only limited cost report data are available to assess the performance of small rural hospitals under the OPPS. MedPAC stated that we should consider other regulatory options to ensure access to care for rural beneficiaries, such as a low-volume adjustment and pointed out that any payment adjustment should be accompanied by an analysis of how small rural hospitals have fared under the OPPS, the impact of any payment adjustment, and the impact of other policies that affect rural hospitals such as conversion to critical access status. MedPAC also stated that legislative remedies could include extending the hold harmless policy or providing a transition from hold harmless status.

Response: Although we expressed concerns in the August 12, 2003 proposed rule that the sunsetting of transitional corridor payments might significantly impact small rural hospitals and we invited comments about whether we should provide for some type of adjustment to payments for these hospitals, we did not receive a large number of comments and the comments we did receive are mixed on the issue. Although some commenters called for an extension of hold harmless transitional corridor payments for small rural hospitals, we do not believe that is a viable option because any adjustment we would make under the authority of section 1833(t) of the Act would have to be made on a budget neutral basis and would result in decreased APC payments for all providers. Because we did not receive a strong response in favor of increased visit payments to small rural hospitals or compelling evidence that clearly supported the position that an adjustment for small rural hospitals is necessary to ensure access to hospital outpatient services in areas served by small rural hospitals, we will not adopt a payment adjustment for small rural hospitals. We will continue to seek information related to specific situations that demonstrate that access to care is a problem for Medicare beneficiaries.

XI. Other Policy Decisions and Changes

A. Hospital Coding for Evaluation and Management (E/M) Services

Facilities code clinic and emergency department visits using the same [Physicians'] Current Procedural Terminology (CPT) codes as physicians. For both clinic and emergency department visits, there are currently five levels of care. Because these codes were defined to reflect only the activities of physicians, they are inadequate to describe the range and mix of services provided to patients in the clinic and emergency department settings (for example, ongoing nursing care, preparation for diagnostic tests, and patient education).

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In the April 7, 2000 final rule (65 FR 18434), we stated that in order to ensure proper payment to hospitals, it was important that emergency and clinic visits be coded properly. To facilitate proper coding, we required each hospital to create an internal set of guidelines to determine what level of visit to report for each patient. In the August 24, 2001 proposed rule (66 FR 44672), we asked for public comments regarding national guidelines for hospital coding of emergency and clinic visits. Commenters recommended that we keep the current E/M coding system until facility-specific E/M codes for emergency department and clinic visits, along with national coding guidelines, were established. Commenters also recommended that we convene a panel of experts to develop codes and guidelines that are simple to understand, implement, and that are compliant with the Health Insurance Portability and Accountability Act (HIPAA) requirements.

Outcome of January 2002 APC Panel Meeting

During its January 2002 meeting, the APC Panel made several recommendations regarding coding for evaluation and management services. After careful review and consideration of written comments, oral testimony, and the APC Panel's recommendations, we proposed the following in the August 9, 2002 proposed rule (for implementation no earlier than January 2004):

1. To develop five G codes to describe emergency department services:

GXXX1--Level 1 Facility Emergency Services;

GXXX2--Level 2 Facility Emergency Services;

GXXX3--Level 3 Facility Emergency Services;

GXXX4--Level 4 Facility Emergency Services; and

GXXX5--Level 5 Facility Emergency Services.

2. To develop five G codes to describe clinic services:

GXXX6--Level 1 Facility Clinic Services;

GXXX7--Level 2 Facility Clinic Services;

GXXX8--Level 3 Facility Clinic Services;

GXXX9--Level 4 Facility Clinic Services; and

GXXX10--Level 5 Facility Clinic Services.

3. To replace CPT Visit Codes with the 10 new G codes for OPPS payment purposes.

4. To establish separate documentation guidelines for emergency visits and clinic visits.

In our November 1, 2002 final rule (67 FR 66792), we stated that the most appropriate forum for development of new code definitions and guidelines would be an independent expert panel that would make recommendations to us. In light of the expertise of organizations such as the American Hospital Association (AHA) and the American Health Information Management Association (AHIMA), we felt that these organizations were particularly well equipped to make recommendations to us and to provide ongoing education to providers.

On their own initiative, the AHA and the AHIMA convened an independent expert panel of individuals from various organizations to develop code descriptions and guidelines for hospital emergency department and clinic visits and to make recommendations to us.

The panel recommended the following to us.

1. We should make payment for emergency and clinic visits based on four levels of care.

2. We should create HCPCS codes to describe these levels of care as follows:

GXXX1--Level 1 Emergency Visit.

GXXX2--Level 2 Emergency Visit.

GXXX3--Level 3 Emergency Visit.

GXXX4--Critical Care provided in the emergency department.

GXXX5--Level 1 Clinic Visit.

GXXX6--Level 2 Clinic Visit.

GXXX7--Level 3 Clinic Visit.

GXXX8--Critical Care provided in the clinic.

3. We should replace all the HCPCS currently in APCs 600, 601, 602, 610, 611, 612, and 620 with GXXX1 through GXXX8.

4. Based on the above recommendations, we would crosswalk payments as follows: GXXX1 to APC 610, GXXX2 to APC 611, GXXX3 to APC 612, GXXX4 to APC 620, GXXX5 to APC600, GXXX6 to APC 601, GXXX7 to APC 602, and GXXX8 to APC 620. These crosswalks and code descriptions are listed in Table 14 below.

Table 14.--Crosswalks of 2003 HCPCS Codes to the Proposed G Codes

2003 2004 Proposed G

Payment 2003 HCPCS description

2004 G code description HCPCS

codes

APC amount

Emergency department visit........ Level 1 Emergency Visit. 99281

GXXX1 0610 $74.70 99282 Emergency department visit........ Level 2 Emergency Visit. 99283

GXXX2 0611 130.77 Emergency department visit........ Level 3 Emergency Visit. 99284

GXXX3 0612 226.30 99285 Critical care..................... Level 4 Critical Care

99291

GXXX4 0620 491.01 provided in the

99292 emergency department. Office/outpatient visit, new...... Level 1 Clinic Visit.... 99201

GXXX5 0600 50.62 99202 Office/outpatient visit, new...... Level 2 Clinic Visit.... 99203

GXXX6 0601 53.56 Office/outpatient visit, new...... Level 3 Clinic Visit.... 99204

GXXX7 0602 82.07 99205 Office/outpatient visit,

Level 1 Clinic Visit.... 99211

GXXX5 0600 50.62 established.

99212 Office/outpatient visit,

Level 2 Clinic Visit.... 99213

GXXX6 0601 53.56 established. Office/outpatient visit,

Level 3 Clinic Visit.... 99214

GXXX7 0602 82.07 established.

99215 Office consultation............... Level 1 Clinic Visit.... 99241

GXXX5 0600 50.62 99242 Office consultation............... Level 2 Clinic Visit.... 99243

GXXX6 0601 53.56 Office consultation............... Level 3 Clinic Visit.... 99244

GXXX7 0602 82.07 99245

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Critical care..................... Level 4 Critical Care

99291

GXXX8 0620 491.01 provided in the clinic. 99292

The independent panel convened by the AHA and AHIMA recommended these levels in anticipation of the development of national coding guidelines for emergency and clinic visits that meet the following criteria we announced in the August 9, 2002 proposed rule (67 FR 52131):

1. Coding guidelines for emergency and clinic visits should be based on emergency department or clinic facility resource use, rather than physician resource use.

2. Coding guidelines should be clear, facilitate accurate payment, be usable for compliance purposes and audits, and comply with HIPAA.

3. Coding guidelines should only require documentation that is clinically necessary for patient care. Preferably, coding guidelines should be based on current hospital documentation requirements.

4. Coding guidelines should not create incentives for inappropriate coding (for example, up-coding).

We have received recommendations for a set of coding guidelines from the independent E/M panel comprised of members of the AHA and AHIMA. We proposed to implement new evaluation and management codes only when we are also ready to implement guidelines for their use, after allowing ample opportunity for public comment, systems change, and provider education. We also proposed to use cost data from the current HCPCS codes in these APCs to determine the relative weights of these APCs until cost data from GXXX1 through GXXX8 are available to set relative weights. We note that this proposal requires discontinuing the use of all HCPCS codes in these APCs and would not allow us to collect cost data for the five levels of emergency and clinic visits that are currently described by CPT codes. We further note that we would no longer be able to distinguish among the costs for visits by new patients, established patients, consultation patients, or patients being seen for more specialized care (for example, pelvic screening exams and glaucoma screening exams).

We would be using claims data from current HCPCS codes and crosswalking those data to the new codes in the same APCs; therefore, there would be no change in payment for any of these services as a result of these coding changes. Once cost data become available from the new HCPCS codes, we would use those data to set the relative weights, and, therefore, there should be no budgetary impact.

We are currently considering the set of proposed national coding guidelines for emergency and clinic visits recommended by the independent panel. We plan to make any proposed guidelines available to the public for comment on the OPPS web site as soon as they are complete. We will notify the public through our listserve when these proposed guidelines become available. To subscribe to this listserve, please go to the following Web site: http://www.cms.hhs.gov/medlearn/listserv.asp and follow the directions to the OPPS listserve. With regard to the development of these guidelines, our primary concerns are--

1. To make appropriate payment for medically necessary care;

2. To minimize the information collection and reporting burden on facilities;

3. To minimize any incentives to provide unnecessary or low quality care;

4. To minimize the extent to which separately billable services are counted as E/M services;

5. To develop coding guidelines that are consistent with facility resource use; and

6. To develop coding guidelines that are clear, facilitate accurate payment, are useful for compliance purposes and audits, and comply with HIPAA. Before adoption and implementation of any coding changes or coding guidelines, ample time will be provided for the public to comment on our proposal and, following announcement of any final decisions, for the education of clinicians and coders and for hospitals to make the necessary changes in their systems to accommodate the codes and guidelines. In the proposed rule, we requested comments on the amount of time hospitals believe would be adequate to implement these new codes and guidelines. We stated that we remain committed to working with appropriate organizations and stakeholders in our continuing development of a standard set of codes and national guidelines for facility coding of emergency and clinic visits.

We received comments on our proposal, which are summarized below with our responses.

Comment: Several physician societies objected to the creation of new G codes to replace existing CPT codes for facility coding of emergency and clinic visits. These commenters stated that new G codes for these services would add an unnecessary layer of complexity and confusion to the system, and that the existing CPT codes adequately and appropriately describe the services provided in the emergency and clinic settings. One physician society supported the creation of new G codes for facility coding of emergency and clinic visits, agreeing that CPT codes fail to accurately describe facility resources used to provide E/M services, but expressed concern that payers or auditors might refer to crosswalks made in establishing facility E/M code levels to determine appropriate level of coding for physician E/M services. This commenter urged CMS to clarify that the levels of visits for facility E/M services should not be used by payers or auditors to verify that physicians have billed for the appropriate level of visit.

Several commenters, including a hospital association and federation, commended CMS for proposing new G codes for facility coding of emergency and clinic visits, stating that existing CPT codes for E/M services correspond to different levels of physician effort and fail to adequately describe non-physician resources. These commenters stated that the proposed new G codes would appropriately capture facility resources, minimize confusion relative to physician versus facility E/M services, and adequately meet hospitals' need to comply with HIPAA regulations.

Response: We agree with those commenters who believe that CPT codes for E/M services describe different levels of physician effort, and therefore, fail to accurately describe facility resources used to provide E/M services. In the November 1, 2002 final rule (67 FR 66718), we explained that the development of new HCPCS codes for facility visits was necessary to address potential HIPAA compliance issues. We also agree with comments that the

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proposed new G codes would appropriately capture facility resources and minimize confusion relative to physician versus facility E/M services. Therefore, we will continue to develop coding guidelines for facility E/M codes that are clear, facilitate accurate payment, are useful for compliance purposes and audits, and comply with HIPAA. For clarification purposes, levels of visits for facility E/M services should not be used by payers or auditors to verify that physicians have billed for the appropriate level of visit.

Comment: We received a number of comments regarding our proposal of three levels of care (plus critical care) for clinic and emergency department visits. Several commenters stated that variation in cost per visit warrants five levels of service mapping to five separate APCs to maintain reasonable steps in payment as treatment costs increase. These commenters expressed concern that the agency will no longer have the ability to collect cost data for the five levels of emergency and clinic visits currently described by CPT codes, and that an averaging of charges over only three levels of service will result in adverse effects (that is, overpayments and underpayments) at the low and high end of visit codes. Furthermore, these commenters stated that private payers require a five tiered system and may not recognize the new G codes for payment. In contrast, we received several comments supporting our proposal of three levels of care (plus critical care) for clinic and emergency department visits. These commenters stated that three levels would help reduce the coding complexity and would be a more appropriate and accurate mechanism for reporting emergency and clinic visits.

Response: We appreciate the commenters' concerns while at the same time recognizing merits in the independent expert panel's recommendation to create three levels of care (plus critical care) for clinic and emergency visits. Given the level of interest in this issue and the importance to Medicare and to hospitals of establishing the appropriate codes and payment levels for these services, we will continue to study the issue. Prior to implementation of new facility E/ M codes we will carefully consider all commenters' concerns related to variation in visit costs and recognition of a three tiered system by private payers. We will also consider placing this issue on the agenda for the 2004 APC Panel meeting.

Comment: Several physician societies expressed concern about potential discrepancies in payment for the same services furnished in clinic and emergency departments versus physician offices. One commenter stated that the proposal lacked physician input. While acknowledging statutory requirements that dictate the structure of the payment system for non-physician resources required to support physician services and the payment system for outpatient facility resources, commenters stated that we should avoid adopting policies that further increase the inequity in Medicare's payment systems. These commenters urged us to establish payment equity for the same services furnished in these respective settings.

Response: As stated elsewhere, the statute contains different provisions for how payments are established under the physician fee schedule and how payments are established under the OPPS. With respect to the absence of physician input on the proposal, we welcome comments from all interested parties as we continue to develop our policy.

Comment: We received numerous and detailed comments in reference to the model guidelines proposed by the independent expert panel convened by the American Hospital Association (AHA) and the American Health Information Management Association (AHIMA).

Response: We are appreciative of the detailed comments we received in reference to the model guidelines proposed by the independent expert panel convened by the AHA and AHIMA. While we will carefully consider these comments in our continued review of the independent panel's proposed guidelines, we will not be responding to such comments in this rule since CMS did not propose these coding guidelines in the August 12, 2003 proposed rule.

Comment: Several commenters supported our decision to delay implementation of new E/M codes for clinic and emergency department visits until we have established defined and uniform coding guidelines.

Response: To minimize confusion, we continue to believe that a national set of defined coding guidelines must be established and implemented in conjunction with any new E/M codes for clinic and emergency department visits.

Comment: Several commenters encouraged CMS to make any proposed guidelines for billing hospital emergency room and clinic visits publicly available with opportunity to comment as soon as they are complete.

Response: We plan to make any coding guidelines that we are considering available to the public for comment on the OPPS Web site as soon as they are complete. We will notify the public through our listserve when these proposed guidelines become available. To subscribe to this listserve, please go to the following Web site: http://www.cms.hhs.gov/medlearn/listserv.asp and follow the directions to the OPPS listserve. As stated elsewhere, we will provide ample opportunity for the public to comment on the proposal.

Comment: Several commenters requested that CMS provide adequate time for the education of clinicians and coders and for hospitals to make the necessary changes in their systems to accommodate new evaluation and management (E/M) codes and guidelines. While two commenters requested a minimum notice of three months prior to implementation, the majority of commenters requested a minimum notice of between six and twelve months prior to implementation of facility evaluation and management codes and guidelines.

Response: We will continue to be considerate of the time necessary to educate clinicians and coders and for hospitals to modify their systems to accommodate new codes and guidelines. Based on comments received, we will provide a minimum notice of between six and twelve months prior to implementation of facility evaluation and management codes and guidelines. We do not expect to implement these new codes and guidelines any earlier than January 2005.

B. Status Indicators and Issues Related to OCE Editing

The status indicators we assign to HCPCS codes and APCs under the OPPS have an important role in payment for services under the OPPS because they indicate whether a service represented by an HCPCS code is payable under the OPPS or another payment system and also whether particular OPPS policies apply to the code. We are providing our status indicator (SI) assignments for APCs in Addendum A, HCPCS codes in Addendum B, definitions of the status indicators in Addendum D1, and definitions of code condition indicators in Addendum D2.

The OPPS is based on HCPCS codes for medical and other health services. These codes are used for a wide variety of payment systems under Medicare, including, but not limited to, the Medicare fee schedule for physician services, the Medicare fee schedule for durable medical equipment and prosthetic devices, and the Medicare clinical laboratory fee schedule. For purposes of making payment under the

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OPPS, we must be able to signal the claims processing system which HCPCS codes are paid under the OPPS and those codes to which particular OPPS payment policies apply. We accomplish this identification in the OPPS through a system of payment status indicators with specific meanings.

We assign one and only one status indicator to each APC and to each HCPCS code. Each HCPCS code that is assigned to an APC has the same status indicator as the APC to which it is assigned.

The software that controls Medicare payment looks to the status indicators attached to the HCPCS codes and APCs for direction in the processing of the claim. Therefore, the assignment of the status indicators has significance for the payment of services.

In the August 12, 2003 proposed rule, we listed the OPPS status indicators and described how we proposed to use them in the 2004 OPPS. We also solicited comments on the appropriateness of the status indicator that we proposed to assign to each APC in Addendum A and each HCPCS code in Addendum B. Because the assignment of a status indicator designates how a particular outpatient service will be paid, either under the OPPS or under another payment system, or why payment is not made for a code, the comments that we received regarding the status indicator assigned to a particular APC or HCPCS code are discussed elsewhere in this final rule, within the context of the payment policy or rule that affect how payment is determined for the APC or HCPCS code.

Since publication of the August 12 proposed rule, we have been preparing specifications for the January 1, 2004 outpatient code editor (OCE) and PRICER, which are pivotal in determining how hospital claims for outpatient services are processed and paid. In the course of discussions with the contractors and systems maintainers with whom we work to ensure that claims are processed appropriately and in accordance with the policies and changes that we are implementing in this final OPPS rule for 2004, several issues related to status indicator definitions and claims processing edits and dispositions have arisen. As a result of these discussions, we have determined that claims would be processed more accurately if we established two additional payment status indicators to designate with greater specificity the appropriate disposition of certain codes for which payment is not made under the OPPS. Therefore, we are adding two status indicators, status indicator ``B'' and status indicator ``Y,'' to Addendum D1, which lists all of the status indicators established as part of the OPPS and describes what they signify. We have also revised and refined the status indicator definitions and clarified the explanation of what each status indicator means. None of these changes affect how services are paid under the OPPS. Rather, the changes are intended to clarify how the status indicators relate to existing payment policy and rules and to assist hospitals and our contractors in determining the disposition of individual HCPCS codes when they are billed to Medicare.

In 2004, we are adding a new Status Indicator ``Y'' to designate codes for non-implantable Durable Medical Equipment (DME) to assist hospitals in identifying codes that they must bill directly to the Durable Medical Equipment Regional Carrier (DMERC) rather than to the fiscal intermediary. Codes assigned Status Indicator ``Y'' are listed in Addendum B.

Historically, we have used Status Indicator ``E'' to identify certain HCPCS codes that are recognized by Medicare but that are not payable under the OPPS when they are submitted on an outpatient hospital Part B bill type (bill type 12x, 13x, or 14x). Beginning with implementation of the 2004 final rule, we are assigning Status Indicator ``B'' to HCPCS codes that are not payable under OPPS when submitted on an outpatient hospital Part B bill type (12x, 13x, and 14x), but that may be payable by intermediaries to other provider types when submitted on an appropriate bill type, such as bill type 75x submitted by a CORF. In some cases, another code may be submitted by hospitals on an outpatient hospital Part B bill type (12x, 13x, and 14x) to receive payment for a service or code that is assigned status indicator ``B'' in Addendum B. Because we did not include these status indicator changes in the August 12, 2003 proposed rule, we invite comments on their addition to Addendum D1, and on the revised definitions and explanations that we included in Addendum D1.

Addendum D2 shows the indicators that we use to designate codes that are new in 2004 for which comments may be submitted as well as codes that are deleted in 2004 either with or without a grace period.

C. Observation Services

In the November 1, 2002 update to the OPPS (67 FR 66794), we summarized and clarified previously published guidance (Transmittal A- 02-026) regarding payment requirements for HCPCS code G0244, Observation care provided by a facility to a patient with congestive heart failure, chest pain or asthma, minimum of 8 hours, maximum 48 hours. We also implemented HCPCS codes G0263 and G0264 to identify patients directly admitted to observation. In January 2003, we published Transmittal A-02-129, which provides further instructions regarding billing for observation services. In the proposed rule, we did not propose anything new with regard to observation services, nor did we seek public comment on observation issues. We stated that we would update by Program Memorandum any changes in the list of ICD-9-CM codes required for payment of HCPCS code G0244 resulting from the October 1 annual update of ICD-9-CM. We also stated in the proposed rule that we would include any changes in the 2004 final OPPS rule and allow the public an opportunity to comment.

We have had an opportunity to review the October 1, 2003 update of the ICD-9-CM and we have determined that there are not changes that affect the list of diagnosis codes required for payment of HCPCS code G0244. Therefore, we are not implementing any changes in the way we pay for observation services under the 2004 OPPS.

D. Procedures That Will Be Paid Only as Inpatient Procedures

Before implementation of the OPPS, Medicare paid reasonable costs for services provided in the outpatient department. The claims submitted were subject to medical review by the fiscal intermediaries to determine the appropriateness of providing certain services in the outpatient setting. We did not specify in regulations those services that were appropriate to be provided only in the inpatient setting and that, therefore, should be payable only when provided in that setting.

Section 1833(t)(1)(B)(i) of the Act gives the Secretary broad authority to determine the services to be covered and paid for under the OPPS. In the April 7, 2000 final rule, we identified procedures that are typically provided only in an inpatient setting and, therefore, would not be paid by Medicare under the OPPS (65 FR 18455). These procedures comprise what is referred to as the ``inpatient list.'' The inpatient list specifies those services that are only paid when provided in an inpatient setting. These are services that require inpatient care because of the nature of the procedure, the need for at least 24 hours of post-operative recovery time or monitoring before the patient can be safely discharged, or the underlying physical condition of the patient. As we

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discussed in the April 7, 2000 and the November 30, 2001 final rules, we use the following criteria when reviewing procedures to determine whether or not they should be moved from the inpatient list and assigned to an APC group for payment under the OPPS:

[sbull] Most outpatient departments are equipped to provide the services to the Medicare population.

[sbull] The simplest procedure described by the code may be performed in most outpatient departments.

[sbull] The procedure is related to codes that we have already removed from the inpatient list.

In the November 1, 2002 final rule, we added the following criteria for use in reviewing procedures to determine whether they should be removed from the inpatient list and assigned to an APC group for payment under the OPPS:

[sbull] We have determined that the procedure is being performed in multiple hospitals on an outpatient basis; or

[sbull] We have determined that the procedure can be appropriately and safely performed in an ASC and is on the list of approved ambulatory surgical center (ASC) procedures or proposed by us for addition to the ASC list.

At its January 2003 meeting, the APC Panel did not make recommendations regarding procedures on the inpatient list, and in the proposed rule, we did not propose to make any of the procedures that are currently on the inpatient list in Addendum E payable under the OPPS in 2004. We solicited comments on whether any procedures in Addendum E should be paid under the OPPS. We asked commenters recommending reclassification of a procedure to an APC to include evidence (preferably from peer-reviewed medical literature) that the procedure is being performed on an outpatient basis in a safe and effective manner. We also solicited comments on the appropriate APC assignment for the procedure in the event that we determine in the final rule, based on comments, that the procedure would be payable under the OPPS in 2004.

Following our review of any comments that we receive about the procedures in Addendum E, we indicated in the proposed rule that we would propose either to assign a CPT code to an APC for payment under the OPPS or, if the comments did not provide sufficient information and data to enable us to make a decision, to present the comments to the APC Panel at its 2004 meeting.

Procedures on the inpatient list can be found in Addendum E. CPT codes that are new in 2004 and that we believe are appropriately assigned status indicator ``C'' to designate that they are on the inpatient list can be found in Addendum B with condition code ``NI''. We invite comment on assignment of these codes to the inpatient list.

We received a few comments regarding the inpatient list, which are summarized below with our responses.

Comment: A group of providers representing 18 health care systems around the country requested that CMS clarify the intent of the inpatient list. The commenter expressed concern that some independent medical review criteria appear to equate codes with APC payments as procedures that CMS has determined must be outpatient services both because they are payable under the OPPS and because they are not included on the inpatient list. The commenter is concerned that hospitals will interpret these criteria to mean that any procedure or service not on the inpatient list must be furnished on an outpatient basis, regardless of the needs of the patient.

Response: We wish to clarify that assignment of an APC payment to a service or procedure does not mean that Medicare covers the service or procedure or that it may only be payable when furnished in an outpatient setting. In the November 1, 2002 final rule (67 FR 66739) as well as the April 7, 2000 and the November 30, 2001 final rules, we explain in detail our rationale for the inpatient list. Assignment of an APC payment to a service or procedure does not prohibit hospitals from providing these services on an inpatient basis when it is reasonable and necessary to admit the patient based on the patient's medical condition.

Comment: The same commenter repeated objections that have been submitted in comments to OPPS rules in prior years, that it is unfair to deny payment to hospitals for procedures on the inpatient list, but to pay physicians when they perform procedures on the inpatient list in a hospital outpatient setting. The commenter asserts that physicians are not responsive to hospital efforts to educate them regarding Medicare payment for procedures on the inpatient list performed on a patient who has not been admitted as an inpatient because the location that the physician chooses to perform a procedure has no impact on Medicare payment for the physician's professional services. Moreover, the commenter asserts that physicians disagree with assignment of procedures to the inpatient list because new technology or surgical advances allow the procedure to be appropriately performed on an outpatient basis. The commenter urged us to release the inpatient list as part of the physician's fee schedule in order to align hospital and physician incentives.

Response: In the November 1, 2002 final rule (67 FR 66740) we responded to similar comments regarding hospitals' concerns about physicians being paid for procedures on the inpatient list that are performed on an outpatient basis even though payment is denied to hospitals for those procedures. As we state above, the basis for the inpatient list is rooted in section 1833(t)(1)(B)(i) of the Act, which gives the Secretary broad authority to determine the services to be covered and paid for under the OPPS. The authority in this section of the Act does not extend to services that are covered and paid for under the Medicare physician fee schedule, which is a separate benefit and payment system. However, we believe that as hospitals and physicians continue to gain experience and become more knowledgeable about how Medicare pays for services under the OPPS, problems associated with the existence of the inpatient list will continue to diminish.

Moreover, we welcome at any time recommendations from hospitals and/or physicians regarding procedures currently on the inpatient list that are being safely and appropriately performed on an outpatient basis. Requests for review of a code or group of codes on the inpatient list should be sent to the Director, Division of Outpatient Care, Centers for Medicare & Medicaid Services, Mailstop C4-05-17, 7500 Security Boulevard, Baltimore, MD 21244-1850. Such requests should include supporting information and data to demonstrate that the code meets the five criteria for payment under the OPPS that are listed above, and that are also discussed in the November 1, 2002 final rule (67 FR 66739). In addition, we ask that evidence be submitted, including operative reports of actual cases and peer-reviewed medical literature, to demonstrate that the procedure is being performed on an outpatient basis in a safe and appropriate manner in a variety of different types of hospitals.

Comment: The same commenter recommended that we change our policy for OPPS payment of inpatient services when the patient is transferred to another hospital. They state that the current requirement creates unnecessary administrative burden when a hospital, in order to receive payment, must admit a patient simply to stabilize them prior to transfer. The commenter

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recommended that, when procedures on the inpatient list are provided to patients in order to stabilize the patient immediately prior to transfer, we ignore the payment status indicator of ``C'' assigned to the procedure on a claim and allow the claim to be paid under the OPPS.

Response: Procedures on the inpatient list performed on patients whose status is that of outpatient are not payable under the OPPS. However, we recognize that there are occasions when a procedure on the inpatient list may have to be performed to resuscitate or stabilize a patient with an emergent, life-threatening condition whose status is that of an outpatient. We also recognize that, once stabilized, such a patient may subsequently require transfer to another facility in order to receive appropriate care. As we explain in the November 1, 2002 final rule (67 FR 66798), when a physician performs a procedure on the inpatient list to resuscitate or stabilize a patient with an emergent, life-threatening condition whose status is that of an outpatient, we expect the physician to order that the patient be admitted following the procedure for the purpose of receiving inpatient hospital services and occupying an inpatient hospital bed. Or, the physician may order that the patient be admitted and then determine that the patient should be transferred to another provider. In the latter instance, Medicare allows payment for services furnished to a patient who is transferred to another provider. However, in order for the discharging hospital to receive payment in cases where it is determined that appropriate care for the patient necessitates transfer to another provider, long- standing Medicare rules provide that the patient has to have been admitted to the discharging hospital. Further, as we discuss in the November 1, 2002 final rule, it is important that the particular circumstances necessitating performance of a procedure on the inpatient list when the patient's status is that of an outpatient be thoroughly documented in the medical record. For these reasons, we disagree with and are not implementing the commenter's recommendation that we modify the outpatient code editor (OCE) to allow payment under the OPPS for services furnished to resuscitate or stabilize an outpatient with an emergent, life-threatening condition who is transferred to another facility following a procedure on the inpatient list.

Comment: One hospital requested that we remove CPT 37182, Insertion of transvenous intrahepatic protosystemic shunts(s) (TIPS), from the inpatient list. One health system requested that we remove CPT 20660, Application of cranial tongs, caliper, or stereotactic frame, including removal (separate procedure) and CPT 49061, Drainage of retroperitoneal abscess; percutaneous, from the inpatient list.

Response: Our medical officers reviewed these recommendations and determined that these codes do not meet the criteria for removing a procedure from the inpatient list and assignment to an APC. We would expect patients whose medical condition requires these procedures to be admitted as inpatients in order to have these procedures performed. Our data indicate that these procedures are performed predominantly in the inpatient setting. Therefore, in the absence of evidence demonstrating that these procedures are being performed on an outpatient basis in a safe and appropriate manner in a variety of different types of hospitals and that the criteria for removing a procedure from the inpatient list are met, we are retaining these codes on the inpatient list.

Comment: A provider group requested that we change the status indicator of the following codes from ``N'' to ``C,'' because these are add-on codes for procedures already on the inpatient list: CPT 61316, Incision and subcutaneous placement of cranial bone graft; CPT 61517, Implantation of brain intracavitary chemotherapy agent; CPT 62148, Incision and retrieval of subcutaneous cranial bone graft for cranioplasty; and, CPT 62160, Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage.

Response: We thank the commenter for bringing these codes to our attention and we agree that the status indicator for these codes should be changed from ``N'' to ``C.''

New APC To Pay for Services Furnished on Same Date as Service With Modifier -CA:

In the 2003 update of the OPPS, we implemented a new modifier -CA, Procedure payable only in the inpatient setting when performed emergently on an outpatient who dies before admission. In section VI of Transmittal A-02-129, issued on January 3, 2003, we instructed hospitals on the use of modifier -CA when submitting a claim on bill type 13x for a procedure that is on the inpatient list and that is assigned payment SI ``C.'' (Transmittal A-02-129 can be found on our web site at cms.hhs.gov.) We also implemented in the November 1, 2002 final rule (67 FR 66799) a new payment policy to allow payment, under certain conditions, for outpatient services on a claim that have the same date of service as the HCPCS code billed with modifier -CA. A single payment for outpatient services on the claim, other than those coded with SI ``C'' and modifier -CA, is currently made under APC 0977.

We reviewed this policy and determined that assigning payment for these services to APC 0977, which is a New Technology APC, is problematic because payment under New Technology APCs is a fixed amount that does not have a relative payment weight and is, therefore, not subject to recalibration based on hospital costs. We proposed to establish a new APC for which payment would be made under certain conditions for otherwise payable outpatient services furnished on the same date of service that a procedure with SI ``C'' is performed emergently on an outpatient who dies before admission to the hospital as an inpatient. Beginning in 2004, hospitals would be paid under APC 0375 instead of APC 0977 for services furnished on the same date of service that a procedure with SI ``C'' and modifier -CA is billed. We proposed at the outset to set the payment rate for APC 0375 in the amount of $1,150, which is the payment amount for the newly structured New Technology APC that would replace APC 0977. When the APC weights are recalibrated in 2005, we would use charge data from CY 2003 claims for line items that have the same date of service as the line with modifier -CA and that show a HCPCS code with status indicator ``V,'' ``S,'' ``T,'' ``X,'' ``N,'' or ``K'' to calculate a median cost and relative payment weight for APC 375. Once we have claims data, we would be able to determine whether it is appropriate to calculate a relative payment weight based on median costs from our claims data or to continue a fixed payment rate for these special cases. In the proposed rule, we invited comments on these proposed changes.

Comment: One commenter was concerned with the methodology for calculation of APC 375, Ancillary Outpatient Services when Patient Expires. The commenter stated that items such as pass-through devices and drugs and packaged items reported without HCPCS should be included in the calculation.

Response: It is conceivable that a pass-through drug or device could be furnished to a patient during the same encounter when a procedure billed with modifier -CA is performed. If that were the case, we would expect the hospital to include these services on the claim submitted for the encounter. Although

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we would not pay separately for the pass-through items, we agree with the commenter that we should consider taking these costs into account when evaluating how best to establish the payment rate for APC 375 in future updates of the OPPS. We also agree that charges reported with a revenue code but without a HCPCS code should be considered as well.

E. Partial Hospitalization Payment Methodology

1. Background

As we discussed in the April 7, 2000 OPPS final rule (65 FR 18452), partial hospitalization is an intensive outpatient program of psychiatric services provided to patients in place of inpatient psychiatric care. A partial hospitalization program (PHP) may be provided by a hospital to its outpatients or by a Medicare-certified community mental health center (CMHC). Payment to providers under the OPPS for PHPs represents the provider's overhead costs associated with the program. Because a day of care is the unit that defines the structure and scheduling of partial hospitalization services, we established a per diem payment methodology for the PHP APC, effective for services furnished on or after August 1, 2000.

The analysis of hospital partial hospitalization claims resulted in a per diem payment of $202.19, effective August 1, 2000. This amount was updated effective January 1, 2001 and April 1, 2002 to $206.82 and $212.27, respectively.

Effective January 1, 2003, the PHP APC amount was $240.03, of which $48.17 is the beneficiary's coinsurance. In the proposed rule, we described the methodology we followed in developing the 2003 PHP payment rate. 2. PHP APC Update for CY 2004

For CY 2004, we analyzed hospital and CMHC PHP claims for services furnished between April 1, 2002 and December 31, 2002. We intended to propose to use the same methodology for computing median costs per day for CY 2004 that was used to compute the CY 2003 PHP median cost per day. However, when we applied the methodology to the CMHC claims, the CMHC median cost per day was determined to be significantly higher than the median cost per day for hospital outpatient departments to provide the same benefit. In addition, the difference in median costs per day was significantly larger than last year.

As a result, we proposed a per diem rate for PHP services furnished during CY 2004 based solely on hospital PHP data. The proposed PHP APC 0033 amount, after scaling, was determined to be $208.95, of which $41.69 is the beneficiary's coinsurance.

However, a Program Memorandum issued on January 17, 2003, directed the FIs to recalculate hospital and CMHC cost-to-charge ratios. We anticipated receipt of the updated ratios this summer, and indicated that if the updated cost-to-charge ratios resulted in a more reasonable median per diem rate, we would use the CMHC data in developing the final rate for CY 2004.

We received 42 public comments in response to this proposal. A summary of the comments is provided below along with our responses.

Comment: In general, the commenters expressed concern that a reduction in the PHP rate of this magnitude would lead to the closure of many PHPs and that limited access to this crucial service would result in more costly inpatient hospital care as the ony alternative. A hospital association commented that basing the rate on only hospital data is inconsistent with other prospective payment systems and recommended that we find an alternative method to secure reliable CMHC data. CMHCs commented that their costs are higher than hospitals', with most in the $300 to $400 range. One commenter provided summary information on the average per day costs for seven CMHCs. Although the average per day cost for these seven providers was $390, the costs for individual providers ranged from $216 to $725. Unfortunately, the commenter did not provide a breakdown of these costs. Another commenter indicated that a per day rate of $300 to $350 was more appropriate than our proposed amount.

Another commenter stated that our inability to process the data timely does not constitute an appropriate basis for excluding all CMHC data from the per diem calculations. The commenters suggested alternatives such as including prior years' CMHC data trended forward based on medical inflation or maintaining the CY 2003 payment rate for PHP services furnished in CY 2004. One commenter questioned why the median cost per day for hospitals was reported as $225 but the proposed rate was reduced to $208.95.

Response: As we stated in the August 12, 2003 proposed rule, we intended to review the PHP data using the updated cost-to-charge ratios to compute the final CY 2004 PHP APC. As expected, the updated ratios reduced the median cost per day for CMHCs. The revised medians are $440 for CMHCs and $206 for hospitals. Combining these files results in a median per diem PHP cost of $303. As with all APCs in the OPPS, the median cost for each APC is scaled to be relative to a mid-level office visit and the conversion factor is applied. The resulting APC amount for CY 2004 is $286.82 of which $57.36 is the beneficiary's coinsurance.

Comment: With respect to the methodology used to establish the PHP APC amount, commenters expressed concern that data from settled cost reports fails to include costs reversed on appeal and that there are inherent problems in using claims data from a different time period like available cost-to-charge ratios on settled cost reports.

Response: We used the best available data in computing the APCs. The January 17, 2003 Program Memorandum directed FIs to update the cost-to-charge ratios on an ongoing basis whenever a more recent full year cost report is available. In this way, we hope to minimize the time lag between the cost-to-charge ratios and claims data.

Comment: One commenter provided links to certain data files that were used to establish the APC rates. Since APC 0033 and certain HCPCS codes that are only paid under OPPS when they are furnished as part of a PHP were not included in these data files, the commenter believed that the data used to establish the PHP APC amount is incomplete.

Response: These data files are provided so that interested parties can study the costs associated with the HCPCS codes that comprise each APC and other analyses. We are required to include the HCPCS codes within each APC that are similar in resource use. This is not the case with the PHP APC (0033) in which the day of care is the unit that defines the structure and scheduling of PHPs and the composition of the PHP APC consists of the cost of all services provided each day. Although we require that each PHP day include a psychotherapy service, we do not specify the specific mix of other services provided and have focused our analysis on the cost per day rather than the cost of each service furnished within the day. As a result, we will add APC 0033 to the file that displays the APC median costs, but not the PHP data that show medians by HCPCS codes. We will continue to analyze the PHP data and will reconsider this position in the future.

Comment: One commenter related that administrative costs for CMHCs continue to be a major impediment to operating PHPs for Medicare beneficiaries. Medicare does not cover transportation to and from programs and does not cover meals. Almost all programs offer transportation because in

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most cases Medicare beneficiaries with serious mental illnesses would not be able to access these programs without the transportation. They also commented about the current Medicare bad debt policy, which is beyond the scope of the August 12, 2003 proposed rule.

Response: The services that are covered as part of a PHP are specified in section 1861(ff) of the Act. Meals and transportation are specifically excluded under section 1861(ff)(2)(I) of the Act.

Comment: Several commenters summed the median cost figures for various combinations of HCPCS codes 90853 (group psychotherapy), 90818 (individual psychotherapy, 45-50 minutes), and 90847 (family psychotherapy, with patient present) and concluded that the per diem amount is considerably less than the combined cost of these services.

Response: We believe that the figures cited by the commenters were taken from a file that shows the median cost for single bills, for example, where group psychotherapy was the only service furnished. We do not believe that this is an appropriate comparison. These amounts are provided to enable the public to identify the median cost of services before scaling. It is important to note that these services are not PHP services, but rather single outpatient therapeutic sessions. As stated earlier, we used data from PHP programs (both hospitals and CMHCs) to determine the median cost of a day of PHP. PHP is a program of services where savings can be realized by hospitals and CMHCs over delivering individual psychotherapy services.

Comment: Several commenters compared the proposed per diem amount to the cost of the minimum services mandated by us or by the local medical review policies (LMRP) used by their FIs.

Response: We have not specified the specific daily components of a PHP. However, there is an edit in our claims processing system to identify claims that do not have at least three services, with at least one psychotherapy service (individual, group, or family therapy) for each day of PHP care. We have implemented this edit to ensure that PHPs meet the statutory requirement that they be intensive treatment programs provided in lieu of inpatient psychiatric hospital services. Claims with fewer than three services per day undergo medical review by the FIs to ensure that the patient is receiving intensive treatment. There may be legitimate reasons for a day on a claim to have fewer services, for example, where the patient leaves the program early to receive medical care. Medical review of these claims verifies that the patient requires and is receiving a PHP level of care.

Comment: The commenters also questioned our requirement that psychotherapy services be conducted by a Master's level practitioner. One commenter questioned how a hospital could comply with the three services per day requirement when licensed clinical social worker (CSW) services are bundled into the per diem payment.

Response: We do not require that a Master's prepared practitioner furnish psychotherapy services in a PHP. However, in accordance with section 1861(ff)(2)(A) of the Act, we require that practitioners who furnish psychotherapy services are authorized to do so by their States, through licensure, certification, or other official State processes. When a service is furnished by a practitioner who is not authorized by the State to furnish psychotherapy services, the service would not be recognized as a PHP service.

With respect to billing by CSWs, the professional component of services furnished by CSWs to PHP patients is bundled into the per diem payment amount and no billing to the Part B carrier is permitted. The rationale for this policy was explained in the interim final regulation with comment period we published on February 11, 1994 (59 FR 6570).

The OPPS is intended to pay PHP providers for the resources associated with sponsoring a PHP, for example, building maintenance, utilities, and support staff, including the cost of CSWs. Thus, where a PHP provider utilizes CSWs for psychotherapy services to PHP patients, payment for the professional costs of the CSW is made through the OPPS per diem payment. However, if a PHP utilizes psychiatrists, clinical psychologists, nurse practitioners, physician assistants, or clinical nurse specialists to furnish therapeutic services to PHP patients, the physician or practitioner may bill the Part B carrier for payment under the physician fee schedule for their professional services. When this occurs, the PHP provider may bill the FI under the OPPS for the facility resources associated with the psychotherapy service.

We note that a physician or any of the practitioners specified in 42 CFR 410.43(b) (including CSWs) may bill the Part B carrier for their professional services furnished to hospital outpatients who are not in a PHP. In this case, the hospital would bill the FI under the OPPS for the facility resources associated with the service furnished.

Comment: Several commenters suggested alternative methodologies for paying PHP providers, such as linking per diem and outlier payments to the units of service furnished each day or paying providers the average of all PHP costs plus 40 percent, subject to final settlement based on the provider's cost.

Response: We plan further analysis of the PHP data and may propose changes to the payment methodology for CY 2005. We note that OPPS is a prospective system and a methodology with interim payments subject to cost settlement would not be allowable under the statute.

Comment: One commenter believes the sample used to determine the rates is skewed and represents a subset of the provider community that provides PHP services.

Response: We do not agree that the sample is skewed. All facilities that submit claims for PHP services have been included in the development of the final rate. 3. Outlier Payments for PHPs

In a related matter, the use of historical cost-to-charge ratios applied to current charges has resulted in an excessive amount of outlier payments being made to CMHCs. As a result of more in-depth analysis of the 2001 data files that were used to compute the CY 2003 PHP per diem amount, we discovered a significant difference in the amount of outlier payments made to hospitals and CMHCs for PHP.

In the August 12, 2003 proposed rule, we stated that given the difference in PHP charges between hospitals and CMHCs, we did not believe it was appropriate to make outlier payments to CMHCs using the outlier percentage target amount and threshold established for hospitals. Therefore, we proposed to designate a portion of the estimated 2.0 percent outlier target amount specifically for CMHCs, consistent with the percentage of projected payments to CMHCs under the OPPS in CY 2004, excluding outlier payments. Since CMHCs were projected to receive 0.36 percent of total OPPS payments in CY 2004, excluding outlier payments, we proposed to designate 0.36 percent of the estimated 2.0 percent outlier target amount for CMHCs and establish a threshold to achieve that level of outlier payments. Based on our simulations of CMHC payments in 2004, we proposed to set the threshold for CY 2004 at 11.75 times the PHP APC payment amount. We proposed to apply the same outlier payment percentage that applies to hospitals. Therefore, for CY 2004, we

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proposed to pay 50 percent of CMHC and hospital per diem costs over the threshold.

Comment: Several commenters representing CMHCs suggested that in developing our proposed outlier policy, we made generalizations and overreacted to a few aberrant providers. Also, these commenters believe the per diem amount is insufficient and that outlier payments would provide the additional amounts they needed to stay in business until more representative data could be obtained and analyzed.

Response: Based on our analysis of PHP claims data, nearly half of the CMHCs billing for PHP services in 2002 received outlier payments. The total dollar amount of outlier payments received by these CMHCs was nearly equal to the total amount all CMHCs received in per diem payments. Of those CMHCs that received outlier payments, 56 percent received an average of more than $200 per day in outlier payments, 30 percent received more than $300 per day in outlier payments, 21 percent received more than $400 per day in outlier payments, and 11 percent received more than $500 per day in outlier payments.

The outlier policy is intended to compensate providers for treating exceptionally resource-intensive patients. Outlier payments were never intended to be made for all patients and used as a supplement to the per diem payment amount. Our analysis showed that the CMHC average charge per day increased by 31 percent from CY 2001 to CY 2002. We do not believe this increase in charges correlates to an equivalent increase in CMHC costs. Rather, our analysis indicates that the increase in charges was made in order to qualify for outlier payments to cover CMHC operating expenses, not for patients who are exceptionally resource-intensive. We are concerned that if CMHCs continue this pattern of escalating charges, CMHCs will receive a disproportionate share of outlier payments compared to non-CMHCs that do not artificially inflate their charges, thereby limiting outlier money for truly deserving cases.

Comment: Although one commenter supported our proposed outlier policy, most commenters, including major hospital associations, did not believe it was sound policy to create separate outlier thresholds based on site of service.

Response: Applying the updated cost-to-charge ratios reduced the CMHC charges to better reflect their costs. We are concerned, however, that the impact of updated cost-to-charge ratios may be mitigated by future increases in charges. We proposed an outlier policy in consideration of the charges on the claims, the cost report data available, and the payments made to CMHCs. Our analysis indicates that CMHCs have dramatically increased their charges between CY 2001 and CY 2002. Between CYs 2001 to 2002, CMHC average per diem charges increased by 31 percent. We believe that in most cases, these increases in charges were not related to a corresponding increase in costs, but rather were designed to enhance outlier payments. We believe the data may indicate a pattern of artificially inflated charges by CMHCs that needs to be addressed. Although we agree that establishing site of service differences is not generally the preferred approach, we continue to believe that establishing two separate outlier percentages is the most appropriate way to address the problem to account for the disparity between hospital and CMHC PHP per diem charges.

For these reasons, for CY 2004, we are establishing a separate CMHC threshold. The threshold is based on the proportion of total OPPS payments CMHCs are estimated to receive in CY 2004. As stated earlier in this section, our analysis indicated that CMHCs were projected to receive 0.36 percent of total OPPS payments in CY 2004, excluding outlier payments. Therefore, we proposed to designate 0.36 percent of the estimated 2.0 percent outlier target amount for CMHCs and establish a threshold to achieve that level of outlier payments. Based on our simulations of CMHC payments in 2004, we proposed to set the threshold for CY 2004 at 11.75 times the PHP APC payment amount. We have updated our simulations using the final CY 2004 PHP per diem rate. CMHCs are now projected to receive approximately 0.5 percent of estimated total OPPS payments in CY 2004, excluding outlier payments. We have calculated the CMHC outlier threshold to achieve that level of payment. The resulting threshold for CY 2004 is 3.65 percent times the APC 0033 payment amount. We will apply the same outlier payment percentage that applies to hospitals. Therefore, for CY 2004, we will pay 50 percent of the difference between CMHC per diem costs and the CMHC outlier threshold amount. We intend to analyze whether a separate CMHC outlier threshold will continue to be appropriate in future updates.

XII. General Data, Billing, and Coding Issues

We received a number of general comments about OPPS data and related issues to which we respond below. Not all coding questions are addressed, however. We do not believe that the final rule is the appropriate venue in which to address specific inquiries about billing.

OPPS Data

Comment: A commenter indicated that it was difficult to model the August 12, 2003 proposed rule after its release and urged us to provide timely responses to questions about data, data files, and the specifics of the methodology used to generate relative weights, either by having data meetings or by clarifying the language in the final rule and median cost files. The commenter asked that we create a web-site to post responses to questions on data so that the information will be available for all to use. The commenter also asked that a number of data elements be added to the median cost file and the limited data set of claims that is available for public purchase.

Response: We have tried to respond to questions on data related issues on a flow basis. However, staff limitations and the need to develop the final rule greatly restrict the amount of time that our staff can devote to replying to these questions. Moreover, creation and maintenance of a web-site to post answers to questions from a few people with special interests is not a good use of our limited staff resources. We would encourage interested parties who have suggestions for improving our data file clarity to contact us with those specifics.

Creation of a National Outpatient Coding Governing Body

Comment: A commenter indicated that we should create an outpatient coding governing body that would educate providers regarding the correct use of codes, maintain a web-site on which all guidance on coding would be maintained, and oversee the Medicare fiscal intermediary interpretation of codes to ensure national uniformity across fiscal intermediaries.

Response: The HCPCS codes most often used for payment under OPPS are CPT codes, which are created and owned by the American Medical Association (AMA). Providers should look to the many resources available from the AMA for education regarding the correct use of CPT codes. The alphanumeric HCPCS codes are created and owned by us but they form a very limited portion of the services payable under OPPS and, as providers have frequently asked, we attempt to eliminate alphanumeric codes whenever possible and to work with the AMA to create CPT codes for use in both the physician fee schedule and the OPPS.

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We attempt to provide coding guidance on alphanumeric codes, which are usually created only when there is a coverage or payment decision and when there is no CPT code that describes the service being covered or paid. However, providers must look to the AMA for education and support in the use of the CPT codes that form the bulk of OPPS.

Comment: We received one comment requesting that we publish updated addenda each quarter.

Response: The addenda that are published annually online are an official public record that cannot be changed without going through the Federal Register. We provide the Addenda in Excel format for the convenience of users since it is difficult to manipulate data in pdf format.

We also received a number of comments that were not relevant to the proposals made in the August 12, 2003 proposed rule. The commenters requested specific coding changes and requested clarification or guidance regarding certain billing requirements. Although we will provide answers to the questions raised, the final rule is not the appropriate venue for that guidance. We will consider the requests and suggestions provided, and will continue our ongoing efforts to formulate and publish billing instructions. Similarly, we will consult with our clinical experts regarding the suggestions made regarding coding of outpatient department procedures and other services.

Revenue Code Edits

Comment: A commenter asked whether we permit fiscal intermediaries to impose CPT to revenue code edits. The commenter believes that CMS has said that providers may choose the revenue code that applies to the item or service being billed but that some fiscal intermediaries have imposed revenue code to CPT edits that prevent hospitals from billing the service under the revenue code that they believe is appropriate and that cause unnecessary and unfair payment denials.

Response: We have issued some instructions that require that specific revenue codes be billed with certain HCPCS codes, such as specific revenues codes that must be used when billing for devices that qualify for pass-through payments. Where explicit instructions have not been issued, we instructed intermediaries to advise hospitals to report charges under the revenue code that will result in the charges being assigned to the same cost center to which the cost of those services are assigned in the cost report. However, we have not explicitly prohibited intermediaries from installing the revenue code to HCPCS code edits, so it is possible that certain edits are applied by some intermediaries and not others. The commenter did not provide examples of the edits that are causing what the commenter considers to be unnecessary and unfair payment denials.

New CPT Venous Access Codes

Comment: A commenter indicated that CPT had revised its venous access codes and encouraged us to use external information to determine hospital acquisition costs for devices used in these procedures.

Response: We carefully reviewed the new CPT codes for insertion of venous access devices and we assigned the new CPT codes to APCs based on our clinicians' view of the relative amount of hospital resources that the services, as described by the new codes, would use. We note that the new CPT codes represent longstanding services, albeit with new code descriptions and code numbers. Since these are new CPT codes (albeit for existing services), the APC and status indicator assignments are interim and subject to comment.

New ``NI'' Drug Codes

There are several new HCPCS codes for drugs, biologicals, and radiopharmaceuticals that are new for 2004. Since these codes were not subject to public comment in the August 12, 2003 proposed rule, they have been assigned to code condition ``NI'' and are subject to public comments following the publication of this rule. Some of these new codes for drugs and radiopharmaceuticals are replacements for codes for which we have hospital cost data. In these cases, we cross-walked the data for the expired codes to the new codes to determine their packaging status and payment rates. For codes that did not have a predecessor, we had no means to determine associated hospital costs; therefore, we assigned the codes to packaged status for 2004. We reinforce the importance of billing for packaged codes with appropriate charges so that we can collect cost data on these codes to use for future rate setting. We invite comments on the status indicators that have been assigned to these codes. Commenters who would like us to consider their cost data for these codes may submit verifiable external information according to the criteria set forth in the August 12, 2003 proposed rule.

Status Indicator Changes for Services Currently Packaged

Comment: A commenter asked us to pay separately for the following services for which payment is currently packaged into payment for other services. Commenters asked that we change the SI for CPT code 36540, collection of blood from an implanted access device, to a payable SI because otherwise hospitals would be forced to bill an E&M code when this is the only service provided. Commenters asked that we change the SI for 36600, withdrawal of arterial blood, from an ``N'' to a ``T'' since it requires more effort and risk than a simple venipuncture (which is paid separately under the clinical laboratory fee schedule). Commenters asked that we change the SI for 90471 and 90472, vaccine administration and each subsequent administration, from N to X since patients may present only to receive the vaccine because otherwise hospitals must bill an E&M to receive any payment. Commenters asked that we change the SI for CPT codes 94760, 94761, and 94762, Pulse oximetry, multiple and continuous, from ``N'' to ``X'' because these may be the only services the patient receives and, in the case of CPT code 94762, the service continues for a long period of time. Commenters also asked that we change the SI for the following services from ``N'' to ``C'' since they are add-ons to services that are inpatient only: 61316, 61517, 62148, and 62160.

Response: We will carefully consider the status indicator changes for the currently packaged services for which the commenter wants separate payment for 2005 OPPS. The commenters did not provide enough information or empirical evidence to convince us of the need for these changes and so we would like to have the opportunity to receive input about this from the APC Panel. We have revised the SI for the following codes from ``N'' to a ``C'' in recognition that if there are charges for these codes which are add-ons to inpatient only procedures, they are billing errors and should not be packaged into the median costs for other procedures on the claim that can be paid in the outpatient department: 61316, 61517, 62148, and 62160.

XIII. Provisions of the Final Rule With Comment Period for 2004

A. Changes Required By Statute

We made the following changes to implement statutory requirements:

[sbull] Added APCs, deleted APCs, and modified the composition of some existing APCs.

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[sbull] Recalibrated the relative payment weights of the APCs.

[sbull] Updated the conversion factor and the wage index.

[sbull] Revised the APC payment amounts to reflect the APC reclassifications, the recalibration of payment weights, and the other required updates and adjustments.

[sbull] Ceased transitional pass-through payments for drugs and biologicals and devices that will have been paid under the transitional pass-through methodology for at least 2 years by January 1, 2004.

[sbull] Ceased transitional outpatient payments (TOPS payments) for all hospitals paid under OPPS except for cancer hospitals and children's hospitals.

B. Additional Changes

We made the following additional changes to the OPPS:

[sbull] Adjusted payment to moderate the effects of decreased median costs for non-pass-through drugs, biologicals, and radiopharmaceuticals.

[sbull] Changed status indicators for HCPCS codes.

[sbull] Listed midyear and proposed HCPCS codes that are paid under OPPS.

[sbull] Allocated a portion of the outlier percentage target amount to CMHCs and created a separate threshold for outlier payments for partial hospitalization services.

[sbull] Created methodology and payment rates for separately payable drugs and radiopharmaceuticals for 2004.

[sbull] Changed the status indicator and payment amount for P901 by assigning it to APC 0957 (Platelet concentrate) with a payment rate of $37.30.

C. Major Changes From the Proposed Rule

[sbull] We will apply a $50 threshold in lieu of the proposed $150 threshold in determining which drugs to pay for separately.

[sbull] We will set payment for all except two orphan drugs that meet our criteria for special payment under the OPPS at 88 percent of their AWP as established in the April 2003 single drug pricer (SDP). Based on widely available market prices for two orphan drugs, we will set the payment for these two orphan drugs at 94 percent of their AWP.

[sbull] We will set payment rates for 2004 for blood and blood products at 2003 payment rates.

XIV. Collection of Information Requirements

Under the Paperwork Reduction Act of 1995, we are required to provide 60-day notice in the Federal Register and solicit public comment before a collection of information requirement is submitted to the Office of Management and Budget (OMB) for review and approval. In order to fairly evaluate whether an information collection should be approved by OMB, section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995 requires that we solicit comment on the following issues:

[sbull] The need for the information collection and its usefulness in carrying out the proper functions of our agency.

[sbull] The accuracy of our estimate of the information collection burden.

[sbull] The quality, utility, and clarity of the information to be collected.

[sbull] Recommendations to minimize the information collection burden on the affected public, including automated collection techniques.

The OPPS provisions set forth in this final rule do not impose information collection and recordkeeping requirements. Consequently, it need not be reviewed by the Office of Management and Budget under the authority of the Paperwork Reduction Act of 1995.

XV. Response to Public Comments

Because of the large number of items of correspondence we normally receive on Federal Register documents, we are not able to acknowledge or respond to them individually. We will consider all comments we receive by the date and time specified in the DATES section of this preamble, and, if we proceed with a subsequent document, we will respond to comments in the preamble to that document.

XVI. Regulatory Impact Analysis

A. General

We have examined the impacts of this final rule as required by Executive Order 12866 (September 1993, Regulatory Planning and Review), the Regulatory Flexibility Act (RFA) (September 16, 1980, Pub. L. 96- 354), section 1102(b) of the Social Security Act, the Unfunded Mandates Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132.

Executive Order 12866 (as amended by Executive Order 13258, which merely reassigns responsibility of duties) directs agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). A regulatory impact analysis (RIA) must be prepared for major rules with economically significant effects ($100 million or more in any 1 year).

We estimate the effects of the provisions that will be implemented by this final rule will result in expenditures exceeding $100 million in any 1 year. We estimate the total increase (from changes in the final rule as well as enrollment, utilization, and case mix changes) in expenditures under the OPPS for CY 2004 compared to CY 2003 to be approximately $0.607 billion. Therefore, this final rule is an economically significant rule under Executive Order 12866, and a major rule under 5 U.S.C. 804(2).

The RFA requires agencies to determine whether a rule will have a significant economic impact on a substantial number of small entities. For purposes of the RFA, small entities include small businesses, nonprofit organizations, and government agencies. Most hospitals and most other providers and suppliers are small entities, either by nonprofit status or by having revenues of $6 million to $29 million in any 1 year (see 65 FR 69432).

For purposes of the RFA, we have determined that approximately 37 percent of hospitals will be considered small entities according to the Small Business Administration (SBA) size standards. We do not have data available to calculate the percentages of entities in the pharmaceutical preparation manufacturing, biological products, or medical instrument industries that will be considered to be small entities according to the SBA size standards. For the pharmaceutical preparation manufacturing industry (NAICS 325412), the size standard is 750 or fewer employees and $67.6 billion in annual sales (1997 business census). For biological products (except diagnostic) (NAICS 325414), with $5.7 billion in annual sales, and medical instruments (NAICS 339112), with $18.5 billion in annual sales, the standard is 50 or fewer employees (see the standards Web site at http://www.sba.gov/regulations/siccodes/ ). Individuals and States are not included in the definition of a small entity.

In addition, section 1102(b) of the Act requires us to prepare a regulatory impact analysis if a rule may have a significant impact on the operations of a substantial number of small rural hospitals. This analysis must conform to the provisions of section 603 of the RFA. With the exception of hospitals located in certain New England counties, for purposes of section 1102(b) of the Act, we define a small rural hospital as a hospital that is located outside of a Metropolitan Statistical Area (MSA) and has fewer than 100

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beds (or New England County Metropolitan Area (NECMA)). Section 601(g) of the Social Security Amendments of 1983 (Pub. L. 98-21) designated hospitals in certain New England counties as belonging to the adjacent NECMA. Thus, for purposes of the OPPS, we classify these hospitals as urban hospitals. We believe that the changes in this final rule will affect both a substantial number of rural hospitals as well as other classes of hospitals and that the effects on some may be significant. Therefore, we conclude that this final rule will have a significant impact on a substantial number of small entities. Unfunded Mandates

Section 202 of the Unfunded Mandates Reform Act of 1995 (Pub. L. 104-4) also requires that agencies assess anticipated costs and benefits before issuing any rule that may result in an expenditure in any 1 year by State, local, or tribal governments, in the aggregate, or by the private sector, of $110 million. This final rule will not mandate any requirements for State, local, or tribal governments. This final rule will not impose unfunded mandates on the private sector of more than $110 million dollars. Federalism

Executive Order 13132 establishes certain requirements that an agency must meet when it publishes a final rule that imposes substantial direct costs on State and local governments, preempts State law, or otherwise has Federalism implications.

We have examined this final rule in accordance with Executive Order 13132, Federalism, and have determined that it will not have an impact on the rights, roles, and responsibilities of State, local or tribal governments. The impact analysis (see Table 15) shows that payments to governmental hospitals (including State, local, and tribal governmental hospitals) will increase by 4.9 percent under the final rule.

B. Changes in This Final Rule

We are making several changes to the OPPS that are required by the statute. We are required under section 1833(t)(3)(C)(ii) of the Act to update annually the conversion factor used to determine the APC payment rates. We are also required under section 1833(t)(9)(A) of the Act to revise, not less often than annually, the wage index and other adjustments. In addition, we must review the clinical integrity of payment groups and weights at least annually. Accordingly, in this final rule, we are updating the conversion factor and the wage index adjustment for hospital outpatient services furnished beginning January 1, 2004 as we discuss in sections IX and VII, respectively, of this final rule. We are also revising the relative APC payment weights based on claims data from April 1, 2002 through December 31, 2002. Finally, we are removing two devices and eight drugs and biological agents from pass-through payment status. Alternatives to the changes we proposed and why we did not accept them are discussed throughout this final rule. In particular, see section V.B with regard to the expiration of pass-through payment for devices; see section VI.B with regard to the expiration of pass-through payment for drugs and biological agents.

Under this final rule, the change to the conversion factor as provided by statute will increase total OPPS payments by 4.5 percent in 2004. The changes to the wage index and to the APC weights (which incorporate the cessation of pass-through payments for many drugs and devices) will not increase OPPS payments because the OPPS is budget neutral. However, the wage index and APC weight changes will change the distribution of payments within the budget neutral system as shown in Table 15 and described in more detail in this section. The overall 4.5 percent increase does not take into account the expiration of transitional corridor payments or the end of the hold harmless provisions for small rural hospitals.

A. Alternatives Considered

Alternatives to the changes we are making and the reasons that we have chosen the options we have are discussed throughout this final rule. Some of the major issues discussed in this rule and the sections in which they are discussed follow:

Issue

Preamble section

Drug packaging threshold.................. VI.B.2. Drug administration....................... VI.B.4. Adjustment of median costs................ II.B. Outlier policy............................ X.A. Device coding............................. V.C. Payment adjustment for small rural

X.B. hospitals. Payment for orphan drugs, generic drugs VI.B. and blood. APC changes............................... II.A and III.C.

Conclusion

It is clear that the changes in this final rule will affect both a substantial number of rural hospitals as well as other classes of hospitals, and the effects on some may be significant. Therefore, the discussion below, in combination with the rest of this final rule, constitutes a regulatory impact analysis.

The OPPS rates for CY 2004 will have, overall, a positive effect for every category of hospital. These changes in the OPPS for 2004 will result in an overall 4.5 percent increase in Medicare payments to hospitals, exclusive of outlier and transitional pass-through payments. We also noted that both the overall 4.5 percent increase and the percent changes to individual classes of hospitals depicted in Table 15 are exclusive of any impacts to those hospitals that would result from the expiration of the transitional corridor payments or the end of the hold harmless provision for small rural hospitals. As described in the preamble, budget neutrality adjustments are made to the conversion factor and the relative weights to ensure that the revisions in the wage index, APC groups, and relative weights do not affect aggregate payments. We also note that both the overall 4.5 percent increase and the percent changes to individual classes of hospitals depicted in Table 15 are exclusive of any impacts to those hospitals that would result from the expiration of the transitional corridor payments or the end of the hold harmless provision for small rural hospitals. The impact of the wage and recalibration changes does vary somewhat by hospital group. Estimates of these impacts are displayed on Table 15.

The overall projected increase in payments for urban hospitals is slightly lower (4.3 percent) than the average increase for all hospitals (4.5 percent) while the increase for rural hospitals is slightly greater (4.9 percent) than the average increase. Again, as noted above, these numbers do not include the effect of the expiration of the transitional hold harmless payments to small rural hospitals. The introduction of a new wage index combined with changes to the APC structure will result in small distributional changes for all categories of hospitals. Rural hospitals will gain 0.2 percent from the wage index change and another 0.2 percent as a result of APC changes. Large urban hospitals will lose 0.2 percent from the APC change, whereas ``other'' urban hospitals show an increase of 0.1 percent from the APC changes. A discussion of the distribution of outlier payments that we project under this final rule can be found under section XV.E below. Table 16 presents the outlier distribution that we expect to see under this final rule.

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C. Limitations of Our Analysis

The distributional impacts represent the projected effects of the policy changes, as well as statutory changes effective for 2004, on various hospital groups. We estimate the effects of individual policy changes by estimating payments per service while holding all other payment policies constant. We use the best data available but do not attempt to predict behavioral responses to our policy changes. In addition, we do not make adjustments for future changes in variables such as service volume, service mix, or number of encounters.

D. Estimated Impacts of This Final Rule on Hospitals

The OPPS is a budget neutral payment system under which the increase to the total payments made under OPPS is limited by the increase to the conversion factor set under the methodology in the statute. The impact tables show the redistribution of hospital payments among providers as a result of a new wage index and APC structure. In some cases, under this final rule, hospitals will receive more total payment than in 2003 while in other cases they will receive less total payment than they received in 2003. The impact of this final rule will depend on a number of factors, most significant of which are the mix of services furnished by a hospital (for example, how the APCs for the hospital's most frequently furnished services will change) and the impact of the wage index changes on the hospital.

Column 4 in Table 15 represents the full impact on each hospital group of all the changes for 2004. Columns 2 and 3 in the table reflect the independent effects of the final change in the wage index and the APC reclassification and recalibration changes, respectively. We excluded critical access hospitals (CAHs) from the analysis of the impact of the final 2004 OPPS rates that is summarized in Table 15. For that reason, the total number of hospitals included in Table 15 (4,378) is lower than in previous years. CAHs are excluded from the OPPS.

To a very limited extent, wage index changes favor rural hospital categories. Large urban hospitals with greater than 500 beds show the largest percent decrease (-3.0) attributable to wage index changes. Rural hospitals show modest increases of 0.2 percent for most bed sizes but show the largest gains for categories with fewer than 50 beds or 150 to 199 beds where the wage index change results in a 0.4 percent increase. Rural hospitals located in Puerto Rico show the largest negative impact (-2.5 percent) due to changes in the wage index. Hospitals located in the Middle Atlantic region also experience a large negative impact -0.6 percent due to wage index changes regardless of urban or rural designation. However, this effect is somewhat lessened by the distribution of outlier payments as discussed in more detail below.

The APC reclassification and recalibration changes also favor rural hospitals with the exception of rural hospitals with 200 or more beds that show a negative effect (-0.8 percent). Conversely, urban hospitals with greater than 199 beds show a decrease attributed to APC recalibration. Urban hospitals in excess of 500 beds show a 0.5 percent decrease as a result of APC recalibration. In general, APC changes are small and result in very few distributional changes among hospital categories.

In both urban and rural areas, hospitals that provide a lower volume of outpatient services are projected to receive a larger increase in payments than higher volume hospitals. In rural areas, hospitals with volumes between 5,000 and 20,999 are projected to experience increases larger than 5.0 percent. Urban hospitals that provide low-volume services show similar rates of increases (5.0 percent). Conversely, urban and rural hospitals providing more than 21,000 services are projected to experience a rate of increase in the 4.0 to 4.7 percent range.

Major teaching hospitals are projected to experience a smaller increase in payments (3.7 percent) than the aggregate for all hospitals (4.5 percent) due to negative impacts from both the wage index (-0.4 percent) and APC recalibration (-0.4 percent). Hospitals with less intensive teaching programs are projected to experience an overall increase (4.5 percent) that is equal to the average for all hospitals. There is little difference in impact among hospitals that serve low- income patients where increases in payments range from 4.3 to 4.7 percent higher than in 2003.

Psychiatric hospitals and long term care facilities show the largest increase in payment rates among all categories of hospital providers. Psychiatric hospitals show an increase of 18.2 percent as a result of an increase in payment rates for partial hospitalization programs and for other services such as psychotherapy. Also, payments made to psychiatric facilities represent a small portion of total spending for OPPS, approximately 60.6 million dollars for 2004. Long- term care facilities show a growth rate of 7.5 percent over payments made in 2003. We believe this is the result of a policy change that removes payments made for therapy services from the physician fee schedule to the hospital outpatient prospective payment system. Payments made for long-term care account for a small amount of OPPS payments, approximately 14.5 million for 2004.

Table 15.--Impact of Change for CY 2004 Hospital Outpatient Prospective Payment System

[Percent change in total payments to hospital (program and beneficiary); does not include hold harmless, corridor, outlier or transitional pass-through payments]

Number of hospitals New Wage APC changes All CY 2004 (1) index (2) (3) changes (4)

ALL HOSPITALS...............................................

4,378

0

0

4.5 NON-TEFRA HOSPITALS.........................................

3,854

0

-0.1

4.4 URBAN HOSPS.................................................

2,383

-0.1

-0.1

4.3 LARGE URBAN (GT 1 MILL.)....................................

1,377

0

-0.2

4.2 OTHER URBAN (LE 1 MILL.)....................................

1,006

-0.1

0.1

4.4 RURAL HOSPS.................................................

1,471

0.2

0.2

4.9 BEDS (URBAN)

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

538

0.1

0.6

5.2

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

878

-0.1

0.3

4.8

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

454

-0.1

-0.1

4.3

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

363

0.1

-0.4

4.2

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

150

-0.3

-0.5

3.7 BEDS (RURAL)

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

699

0.4

0.6

5.6

[[Page 63475]]

50-99 BEDS..............................................

454

0.2

0.6

5.3

100-149 BEDS............................................

190

0.2

0

4.7

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

66

0.4

0.1

4.9

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

62

0.1

-0.8

3.7 VOLUME (URBAN)

LT 5,000 Lines..........................................

186

0.1

1

5.6

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

350

0

0.9

5.4

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

499

-0.1

0.7

5.1

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

720

0.1

0.1

4.6

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

628

-0.1

-0.4

4 VOLUME (RURAL)

LT 5,000 Lines..........................................

364

0.3

0

4.8

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

466

0.3

0.5

5.3

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

346

0.2

0.7

5.4

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

234

0.3

0

4.7

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

61

0.1

-0.4

4.2 REGION (URBAN)

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

128

-0.3

-0.3

3.9

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

369

-0.6

-0.5

3.4

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

353

0

0

4.5

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

400

-0.2

-0.2

4

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

149

0.3

0.2

5

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

163

0.2

0.5

5.1

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

295

0.1

0.1

4.7

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

122

0.8

0

5.3

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

364

0.3

-0.2

4.6

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

40

0

4.8

9.5 REGION (RURAL)

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

36

0.4

1.7

6.7

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

65

-0.6

0.9

4.9

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

216

0.1

0

4.6

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

193

0.2

0

4.7

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

227

0.2

-0.2

4.5

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

247

0.8

0.5

5.8

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

269

0.4

0.2

5.2

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

123

0.2

-0.1

4.6

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

90

0.4

-0.9

3.9

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

5

-2.5

0.3

2.2 TEACHING STATUS

NON-TEACHING............................................

2,805

0.1

0.1

4.7

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

761

0.1

-0.1

4.5

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

288

-0.4

-0.4

3.7 DSH PATIENT (PERCENT)

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

10

3

3.8

11.6

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

897

0

-0.2

4.3

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

837

-0.1

0

4.4

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

787

0.1

-0.2

4.3

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

744

0

0.1

4.5

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

579

-0.1

0.2

4.7 URBAN IME/DSH

IME & DSH...............................................

965

-0.1

-0.2

4.1

IME/NO DSH..............................................

1

-0.1

8.5

13.3

NO IME/DSH..............................................

1,409

0

0.1

4.6

NO IME/NO DSH...........................................

8

3

3.7

11.6 RURAL HOSP. TYPES

NO SPECIAL STATUS.......................................

469

0.1

0.2

4.9

RRC.....................................................

161

0.3

-0.5

4.3

SCH/EACH................................................

489

0.3

0.5

5.4

MDH.....................................................

250

0.3

1.6

6.5

SCH AND RRC.............................................

75

0.1

-0.3

4.3 TYPE OF OWNERSHIP

VOLUNTARY...............................................

2,370

-0.1

-0.2

4.2

PROPRIETARY.............................................

696

0.2

0.5

5.2

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

788

0.2

0.3

4.9 SPECIALTY HOSPITALS

EYE AND EAR.............................................

13

-0.6

1.8

5.7

CANCER..................................................

11

0

-1.2

3.2 TEFRA HOSPITALS (NOT INCLUDED ON OTHER LINES)

REHAB...................................................

155

0.5

-1.1

3.9

[[Page 63476]]

PSYCH...................................................

175

0.8

12.2

18.2

LTC.....................................................

150

1.6

1.2

7.5

CHILDREN................................................

44

0

0.5

4.9

1. Some data necessary to classify hospitals by category were missing; thus, the total number of hospitals in each category may not equal the national total. 2. This column shows the impact of updating the wage index used to calculate payment by applying the FY 2004 hospital inpatient wage index after geographic reclassification by the Medicare Geographic Classification Review Board. The appropriate hospital inpatient wage index appears in a correction notice published in the Federal Register on October 6, 2003 68FR 57732. 3. This column shows the impact of changes resulting from the reclassification of HCPCS codes among APC groups and the recalibration of APC weights based on 2002 hospital claims data. 4. This column shows changes in total payment from CY 2003 to CY 2004, excluding outlier and pass-through payments. It incorporates all of the changes reflected in columns 2 and 3. In addition, it shows the impact of the FY 2004 payment update. The sum of the columns may be different from the percentage changes shown here due to rounding. 5. Volume is expressed in terms of the number of lines that appear on a claim.

E. Projected Distribution of Outlier Payments

As stated elsewhere in this preamble, we have allocated 2 percent of the estimated 2004 expenditures to outlier payments. Table 16 below illustrates the percentage of outlier payments relative to the total projected payments for the categories of hospitals that we show in the impact table.

We project, based on the mix of services for the hospitals that will be paid under the OPPS in 2004, that approximately 95 percent of hospitals will receive outlier payments. For the majority of provider groups, the table shows outlier payments as a percent of total payments in the 1.5 to 3.5 percent range. Two categories, Rehabilitation and Children's hospitals are the exception with outlier to total payment ratios of 6.7 and 11.9 percent respectively. We would point out that these hospital types represent a small number of providers with a low volume of services. The anticipated outlier payments for urban hospitals can be expected to ameliorate the impact of the wage index and APC changes on payments to urban hospitals.

Table 16.--Distribution of Outlier Payments for CY 2004 Hospital Outpatient Prospective Payment

Outlier Number of payments as Number of Percent of hospitals a percent hospitals total

with of total hospitals outliers payments (percent)

ALL HOSPITALS...............................................

4,378

100

4,144

2.0 NON-TEFRA HOSPITALS.........................................

3,854

88

3,841

2.0 URBAN HOSPS.................................................

2,383

54.4

2,372

2.1 LARGE URBAN (GT 1 MILL.)....................................

1,377

31.4

1,371

2.3 OTHER URBAN (LE 1 MILL.)....................................

1,006

23

1,001

1.8 RURAL HOSPS.................................................

1,471

33.6

1,469

1.7 BEDS (URBAN)

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

538

12.2

529

2.5

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

878

20

877

1.8

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

454

10.4

453

1.9

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

363

8.2

363

2.1

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

150

3.4

150

2.6 BEDS (RURAL)

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

699

16

698

2.3

50-99 BEDS..............................................

454

10.4

453

1.9

100-149 BEDS............................................

190

4.4

190

1.4

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

66

1.6

66

1.7

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

62

1.4

62

1.4 VOLUME (URBAN)

LT 5,000................................................

186

4.2

175

3.2

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

350

8

350

3.0

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

499

11.4

499

2.1

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

720

16.4

720

2.0

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

628

14.4

628

2.1 VOLUME (RURAL)

LT 5,000................................................

364

8.4

362

3.1

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

466

10.6

466

2.2

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

346

8

346

1.8

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

234

5.4

234

1.5

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

61

1.4

61

1.5 REGION (URBAN)

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

128

3

127

1.8

[[Page 63477]]

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

369

8.4

369

3.1

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

353

8

353

1.9

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

400

9.2

396

1.9

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

149

3.4

148

1.4

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

163

3.8

163

1.6

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

295

6.8

295

2.4

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

122

2.8

120

1.9

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

364

8.4

361

2.0

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

40

1

40

0.6 REGION (RURAL)

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

36

0.8

36

2.2

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

65

1.4

65

1.6

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

216

5

215

1.6

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

193

4.4

193

1.6

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

227

5.2

227

1.2

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

247

5.6

246

1.8

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

269

6.2

269

1.8

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

123

2.8

123

2.8

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

90

2

90

2.4

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

5

0.2

5

1.0 TEACHING STATUS

NON-TEACHING............................................

2,805

64

2,793

1.8

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

761

17.4

760

1.7

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

288

6.6

288

3.0 DSH PATIENT (PERCENT)

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

10

0.2

8

3.5

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

897

20.4

892

1.9

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

837

19.2

837

1.8

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

787

18

787

1.7

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

744

17

741

2.3

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

579

13.2

576

2.9 URBAN IME/DSH

IME & DSH...............................................

965

22

965

2.3

IME/NO DSH..............................................

1

0

0

0.0

NO IME/DSH..............................................

1,409

32.2

1,400

1.8

NO IME/NO DSH...........................................

8

0.2

7

3.5 RURAL HOSP. TYPES

NO SPECIAL STATUS.......................................

469

10.8

467

1.8

RRC.....................................................

161

3.6

161

1.4

SCH/EACH................................................

489

11.2

489

2.1

MDH.....................................................

250

5.8

250

2.0

SCH AND RRC.............................................

75

1.8

75

1.5 TYPE OF OWNERSHIP

VOLUNTARY...............................................

2,370

54.2

2,366

1.9

PROPRIETARY.............................................

696

15.8

689

2.0

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

788

18

786

2.5 SPECIALTY HOSPITALS

EYE AND EAR.............................................

13

0.2

13

2.7

CANCER..................................................

11

0.2

11

3.9 TEFRA HOSPITALS (NOT INCLUDED ON OTHER LINES)

REHAB...................................................

155

3.6

103

6.7

PSYCH...................................................

175

4

59

0.5

LTC.....................................................

150

3.4

98

2.5

CHILDREN................................................

44

1

43

11.9

F. Estimated Impacts of This Final Rule on Beneficiaries

For services for which the beneficiary pays a coinsurance of 20 percent of the payment rate, the beneficiary share of payment will increase for services for which OPPS payments will rise and will decrease for services for which OPPS payments will fall. For example, for a mid-level office visit (APC 0601), the minimum unadjusted co- payment in 2003 was $10.11; under this final rule, the minimum unadjusted co-payment for APC 601 will be $10.71 because the OPPS payment for the service will increase under this final rule. For some services (those services for which a national unadjusted co-payment amount is shown in Addendum B) the beneficiary co-payment is frozen based on historic data and will not change, and will therefore present no potential impact on beneficiaries.

[[Page 63478]]

However, in all cases, the statute limits beneficiary liability for co-payment for a service to the inpatient hospital deductible for the applicable year. This amount is $876 for 2004. In general, the impact of this final rule on beneficiaries will vary based on the service the beneficiary receives and whether the co-payment for the service is one that is frozen under the OPPS.

In accordance with the provisions of Executive Order 12866, this regulation was reviewed by the Office of Management and Budget.

(Catalog of Federal Domestic Assistance Program No. 93.773, Medicare--Hospital Insurance; and Program No. 93.774, Medicare-- Supplementary Medical Insurance Program)

Dated: October 27, 2003. Thomas A. Scully, Administrator, Centers for Medicare & Medicaid Services.

Approved: October 29, 2003. Tommy G. Thompson, Secretary.

Addendum A.--List of Ambulatory Payment Classifications (APCs) with Status Indicators, Relative Weights, Payment Rates, and Copayment Amounts Calendar Year 2004

National Minimum APC

Group title

Status indicator Relative Payment unadjusted unadjusted weight rate copayment copayment

0001............ Level I

S................... 0.4237 $23.12

$7.09

$4.62 Photochemotherapy. 0002............ Level I Fine Needle T................... 0.8083 $44.10 ............

$8.82 Biopsy/Aspiration. 0003............ Bone Marrow Biopsy/ T................... 2.3229 $126.74 ............

$25.35 Aspiration. 0004............ Level I Needle

T................... 1.5882 $86.65

$22.36

$17.33 Biopsy/ Aspiration Except Bone Marrow. 0005............ Level II Needle T................... 3.2698 $178.40

$71.59

$35.68 Biopsy/Aspiration Except Bone Marrow. 0006............ Level I Incision & T................... 1.6527 $90.17

$23.26

$18.03 Drainage. 0007............ Level II Incision & T................... 11.8633 $647.27 ............ $129.45 Drainage. 0008............ Level III Incision T................... 19.4831 $1,063.02 ............ $212.60 and Drainage. 0009............ Nail Procedures..... T................... 0.6652 $36.29

$8.34

$7.26 0010............ Level I Destruction T................... 0.6480 $35.36

$10.08

$7.07 of Lesion. 0011............ Level II Destruction T................... 2.2217 $121.22

$27.88

$24.24 of Lesion. 0012............ Level I Debridement T................... 0.7694 $41.98

$11.18

$8.40 & Destruction. 0013............ Level II Debridement T................... 1.1272 $61.50

$14.20

$12.30 & Destruction. 0015............ Level III

T................... 1.5968 $87.12

$20.35

$17.42 Debridement & Destruction. 0016............ Level IV Debridement T................... 2.5724 $140.35

$57.31

$28.07 & Destruction. 0017............ Level VI Debridement T................... 16.3697 $893.15 $227.84 $178.63 & Destruction. 0018............ Biopsy of Skin/ T................... 0.9178 $50.08

$16.04

$10.02 Puncture of Lesion. 0019............ Level I Excision/ T................... 3.9493 $215.48

$71.87

$43.10 Biopsy. 0020............ Level II Excision/ T................... 7.0842 $386.52 $113.25

$77.30 Biopsy. 0021............ Level III Excision/ T................... 14.3594 $783.46 $219.48 $156.69 Biopsy. 0022............ Level IV Excision/ T................... 18.7932 $1,025.38 $354.45 $205.08 Biopsy. 0023............ Exploration

T................... 2.8141 $153.54

$40.37

$30.71 Penetrating Wound. 0024............ Level I Skin Repair. T................... 1.6850 $91.94

$33.10

$18.39 0025............ Level II Skin Repair T................... 5.1912 $283.24 $107.00

$56.65 0027............ Level IV Skin Repair T................... 15.8990 $867.47 $329.72 $173.49 0028............ Level I Breast

T................... 17.6584 $963.46 $303.74 $192.69 Surgery. 0029............ Level II Breast T................... 30.1167 $1,643.20 $632.64 $328.64 Surgery. 0030............ Level III Breast T................... 37.3083 $2,035.58 $763.55 $407.12 Surgery. 0032............ Insertion of Central T................... 11.4907 $626.94 ............ $125.39 Venous/Arterial Catheter. 0033............ Partial

P................... 5.2569 $286.82 ............

$57.36 Hospitalization. 0035............ Placement of

T................... 0.1691

$9.23

$2.79

$1.85 Arterial or Central Venous Catheter. 0036............ Level II Fine Needle T................... 1.5170 $82.77 ............

$16.55 Biopsy/Aspiration. 0037............ Level III Needle T................... 9.8921 $539.72 $237.45 $107.94 Biopsy/Aspiration Except Bone Marrow. 0039............ Implantation of S................... 235.1866 $12,832.02 ............ $2,566.40 Neurostimulator. 0040............ Level II

S................... 52.1002 $2,842.64 ............ $568.53 Implantation of Neurostimulator Electrodes. 0041............ Level I Arthroscopy. T................... 27.3819 $1,493.98 ............ $298.80 0042............ Level II Arthroscopy T................... 43.0808 $2,350.53 $804.74 $470.11 0043............ Closed Treatment T................... 1.9074 $104.07 ............

$20.81 Fracture Finger/Toe/ Trunk. 0045............ Bone/Joint

T................... 13.5889 $741.42 $268.47 $148.28 Manipulation Under Anesthesia. 0046............ Open/Percutaneous T................... 32.5581 $1,776.40 $535.76 $355.28 Treatment Fracture or Dislocation. 0047............ Arthroplasty without T................... 29.9582 $1,634.55 $537.03 $326.91 Prosthesis. 0048............ Arthroplasty with T................... 51.4609 $2,807.76 $695.60 $561.55 Prosthesis. 0049............ Level I

T................... 19.6046 $1,069.65 ............ $213.93 Musculoskeletal Procedures Except Hand and Foot. 0050............ Level II

T................... 24.8651 $1,356.66 ............ $271.33 Musculoskeletal Procedures Except Hand and Foot. 0051............ Level III

T................... 34.5144 $1,883.14 ............ $376.63 Musculoskeletal Procedures Except Hand and Foot. 0052............ Level IV

T................... 42.7126 $2,330.44 ............ $466.09 Musculoskeletal Procedures Except Hand and Foot. 0053............ Level I Hand

T................... 14.8831 $812.04 $253.49 $162.41 Musculoskeletal Procedures. 0054............ Level II Hand

T................... 24.2456 $1,322.86 ............ $264.57 Musculoskeletal Procedures. 0055............ Level I Foot

T................... 18.7205 $1,021.41 $355.34 $204.28 Musculoskeletal Procedures. 0056............ Level II Foot

T................... 25.3930 $1,385.47 $405.81 $277.09 Musculoskeletal Procedures. 0057............ Bunion Procedures... T................... 25.5035 $1,391.50 $475.91 $278.30 0058............ Level I Strapping S................... 1.0931 $59.64 ............

$11.93 and Cast Application. 0060............ Manipulation Therapy S................... 0.2788 $15.21 ............

$3.04 0068............ CPAP Initiation..... S................... 1.0807 $58.96

$29.48

$11.79 0069............ Thoracoscopy........ T................... 28.9392 $1,578.95 $591.64 $315.79 0070............ Thoracentesis/Lavage T................... 3.0717 $167.60 ............

$33.52 Procedures. 0071............ Level I Endoscopy T................... 0.8799 $48.01

$12.89

$9.60 Upper Airway.

[[Page 63479]]

0072............ Level II Endoscopy T................... 1.7613 $96.10

$26.68

$19.22 Upper Airway. 0073............ Level III Endoscopy T................... 3.4541 $188.46

$73.38

$37.69 Upper Airway. 0074............ Level IV Endoscopy T................... 13.9480 $761.02 $295.70 $152.20 Upper Airway. 0075............ Level V Endoscopy T................... 20.3815 $1,112.04 $445.92 $222.41 Upper Airway. 0076............ Level I Endoscopy T................... 9.2346 $503.85 $189.82 $100.77 Lower Airway. 0077............ Level I Pulmonary S................... 0.2837 $15.48

$7.74

$3.10 Treatment. 0078............ Level II Pulmonary S................... 0.7917 $43.20

$14.55

$8.64 Treatment. 0079............ Ventilation

S................... 2.1494 $117.27 ............

$23.45 Initiation and Management. 0080............ Diagnostic Cardiac T................... 36.0160 $1,965.07 $838.92 $393.01 Catheterization. 0081............ Non-Coronary

T................... 35.0285 $1,911.19 ............ $382.24 Angioplasty or Atherectomy. 0082............ Coronary Atherectomy T................... 110.2196 $6,013.69 $1,293.59 $1,202.74 0083............ Coronary Angioplasty T................... 59.2047 $3,230.27 ............ $646.05 and Percutaneous Valvuloplasty. 0084............ Level I

S................... 10.5226 $574.12 ............ $114.82 Electrophysiologic Evaluation. 0085............ Level II

T................... 35.4126 $1,932.15 $426.25 $386.43 Electrophysiologic Evaluation. 0086............ Ablate Heart

T................... 44.9389 $2,451.91 $833.33 $490.38 Dysrhythm Focus. 0087............ Cardiac

T................... 39.8161 $2,172.41 ............ $434.48 Electrophysiologic Recording/Mapping. 0088............ Thrombectomy........ T................... 34.6942 $1,892.95 $655.22 $378.59 0089............ Insertion/

T................... 117.1896 $6,393.98 $1,722.59 $1,278.80 Replacement of Permanent Pacemaker and Electrodes. 0090............ Insertion/

T................... 96.8284 $5,283.05 $1,651.45 $1,056.61 Replacement of Pacemaker Pulse Generator. 0091............ Level II Vascular T................... 28.8326 $1,573.14 $348.23 $314.63 Ligation. 0092............ Level I Vascular T................... 25.0959 $1,369.26 $505.37 $273.85 Ligation. 0093............ Vascular

T................... 21.3104 $1,162.72 $277.34 $232.54 Reconstruction/ Fistula Repair without Device. 0094............ Level I

S................... 2.6345 $143.74

$48.58

$28.75 Resuscitation and Cardioversion. 0095............ Cardiac

S................... 0.5994 $32.70

$16.35

$6.54 Rehabilitation. 0096............ Non-Invasive

S................... 1.7176 $93.71

$46.85

$18.74 Vascular Studies. 0097............ Cardiac and

X................... 1.0635 $58.03

$23.80

$11.61 Ambulatory Blood Pressure Monitoring. 0098............ Injection of

T................... 1.0729 $58.54

$14.06

$11.71 Sclerosing Solution. 0099............ Electrocardiograms.. S................... 0.3703 $20.20 ............

$4.04 0100............ Cardiac Stress Tests X................... 1.5862 $86.54

$41.44

$17.31 0101............ Tilt Table

S................... 4.4040 $240.29 $105.27

$48.06 Evaluation. 0103............ Miscellaneous

T................... 11.6202 $634.01 $223.63 $126.80 Vascular Procedures. 0104............ Transcatheter

T................... 82.6713 $4,510.63 ............ $902.13 Placement of Intracoronary Stents. 0105............ Revision/Removal of T................... 19.1898 $1,047.01 $370.40 $209.40 Pacemakers, AICD, or Vascular. 0106............ Insertion/

T................... 58.9719 $3,217.57 ............ $643.51 Replacement/Repair of Pacemaker and/or Electrodes. 0107............ Insertion of

T................... 337.1304 $18,394.17 $3,699.14 $3,678.83 Cardioverter- Defibrillator. 0108............ Insertion/

T................... 433.2998 $23,641.27 ............ $4,728.25 Replacement/Repair of Cardioverter- Defibrillator Leads. 0109............ Removal of Implanted T................... 7.4705 $407.60 $131.49

$81.52 Devices. 0110............ Transfusion......... S................... 3.6718 $200.34 ............

$40.07 0111............ Blood Product

S................... 13.1719 $718.67 $200.18 $143.73 Exchange. 0112............ Apheresis,

S................... 37.5832 $2,050.58 $612.47 $410.12 Photopheresis, and Plasmapheresis. 0113............ Excision Lymphatic T................... 19.9322 $1,087.52 ............ $217.50 System. 0114............ Thyroid/

T................... 37.5963 $2,051.29 $485.91 $410.26 Lymphadenectomy Procedures. 0115............ Cannula/Access

T................... 25.6437 $1,399.15 $459.35 $279.83 Device Procedures. 0116............ Chemotherapy

S................... 0.7996 $43.63 ............

$8.73 Administration by Other Technique Except Infusion. 0117............ Chemotherapy

S................... 3.0360 $165.65

$42.54

$33.13 Administration by Infusion Only. 0119............ Implantation of T................... 134.7194 $7,350.43 ............ $1,470.09 Infusion Pump. 0120............ Infusion Therapy T................... 1.9114 $104.29

$28.21

$20.86 Except Chemotherapy. 0121............ Level I Tube changes T................... 2.1189 $115.61

$43.80

$23.12 and Repositioning. 0122............ Level II Tube

T................... 8.8621 $483.53

$99.16

$96.71 changes and Repositioning. 0123............ Bone Marrow

S................... 5.2882 $288.53 ............

$57.71 Harvesting and Bone Marrow/Stem Cell Transplant. 0124............ Revision of

T................... 23.8050 $1,298.82 ............ $259.76 Implanted Infusion Pump. 0125............ Refilling of

T................... 2.1606 $117.88 ............

$23.58 Infusion Pump. 0130............ Level I Laparoscopy. T................... 32.7724 $1,788.09 $659.53 $357.62 0131............ Level II Laparoscopy T................... 40.8064 $2,226.44 $1,001.89 $445.29 0132............ Level III

T................... 57.2045 $3,121.13 $1,239.22 $624.23 Laparoscopy. 0140............ Esophageal Dilation T................... 6.4525 $352.05 $107.24

$70.41 without Endoscopy. 0141............ Upper GI Procedures. T................... 7.8206 $426.70 $143.38

$85.34 0142............ Small Intestine T................... 8.7959 $479.91 $152.78

$95.98 Endoscopy. 0143............ Lower GI Endoscopy.. T................... 8.2957 $452.62 $186.06

$90.52 0146............ Level I

T................... 3.9826 $217.29

$64.40

$43.46 Sigmoidoscopy. 0147............ Level II

T................... 7.6808 $419.07 ............

$83.81 Sigmoidoscopy. 0148............ Level I Anal/Rectal T................... 3.8320 $209.08

$63.38

$41.82 Procedure. 0149............ Level III Anal/ T................... 17.1425 $935.31 $293.06 $187.06 Rectal Procedure. 0150............ Level IV Anal/Rectal T................... 22.1919 $1,210.81 $437.12 $242.16 Procedure.

[[Page 63480]]

0151............ Endoscopic

T................... 17.9462 $979.16 $245.46 $195.83 Retrograde Cholangio- Pancreatography (ERCP). 0152............ Percutaneous

T................... 9.1474 $499.09 $125.28

$99.82 Abdominal and Biliary Procedures. 0153............ Peritoneal and

T................... 20.8723 $1,138.81 $410.87 $227.76 Abdominal Procedures. 0154............ Hernia/Hydrocele T................... 26.9636 $1,471.16 $464.85 $294.23 Procedures. 0155............ Level II Anal/Rectal T................... 10.0809 $550.02 $188.89 $110.00 Procedure. 0156............ Level II Urinary and T................... 2.4747 $135.02

$40.52

$27.00 Anal Procedures. 0157............ Colorectal Cancer S................... 2.5693 $140.18 ............

$28.04 Screening: Barium Enema. 0158............ Colorectal Cancer T................... 7.4244 $405.08 ............ $101.27 Screening: Colonoscopy. 0159............ Colorectal Cancer S................... 2.7823 $151.81 ............

$37.95 Screening: Flexible Sigmoidoscopy. 0160............ Level I

T................... 6.8801 $375.39 $105.06

$75.08 Cystourethroscopy and other Genitourinary Procedures. 0161............ Level II

T................... 16.8407 $918.85 $249.36 $183.77 Cystourethroscopy and other Genitourinary Procedures. 0162............ Level III

T................... 21.9098 $1,195.42 ............ $239.08 Cystourethroscopy and other Genitourinary Procedures. 0163............ Level IV

T................... 33.8805 $1,848.55 ............ $369.71 Cystourethroscopy and other Genitourinary Procedures. 0164............ Level I Urinary and T................... 1.2021 $65.59

$17.59

$13.12 Anal Procedures. 0165............ Level III Urinary T................... 14.6838 $801.16 ............ $160.23 and Anal Procedures. 0166............ Level I Urethral T................... 16.7918 $916.18 $218.73 $183.24 Procedures. 0167............ Level III Urethral T................... 30.0186 $1,637.84 $555.84 $327.57 Procedures. 0168............ Level II Urethral T................... 30.0147 $1,637.63 $405.60 $327.53 Procedures. 0169............ Lithotripsy......... T................... 45.1150 $2,461.52 $1,115.69 $492.30 0170............ Dialysis............ S................... 5.9678 $325.61 ............

$65.12 0180............ Circumcision........ T................... 18.6176 $1,015.79 $304.87 $203.16 0181............ Penile Procedures... T................... 29.4217 $1,605.28 $621.82 $321.06 0183............ Testes/Epididymis T................... 21.6724 $1,182.47 ............ $236.49 Procedures. 0184............ Prostate Biopsy..... T................... 3.8995 $212.76

$96.27

$42.55 0187............ Miscellaneous

X................... 4.4288 $241.64

$90.71

$48.33 Placement/ Repositioning. 0188............ Level II Female T................... 1.1365 $62.01 ............

$12.40 Reproductive Proc. 0189............ Level III Female T................... 1.4232 $77.65

$18.09

$15.53 Reproductive Proc. 0190............ Level I Hysteroscopy T................... 19.6922 $1,074.43 $424.28 $214.89 0191............ Level I Female

T................... 0.1853 $10.11

$2.93

$2.02 Reproductive Proc. 0192............ Level IV Female T................... 2.7121 $147.97

$39.11

$29.59 Reproductive Proc. 0193............ Level V Female

T................... 15.0453 $820.89 $171.13 $164.18 Reproductive Proc. 0194............ Level VIII Female T................... 18.4286 $1,005.48 $397.84 $201.10 Reproductive Proc. 0195............ Level IX Female T................... 25.6950 $1,401.94 $483.80 $280.39 Reproductive Proc. 0196............ Dilation and

T................... 16.1219 $879.63 $338.23 $175.93 Curettage. 0197............ Infertility

T................... 4.8280 $263.42 ............

$52.68 Procedures. 0198............ Pregnancy and

T................... 1.3578 $74.08

$32.19

$14.82 Neonatal Care Procedures. 0199............ Obstetrical Care T................... 17.2831 $942.98 ............ $188.60 Service. 0200............ Level VII Female T................... 17.9920 $981.66 $307.83 $196.33 Reproductive Proc. 0201............ Level VI Female T................... 16.8660 $920.23 $329.65 $184.05 Reproductive Proc. 0202............ Level X Female

T................... 38.9821 $2,126.90 $1,042.18 $425.38 Reproductive Proc. 0203............ Level IV Nerve

T................... 11.5969 $632.74 $276.76 $126.55 Injections. 0204............ Level I Nerve

T................... 2.1711 $118.46

$40.13

$23.69 Injections. 0206............ Level II Nerve

T................... 5.2875 $288.49

$75.55

$57.70 Injections. 0207............ Level III Nerve T................... 6.4554 $352.21 $123.69

$70.44 Injections. 0208............ Laminotomies and T................... 40.2830 $2,197.88 ............ $439.58 Laminectomies. 0209............ Extended EEG Studies S................... 11.5435 $629.82 $280.58 $125.96 and Sleep Studies, Level II. 0212............ Nervous System

T................... 2.9739 $162.26

$74.67

$32.45 Injections. 0213............ Extended EEG Studies S................... 2.9055 $158.53

$65.74

$31.71 and Sleep Studies, Level I. 0214............ Electroencephalogram S................... 2.2176 $120.99

$58.12

$24.20 0215............ Level I Nerve and S................... 0.6457 $35.23

$15.76

$7.05 Muscle Tests. 0216............ Level III Nerve and S................... 2.8535 $155.69

$67.98

$31.14 Muscle Tests. 0218............ Level II Nerve and S................... 1.1404 $62.22 ............

$12.44 Muscle Tests. 0220............ Level I Nerve

T................... 16.5554 $903.28 ............ $180.66 Procedures. 0221............ Level II Nerve

T................... 24.8875 $1,357.89 $463.62 $271.58 Procedures. 0222............ Implantation of T................... 232.2024 $12,669.20 ............ $2,533.84 Neurological Device. 0223............ Implantation or T................... 26.7610 $1,460.11 ............ $292.02 Revision of Pain Management Catheter. 0224............ Implantation of T................... 34.1770 $1,864.73 $453.41 $372.95 Reservoir/Pump/ Shunt. 0225............ Level I

S................... 206.0034 $11,239.75 ............ $2,247.95 Implementation of Neurostimulator Electrodes. 0226............ Implantation of Drug T................... 136.2989 $7,436.60 ............ $1,487.32 Infusion Reservoir. 0227............ Implantation of Drug T................... 160.8363 $8,775.39 ............ $1,755.08 Infusion Device. 0228............ Creation of Lumbar T................... 52.2880 $2,852.89 $639.03 $570.58 Subarachnoid Shunt. 0229............ Transcatherter

T................... 61.9895 $3,382.21 $771.23 $676.44 Placement of Intravascular Shunts. 0230............ Level I Eye Tests & S................... 0.7619 $41.57

$14.97

$8.31 Treatments. 0231............ Level III Eye Tests S................... 2.1883 $119.40

$50.94

$23.88 & Treatments.

[[Page 63481]]

0232............ Level I Anterior T................... 4.9206 $268.47 $103.17

$53.69 Segment Eye Procedures. 0233............ Level II Anterior T................... 14.4205 $786.80 $266.33 $157.36 Segment Eye Procedures. 0234............ Level III Anterior T................... 21.4631 $1,171.05 $511.31 $234.21 Segment Eye Procedures. 0235............ Level I Posterior T................... 5.0749 $276.89

$72.04

$55.38 Segment Eye Procedures. 0236............ Level II Posterior T................... 18.6701 $1,018.66 ............ $203.73 Segment Eye Procedures. 0237............ Level III Posterior T................... 34.1784 $1,864.81 $818.54 $372.96 Segment Eye Procedures. 0238............ Level I Repair and T................... 3.1954 $174.34

$58.96

$34.87 Plastic Eye Procedures. 0239............ Level II Repair and T................... 6.1331 $334.63 ............

$66.93 Plastic Eye Procedures. 0240............ Level III Repair and T................... 17.4535 $952.28 $315.31 $190.46 Plastic Eye Procedures. 0241............ Level IV Repair and T................... 22.1969 $1,211.09 $384.47 $242.22 Plastic Eye Procedures. 0242............ Level V Repair and T................... 29.4294 $1,605.70 $597.36 $321.14 Plastic Eye Procedures. 0243............ Strabismus/Muscle T................... 21.7323 $1,185.74 $431.39 $237.15 Procedures. 0244............ Corneal Transplant.. T................... 37.6284 $2,053.04 $803.26 $410.61 0245............ Level I Cataract T................... 12.2973 $670.95 $222.22 $134.19 Procedures without IOL Insert. 0246............ Cataract Procedures T................... 22.9755 $1,253.57 $495.96 $250.71 with IOL Insert. 0247............ Laser Eye Procedures T................... 4.9482 $269.98 $104.31

$54.00 Except Retinal. 0248............ Laser Retinal

T................... 4.8223 $263.11

$95.08

$52.62 Procedures. 0249............ Level II Cataract T................... 27.7406 $1,513.55 $524.67 $302.71 Procedures without IOL Insert. 0250............ Nasal Cauterization/ T................... 1.4697 $80.19

$28.07

$16.04 Packing. 0251............ Level I ENT

T................... 1.7880 $97.56 ............

$19.51 Procedures. 0252............ Level II ENT

T................... 6.4469 $351.75 $113.41

$70.35 Procedures. 0253............ Level III ENT

T................... 15.2249 $830.69 $282.29 $166.14 Procedures. 0254............ Level IV ENT

T................... 21.8901 $1,194.35 $321.35 $238.87 Procedures. 0256............ Level V ENT

T................... 35.1548 $1,918.08 ............ $383.62 Procedures. 0258............ Tonsil and Adenoid T................... 20.6265 $1,125.40 $437.25 $225.08 Procedures. 0259............ Level VI ENT

T................... 392.8622 $21,434.95 $9,394.83 $4,286.99 Procedures. 0260............ Level I Plain Film X................... 0.7802 $42.57

$21.28

$8.51 Except Teeth. 0261............ Level II Plain Film X................... 1.3176 $71.89 ............

$14.38 Except Teeth Including Bone Density Measurement. 0262............ Plain Film of Teeth. X................... 0.7540 $41.14

$9.82

$8.23 0263............ Level I

X................... 2.1883 $119.40

$43.58

$23.88 Miscellaneous Radiology Procedures. 0264............ Level II

X................... 3.0287 $165.25

$79.41

$33.05 Miscellaneous Radiology Procedures. 0265............ Level I Diagnostic S................... 1.0289 $56.14

$28.07

$11.23 Ultrasound Except Vascular. 0266............ Level II Diagnostic S................... 1.6117 $87.94

$43.97

$17.59 Ultrasound Except Vascular. 0267............ Level III Diagnostic S................... 2.4586 $134.14

$65.52

$26.83 Ultrasound Except Vascular. 0268............ Ultrasound Guidance S................... 1.3081 $71.37 ............

$14.27 Procedures. 0269............ Level III

S................... 3.2309 $176.28

$87.24

$35.26 Echocardiogram Except Transesophageal. 0270............ Transesophageal S................... 5.8546 $319.43 $146.79

$63.89 Echocardiogram. 0271............ Mammography......... S................... 0.6499 $35.46

$16.80

$7.09 0272............ Level I Fluoroscopy. X................... 1.4166 $77.29

$38.36

$15.46 0274............ Myelography......... S................... 3.5931 $196.04

$93.63

$39.21 0275............ Arthrography........ S................... 3.2775 $178.82

$69.09

$35.76 0276............ Level I Digestive S................... 1.5906 $86.78

$41.72

$17.36 Radiology. 0277............ Level II Digestive S................... 2.4444 $133.37

$60.47

$26.67 Radiology. 0278............ Diagnostic Urography S................... 2.7012 $147.38

$66.07

$29.48 0279............ Level II Angiography S................... 10.7073 $584.20 $174.57 $116.84 and Venography except Extremity. 0280............ Level III

S................... 19.1015 $1,042.20 $353.85 $208.44 Angiography and Venography except Extremity. 0281............ Venography of

S................... 6.6031 $360.27 $115.16

$72.05 Extremity. 0282............ Miscellaneous

S................... 1.6834 $91.85

$44.51

$18.37 Computerized Axial Tomography. 0283............ Computerized Axial S................... 4.6543 $253.94 $126.27

$50.79 Tomography with Contrast Material. 0284............ Magnetic Resonance S................... 7.1165 $388.28 $194.13

$77.66 Imaging and Magnetic Resonance Angiography with Contras. 0285............ Myocardial Positron S................... 14.1508 $772.08 $334.45 $154.42 Emission Tomography (PET). 0287............ Complex Venography.. S................... 6.4923 $354.23 $111.33

$70.85 0288............ Bone Density:Axial S................... 1.2726 $69.43 ............

$13.89 Skeleton. 0289............ Needle Localization X................... 3.4900 $190.42

$44.80

$38.08 for Breast Biopsy. 0296............ Level I Therapeutic S................... 2.8635 $156.24

$69.20

$31.25 Radiologic Procedures. 0297............ Level II Therapeutic S................... 7.7145 $420.91 $172.51

$84.18 Radiologic Procedures. 0299............ Miscellaneous

S................... 5.7618 $314.37 ............

$62.87 Radiation Treatment. 0300............ Level I Radiation S................... 1.4912 $81.36 ............

$16.27 Therapy. 0301............ Level II Radiation S................... 2.1340 $116.43 ............

$23.29 Therapy. 0302............ Level III Radiation S................... 6.3268 $345.20 $130.77

$69.04 Therapy. 0303............ Treatment Device X................... 2.8835 $157.33

$66.95

$31.47 Construction. 0304............ Level I Therapeutic X................... 1.6742 $91.35

$41.52

$18.27 Radiation Treatment Preparation. 0305............ Level II Therapeutic X................... 3.6767 $200.60

$91.38

$40.12 Radiation Treatment Preparation. 0310............ Level III

X................... 13.7165 $748.39 $325.27 $149.68 Therapeutic Radiation Treatment Preparation. 0312............ Radioelement

S................... 3.6637 $199.90 ............

$39.98 Applications. 0313............ Brachytherapy....... S................... 16.2481 $886.51 ............ $177.30 0314............ Hyperthermic

S................... 4.6041 $251.20 $101.77

$50.24 Therapies.

[[Page 63482]]

0320............ Electroconvulsive S................... 5.3785 $293.46

$80.06

$58.69 Therapy. 0321............ Biofeedback and S................... 1.2387 $67.58

$21.78

$13.52 Other Training. 0322............ Brief Individual S................... 1.2802 $69.85 ............

$13.97 Psychotherapy. 0323............ Extended Individual S................... 1.8689 $101.97

$21.26

$20.39 Psychotherapy. 0324............ Family Psychotherapy S................... 2.4473 $133.53 ............

$26.71 0325............ Group Psychotherapy. S................... 1.4865 $81.10

$18.27

$16.22 0330............ Dental Procedures... S................... 0.5745 $31.35 ............

$6.27 0332............ Computerized Axial S................... 3.3936 $185.16

$91.27

$37.03 Tomography and Computerized Angiography without Contras. 0333............ Computerized Axial S................... 5.4241 $295.94 $146.98

$59.19 Tomography and Computerized Angio w/o Contrast Material. 0335............ Magnetic Resonance S................... 6.3499 $346.46 $151.46

$69.29 Imaging, Miscellaneous. 0336............ Magnetic Resonance S................... 6.3897 $348.63 $174.31

$69.73 Imaging and Magnetic Resonance Angiography without Cont. 0337............ MRI and Magnetic S................... 9.2075 $502.37 $240.77 $100.47 Resonance Angiography without Contrast Material followed. 0339............ Observation......... S................... 3.8356 $209.27 ............

$41.85 0340............ Minor Ancillary X................... 0.6314 $34.45 ............

$6.89 Procedures. 0341............ Skin Tests.......... X................... 0.1365

$7.45

$3.03

$1.49 0342............ Level I Pathology... X................... 0.2162 $11.80

$5.88

$2.36 0343............ Level II Pathology.. X................... 0.4617 $25.19

$12.55

$5.04 0344............ Level III Pathology. X................... 0.6291 $34.32

$17.16

$6.86 0345............ Level I Transfusion X................... 0.2550 $13.91

$3.10

$2.78 Laboratory Procedures. 0346............ Level II Transfusion X................... 0.3866 $21.09

$5.32

$4.22 Laboratory Procedures. 0347............ Level III

X................... 0.9610 $52.43

$13.20

$10.49 Transfusion Laboratory Procedures. 0348............ Fertility Laboratory X................... 0.8194 $44.71 ............

$8.94 Procedures. 0352............ Level I Injections.. X................... 0.1230

$6.71 ............

$1.34 0353............ Level II Allergy X................... 0.3982 $21.73 ............

$4.35 Injections. 0355............ Level III

K................... 0.2749 $15.00 ............

$3.00 Immunizations. 0356............ Level IV

K................... 0.7698 $42.00 ............

$8.40 Immunizations. 0359............ Level II Injections. X................... 0.8000 $43.65 ............

$8.73 0360............ Level I Alimentary X................... 1.7313 $94.46

$42.45

$18.89 Tests. 0361............ Level II Alimentary X................... 3.5510 $193.75

$83.23

$38.75 Tests. 0362............ Level III

X................... 2.6984 $147.23 ............

$29.45 Otorhinolaryngologi c Function Tests. 0363............ Level I

X................... 0.8641 $47.15

$17.44

$9.43 Otorhinolaryngologi c Function Tests. 0364............ Level I Audiometry.. X................... 0.4459 $24.33

$9.06

$4.87 0365............ Level II Audiometry. X................... 1.2132 $66.19

$18.95

$13.24 0367............ Level I Pulmonary X................... 0.5887 $32.12

$15.16

$6.42 Test. 0368............ Level II Pulmonary X................... 0.9319 $50.85

$25.42

$10.17 Tests. 0369............ Level III Pulmonary X................... 2.4984 $136.32

$44.18

$27.26 Tests. 0370............ Allergy Tests....... X................... 0.9185 $50.11

$11.58

$10.02 0371............ Level I Allergy X................... 0.4105 $22.40 ............

$4.48 Injections. 0372............ Therapeutic

X................... 0.5607 $30.59

$10.09

$6.12 Phlebotomy. 0373............ Neuropsychological X................... 2.0899 $114.03 ............

$22.81 Testing. 0374............ Monitoring

X................... 1.1252 $61.39 ............

$12.28 Psychiatric Drugs. 0375............ Ancillary Outpatient T................... ......... $1,150.00 ............ $230.00 Services When Patient Expires. 0376............ Level II Cardiac S................... 4.4510 $242.85 $121.42

$48.57 Imaging. 0377............ Level III Cardiac S................... 6.8830 $375.54 $187.76

$75.11 Imaging. 0378............ Level II Pulmonary S................... 5.4852 $299.28 $149.63

$59.86 Imaging. 0379............ Injection adenosine K................... 0.2078 $11.34 ............

$2.27 6 MG. 0380............ Dipyridamole

K................... 0.2525 $13.78 ............

$2.76 injection. 0384............ GI Procedures with T................... 20.6602 $1,127.24 $244.83 $225.45 Stents. 0385............ Level I Prosthetic S................... 67.1530 $3,663.93 ............ $732.79 Urological Procedures. 0386............ Level II Prosthetic S................... 116.2382 $6,342.07 ............ $1,268.41 Urological Procedures. 0387............ Level II

T................... 28.1480 $1,535.78 $655.55 $307.16 Hysteroscopy. 0388............ Discography......... S................... 11.6347 $634.80 $303.19 $126.96 0389............ Non-imaging Nuclear S................... 1.6328 $89.09

$44.54

$17.82 Medicine. 0390............ Level I Endocrine S................... 2.7907 $152.26

$76.13

$30.45 Imaging. 0391............ Level II Endocrine S................... 3.1956 $174.36

$87.18

$34.87 Imaging. 0393............ Red Cell/Plasma S................... 4.4354 $242.00 $121.00

$48.40 Studies. 0394............ Hepatobiliary

S................... 4.3714 $238.51 $119.25

$47.70 Imaging. 0395............ GI Tract Imaging.... S................... 3.9536 $215.71 $107.85

$43.14 0396............ Bone Imaging........ S................... 4.1883 $228.52 $114.26

$45.70 0397............ Vascular Imaging.... S................... 2.2183 $121.03

$60.51

$24.21 0398............ Level I Cardiac S................... 4.5091 $246.02 $123.01

$49.20 Imaging. 0399............ Nuclear Medicine Add- S................... 1.5273 $83.33

$41.66

$16.67 on Imaging. 0400............ Hematopoietic

S................... 3.8242 $208.65 $104.32

$41.73 Imaging. 0401............ Level I Pulmonary S................... 3.3736 $184.07

$92.03

$36.81 Imaging. 0402............ Brain Imaging....... S................... 5.4063 $294.97 $147.48

$58.99

[[Page 63483]]

0403............ CSF Imaging......... S................... 3.8402 $209.53 $104.76

$41.91 0404............ Renal and

S................... 3.7303 $203.53 $101.76

$40.71 Genitourinary Studies Level I. 0405............ Renal and

S................... 4.3432 $236.97 $118.48

$47.39 Genitourinary Studies Level II. 0406............ Tumor/Infection S................... 4.3955 $239.82 $119.91 $47.96 W 0407............ Radionuclide Therapy S................... 3.5841 $195.55

$97.77

$39.11 0409............ Red Blood Cell Tests X................... 0.1390

$7.58

$2.32

$1.52 0410............ Mammogram Add On.... S................... 0.1523

$8.31 ............

$1.66 0411............ Respiratory

S................... 0.4367 $23.83 ............

$4.77 Procedures. 0412............ IMRT Treatment

S................... 5.3904 $294.11 ............

$58.82 Delivery. 0413............ IMRT Treatment Plan. S................... 7.4469 $406.31 ............

$81.26 0415............ Level II Endoscopy T................... 20.7348 $1,131.31 $459.92 $226.26 Lower Airway. 0600............ Low Level Clinic V................... 0.9278 $50.62 ............

$10.12 Visits. 0601............ Mid Level Clinic V................... 0.9816 $53.56 ............

$10.71 Visits. 0602............ High Level Clinic V................... 1.5041 $82.07 ............

$16.41 Visits. 0610............ Low Level Emergency V................... 1.3691 $74.70

$19.57

$14.94 Visits. 0611............ Mid Level Emergency V................... 2.3967 $130.77

$36.16

$26.15 Visits. 0612............ High Level Emergency V................... 4.1476 $226.30

$54.12

$45.26 Visits. 0620............ Critical Care....... S................... 8.9992 $491.01 $142.30

$98.20 0648............ Breast

T................... 54.0165 $2,947.19 ............ $589.44 Reconstruction with Prosthesis. 0651............ Complex Interstitial S................... 10.2314 $558.24 ............ $111.65 Radiation Source Application. 0652............ Insertion of

T................... 27.0364 $1,475.13 ............ $295.03 Intraperitoneal Catheters. 0653............ Vascular

T................... 30.0334 $1,638.65 ............ $327.73 Reconstruction/ Fistula Repair with Device. 0654............ Insertion/

T................... 112.6957 $6,148.79 ............ $1,229.76 Replacement of a permanent dual chamber pacemaker. 0655............ Insertion/

T................... 142.7039 $7,786.07 ............ $1,557.21 Replacement/ Conversion of a permanent dual chamber pacemaker. 0656............ Transcatheter

T................... 103.4907 $5,646.56 ............ $1,129.31 Placement of Intracoronary Drug- Eluting Stents. 0657............ Placement of Tissue S................... 1.5102 $82.40 ............

$16.48 Clips. 0658............ Percutaneous Breast T................... 5.5779 $304.34 ............

$60.87 Biopsies. 0659............ Hyperbaric Oxygen... S................... 3.0228 $164.93 ............

$32.99 0660............ Level II

X................... 1.7353 $94.68

$30.66

$18.94 Otorhinolaryngologi c Function Tests. 0661............ Level IV Pathology.. X................... 3.2576 $177.74

$88.87

$35.55 0662............ CT Angiography...... S................... 5.8775 $320.68 $156.47

$64.14 0664............ Proton Beam

S................... 9.7295 $530.85 ............ $106.17 Radiation Therapy. 0665............ Bone

S................... 0.7257 $39.59 ............

$7.92 Density:Appendicula rSkeleton. 0668............ Level I Angiography S................... 10.2660 $560.12 $237.76 $112.02 and Venography except Extremity. 0669............ Digital Mammography. S................... 0.9009 $49.15 ............

$9.83 0670............ Intravenous and S................... 27.4483 $1,497.61 $542.37 $299.52 Intracardiac Ultrasound. 0671............ Level II

S................... 1.6384 $89.39

$44.69

$17.88 Echocardiogram Except Transesophageal. 0672............ Level IV Posterior T................... 38.9476 $2,125.02 $988.43 $425.00 Segment Procedures. 0673............ Level IV Anterior T................... 26.8390 $1,464.36 $649.56 $292.87 Segment Eye Procedures. 0674............ Prostate

T................... 119.9733 $6,545.86 ............ $1,309.17 Cryoablation. 0675............ Prostatic

T................... 49.3452 $2,692.32 ............ $538.46 Thermotherapy. 0676............ Level II

T................... 2.7315 $149.03

$40.30

$29.81 Transcatheter Thrombolysis. 0677............ Level I

T................... 2.1805 $118.97 ............

$23.79 Transcatheter Thrombolysis. 0678............ External

T................... 2.0659 $112.72 ............

$22.54 Counterpulsation. 0679............ Level II

S................... 5.4887 $299.47

$95.30

$59.89 Resuscitation and Cardioversion. 0680............ Insertion of Patient S................... 62.8252 $3,427.81 ............ $685.56 Activated Event Recorders. 0681............ Knee Arthroplasty... T................... 98.1613 $5,355.78 $2,131.36 $1,071.16 0682............ Level V Debridement T................... 8.0790 $440.80 $174.57

$88.16 & Destruction. 0683............ Level II

S................... 1.5489 $84.51

$30.42

$16.90 Photochemotherapy. 0685............ Level III Needle T................... 4.8100 $262.44 $115.47

$52.49 Biopsy/Aspiration Except Bone Marrow. 0686............ Level III Skin

T................... 7.9247 $432.38 $198.89

$86.48 Repair. 0687............ Revision/Removal of T................... 20.4416 $1,115.31 $513.05 $223.06 Neurostimulator Electrodes. 0688............ Revision/Removal of T................... 46.7347 $2,549.89 $1,249.45 $509.98 Neurostimulator Pulse Generator Receiver. 0689............ Electronic Analysis S................... 0.5533 $30.19 ............

$6.04 of Cardioverter- defibrillators. 0690............ Electronic Analysis S................... 0.4074 $22.23

$10.63

$4.45 of Pacemakers and other Cardiac Devices. 0691............ Electronic Analysis S................... 2.8066 $153.13

$76.56

$30.63 of Programmable Shunts/Pumps. 0692............ Electronic Analysis S................... 1.1057 $60.33

$30.16

$12.07 of Neurostimulator Pulse Generators. 0693............ Level II Breast T................... 39.0111 $2,128.48 $798.17 $425.70 Reconstruction. 0694............ Mohs Surgery........ T................... 2.9752 $162.33

$64.93

$32.47 0695............ Level VII

T................... 19.1849 $1,046.75 $266.59 $209.35 Debridement & Destruction. 0697............ Level I

S................... 1.4415 $78.65

$39.32

$15.73 Echocardiogram Except Transesophageal. 0698............ Level II Eye Tests & S................... 0.9599 $52.37

$18.72

$10.47 Treatments. 0699............ Level IV Eye Tests & T................... 2.2303 $121.69

$47.46

$24.34 Treatments. 0700............ Antepartum

T................... 2.4306 $132.62

$37.13

$26.52 Manipulation.

[[Page 63484]]

0701............ SR 89 chloride, per K................... 7.3835 $402.85 ............

$80.57 mCi. 0702............ SM 153 lexidronam, K................... 16.0268 $874.44 ............ $174.89 50 mCi. 0704............ IN 111 Satumomab K................... 2.2811 $124.46 ............

$24.89 pendetide per dose. 0705............ Technetium TC99M K................... 1.0642 $58.06 ............

$11.61 tetrofosmin. 0726............ Dexrazoxane hcl K................... 2.0616 $112.48 ............

$22.50 injection, 250 mg. 0728............ Filgrastim 300 mcg K................... 2.2631 $123.48 ............

$24.70 injection. 0730............ Pamidronate disodium K................... 3.1949 $174.32 ............

$34.86 , 30 mg. 0731............ Sargramostim

K................... 0.2991 $16.32 ............

$3.26 injection. 0732............ Mesna injection 200 K................... 0.5211 $28.43 ............

$5.69 mg. 0733............ Non esrd epoetin K................... 0.1802

$9.83 ............

$1.97 alpha inj, 1000 u. 0734............ Injection,

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

$3.24 ............

$0.65 darbepoetin alfa (for non-ESRD), per 1 mcg. 0763............ Dolasetron mesylate K................... 0.7514 $41.00 ............

$8.20 oral. 0764............ Granisetron HCl K................... 0.1044

$5.70 ............

$1.14 injection. 0765............ Granisetron HCl 1 mg K................... 0.6322 $34.49 ............

$6.90 oral. 0800............ Leuprolide acetate, K................... 3.3525 $182.92 ............

$36.58 3.75 mg. 0802............ Etoposide oral 50 mg K................... 0.5016 $27.37 ............

$5.47 0807............ Aldesleukin/single K................... ......... $680.35 ............ $136.07 use vial. 0809............ Bcg live

K................... 1.9015 $103.75 ............

$20.75 intravesical vac. 0810............ Goserelin acetate K................... 5.2265 $285.16 ............

$57.03 implant 3.6 mg. 0811............ Carboplatin

K................... 1.5849 $86.47 ............

$17.29 injection 50 mg. 0813............ Cisplatin 10 mg K................... 0.3985 $21.74 ............

$4.35 injection. 0814............ Asparaginase

K................... 0.2957 $16.13 ............

$3.23 injection. 0815............ Cyclophosphamide 100 K................... 0.0868

$4.74 ............

$0.95 MG inj. 0816............ Cyclophosphamide K................... 0.0825

$4.50 ............

$0.90 lyophilized. 0817............ Cytarabine hcl 100 K................... 0.0930

$5.07 ............

$1.01 MG inj. 0819............ Dacarbazine 100 mg K................... 0.0974

$5.31 ............

$1.06 inj. 0820............ Daunorubicin 10 mg.. K................... 1.3557 $73.97 ............

$14.79 0821............ Daunorubicin citrate K................... 2.9976 $163.55 ............

$32.71 liposom 10 mg. 0823............ Docetaxel, 20 mg.... K................... 4.0499 $220.97 ............

$44.19 0824............ Etoposide 10 MG inj. K................... 0.0836

$4.56 ............

$0.91 0827............ Floxuridine

K................... 2.0928 $114.19 ............

$22.84 injection 500 mg. 0828............ Gemcitabine HCL 200 K................... 1.4742 $80.43 ............

$16.09 mg. 0830............ Irinotecan injection K................... 1.8428 $100.55 ............

$20.11 20 mg. 0831............ Ifosfomide injection K................... 1.9435 $106.04 ............

$21.21 1 gm. 0832............ Idarubicin hcl

K................... 3.2663 $178.21 ............

$35.64 injection 5 mg. 0834............ Interferon alfa-2a K................... 0.3777 $20.61 ............

$4.12 inj. 0836............ Interferon alfa-2b K................... 0.2003 $10.93 ............

$2.19 inj recombinant, 1 million. 0838............ Interferon gamma 1-b K................... ......... $180.15 ............

$36.03 inj, 3 million u. 0840............ Melphalan hydrochl K................... 4.6719 $254.90 ............

$50.98 50 mg. 0842............ Fludarabine

K................... 3.7708 $205.74 ............

$41.15 phosphate inj 50 mg. 0844............ Pentostatin

K................... 17.7045 $965.98 ............ $193.20 injection, 10 mg. 0847............ Doxorubic hcl 10 MG K................... 0.1212

$6.61 ............

$1.32 vl chemo. 0849............ Rituximab, 100 mg... K................... 5.6158 $306.40 ............

$61.28 0850............ Streptozocin

K................... 1.1948 $65.19 ............

$13.04 injection, 1 gm. 0851............ Thiotepa injection.. K................... 1.0984 $59.93 ............

$11.99 0852............ Topotecan, 4 mg..... K................... 7.9435 $433.41 ............

$86.68 0855............ Vinorelbine

K................... 1.1874 $64.79 ............

$12.96 tartrate, 10 mg. 0856............ Porfimer sodium, 75 K................... 29.2205 $1,594.30 ............ $318.86 mg. 0857............ Bleomycin sulfate K................... 2.9427 $160.56 ............

$32.11 injection 15 u. 0858............ Cladribine, 1mg..... K................... 0.6931 $37.82 ............

$7.56 0860............ Plicamycin

K................... 0.2826 $15.42 ............

$3.08 (mithramycin) inj. 0861............ Leuprolide acetate K................... 0.7991 $43.60 ............

$8.72 injection 1 mg. 0862............ Mitomycin 5 mg inj.. K................... 0.9719 $53.03 ............

$10.61 0863............ Paclitaxel

K................... 2.0553 $112.14 ............

$22.43 injection, 30 mg. 0864............ Mitoxantrone hcl, 5 K................... 3.1832 $173.68 ............

$34.74 mg. 0865............ Interferon alfa-n3 K................... 1.4598 $79.65 ............

$15.93 inj, human leukocyte derived, 2. 0884............ Rho d immune

K................... 0.1863 $10.16 ............

$2.03 globulin inj, 1 dose pkg. 0888............ Cyclosporine oral K................... 0.0470

$2.56 ............

$0.51 100 mg. 0890............ Lymphocyte immune K................... 2.3439 $127.89 ............

$25.58 globulin 250 mg. 0891............ Tacrolimus oral per K................... 0.0246

$1.34 ............

$0.27 1 mg. 0900............ Alglucerase

K................... ......... $37.13 ............

$7.43 injection, per 10 u. 0901............ Alpha 1 proteinase K................... .........

$3.43 ............

$0.69 inhibitor, 10 mg. 0902............ Botulinum toxin a, K................... 0.0588

$3.21 ............

$0.64 per unit. 0903............ Cytomegalovirus imm K................... 5.3368 $291.18 ............

$58.24 IV/vial. 0905............ Immune globulin, 1g. K................... 0.8057 $43.96 ............

$8.79 0906............ RSV-ivig, 50 mg..... K................... 0.8910 $48.61 ............

$9.72 0907............ Ganciclovir sodium K................... 0.5918 $32.29 ............

$6.46 injection. 0909............ Interferon beta-1a, K................... 3.3868 $184.79 ............

$36.96 33 mcg. 0910............ Interferon beta-1b / K................... 1.8421 $100.51 ............

$20.10 0.25 mg.

[[Page 63485]]

0911............ Streptokinase per K................... 1.5733 $85.84 ............

$17.17 250,000 iu. 0913............ Ganciclovir long act K................... 1.5861 $86.54 ............

$17.31 implant. 0916............ Imiglucerase

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

$3.71 ............

$0.74 injection/unit. 0917............ Adenosine injection. K................... 1.0393 $56.71 ............

$11.34 0925............ Factor viii per iu.. K................... .........

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

$0.10 0926............ Factor VIII

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

$1.52 ............

$0.30 (porcine) per iu. 0927............ Factor viii

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

$1.01 ............

$0.20 recombinant per iu. 0928............ Factor ix complex K................... .........

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

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

$1.01 ............

$0.20 iu. 0931............ Factor IX non-

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

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

$0.10 recombinant, per iu. 0932............ Factor IX

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

$1.01 ............

$0.20 recombinant, per iu. 0949............ Plasma, Pooled

K................... ......... $124.31 ............

$24.86 Multiple Donor, Solvent/Detergent T. 0950............ Blood (Whole) For K................... ......... $87.93 ............

$17.59 Transfusion. 0952............ Cryoprecipitate..... K................... ......... $29.31 ............

$5.86 0954............ RBC leukocytes

K................... ......... $119.26 ............

$23.85 reduced. 0955............ Plasma, Fresh Frozen K................... ......... $95.00 ............

$19.00 0956............ Plasma Protein

K................... ......... $92.98 ............

$18.60 Fraction. 0957............ Platelet Concentrate K................... ......... $41.44 ............

$8.29 0958............ Platelet Rich Plasma K................... ......... $53.56 ............

$10.71 0959............ Red Blood Cells..... K................... ......... $86.41 ............

$17.28 0960............ Washed Red Blood K................... ......... $160.69 ............

$32.14 Cells. 0961............ Infusion, Albumin K................... 0.2802 $15.29 ............

$3.06 (Human) 5%, 50 ml. 0963............ Albumin (human), 5%, K................... 1.0901 $59.48 ............

$11.90 250 ml. 0964............ Albumin (human), K................... 0.3741 $20.41 ............

$4.08 25%, 20 ml. 0965............ Albumin (human), K................... 0.8869 $48.39 ............

$9.68 25%, 50ml. 0966............ Plasmaprotein

K................... ......... $464.90 ............

$92.98 fract,5%,250ml. 1009............ Cryoprecip reduced K................... ......... $37.39 ............

$7.48 plasma. 1010............ Blood, L/R, CMV-neg. K................... ......... $121.78 ............

$24.36 1011............ Platelets, HLA-m, L/ K................... ......... $499.77 ............

$99.95 R, unit. 1013............ Platelet

K................... ......... $49.52 ............

$9.90 concentrate, L/R, unit. 1016............ Blood, L/R, froz/ K................... ......... $301.68 ............

$60.34 deglycerol/washed. 1017............ Platelets, aph/pher, K................... ......... $393.15 ............

$78.63 L/R, CMV-neg, unit. 1018............ Blood, L/R,

K................... ......... $132.40 ............

$26.48 irradiated. 1019............ Platelets, aph/pher, K................... ......... $406.28 ............

$81.26 L/R, irradiated, unit. 1020............ Pit, pher,L/

K................... ......... $495.22 ............

$99.04 R,CMV,irrad. 1021............ RBC, frz/deg/wsh, L/ K................... ......... $336.04 ............

$67.21 R, irrad. 1022............ RBC, L/R, CMV neg, K................... ......... $201.12 ............

$40.22 irrad. 1045............ Iobenguane sulfate I- K................... 3.0392 $165.82 ............

$33.16 131per 0.5 mCi. 1064............ I-131 sodium iodide K................... 0.1004

$5.48 ............

$1.10 capsule. 1065............ I-131 sodium iodide K................... 0.1189

$6.49 ............

$1.30 solution. 1079............ CO 57/58 per 0.5 uCi K................... 1.2556 $68.51 ............

$13.70 1080............ I-131 tositumomab, K................... ......... $2,260.00 ............ $452.00 dx. 1081............ I-131 tositumomab, K................... ......... $19,565.00 ............ $3,913.00 tx. 1084............ Denileukin diftitox, K................... ......... $1,232.88 ............ $246.58 300 MCG. 1086............ Temozolomide,oral 5 K................... 0.0690

$3.76 ............

$0.75 mg. 1089............ Cyanocobalamin

K................... 1.0460 $57.07 ............

$11.41 cobalt co57. 1091............ IN 111 Oxyquinoline, K................... 4.1151 $224.52 ............

$44.90 per .5 mCi. 1092............ IN 111 Pentetate, K................... 3.9855 $217.45 ............

$43.49 per 0.5 mCi. 1095............ Technetium TC 99M K................... 0.6940 $37.87 ............

$7.57 Depreotide. 1096............ TC 99M Exametazime, K................... 3.8609 $210.65 ............

$42.13 per dose. 1122............ TC 99M arcitumomab, K................... 9.8014 $534.77 ............ $106.95 per vial. 1166............ Cytarabine liposome. K................... 5.1134 $278.99 ............

$55.80 1167............ Epirubicin hcl, 2 mg K................... 0.3744 $20.43 ............

$4.09 1178............ Busulfan IV, 6 mg... K................... 5.4930 $299.70 ............

$59.94 1200............ TC 99M Sodium

K................... 0.5550 $30.28 ............

$6.06 Glucoheptonat. 1201............ TC 99M SUCCIMER, PER K................... 1.4706 $80.24 ............

$16.05 Vial. 1203............ Verteporfin for K................... 16.4439 $897.20 ............ $179.44 injection. 1207............ Octreotide

K................... 1.2049 $65.74 ............

$13.15 injection, depot. 1305............ Apligraf............ K................... 15.0691 $822.19 ............ $164.44 1409............ Factor viia

K................... ......... $1,083.93 ............ $216.79 recombinant, per 1.2 mg. 1501............ New Technology-- S................... ......... $25.00 ............

$5.00 Level I ($0-$50). 1502............ New Technology-- S................... ......... $75.00 ............

$15.00 Level II ($50-$100). 1503............ New Technology-- S................... ......... $150.00 ............

$30.00 Level III ($100- $200). 1504............ New Technology-- S................... ......... $250.00 ............

$50.00 Level IV ($200- $300). 1505............ New Technology-- S................... ......... $350.00 ............

$70.00 Level V ($300-$400). 1506............ New Technology-- S................... ......... $450.00 ............

$90.00 Level VI ($400- $500). 1507............ New Technology-- S................... ......... $550.00 ............ $110.00 Level VII ($500- $600). 1508............ New Technology-- S................... ......... $650.00 ............ $130.00 Level VIII ($600- $700). 1509............ New Technology-- S................... ......... $750.00 ............ $150.00 Level IX ($700- $800).

[[Page 63486]]

1510............ New Technology-- S................... ......... $850.00 ............ $170.00 Level X ($800-$900). 1511............ New Technology-- S................... ......... $950.00 ............ $190.00 Level XI ($900- $1000). 1512............ New Technology-- S................... ......... $1,050.00 ............ $210.00 Level XII ($1000- $1100). 1513............ New Technology-- S................... ......... $1,150.00 ............ $230.00 Level XIII ($1100- $1200). 1514............ New Technology-Level S................... ......... $1,250.00 ............ $250.00 XIV ($1200- $1300). 1515............ New Technology-- S................... ......... $1,350.00 ............ $270.00 Level XV ($1300- $1400). 1516............ New Technology-- S................... ......... $1,450.00 ............ $290.00 Level XVI ($1400- $1500). 1517............ New Technology-- S................... ......... $1,550.00 ............ $310.00 Level XVII ($1500- $1600). 1518............ New Technology-- S................... ......... $1,650.00 ............ $330.00 Level XVIII ($1600- $1700). 1519............ New Technology-- S................... ......... $1,750.00 ............ $350.00 Level IXX ($1700- $1800). 1520............ New Technology-- S................... ......... $1,850.00 ............ $370.00 Level XX ($1800- $1900). 1521............ New Technology-- S................... ......... $1,950.00 ............ $390.00 Level XXI ($1900- $2000). 1522............ New Technology-- S................... ......... $2,250.00 ............ $450.00 Level XXII ($2000- $2500). 1523............ New Technology-- S................... ......... $2,750.00 ............ $550.00 Level XXIII ($2500- $3000). 1524............ New Technology-- S................... ......... $3,250.00 ............ $650.00 Level XIV ($3000- $3500). 1525............ New Technology-- S................... ......... $3,750.00 ............ $750.00 Level XXV ($3500- $4000). 1526............ New Technology-- S................... ......... $4,250.00 ............ $850.00 Level XXVI ($4000- $4500). 1527............ New Technology-- S................... ......... $4,750.00 ............ $950.00 Level XXVII ($4500- $5000). 1528............ New Technology-- S................... ......... $5,250.00 ............ $1,050.00 Level XXVIII ($5000- $5500). 1529............ New Technology-- S................... ......... $5,750.00 ............ $1,150.00 Level XXIX ($5500- $6000). 1530............ New Technology-- S................... ......... $6,250.00 ............ $1,250.00 Level XXX ($6000- $6500). 1531............ New Technology-- S................... ......... $6,750.00 ............ $1,350.00 Level XXXI ($6500- $7000). 1532............ New Technology-- S................... ......... $7,250.00 ............ $1,450.00 Level XXXII ($7000- $7500). 1533............ New Technology-- S................... ......... $7,750.00 ............ $1,550.00 Level XXXIII ($7500- $8000). 1534............ New Technology-- S................... ......... $8,250.00 ............ $1,650.00 Level XXXIV ($8000- $8500). 1535............ New Technology-- S................... ......... $8,750.00 ............ $1,750.00 Level XXXV ($8500- $9000). 1536............ New Technology-- S................... ......... $9,250.00 ............ $1,850.00 Level XXXVI ($9000- $9500). 1537............ New Technology-- S................... ......... $9,750.00 ............ $1,950.00 Level XXXVII ($9500- $10000). 1538............ New Technology-- T................... ......... $25.00 ............

$5.00 Level I ($0-$50). 1539............ New Technology-- T................... ......... $75.00 ............

$15.00 Level II ($50-$100). 1540............ New Technology-- T................... ......... $150.00 ............

$30.00 Level III ($100- $200). 1541............ New Technology-- T................... ......... $250.00 ............

$50.00 Level IV ($200- $300). 1542............ New Technology-- T................... ......... $350.00 ............

$70.00 Level V ($300-$400). 1543............ New Technology-- T................... ......... $450.00 ............

$90.00 Level VI ($400- $500). 1544............ New Technology-- T................... ......... $550.00 ............ $110.00 Level VII ($500- $600). 1545............ New Technology-- T................... ......... $650.00 ............ $130.00 Level VIII ($600- $700). 1546............ New Technology-- T................... ......... $750.00 ............ $150.00 Level IX ($700- $800). 1547............ New Technology-- T................... ......... $850.00 ............ $170.00 Level X ($800-$900). 1548............ New Technology-- T................... ......... $950.00 ............ $190.00 Level XI ($900- $1000). 1549............ New Technology-- T................... ......... $1,050.00 ............ $210.00 Level XII ($1000- $1100). 1550............ New Technology-- T................... ......... $1,150.00 ............ $230.00 Level XIII ($1100- $1200). 1551............ New Technology-Level T................... ......... $1,250.00 ............ $250.00 XIV ($1200- $1300). 1552............ New Technology-- T................... ......... $1,350.00 ............ $270.00 Level XV ($1300- $1400). 1553............ New Technology-- T................... ......... $1,450.00 ............ $290.00 Level XVI ($1400- $1500). 1554............ New Technology-- T................... ......... $1,550.00 ............ $310.00 Level XVII ($1500- $1600). 1555............ New Technology-- T................... ......... $1,650.00 ............ $330.00 Level XVIII ($1600- $1700). 1556............ New Technology-- T................... ......... $1,750.00 ............ $350.00 Level XIX ($1700- $1800). 1557............ New Technology-- T................... ......... $1,850.00 ............ $370.00 Level XX ($1800- $1900). 1558............ New Technology-- T................... ......... $1,950.00 ............ $390.00 Level XXI ($1900- $2000). 1559............ New Technology-- T................... ......... $2,250.00 ............ $450.00 Level XXII ($2000- $2500). 1560............ New Technology-- T................... ......... $2,750.00 ............ $550.00 Level XXIII ($2500- $3000). 1561............ New Technology-- T................... ......... $3,250.00 ............ $650.00 Level XXIV ($3000- $3500). 1562............ New Technology-- T................... ......... $3,750.00 ............ $750.00 Level XXV ($3500- $4000). 1563............ New Technology-- T................... ......... $4,250.00 ............ $850.00 Level XXVI ($4000- $4500). 1564............ New Technology-- T................... ......... $4,750.00 ............ $950.00 Level XXVII ($4500- $5000). 1565............ New Technology-- T................... ......... $5,250.00 ............ $1,050.00 Level XXVIII ($5000- $5500). 1566............ New Technology-- T................... ......... $5,750.00 ............ $1,150.00 Level XXIX ($5500- $6000). 1567............ New Technology-- T................... ......... $6,250.00 ............ $1,250.00 Level XXX ($6000- $6500). 1568............ New Technology-- T................... ......... $6,750.00 ............ $1,350.00 Level XXXI ($6500- $7000). 1569............ New Technology-- T................... ......... $7,250.00 ............ $1,450.00 Level XXXII ($7000- $7500). 1570............ New Technology-- T................... ......... $7,750.00 ............ $1,550.00 Level XXXIII ($7500- $8000). 1571............ New Technology-- T................... ......... $8,250.00 ............ $1,650.00 Level XXXIV ($8000- $8500). 1572............ New Technology-- T................... ......... $8,750.00 ............ $1,750.00 Level XXXV ($8500- $9000). 1573............ New Technology-- T................... ......... $9,250.00 ............ $1,850.00 Level XXXVI ($9000- $9500). 1574............ New Technology-- T................... ......... $9,750.00 ............ $1,950.00 Level XXXVII ($9500- $10000). 1600............ Technetium TC 99m K................... 1.1782 $64.28 ............

$12.86 sestamibi. 1603............ Thallous chloride TL K................... 0.3645 $19.89 ............

$3.98 201/mci. 1604............ IN 111 capromab K................... 12.6045 $687.71 ............ $137.54 pendetide, per dose. 1605............ Abciximab injection, K................... 5.3048 $289.44 ............

$57.89 10 mg.

[[Page 63487]]

1606............ Anistreplase, 30 u.. K................... 27.7939 $1,516.46 ............ $303.29 1607............ Eptifibatide

K................... 0.1465

$7.99 ............

$1.60 injection, 5mg. 1608............ Etanercept injection K................... 1.8762 $102.37 ............

$20.47 1609............ Rho(D) immune

K................... 0.1789

$9.76 ............

$1.95 globulin h, sd, 100 iu. 1611............ Hylan G-F 20

K................... 2.2628 $123.46 ............

$24.69 injection, 16 mg. 1612............ Daclizumab,

K................... ......... $393.78 ............

$78.76 parenteral, 25 mg. 1613............ Trastuzumab, 10 mg.. K................... 0.7434 $40.56 ............

$8.11 1614............ Valrubicin, 200 mg.. K................... 8.4635 $461.78 ............

$92.36 1615............ Basiliximab, 20 mg.. K................... ......... $1,425.06 ............ $285.01 1618............ Vonwillebrandfactrcm K................... .........

$1.01 ............

$0.20 plx, per iu. 1619............ Gallium ga 67....... K................... 0.2056 $11.22 ............

$2.24 1620............ Technetium tc99m K................... 3.3666 $183.69 ............

$36.74 bicisate. 1622............ Technetium tc99m K................... 0.3782 $20.63 ............

$4.13 mertiatide. 1624............ Sodium phosphate p32 K................... 1.2941 $70.61 ............

$14.12 1625............ Indium 111-in

K................... 8.2447 $449.84 ............

$89.97 pentetreotide. 1628............ Chromic phosphate K................... 1.8057 $98.52 ............

$19.70 p32. 1716............ Brachytx source, K................... 1.3811 $75.35 ............

$15.07 Gold 198. 1718............ Brachytx source, K................... 0.6843 $37.34 ............

$7.47 Iodine 125. 1719............ Brachytx source,Non- K................... 0.3187 $17.39 ............

$3.48 HDR Ir-192. 1720............ Brachytx source, K................... 0.8187 $44.67 ............

$8.93 Palladium 103. 1775............ FDG, per dose (4-40 K................... 5.9471 $324.48 ............

$64.90 mCi/ml). 1783............ Ocular implant, H................... ......... ........... ............

$0.00 aqueous drain device. 1814............ Retinal Tamp,

H................... ......... ........... ............

$-.00 silicone oil. 1818............ Integrated

H................... ......... ........... ............

$0.00 keratoprosthesis. 1819............ Tissue localization- H................... ......... ........... ............

$0.00 excision dev. 1884............ Embolization Protect H................... ......... ........... ............

$0.00 syst. 1888............ Catheter, ablation, H................... ......... ........... ............

$0.00 non-cardiac, endovascular (implantable). 1900............ Lead coronary venous H................... ......... ........... ............

$0.00 2614............ Probe, percutaneous H................... ......... ........... ............

$0.00 lumbar disc. 2616............ Brachytx source, K................... 176.2339 $9,615.50 ............ $1,923.10 Yttrium-90. 2632............ Brachytx sol, I-125, H................... ......... ........... ............

$0.00 per mCi. 2633............ Brachytx source, K................... 0.8187 $44.67 ............

$8.93 Cesium-131. 7000............ Amifostine, 500 mg.. K................... 5.3041 $289.40 ............

$57.88 7007............ Inj milrinone

K................... 0.2129 $11.62 ............

$2.32 lactate, per 5 mg. 7011............ Oprelvekin

K................... ......... $248.16 ............

$49.63 injection, 5 mg. 7015............ Busulfan, oral, 2 mg K................... 0.0288

$1.57 ............

$0.31 7019............ Aprotinin, 10,000 K................... 0.0215

$1.17 ............

$0.23 kiu. 7024............ Corticorelin ovine K................... 4.1221 $224.91 ............

$44.98 triflutat. 7025............ Digoxin immune FAB K................... 4.9694 $271.14 ............

$54.23 (ovine). 7026............ Ethanolamine oleate K................... 0.5099 $27.82 ............

$5.56 100 mg. 7027............ Fomepizole, 15mg.... K................... 0.1325

$7.23 ............

$1.45 7028............ Fosphenytoin, 50 mg. K................... 0.0895

$4.88 ............

$0.98 7030............ Hemin, per 1 mg..... K................... 0.0118

$0.64 ............

$0.13 7031............ Octreotide acetate K................... 0.0264

$1.44 ............

$0.29 injection. 7034............ Somatropin injection K................... 0.7547 $41.18 ............

$8.24 7035............ Teniposide, 50 mg... K................... 2.5185 $137.41 ............

$27.48 7036............ Urokinase 250,000 iu K................... 3.7855 $206.54 ............

$41.31 inj. 7037............ Urofollitropin, 75 K................... 1.1634 $63.48 ............

$12.70 iu. 7038............ Muromonab-CD3, 5 mg. K................... 5.8803 $320.84 ............

$64.17 7040............ Pentastarch 10% K................... 0.4838 $26.40 ............

$5.28 solution. 7041............ Tirofiban

K................... 4.176 $227.85 ............

$45.57 hydrochloride 12.5 mg. 7042............ Capecitabine, oral, K................... 0.0302

$1.65 ............

$0.33 150 mg. 7043............ Infliximab injection K................... 0.7122 $38.86 ............

$7.77 10 mg. 7045............ Trimetrexate

K................... 1.1246 $61.36 ............

$12.27 glucoronate. 7046............ Doxorubicin hcl K................... 4.6982 $256.34 ............

$51.27 liposome inj 10 mg. 7048............ Alteplase

K................... 0.2856 $15.58 ............

$3.12 recombinant. 7049............ Filgrastim 480 mcg K................... 3.2251 $175.96 ............

$35.19 injection. 7051............ Leuprolide acetate K................... 67.2039 $3,666.71 ............ $733.34 implant, 65 mg. 7316............ Sodium hyaluronate K................... 2.5436 $138.78 ............

$27.76 injection. 9001............ Linezolid injection. K................... 0.2771 $15.12 ............

$3.02 9002............ Tenecteplase, 50mg/ K................... 23.7669 $1,296.75 ............ $259.35 vial. 9003............ Palivizumab, per K................... 6.3077 $344.15 ............

$68.83 50mg. 9004............ Gemtuzumab

K................... ......... $2,022.90 ............ $404.58 ozogamicin inj,5mg. 9005............ Reteplase injection. K................... 10.4165 $568.33 ............ $113.67 9006............ Tacrolimus injection K................... 0.1048

$5.72 ............

$1.14 9008............ Baclofen Refill Kit- K................... 0.1264

$6.90 ............

$1.38 500mcg. 9009............ Baclofen refill kit-- K................... 0.7499 $40.92 ............

$8.18 per 2000 mcg. 9010............ Baclofen refill kit-- K................... 0.7739 $42.22 ............

$8.44 per 4000 mcg. 9012............ Arsenic Trioxide.... K................... 0.4933 $26.91 ............

$5.38

[[Page 63488]]

9013............ Co 57 cobaltous K................... 1.0386 $56.67 ............

$11.33 chloride. 9015............ Mycophenolate

K................... 0.0374

$2.04 ............

$0.41 mofetil oral 250 mg. 9018............ Botulinum toxin B, K................... 0.1279

$6.98 ............

$1.40 per 100 u. 9019............ Caspofungin acetate, K................... 0.5432 $29.64 ............

$5.93 5 mg. 9020............ Sirolimus tablet, 1 K................... 0.0529

$2.89 ............

$0.58 mg. 9021............ Immune globulin 10 K................... 0.0080

$0.44 ............

$0.09 mg. 9022............ IM inj interferon K................... 1.1290 $61.60 ............

$12.32 beta 1-a. 9023............ Rho d immune

K................... 0.0310

$1.69 ............

$0.34 globulin 50 mcg. 9024............ Amphotericin B, K................... 0.3823 $20.86 ............

$4.17 lipid formulation. 9025............ Radiopharms Used to K................... 2.6372 $143.89 ............

$28.78 Image Perfusion of Heart. 9100............ Iodinated I-

K................... 0.0066

$0.36 ............

$0.07 131albumin, per 5 uci. 9104............ Anti-thymocycte K................... 2.9978 $163.56 ............

$32.71 globulin rabbit. 9105............ Hep B imm glob, per K................... 1.3074 $71.33 ............

$14.27 1 ml. 9108............ Thyrotropin alfa, K................... ......... $572.00 ............ $114.40 per 1.1 mg. 9109............ Tirofliban hcl, per K................... 2.1737 $118.60 ............

$23.72 6.25 mg. 9110............ Alemtuzumab, per 10 K................... 7.7873 $424.88 ............

$84.98 mg. 9111............ Inj, bivalirudin, G................... .........

$1.60 ............

$0.24 per 250 mg vial. 9112............ Perflutren lipid G................... ......... $148.20 ............

$22.15 micro, per 2ml. 9113............ Inj, pantoprazole G................... ......... $25.08 ............

$3.75 sodium, vial. 9114............ Nesiritide, per 0.5 G................... ......... $151.62 ............

$22.66 mg vial. 9115............ Inj, zoledronic G................... ......... $217.43 ............

$32.50 acid, per 1 mg. 9116............ Inj, Ertapenem

G................... ......... $23.74 ............

$3.55 sodium, per 1 gm vial. 9117............ Yttrium 90

K................... ......... $19,565.00 ............ $3,913.00 ibritumomab tiuxetan. 9118............ In-111 ibritumomab K................... ......... $2,260.00 ............ $452.00 tiuxetan. 9119............ Pegfilgrastim, per 1 G................... ......... $2,802.50 ............ $418.90 mg. 9120............ Inj, Fulvestrant, G................... ......... $87.58 ............

$13.09 per 50 mg. 9121............ Inj, Argatroban, per G................... ......... $16.35 ............

$2.44 5 mg. 9122............ Inj, Triptorelin G................... ......... $398.62 ............

$59.58 pamoate, per 3.75 mg. 9123............ Transcyte, per 247 G................... ......... $770.93 ............ $115.23 sq cm. 9200............ Orcel, per 36 cm2... G................... ......... $1,135.25 ............ $169.69 9201............ Dermagraft, per 37.5 G................... ......... $577.60 ............

$86.34 sq cm. 9202............ Octafluoropropane... K................... 2.1737 $118.60 ............

$23.72 9203............ Perflexane lipid G................... ......... $142.50 ............

$21.30 micro. 9204............ Ziprasidone mesylate G................... ......... $20.79 ............

$3.11 9205............ Oxaliplatin......... G................... ......... $94.46 ............

$14.12 9207............ Injection,

G................... ......... $1,039.68 ............ $155.40 bortezomib. 9208............ Injection,

G................... ......... $123.78 ............

$18.50 agalsidase beta. 9209............ Injection,

G................... ......... $644.10 ............

$96.28 laronidase. 9210............ Injection,

G................... ......... $307.80 ............

$46.01 palonosetron HCL. 9211............ Inj, alefacept, IV.. G................... ......... $665.00 ............

$99.40 9212............ Inj, alefacept, IM.. G................... ......... $472.63 ............

$70.65 9217............ Leuprolide acetate K................... 5.7252 $312.37 ............

$62.47 suspnsion, 7.5 mg. 9500............ Platelets,

K................... ......... $74.79 ............

$14.96 irradiated. 9501............ Platelets, pheresis. K................... ......... $408.81 ............

$81.76 9502............ Platelet pheresis K................... ......... $443.68 ............

$88.74 irradiated. 9503............ Fresh frozen plasma, K................... ......... $69.74 ............

$13.95 ea unit. 9504............ RBC deglycerolized.. K................... ......... $183.44 ............

$36.69 9505............ RBC irradiated...... K................... ......... $108.65 ............

$21.73 9506............ Granulocytes,

K................... ......... $1,248.66 ............ $249.73 pheresis.

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 63488]]

Addendum B.--Payment Status by HCPCS Code and Related Information Calender Year 2004

National Minimum CPT/HCPCS

Status indicator

Condition

Description

APC

Relative Payment unadjusted unadjusted weight

rate copayment copayment

0001F................ E.................... NI................. Blood pressure, ........... ........... ........... ........... ........... measured. 0001T................ C.................... ................... Endovas repr abdo ao ........... ........... ........... ........... ........... aneurys. 0002F................ E.................... NI................. Tobacco use,

........... ........... ........... ........... ........... smoking, assess. 0002T................ C.................... DG................. Endovas repr abdo ao ........... ........... ........... ........... ........... aneurys. 0003F................ E.................... NI................. Tobacco use, non- ........... ........... ........... ........... ........... smoking. 0003T................ S.................... ................... Cervicography.......

1501 ........... $25.00 ...........

$5.00 0004F................ E.................... NI................. Tobacco use txmnt ........... ........... ........... ........... ........... counseling. 0005F................ E.................... NI................. Tobacco use txmnt, ........... ........... ........... ........... ........... pharmacol. 0005T................ C.................... ................... Perc cath stent/ ........... ........... ........... ........... ........... brain cv art.

[[Page 63489]]

0006F................ E.................... NI................. Statin therapy, ........... ........... ........... ........... ........... prescribed. 0006T................ C.................... ................... Perc cath stent/ ........... ........... ........... ........... ........... brain cv art. 0007F................ E.................... NI................. Beta-blocker thx ........... ........... ........... ........... ........... prescribed. 0007T................ C.................... ................... Perc cath stent/ ........... ........... ........... ........... ........... brain cv art. 0008F................ E.................... NI................. Ace inhibitor thx ........... ........... ........... ........... ........... prescribed. 0008T................ E.................... ................... Upper gi endoscopy w/ ........... ........... ........... ........... ........... suture. 0009F................ E.................... NI................. Assess anginal

........... ........... ........... ........... ........... symptom/level. 0009T................ T.................... ................... Endometrial

1557 ........... $1,850.00 ........... $370.00 cryoablation. 00100................ N.................... ................... Anesth, salivary ........... ........... ........... ........... ........... gland. 00102................ N.................... ................... Anesth, repair of ........... ........... ........... ........... ........... cleft lip. 00103................ N.................... ................... Anesth,

........... ........... ........... ........... ........... blepharoplasty. 00104................ N.................... ................... Anesth, electroshock ........... ........... ........... ........... ........... 0010F................ E.................... NI................. Assess anginal

........... ........... ........... ........... ........... symptom/level. 0010T................ A.................... ................... Tb test, gamma

........... ........... ........... ........... ........... interferon. 0011F................ E.................... NI................. Oral antiplat thx ........... ........... ........... ........... ........... prescribed. 00120................ N.................... ................... Anesth, ear surgery. ........... ........... ........... ........... ........... 00124................ N.................... ................... Anesth, ear exam.... ........... ........... ........... ........... ........... 00126................ N.................... ................... Anesth, tympanotomy. ........... ........... ........... ........... ........... 0012T................ T.................... ................... Osteochondral knee

0041 27.3819 $1,493.98 ........... $298.80 autograft. 0013T................ T.................... ................... Osteochondral knee

0041 27.3819 $1,493.98 ........... $298.80 allograft. 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.... ........... ........... ........... ........... ........... 0014T................ T.................... ................... Meniscal transplant,

0041 27.3819 $1,493.98 ........... $298.80 knee. 00160................ N.................... ................... Anesth, nose/sinus ........... ........... ........... ........... ........... surgery. 00162................ N.................... ................... Anesth, nose/sinus ........... ........... ........... ........... ........... surgery. 00164................ N.................... ................... Anesth, biopsy of ........... ........... ........... ........... ........... nose. 0016T................ T.................... ................... Thermotx choroid

0235 5.0749 $276.89 $72.04 $55.38 vasc lesion. 00170................ N.................... ................... Anesth, procedure on ........... ........... ........... ........... ........... mouth. 00172................ N.................... ................... Anesth, cleft palate ........... ........... ........... ........... ........... repair. 00174................ C.................... ................... Anesth, pharyngeal ........... ........... ........... ........... ........... surgery. 00176................ C.................... ................... Anesth, pharyngeal ........... ........... ........... ........... ........... surgery. 0017T................ E.................... ................... Photocoagulat

........... ........... ........... ........... ........... macular drusen. 0018T................ S.................... ................... Transcranial

0215 0.6457 $35.23 $15.76

$7.05 magnetic stimul. 00190................ N.................... ................... Anesth, face/skull ........... ........... ........... ........... ........... bone surg. 00192................ C.................... ................... Anesth, facial bone ........... ........... ........... ........... ........... surgery. 0019T................ E.................... ................... Extracorp shock wave ........... ........... ........... ........... ........... tx, ms. 0020T................ A.................... ................... 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. 0025T................ S.................... DG................. Ultrasonic

0230 0.7619 $41.57 $14.97

$8.31 pachymetry. 0026T................ A.................... ................... Measure remnant ........... ........... ........... ........... ........... lipoproteins. 0027T................ T.................... ................... Endoscopic epidural

1547 ........... $850.00 ........... $170.00 lysis. 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, 3. 20600................ T.................... ................... Drain/inject, joint/

0204 2.1711 $118.46 $40.13 $23.69 bursa. 20605................ T.................... ................... Drain/inject, joint/

0204 2.1711 $118.46 $40.13 $23.69 bursa. 20610................ T.................... ................... Drain/inject, joint/

0204 2.1711 $118.46 $40.13 $23.69 bursa. 20612................ T.................... ................... Aspirate/inj

0204 2.1711 $118.46 $40.13 $23.69 ganglion cyst. 20615................ T.................... ................... Treatment of bone

0004 1.5882 $86.65 $22.36 $17.33 cyst. 20650................ T.................... ................... Insert and remove

0049 19.6046 $1,069.65 ........... $213.93 bone pin. 20660................ C.................... ................... Apply, rem fixation ........... ........... ........... ........... ........... device. 20661................ C.................... ................... Application of head ........... ........... ........... ........... ........... brace. 20662................ C.................... ................... Application of

........... ........... ........... ........... ........... pelvis brace. 20663................ C.................... ................... Application of thigh ........... ........... ........... ........... ........... brace. 20664................ C.................... ................... Halo brace

........... ........... ........... ........... ........... application. 20665................ X.................... ................... Removal of fixation

0340 0.6314 $34.45 ...........

$6.89 device. 20670................ T.................... ................... Removal of support

0021 14.3594 $783.46 $219.48 $156.69 implant. 20680................ T.................... ................... Removal of support

0022 18.7932 $1,025.38 $354.45 $205.08 implant. 20690................ T.................... ................... Apply bone fixation

0050 24.8651 $1,356.66 ........... $271.33 device. 20692................ T.................... ................... Apply bone fixation

0050 24.8651 $1,356.66 ........... $271.33 device. 20693................ T.................... ................... Adjust bone fixation

0049 19.6046 $1,069.65 ........... $213.93 device. 20694................ T.................... ................... Remove bone fixation

0049 19.6046 $1,069.65 ........... $213.93 device. 20802................ C.................... ................... Replantation, arm, ........... ........... ........... ........... ........... complete. 20805................ C.................... ................... Replant forearm, ........... ........... ........... ........... ........... complete. 20808................ C.................... ................... Replantation hand, ........... ........... ........... ........... ........... complete.

[[Page 63499]]

20816................ C.................... ................... Replantation digit, ........... ........... ........... ........... ........... complete. 20822................ C.................... ................... Replantation digit, ........... ........... ........... ........... ........... complete. 20824................ C.................... ................... Replantation thumb, ........... ........... ........... ........... ........... complete. 20827................ C.................... ................... Replantation thumb, ........... ........... ........... ........... ........... complete. 20838................ C.................... ................... Replantation foot, ........... ........... ........... ........... ........... complete. 20900................ T.................... ................... Removal of bone for

0050 24.8651 $1,356.66 ........... $271.33 graft. 20902................ T.................... ................... Removal of bone for

0050 24.8651 $1,356.66 ........... $271.33 graft. 20910................ T.................... ................... Remove cartilage for

0027 15.8990 $867.47 $329.72 $173.49 graft. 20912................ T.................... ................... Remove cartilage for

0027 15.8990 $867.47 $329.72 $173.49 graft. 20920................ T.................... ................... Removal of fascia

0027 15.8990 $867.47 $329.72 $173.49 for graft. 20922................ T.................... ................... Removal of fascia

0027 15.8990 $867.47 $329.72 $173.49 for graft. 20924................ T.................... ................... Removal of tendon

0050 24.8651 $1,356.66 ........... $271.33 for graft. 20926................ T.................... ................... Removal of tissue

0027 15.8990 $867.47 $329.72 $173.49 for graft. 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,

0006 1.6527 $90.17 $23.26 $18.03 muscle. 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................ C.................... ................... Bone/skin graft, ........... ........... ........... ........... ........... metatarsal. 20973................ C.................... ................... Bone/skin graft, ........... ........... ........... ........... ........... great toe. 20974................ A.................... ................... Electrical bone ........... ........... ........... ........... ........... stimulation. 20975................ T.................... ................... Electrical bone

0049 19.6046 $1,069.65 ........... $213.93 stimulation. 20979................ A.................... ................... Us bone stimulation. ........... ........... ........... ........... ........... 20982................ T.................... NI................. Ablate, bone

1557 ........... $1,850.00 ........... $370.00 tumor(s) perq. 20999................ T.................... ................... Musculoskeletal

0049 19.6046 $1,069.65 ........... $213.93 surgery. 21010................ T.................... ................... Incision of jaw

0254 21.8901 $1,194.35 $321.35 $238.87 joint. 21015................ T.................... ................... Resection of facial

0253 15.2249 $830.69 $282.29 $166.14 tumor. 21025................ T.................... ................... Excision of bone,

0256 35.1548 $1,918.08 ........... $383.62 lower jaw. 21026................ T.................... ................... Excision of facial

0256 35.1548 $1,918.08 ........... $383.62 bone(s). 21029................ T.................... ................... Contour of face bone

0256 35.1548 $1,918.08 ........... $383.62 lesion. 21030................ T.................... ................... Removal of face bone

0254 21.8901 $1,194.35 $321.35 $238.87 lesion. 21031................ T.................... ................... Remove exostosis,

0254 21.8901 $1,194.35 $321.35 $238.87 mandible. 21032................ T.................... ................... Remove exostosis,

0254 21.8901 $1,194.35 $321.35 $238.87 maxilla. 21034................ T.................... ................... Removal of face bone

0256 35.1548 $1,918.08 ........... $383.62 lesion. 21040................ T.................... ................... Removal of jaw bone

0254 21.8901 $1,194.35 $321.35 $238.87 lesion. 21044................ T.................... ................... Removal of jaw bone

0256 35.1548 $1,918.08 ........... $383.62 lesion. 21045................ C.................... ................... Extensive jaw

........... ........... ........... ........... ........... surgery. 21046................ T.................... ................... Remove mandible cyst

0256 35.1548 $1,918.08 ........... $383.62 complex. 21047................ T.................... ................... Excise lwr jaw cyst

0256 35.1548 $1,918.08 ........... $383.62 w/repair. 21048................ T.................... ................... Remove maxilla cyst

0256 35.1548 $1,918.08 ........... $383.62 complex. 21049................ T.................... ................... Excis uppr jaw cyst

0256 35.1548 $1,918.08 ........... $383.62 w/repair. 21050................ T.................... ................... Removal of jaw joint

0256 35.1548 $1,918.08 ........... $383.62 21060................ T.................... ................... Remove jaw joint

0256 35.1548 $1,918.08 ........... $383.62 cartilage. 21070................ T.................... ................... Remove coronoid

0256 35.1548 $1,918.08 ........... $383.62 process. 21076................ T.................... ................... Prepare face/oral

0254 21.8901 $1,194.35 $321.35 $238.87 prosthesis. 21077................ T.................... ................... Prepare face/oral

0256 35.1548 $1,918.08 ........... $383.62 prosthesis. 21079................ T.................... ................... Prepare face/oral

0256 35.1548 $1,918.08 ........... $383.62 prosthesis. 21080................ T.................... ................... Prepare face/oral

0256 35.1548 $1,918.08 ........... $383.62 prosthesis. 21081................ T.................... ................... Prepare face/oral

0256 35.1548 $1,918.08 ........... $383.62 prosthesis. 21082................ T.................... ................... Prepare face/oral

0256 35.1548 $1,918.08 ........... $383.62 prosthesis. 21083................ T.................... ................... Prepare face/oral

0256 35.1548 $1,918.08 ........... $383.62 prosthesis. 21084................ T.................... ................... Prepare face/oral

0256 35.1548 $1,918.08 ........... $383.62 prosthesis. 21085................ T.................... ................... Prepare face/oral

0253 15.2249 $830.69 $282.29 $166.14 prosthesis. 21086................ T.................... ................... Prepare face/oral

0256 35.1548 $1,918.08 ........... $383.62 prosthesis. 21087................ T.................... ................... Prepare face/oral

0256 35.1548 $1,918.08 ........... $383.62 prosthesis. 21088................ T.................... ................... Prepare face/oral

0256 35.1548 $1,918.08 ........... $383.62 prosthesis. 21089................ T.................... ................... Prepare face/oral

0253 15.2249 $830.69 $282.29 $166.14 prosthesis. 21100................ T.................... ................... Maxillofacial

0256 35.1548 $1,918.08 ........... $383.62 fixation. 21110................ T.................... ................... Interdental fixation

0252 6.4469 $351.75 $113.41 $70.35 21116................ N.................... ................... Injection, jaw joint ........... ........... ........... ........... ........... x-ray. 21120................ T.................... ................... Reconstruction of

0254 21.8901 $1,194.35 $321.35 $238.87 chin. 21121................ T.................... ................... Reconstruction of

0254 21.8901 $1,194.35 $321.35 $238.87 chin. 21122................ T.................... ................... Reconstruction of

0254 21.8901 $1,194.35 $321.35 $238.87 chin. 21123................ T.................... ................... Reconstruction of

0254 21.8901 $1,194.35 $321.35 $238.87 chin. 21125................ T.................... ................... Augmentation, lower

0254 21.8901 $1,194.35 $321.35 $238.87 jaw bone. 21127................ T.................... ................... Augmentation, lower

0256 35.1548 $1,918.08 ........... $383.62 jaw bone. 21137................ T.................... ................... Reduction of

0254 21.8901 $1,194.35 $321.35 $238.87 forehead. 21138................ T.................... ................... Reduction of

0256 35.1548 $1,918.08 ........... $383.62 forehead.

[[Page 63500]]

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

0256 35.1548 $1,918.08 ........... $383.62 forehead. 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................ C.................... ................... Reconstruct midface, ........... ........... ........... ........... ........... lefort. 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................ C.................... ................... Reconstruct orbit/ ........... ........... ........... ........... ........... forehead. 21179................ C.................... ................... Reconstruct entire ........... ........... ........... ........... ........... forehead. 21180................ C.................... ................... Reconstruct entire ........... ........... ........... ........... ........... forehead. 21181................ T.................... ................... Contour cranial bone

0254 21.8901 $1,194.35 $321.35 $238.87 lesion. 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................ C.................... ................... Reconst lwr jaw w/o ........... ........... ........... ........... ........... fixation. 21196................ C.................... ................... Reconst lwr jaw w/ ........... ........... ........... ........... ........... fixation. 21198................ T.................... ................... Reconstr lwr jaw

0256 35.1548 $1,918.08 ........... $383.62 segment. 21199................ T.................... ................... Reconstr lwr jaw w/

0256 35.1548 $1,918.08 ........... $383.62 advance. 21206................ T.................... ................... Reconstruct upper

0256 35.1548 $1,918.08 ........... $383.62 jaw bone. 21208................ T.................... ................... Augmentation of

0256 35.1548 $1,918.08 ........... $383.62 facial bones. 21209................ T.................... ................... Reduction of facial

0256 35.1548 $1,918.08 ........... $383.62 bones. 21210................ T.................... ................... Face bone graft.....

0256 35.1548 $1,918.08 ........... $383.62 21215................ T.................... ................... Lower jaw bone graft

0256 35.1548 $1,918.08 ........... $383.62 21230................ T.................... ................... Rib cartilage graft.

0256 35.1548 $1,918.08 ........... $383.62 21235................ T.................... ................... Ear cartilage graft.

0254 21.8901 $1,194.35 $321.35 $238.87 21240................ T.................... ................... Reconstruction of

0256 35.1548 $1,918.08 ........... $383.62 jaw joint. 21242................ T.................... ................... Reconstruction of

0256 35.1548 $1,918.08 ........... $383.62 jaw joint. 21243................ T.................... ................... Reconstruction of

0256 35.1548 $1,918.08 ........... $383.62 jaw joint. 21244................ T.................... ................... Reconstruction of

0256 35.1548 $1,918.08 ........... $383.62 lower jaw. 21245................ T.................... ................... Reconstruction of

0256 35.1548 $1,918.08 ........... $383.62 jaw. 21246................ T.................... ................... Reconstruction of

0256 35.1548 $1,918.08 ........... $383.62 jaw. 21247................ C.................... ................... Reconstruct lower ........... ........... ........... ........... ........... jaw bone. 21248................ T.................... ................... Reconstruction of

0256 35.1548 $1,918.08 ........... $383.62 jaw. 21249................ T.................... ................... Reconstruction of

0256 35.1548 $1,918.08 ........... $383.62 jaw. 21255................ C.................... ................... Reconstruct lower ........... ........... ........... ........... ........... jaw bone. 21256................ C.................... ................... Reconstruction of ........... ........... ........... ........... ........... orbit. 21260................ T.................... ................... Revise eye sockets..

0256 35.1548 $1,918.08 ........... $383.62 21261................ T.................... ................... Revise eye sockets..

0256 35.1548 $1,918.08 ........... $383.62 21263................ T.................... ................... Revise eye sockets..

0256 35.1548 $1,918.08 ........... $383.62 21267................ T.................... ................... Revise eye sockets..

0256 35.1548 $1,918.08 ........... $383.62 21268................ C.................... ................... Revise eye sockets.. ........... ........... ........... ........... ........... 21270................ T.................... ................... Augmentation, cheek

0256 35.1548 $1,918.08 ........... $383.62 bone. 21275................ T.................... ................... Revision,

0256 35.1548 $1,918.08 ........... $383.62 orbitofacial bones. 21280................ T.................... ................... Revision of eyelid..

0256 35.1548 $1,918.08 ........... $383.62 21282................ T.................... ................... Revision of eyelid..

0253 15.2249 $830.69 $282.29 $166.14 21295................ T.................... ................... Revision of jaw

0252 6.4469 $351.75 $113.41 $70.35 muscle/bone. 21296................ T.................... ................... Revision of jaw

0254 21.8901 $1,194.35 $321.35 $238.87 muscle/bone. 21299................ T.................... ................... Cranio/maxillofacial

0253 15.2249 $830.69 $282.29 $166.14 surgery. 21300................ T.................... ................... Treatment of skull

0253 15.2249 $830.69 $282.29 $166.14 fracture. 21310................ X.................... ................... Treatment of nose

0340 0.6314 $34.45 ...........

$6.89 fracture. 21315................ X.................... ................... Treatment of nose

0340 0.6314 $34.45 ...........

$6.89 fracture. 21320................ X.................... ................... Treatment of nose

0340 0.6314 $34.45 ...........

$6.89 fracture. 21325................ T.................... ................... Treatment of nose

0254 21.8901 $1,194.35 $321.35 $238.87 fracture. 21330................ T.................... ................... Treatment of nose

0254 21.8901 $1,194.35 $321.35 $238.87 fracture. 21335................ T.................... ................... Treatment of nose

0254 21.8901 $1,194.35 $321.35 $238.87 fracture. 21336................ T.................... ................... Treat nasal septal

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 21337................ T.................... ................... Treat nasal septal

0253 15.2249 $830.69 $282.29 $166.14 fracture. 21338................ T.................... ................... Treat nasoethmoid

0254 21.8901 $1,194.35 $321.35 $238.87 fracture. 21339................ T.................... ................... Treat nasoethmoid

0254 21.8901 $1,194.35 $321.35 $238.87 fracture. 21340................ T.................... ................... Treatment of nose

0256 35.1548 $1,918.08 ........... $383.62 fracture. 21343................ C.................... ................... Treatment of sinus ........... ........... ........... ........... ........... fracture. 21344................ C.................... ................... Treatment of sinus ........... ........... ........... ........... ........... fracture. 21345................ T.................... ................... Treat nose/jaw

0254 21.8901 $1,194.35 $321.35 $238.87 fracture. 21346................ C.................... ................... Treat nose/jaw

........... ........... ........... ........... ........... fracture. 21347................ C.................... ................... Treat nose/jaw

........... ........... ........... ........... ........... fracture.

[[Page 63501]]

21348................ C.................... ................... Treat nose/jaw

........... ........... ........... ........... ........... fracture. 21355................ T.................... ................... Treat cheek bone

0256 35.1548 $1,918.08 ........... $383.62 fracture. 21356................ C.................... ................... Treat cheek bone ........... ........... ........... ........... ........... fracture. 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

0256 35.1548 $1,918.08 ........... $383.62 fracture. 21395................ C.................... ................... Treat eye socket ........... ........... ........... ........... ........... fracture. 21400................ T.................... ................... Treat eye socket

0252 6.4469 $351.75 $113.41 $70.35 fracture. 21401................ T.................... ................... Treat eye socket

0253 15.2249 $830.69 $282.29 $166.14 fracture. 21406................ T.................... ................... Treat eye socket

0256 35.1548 $1,918.08 ........... $383.62 fracture. 21407................ T.................... ................... Treat eye socket

0256 35.1548 $1,918.08 ........... $383.62 fracture. 21408................ C.................... ................... Treat eye socket ........... ........... ........... ........... ........... fracture. 21421................ T.................... ................... Treat mouth roof

0254 21.8901 $1,194.35 $321.35 $238.87 fracture. 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

0254 21.8901 $1,194.35 $321.35 $238.87 fracture. 21445................ T.................... ................... Treat dental ridge

0254 21.8901 $1,194.35 $321.35 $238.87 fracture. 21450................ T.................... ................... Treat lower jaw

0251 1.7880 $97.56 ........... $19.51 fracture. 21451................ T.................... ................... Treat lower jaw

0252 6.4469 $351.75 $113.41 $70.35 fracture. 21452................ T.................... ................... Treat lower jaw

0253 15.2249 $830.69 $282.29 $166.14 fracture. 21453................ T.................... ................... Treat lower jaw

0256 35.1548 $1,918.08 ........... $383.62 fracture. 21454................ T.................... ................... Treat lower jaw

0254 21.8901 $1,194.35 $321.35 $238.87 fracture. 21461................ T.................... ................... Treat lower jaw

0256 35.1548 $1,918.08 ........... $383.62 fracture. 21462................ T.................... ................... Treat lower jaw

0256 35.1548 $1,918.08 ........... $383.62 fracture. 21465................ T.................... ................... Treat lower jaw

0256 35.1548 $1,918.08 ........... $383.62 fracture. 21470................ T.................... ................... Treat lower jaw

0256 35.1548 $1,918.08 ........... $383.62 fracture. 21480................ T.................... ................... Reset dislocated jaw

0251 1.7880 $97.56 ........... $19.51 21485................ T.................... ................... Reset dislocated jaw

0253 15.2249 $830.69 $282.29 $166.14 21490................ T.................... ................... Repair dislocated

0256 35.1548 $1,918.08 ........... $383.62 jaw. 21493................ T.................... ................... Treat hyoid bone

0252 6.4469 $351.75 $113.41 $70.35 fracture. 21494................ T.................... ................... Treat hyoid bone

0252 6.4469 $351.75 $113.41 $70.35 fracture. 21495................ C.................... ................... Treat hyoid bone ........... ........... ........... ........... ........... fracture. 21497................ T.................... ................... Interdental wiring..

0253 15.2249 $830.69 $282.29 $166.14 21499................ T.................... ................... Head surgery

0253 15.2249 $830.69 $282.29 $166.14 procedure. 21501................ T.................... ................... Drain neck/chest

0008 19.4831 $1,063.02 ........... $212.60 lesion. 21502................ T.................... ................... Drain chest lesion..

0049 19.6046 $1,069.65 ........... $213.93 21510................ C.................... ................... Drainage of bone ........... ........... ........... ........... ........... lesion. 21550................ T.................... ................... Biopsy of neck/chest

0021 14.3594 $783.46 $219.48 $156.69 21555................ T.................... ................... Remove lesion, neck/

0022 18.7932 $1,025.38 $354.45 $205.08 chest. 21556................ T.................... ................... Remove lesion, neck/

0022 18.7932 $1,025.38 $354.45 $205.08 chest. 21557................ C.................... ................... Remove tumor, neck/ ........... ........... ........... ........... ........... chest. 21600................ T.................... ................... Partial removal of

0050 24.8651 $1,356.66 ........... $271.33 rib. 21610................ T.................... ................... Partial removal of

0050 24.8651 $1,356.66 ........... $271.33 rib. 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. 21632................ C.................... ................... Extensive sternum ........... ........... ........... ........... ........... surgery. 21685................ T.................... NI................. Hyoid myotomy &

0252 6.4469 $351.75 $113.41 $70.35 suspension. 21700................ T.................... ................... Revision of neck

0049 19.6046 $1,069.65 ........... $213.93 muscle. 21705................ C.................... ................... Revision of neck ........... ........... ........... ........... ........... muscle/rib. 21720................ T.................... ................... Revision of neck

0049 19.6046 $1,069.65 ........... $213.93 muscle. 21725................ T.................... ................... Revision of neck

0006 1.6527 $90.17 $23.26 $18.03 muscle. 21740................ C.................... ................... Reconstruction of ........... ........... ........... ........... ........... sternum. 21742................ T.................... ................... Repair stern/nuss w/

0051 34.5144 $1,883.14 ........... $376.63 o scope. 21743................ T.................... ................... Repair sternum/nuss

0051 34.5144 $1,883.14 ........... $376.63 w/scope. 21750................ C.................... ................... Repair of sternum ........... ........... ........... ........... ........... separation. 21800................ T.................... ................... Treatment of rib

0043 1.9074 $104.07 ........... $20.81 fracture. 21805................ T.................... ................... Treatment of rib

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 21810................ C.................... ................... Treatment of rib ........... ........... ........... ........... ........... fracture(s). 21820................ T.................... ................... Treat sternum

0043 1.9074 $104.07 ........... $20.81 fracture. 21825................ C.................... ................... Treat sternum

........... ........... ........... ........... ........... fracture. 21899................ T.................... ................... Neck/chest surgery

0252 6.4469 $351.75 $113.41 $70.35 procedure. 21920................ T.................... ................... Biopsy soft tissue

0020 7.0842 $386.52 $113.25 $77.30 of back. 21925................ T.................... ................... Biopsy soft tissue

0022 18.7932 $1,025.38 $354.45 $205.08 of back.

[[Page 63502]]

21930................ T.................... ................... Remove lesion, back

0022 18.7932 $1,025.38 $354.45 $205.08 or flank. 21935................ T.................... ................... Remove tumor, back..

0022 18.7932 $1,025.38 $354.45 $205.08 22100................ T.................... ................... Remove part of neck

0208 40.2830 $2,197.88 ........... $439.58 vertebra. 22101................ T.................... ................... Remove part, thorax

0208 40.2830 $2,197.88 ........... $439.58 vertebra. 22102................ T.................... ................... Remove part, lumbar

0208 40.2830 $2,197.88 ........... $439.58 vertebra. 22103................ T.................... ................... Remove extra spine

0208 40.2830 $2,197.88 ........... $439.58 segment. 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................ C.................... ................... Revision of thorax ........... ........... ........... ........... ........... spine. 22224................ C.................... ................... Revision of lumbar ........... ........... ........... ........... ........... spine. 22226................ C.................... ................... Revise, extra spine ........... ........... ........... ........... ........... segment. 22305................ T.................... ................... Treat spine process

0043 1.9074 $104.07 ........... $20.81 fracture. 22310................ T.................... ................... Treat spine fracture

0043 1.9074 $104.07 ........... $20.81 22315................ T.................... ................... Treat spine fracture

0043 1.9074 $104.07 ........... $20.81 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

0045 13.5889 $741.42 $268.47 $148.28 spine. 22520................ T.................... ................... Percut

0050 24.8651 $1,356.66 ........... $271.33 vertebroplasty thor. 22521................ T.................... ................... Percut

0050 24.8651 $1,356.66 ........... $271.33 vertebroplasty lumb. 22522................ T.................... ................... Percut

0050 24.8651 $1,356.66 ........... $271.33 vertebroplasty add'l. 22532................ C.................... NI................. Lat thorax spine ........... ........... ........... ........... ........... fusion. 22533................ C.................... NI................. Lat lumbar spine ........... ........... ........... ........... ........... fusion. 22534................ C.................... NI................. 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 40.2830 $2,197.88 ........... $439.58 22614................ T.................... ................... Spine fusion, extra

0208 40.2830 $2,197.88 ........... $439.58 segment. 22630................ C.................... ................... Lumbar spine fusion. ........... ........... ........... ........... ........... 22632................ C.................... ................... Spine fusion, extra ........... ........... ........... ........... ........... segment. 22800................ C.................... ................... Fusion of spine..... ........... ........... ........... ........... ........... 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

0043 1.9074 $104.07 ........... $20.81 procedure. 22900................ T.................... ................... Remove abdominal

0022 18.7932 $1,025.38 $354.45 $205.08 wall lesion. 22999................ T.................... ................... Abdomen surgery

0022 18.7932 $1,025.38 $354.45 $205.08 procedure. 23000................ T.................... ................... Removal of calcium

0021 14.3594 $783.46 $219.48 $156.69 deposits. 23020................ T.................... ................... Release shoulder

0051 34.5144 $1,883.14 ........... $376.63 joint.

[[Page 63503]]

23030................ T.................... ................... Drain shoulder

0008 19.4831 $1,063.02 ........... $212.60 lesion. 23031................ T.................... ................... Drain shoulder bursa

0008 19.4831 $1,063.02 ........... $212.60 23035................ T.................... ................... Drain shoulder bone

0049 19.6046 $1,069.65 ........... $213.93 lesion. 23040................ T.................... ................... Exploratory shoulder

0050 24.8651 $1,356.66 ........... $271.33 surgery. 23044................ T.................... ................... Exploratory shoulder

0050 24.8651 $1,356.66 ........... $271.33 surgery. 23065................ T.................... ................... Biopsy shoulder

0021 14.3594 $783.46 $219.48 $156.69 tissues. 23066................ T.................... ................... Biopsy shoulder

0022 18.7932 $1,025.38 $354.45 $205.08 tissues. 23075................ T.................... ................... Removal of shoulder

0021 14.3594 $783.46 $219.48 $156.69 lesion. 23076................ T.................... ................... Removal of shoulder

0022 18.7932 $1,025.38 $354.45 $205.08 lesion. 23077................ T.................... ................... Remove tumor of

0022 18.7932 $1,025.38 $354.45 $205.08 shoulder. 23100................ T.................... ................... Biopsy of shoulder

0049 19.6046 $1,069.65 ........... $213.93 joint. 23101................ T.................... ................... Shoulder joint

0050 24.8651 $1,356.66 ........... $271.33 surgery. 23105................ T.................... ................... Remove shoulder

0050 24.8651 $1,356.66 ........... $271.33 joint lining. 23106................ T.................... ................... Incision of

0050 24.8651 $1,356.66 ........... $271.33 collarbone joint. 23107................ T.................... ................... Explore treat

0050 24.8651 $1,356.66 ........... $271.33 shoulder joint. 23120................ T.................... ................... Partial removal,

0051 34.5144 $1,883.14 ........... $376.63 collar bone. 23125................ T.................... ................... Removal of collar

0051 34.5144 $1,883.14 ........... $376.63 bone. 23130................ T.................... ................... Remove shoulder

0051 34.5144 $1,883.14 ........... $376.63 bone, part. 23140................ T.................... ................... Removal of bone

0049 19.6046 $1,069.65 ........... $213.93 lesion. 23145................ T.................... ................... Removal of bone

0050 24.8651 $1,356.66 ........... $271.33 lesion. 23146................ T.................... ................... Removal of bone

0050 24.8651 $1,356.66 ........... $271.33 lesion. 23150................ T.................... ................... Removal of humerus

0050 24.8651 $1,356.66 ........... $271.33 lesion. 23155................ T.................... ................... Removal of humerus

0050 24.8651 $1,356.66 ........... $271.33 lesion. 23156................ T.................... ................... Removal of humerus

0050 24.8651 $1,356.66 ........... $271.33 lesion. 23170................ T.................... ................... Remove collar bone

0050 24.8651 $1,356.66 ........... $271.33 lesion. 23172................ T.................... ................... Remove shoulder

0050 24.8651 $1,356.66 ........... $271.33 blade lesion. 23174................ T.................... ................... Remove humerus

0050 24.8651 $1,356.66 ........... $271.33 lesion. 23180................ T.................... ................... Remove collar bone

0050 24.8651 $1,356.66 ........... $271.33 lesion. 23182................ T.................... ................... Remove shoulder

0050 24.8651 $1,356.66 ........... $271.33 blade lesion. 23184................ T.................... ................... Remove humerus

0050 24.8651 $1,356.66 ........... $271.33 lesion. 23190................ T.................... ................... Partial removal of

0050 24.8651 $1,356.66 ........... $271.33 scapula. 23195................ T.................... ................... Removal of head of

0050 24.8651 $1,356.66 ........... $271.33 humerus. 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

0020 7.0842 $386.52 $113.25 $77.30 foreign body. 23331................ T.................... ................... Remove shoulder

0022 18.7932 $1,025.38 $354.45 $205.08 foreign body. 23332................ C.................... ................... Remove shoulder ........... ........... ........... ........... ........... foreign body. 23350................ N.................... ................... Injection for

........... ........... ........... ........... ........... shoulder x-ray. 23395................ T.................... ................... Muscle

0051 34.5144 $1,883.14 ........... $376.63 transfer,shoulder/ arm. 23397................ T.................... ................... Muscle transfers....

0052 42.7126 $2,330.44 ........... $466.09 23400................ T.................... ................... Fixation of shoulder

0050 24.8651 $1,356.66 ........... $271.33 blade. 23405................ T.................... ................... Incision of tendon &

0050 24.8651 $1,356.66 ........... $271.33 muscle. 23406................ T.................... ................... Incise tendon(s) &

0050 24.8651 $1,356.66 ........... $271.33 muscle(s). 23410................ T.................... ................... Repair of tendon(s).

0052 42.7126 $2,330.44 ........... $466.09 23412................ T.................... ................... Repair rotator cuff,

0052 42.7126 $2,330.44 ........... $466.09 chronic. 23415................ T.................... ................... Release of shoulder

0051 34.5144 $1,883.14 ........... $376.63 ligament. 23420................ T.................... ................... Repair of shoulder..

0052 42.7126 $2,330.44 ........... $466.09 23430................ T.................... ................... Repair biceps tendon

0052 42.7126 $2,330.44 ........... $466.09 23440................ T.................... ................... Remove/transplant

0052 42.7126 $2,330.44 ........... $466.09 tendon. 23450................ T.................... ................... Repair shoulder

0052 42.7126 $2,330.44 ........... $466.09 capsule. 23455................ T.................... ................... Repair shoulder

0052 42.7126 $2,330.44 ........... $466.09 capsule. 23460................ T.................... ................... Repair shoulder

0052 42.7126 $2,330.44 ........... $466.09 capsule. 23462................ T.................... ................... Repair shoulder

0052 42.7126 $2,330.44 ........... $466.09 capsule. 23465................ T.................... ................... Repair shoulder

0052 42.7126 $2,330.44 ........... $466.09 capsule. 23466................ T.................... ................... Repair shoulder

0052 42.7126 $2,330.44 ........... $466.09 capsule. 23470................ T.................... ................... Reconstruct shoulder

0048 51.4609 $2,807.76 $695.60 $561.55 joint. 23472................ C.................... ................... Reconstruct shoulder ........... ........... ........... ........... ........... joint. 23480................ T.................... ................... Revision of collar

0051 34.5144 $1,883.14 ........... $376.63 bone. 23485................ T.................... ................... Revision of collar

0051 34.5144 $1,883.14 ........... $376.63 bone. 23490................ T.................... ................... Reinforce clavicle..

0051 34.5144 $1,883.14 ........... $376.63 23491................ T.................... ................... Reinforce shoulder

0051 34.5144 $1,883.14 ........... $376.63 bones. 23500................ T.................... ................... Treat clavicle

0043 1.9074 $104.07 ........... $20.81 fracture. 23505................ T.................... ................... Treat clavicle

0043 1.9074 $104.07 ........... $20.81 fracture. 23515................ T.................... ................... Treat clavicle

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 23520................ T.................... ................... Treat clavicle

0043 1.9074 $104.07 ........... $20.81 dislocation. 23525................ T.................... ................... Treat clavicle

0043 1.9074 $104.07 ........... $20.81 dislocation. 23530................ T.................... ................... Treat clavicle

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 23532................ T.................... ................... Treat clavicle

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 23540................ T.................... ................... Treat clavicle

0043 1.9074 $104.07 ........... $20.81 dislocation. 23545................ T.................... ................... Treat clavicle

0043 1.9074 $104.07 ........... $20.81 dislocation. 23550................ T.................... ................... Treat clavicle

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 23552................ T.................... ................... Treat clavicle

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation.

[[Page 63504]]

23570................ T.................... ................... Treat shoulder blade

0043 1.9074 $104.07 ........... $20.81 fx. 23575................ T.................... ................... Treat shoulder blade

0043 1.9074 $104.07 ........... $20.81 fx. 23585................ T.................... ................... Treat scapula

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 23600................ T.................... ................... Treat humerus

0043 1.9074 $104.07 ........... $20.81 fracture. 23605................ T.................... ................... Treat humerus

0043 1.9074 $104.07 ........... $20.81 fracture. 23615................ T.................... ................... Treat humerus

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 23616................ T.................... ................... Treat humerus

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 23620................ T.................... ................... Treat humerus

0043 1.9074 $104.07 ........... $20.81 fracture. 23625................ T.................... ................... Treat humerus

0043 1.9074 $104.07 ........... $20.81 fracture. 23630................ T.................... ................... Treat humerus

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 23650................ T.................... ................... Treat shoulder

0043 1.9074 $104.07 ........... $20.81 dislocation. 23655................ T.................... ................... Treat shoulder

0045 13.5889 $741.42 $268.47 $148.28 dislocation. 23660................ T.................... ................... Treat shoulder

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 23665................ T.................... ................... Treat dislocation/

0043 1.9074 $104.07 ........... $20.81 fracture. 23670................ T.................... ................... Treat dislocation/

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 23675................ T.................... ................... Treat dislocation/

0043 1.9074 $104.07 ........... $20.81 fracture. 23680................ T.................... ................... Treat dislocation/

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 23700................ T.................... ................... Fixation of shoulder

0045 13.5889 $741.42 $268.47 $148.28 23800................ T.................... ................... Fusion of shoulder

0051 34.5144 $1,883.14 ........... $376.63 joint. 23802................ T.................... ................... Fusion of shoulder

0051 34.5144 $1,883.14 ........... $376.63 joint. 23900................ C.................... ................... Amputation of arm & ........... ........... ........... ........... ........... girdle. 23920................ C.................... ................... Amputation at

........... ........... ........... ........... ........... shoulder joint. 23921................ T.................... ................... Amputation follow-up

0025 5.1912 $283.24 $107.00 $56.65 surgery. 23929................ T.................... ................... Shoulder surgery

0043 1.9074 $104.07 ........... $20.81 procedure. 23930................ T.................... ................... Drainage of arm

0008 19.4831 $1,063.02 ........... $212.60 lesion. 23931................ T.................... ................... Drainage of arm

0007 11.8633 $647.27 ........... $129.45 bursa. 23935................ T.................... ................... Drain arm/elbow bone

0049 19.6046 $1,069.65 ........... $213.93 lesion. 24000................ T.................... ................... Exploratory elbow

0050 24.8651 $1,356.66 ........... $271.33 surgery. 24006................ T.................... ................... Release elbow joint.

0050 24.8651 $1,356.66 ........... $271.33 24065................ T.................... ................... Biopsy arm/elbow

0021 14.3594 $783.46 $219.48 $156.69 soft tissue. 24066................ T.................... ................... Biopsy arm/elbow

0021 14.3594 $783.46 $219.48 $156.69 soft tissue. 24075................ T.................... ................... Remove arm/elbow

0021 14.3594 $783.46 $219.48 $156.69 lesion. 24076................ T.................... ................... Remove arm/elbow

0022 18.7932 $1,025.38 $354.45 $205.08 lesion. 24077................ T.................... ................... Remove tumor of arm/

0022 18.7932 $1,025.38 $354.45 $205.08 elbow. 24100................ T.................... ................... Biopsy elbow joint

0049 19.6046 $1,069.65 ........... $213.93 lining. 24101................ T.................... ................... Explore/treat elbow

0050 24.8651 $1,356.66 ........... $271.33 joint. 24102................ T.................... ................... Remove elbow joint

0050 24.8651 $1,356.66 ........... $271.33 lining. 24105................ T.................... ................... Removal of elbow

0049 19.6046 $1,069.65 ........... $213.93 bursa. 24110................ T.................... ................... Remove humerus

0049 19.6046 $1,069.65 ........... $213.93 lesion. 24115................ T.................... ................... Remove/graft bone

0050 24.8651 $1,356.66 ........... $271.33 lesion. 24116................ T.................... ................... Remove/graft bone

0050 24.8651 $1,356.66 ........... $271.33 lesion. 24120................ T.................... ................... Remove elbow lesion.

0049 19.6046 $1,069.65 ........... $213.93 24125................ T.................... ................... Remove/graft bone

0050 24.8651 $1,356.66 ........... $271.33 lesion. 24126................ T.................... ................... Remove/graft bone

0050 24.8651 $1,356.66 ........... $271.33 lesion. 24130................ T.................... ................... Removal of head of

0050 24.8651 $1,356.66 ........... $271.33 radius. 24134................ T.................... ................... Removal of arm bone

0050 24.8651 $1,356.66 ........... $271.33 lesion. 24136................ T.................... ................... Remove radius bone

0050 24.8651 $1,356.66 ........... $271.33 lesion. 24138................ T.................... ................... Remove elbow bone

0050 24.8651 $1,356.66 ........... $271.33 lesion. 24140................ T.................... ................... Partial removal of

0050 24.8651 $1,356.66 ........... $271.33 arm bone. 24145................ T.................... ................... Partial removal of

0050 24.8651 $1,356.66 ........... $271.33 radius. 24147................ T.................... ................... Partial removal of

0050 24.8651 $1,356.66 ........... $271.33 elbow. 24149................ C.................... ................... Radical resection of ........... ........... ........... ........... ........... elbow. 24150................ T.................... ................... Extensive humerus

0052 42.7126 $2,330.44 ........... $466.09 surgery. 24151................ T.................... ................... Extensive humerus

0052 42.7126 $2,330.44 ........... $466.09 surgery. 24152................ T.................... ................... Extensive radius

0052 42.7126 $2,330.44 ........... $466.09 surgery. 24153................ T.................... ................... Extensive radius

0052 42.7126 $2,330.44 ........... $466.09 surgery. 24155................ T.................... ................... Removal of elbow

0051 34.5144 $1,883.14 ........... $376.63 joint. 24160................ T.................... ................... Remove elbow joint

0050 24.8651 $1,356.66 ........... $271.33 implant. 24164................ T.................... ................... Remove radius head

0050 24.8651 $1,356.66 ........... $271.33 implant. 24200................ T.................... ................... Removal of arm

0019 3.9493 $215.48 $71.87 $43.10 foreign body. 24201................ T.................... ................... Removal of arm

0021 14.3594 $783.46 $219.48 $156.69 foreign body. 24220................ N.................... ................... Injection for elbow ........... ........... ........... ........... ........... x-ray. 24300................ T.................... ................... Manipulate elbow w/

0045 13.5889 $741.42 $268.47 $148.28 anesth. 24301................ T.................... ................... Muscle/tendon

0050 24.8651 $1,356.66 ........... $271.33 transfer. 24305................ T.................... ................... Arm tendon

0050 24.8651 $1,356.66 ........... $271.33 lengthening. 24310................ T.................... ................... Revision of arm

0049 19.6046 $1,069.65 ........... $213.93 tendon. 24320................ T.................... ................... Repair of arm tendon

0051 34.5144 $1,883.14 ........... $376.63 24330................ T.................... ................... Revision of arm

0051 34.5144 $1,883.14 ........... $376.63 muscles. 24331................ T.................... ................... Revision of arm

0051 34.5144 $1,883.14 ........... $376.63 muscles. 24332................ T.................... ................... Tenolysis, triceps..

0049 19.6046 $1,069.65 ........... $213.93 24340................ T.................... ................... Repair of biceps

0051 34.5144 $1,883.14 ........... $376.63 tendon. 24341................ T.................... ................... Repair arm tendon/

0051 34.5144 $1,883.14 ........... $376.63 muscle. 24342................ T.................... ................... Repair of ruptured

0051 34.5144 $1,883.14 ........... $376.63 tendon. 24343................ T.................... ................... Repr elbow lat

0050 24.8651 $1,356.66 ........... $271.33 ligmnt w/tiss. 24344................ T.................... ................... Reconstruct elbow

0051 34.5144 $1,883.14 ........... $376.63 lat ligmnt.

[[Page 63505]]

24345................ T.................... ................... Repr elbw med ligmnt

0050 24.8651 $1,356.66 ........... $271.33 w/tissu. 24346................ T.................... ................... Reconstruct elbow

0051 34.5144 $1,883.14 ........... $376.63 med ligmnt. 24350................ T.................... ................... Repair of tennis

0050 24.8651 $1,356.66 ........... $271.33 elbow. 24351................ T.................... ................... Repair of tennis

0050 24.8651 $1,356.66 ........... $271.33 elbow. 24352................ T.................... ................... Repair of tennis

0050 24.8651 $1,356.66 ........... $271.33 elbow. 24354................ T.................... ................... Repair of tennis

0050 24.8651 $1,356.66 ........... $271.33 elbow. 24356................ T.................... ................... Revision of tennis

0050 24.8651 $1,356.66 ........... $271.33 elbow. 24360................ T.................... ................... Reconstruct elbow

0047 29.9582 $1,634.55 $537.03 $326.91 joint. 24361................ T.................... ................... Reconstruct elbow

0048 51.4609 $2,807.76 $695.60 $561.55 joint. 24362................ T.................... ................... Reconstruct elbow

0048 51.4609 $2,807.76 $695.60 $561.55 joint. 24363................ T.................... ................... Replace elbow joint.

0048 51.4609 $2,807.76 $695.60 $561.55 24365................ T.................... ................... Reconstruct head of

0047 29.9582 $1,634.55 $537.03 $326.91 radius. 24366................ T.................... ................... Reconstruct head of

0048 51.4609 $2,807.76 $695.60 $561.55 radius. 24400................ T.................... ................... Revision of humerus.

0050 24.8651 $1,356.66 ........... $271.33 24410................ T.................... ................... Revision of humerus.

0050 24.8651 $1,356.66 ........... $271.33 24420................ T.................... ................... Revision of humerus.

0051 34.5144 $1,883.14 ........... $376.63 24430................ T.................... ................... Repair of humerus...

0051 34.5144 $1,883.14 ........... $376.63 24435................ T.................... ................... Repair humerus with

0051 34.5144 $1,883.14 ........... $376.63 graft. 24470................ T.................... ................... Revision of elbow

0051 34.5144 $1,883.14 ........... $376.63 joint. 24495................ T.................... ................... Decompression of

0050 24.8651 $1,356.66 ........... $271.33 forearm. 24498................ T.................... ................... Reinforce humerus...

0051 34.5144 $1,883.14 ........... $376.63 24500................ T.................... ................... Treat humerus

0043 1.9074 $104.07 ........... $20.81 fracture. 24505................ T.................... ................... Treat humerus

0043 1.9074 $104.07 ........... $20.81 fracture. 24515................ T.................... ................... Treat humerus

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 24516................ T.................... ................... Treat humerus

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 24530................ T.................... ................... Treat humerus

0043 1.9074 $104.07 ........... $20.81 fracture. 24535................ T.................... ................... Treat humerus

0043 1.9074 $104.07 ........... $20.81 fracture. 24538................ T.................... ................... Treat humerus

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 24545................ T.................... ................... Treat humerus

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 24546................ T.................... ................... Treat humerus

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 24560................ T.................... ................... Treat humerus

0043 1.9074 $104.07 ........... $20.81 fracture. 24565................ T.................... ................... Treat humerus

0043 1.9074 $104.07 ........... $20.81 fracture. 24566................ T.................... ................... Treat humerus

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 24575................ T.................... ................... Treat humerus

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 24576................ T.................... ................... Treat humerus

0043 1.9074 $104.07 ........... $20.81 fracture. 24577................ T.................... ................... Treat humerus

0043 1.9074 $104.07 ........... $20.81 fracture. 24579................ T.................... ................... Treat humerus

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 24582................ T.................... ................... Treat humerus

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 24586................ T.................... ................... Treat elbow fracture

0046 32.5581 $1,776.40 $535.76 $355.28 24587................ T.................... ................... Treat elbow fracture

0046 32.5581 $1,776.40 $535.76 $355.28 24600................ T.................... ................... Treat elbow

0043 1.9074 $104.07 ........... $20.81 dislocation. 24605................ T.................... ................... Treat elbow

0045 13.5889 $741.42 $268.47 $148.28 dislocation. 24615................ T.................... ................... Treat elbow

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 24620................ T.................... ................... Treat elbow fracture

0043 1.9074 $104.07 ........... $20.81 24635................ T.................... ................... Treat elbow fracture

0046 32.5581 $1,776.40 $535.76 $355.28 24640................ T.................... ................... Treat elbow

0043 1.9074 $104.07 ........... $20.81 dislocation. 24650................ T.................... ................... Treat radius

0043 1.9074 $104.07 ........... $20.81 fracture. 24655................ T.................... ................... Treat radius

0043 1.9074 $104.07 ........... $20.81 fracture. 24665................ T.................... ................... Treat radius

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 24666................ T.................... ................... Treat radius

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 24670................ T.................... ................... Treat ulnar fracture

0043 1.9074 $104.07 ........... $20.81 24675................ T.................... ................... Treat ulnar fracture

0043 1.9074 $104.07 ........... $20.81 24685................ T.................... ................... Treat ulnar fracture

0046 32.5581 $1,776.40 $535.76 $355.28 24800................ T.................... ................... Fusion of elbow

0051 34.5144 $1,883.14 ........... $376.63 joint. 24802................ T.................... ................... Fusion/graft of

0051 34.5144 $1,883.14 ........... $376.63 elbow joint. 24900................ C.................... ................... Amputation of upper ........... ........... ........... ........... ........... arm. 24920................ C.................... ................... Amputation of upper ........... ........... ........... ........... ........... arm. 24925................ T.................... ................... Amputation follow-up

0049 19.6046 $1,069.65 ........... $213.93 surgery. 24930................ C.................... ................... Amputation follow-up ........... ........... ........... ........... ........... surgery. 24931................ C.................... ................... Amputate upper arm & ........... ........... ........... ........... ........... implant. 24935................ T.................... ................... Revision of

0052 42.7126 $2,330.44 ........... $466.09 amputation. 24940................ C.................... ................... Revision of upper ........... ........... ........... ........... ........... arm. 24999................ T.................... ................... Upper arm/elbow

0043 1.9074 $104.07 ........... $20.81 surgery. 25000................ T.................... ................... Incision of tendon

0049 19.6046 $1,069.65 ........... $213.93 sheath. 25001................ T.................... ................... Incise flexor carpi

0049 19.6046 $1,069.65 ........... $213.93 radialis. 25020................ T.................... ................... Decompress forearm 1

0049 19.6046 $1,069.65 ........... $213.93 space. 25023................ T.................... ................... Decompress forearm 1

0050 24.8651 $1,356.66 ........... $271.33 space. 25024................ T.................... ................... Decompress forearm 2

0050 24.8651 $1,356.66 ........... $271.33 spaces. 25025................ T.................... ................... Decompress forearm 2

0050 24.8651 $1,356.66 ........... $271.33 spaces. 25028................ T.................... ................... Drainage of forearm

0049 19.6046 $1,069.65 ........... $213.93 lesion. 25031................ T.................... ................... Drainage of forearm

0049 19.6046 $1,069.65 ........... $213.93 bursa. 25035................ T.................... ................... Treat forearm bone

0049 19.6046 $1,069.65 ........... $213.93 lesion. 25040................ T.................... ................... Explore/treat wrist

0050 24.8651 $1,356.66 ........... $271.33 joint. 25065................ T.................... ................... Biopsy forearm soft

0021 14.3594 $783.46 $219.48 $156.69 tissues. 25066................ T.................... ................... Biopsy forearm soft

0022 18.7932 $1,025.38 $354.45 $205.08 tissues.

[[Page 63506]]

25075................ T.................... ................... Removel forearm

0021 14.3594 $783.46 $219.48 $156.69 lesion subcu. 25076................ T.................... ................... Removel forearm

0022 18.7932 $1,025.38 $354.45 $205.08 lesion deep. 25077................ T.................... ................... Remove tumor,

0022 18.7932 $1,025.38 $354.45 $205.08 forearm/wrist. 25085................ T.................... ................... Incision of wrist

0049 19.6046 $1,069.65 ........... $213.93 capsule. 25100................ T.................... ................... Biopsy of wrist

0049 19.6046 $1,069.65 ........... $213.93 joint. 25101................ T.................... ................... Explore/treat wrist

0050 24.8651 $1,356.66 ........... $271.33 joint. 25105................ T.................... ................... Remove wrist joint

0050 24.8651 $1,356.66 ........... $271.33 lining. 25107................ T.................... ................... Remove wrist joint

0050 24.8651 $1,356.66 ........... $271.33 cartilage. 25110................ T.................... ................... Remove wrist tendon

0049 19.6046 $1,069.65 ........... $213.93 lesion. 25111................ T.................... ................... Remove wrist tendon

0053 14.8831 $812.04 $253.49 $162.41 lesion. 25112................ T.................... ................... Reremove wrist

0053 14.8831 $812.04 $253.49 $162.41 tendon lesion. 25115................ T.................... ................... Remove wrist/forearm

0049 19.6046 $1,069.65 ........... $213.93 lesion. 25116................ T.................... ................... Remove wrist/forearm

0049 19.6046 $1,069.65 ........... $213.93 lesion. 25118................ T.................... ................... Excise wrist tendon

0050 24.8651 $1,356.66 ........... $271.33 sheath. 25119................ T.................... ................... Partial removal of

0050 24.8651 $1,356.66 ........... $271.33 ulna. 25120................ T.................... ................... Removal of forearm

0050 24.8651 $1,356.66 ........... $271.33 lesion. 25125................ T.................... ................... Remove/graft forearm

0050 24.8651 $1,356.66 ........... $271.33 lesion. 25126................ T.................... ................... Remove/graft forearm

0050 24.8651 $1,356.66 ........... $271.33 lesion. 25130................ T.................... ................... Removal of wrist

0050 24.8651 $1,356.66 ........... $271.33 lesion. 25135................ T.................... ................... Remove & graft wrist

0050 24.8651 $1,356.66 ........... $271.33 lesion. 25136................ T.................... ................... Remove & graft wrist

0050 24.8651 $1,356.66 ........... $271.33 lesion. 25145................ T.................... ................... Remove forearm bone

0050 24.8651 $1,356.66 ........... $271.33 lesion. 25150................ T.................... ................... Partial removal of

0050 24.8651 $1,356.66 ........... $271.33 ulna. 25151................ T.................... ................... Partial removal of

0050 24.8651 $1,356.66 ........... $271.33 radius. 25170................ T.................... ................... Extensive forearm

0052 42.7126 $2,330.44 ........... $466.09 surgery. 25210................ T.................... ................... Removal of wrist

0054 24.2456 $1,322.86 ........... $264.57 bone. 25215................ T.................... ................... Removal of wrist

0054 24.2456 $1,322.86 ........... $264.57 bones. 25230................ T.................... ................... Partial removal of

0050 24.8651 $1,356.66 ........... $271.33 radius. 25240................ T.................... ................... Partial removal of

0050 24.8651 $1,356.66 ........... $271.33 ulna. 25246................ N.................... ................... Injection for wrist ........... ........... ........... ........... ........... x-ray. 25248................ T.................... ................... Remove forearm

0049 19.6046 $1,069.65 ........... $213.93 foreign body. 25250................ T.................... ................... Removal of wrist

0050 24.8651 $1,356.66 ........... $271.33 prosthesis. 25251................ T.................... ................... Removal of wrist

0050 24.8651 $1,356.66 ........... $271.33 prosthesis. 25259................ T.................... ................... Manipulate wrist w/

0043 1.9074 $104.07 ........... $20.81 anesthes. 25260................ T.................... ................... Repair forearm

0050 24.8651 $1,356.66 ........... $271.33 tendon/muscle. 25263................ T.................... ................... Repair forearm

0050 24.8651 $1,356.66 ........... $271.33 tendon/muscle. 25265................ T.................... ................... Repair forearm

0050 24.8651 $1,356.66 ........... $271.33 tendon/muscle. 25270................ T.................... ................... Repair forearm

0050 24.8651 $1,356.66 ........... $271.33 tendon/muscle. 25272................ T.................... ................... Repair forearm

0050 24.8651 $1,356.66 ........... $271.33 tendon/muscle. 25274................ T.................... ................... Repair forearm

0050 24.8651 $1,356.66 ........... $271.33 tendon/muscle. 25275................ T.................... ................... Repair forearm

0050 24.8651 $1,356.66 ........... $271.33 tendon sheath. 25280................ T.................... ................... Revise wrist/forearm

0050 24.8651 $1,356.66 ........... $271.33 tendon. 25290................ T.................... ................... Incise wrist/forearm

0050 24.8651 $1,356.66 ........... $271.33 tendon. 25295................ T.................... ................... Release wrist/

0049 19.6046 $1,069.65 ........... $213.93 forearm tendon. 25300................ T.................... ................... Fusion of tendons at

0050 24.8651 $1,356.66 ........... $271.33 wrist. 25301................ T.................... ................... Fusion of tendons at

0050 24.8651 $1,356.66 ........... $271.33 wrist. 25310................ T.................... ................... Transplant forearm

0051 34.5144 $1,883.14 ........... $376.63 tendon. 25312................ T.................... ................... Transplant forearm

0051 34.5144 $1,883.14 ........... $376.63 tendon. 25315................ T.................... ................... Revise palsy hand

0051 34.5144 $1,883.14 ........... $376.63 tendon(s). 25316................ T.................... ................... Revise palsy hand

0051 34.5144 $1,883.14 ........... $376.63 tendon(s). 25320................ T.................... ................... Repair/revise wrist

0051 34.5144 $1,883.14 ........... $376.63 joint. 25332................ T.................... ................... Revise wrist joint..

0047 29.9582 $1,634.55 $537.03 $326.91 25335................ T.................... ................... Realignment of hand.

0051 34.5144 $1,883.14 ........... $376.63 25337................ T.................... ................... Reconstruct ulna/

0051 34.5144 $1,883.14 ........... $376.63 radioulnar. 25350................ T.................... ................... Revision of radius..

0051 34.5144 $1,883.14 ........... $376.63 25355................ T.................... ................... Revision of radius..

0051 34.5144 $1,883.14 ........... $376.63 25360................ T.................... ................... Revision of ulna....

0050 24.8651 $1,356.66 ........... $271.33 25365................ T.................... ................... Revise radius & ulna

0050 24.8651 $1,356.66 ........... $271.33 25370................ T.................... ................... Revise radius or

0051 34.5144 $1,883.14 ........... $376.63 ulna. 25375................ T.................... ................... Revise radius & ulna

0051 34.5144 $1,883.14 ........... $376.63 25390................ T.................... ................... Shorten radius or

0050 24.8651 $1,356.66 ........... $271.33 ulna. 25391................ T.................... ................... Lengthen radius or

0051 34.5144 $1,883.14 ........... $376.63 ulna. 25392................ T.................... ................... Shorten radius &

0050 24.8651 $1,356.66 ........... $271.33 ulna. 25393................ T.................... ................... Lengthen radius &

0051 34.5144 $1,883.14 ........... $376.63 ulna. 25394................ T.................... ................... Repair carpal bone,

0053 14.8831 $812.04 $253.49 $162.41 shorten. 25400................ T.................... ................... Repair radius or

0050 24.8651 $1,356.66 ........... $271.33 ulna. 25405................ T.................... ................... Repair/graft radius

0050 24.8651 $1,356.66 ........... $271.33 or ulna. 25415................ T.................... ................... Repair radius & ulna

0050 24.8651 $1,356.66 ........... $271.33 25420................ T.................... ................... Repair/graft radius

0051 34.5144 $1,883.14 ........... $376.63 & ulna. 25425................ T.................... ................... Repair/graft radius

0051 34.5144 $1,883.14 ........... $376.63 or ulna. 25426................ T.................... ................... Repair/graft radius

0051 34.5144 $1,883.14 ........... $376.63 & ulna. 25430................ T.................... ................... Vasc graft into

0054 24.2456 $1,322.86 ........... $264.57 carpal bone. 25431................ T.................... ................... Repair nonunion

0054 24.2456 $1,322.86 ........... $264.57 carpal bone. 25440................ T.................... ................... Repair/graft wrist

0051 34.5144 $1,883.14 ........... $376.63 bone. 25441................ T.................... ................... Reconstruct wrist

0048 51.4609 $2,807.76 $695.60 $561.55 joint.

[[Page 63507]]

25442................ T.................... ................... Reconstruct wrist

0048 51.4609 $2,807.76 $695.60 $561.55 joint. 25443................ T.................... ................... Reconstruct wrist

0048 51.4609 $2,807.76 $695.60 $561.55 joint. 25444................ T.................... ................... Reconstruct wrist

0048 51.4609 $2,807.76 $695.60 $561.55 joint. 25445................ T.................... ................... Reconstruct wrist

0048 51.4609 $2,807.76 $695.60 $561.55 joint. 25446................ T.................... ................... Wrist replacement...

0048 51.4609 $2,807.76 $695.60 $561.55 25447................ T.................... ................... Repair wrist

0047 29.9582 $1,634.55 $537.03 $326.91 joint(s). 25449................ T.................... ................... Remove wrist joint

0047 29.9582 $1,634.55 $537.03 $326.91 implant. 25450................ T.................... ................... Revision of wrist

0051 34.5144 $1,883.14 ........... $376.63 joint. 25455................ T.................... ................... Revision of wrist

0051 34.5144 $1,883.14 ........... $376.63 joint. 25490................ T.................... ................... Reinforce radius....

0051 34.5144 $1,883.14 ........... $376.63 25491................ T.................... ................... Reinforce ulna......

0051 34.5144 $1,883.14 ........... $376.63 25492................ T.................... ................... Reinforce radius and

0051 34.5144 $1,883.14 ........... $376.63 ulna. 25500................ T.................... ................... Treat fracture of

0043 1.9074 $104.07 ........... $20.81 radius. 25505................ T.................... ................... Treat fracture of

0043 1.9074 $104.07 ........... $20.81 radius. 25515................ T.................... ................... Treat fracture of

0046 32.5581 $1,776.40 $535.76 $355.28 radius. 25520................ T.................... ................... Treat fracture of

0043 1.9074 $104.07 ........... $20.81 radius. 25525................ T.................... ................... Treat fracture of

0046 32.5581 $1,776.40 $535.76 $355.28 radius. 25526................ T.................... ................... Treat fracture of

0046 32.5581 $1,776.40 $535.76 $355.28 radius. 25530................ T.................... ................... Treat fracture of

0043 1.9074 $104.07 ........... $20.81 ulna. 25535................ T.................... ................... Treat fracture of

0043 1.9074 $104.07 ........... $20.81 ulna. 25545................ T.................... ................... Treat fracture of

0046 32.5581 $1,776.40 $535.76 $355.28 ulna. 25560................ T.................... ................... Treat fracture

0043 1.9074 $104.07 ........... $20.81 radius & ulna. 25565................ T.................... ................... Treat fracture

0043 1.9074 $104.07 ........... $20.81 radius & ulna. 25574................ T.................... ................... Treat fracture

0046 32.5581 $1,776.40 $535.76 $355.28 radius & ulna. 25575................ T.................... ................... Treat fracture

0046 32.5581 $1,776.40 $535.76 $355.28 radius/ulna. 25600................ T.................... ................... Treat fracture

0043 1.9074 $104.07 ........... $20.81 radius/ulna. 25605................ T.................... ................... Treat fracture

0043 1.9074 $104.07 ........... $20.81 radius/ulna. 25611................ T.................... ................... Treat fracture

0046 32.5581 $1,776.40 $535.76 $355.28 radius/ulna. 25620................ T.................... ................... Treat fracture

0046 32.5581 $1,776.40 $535.76 $355.28 radius/ulna. 25622................ T.................... ................... Treat wrist bone

0043 1.9074 $104.07 ........... $20.81 fracture. 25624................ T.................... ................... Treat wrist bone

0043 1.9074 $104.07 ........... $20.81 fracture. 25628................ T.................... ................... Treat wrist bone

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 25630................ T.................... ................... Treat wrist bone

0043 1.9074 $104.07 ........... $20.81 fracture. 25635................ T.................... ................... Treat wrist bone

0043 1.9074 $104.07 ........... $20.81 fracture. 25645................ T.................... ................... Treat wrist bone

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 25650................ T.................... ................... Treat wrist bone

0043 1.9074 $104.07 ........... $20.81 fracture. 25651................ T.................... ................... Pin ulnar styloid

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 25652................ T.................... ................... Treat fracture ulnar

0046 32.5581 $1,776.40 $535.76 $355.28 styloid. 25660................ T.................... ................... Treat wrist

0043 1.9074 $104.07 ........... $20.81 dislocation. 25670................ T.................... ................... Treat wrist

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 25671................ T.................... ................... Pin radioulnar

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 25675................ T.................... ................... Treat wrist

0043 1.9074 $104.07 ........... $20.81 dislocation. 25676................ T.................... ................... Treat wrist

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 25680................ T.................... ................... Treat wrist fracture

0043 1.9074 $104.07 ........... $20.81 25685................ T.................... ................... Treat wrist fracture

0046 32.5581 $1,776.40 $535.76 $355.28 25690................ T.................... ................... Treat wrist

0043 1.9074 $104.07 ........... $20.81 dislocation. 25695................ T.................... ................... Treat wrist

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 25800................ T.................... ................... Fusion of wrist

0051 34.5144 $1,883.14 ........... $376.63 joint. 25805................ T.................... ................... Fusion/graft of

0051 34.5144 $1,883.14 ........... $376.63 wrist joint. 25810................ T.................... ................... Fusion/graft of

0051 34.5144 $1,883.14 ........... $376.63 wrist joint. 25820................ T.................... ................... Fusion of hand bones

0053 14.8831 $812.04 $253.49 $162.41 25825................ T.................... ................... Fuse hand bones with

0054 24.2456 $1,322.86 ........... $264.57 graft. 25830................ T.................... ................... Fusion, radioulnar

0051 34.5144 $1,883.14 ........... $376.63 jnt/ulna. 25900................ C.................... ................... Amputation of

........... ........... ........... ........... ........... forearm. 25905................ C.................... ................... Amputation of

........... ........... ........... ........... ........... forearm. 25907................ T.................... ................... Amputation follow-up

0049 19.6046 $1,069.65 ........... $213.93 surgery. 25909................ C.................... ................... Amputation follow-up ........... ........... ........... ........... ........... surgery. 25915................ C.................... ................... Amputation of

........... ........... ........... ........... ........... forearm. 25920................ C.................... ................... Amputate hand at ........... ........... ........... ........... ........... wrist. 25922................ T.................... ................... Amputate hand at

0049 19.6046 $1,069.65 ........... $213.93 wrist. 25924................ C.................... ................... Amputation follow-up ........... ........... ........... ........... ........... surgery. 25927................ C.................... ................... Amputation of hand.. ........... ........... ........... ........... ........... 25929................ T.................... ................... Amputation follow-up

0027 15.8990 $867.47 $329.72 $173.49 surgery. 25931................ C.................... ................... Amputation follow-up ........... ........... ........... ........... ........... surgery. 25999................ T.................... ................... Forearm or wrist

0043 1.9074 $104.07 ........... $20.81 surgery. 26010................ T.................... ................... Drainage of finger

0006 1.6527 $90.17 $23.26 $18.03 abscess. 26011................ T.................... ................... Drainage of finger

0007 11.8633 $647.27 ........... $129.45 abscess. 26020................ T.................... ................... Drain hand tendon

0053 14.8831 $812.04 $253.49 $162.41 sheath. 26025................ T.................... ................... Drainage of palm

0053 14.8831 $812.04 $253.49 $162.41 bursa. 26030................ T.................... ................... Drainage of palm

0053 14.8831 $812.04 $253.49 $162.41 bursa(s). 26034................ T.................... ................... Treat hand bone

0053 14.8831 $812.04 $253.49 $162.41 lesion. 26035................ T.................... ................... Decompress fingers/

0053 14.8831 $812.04 $253.49 $162.41 hand. 26037................ T.................... ................... Decompress fingers/

0053 14.8831 $812.04 $253.49 $162.41 hand. 26040................ T.................... ................... Release palm

0054 24.2456 $1,322.86 ........... $264.57 contracture. 26045................ T.................... ................... Release palm

0054 24.2456 $1,322.86 ........... $264.57 contracture.

[[Page 63508]]

26055................ T.................... ................... Incise finger tendon

0053 14.8831 $812.04 $253.49 $162.41 sheath. 26060................ T.................... ................... Incision of finger

0053 14.8831 $812.04 $253.49 $162.41 tendon. 26070................ T.................... ................... Explore/treat hand

0053 14.8831 $812.04 $253.49 $162.41 joint. 26075................ T.................... ................... Explore/treat finger

0053 14.8831 $812.04 $253.49 $162.41 joint. 26080................ T.................... ................... Explore/treat finger

0053 14.8831 $812.04 $253.49 $162.41 joint. 26100................ T.................... ................... Biopsy hand joint

0053 14.8831 $812.04 $253.49 $162.41 lining. 26105................ T.................... ................... Biopsy finger joint

0053 14.8831 $812.04 $253.49 $162.41 lining. 26110................ T.................... ................... Biopsy finger joint

0053 14.8831 $812.04 $253.49 $162.41 lining. 26115................ T.................... ................... Removel hand lesion

0022 18.7932 $1,025.38 $354.45 $205.08 subcut. 26116................ T.................... ................... Removel hand lesion,

0022 18.7932 $1,025.38 $354.45 $205.08 deep. 26117................ T.................... ................... Remove tumor, hand/

0022 18.7932 $1,025.38 $354.45 $205.08 finger. 26121................ T.................... ................... Release palm

0054 24.2456 $1,322.86 ........... $264.57 contracture. 26123................ T.................... ................... Release palm

0054 24.2456 $1,322.86 ........... $264.57 contracture. 26125................ T.................... ................... Release palm

0054 24.2456 $1,322.86 ........... $264.57 contracture. 26130................ T.................... ................... Remove wrist joint

0053 14.8831 $812.04 $253.49 $162.41 lining. 26135................ T.................... ................... Revise finger joint,

0054 24.2456 $1,322.86 ........... $264.57 each. 26140................ T.................... ................... Revise finger joint,

0053 14.8831 $812.04 $253.49 $162.41 each. 26145................ T.................... ................... Tendon excision,

0053 14.8831 $812.04 $253.49 $162.41 palm/finger. 26160................ T.................... ................... Remove tendon sheath

0053 14.8831 $812.04 $253.49 $162.41 lesion. 26170................ T.................... ................... Removal of palm

0053 14.8831 $812.04 $253.49 $162.41 tendon, each. 26180................ T.................... ................... Removal of finger

0053 14.8831 $812.04 $253.49 $162.41 tendon. 26185................ T.................... ................... Remove finger bone..

0053 14.8831 $812.04 $253.49 $162.41 26200................ T.................... ................... Remove hand bone

0053 14.8831 $812.04 $253.49 $162.41 lesion. 26205................ T.................... ................... Remove/graft bone

0054 24.2456 $1,322.86 ........... $264.57 lesion. 26210................ T.................... ................... Removal of finger

0053 14.8831 $812.04 $253.49 $162.41 lesion. 26215................ T.................... ................... Remove/graft finger

0053 14.8831 $812.04 $253.49 $162.41 lesion. 26230................ T.................... ................... Partial removal of

0053 14.8831 $812.04 $253.49 $162.41 hand bone. 26235................ T.................... ................... Partial removal,

0053 14.8831 $812.04 $253.49 $162.41 finger bone. 26236................ T.................... ................... Partial removal,

0053 14.8831 $812.04 $253.49 $162.41 finger bone. 26250................ T.................... ................... Extensive hand

0053 14.8831 $812.04 $253.49 $162.41 surgery. 26255................ T.................... ................... Extensive hand

0054 24.2456 $1,322.86 ........... $264.57 surgery. 26260................ T.................... ................... Extensive finger

0053 14.8831 $812.04 $253.49 $162.41 surgery. 26261................ T.................... ................... Extensive finger

0053 14.8831 $812.04 $253.49 $162.41 surgery. 26262................ T.................... ................... Partial removal of

0053 14.8831 $812.04 $253.49 $162.41 finger. 26320................ T.................... ................... Removal of implant

0021 14.3594 $783.46 $219.48 $156.69 from hand. 26340................ T.................... ................... Manipulate finger w/

0043 1.9074 $104.07 ........... $20.81 anesth. 26350................ T.................... ................... Repair finger/hand

0054 24.2456 $1,322.86 ........... $264.57 tendon. 26352................ T.................... ................... Repair/graft hand

0054 24.2456 $1,322.86 ........... $264.57 tendon. 26356................ T.................... ................... Repair finger/hand

0054 24.2456 $1,322.86 ........... $264.57 tendon. 26357................ T.................... ................... Repair finger/hand

0054 24.2456 $1,322.86 ........... $264.57 tendon. 26358................ T.................... ................... Repair/graft hand

0054 24.2456 $1,322.86 ........... $264.57 tendon. 26370................ T.................... ................... Repair finger/hand

0054 24.2456 $1,322.86 ........... $264.57 tendon. 26372................ T.................... ................... Repair/graft hand

0054 24.2456 $1,322.86 ........... $264.57 tendon. 26373................ T.................... ................... Repair finger/hand

0054 24.2456 $1,322.86 ........... $264.57 tendon. 26390................ T.................... ................... Revise hand/finger

0054 24.2456 $1,322.86 ........... $264.57 tendon. 26392................ T.................... ................... Repair/graft hand

0054 24.2456 $1,322.86 ........... $264.57 tendon. 26410................ T.................... ................... Repair hand tendon..

0053 14.8831 $812.04 $253.49 $162.41 26412................ T.................... ................... Repair/graft hand

0054 24.2456 $1,322.86 ........... $264.57 tendon. 26415................ T.................... ................... Excision, hand/

0054 24.2456 $1,322.86 ........... $264.57 finger tendon. 26416................ T.................... ................... Graft hand or finger

0054 24.2456 $1,322.86 ........... $264.57 tendon. 26418................ T.................... ................... Repair finger tendon

0053 14.8831 $812.04 $253.49 $162.41 26420................ T.................... ................... Repair/graft finger

0054 24.2456 $1,322.86 ........... $264.57 tendon. 26426................ T.................... ................... Repair finger/hand

0054 24.2456 $1,322.86 ........... $264.57 tendon. 26428................ T.................... ................... Repair/graft finger

0054 24.2456 $1,322.86 ........... $264.57 tendon. 26432................ T.................... ................... Repair finger tendon

0053 14.8831 $812.04 $253.49 $162.41 26433................ T.................... ................... Repair finger tendon

0053 14.8831 $812.04 $253.49 $162.41 26434................ T.................... ................... Repair/graft finger

0054 24.2456 $1,322.86 ........... $264.57 tendon. 26437................ T.................... ................... Realignment of

0053 14.8831 $812.04 $253.49 $162.41 tendons. 26440................ T.................... ................... Release palm/finger

0053 14.8831 $812.04 $253.49 $162.41 tendon. 26442................ T.................... ................... Release palm &

0054 24.2456 $1,322.86 ........... $264.57 finger tendon. 26445................ T.................... ................... Release hand/finger

0053 14.8831 $812.04 $253.49 $162.41 tendon. 26449................ T.................... ................... Release forearm/hand

0054 24.2456 $1,322.86 ........... $264.57 tendon. 26450................ T.................... ................... Incision of palm

0053 14.8831 $812.04 $253.49 $162.41 tendon. 26455................ T.................... ................... Incision of finger

0053 14.8831 $812.04 $253.49 $162.41 tendon. 26460................ T.................... ................... Incise hand/finger

0053 14.8831 $812.04 $253.49 $162.41 tendon. 26471................ T.................... ................... Fusion of finger

0053 14.8831 $812.04 $253.49 $162.41 tendons. 26474................ T.................... ................... Fusion of finger

0053 14.8831 $812.04 $253.49 $162.41 tendons. 26476................ T.................... ................... Tendon lengthening..

0053 14.8831 $812.04 $253.49 $162.41 26477................ T.................... ................... Tendon shortening...

0053 14.8831 $812.04 $253.49 $162.41 26478................ T.................... ................... Lengthening of hand

0053 14.8831 $812.04 $253.49 $162.41 tendon. 26479................ T.................... ................... Shortening of hand

0053 14.8831 $812.04 $253.49 $162.41 tendon. 26480................ T.................... ................... Transplant hand

0054 24.2456 $1,322.86 ........... $264.57 tendon. 26483................ T.................... ................... Transplant/graft

0054 24.2456 $1,322.86 ........... $264.57 hand tendon. 26485................ T.................... ................... Transplant palm

0054 24.2456 $1,322.86 ........... $264.57 tendon. 26489................ T.................... ................... Transplant/graft

0054 24.2456 $1,322.86 ........... $264.57 palm tendon.

[[Page 63509]]

26490................ T.................... ................... Revise thumb tendon.

0054 24.2456 $1,322.86 ........... $264.57 26492................ T.................... ................... Tendon transfer with

0054 24.2456 $1,322.86 ........... $264.57 graft. 26494................ T.................... ................... Hand tendon/muscle

0054 24.2456 $1,322.86 ........... $264.57 transfer. 26496................ T.................... ................... Revise thumb tendon.

0054 24.2456 $1,322.86 ........... $264.57 26497................ T.................... ................... Finger tendon

0054 24.2456 $1,322.86 ........... $264.57 transfer. 26498................ T.................... ................... Finger tendon

0054 24.2456 $1,322.86 ........... $264.57 transfer. 26499................ T.................... ................... Revision of finger..

0054 24.2456 $1,322.86 ........... $264.57 26500................ T.................... ................... Hand tendon

0053 14.8831 $812.04 $253.49 $162.41 reconstruction. 26502................ T.................... ................... Hand tendon

0054 24.2456 $1,322.86 ........... $264.57 reconstruction. 26504................ T.................... ................... Hand tendon

0054 24.2456 $1,322.86 ........... $264.57 reconstruction. 26508................ T.................... ................... Release thumb

0053 14.8831 $812.04 $253.49 $162.41 contracture. 26510................ T.................... ................... Thumb tendon

0054 24.2456 $1,322.86 ........... $264.57 transfer. 26516................ T.................... ................... Fusion of knuckle

0054 24.2456 $1,322.86 ........... $264.57 joint. 26517................ T.................... ................... Fusion of knuckle

0054 24.2456 $1,322.86 ........... $264.57 joints. 26518................ T.................... ................... Fusion of knuckle

0054 24.2456 $1,322.86 ........... $264.57 joints. 26520................ T.................... ................... Release knuckle

0053 14.8831 $812.04 $253.49 $162.41 contracture. 26525................ T.................... ................... Release finger

0053 14.8831 $812.04 $253.49 $162.41 contracture. 26530................ T.................... ................... Revise knuckle joint

0047 29.9582 $1,634.55 $537.03 $326.91 26531................ T.................... ................... Revise knuckle with

0048 51.4609 $2,807.76 $695.60 $561.55 implant. 26535................ T.................... ................... Revise finger joint.

0047 29.9582 $1,634.55 $537.03 $326.91 26536................ T.................... ................... Revise/implant

0048 51.4609 $2,807.76 $695.60 $561.55 finger joint. 26540................ T.................... ................... Repair hand joint...

0053 14.8831 $812.04 $253.49 $162.41 26541................ T.................... ................... Repair hand joint

0054 24.2456 $1,322.86 ........... $264.57 with graft. 26542................ T.................... ................... Repair hand joint

0053 14.8831 $812.04 $253.49 $162.41 with graft. 26545................ T.................... ................... Reconstruct finger

0054 24.2456 $1,322.86 ........... $264.57 joint. 26546................ T.................... ................... Repair nonunion hand

0054 24.2456 $1,322.86 ........... $264.57 26548................ T.................... ................... Reconstruct finger

0054 24.2456 $1,322.86 ........... $264.57 joint. 26550................ T.................... ................... Construct thumb

0054 24.2456 $1,322.86 ........... $264.57 replacement. 26551................ C.................... ................... Great toe-hand

........... ........... ........... ........... ........... transfer. 26553................ C.................... ................... Single transfer, toe- ........... ........... ........... ........... ........... hand. 26554................ C.................... ................... Double transfer, toe- ........... ........... ........... ........... ........... hand. 26555................ T.................... ................... Positional change of

0054 24.2456 $1,322.86 ........... $264.57 finger. 26556................ C.................... ................... Toe joint transfer.. ........... ........... ........... ........... ........... 26560................ T.................... ................... Repair of web finger

0053 14.8831 $812.04 $253.49 $162.41 26561................ T.................... ................... Repair of web finger

0054 24.2456 $1,322.86 ........... $264.57 26562................ T.................... ................... Repair of web finger

0054 24.2456 $1,322.86 ........... $264.57 26565................ T.................... ................... Correct metacarpal

0054 24.2456 $1,322.86 ........... $264.57 flaw. 26567................ T.................... ................... Correct finger

0054 24.2456 $1,322.86 ........... $264.57 deformity. 26568................ T.................... ................... Lengthen metacarpal/

0054 24.2456 $1,322.86 ........... $264.57 finger. 26580................ T.................... ................... Repair hand

0054 24.2456 $1,322.86 ........... $264.57 deformity. 26587................ T.................... ................... Reconstruct extra

0053 14.8831 $812.04 $253.49 $162.41 finger. 26590................ T.................... ................... Repair finger

0054 24.2456 $1,322.86 ........... $264.57 deformity. 26591................ T.................... ................... Repair muscles of

0054 24.2456 $1,322.86 ........... $264.57 hand. 26593................ T.................... ................... Release muscles of

0053 14.8831 $812.04 $253.49 $162.41 hand. 26596................ T.................... ................... Excision

0054 24.2456 $1,322.86 ........... $264.57 constricting tissue. 26600................ T.................... ................... Treat metacarpal

0043 1.9074 $104.07 ........... $20.81 fracture. 26605................ T.................... ................... Treat metacarpal

0043 1.9074 $104.07 ........... $20.81 fracture. 26607................ T.................... ................... Treat metacarpal

0043 1.9074 $104.07 ........... $20.81 fracture. 26608................ T.................... ................... Treat metacarpal

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 26615................ T.................... ................... Treat metacarpal

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 26641................ T.................... ................... Treat thumb

0043 1.9074 $104.07 ........... $20.81 dislocation. 26645................ T.................... ................... Treat thumb fracture

0043 1.9074 $104.07 ........... $20.81 26650................ T.................... ................... Treat thumb fracture

0046 32.5581 $1,776.40 $535.76 $355.28 26665................ T.................... ................... Treat thumb fracture

0046 32.5581 $1,776.40 $535.76 $355.28 26670................ T.................... ................... Treat hand

0043 1.9074 $104.07 ........... $20.81 dislocation. 26675................ T.................... ................... Treat hand

0043 1.9074 $104.07 ........... $20.81 dislocation. 26676................ T.................... ................... Pin hand dislocation

0046 32.5581 $1,776.40 $535.76 $355.28 26685................ T.................... ................... Treat hand

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 26686................ T.................... ................... Treat hand

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 26700................ T.................... ................... Treat knuckle

0043 1.9074 $104.07 ........... $20.81 dislocation. 26705................ T.................... ................... Treat knuckle

0043 1.9074 $104.07 ........... $20.81 dislocation. 26706................ T.................... ................... Pin knuckle

0043 1.9074 $104.07 ........... $20.81 dislocation. 26715................ T.................... ................... Treat knuckle

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 26720................ T.................... ................... Treat finger

0043 1.9074 $104.07 ........... $20.81 fracture, each. 26725................ T.................... ................... Treat finger

0043 1.9074 $104.07 ........... $20.81 fracture, each. 26727................ T.................... ................... Treat finger

0046 32.5581 $1,776.40 $535.76 $355.28 fracture, each. 26735................ T.................... ................... Treat finger

0046 32.5581 $1,776.40 $535.76 $355.28 fracture, each. 26740................ T.................... ................... Treat finger

0043 1.9074 $104.07 ........... $20.81 fracture, each. 26742................ T.................... ................... Treat finger

0043 1.9074 $104.07 ........... $20.81 fracture, each. 26746................ T.................... ................... Treat finger

0046 32.5581 $1,776.40 $535.76 $355.28 fracture, each. 26750................ T.................... ................... Treat finger

0043 1.9074 $104.07 ........... $20.81 fracture, each. 26755................ T.................... ................... Treat finger

0043 1.9074 $104.07 ........... $20.81 fracture, each. 26756................ T.................... ................... Pin finger fracture,

0046 32.5581 $1,776.40 $535.76 $355.28 each. 26765................ T.................... ................... Treat finger

0046 32.5581 $1,776.40 $535.76 $355.28 fracture, each. 26770................ T.................... ................... Treat finger

0043 1.9074 $104.07 ........... $20.81 dislocation.

[[Page 63510]]

26775................ T.................... ................... Treat finger

0045 13.5889 $741.42 $268.47 $148.28 dislocation. 26776................ T.................... ................... Pin finger

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 26785................ T.................... ................... Treat finger

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 26820................ T.................... ................... Thumb fusion with

0054 24.2456 $1,322.86 ........... $264.57 graft. 26841................ T.................... ................... Fusion of thumb.....

0054 24.2456 $1,322.86 ........... $264.57 26842................ T.................... ................... Thumb fusion with

0054 24.2456 $1,322.86 ........... $264.57 graft. 26843................ T.................... ................... Fusion of hand joint

0054 24.2456 $1,322.86 ........... $264.57 26844................ T.................... ................... Fusion/graft of hand

0054 24.2456 $1,322.86 ........... $264.57 joint. 26850................ T.................... ................... Fusion of knuckle...

0054 24.2456 $1,322.86 ........... $264.57 26852................ T.................... ................... Fusion of knuckle

0054 24.2456 $1,322.86 ........... $264.57 with graft. 26860................ T.................... ................... Fusion of finger

0054 24.2456 $1,322.86 ........... $264.57 joint. 26861................ T.................... ................... Fusion of finger

0054 24.2456 $1,322.86 ........... $264.57 jnt, add-on. 26862................ T.................... ................... Fusion/graft of

0054 24.2456 $1,322.86 ........... $264.57 finger joint. 26863................ T.................... ................... Fuse/graft added

0054 24.2456 $1,322.86 ........... $264.57 joint. 26910................ T.................... ................... Amputate metacarpal

0054 24.2456 $1,322.86 ........... $264.57 bone. 26951................ T.................... ................... Amputation of finger/

0053 14.8831 $812.04 $253.49 $162.41 thumb. 26952................ T.................... ................... Amputation of finger/

0053 14.8831 $812.04 $253.49 $162.41 thumb. 26989................ T.................... ................... Hand/finger surgery.

0043 1.9074 $104.07 ........... $20.81 26990................ T.................... ................... Drainage of pelvis

0049 19.6046 $1,069.65 ........... $213.93 lesion. 26991................ T.................... ................... Drainage of pelvis

0049 19.6046 $1,069.65 ........... $213.93 bursa. 26992................ C.................... ................... Drainage of bone ........... ........... ........... ........... ........... lesion. 27000................ T.................... ................... Incision of hip

0049 19.6046 $1,069.65 ........... $213.93 tendon. 27001................ T.................... ................... Incision of hip

0050 24.8651 $1,356.66 ........... $271.33 tendon. 27003................ T.................... ................... Incision of hip

0050 24.8651 $1,356.66 ........... $271.33 tendon. 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

0051 34.5144 $1,883.14 ........... $376.63 joint. 27035................ T.................... ................... Denervation of hip

0052 42.7126 $2,330.44 ........... $466.09 joint. 27036................ C.................... ................... Excision of hip ........... ........... ........... ........... ........... joint/muscle. 27040................ T.................... ................... Biopsy of soft

0020 7.0842 $386.52 $113.25 $77.30 tissues. 27041................ T.................... ................... Biopsy of soft

0019 3.9493 $215.48 $71.87 $43.10 tissues. 27047................ T.................... ................... Remove hip/pelvis

0022 18.7932 $1,025.38 $354.45 $205.08 lesion. 27048................ T.................... ................... Remove hip/pelvis

0022 18.7932 $1,025.38 $354.45 $205.08 lesion. 27049................ T.................... ................... Remove tumor, hip/

0022 18.7932 $1,025.38 $354.45 $205.08 pelvis. 27050................ T.................... ................... Biopsy of sacroiliac

0049 19.6046 $1,069.65 ........... $213.93 joint. 27052................ T.................... ................... Biopsy of hip joint.

0049 19.6046 $1,069.65 ........... $213.93 27054................ C.................... ................... Removal of hip joint ........... ........... ........... ........... ........... lining. 27060................ T.................... ................... Removal of ischial

0049 19.6046 $1,069.65 ........... $213.93 bursa. 27062................ T.................... ................... Remove femur lesion/

0049 19.6046 $1,069.65 ........... $213.93 bursa. 27065................ T.................... ................... Removal of hip bone

0049 19.6046 $1,069.65 ........... $213.93 lesion. 27066................ T.................... ................... Removal of hip bone

0050 24.8651 $1,356.66 ........... $271.33 lesion. 27067................ T.................... ................... Remove/graft hip

0050 24.8651 $1,356.66 ........... $271.33 bone lesion. 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 24.8651 $1,356.66 ........... $271.33 27086................ T.................... ................... Remove hip foreign

0020 7.0842 $386.52 $113.25 $77.30 body. 27087................ T.................... ................... Remove hip foreign

0049 19.6046 $1,069.65 ........... $213.93 body. 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

0050 24.8651 $1,356.66 ........... $271.33 tendon. 27098................ T.................... ................... Transfer tendon to

0050 24.8651 $1,356.66 ........... $271.33 pelvis. 27100................ T.................... ................... Transfer of

0051 34.5144 $1,883.14 ........... $376.63 abdominal muscle. 27105................ T.................... ................... Transfer of spinal

0051 34.5144 $1,883.14 ........... $376.63 muscle. 27110................ T.................... ................... Transfer of

0051 34.5144 $1,883.14 ........... $376.63 iliopsoas muscle. 27111................ T.................... ................... Transfer of

0051 34.5144 $1,883.14 ........... $376.63 iliopsoas muscle. 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 ........... ........... ........... ........... ...........

[[Page 63511]]

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

0043 1.9074 $104.07 ........... $20.81 fracture. 27194................ T.................... ................... Treat pelvic ring

0045 13.5889 $741.42 $268.47 $148.28 fracture. 27200................ T.................... ................... Treat tail bone

0043 1.9074 $104.07 ........... $20.81 fracture. 27202................ T.................... ................... Treat tail bone

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 27215................ C.................... ................... Treat pelvic

........... ........... ........... ........... ........... fracture(s). 27216................ T.................... ................... Treat pelvic ring

0050 24.8651 $1,356.66 ........... $271.33 fracture. 27217................ C.................... ................... Treat pelvic ring ........... ........... ........... ........... ........... fracture. 27218................ C.................... ................... Treat pelvic ring ........... ........... ........... ........... ........... fracture. 27220................ T.................... ................... Treat hip socket

0043 1.9074 $104.07 ........... $20.81 fracture. 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 1.9074 $104.07 ........... $20.81 27232................ C.................... ................... Treat thigh fracture ........... ........... ........... ........... ........... 27235................ T.................... ................... Treat thigh fracture

0050 24.8651 $1,356.66 ........... $271.33 27236................ C.................... ................... Treat thigh fracture ........... ........... ........... ........... ........... 27238................ T.................... ................... Treat thigh fracture

0043 1.9074 $104.07 ........... $20.81 27240................ C.................... ................... Treat thigh fracture ........... ........... ........... ........... ........... 27244................ C.................... ................... Treat thigh fracture ........... ........... ........... ........... ........... 27245................ C.................... ................... Treat thigh fracture ........... ........... ........... ........... ........... 27246................ T.................... ................... Treat thigh fracture

0043 1.9074 $104.07 ........... $20.81 27248................ C.................... ................... Treat thigh fracture ........... ........... ........... ........... ........... 27250................ T.................... ................... Treat hip

0043 1.9074 $104.07 ........... $20.81 dislocation. 27252................ T.................... ................... Treat hip

0045 13.5889 $741.42 $268.47 $148.28 dislocation. 27253................ C.................... ................... Treat hip

........... ........... ........... ........... ........... dislocation. 27254................ C.................... ................... Treat hip

........... ........... ........... ........... ........... dislocation. 27256................ T.................... ................... Treat hip

0043 1.9074 $104.07 ........... $20.81 dislocation. 27257................ T.................... ................... Treat hip

0045 13.5889 $741.42 $268.47 $148.28 dislocation. 27258................ C.................... ................... Treat hip

........... ........... ........... ........... ........... dislocation. 27259................ C.................... ................... Treat hip

........... ........... ........... ........... ........... dislocation. 27265................ T.................... ................... Treat hip

0043 1.9074 $104.07 ........... $20.81 dislocation. 27266................ T.................... ................... Treat hip

0045 13.5889 $741.42 $268.47 $148.28 dislocation. 27275................ T.................... ................... Manipulation of hip

0045 13.5889 $741.42 $268.47 $148.28 joint. 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

0043 1.9074 $104.07 ........... $20.81 surgery. 27301................ T.................... ................... Drain thigh/knee

0008 19.4831 $1,063.02 ........... $212.60 lesion. 27303................ C.................... ................... Drainage of bone ........... ........... ........... ........... ........... lesion. 27305................ T.................... ................... Incise thigh tendon

0049 19.6046 $1,069.65 ........... $213.93 & fascia. 27306................ T.................... ................... Incision of thigh

0049 19.6046 $1,069.65 ........... $213.93 tendon. 27307................ T.................... ................... Incision of thigh

0049 19.6046 $1,069.65 ........... $213.93 tendons. 27310................ T.................... ................... Exploration of knee

0050 24.8651 $1,356.66 ........... $271.33 joint. 27315................ T.................... ................... Partial removal,

0220 16.5554 $903.28 ........... $180.66 thigh nerve. 27320................ T.................... ................... Partial removal,

0220 16.5554 $903.28 ........... $180.66 thigh nerve. 27323................ T.................... ................... Biopsy, thigh soft

0021 14.3594 $783.46 $219.48 $156.69 tissues. 27324................ T.................... ................... Biopsy, thigh soft

0022 18.7932 $1,025.38 $354.45 $205.08 tissues. 27327................ T.................... ................... Removal of thigh

0022 18.7932 $1,025.38 $354.45 $205.08 lesion. 27328................ T.................... ................... Removal of thigh

0022 18.7932 $1,025.38 $354.45 $205.08 lesion. 27329................ T.................... ................... Remove tumor, thigh/

0022 18.7932 $1,025.38 $354.45 $205.08 knee. 27330................ T.................... ................... Biopsy, knee joint

0050 24.8651 $1,356.66 ........... $271.33 lining. 27331................ T.................... ................... Explore/treat knee

0050 24.8651 $1,356.66 ........... $271.33 joint. 27332................ T.................... ................... Removal of knee

0050 24.8651 $1,356.66 ........... $271.33 cartilage. 27333................ T.................... ................... Removal of knee

0050 24.8651 $1,356.66 ........... $271.33 cartilage. 27334................ T.................... ................... Remove knee joint

0050 24.8651 $1,356.66 ........... $271.33 lining. 27335................ T.................... ................... Remove knee joint

0050 24.8651 $1,356.66 ........... $271.33 lining.

[[Page 63512]]

27340................ T.................... ................... Removal of kneecap

0049 19.6046 $1,069.65 ........... $213.93 bursa. 27345................ T.................... ................... Removal of knee cyst

0049 19.6046 $1,069.65 ........... $213.93 27347................ T.................... ................... Remove knee cyst....

0049 19.6046 $1,069.65 ........... $213.93 27350................ T.................... ................... Removal of kneecap..

0050 24.8651 $1,356.66 ........... $271.33 27355................ T.................... ................... Remove femur lesion.

0050 24.8651 $1,356.66 ........... $271.33 27356................ T.................... ................... Remove femur lesion/

0050 24.8651 $1,356.66 ........... $271.33 graft. 27357................ T.................... ................... Remove femur lesion/

0050 24.8651 $1,356.66 ........... $271.33 graft. 27358................ T.................... ................... Remove femur lesion/

0050 24.8651 $1,356.66 ........... $271.33 fixation. 27360................ T.................... ................... Partial removal, leg

0050 24.8651 $1,356.66 ........... $271.33 bone(s). 27365................ C.................... ................... Extensive leg

........... ........... ........... ........... ........... surgery. 27370................ N.................... ................... Injection for knee x- ........... ........... ........... ........... ........... ray. 27372................ T.................... ................... Removal of foreign

0022 18.7932 $1,025.38 $354.45 $205.08 body. 27380................ T.................... ................... Repair of kneecap

0049 19.6046 $1,069.65 ........... $213.93 tendon. 27381................ T.................... ................... Repair/graft kneecap

0049 19.6046 $1,069.65 ........... $213.93 tendon. 27385................ T.................... ................... Repair of thigh

0049 19.6046 $1,069.65 ........... $213.93 muscle. 27386................ T.................... ................... Repair/graft of

0049 19.6046 $1,069.65 ........... $213.93 thigh muscle. 27390................ T.................... ................... Incision of thigh

0049 19.6046 $1,069.65 ........... $213.93 tendon. 27391................ T.................... ................... Incision of thigh

0049 19.6046 $1,069.65 ........... $213.93 tendons. 27392................ T.................... ................... Incision of thigh

0049 19.6046 $1,069.65 ........... $213.93 tendons. 27393................ T.................... ................... Lengthening of thigh

0050 24.8651 $1,356.66 ........... $271.33 tendon. 27394................ T.................... ................... Lengthening of thigh

0050 24.8651 $1,356.66 ........... $271.33 tendons. 27395................ T.................... ................... Lengthening of thigh

0051 34.5144 $1,883.14 ........... $376.63 tendons. 27396................ T.................... ................... Transplant of thigh

0050 24.8651 $1,356.66 ........... $271.33 tendon. 27397................ T.................... ................... Transplants of thigh

0051 34.5144 $1,883.14 ........... $376.63 tendons. 27400................ T.................... ................... Revise thigh muscles/

0051 34.5144 $1,883.14 ........... $376.63 tendons. 27403................ T.................... ................... Repair of knee

0050 24.8651 $1,356.66 ........... $271.33 cartilage. 27405................ T.................... ................... Repair of knee

0051 34.5144 $1,883.14 ........... $376.63 ligament. 27407................ T.................... ................... Repair of knee

0051 34.5144 $1,883.14 ........... $376.63 ligament. 27409................ T.................... ................... Repair of knee

0051 34.5144 $1,883.14 ........... $376.63 ligaments. 27418................ T.................... ................... Repair degenerated

0051 34.5144 $1,883.14 ........... $376.63 kneecap. 27420................ T.................... ................... Revision of unstable

0051 34.5144 $1,883.14 ........... $376.63 kneecap. 27422................ T.................... ................... Revision of unstable

0051 34.5144 $1,883.14 ........... $376.63 kneecap. 27424................ T.................... ................... Revision/removal of

0051 34.5144 $1,883.14 ........... $376.63 kneecap. 27425................ T.................... ................... Lateral retinacular

0050 24.8651 $1,356.66 ........... $271.33 release. 27427................ T.................... ................... Reconstruction, knee

0052 42.7126 $2,330.44 ........... $466.09 27428................ T.................... ................... Reconstruction, knee

0052 42.7126 $2,330.44 ........... $466.09 27429................ T.................... ................... Reconstruction, knee

0052 42.7126 $2,330.44 ........... $466.09 27430................ T.................... ................... Revision of thigh

0051 34.5144 $1,883.14 ........... $376.63 muscles. 27435................ T.................... ................... Incision of knee

0051 34.5144 $1,883.14 ........... $376.63 joint. 27437................ T.................... ................... Revise kneecap......

0047 29.9582 $1,634.55 $537.03 $326.91 27438................ T.................... ................... Revise kneecap with

0048 51.4609 $2,807.76 $695.60 $561.55 implant. 27440................ T.................... ................... Revision of knee

0047 29.9582 $1,634.55 $537.03 $326.91 joint. 27441................ T.................... ................... Revision of knee

0047 29.9582 $1,634.55 $537.03 $326.91 joint. 27442................ T.................... ................... Revision of knee

0047 29.9582 $1,634.55 $537.03 $326.91 joint. 27443................ T.................... ................... Revision of knee

0047 29.9582 $1,634.55 $537.03 $326.91 joint. 27445................ C.................... ................... Revision of knee ........... ........... ........... ........... ........... joint. 27446................ T.................... ................... Revision of knee

0681 98.1613 $5,355.78 $2,131.36 $1,071.16 joint. 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................ C.................... ................... Surgery to stop leg ........... ........... ........... ........... ........... growth. 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

0049 19.6046 $1,069.65 ........... $213.93 thigh/knee. 27497................ T.................... ................... Decompression of

0049 19.6046 $1,069.65 ........... $213.93 thigh/knee. 27498................ T.................... ................... Decompression of

0049 19.6046 $1,069.65 ........... $213.93 thigh/knee. 27499................ T.................... ................... Decompression of

0049 19.6046 $1,069.65 ........... $213.93 thigh/knee. 27500................ T.................... ................... Treatment of thigh

0043 1.9074 $104.07 ........... $20.81 fracture. 27501................ T.................... ................... Treatment of thigh

0043 1.9074 $104.07 ........... $20.81 fracture. 27502................ T.................... ................... Treatment of thigh

0043 1.9074 $104.07 ........... $20.81 fracture. 27503................ T.................... ................... Treatment of thigh

0043 1.9074 $104.07 ........... $20.81 fracture. 27506................ C.................... ................... Treatment of thigh ........... ........... ........... ........... ........... fracture.

[[Page 63513]]

27507................ C.................... ................... Treatment of thigh ........... ........... ........... ........... ........... fracture. 27508................ T.................... ................... Treatment of thigh

0043 1.9074 $104.07 ........... $20.81 fracture. 27509................ T.................... ................... Treatment of thigh

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 27510................ T.................... ................... Treatment of thigh

0043 1.9074 $104.07 ........... $20.81 fracture. 27511................ C.................... ................... Treatment of thigh ........... ........... ........... ........... ........... fracture. 27513................ C.................... ................... Treatment of thigh ........... ........... ........... ........... ........... fracture. 27514................ C.................... ................... Treatment of thigh ........... ........... ........... ........... ........... fracture. 27516................ T.................... ................... Treat thigh fx

0043 1.9074 $104.07 ........... $20.81 growth plate. 27517................ T.................... ................... Treat thigh fx

0043 1.9074 $104.07 ........... $20.81 growth plate. 27519................ C.................... ................... Treat thigh fx

........... ........... ........... ........... ........... growth plate. 27520................ T.................... ................... Treat kneecap

0043 1.9074 $104.07 ........... $20.81 fracture. 27524................ T.................... ................... Treat kneecap

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 27530................ T.................... ................... Treat knee fracture.

0043 1.9074 $104.07 ........... $20.81 27532................ T.................... ................... Treat knee fracture.

0043 1.9074 $104.07 ........... $20.81 27535................ C.................... ................... Treat knee fracture. ........... ........... ........... ........... ........... 27536................ C.................... ................... Treat knee fracture. ........... ........... ........... ........... ........... 27538................ T.................... ................... Treat knee

0043 1.9074 $104.07 ........... $20.81 fracture(s). 27540................ C.................... ................... Treat knee fracture. ........... ........... ........... ........... ........... 27550................ T.................... ................... Treat knee

0043 1.9074 $104.07 ........... $20.81 dislocation. 27552................ T.................... ................... Treat knee

0045 13.5889 $741.42 $268.47 $148.28 dislocation. 27556................ C.................... ................... Treat knee

........... ........... ........... ........... ........... dislocation. 27557................ C.................... ................... Treat knee

........... ........... ........... ........... ........... dislocation. 27558................ C.................... ................... Treat knee

........... ........... ........... ........... ........... dislocation. 27560................ T.................... ................... Treat kneecap

0043 1.9074 $104.07 ........... $20.81 dislocation. 27562................ T.................... ................... Treat kneecap

0045 13.5889 $741.42 $268.47 $148.28 dislocation. 27566................ T.................... ................... Treat kneecap

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 27570................ T.................... ................... Fixation of knee

0045 13.5889 $741.42 $268.47 $148.28 joint. 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

0049 19.6046 $1,069.65 ........... $213.93 surgery. 27596................ C.................... ................... Amputation follow-up ........... ........... ........... ........... ........... surgery. 27598................ C.................... ................... Amputate lower leg ........... ........... ........... ........... ........... at knee. 27599................ T.................... ................... Leg surgery

0043 1.9074 $104.07 ........... $20.81 procedure. 27600................ T.................... ................... Decompression of

0049 19.6046 $1,069.65 ........... $213.93 lower leg. 27601................ T.................... ................... Decompression of

0049 19.6046 $1,069.65 ........... $213.93 lower leg. 27602................ T.................... ................... Decompression of

0049 19.6046 $1,069.65 ........... $213.93 lower leg. 27603................ T.................... ................... Drain lower leg

0007 11.8633 $647.27 ........... $129.45 lesion. 27604................ T.................... ................... Drain lower leg

0049 19.6046 $1,069.65 ........... $213.93 bursa. 27605................ T.................... ................... Incision of achilles

0055 18.7205 $1,021.41 $355.34 $204.28 tendon. 27606................ T.................... ................... Incision of achilles

0049 19.6046 $1,069.65 ........... $213.93 tendon. 27607................ T.................... ................... Treat lower leg bone

0049 19.6046 $1,069.65 ........... $213.93 lesion. 27610................ T.................... ................... Explore/treat ankle

0050 24.8651 $1,356.66 ........... $271.33 joint. 27612................ T.................... ................... Exploration of ankle

0050 24.8651 $1,356.66 ........... $271.33 joint. 27613................ T.................... ................... Biopsy lower leg

0020 7.0842 $386.52 $113.25 $77.30 soft tissue. 27614................ T.................... ................... Biopsy lower leg

0022 18.7932 $1,025.38 $354.45 $205.08 soft tissue. 27615................ T.................... ................... Remove tumor, lower

0046 32.5581 $1,776.40 $535.76 $355.28 leg. 27618................ T.................... ................... Remove lower leg

0021 14.3594 $783.46 $219.48 $156.69 lesion. 27619................ T.................... ................... Remove lower leg

0022 18.7932 $1,025.38 $354.45 $205.08 lesion. 27620................ T.................... ................... Explore/treat ankle

0050 24.8651 $1,356.66 ........... $271.33 joint. 27625................ T.................... ................... Remove ankle joint

0050 24.8651 $1,356.66 ........... $271.33 lining. 27626................ T.................... ................... Remove ankle joint

0050 24.8651 $1,356.66 ........... $271.33 lining. 27630................ T.................... ................... Removal of tendon

0049 19.6046 $1,069.65 ........... $213.93 lesion. 27635................ T.................... ................... Remove lower leg

0050 24.8651 $1,356.66 ........... $271.33 bone lesion. 27637................ T.................... ................... Remove/graft leg

0050 24.8651 $1,356.66 ........... $271.33 bone lesion. 27638................ T.................... ................... Remove/graft leg

0050 24.8651 $1,356.66 ........... $271.33 bone lesion. 27640................ T.................... ................... Partial removal of

0051 34.5144 $1,883.14 ........... $376.63 tibia. 27641................ T.................... ................... Partial removal of

0050 24.8651 $1,356.66 ........... $271.33 fibula. 27645................ C.................... ................... Extensive lower leg ........... ........... ........... ........... ........... surgery. 27646................ C.................... ................... Extensive lower leg ........... ........... ........... ........... ........... surgery. 27647................ T.................... ................... Extensive ankle/heel

0051 34.5144 $1,883.14 ........... $376.63 surgery. 27648................ N.................... ................... Injection for ankle ........... ........... ........... ........... ........... x-ray. 27650................ T.................... ................... Repair achilles

0051 34.5144 $1,883.14 ........... $376.63 tendon. 27652................ T.................... ................... Repair/graft

0051 34.5144 $1,883.14 ........... $376.63 achilles tendon. 27654................ T.................... ................... Repair of achilles

0051 34.5144 $1,883.14 ........... $376.63 tendon. 27656................ T.................... ................... Repair leg fascia

0049 19.6046 $1,069.65 ........... $213.93 defect. 27658................ T.................... ................... Repair of leg

0049 19.6046 $1,069.65 ........... $213.93 tendon, each. 27659................ T.................... ................... Repair of leg

0049 19.6046 $1,069.65 ........... $213.93 tendon, each. 27664................ T.................... ................... Repair of leg

0049 19.6046 $1,069.65 ........... $213.93 tendon, each. 27665................ T.................... ................... Repair of leg

0050 24.8651 $1,356.66 ........... $271.33 tendon, each. 27675................ T.................... ................... Repair lower leg

0049 19.6046 $1,069.65 ........... $213.93 tendons. 27676................ T.................... ................... Repair lower leg

0050 24.8651 $1,356.66 ........... $271.33 tendons. 27680................ T.................... ................... Release of lower leg

0050 24.8651 $1,356.66 ........... $271.33 tendon. 27681................ T.................... ................... Release of lower leg

0050 24.8651 $1,356.66 ........... $271.33 tendons.

[[Page 63514]]

27685................ T.................... ................... Revision of lower

0050 24.8651 $1,356.66 ........... $271.33 leg tendon. 27686................ T.................... ................... Revise lower leg

0050 24.8651 $1,356.66 ........... $271.33 tendons. 27687................ T.................... ................... Revision of calf

0050 24.8651 $1,356.66 ........... $271.33 tendon. 27690................ T.................... ................... Revise lower leg

0051 34.5144 $1,883.14 ........... $376.63 tendon. 27691................ T.................... ................... Revise lower leg

0051 34.5144 $1,883.14 ........... $376.63 tendon. 27692................ T.................... ................... Revise additional

0051 34.5144 $1,883.14 ........... $376.63 leg tendon. 27695................ T.................... ................... Repair of ankle

0050 24.8651 $1,356.66 ........... $271.33 ligament. 27696................ T.................... ................... Repair of ankle

0050 24.8651 $1,356.66 ........... $271.33 ligaments. 27698................ T.................... ................... Repair of ankle

0050 24.8651 $1,356.66 ........... $271.33 ligament. 27700................ T.................... ................... Revision of ankle

0047 29.9582 $1,634.55 $537.03 $326.91 joint. 27702................ C.................... ................... Reconstruct ankle ........... ........... ........... ........... ........... joint. 27703................ C.................... ................... Reconstruction, ........... ........... ........... ........... ........... ankle joint. 27704................ T.................... ................... Removal of ankle

0049 19.6046 $1,069.65 ........... $213.93 implant. 27705................ T.................... ................... Incision of tibia...

0051 34.5144 $1,883.14 ........... $376.63 27707................ T.................... ................... Incision of fibula..

0049 19.6046 $1,069.65 ........... $213.93 27709................ T.................... ................... Incision of tibia &

0050 24.8651 $1,356.66 ........... $271.33 fibula. 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

0050 24.8651 $1,356.66 ........... $271.33 epiphysis. 27732................ T.................... ................... Repair of fibula

0050 24.8651 $1,356.66 ........... $271.33 epiphysis. 27734................ T.................... ................... Repair lower leg

0050 24.8651 $1,356.66 ........... $271.33 epiphyses. 27740................ T.................... ................... Repair of leg

0050 24.8651 $1,356.66 ........... $271.33 epiphyses. 27742................ T.................... ................... Repair of leg

0051 34.5144 $1,883.14 ........... $376.63 epiphyses. 27745................ T.................... ................... Reinforce tibia.....

0051 34.5144 $1,883.14 ........... $376.63 27750................ T.................... ................... Treatment of tibia

0043 1.9074 $104.07 ........... $20.81 fracture. 27752................ T.................... ................... Treatment of tibia

0043 1.9074 $104.07 ........... $20.81 fracture. 27756................ T.................... ................... Treatment of tibia

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 27758................ T.................... ................... Treatment of tibia

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 27759................ T.................... ................... Treatment of tibia

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 27760................ T.................... ................... Treatment of ankle

0043 1.9074 $104.07 ........... $20.81 fracture. 27762................ T.................... ................... Treatment of ankle

0043 1.9074 $104.07 ........... $20.81 fracture. 27766................ T.................... ................... Treatment of ankle

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 27780................ T.................... ................... Treatment of fibula

0043 1.9074 $104.07 ........... $20.81 fracture. 27781................ T.................... ................... Treatment of fibula

0043 1.9074 $104.07 ........... $20.81 fracture. 27784................ T.................... ................... Treatment of fibula

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 27786................ T.................... ................... Treatment of ankle

0043 1.9074 $104.07 ........... $20.81 fracture. 27788................ T.................... ................... Treatment of ankle

0043 1.9074 $104.07 ........... $20.81 fracture. 27792................ T.................... ................... Treatment of ankle

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 27808................ T.................... ................... Treatment of ankle

0043 1.9074 $104.07 ........... $20.81 fracture. 27810................ T.................... ................... Treatment of ankle

0043 1.9074 $104.07 ........... $20.81 fracture. 27814................ T.................... ................... Treatment of ankle

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 27816................ T.................... ................... Treatment of ankle

0043 1.9074 $104.07 ........... $20.81 fracture. 27818................ T.................... ................... Treatment of ankle

0043 1.9074 $104.07 ........... $20.81 fracture. 27822................ T.................... ................... Treatment of ankle

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 27823................ T.................... ................... Treatment of ankle

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 27824................ T.................... ................... Treat lower leg

0043 1.9074 $104.07 ........... $20.81 fracture. 27825................ T.................... ................... Treat lower leg

0043 1.9074 $104.07 ........... $20.81 fracture. 27826................ T.................... ................... Treat lower leg

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 27827................ T.................... ................... Treat lower leg

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 27828................ T.................... ................... Treat lower leg

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 27829................ T.................... ................... Treat lower leg

0046 32.5581 $1,776.40 $535.76 $355.28 joint. 27830................ T.................... ................... Treat lower leg

0043 1.9074 $104.07 ........... $20.81 dislocation. 27831................ T.................... ................... Treat lower leg

0043 1.9074 $104.07 ........... $20.81 dislocation. 27832................ T.................... ................... Treat lower leg

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 27840................ T.................... ................... Treat ankle

0043 1.9074 $104.07 ........... $20.81 dislocation. 27842................ T.................... ................... Treat ankle

0045 13.5889 $741.42 $268.47 $148.28 dislocation. 27846................ T.................... ................... Treat ankle

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 27848................ T.................... ................... Treat ankle

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 27860................ T.................... ................... Fixation of ankle

0045 13.5889 $741.42 $268.47 $148.28 joint. 27870................ T.................... ................... Fusion of ankle

0051 34.5144 $1,883.14 ........... $376.63 joint. 27871................ T.................... ................... Fusion of

0051 34.5144 $1,883.14 ........... $376.63 tibiofibular joint. 27880................ C.................... ................... Amputation of lower ........... ........... ........... ........... ........... leg. 27881................ C.................... ................... Amputation of lower ........... ........... ........... ........... ........... leg. 27882................ C.................... ................... Amputation of lower ........... ........... ........... ........... ........... leg. 27884................ T.................... ................... Amputation follow-up

0049 19.6046 $1,069.65 ........... $213.93 surgery. 27886................ C.................... ................... Amputation follow-up ........... ........... ........... ........... ........... surgery. 27888................ C.................... ................... Amputation of foot ........... ........... ........... ........... ........... at ankle. 27889................ T.................... ................... Amputation of foot

0050 24.8651 $1,356.66 ........... $271.33 at ankle. 27892................ T.................... ................... Decompression of leg

0049 19.6046 $1,069.65 ........... $213.93 27893................ T.................... ................... Decompression of leg

0049 19.6046 $1,069.65 ........... $213.93

[[Page 63515]]

27894................ T.................... ................... Decompression of leg

0049 19.6046 $1,069.65 ........... $213.93 27899................ T.................... ................... Leg/ankle surgery

0043 1.9074 $104.07 ........... $20.81 procedure. 28001................ T.................... ................... Drainage of bursa of

0007 11.8633 $647.27 ........... $129.45 foot. 28002................ T.................... ................... Treatment of foot

0049 19.6046 $1,069.65 ........... $213.93 infection. 28003................ T.................... ................... Treatment of foot

0049 19.6046 $1,069.65 ........... $213.93 infection. 28005................ T.................... ................... Treat foot bone

0055 18.7205 $1,021.41 $355.34 $204.28 lesion. 28008................ T.................... ................... Incision of foot

0055 18.7205 $1,021.41 $355.34 $204.28 fascia. 28010................ T.................... ................... Incision of toe

0055 18.7205 $1,021.41 $355.34 $204.28 tendon. 28011................ T.................... ................... Incision of toe

0055 18.7205 $1,021.41 $355.34 $204.28 tendons. 28020................ T.................... ................... Exploration of foot

0055 18.7205 $1,021.41 $355.34 $204.28 joint. 28022................ T.................... ................... Exploration of foot

0055 18.7205 $1,021.41 $355.34 $204.28 joint. 28024................ T.................... ................... Exploration of toe

0055 18.7205 $1,021.41 $355.34 $204.28 joint. 28030................ T.................... ................... Removal of foot

0220 16.5554 $903.28 ........... $180.66 nerve. 28035................ T.................... ................... Decompression of

0220 16.5554 $903.28 ........... $180.66 tibia nerve. 28043................ T.................... ................... Excision of foot

0021 14.3594 $783.46 $219.48 $156.69 lesion. 28045................ T.................... ................... Excision of foot

0055 18.7205 $1,021.41 $355.34 $204.28 lesion. 28046................ T.................... ................... Resection of tumor,

0055 18.7205 $1,021.41 $355.34 $204.28 foot. 28050................ T.................... ................... Biopsy of foot joint

0055 18.7205 $1,021.41 $355.34 $204.28 lining. 28052................ T.................... ................... Biopsy of foot joint

0055 18.7205 $1,021.41 $355.34 $204.28 lining. 28054................ T.................... ................... Biopsy of toe joint

0055 18.7205 $1,021.41 $355.34 $204.28 lining. 28060................ T.................... ................... Partial removal,

0056 25.3930 $1,385.47 $405.81 $277.09 foot fascia. 28062................ T.................... ................... Removal of foot

0056 25.3930 $1,385.47 $405.81 $277.09 fascia. 28070................ T.................... ................... Removal of foot

0056 25.3930 $1,385.47 $405.81 $277.09 joint lining. 28072................ T.................... ................... Removal of foot

0056 25.3930 $1,385.47 $405.81 $277.09 joint lining. 28080................ T.................... ................... Removal of foot

0055 18.7205 $1,021.41 $355.34 $204.28 lesion. 28086................ T.................... ................... Excise foot tendon

0055 18.7205 $1,021.41 $355.34 $204.28 sheath. 28088................ T.................... ................... Excise foot tendon

0055 18.7205 $1,021.41 $355.34 $204.28 sheath. 28090................ T.................... ................... Removal of foot

0055 18.7205 $1,021.41 $355.34 $204.28 lesion. 28092................ T.................... ................... Removal of toe

0055 18.7205 $1,021.41 $355.34 $204.28 lesions. 28100................ T.................... ................... Removal of ankle/

0055 18.7205 $1,021.41 $355.34 $204.28 heel lesion. 28102................ T.................... ................... Remove/graft foot

0056 25.3930 $1,385.47 $405.81 $277.09 lesion. 28103................ T.................... ................... Remove/graft foot

0056 25.3930 $1,385.47 $405.81 $277.09 lesion. 28104................ T.................... ................... Removal of foot

0055 18.7205 $1,021.41 $355.34 $204.28 lesion. 28106................ T.................... ................... Remove/graft foot

0056 25.3930 $1,385.47 $405.81 $277.09 lesion. 28107................ T.................... ................... Remove/graft foot

0056 25.3930 $1,385.47 $405.81 $277.09 lesion. 28108................ T.................... ................... Removal of toe

0055 18.7205 $1,021.41 $355.34 $204.28 lesions. 28110................ T.................... ................... Part removal of

0056 25.3930 $1,385.47 $405.81 $277.09 metatarsal. 28111................ T.................... ................... Part removal of

0055 18.7205 $1,021.41 $355.34 $204.28 metatarsal. 28112................ T.................... ................... Part removal of

0055 18.7205 $1,021.41 $355.34 $204.28 metatarsal. 28113................ T.................... ................... Part removal of

0055 18.7205 $1,021.41 $355.34 $204.28 metatarsal. 28114................ T.................... ................... Removal of

0055 18.7205 $1,021.41 $355.34 $204.28 metatarsal heads. 28116................ T.................... ................... Revision of foot....

0055 18.7205 $1,021.41 $355.34 $204.28 28118................ T.................... ................... Removal of heel bone

0055 18.7205 $1,021.41 $355.34 $204.28 28119................ T.................... ................... Removal of heel spur

0055 18.7205 $1,021.41 $355.34 $204.28 28120................ T.................... ................... Part removal of

0055 18.7205 $1,021.41 $355.34 $204.28 ankle/heel. 28122................ T.................... ................... Partial removal of

0055 18.7205 $1,021.41 $355.34 $204.28 foot bone. 28124................ T.................... ................... Partial removal of

0055 18.7205 $1,021.41 $355.34 $204.28 toe. 28126................ T.................... ................... Partial removal of

0055 18.7205 $1,021.41 $355.34 $204.28 toe. 28130................ T.................... ................... Removal of ankle

0055 18.7205 $1,021.41 $355.34 $204.28 bone. 28140................ T.................... ................... Removal of

0055 18.7205 $1,021.41 $355.34 $204.28 metatarsal. 28150................ T.................... ................... Removal of toe......

0055 18.7205 $1,021.41 $355.34 $204.28 28153................ T.................... ................... Partial removal of

0055 18.7205 $1,021.41 $355.34 $204.28 toe. 28160................ T.................... ................... Partial removal of

0055 18.7205 $1,021.41 $355.34 $204.28 toe. 28171................ T.................... ................... Extensive foot

0055 18.7205 $1,021.41 $355.34 $204.28 surgery. 28173................ T.................... ................... Extensive foot

0055 18.7205 $1,021.41 $355.34 $204.28 surgery. 28175................ T.................... ................... Extensive foot

0055 18.7205 $1,021.41 $355.34 $204.28 surgery. 28190................ T.................... ................... Removal of foot

0019 3.9493 $215.48 $71.87 $43.10 foreign body. 28192................ T.................... ................... Removal of foot

0021 14.3594 $783.46 $219.48 $156.69 foreign body. 28193................ T.................... ................... Removal of foot

0020 7.0842 $386.52 $113.25 $77.30 foreign body. 28200................ T.................... ................... Repair of foot

0055 18.7205 $1,021.41 $355.34 $204.28 tendon. 28202................ T.................... ................... Repair/graft of foot

0056 25.3930 $1,385.47 $405.81 $277.09 tendon. 28208................ T.................... ................... Repair of foot

0055 18.7205 $1,021.41 $355.34 $204.28 tendon. 28210................ T.................... ................... Repair/graft of foot

0056 25.3930 $1,385.47 $405.81 $277.09 tendon. 28220................ T.................... ................... Release of foot

0055 18.7205 $1,021.41 $355.34 $204.28 tendon. 28222................ T.................... ................... Release of foot

0055 18.7205 $1,021.41 $355.34 $204.28 tendons. 28225................ T.................... ................... Release of foot

0055 18.7205 $1,021.41 $355.34 $204.28 tendon. 28226................ T.................... ................... Release of foot

0055 18.7205 $1,021.41 $355.34 $204.28 tendons. 28230................ T.................... ................... Incision of foot

0055 18.7205 $1,021.41 $355.34 $204.28 tendon(s). 28232................ T.................... ................... Incision of toe

0055 18.7205 $1,021.41 $355.34 $204.28 tendon. 28234................ T.................... ................... Incision of foot

0055 18.7205 $1,021.41 $355.34 $204.28 tendon. 28238................ T.................... ................... Revision of foot

0056 25.3930 $1,385.47 $405.81 $277.09 tendon. 28240................ T.................... ................... Release of big toe..

0055 18.7205 $1,021.41 $355.34 $204.28 28250................ T.................... ................... Revision of foot

0056 25.3930 $1,385.47 $405.81 $277.09 fascia. 28260................ T.................... ................... Release of midfoot

0056 25.3930 $1,385.47 $405.81 $277.09 joint. 28261................ T.................... ................... Revision of foot

0056 25.3930 $1,385.47 $405.81 $277.09 tendon.

[[Page 63516]]

28262................ T.................... ................... Revision of foot and

0056 25.3930 $1,385.47 $405.81 $277.09 ankle. 28264................ T.................... ................... Release of midfoot

0056 25.3930 $1,385.47 $405.81 $277.09 joint. 28270................ T.................... ................... Release of foot

0055 18.7205 $1,021.41 $355.34 $204.28 contracture. 28272................ T.................... ................... Release of toe

0055 18.7205 $1,021.41 $355.34 $204.28 joint, each. 28280................ T.................... ................... Fusion of toes......

0055 18.7205 $1,021.41 $355.34 $204.28 28285................ T.................... ................... Repair of hammertoe.

0055 18.7205 $1,021.41 $355.34 $204.28 28286................ T.................... ................... Repair of hammertoe.

0055 18.7205 $1,021.41 $355.34 $204.28 28288................ T.................... ................... Partial removal of

0056 25.3930 $1,385.47 $405.81 $277.09 foot bone. 28289................ T.................... ................... Repair hallux

0056 25.3930 $1,385.47 $405.81 $277.09 rigidus. 28290................ T.................... ................... Correction of bunion

0056 25.3930 $1,385.47 $405.81 $277.09 28292................ T.................... ................... Correction of bunion

0057 25.5035 $1,391.50 $475.91 $278.30 28293................ T.................... ................... Correction of bunion

0057 25.5035 $1,391.50 $475.91 $278.30 28294................ T.................... ................... Correction of bunion

0056 25.3930 $1,385.47 $405.81 $277.09 28296................ T.................... ................... Correction of bunion

0056 25.3930 $1,385.47 $405.81 $277.09 28297................ T.................... ................... Correction of bunion

0057 25.5035 $1,391.50 $475.91 $278.30 28298................ T.................... ................... Correction of bunion

0056 25.3930 $1,385.47 $405.81 $277.09 28299................ T.................... ................... Correction of bunion

0057 25.5035 $1,391.50 $475.91 $278.30 28300................ T.................... ................... Incision of heel

0056 25.3930 $1,385.47 $405.81 $277.09 bone. 28302................ T.................... ................... Incision of ankle

0056 25.3930 $1,385.47 $405.81 $277.09 bone. 28304................ T.................... ................... Incision of midfoot

0056 25.3930 $1,385.47 $405.81 $277.09 bones. 28305................ T.................... ................... Incise/graft midfoot

0056 25.3930 $1,385.47 $405.81 $277.09 bones. 28306................ T.................... ................... Incision of

0056 25.3930 $1,385.47 $405.81 $277.09 metatarsal. 28307................ T.................... ................... Incision of

0056 25.3930 $1,385.47 $405.81 $277.09 metatarsal. 28308................ T.................... ................... Incision of

0056 25.3930 $1,385.47 $405.81 $277.09 metatarsal. 28309................ T.................... ................... Incision of

0056 25.3930 $1,385.47 $405.81 $277.09 metatarsals. 28310................ T.................... ................... Revision of big toe.

0055 18.7205 $1,021.41 $355.34 $204.28 28312................ T.................... ................... Revision of toe.....

0055 18.7205 $1,021.41 $355.34 $204.28 28313................ T.................... ................... Repair deformity of

0055 18.7205 $1,021.41 $355.34 $204.28 toe. 28315................ T.................... ................... Removal of sesamoid

0055 18.7205 $1,021.41 $355.34 $204.28 bone. 28320................ T.................... ................... Repair of foot bones

0056 25.3930 $1,385.47 $405.81 $277.09 28322................ T.................... ................... Repair of

0056 25.3930 $1,385.47 $405.81 $277.09 metatarsals. 28340................ T.................... ................... Resect enlarged toe

0055 18.7205 $1,021.41 $355.34 $204.28 tissue. 28341................ T.................... ................... Resect enlarged toe.

0055 18.7205 $1,021.41 $355.34 $204.28 28344................ T.................... ................... Repair extra toe(s).

0056 25.3930 $1,385.47 $405.81 $277.09 28345................ T.................... ................... Repair webbed toe(s)

0056 25.3930 $1,385.47 $405.81 $277.09 28360................ T.................... ................... Reconstruct cleft

0056 25.3930 $1,385.47 $405.81 $277.09 foot. 28400................ T.................... ................... Treatment of heel

0043 1.9074 $104.07 ........... $20.81 fracture. 28405................ T.................... ................... Treatment of heel

0043 1.9074 $104.07 ........... $20.81 fracture. 28406................ T.................... ................... Treatment of heel

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 28415................ T.................... ................... Treat heel fracture.

0046 32.5581 $1,776.40 $535.76 $355.28 28420................ T.................... ................... Treat/graft heel

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 28430................ T.................... ................... Treatment of ankle

0043 1.9074 $104.07 ........... $20.81 fracture. 28435................ T.................... ................... Treatment of ankle

0043 1.9074 $104.07 ........... $20.81 fracture. 28436................ T.................... ................... Treatment of ankle

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 28445................ T.................... ................... Treat ankle fracture

0046 32.5581 $1,776.40 $535.76 $355.28 28450................ T.................... ................... Treat midfoot

0043 1.9074 $104.07 ........... $20.81 fracture, each. 28455................ T.................... ................... Treat midfoot

0043 1.9074 $104.07 ........... $20.81 fracture, each. 28456................ T.................... ................... Treat midfoot

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 28465................ T.................... ................... Treat midfoot

0046 32.5581 $1,776.40 $535.76 $355.28 fracture, each. 28470................ T.................... ................... Treat metatarsal

0043 1.9074 $104.07 ........... $20.81 fracture. 28475................ T.................... ................... Treat metatarsal

0043 1.9074 $104.07 ........... $20.81 fracture. 28476................ T.................... ................... Treat metatarsal

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 28485................ T.................... ................... Treat metatarsal

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 28490................ T.................... ................... Treat big toe

0043 1.9074 $104.07 ........... $20.81 fracture. 28495................ T.................... ................... Treat big toe

0043 1.9074 $104.07 ........... $20.81 fracture. 28496................ T.................... ................... Treat big toe

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 28505................ T.................... ................... Treat big toe

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 28510................ T.................... ................... Treatment of toe

0043 1.9074 $104.07 ........... $20.81 fracture. 28515................ T.................... ................... Treatment of toe

0043 1.9074 $104.07 ........... $20.81 fracture. 28525................ T.................... ................... Treat toe fracture..

0046 32.5581 $1,776.40 $535.76 $355.28 28530................ T.................... ................... Treat sesamoid bone

0043 1.9074 $104.07 ........... $20.81 fracture. 28531................ T.................... ................... Treat sesamoid bone

0046 32.5581 $1,776.40 $535.76 $355.28 fracture. 28540................ T.................... ................... Treat foot

0043 1.9074 $104.07 ........... $20.81 dislocation. 28545................ T.................... ................... Treat foot

0045 13.5889 $741.42 $268.47 $148.28 dislocation. 28546................ T.................... ................... Treat foot

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 28555................ T.................... ................... Repair foot

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 28570................ T.................... ................... Treat foot

0043 1.9074 $104.07 ........... $20.81 dislocation. 28575................ T.................... ................... Treat foot

0043 1.9074 $104.07 ........... $20.81 dislocation. 28576................ T.................... ................... Treat foot

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 28585................ T.................... ................... Repair foot

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 28600................ T.................... ................... Treat foot

0043 1.9074 $104.07 ........... $20.81 dislocation. 28605................ T.................... ................... Treat foot

0043 1.9074 $104.07 ........... $20.81 dislocation. 28606................ T.................... ................... Treat foot

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 28615................ T.................... ................... Repair foot

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 28630................ T.................... ................... Treat toe

0043 1.9074 $104.07 ........... $20.81 dislocation.

[[Page 63517]]

28635................ T.................... ................... Treat toe

0045 13.5889 $741.42 $268.47 $148.28 dislocation. 28636................ T.................... ................... Treat toe

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 28645................ T.................... ................... Repair toe

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 28660................ T.................... ................... Treat toe

0043 1.9074 $104.07 ........... $20.81 dislocation. 28665................ T.................... ................... Treat toe

0045 13.5889 $741.42 $268.47 $148.28 dislocation. 28666................ T.................... ................... Treat toe

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 28675................ T.................... ................... Repair of toe

0046 32.5581 $1,776.40 $535.76 $355.28 dislocation. 28705................ T.................... ................... Fusion of foot bones

0056 25.3930 $1,385.47 $405.81 $277.09 28715................ T.................... ................... Fusion of foot bones

0056 25.3930 $1,385.47 $405.81 $277.09 28725................ T.................... ................... Fusion of foot bones

0056 25.3930 $1,385.47 $405.81 $277.09 28730................ T.................... ................... Fusion of foot bones

0056 25.3930 $1,385.47 $405.81 $277.09 28735................ T.................... ................... Fusion of foot bones

0056 25.3930 $1,385.47 $405.81 $277.09 28737................ T.................... ................... Revision of foot

0056 25.3930 $1,385.47 $405.81 $277.09 bones. 28740................ T.................... ................... Fusion of foot bones

0056 25.3930 $1,385.47 $405.81 $277.09 28750................ T.................... ................... Fusion of big toe

0056 25.3930 $1,385.47 $405.81 $277.09 joint. 28755................ T.................... ................... Fusion of big toe

0055 18.7205 $1,021.41 $355.34 $204.28 joint. 28760................ T.................... ................... Fusion of big toe

0056 25.3930 $1,385.47 $405.81 $277.09 joint. 28800................ C.................... ................... Amputation of

........... ........... ........... ........... ........... midfoot. 28805................ C.................... ................... Amputation thru ........... ........... ........... ........... ........... metatarsal. 28810................ T.................... ................... Amputation toe &

0055 18.7205 $1,021.41 $355.34 $204.28 metatarsal. 28820................ T.................... ................... Amputation of toe...

0055 18.7205 $1,021.41 $355.34 $204.28 28825................ T.................... ................... Partial amputation

0055 18.7205 $1,021.41 $355.34 $204.28 of toe. 28899................ T.................... ................... Foot/toes surgery

0043 1.9074 $104.07 ........... $20.81 procedure. 29000................ S.................... ................... Application of body

0058 1.0931 $59.64 ........... $11.93 cast. 29010................ S.................... ................... Application of body

0058 1.0931 $59.64 ........... $11.93 cast. 29015................ S.................... ................... Application of body

0058 1.0931 $59.64 ........... $11.93 cast. 29020................ S.................... ................... Application of body

0058 1.0931 $59.64 ........... $11.93 cast. 29025................ S.................... ................... Application of body

0058 1.0931 $59.64 ........... $11.93 cast. 29035................ S.................... ................... Application of body

0058 1.0931 $59.64 ........... $11.93 cast. 29040................ S.................... ................... Application of body

0058 1.0931 $59.64 ........... $11.93 cast. 29044................ S.................... ................... Application of body

0058 1.0931 $59.64 ........... $11.93 cast. 29046................ S.................... ................... Application of body

0058 1.0931 $59.64 ........... $11.93 cast. 29049................ S.................... ................... Application of

0058 1.0931 $59.64 ........... $11.93 figure eight. 29055................ S.................... ................... Application of

0058 1.0931 $59.64 ........... $11.93 shoulder cast. 29058................ S.................... ................... Application of

0058 1.0931 $59.64 ........... $11.93 shoulder cast. 29065................ S.................... ................... Application of long

0058 1.0931 $59.64 ........... $11.93 arm cast. 29075................ S.................... ................... Application of

0058 1.0931 $59.64 ........... $11.93 forearm cast. 29085................ S.................... ................... Apply hand/wrist

0058 1.0931 $59.64 ........... $11.93 cast. 29086................ S.................... ................... Apply finger cast...

0058 1.0931 $59.64 ........... $11.93 29105................ S.................... ................... Apply long arm

0058 1.0931 $59.64 ........... $11.93 splint. 29125................ S.................... ................... Apply forearm splint

0058 1.0931 $59.64 ........... $11.93 29126................ S.................... ................... Apply forearm splint

0058 1.0931 $59.64 ........... $11.93 29130................ S.................... ................... Application of

0058 1.0931 $59.64 ........... $11.93 finger splint. 29131................ S.................... ................... Application of

0058 1.0931 $59.64 ........... $11.93 finger splint. 29200................ S.................... ................... Strapping of chest..

0058 1.0931 $59.64 ........... $11.93 29220................ S.................... ................... Strapping of low

0058 1.0931 $59.64 ........... $11.93 back. 29240................ S.................... ................... Strapping of

0058 1.0931 $59.64 ........... $11.93 shoulder. 29260................ S.................... ................... Strapping of elbow

0058 1.0931 $59.64 ........... $11.93 or wrist. 29280................ S.................... ................... Strapping of hand or

0058 1.0931 $59.64 ........... $11.93 finger. 29305................ S.................... ................... Application of hip

0058 1.0931 $59.64 ........... $11.93 cast. 29325................ S.................... ................... Application of hip

0058 1.0931 $59.64 ........... $11.93 casts. 29345................ S.................... ................... Application of long

0058 1.0931 $59.64 ........... $11.93 leg cast. 29355................ S.................... ................... Application of long

0058 1.0931 $59.64 ........... $11.93 leg cast. 29358................ S.................... ................... Apply long leg cast

0058 1.0931 $59.64 ........... $11.93 brace. 29365................ S.................... ................... Application of long

0058 1.0931 $59.64 ........... $11.93 leg cast. 29405................ S.................... ................... Apply short leg cast

0058 1.0931 $59.64 ........... $11.93 29425................ S.................... ................... Apply short leg cast

0058 1.0931 $59.64 ........... $11.93 29435................ S.................... ................... Apply short leg cast

0058 1.0931 $59.64 ........... $11.93 29440................ S.................... ................... Addition of walker

0058 1.0931 $59.64 ........... $11.93 to cast. 29445................ S.................... ................... Apply rigid leg cast

0058 1.0931 $59.64 ........... $11.93 29450................ S.................... ................... Application of leg

0058 1.0931 $59.64 ........... $11.93 cast. 29505................ S.................... ................... Application, long

0058 1.0931 $59.64 ........... $11.93 leg splint. 29515................ S.................... ................... Application lower

0058 1.0931 $59.64 ........... $11.93 leg splint. 29520................ S.................... ................... Strapping of hip....

0058 1.0931 $59.64 ........... $11.93 29530................ S.................... ................... Strapping of knee...

0058 1.0931 $59.64 ........... $11.93 29540................ S.................... ................... Strapping of ankle..

0058 1.0931 $59.64 ........... $11.93 29550................ S.................... ................... Strapping of toes...

0058 1.0931 $59.64 ........... $11.93 29580................ S.................... ................... Application of paste

0058 1.0931 $59.64 ........... $11.93 boot. 29590................ S.................... ................... Application of foot

0058 1.0931 $59.64 ........... $11.93 splint. 29700................ S.................... ................... Removal/revision of

0058 1.0931 $59.64 ........... $11.93 cast. 29705................ S.................... ................... Removal/revision of

0058 1.0931 $59.64 ........... $11.93 cast. 29710................ S.................... ................... Removal/revision of

0058 1.0931 $59.64 ........... $11.93 cast. 29715................ S.................... ................... Removal/revision of

0058 1.0931 $59.64 ........... $11.93 cast. 29720................ S.................... ................... Repair of body cast.

0058 1.0931 $59.64 ........... $11.93 29730................ S.................... ................... Windowing of cast...

0058 1.0931 $59.64 ........... $11.93

[[Page 63518]]

29740................ S.................... ................... Wedging of cast.....

0058 1.0931 $59.64 ........... $11.93 29750................ S.................... ................... Wedging of clubfoot

0058 1.0931 $59.64 ........... $11.93 cast. 29799................ S.................... ................... Casting/strapping

0058 1.0931 $59.64 ........... $11.93 procedure. 29800................ T.................... ................... Jaw arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29804................ T.................... ................... Jaw arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29805................ T.................... ................... Shoulder

0041 27.3819 $1,493.98 ........... $298.80 arthroscopy, dx. 29806................ T.................... ................... Shoulder arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29807................ T.................... ................... Shoulder arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29819................ T.................... ................... Shoulder arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29820................ T.................... ................... Shoulder arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29821................ T.................... ................... Shoulder arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29822................ T.................... ................... Shoulder arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29823................ T.................... ................... Shoulder arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29824................ T.................... ................... Shoulder arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29825................ T.................... ................... Shoulder arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29826................ T.................... ................... Shoulder arthroscopy/

0042 43.0808 $2,350.53 $804.74 $470.11 surgery. 29827................ T.................... ................... Arthroscop rotator

0041 27.3819 $1,493.98 ........... $298.80 cuff repr. 29830................ T.................... ................... Elbow arthroscopy...

0041 27.3819 $1,493.98 ........... $298.80 29834................ T.................... ................... Elbow arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29835................ T.................... ................... Elbow arthroscopy/

0042 43.0808 $2,350.53 $804.74 $470.11 surgery. 29836................ T.................... ................... Elbow arthroscopy/

0042 43.0808 $2,350.53 $804.74 $470.11 surgery. 29837................ T.................... ................... Elbow arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29838................ T.................... ................... Elbow arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29840................ T.................... ................... Wrist arthroscopy...

0041 27.3819 $1,493.98 ........... $298.80 29843................ T.................... ................... Wrist arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29844................ T.................... ................... Wrist arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29845................ T.................... ................... Wrist arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29846................ T.................... ................... Wrist arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29847................ T.................... ................... Wrist arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29848................ T.................... ................... Wrist endoscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29850................ T.................... ................... Knee arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29851................ T.................... ................... Knee arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29855................ T.................... ................... Tibial arthroscopy/

0042 43.0808 $2,350.53 $804.74 $470.11 surgery. 29856................ T.................... ................... Tibial arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29860................ T.................... ................... Hip arthroscopy, dx.

0041 27.3819 $1,493.98 ........... $298.80 29861................ T.................... ................... Hip arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29862................ T.................... ................... Hip arthroscopy/

0042 43.0808 $2,350.53 $804.74 $470.11 surgery. 29863................ T.................... ................... Hip arthroscopy/

0042 43.0808 $2,350.53 $804.74 $470.11 surgery. 29870................ T.................... ................... Knee arthroscopy, dx

0041 27.3819 $1,493.98 ........... $298.80 29871................ T.................... ................... Knee arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 drainage. 29873................ T.................... ................... Knee arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29874................ T.................... ................... Knee arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29875................ T.................... ................... Knee arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29876................ T.................... ................... Knee arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29877................ T.................... ................... Knee arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29879................ T.................... ................... Knee arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29880................ T.................... ................... Knee arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29881................ T.................... ................... Knee arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29882................ T.................... ................... Knee arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29883................ T.................... ................... Knee arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29884................ T.................... ................... Knee arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29885................ T.................... ................... Knee arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29886................ T.................... ................... Knee arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29887................ T.................... ................... Knee arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29888................ T.................... ................... Knee arthroscopy/

0042 43.0808 $2,350.53 $804.74 $470.11 surgery. 29889................ T.................... ................... Knee arthroscopy/

0042 43.0808 $2,350.53 $804.74 $470.11 surgery. 29891................ T.................... ................... Ankle arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29892................ T.................... ................... Ankle arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29893................ T.................... ................... Scope, plantar

0055 18.7205 $1,021.41 $355.34 $204.28 fasciotomy. 29894................ T.................... ................... Ankle arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29895................ T.................... ................... Ankle arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29897................ T.................... ................... Ankle arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29898................ T.................... ................... Ankle arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29899................ T.................... ................... Ankle arthroscopy/

0041 27.3819 $1,493.98 ........... $298.80 surgery. 29900................ T.................... ................... Mcp joint

0053 14.8831 $812.04 $253.49 $162.41 arthroscopy, dx. 29901................ T.................... ................... Mcp joint

0053 14.8831 $812.04 $253.49 $162.41 arthroscopy, surg. 29902................ T.................... ................... Mcp joint

0053 14.8831 $812.04 $253.49 $162.41 arthroscopy, surg. 29999................ T.................... ................... Arthroscopy of joint

0041 27.3819 $1,493.98 ........... $298.80 30000................ T.................... ................... Drainage of nose

0251 1.7880 $97.56 ........... $19.51 lesion. 30020................ T.................... ................... Drainage of nose

0251 1.7880 $97.56 ........... $19.51 lesion. 30100................ T.................... ................... Intranasal biopsy...

0252 6.4469 $351.75 $113.41 $70.35 30110................ T.................... ................... Removal of nose

0253 15.2249 $830.69 $282.29 $166.14 polyp(s). 30115................ T.................... ................... Removal of nose

0253 15.2249 $830.69 $282.29 $166.14 polyp(s). 30117................ T.................... ................... Removal of

0253 15.2249 $830.69 $282.29 $166.14 intranasal lesion. 30118................ T.................... ................... Removal of

0254 21.8901 $1,194.35 $321.35 $238.87 intranasal lesion.

[[Page 63519]]

30120................ T.................... ................... Revision of nose....

0253 15.2249 $830.69 $282.29 $166.14 30124................ T.................... ................... Removal of nose

0252 6.4469 $351.75 $113.41 $70.35 lesion. 30125................ T.................... ................... Removal of nose

0256 35.1548 $1,918.08 ........... $383.62 lesion. 30130................ T.................... ................... Removal of turbinate

0253 15.2249 $830.69 $282.29 $166.14 bones. 30140................ T.................... ................... Removal of turbinate

0254 21.8901 $1,194.35 $321.35 $238.87 bones. 30150................ T.................... ................... Partial removal of

0256 35.1548 $1,918.08 ........... $383.62 nose. 30160................ T.................... ................... Removal of nose.....

0256 35.1548 $1,918.08 ........... $383.62 30200................ T.................... ................... Injection treatment

0253 15.2249 $830.69 $282.29 $166.14 of nose. 30210................ T.................... ................... Nasal sinus therapy.

0252 6.4469 $351.75 $113.41 $70.35 30220................ T.................... ................... Insert nasal septal

0252 6.4469 $351.75 $113.41 $70.35 button. 30300................ X.................... ................... Remove nasal foreign

0340 0.6314 $34.45 ...........

$6.89 body. 30310................ T.................... ................... Remove nasal foreign

0253 15.2249 $830.69 $282.29 $166.14 body. 30320................ T.................... ................... Remove nasal foreign

0253 15.2249 $830.69 $282.29 $166.14 body. 30400................ T.................... ................... Reconstruction of

0256 35.1548 $1,918.08 ........... $383.62 nose. 30410................ T.................... ................... Reconstruction of

0256 35.1548 $1,918.08 ........... $383.62 nose. 30420................ T.................... ................... Reconstruction of

0256 35.1548 $1,918.08 ........... $383.62 nose. 30430................ T.................... ................... Revision of nose....

0254 21.8901 $1,194.35 $321.35 $238.87 30435................ T.................... ................... Revision of nose....

0256 35.1548 $1,918.08 ........... $383.62 30450................ T.................... ................... Revision of nose....

0256 35.1548 $1,918.08 ........... $383.62 30460................ T.................... ................... Revision of nose....

0256 35.1548 $1,918.08 ........... $383.62 30462................ T.................... ................... Revision of nose....

0256 35.1548 $1,918.08 ........... $383.62 30465................ T.................... ................... Repair nasal

0256 35.1548 $1,918.08 ........... $383.62 stenosis. 30520................ T.................... ................... Repair of nasal

0254 21.8901 $1,194.35 $321.35 $238.87 septum. 30540................ T.................... ................... Repair nasal defect.

0256 35.1548 $1,918.08 ........... $383.62 30545................ T.................... ................... Repair nasal defect.

0256 35.1548 $1,918.08 ........... $383.62 30560................ T.................... ................... Release of nasal

0251 1.7880 $97.56 ........... $19.51 adhesions. 30580................ T.................... ................... Repair upper jaw

0256 35.1548 $1,918.08 ........... $383.62 fistula. 30600................ T.................... ................... Repair mouth/nose

0256 35.1548 $1,918.08 ........... $383.62 fistula. 30620................ T.................... ................... Intranasal

0256 35.1548 $1,918.08 ........... $383.62 reconstruction. 30630................ T.................... ................... Repair nasal septum

0254 21.8901 $1,194.35 $321.35 $238.87 defect. 30801................ T.................... ................... Cauterization, inner

0252 6.4469 $351.75 $113.41 $70.35 nose. 30802................ T.................... ................... Cauterization, inner

0253 15.2249 $830.69 $282.29 $166.14 nose. 30901................ T.................... ................... Control of nosebleed

0250 1.4697 $80.19 $28.07 $16.04 30903................ T.................... ................... Control of nosebleed

0250 1.4697 $80.19 $28.07 $16.04 30905................ T.................... ................... Control of nosebleed

0250 1.4697 $80.19 $28.07 $16.04 30906................ T.................... ................... Repeat control of

0250 1.4697 $80.19 $28.07 $16.04 nosebleed. 30915................ T.................... ................... Ligation, nasal

0091 28.8326 $1,573.14 $348.23 $314.63 sinus artery. 30920................ T.................... ................... Ligation, upper jaw

0092 25.0959 $1,369.26 $505.37 $273.85 artery. 30930................ T.................... ................... Therapy, fracture of

0253 15.2249 $830.69 $282.29 $166.14 nose. 30999................ T.................... ................... Nasal surgery

0251 1.7880 $97.56 ........... $19.51 procedure. 31000................ T.................... ................... Irrigation,

0251 1.7880 $97.56 ........... $19.51 maxillary sinus. 31002................ T.................... ................... Irrigation, sphenoid

0252 6.4469 $351.75 $113.41 $70.35 sinus. 31020................ T.................... ................... Exploration,

0254 21.8901 $1,194.35 $321.35 $238.87 maxillary sinus. 31030................ T.................... ................... Exploration,

0256 35.1548 $1,918.08 ........... $383.62 maxillary sinus. 31032................ T.................... ................... Explore sinus,

0256 35.1548 $1,918.08 ........... $383.62 remove polyps. 31040................ T.................... ................... Exploration behind

0254 21.8901 $1,194.35 $321.35 $238.87 upper jaw. 31050................ T.................... ................... Exploration,

0256 35.1548 $1,918.08 ........... $383.62 sphenoid sinus. 31051................ T.................... ................... Sphenoid sinus

0256 35.1548 $1,918.08 ........... $383.62 surgery. 31070................ T.................... ................... Exploration of

0254 21.8901 $1,194.35 $321.35 $238.87 frontal sinus. 31075................ T.................... ................... Exploration of

0256 35.1548 $1,918.08 ........... $383.62 frontal sinus. 31080................ T.................... ................... Removal of frontal

0256 35.1548 $1,918.08 ........... $383.62 sinus. 31081................ T.................... ................... Removal of frontal

0256 35.1548 $1,918.08 ........... $383.62 sinus. 31084................ T.................... ................... Removal of frontal

0256 35.1548 $1,918.08 ........... $383.62 sinus. 31085................ T.................... ................... Removal of frontal

0256 35.1548 $1,918.08 ........... $383.62 sinus. 31086................ T.................... ................... Removal of frontal

0256 35.1548 $1,918.08 ........... $383.62 sinus. 31087................ T.................... ................... Removal of frontal

0256 35.1548 $1,918.08 ........... $383.62 sinus. 31090................ T.................... ................... Exploration of

0256 35.1548 $1,918.08 ........... $383.62 sinuses. 31200................ T.................... ................... Removal of ethmoid

0256 35.1548 $1,918.08 ........... $383.62 sinus. 31201................ T.................... ................... Removal of ethmoid

0256 35.1548 $1,918.08 ........... $383.62 sinus. 31205................ T.................... ................... Removal of ethmoid

0256 35.1548 $1,918.08 ........... $383.62 sinus. 31225................ C.................... ................... Removal of upper jaw ........... ........... ........... ........... ........... 31230................ C.................... ................... Removal of upper jaw ........... ........... ........... ........... ........... 31231................ T.................... ................... Nasal endoscopy, dx.

0071 0.8799 $48.01 $12.89

$9.60 31233................ T.................... ................... Nasal/sinus

0072 1.7613 $96.10 $26.68 $19.22 endoscopy, dx. 31235................ T.................... ................... Nasal/sinus

0074 13.9480 $761.02 $295.70 $152.20 endoscopy, dx. 31237................ T.................... ................... Nasal/sinus

0075 20.3815 $1,112.04 $445.92 $222.41 endoscopy, surg. 31238................ T.................... ................... Nasal/sinus

0074 13.9480 $761.02 $295.70 $152.20 endoscopy, surg. 31239................ T.................... ................... Nasal/sinus

0075 20.3815 $1,112.04 $445.92 $222.41 endoscopy, surg. 31240................ T.................... ................... Nasal/sinus

0074 13.9480 $761.02 $295.70 $152.20 endoscopy, surg. 31254................ T.................... ................... Revision of ethmoid

0075 20.3815 $1,112.04 $445.92 $222.41 sinus. 31255................ T.................... ................... Removal of ethmoid

0075 20.3815 $1,112.04 $445.92 $222.41 sinus. 31256................ T.................... ................... Exploration

0075 20.3815 $1,112.04 $445.92 $222.41 maxillary sinus. 31267................ T.................... ................... Endoscopy, maxillary

0075 20.3815 $1,112.04 $445.92 $222.41 sinus. 31276................ T.................... ................... Sinus endoscopy,

0075 20.3815 $1,112.04 $445.92 $222.41 surgical. 31287................ T.................... ................... Nasal/sinus

0075 20.3815 $1,112.04 $445.92 $222.41 endoscopy, surg.

[[Page 63520]]

31288................ T.................... ................... Nasal/sinus

0075 20.3815 $1,112.04 $445.92 $222.41 endoscopy, surg. 31290................ C.................... ................... Nasal/sinus

........... ........... ........... ........... ........... endoscopy, surg. 31291................ C.................... ................... Nasal/sinus

........... ........... ........... ........... ........... endoscopy, surg. 31292................ C.................... ................... Nasal/sinus

........... ........... ........... ........... ........... endoscopy, surg. 31293................ C.................... ................... Nasal/sinus

........... ........... ........... ........... ........... endoscopy, surg. 31294................ C.................... ................... Nasal/sinus

........... ........... ........... ........... ........... endoscopy, surg. 31299................ T.................... ................... Sinus surgery

0252 6.4469 $351.75 $113.41 $70.35 procedure. 31300................ T.................... ................... Removal of larynx

0254 21.8901 $1,194.35 $321.35 $238.87 lesion. 31320................ T.................... ................... Diagnostic incision,

0256 35.1548 $1,918.08 ........... $383.62 larynx. 31360................ C.................... ................... Removal of larynx... ........... ........... ........... ........... ........... 31365................ C.................... ................... Removal of larynx... ........... ........... ........... ........... ........... 31367................ C.................... ................... Partial removal of ........... ........... ........... ........... ........... larynx. 31368................ C.................... ................... Partial removal of ........... ........... ........... ........... ........... larynx. 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 35.1548 $1,918.08 ........... $383.62 31420................ T.................... ................... Removal of

0256 35.1548 $1,918.08 ........... $383.62 epiglottis. 31500................ S.................... ................... Insert emergency

0094 2.6345 $143.74 $48.58 $28.75 airway. 31502................ T.................... ................... Change of windpipe

0121 2.1189 $115.61 $43.80 $23.12 airway. 31505................ T.................... ................... Diagnostic

0071 0.8799 $48.01 $12.89

$9.60 laryngoscopy. 31510................ T.................... ................... Laryngoscopy with

0074 13.9480 $761.02 $295.70 $152.20 biopsy. 31511................ T.................... ................... Remove foreign body,

0072 1.7613 $96.10 $26.68 $19.22 larynx. 31512................ T.................... ................... Removal of larynx

0074 13.9480 $761.02 $295.70 $152.20 lesion. 31513................ T.................... ................... Injection into vocal

0072 1.7613 $96.10 $26.68 $19.22 cord. 31515................ T.................... ................... Laryngoscopy for

0074 13.9480 $761.02 $295.70 $152.20 aspiration. 31520................ T.................... ................... Diagnostic

0072 1.7613 $96.10 $26.68 $19.22 laryngoscopy. 31525................ T.................... ................... Diagnostic

0074 13.9480 $761.02 $295.70 $152.20 laryngoscopy. 31526................ T.................... ................... Diagnostic

0075 20.3815 $1,112.04 $445.92 $222.41 laryngoscopy. 31527................ T.................... ................... Laryngoscopy for

0075 20.3815 $1,112.04 $445.92 $222.41 treatment. 31528................ T.................... ................... Laryngoscopy and

0074 13.9480 $761.02 $295.70 $152.20 dilation. 31529................ T.................... ................... Laryngoscopy and

0074 13.9480 $761.02 $295.70 $152.20 dilation. 31530................ T.................... ................... Operative

0075 20.3815 $1,112.04 $445.92 $222.41 laryngoscopy. 31531................ T.................... ................... Operative

0075 20.3815 $1,112.04 $445.92 $222.41 laryngoscopy. 31535................ T.................... ................... Operative

0075 20.3815 $1,112.04 $445.92 $222.41 laryngoscopy. 31536................ T.................... ................... Operative

0075 20.3815 $1,112.04 $445.92 $222.41 laryngoscopy. 31540................ T.................... ................... Operative

0075 20.3815 $1,112.04 $445.92 $222.41 laryngoscopy. 31541................ T.................... ................... Operative

0075 20.3815 $1,112.04 $445.92 $222.41 laryngoscopy. 31560................ T.................... ................... Operative

0075 20.3815 $1,112.04 $445.92 $222.41 laryngoscopy. 31561................ T.................... ................... Operative

0075 20.3815 $1,112.04 $445.92 $222.41 laryngoscopy. 31570................ T.................... ................... Laryngoscopy with

0074 13.9480 $761.02 $295.70 $152.20 injection. 31571................ T.................... ................... Laryngoscopy with

0075 20.3815 $1,112.04 $445.92 $222.41 injection. 31575................ T.................... ................... Diagnostic

0072 1.7613 $96.10 $26.68 $19.22 laryngoscopy. 31576................ T.................... ................... Laryngoscopy with

0075 20.3815 $1,112.04 $445.92 $222.41 biopsy. 31577................ T.................... ................... Remove foreign body,

0073 3.4541 $188.46 $73.38 $37.69 larynx. 31578................ T.................... ................... Removal of larynx

0075 20.3815 $1,112.04 $445.92 $222.41 lesion. 31579................ T.................... ................... Diagnostic

0073 3.4541 $188.46 $73.38 $37.69 laryngoscopy. 31580................ T.................... ................... Revision of larynx..

0256 35.1548 $1,918.08 ........... $383.62 31582................ T.................... ................... Revision of larynx..

0256 35.1548 $1,918.08 ........... $383.62 31584................ C.................... ................... Treat larynx

........... ........... ........... ........... ........... fracture. 31585................ T.................... ................... Treat larynx

0253 15.2249 $830.69 $282.29 $166.14 fracture. 31586................ T.................... ................... Treat larynx

0256 35.1548 $1,918.08 ........... $383.62 fracture. 31587................ C.................... ................... Revision of larynx.. ........... ........... ........... ........... ........... 31588................ T.................... ................... Revision of larynx..

0256 35.1548 $1,918.08 ........... $383.62 31590................ T.................... ................... Reinnervate larynx..

0256 35.1548 $1,918.08 ........... $383.62 31595................ T.................... ................... Larynx nerve surgery

0256 35.1548 $1,918.08 ........... $383.62 31599................ T.................... ................... Larynx surgery

0254 21.8901 $1,194.35 $321.35 $238.87 procedure. 31600................ T.................... ................... Incision of windpipe

0254 21.8901 $1,194.35 $321.35 $238.87 31601................ T.................... ................... Incision of windpipe

0254 21.8901 $1,194.35 $321.35 $238.87 31603................ T.................... ................... Incision of windpipe

0252 6.4469 $351.75 $113.41 $70.35 31605................ T.................... ................... Incision of windpipe

0253 15.2249 $830.69 $282.29 $166.14 31610................ T.................... ................... Incision of windpipe

0254 21.8901 $1,194.35 $321.35 $238.87 31611................ T.................... ................... Surgery/speech

0254 21.8901 $1,194.35 $321.35 $238.87 prosthesis. 31612................ T.................... ................... Puncture/clear

0254 21.8901 $1,194.35 $321.35 $238.87 windpipe. 31613................ T.................... ................... Repair windpipe

0254 21.8901 $1,194.35 $321.35 $238.87 opening. 31614................ T.................... ................... Repair windpipe

0256 35.1548 $1,918.08 ........... $383.62 opening. 31615................ T.................... ................... Visualization of

0076 9.2346 $503.85 $189.82 $100.77 windpipe. 31622................ T.................... ................... Dx bronchoscope/wash

0076 9.2346 $503.85 $189.82 $100.77 31623................ T.................... ................... Dx bronchoscope/

0076 9.2346 $503.85 $189.82 $100.77 brush. 31624................ T.................... ................... Dx bronchoscope/

0076 9.2346 $503.85 $189.82 $100.77 lavage. 31625................ T.................... ................... Bronchoscopy w/

0076 9.2346 $503.85 $189.82 $100.77 biopsy(s). 31628................ T.................... ................... Bronchoscopy/lung

0076 9.2346 $503.85 $189.82 $100.77 bx, each.

[[Page 63521]]

31629................ T.................... ................... Bronchoscopy/needle

0076 9.2346 $503.85 $189.82 $100.77 bx, each. 31630................ T.................... ................... Bronchoscopy dilate/

0415 20.7348 $1,131.31 $459.92 $226.26 fx repr. 31631................ T.................... ................... Bronchoscopy, dilate

0415 20.7348 $1,131.31 $459.92 $226.26 w/stent. 31632................ T.................... NI................. Bronchoscopy/lung

0076 9.2346 $503.85 $189.82 $100.77 bx, add'l. 31633................ T.................... NI................. Bronchoscopy/needle

0076 9.2346 $503.85 $189.82 $100.77 bx add'l. 31635................ T.................... ................... Bronchoscopy w/fb

0076 9.2346 $503.85 $189.82 $100.77 removal. 31640................ T.................... ................... Bronchoscopy w/tumor

0415 20.7348 $1,131.31 $459.92 $226.26 excise. 31641................ T.................... ................... Bronchoscopy, treat

0415 20.7348 $1,131.31 $459.92 $226.26 blockage. 31643................ T.................... ................... Diag bronchoscope/

0076 9.2346 $503.85 $189.82 $100.77 catheter. 31645................ T.................... ................... Bronchoscopy, clear

0076 9.2346 $503.85 $189.82 $100.77 airways. 31646................ T.................... ................... Bronchoscopy,

0076 9.2346 $503.85 $189.82 $100.77 reclear airway. 31656................ T.................... ................... Bronchoscopy, inj

0076 9.2346 $503.85 $189.82 $100.77 for x-ray. 31700................ T.................... ................... Insertion of airway

0072 1.7613 $96.10 $26.68 $19.22 catheter. 31708................ N.................... ................... Instill airway

........... ........... ........... ........... ........... contrast dye. 31710................ N.................... ................... Insertion of airway ........... ........... ........... ........... ........... catheter. 31715................ N.................... ................... Injection for

........... ........... ........... ........... ........... bronchus x-ray. 31717................ T.................... ................... Bronchial brush

0073 3.4541 $188.46 $73.38 $37.69 biopsy. 31720................ T.................... ................... Clearance of airways

0071 0.8799 $48.01 $12.89

$9.60 31725................ C.................... ................... Clearance of airways ........... ........... ........... ........... ........... 31730................ T.................... ................... Intro, windpipe wire/

0073 3.4541 $188.46 $73.38 $37.69 tube. 31750................ T.................... ................... Repair of windpipe..

0256 35.1548 $1,918.08 ........... $383.62 31755................ T.................... ................... Repair of windpipe..

0256 35.1548 $1,918.08 ........... $383.62 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

0254 21.8901 $1,194.35 $321.35 $238.87 lesion. 31786................ C.................... ................... Remove windpipe ........... ........... ........... ........... ........... lesion. 31800................ C.................... ................... Repair of windpipe ........... ........... ........... ........... ........... injury. 31805................ C.................... ................... Repair of windpipe ........... ........... ........... ........... ........... injury. 31820................ T.................... ................... Closure of windpipe

0253 15.2249 $830.69 $282.29 $166.14 lesion. 31825................ T.................... ................... Repair of windpipe

0254 21.8901 $1,194.35 $321.35 $238.87 defect. 31830................ T.................... ................... Revise windpipe scar

0254 21.8901 $1,194.35 $321.35 $238.87 31899................ T.................... ................... Airways surgical

0076 9.2346 $503.85 $189.82 $100.77 procedure. 32000................ T.................... ................... Drainage of chest...

0070 3.0717 $167.60 ........... $33.52 32002................ T.................... ................... Treatment of

0070 3.0717 $167.60 ........... $33.52 collapsed lung. 32005................ T.................... ................... Treat lung lining

0070 3.0717 $167.60 ........... $33.52 chemically. 32020................ T.................... ................... Insertion of chest

0070 3.0717 $167.60 ........... $33.52 tube. 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

0070 3.0717 $167.60 ........... $33.52 lesion. 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

0005 3.2698 $178.40 $71.59 $35.68 lining. 32402................ C.................... ................... Open biopsy chest ........... ........... ........... ........... ........... lining. 32405................ T.................... ................... Biopsy, lung or

0685 4.8100 $262.44 $115.47 $52.49 mediastinum. 32420................ T.................... ................... Puncture/clear lung.

0070 3.0717 $167.60 ........... $33.52 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.

[[Page 63522]]

32522................ C.................... ................... Remove lung & revise ........... ........... ........... ........... ........... chest. 32525................ C.................... ................... Remove lung & revise ........... ........... ........... ........... ........... chest. 32540................ C.................... ................... Removal of lung ........... ........... ........... ........... ........... lesion. 32601................ T.................... ................... Thoracoscopy,

0069 28.9392 $1,578.95 $591.64 $315.79 diagnostic. 32602................ T.................... ................... Thoracoscopy,

0069 28.9392 $1,578.95 $591.64 $315.79 diagnostic. 32603................ T.................... ................... Thoracoscopy,

0069 28.9392 $1,578.95 $591.64 $315.79 diagnostic. 32604................ T.................... ................... Thoracoscopy,

0069 28.9392 $1,578.95 $591.64 $315.79 diagnostic. 32605................ T.................... ................... Thoracoscopy,

0069 28.9392 $1,578.95 $591.64 $315.79 diagnostic. 32606................ T.................... ................... Thoracoscopy,

0069 28.9392 $1,578.95 $591.64 $315.79 diagnostic. 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. 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

0070 3.0717 $167.60 ........... $33.52 pneumothorax. 32997................ C.................... ................... Total lung lavage... ........... ........... ........... ........... ........... 32999................ T.................... ................... Chest surgery

0070 3.0717 $167.60 ........... $33.52 procedure. 33010................ T.................... ................... Drainage of heart

0070 3.0717 $167.60 ........... $33.52 sac. 33011................ T.................... ................... Repeat drainage of

0070 3.0717 $167.60 ........... $33.52 heart sac. 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). 33141................ C.................... ................... Heart tmr w/other ........... ........... ........... ........... ........... procedure. 33200................ C.................... ................... Insertion of heart ........... ........... ........... ........... ........... pacemaker. 33201................ C.................... ................... Insertion of heart ........... ........... ........... ........... ........... pacemaker. 33206................ T.................... ................... Insertion of heart

0089 117.1896 $6,393.98 $1,722.59 $1,278.80 pacemaker. 33207................ T.................... ................... Insertion of heart

0089 117.1896 $6,393.98 $1,722.59 $1,278.80 pacemaker. 33208................ T.................... ................... Insertion of heart

0655 142.7039 $7,786.07 ........... $1,557.21 pacemaker. 33210................ T.................... ................... Insertion of heart

0106 58.9719 $3,217.57 ........... $643.51 electrode. 33211................ T.................... ................... Insertion of heart

0106 58.9719 $3,217.57 ........... $643.51 electrode. 33212................ T.................... ................... Insertion of pulse

0090 96.8284 $5,283.05 $1,651.45 $1,056.61 generator. 33213................ T.................... ................... Insertion of pulse

0654 112.6957 $6,148.79 ........... $1,229.76 generator. 33214................ T.................... ................... Upgrade of pacemaker

0655 142.7039 $7,786.07 ........... $1,557.21 system. 33215................ T.................... ................... Reposition pacing-

0105 19.1898 $1,047.01 $370.40 $209.40 defib lead. 33216................ T.................... ................... Revise eltrd pacing-

0106 58.9719 $3,217.57 ........... $643.51 defib. 33217................ T.................... ................... Insert lead pace-

0106 58.9719 $3,217.57 ........... $643.51 defib, dual. 33218................ T.................... ................... Repair lead pace-

0106 58.9719 $3,217.57 ........... $643.51 defib, one. 33220................ T.................... ................... Repair lead pace-

0106 58.9719 $3,217.57 ........... $643.51 defib, dual. 33222................ T.................... ................... Revise pocket,

0027 15.8990 $867.47 $329.72 $173.49 pacemaker. 33223................ T.................... ................... Revise pocket,

0027 15.8990 $867.47 $329.72 $173.49 pacing-defib. 33224................ T.................... ................... Insert pacing lead &

1547 ........... $850.00 ........... $170.00 connect. 33225................ T.................... ................... L ventric pacing

1550 ........... $1,150.00 ........... $230.00 lead add-on. 33226................ T.................... ................... Reposition l ventric

0105 19.1898 $1,047.01 $370.40 $209.40 lead. 33233................ T.................... ................... Removal of pacemaker

0105 19.1898 $1,047.01 $370.40 $209.40 system. 33234................ T.................... ................... Removal of pacemaker

0105 19.1898 $1,047.01 $370.40 $209.40 system.

[[Page 63523]]

33235................ T.................... ................... Removal pacemaker

0105 19.1898 $1,047.01 $370.40 $209.40 electrode. 33236................ C.................... ................... Remove electrode/ ........... ........... ........... ........... ........... thoracotomy. 33237................ C.................... ................... Remove electrode/ ........... ........... ........... ........... ........... thoracotomy. 33238................ C.................... ................... Remove electrode/ ........... ........... ........... ........... ........... thoracotomy. 33240................ B.................... ................... Insert pulse

........... ........... ........... ........... ........... generator. 33241................ T.................... ................... Remove pulse

0105 19.1898 $1,047.01 $370.40 $209.40 generator. 33243................ C.................... ................... Remove eltrd/

........... ........... ........... ........... ........... thoracotomy. 33244................ T.................... ................... Remove eltrd,

0105 19.1898 $1,047.01 $370.40 $209.40 transven. 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

0680 62.8252 $3,427.81 ........... $685.56 ht record. 33284................ T.................... ................... Remove pat-active ht

0109 7.4705 $407.60 $131.49 $81.52 record. 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. 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.

[[Page 63524]]

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. 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 ........... ........... ........... ........... ...........

[[Page 63525]]

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. 33935................ C.................... ................... Transplantation, ........... ........... ........... ........... ........... heart/lung. 33940................ C.................... ................... Removal of donor ........... ........... ........... ........... ........... heart. 33945................ C.................... ................... Transplantation of ........... ........... ........... ........... ........... heart. 33960................ C.................... ................... External circulation ........... ........... ........... ........... ........... assist. 33961................ C.................... ................... External circulation ........... ........... ........... ........... ........... assist. 33967................ C.................... ................... Insert ia percut ........... ........... ........... ........... ........... device. 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

0070 3.0717 $167.60 ........... $33.52 procedure. 34001................ C.................... ................... Removal of artery ........... ........... ........... ........... ........... clot. 34051................ C.................... ................... Removal of artery ........... ........... ........... ........... ........... clot. 34101................ T.................... ................... Removal of artery

0088 34.6942 $1,892.95 $655.22 $378.59 clot. 34111................ T.................... ................... Removal of arm

0088 34.6942 $1,892.95 $655.22 $378.59 artery clot. 34151................ C.................... ................... Removal of artery ........... ........... ........... ........... ........... clot. 34201................ T.................... ................... Removal of artery

0088 34.6942 $1,892.95 $655.22 $378.59 clot. 34203................ T.................... ................... Removal of leg

0088 34.6942 $1,892.95 $655.22 $378.59 artery clot. 34401................ C.................... ................... Removal of vein clot ........... ........... ........... ........... ........... 34421................ T.................... ................... Removal of vein clot

0088 34.6942 $1,892.95 $655.22 $378.59 34451................ C.................... ................... Removal of vein clot ........... ........... ........... ........... ........... 34471................ T.................... ................... Removal of vein clot

0088 34.6942 $1,892.95 $655.22 $378.59 34490................ T.................... ................... Removal of vein clot

0088 34.6942 $1,892.95 $655.22 $378.59 34501................ T.................... ................... Repair valve,

0088 34.6942 $1,892.95 $655.22 $378.59 femoral vein. 34502................ C.................... ................... Reconstruct vena ........... ........... ........... ........... ........... cava. 34510................ T.................... ................... Transposition of

0088 34.6942 $1,892.95 $655.22 $378.59 vein valve. 34520................ T.................... ................... Cross-over vein

0088 34.6942 $1,892.95 $655.22 $378.59 graft. 34530................ T.................... ................... Leg vein fusion.....

0088 34.6942 $1,892.95 $655.22 $378.59 34800................ C.................... ................... Endovasc abdo repair ........... ........... ........... ........... ........... w/tube. 34802................ C.................... ................... Endovasc abdo repr w/ ........... ........... ........... ........... ........... device. 34804................ C.................... ................... Endovasc abdo repr w/ ........... ........... ........... ........... ........... device. 34805................ C.................... NI................. 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

0653 30.0334 $1,638.65 ........... $327.73 artery. 35013................ C.................... ................... Repair artery

........... ........... ........... ........... ........... rupture, arm. 35021................ C.................... ................... Repair defect of ........... ........... ........... ........... ........... artery. 35022................ C.................... ................... Repair artery

........... ........... ........... ........... ........... rupture, chest.

[[Page 63526]]

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. 35141................ C.................... ................... Repair defect of ........... ........... ........... ........... ........... artery. 35142................ C.................... ................... Repair artery

........... ........... ........... ........... ........... rupture, thigh. 35151................ C.................... ................... Repair defect of ........... ........... ........... ........... ........... artery. 35152................ C.................... ................... Repair artery

........... ........... ........... ........... ........... rupture, knee. 35161................ C.................... ................... Repair defect of ........... ........... ........... ........... ........... artery. 35162................ C.................... ................... Repair artery

........... ........... ........... ........... ........... rupture. 35180................ T.................... ................... Repair blood vessel

0093 21.3104 $1,162.72 $277.34 $232.54 lesion. 35182................ C.................... ................... Repair blood vessel ........... ........... ........... ........... ........... lesion. 35184................ T.................... ................... Repair blood vessel

0093 21.3104 $1,162.72 $277.34 $232.54 lesion. 35188................ T.................... ................... Repair blood vessel

0088 34.6942 $1,892.95 $655.22 $378.59 lesion. 35189................ C.................... ................... Repair blood vessel ........... ........... ........... ........... ........... lesion. 35190................ T.................... ................... Repair blood vessel

0093 21.3104 $1,162.72 $277.34 $232.54 lesion. 35201................ T.................... ................... Repair blood vessel

0093 21.3104 $1,162.72 $277.34 $232.54 lesion. 35206................ T.................... ................... Repair blood vessel

0093 21.3104 $1,162.72 $277.34 $232.54 lesion. 35207................ T.................... ................... Repair blood vessel

0088 34.6942 $1,892.95 $655.22 $378.59 lesion. 35211................ C.................... ................... Repair blood vessel ........... ........... ........... ........... ........... lesion. 35216................ C.................... ................... Repair blood vessel ........... ........... ........... ........... ........... lesion. 35221................ C.................... ................... Repair blood vessel ........... ........... ........... ........... ........... lesion. 35226................ T.................... ................... Repair blood vessel

0093 21.3104 $1,162.72 $277.34 $232.54 lesion. 35231................ T.................... ................... Repair blood vessel

0093 21.3104 $1,162.72 $277.34 $232.54 lesion. 35236................ T.................... ................... Repair blood vessel

0093 21.3104 $1,162.72 $277.34 $232.54 lesion. 35241................ C.................... ................... Repair blood vessel ........... ........... ........... ........... ........... lesion. 35246................ C.................... ................... Repair blood vessel ........... ........... ........... ........... ........... lesion. 35251................ C.................... ................... Repair blood vessel ........... ........... ........... ........... ........... lesion. 35256................ T.................... ................... Repair blood vessel

0093 21.3104 $1,162.72 $277.34 $232.54 lesion. 35261................ T.................... ................... Repair blood vessel

0653 30.0334 $1,638.65 ........... $327.73 lesion. 35266................ T.................... ................... Repair blood vessel

0653 30.0334 $1,638.65 ........... $327.73 lesion. 35271................ C.................... ................... Repair blood vessel ........... ........... ........... ........... ........... lesion. 35276................ C.................... ................... Repair blood vessel ........... ........... ........... ........... ........... lesion. 35281................ C.................... ................... Repair blood vessel ........... ........... ........... ........... ........... lesion. 35286................ T.................... ................... Repair blood vessel

0653 30.0334 $1,638.65 ........... $327.73 lesion. 35301................ C.................... ................... Rechanneling of ........... ........... ........... ........... ........... artery. 35311................ C.................... ................... Rechanneling of ........... ........... ........... ........... ........... artery. 35321................ T.................... ................... Rechanneling of

0093 21.3104 $1,162.72 $277.34 $232.54 artery. 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

0081 35.0285 $1,911.19 ........... $382.24 blockage. 35459................ T.................... ................... Repair arterial

0081 35.0285 $1,911.19 ........... $382.24 blockage. 35460................ T.................... ................... Repair venous

0081 35.0285 $1,911.19 ........... $382.24 blockage. 35470................ T.................... ................... Repair arterial

0081 35.0285 $1,911.19 ........... $382.24 blockage. 35471................ T.................... ................... Repair arterial

0081 35.0285 $1,911.19 ........... $382.24 blockage. 35472................ T.................... ................... Repair arterial

0081 35.0285 $1,911.19 ........... $382.24 blockage. 35473................ T.................... ................... Repair arterial

0081 35.0285 $1,911.19 ........... $382.24 blockage. 35474................ T.................... ................... Repair arterial

0081 35.0285 $1,911.19 ........... $382.24 blockage. 35475................ T.................... ................... Repair arterial

0081 35.0285 $1,911.19 ........... $382.24 blockage. 35476................ T.................... ................... Repair venous

0081 35.0285 $1,911.19 ........... $382.24 blockage. 35480................ C.................... ................... Atherectomy, open... ........... ........... ........... ........... ........... 35481................ C.................... ................... Atherectomy, open... ........... ........... ........... ........... ........... 35482................ C.................... ................... Atherectomy, open... ........... ........... ........... ........... ...........

[[Page 63527]]

35483................ C.................... ................... Atherectomy, open... ........... ........... ........... ........... ........... 35484................ T.................... ................... Atherectomy, open...

0081 35.0285 $1,911.19 ........... $382.24 35485................ T.................... ................... Atherectomy, open...

0081 35.0285 $1,911.19 ........... $382.24 35490................ T.................... ................... Atherectomy,

0081 35.0285 $1,911.19 ........... $382.24 percutaneous. 35491................ T.................... ................... Atherectomy,

0081 35.0285 $1,911.19 ........... $382.24 percutaneous. 35492................ T.................... ................... Atherectomy,

0081 35.0285 $1,911.19 ........... $382.24 percutaneous. 35493................ T.................... ................... Atherectomy,

0081 35.0285 $1,911.19 ........... $382.24 percutaneous. 35494................ T.................... ................... Atherectomy,

0081 35.0285 $1,911.19 ........... $382.24 percutaneous. 35495................ T.................... ................... Atherectomy,

0081 35.0285 $1,911.19 ........... $382.24 percutaneous. 35500................ T.................... ................... Harvest vein for

0081 35.0285 $1,911.19 ........... $382.24 bypass. 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.................... NI................. Artery bypass graft. ........... ........... ........... ........... ........... 35511................ C.................... ................... Artery bypass graft. ........... ........... ........... ........... ........... 35512................ C.................... NI................. 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.................... NI................. Artery bypass graft. ........... ........... ........... ........... ........... 35525................ C.................... NI................. 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. 35582................ C.................... ................... Vein bypass graft... ........... ........... ........... ........... ........... 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/

0093 21.3104 $1,162.72 $277.34 $232.54 patch. 35686................ T.................... ................... Bypass graft/av fist

0093 21.3104 $1,162.72 $277.34 $232.54 patency. 35691................ C.................... ................... Arterial

........... ........... ........... ........... ........... transposition.

[[Page 63528]]

35693................ C.................... ................... Arterial

........... ........... ........... ........... ........... transposition. 35694................ C.................... ................... Arterial

........... ........... ........... ........... ........... transposition. 35695................ C.................... ................... Arterial

........... ........... ........... ........... ........... transposition. 35697................ C.................... NI................. 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

0115 25.6437 $1,399.15 $459.35 $279.83 artery/vein. 35800................ C.................... ................... Explore neck vessels ........... ........... ........... ........... ........... 35820................ C.................... ................... Explore chest

........... ........... ........... ........... ........... vessels. 35840................ C.................... ................... Explore abdominal ........... ........... ........... ........... ........... vessels. 35860................ T.................... ................... Explore limb vessels

0093 21.3104 $1,162.72 $277.34 $232.54 35870................ C.................... ................... Repair vessel graft ........... ........... ........... ........... ........... defect. 35875................ T.................... ................... Removal of clot in

0088 34.6942 $1,892.95 $655.22 $378.59 graft. 35876................ T.................... ................... Removal of clot in

0088 34.6942 $1,892.95 $655.22 $378.59 graft. 35879................ T.................... ................... Revise graft w/vein.

0088 34.6942 $1,892.95 $655.22 $378.59 35881................ T.................... ................... Revise graft w/vein.

0088 34.6942 $1,892.95 $655.22 $378.59 35901................ C.................... ................... Excision, graft, ........... ........... ........... ........... ........... neck. 35903................ T.................... ................... Excision, graft,

0115 25.6437 $1,399.15 $459.35 $279.83 extremity. 35905................ C.................... ................... Excision, graft, ........... ........... ........... ........... ........... thorax. 35907................ C.................... ................... Excision, graft, ........... ........... ........... ........... ........... abdomen. 36000................ N.................... ................... Place needle in vein ........... ........... ........... ........... ........... 36002................ S.................... ................... Pseudoaneurysm

0267 2.4586 $134.14 $65.52 $26.83 injection trt. 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

0119 134.7194 $7,350.43 ........... $1,470.09 infusion pump. 36261................ T.................... ................... Revision of infusion

0124 23.8050 $1,298.82 ........... $259.76 pump. 36262................ T.................... ................... Removal of infusion

0124 23.8050 $1,298.82 ........... $259.76 pump. 36299................ N.................... ................... Vessel injection ........... ........... ........... ........... ........... procedure. 36400................ N.................... ................... Bl draw 3 yrs. 36415................ E.................... ................... Drawing blood....... ........... ........... ........... ........... ........... 36416................ E.................... ................... Capillary blood draw ........... ........... ........... ........... ........... 36420................ T.................... ................... Vein access cutdown

0035 0.1691

$9.23

$2.79

$1.85 1 yr. 36430................ S.................... ................... Blood transfusion

0110 3.6718 $200.34 ........... $40.07 service. 36440................ S.................... ................... Bl push transfuse, 2

0110 3.6718 $200.34 ........... $40.07 yr or 5 yr. 49507................ T.................... ................... Prp i/hern init

0154 26.9636 $1,471.16 $464.85 $294.23 block5 yr. 49520................ T.................... ................... Rerepair ing hernia,

0154 26.9636 $1,471.16 $464.85 $294.23 reduce. 49521................ T.................... ................... Rerepair ing hernia,

0154 26.9636 $1,471.16 $464.85 $294.23 blocked. 49525................ T.................... ................... Repair ing hernia,

0154 26.9636 $1,471.16 $464.85 $294.23 sliding. 49540................ T.................... ................... Repair lumbar hernia

0154 26.9636 $1,471.16 $464.85 $294.23 49550................ T.................... ................... Rpr rem hernia,

0154 26.9636 $1,471.16 $464.85 $294.23 init, reduce. 49553................ T.................... ................... Rpr fem hernia, init

0154 26.9636 $1,471.16 $464.85 $294.23 blocked. 49555................ T.................... ................... Rerepair fem hernia,

0154 26.9636 $1,471.16 $464.85 $294.23 reduce. 49557................ T.................... ................... Rerepair fem hernia,

0154 26.9636 $1,471.16 $464.85 $294.23 blocked. 49560................ T.................... ................... Rpr ventral hern

0154 26.9636 $1,471.16 $464.85 $294.23 init, reduc. 49561................ T.................... ................... Rpr ventral hern

0154 26.9636 $1,471.16 $464.85 $294.23 init, block. 49565................ T.................... ................... Rerepair ventrl

0154 26.9636 $1,471.16 $464.85 $294.23 hern, reduce. 49566................ T.................... ................... Rerepair ventrl

0154 26.9636 $1,471.16 $464.85 $294.23 hern, block. 49568................ T.................... ................... Hernia repair w/mesh

0154 26.9636 $1,471.16 $464.85 $294.23 49570................ T.................... ................... Rpr epigastric hern,

0154 26.9636 $1,471.16 $464.85 $294.23 reduce. 49572................ T.................... ................... Rpr epigastric hern,

0154 26.9636 $1,471.16 $464.85 $294.23 blocked. 49580................ T.................... ................... Rpr umbil hern,

0154 26.9636 $1,471.16 $464.85 $294.23 reduc 5 yr. 49587................ T.................... ................... Rpr umbil hern,

0154 26.9636 $1,471.16 $464.85 $294.23 block 5 yr. 49590................ T.................... ................... Repair spigilian

0154 26.9636 $1,471.16 $464.85 $294.23 hernia. 49600................ T.................... ................... Repair umbilical

0154 26.9636 $1,471.16 $464.85 $294.23 lesion. 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

0131 40.8064 $2,226.44 $1,001.89 $445.29 initial. 49651................ T.................... ................... Laparo hernia repair

0131 40.8064 $2,226.44 $1,001.89 $445.29 recur. 49659................ T.................... ................... Laparo proc, hernia

0131 40.8064 $2,226.44 $1,001.89 $445.29 repair. 49900................ C.................... ................... Repair of abdominal ........... ........... ........... ........... ........... wall.

[[Page 63542]]

49904................ C.................... ................... Omental flap, extra- ........... ........... ........... ........... ........... abdom. 49905................ C.................... ................... Omental flap........ ........... ........... ........... ........... ........... 49906................ C.................... ................... Free omental flap, ........... ........... ........... ........... ........... microvasc. 49999................ T.................... ................... Abdomen surgery

0153 20.8723 $1,138.81 $410.87 $227.76 procedure. 50010................ C.................... ................... Exploration of

........... ........... ........... ........... ........... kidney. 50020................ C.................... ................... Renal abscess, open ........... ........... ........... ........... ........... drain. 50021................ T.................... ................... Renal abscess,

0037 9.8921 $539.72 $237.45 $107.94 percut drain. 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

0163 33.8805 $1,848.55 ........... $369.71 stone. 50081................ T.................... ................... Removal of kidney

0163 33.8805 $1,848.55 ........... $369.71 stone. 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 4.8100 $262.44 $115.47 $52.49 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. 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

0685 4.8100 $262.44 $115.47 $52.49 lesion. 50392................ T.................... ................... Insert kidney drain.

0161 16.8407 $918.85 $249.36 $183.77 50393................ T.................... ................... Insert ureteral tube

0161 16.8407 $918.85 $249.36 $183.77 50394................ N.................... ................... Injection for kidney ........... ........... ........... ........... ........... x-ray. 50395................ T.................... ................... Create passage to

0161 16.8407 $918.85 $249.36 $183.77 kidney. 50396................ T.................... ................... Measure kidney

0164 1.2021 $65.59 $17.59 $13.12 pressure. 50398................ T.................... ................... Change kidney tube..

0122 8.8621 $483.53 $99.16 $96.71 50400................ C.................... ................... Revision of kidney/ ........... ........... ........... ........... ........... ureter. 50405................ C.................... ................... Revision of kidney/ ........... ........... ........... ........... ........... ureter. 50500................ C.................... ................... Repair of kidney ........... ........... ........... ........... ........... wound. 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

0130 32.7724 $1,788.09 $659.53 $357.62 cyst. 50542................ T.................... ................... Laparo ablate renal

0131 40.8064 $2,226.44 $1,001.89 $445.29 mass. 50543................ T.................... ................... Laparo partial

0131 40.8064 $2,226.44 $1,001.89 $445.29 nephrectomy. 50544................ T.................... ................... Laparoscopy,

0130 32.7724 $1,788.09 $659.53 $357.62 pyeloplasty. 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,

0130 32.7724 $1,788.09 $659.53 $357.62 renal. 50551................ T.................... ................... Kidney endoscopy....

0160 6.8801 $375.39 $105.06 $75.08 50553................ T.................... ................... Kidney endoscopy....

0161 16.8407 $918.85 $249.36 $183.77 50555................ T.................... ................... Kidney endoscopy &

0160 6.8801 $375.39 $105.06 $75.08 biopsy. 50557................ T.................... ................... Kidney endoscopy &

0162 21.9098 $1,195.42 ........... $239.08 treatment. 50559................ T.................... ................... Renal endoscopy/

0160 6.8801 $375.39 $105.06 $75.08 radiotracer. 50561................ T.................... ................... Kidney endoscopy &

0161 16.8407 $918.85 $249.36 $183.77 treatment. 50562................ T.................... ................... Renal scope w/tumor

0160 6.8801 $375.39 $105.06 $75.08 resect. 50570................ C.................... ................... Kidney endoscopy.... ........... ........... ........... ........... ........... 50572................ C.................... ................... Kidney endoscopy.... ........... ........... ........... ........... ........... 50574................ C.................... ................... Kidney endoscopy & ........... ........... ........... ........... ........... biopsy. 50575................ C.................... ................... Kidney endoscopy.... ........... ........... ........... ........... ........... 50576................ C.................... ................... Kidney endoscopy & ........... ........... ........... ........... ........... treatment. 50578................ C.................... ................... Renal endoscopy/ ........... ........... ........... ........... ........... radiotracer. 50580................ C.................... ................... Kidney endoscopy & ........... ........... ........... ........... ........... treatment. 50590................ T.................... ................... Fragmenting of

0169 45.1150 $2,461.52 $1,115.69 $492.30 kidney stone.

[[Page 63543]]

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

0164 1.2021 $65.59 $17.59 $13.12 pressure. 50688................ T.................... ................... Change of ureter

0122 8.8621 $483.53 $99.16 $96.71 tube. 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

0131 40.8064 $2,226.44 $1,001.89 $445.29 ureterolithotomy. 50947................ T.................... ................... Laparo new ureter/

0131 40.8064 $2,226.44 $1,001.89 $445.29 bladder. 50948................ T.................... ................... Laparo new ureter/

0131 40.8064 $2,226.44 $1,001.89 $445.29 bladder. 50949................ T.................... ................... Laparoscope proc,

0130 32.7724 $1,788.09 $659.53 $357.62 ureter. 50951................ T.................... ................... Endoscopy of ureter.

0160 6.8801 $375.39 $105.06 $75.08 50953................ T.................... ................... Endoscopy of ureter.

0160 6.8801 $375.39 $105.06 $75.08 50955................ T.................... ................... Ureter endoscopy &

0161 16.8407 $918.85 $249.36 $183.77 biopsy. 50957................ T.................... ................... Ureter endoscopy &

0161 16.8407 $918.85 $249.36 $183.77 treatment. 50959................ T.................... ................... Ureter endoscopy &

0161 16.8407 $918.85 $249.36 $183.77 tracer. 50961................ T.................... ................... Ureter endoscopy &

0161 16.8407 $918.85 $249.36 $183.77 treatment. 50970................ T.................... ................... Ureter endoscopy....

0160 6.8801 $375.39 $105.06 $75.08 50972................ T.................... ................... Ureter endoscopy &

0160 6.8801 $375.39 $105.06 $75.08 catheter. 50974................ T.................... ................... Ureter endoscopy &

0161 16.8407 $918.85 $249.36 $183.77 biopsy. 50976................ T.................... ................... Ureter endoscopy &

0161 16.8407 $918.85 $249.36 $183.77 treatment. 50978................ T.................... ................... Ureter endoscopy &

0161 16.8407 $918.85 $249.36 $183.77 tracer. 50980................ T.................... ................... Ureter endoscopy &

0161 16.8407 $918.85 $249.36 $183.77 treatment. 51000................ T.................... ................... Drainage of bladder.

0164 1.2021 $65.59 $17.59 $13.12 51005................ T.................... ................... Drainage of bladder.

0164 1.2021 $65.59 $17.59 $13.12 51010................ T.................... ................... Drainage of bladder.

0165 14.6838 $801.16 ........... $160.23 51020................ T.................... ................... Incise & treat

0162 21.9098 $1,195.42 ........... $239.08 bladder. 51030................ T.................... ................... Incise & treat

0162 21.9098 $1,195.42 ........... $239.08 bladder. 51040................ T.................... ................... Incise & drain

0162 21.9098 $1,195.42 ........... $239.08 bladder. 51045................ T.................... ................... Incise bladder/drain

0160 6.8801 $375.39 $105.06 $75.08 ureter. 51050................ T.................... ................... Removal of bladder

0162 21.9098 $1,195.42 ........... $239.08 stone. 51060................ C.................... ................... Removal of ureter ........... ........... ........... ........... ........... stone. 51065................ T.................... ................... Remove ureter

0162 21.9098 $1,195.42 ........... $239.08 calculus. 51080................ T.................... ................... Drainage of bladder

0007 11.8633 $647.27 ........... $129.45 abscess. 51500................ T.................... ................... Removal of bladder

0154 26.9636 $1,471.16 $464.85 $294.23 cyst. 51520................ T.................... ................... Removal of bladder

0162 21.9098 $1,195.42 ........... $239.08 lesion. 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.

[[Page 63544]]

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

0164 1.2021 $65.59 $17.59 $13.12 bladder. 51701................ N.................... ................... Insert bladder

........... ........... ........... ........... ........... catheter. 51702................ N.................... ................... Insert temp bladder ........... ........... ........... ........... ........... cath. 51703................ N.................... ................... Insert bladder cath, ........... ........... ........... ........... ........... complex. 51705................ T.................... ................... Change of bladder

0121 2.1189 $115.61 $43.80 $23.12 tube. 51710................ T.................... ................... Change of bladder

0122 8.8621 $483.53 $99.16 $96.71 tube. 51715................ T.................... ................... Endoscopic injection/

0167 30.0186 $1,637.84 $555.84 $327.57 implant. 51720................ T.................... ................... Treatment of bladder

0156 2.4747 $135.02 $40.52 $27.00 lesion. 51725................ T.................... ................... Simple

0156 2.4747 $135.02 $40.52 $27.00 cystometrogram. 51726................ T.................... ................... Complex

0156 2.4747 $135.02 $40.52 $27.00 cystometrogram. 51736................ T.................... ................... Urine flow

0164 1.2021 $65.59 $17.59 $13.12 measurement. 51741................ T.................... ................... Electro-

0164 1.2021 $65.59 $17.59 $13.12 uroflowmetry, first. 51772................ T.................... ................... Urethra pressure

0164 1.2021 $65.59 $17.59 $13.12 profile. 51784................ T.................... ................... Anal/urinary muscle

0164 1.2021 $65.59 $17.59 $13.12 study. 51785................ T.................... ................... Anal/urinary muscle

0164 1.2021 $65.59 $17.59 $13.12 study. 51792................ T.................... ................... Urinary reflex study

0164 1.2021 $65.59 $17.59 $13.12 51795................ T.................... ................... Urine voiding

0164 1.2021 $65.59 $17.59 $13.12 pressure study. 51797................ T.................... ................... Intraabdominal

0164 1.2021 $65.59 $17.59 $13.12 pressure test. 51798................ X.................... ................... Us urine capacity

0340 0.6314 $34.45 ...........

$6.89 measure. 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. ........... ........... ........... ........... ........... 51860................ C.................... ................... Repair of bladder ........... ........... ........... ........... ........... wound. 51865................ C.................... ................... Repair of bladder ........... ........... ........... ........... ........... wound. 51880................ T.................... ................... Repair of bladder

0162 21.9098 $1,195.42 ........... $239.08 opening. 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

0131 40.8064 $2,226.44 $1,001.89 $445.29 suspension. 51992................ T.................... ................... Laparo sling

0132 57.2045 $3,121.13 $1,239.22 $624.23 operation. 52000................ T.................... ................... Cystoscopy..........

0160 6.8801 $375.39 $105.06 $75.08 52001................ T.................... ................... Cystoscopy, removal

0160 6.8801 $375.39 $105.06 $75.08 of clots. 52005................ T.................... ................... Cystoscopy & ureter

0161 16.8407 $918.85 $249.36 $183.77 catheter. 52007................ T.................... ................... Cystoscopy and

0161 16.8407 $918.85 $249.36 $183.77 biopsy. 52010................ T.................... ................... Cystoscopy & duct

0160 6.8801 $375.39 $105.06 $75.08 catheter. 52204................ T.................... ................... Cystoscopy..........

0161 16.8407 $918.85 $249.36 $183.77 52214................ T.................... ................... Cystoscopy and

0162 21.9098 $1,195.42 ........... $239.08 treatment. 52224................ T.................... ................... Cystoscopy and

0162 21.9098 $1,195.42 ........... $239.08 treatment. 52234................ T.................... ................... Cystoscopy and

0162 21.9098 $1,195.42 ........... $239.08 treatment. 52235................ T.................... ................... Cystoscopy and

0162 21.9098 $1,195.42 ........... $239.08 treatment. 52240................ T.................... ................... Cystoscopy and

0162 21.9098 $1,195.42 ........... $239.08 treatment. 52250................ T.................... ................... Cystoscopy and

0162 21.9098 $1,195.42 ........... $239.08 radiotracer. 52260................ T.................... ................... Cystoscopy and

0161 16.8407 $918.85 $249.36 $183.77 treatment. 52265................ T.................... ................... Cystoscopy and

0160 6.8801 $375.39 $105.06 $75.08 treatment. 52270................ T.................... ................... Cystoscopy & revise

0161 16.8407 $918.85 $249.36 $183.77 urethra. 52275................ T.................... ................... Cystoscopy & revise

0161 16.8407 $918.85 $249.36 $183.77 urethra. 52276................ T.................... ................... Cystoscopy and

0161 16.8407 $918.85 $249.36 $183.77 treatment. 52277................ T.................... ................... Cystoscopy and

0162 21.9098 $1,195.42 ........... $239.08 treatment. 52281................ T.................... ................... Cystoscopy and

0161 16.8407 $918.85 $249.36 $183.77 treatment. 52282................ S.................... ................... Cystoscopy, implant

0385 67.1530 $3,663.93 ........... $732.79 stent. 52283................ T.................... ................... Cystoscopy and

0161 16.8407 $918.85 $249.36 $183.77 treatment. 52285................ T.................... ................... Cystoscopy and

0161 16.8407 $918.85 $249.36 $183.77 treatment. 52290................ T.................... ................... Cystoscopy and

0161 16.8407 $918.85 $249.36 $183.77 treatment. 52300................ T.................... ................... Cystoscopy and

0161 16.8407 $918.85 $249.36 $183.77 treatment. 52301................ T.................... ................... Cystoscopy and

0161 16.8407 $918.85 $249.36 $183.77 treatment. 52305................ T.................... ................... Cystoscopy and

0161 16.8407 $918.85 $249.36 $183.77 treatment. 52310................ T.................... ................... Cystoscopy and

0160 6.8801 $375.39 $105.06 $75.08 treatment. 52315................ T.................... ................... Cystoscopy and

0161 16.8407 $918.85 $249.36 $183.77 treatment. 52317................ T.................... ................... Remove bladder stone

0162 21.9098 $1,195.42 ........... $239.08 52318................ T.................... ................... Remove bladder stone

0162 21.9098 $1,195.42 ........... $239.08 52320................ T.................... ................... Cystoscopy and

0162 21.9098 $1,195.42 ........... $239.08 treatment.

[[Page 63545]]

52325................ T.................... ................... Cystoscopy, stone

0162 21.9098 $1,195.42 ........... $239.08 removal. 52327................ T.................... ................... Cystoscopy, inject

0162 21.9098 $1,195.42 ........... $239.08 material. 52330................ T.................... ................... Cystoscopy and

0162 21.9098 $1,195.42 ........... $239.08 treatment. 52332................ T.................... ................... Cystoscopy and

0162 21.9098 $1,195.42 ........... $239.08 treatment. 52334................ T.................... ................... Create passage to

0162 21.9098 $1,195.42 ........... $239.08 kidney. 52341................ T.................... ................... Cysto w/ureter

0162 21.9098 $1,195.42 ........... $239.08 stricture tx. 52342................ T.................... ................... Cysto w/up stricture

0162 21.9098 $1,195.42 ........... $239.08 tx. 52343................ T.................... ................... Cysto w/renal

0162 21.9098 $1,195.42 ........... $239.08 stricture tx. 52344................ T.................... ................... Cysto/uretero, stone

0162 21.9098 $1,195.42 ........... $239.08 remove. 52345................ T.................... ................... Cysto/uretero w/up

0162 21.9098 $1,195.42 ........... $239.08 stricture. 52346................ T.................... ................... Cystouretero w/renal

0162 21.9098 $1,195.42 ........... $239.08 strict. 52347................ T.................... ................... Cystoscopy, resect

0161 16.8407 $918.85 $249.36 $183.77 ducts. 52351................ T.................... ................... Cystouretero & or

0161 16.8407 $918.85 $249.36 $183.77 pyeloscope. 52352................ T.................... ................... Cystouretero w/stone

0162 21.9098 $1,195.42 ........... $239.08 remove. 52353................ T.................... ................... Cystouretero w/

0163 33.8805 $1,848.55 ........... $369.71 lithotripsy. 52354................ T.................... ................... Cystouretero w/

0162 21.9098 $1,195.42 ........... $239.08 biopsy. 52355................ T.................... ................... Cystouretero w/

0162 21.9098 $1,195.42 ........... $239.08 excise tumor. 52400................ T.................... ................... Cystouretero w/

0162 21.9098 $1,195.42 ........... $239.08 congen repr. 52450................ T.................... ................... Incision of prostate

0162 21.9098 $1,195.42 ........... $239.08 52500................ T.................... ................... Revision of bladder

0162 21.9098 $1,195.42 ........... $239.08 neck. 52510................ T.................... ................... Dilation prostatic

0161 16.8407 $918.85 $249.36 $183.77 urethra. 52601................ T.................... ................... Prostatectomy (TURP)

0163 33.8805 $1,848.55 ........... $369.71 52606................ T.................... ................... Control postop

0162 21.9098 $1,195.42 ........... $239.08 bleeding. 52612................ T.................... ................... Prostatectomy, first

0163 33.8805 $1,848.55 ........... $369.71 stage. 52614................ T.................... ................... Prostatectomy,

0163 33.8805 $1,848.55 ........... $369.71 second stage. 52620................ T.................... ................... Remove residual

0163 33.8805 $1,848.55 ........... $369.71 prostate. 52630................ T.................... ................... Remove prostate

0163 33.8805 $1,848.55 ........... $369.71 regrowth. 52640................ T.................... ................... Relieve bladder

0162 21.9098 $1,195.42 ........... $239.08 contracture. 52647................ T.................... ................... Laser surgery of

0163 33.8805 $1,848.55 ........... $369.71 prostate. 52648................ T.................... ................... Laser surgery of

0163 33.8805 $1,848.55 ........... $369.71 prostate. 52700................ T.................... ................... Drainage of prostate

0162 21.9098 $1,195.42 ........... $239.08 abscess. 53000................ T.................... ................... Incision of urethra.

0166 16.7918 $916.18 $218.73 $183.24 53010................ T.................... ................... Incision of urethra.

0166 16.7918 $916.18 $218.73 $183.24 53020................ T.................... ................... Incision of urethra.

0166 16.7918 $916.18 $218.73 $183.24 53025................ T.................... ................... Incision of urethra.

0166 16.7918 $916.18 $218.73 $183.24 53040................ T.................... ................... Drainage of urethra

0167 30.0186 $1,637.84 $555.84 $327.57 abscess. 53060................ T.................... ................... Drainage of urethra

0166 16.7918 $916.18 $218.73 $183.24 abscess. 53080................ T.................... ................... Drainage of urinary

0166 16.7918 $916.18 $218.73 $183.24 leakage. 53085................ C.................... ................... Drainage of urinary ........... ........... ........... ........... ........... leakage. 53200................ T.................... ................... Biopsy of urethra...

0166 16.7918 $916.18 $218.73 $183.24 53210................ T.................... ................... Removal of urethra..

0168 30.0147 $1,637.63 $405.60 $327.53 53215................ T.................... ................... Removal of urethra..

0166 16.7918 $916.18 $218.73 $183.24 53220................ T.................... ................... Treatment of urethra

0168 30.0147 $1,637.63 $405.60 $327.53 lesion. 53230................ T.................... ................... Removal of urethra

0168 30.0147 $1,637.63 $405.60 $327.53 lesion. 53235................ T.................... ................... Removal of urethra

0166 16.7918 $916.18 $218.73 $183.24 lesion. 53240................ T.................... ................... Surgery for urethra

0168 30.0147 $1,637.63 $405.60 $327.53 pouch. 53250................ T.................... ................... Removal of urethra

0166 16.7918 $916.18 $218.73 $183.24 gland. 53260................ T.................... ................... Treatment of urethra

0166 16.7918 $916.18 $218.73 $183.24 lesion. 53265................ T.................... ................... Treatment of urethra

0166 16.7918 $916.18 $218.73 $183.24 lesion. 53270................ T.................... ................... Removal of urethra

0167 30.0186 $1,637.84 $555.84 $327.57 gland. 53275................ T.................... ................... Repair of urethra

0166 16.7918 $916.18 $218.73 $183.24 defect. 53400................ T.................... ................... Revise urethra,

0168 30.0147 $1,637.63 $405.60 $327.53 stage 1. 53405................ T.................... ................... Revise urethra,

0168 30.0147 $1,637.63 $405.60 $327.53 stage 2. 53410................ T.................... ................... Reconstruction of

0168 30.0147 $1,637.63 $405.60 $327.53 urethra. 53415................ C.................... ................... Reconstruction of ........... ........... ........... ........... ........... urethra. 53420................ T.................... ................... Reconstruct urethra,

0168 30.0147 $1,637.63 $405.60 $327.53 stage 1. 53425................ T.................... ................... Reconstruct urethra,

0168 30.0147 $1,637.63 $405.60 $327.53 stage 2. 53430................ T.................... ................... Reconstruction of

0168 30.0147 $1,637.63 $405.60 $327.53 urethra. 53431................ T.................... ................... Reconstruct urethra/

0168 30.0147 $1,637.63 $405.60 $327.53 bladder. 53440................ S.................... ................... Correct bladder

0385 67.1530 $3,663.93 ........... $732.79 function. 53442................ T.................... ................... Remove perineal

0167 30.0186 $1,637.84 $555.84 $327.57 prosthesis. 53444................ S.................... ................... Insert tandem cuff..

0385 67.1530 $3,663.93 ........... $732.79 53445................ S.................... ................... Insert uro/ves nck

0386 116.2382 $6,342.07 ........... $1,268.41 sphincter. 53446................ T.................... ................... Remove uro sphincter

0168 30.0147 $1,637.63 $405.60 $327.53 53447................ S.................... ................... Remove/replace ur

0386 116.2382 $6,342.07 ........... $1,268.41 sphincter. 53448................ C.................... ................... Remov/replc ur

........... ........... ........... ........... ........... sphinctr comp. 53449................ T.................... ................... Repair uro sphincter

0168 30.0147 $1,637.63 $405.60 $327.53 53450................ T.................... ................... Revision of urethra.

0168 30.0147 $1,637.63 $405.60 $327.53 53460................ T.................... ................... Revision of urethra.

0166 16.7918 $916.18 $218.73 $183.24 53500................ T.................... NI................. Urethrlys, transvag

0168 30.0147 $1,637.63 $405.60 $327.53 w/ scope. 53502................ T.................... ................... Repair of urethra

0166 16.7918 $916.18 $218.73 $183.24 injury. 53505................ T.................... ................... Repair of urethra

0167 30.0186 $1,637.84 $555.84 $327.57 injury. 53510................ T.................... ................... Repair of urethra

0166 16.7918 $916.18 $218.73 $183.24 injury. 53515................ T.................... ................... Repair of urethra

0168 30.0147 $1,637.63 $405.60 $327.53 injury. 53520................ T.................... ................... Repair of urethra

0168 30.0147 $1,637.63 $405.60 $327.53 defect.

[[Continued on page 63547]]

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

[[pp. 63547-63596]] Medicare Program; Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2004 Payment Rates

[[Continued from page 63546]]

[[Page 63546]]

53600................ T.................... ................... Dilate urethra

0156 2.4747 $135.02 $40.52 $27.00 stricture. 53601................ T.................... ................... Dilate urethra

0164 1.2021 $65.59 $17.59 $13.12 stricture. 53605................ T.................... ................... Dilate urethra

0161 16.8407 $918.85 $249.36 $183.77 stricture. 53620................ T.................... ................... Dilate urethra

0165 14.6838 $801.16 ........... $160.23 stricture. 53621................ T.................... ................... Dilate urethra

0164 1.2021 $65.59 $17.59 $13.12 stricture. 53660................ T.................... ................... Dilation of urethra.

0164 1.2021 $65.59 $17.59 $13.12 53661................ T.................... ................... Dilation of urethra.

0164 1.2021 $65.59 $17.59 $13.12 53665................ T.................... ................... Dilation of urethra.

0166 16.7918 $916.18 $218.73 $183.24 53850................ T.................... ................... Prostatic microwave

0675 49.3452 $2,692.32 ........... $538.46 thermotx. 53852................ T.................... ................... Prostatic rf

0675 49.3452 $2,692.32 ........... $538.46 thermotx. 53853................ T.................... ................... Prostatic water

1550 ........... $1,150.00 ........... $230.00 thermother. 53899................ T.................... ................... Urology surgery

0164 1.2021 $65.59 $17.59 $13.12 procedure. 54000................ T.................... ................... Slitting of prepuce.

0166 16.7918 $916.18 $218.73 $183.24 54001................ T.................... ................... Slitting of prepuce.

0166 16.7918 $916.18 $218.73 $183.24 54015................ T.................... ................... Drain penis lesion..

0007 11.8633 $647.27 ........... $129.45 54050................ T.................... ................... Destruction, penis

0013 1.1272 $61.50 $14.20 $12.30 lesion(s). 54055................ T.................... ................... Destruction, penis

0017 16.3697 $893.15 $227.84 $178.63 lesion(s). 54056................ T.................... ................... Cryosurgery, penis

0012 0.7694 $41.98 $11.18

$8.40 lesion(s). 54057................ T.................... ................... Laser surg, penis

0017 16.3697 $893.15 $227.84 $178.63 lesion(s). 54060................ T.................... ................... Excision of penis

0017 16.3697 $893.15 $227.84 $178.63 lesion(s). 54065................ T.................... ................... Destruction, penis

0695 19.1849 $1,046.75 $266.59 $209.35 lesion(s). 54100................ T.................... ................... Biopsy of penis.....

0021 14.3594 $783.46 $219.48 $156.69 54105................ T.................... ................... Biopsy of penis.....

0022 18.7932 $1,025.38 $354.45 $205.08 54110................ T.................... ................... Treatment of penis

0181 29.4217 $1,605.28 $621.82 $321.06 lesion. 54111................ T.................... ................... Treat penis lesion,

0181 29.4217 $1,605.28 $621.82 $321.06 graft. 54112................ T.................... ................... Treat penis lesion,

0181 29.4217 $1,605.28 $621.82 $321.06 graft. 54115................ T.................... ................... Treatment of penis

0008 19.4831 $1,063.02 ........... $212.60 lesion. 54120................ T.................... ................... Partial removal of

0181 29.4217 $1,605.28 $621.82 $321.06 penis. 54125................ C.................... ................... Removal of penis.... ........... ........... ........... ........... ........... 54130................ C.................... ................... Remove penis & nodes ........... ........... ........... ........... ........... 54135................ C.................... ................... Remove penis & nodes ........... ........... ........... ........... ........... 54150................ T.................... ................... Circumcision........

0180 18.6176 $1,015.79 $304.87 $203.16 54152................ T.................... ................... Circumcision........

0180 18.6176 $1,015.79 $304.87 $203.16 54160................ T.................... ................... Circumcision........

0180 18.6176 $1,015.79 $304.87 $203.16 54161................ T.................... ................... Circumcision........

0180 18.6176 $1,015.79 $304.87 $203.16 54162................ T.................... ................... Lysis penil circumic

0180 18.6176 $1,015.79 $304.87 $203.16 lesion. 54163................ T.................... ................... Repair of

0180 18.6176 $1,015.79 $304.87 $203.16 circumcision. 54164................ T.................... ................... Frenulotomy of penis

0180 18.6176 $1,015.79 $304.87 $203.16 54200................ T.................... ................... Treatment of penis

0156 2.4747 $135.02 $40.52 $27.00 lesion. 54205................ T.................... ................... Treatment of penis

0181 29.4217 $1,605.28 $621.82 $321.06 lesion. 54220................ T.................... ................... Treatment of penis

0156 2.4747 $135.02 $40.52 $27.00 lesion. 54230................ N.................... ................... Prepare penis study. ........... ........... ........... ........... ........... 54231................ T.................... ................... Dynamic

0165 14.6838 $801.16 ........... $160.23 cavernosometry. 54235................ T.................... ................... Penile injection....

0164 1.2021 $65.59 $17.59 $13.12 54240................ T.................... ................... Penis study.........

0164 1.2021 $65.59 $17.59 $13.12 54250................ T.................... ................... Penis study.........

0164 1.2021 $65.59 $17.59 $13.12 54300................ T.................... ................... Revision of penis...

0181 29.4217 $1,605.28 $621.82 $321.06 54304................ T.................... ................... Revision of penis...

0181 29.4217 $1,605.28 $621.82 $321.06 54308................ T.................... ................... Reconstruction of

0181 29.4217 $1,605.28 $621.82 $321.06 urethra. 54312................ T.................... ................... Reconstruction of

0181 29.4217 $1,605.28 $621.82 $321.06 urethra. 54316................ T.................... ................... Reconstruction of

0181 29.4217 $1,605.28 $621.82 $321.06 urethra. 54318................ T.................... ................... Reconstruction of

0181 29.4217 $1,605.28 $621.82 $321.06 urethra. 54322................ T.................... ................... Reconstruction of

0181 29.4217 $1,605.28 $621.82 $321.06 urethra. 54324................ T.................... ................... Reconstruction of

0181 29.4217 $1,605.28 $621.82 $321.06 urethra. 54326................ T.................... ................... Reconstruction of

0181 29.4217 $1,605.28 $621.82 $321.06 urethra. 54328................ T.................... ................... Revise penis/urethra

0181 29.4217 $1,605.28 $621.82 $321.06 54332................ C.................... ................... Revise penis/urethra ........... ........... ........... ........... ........... 54336................ C.................... ................... Revise penis/urethra ........... ........... ........... ........... ........... 54340................ T.................... ................... Secondary urethral

0181 29.4217 $1,605.28 $621.82 $321.06 surgery. 54344................ T.................... ................... Secondary urethral

0181 29.4217 $1,605.28 $621.82 $321.06 surgery. 54348................ T.................... ................... Secondary urethral

0181 29.4217 $1,605.28 $621.82 $321.06 surgery. 54352................ T.................... ................... Reconstruct urethra/

0181 29.4217 $1,605.28 $621.82 $321.06 penis. 54360................ T.................... ................... Penis plastic

0181 29.4217 $1,605.28 $621.82 $321.06 surgery. 54380................ T.................... ................... Repair penis........

0181 29.4217 $1,605.28 $621.82 $321.06 54385................ T.................... ................... Repair penis........

0181 29.4217 $1,605.28 $621.82 $321.06 54390................ C.................... ................... Repair penis and ........... ........... ........... ........... ........... bladder. 54400................ S.................... ................... Insert semi-rigid

0385 67.1530 $3,663.93 ........... $732.79 prosthesis. 54401................ S.................... ................... Insert self-contd

0386 116.2382 $6,342.07 ........... $1,268.41 prosthesis. 54405................ S.................... ................... Insert multi-comp

0386 116.2382 $6,342.07 ........... $1,268.41 penis pros. 54406................ T.................... ................... Remove muti-comp

0181 29.4217 $1,605.28 $621.82 $321.06 penis pros. 54408................ T.................... ................... Repair multi-comp

0181 29.4217 $1,605.28 $621.82 $321.06 penis pros. 54410................ S.................... ................... Remove/replace penis

0386 116.2382 $6,342.07 ........... $1,268.41 prosth. 54411................ C.................... ................... Remov/replc penis ........... ........... ........... ........... ........... pros, comp. 54415................ T.................... ................... Remove self-contd

0181 29.4217 $1,605.28 $621.82 $321.06 penis pros. 54416................ S.................... ................... Remv/repl penis

0385 67.1530 $3,663.93 ........... $732.79 contain pros.

[[Page 63547]]

54417................ C.................... ................... Remv/replc penis ........... ........... ........... ........... ........... pros, compl. 54420................ T.................... ................... Revision of penis...

0181 29.4217 $1,605.28 $621.82 $321.06 54430................ C.................... ................... Revision of penis... ........... ........... ........... ........... ........... 54435................ T.................... ................... Revision of penis...

0181 29.4217 $1,605.28 $621.82 $321.06 54440................ T.................... ................... Repair of penis.....

0181 29.4217 $1,605.28 $621.82 $321.06 54450................ T.................... ................... Preputial stretching

0156 2.4747 $135.02 $40.52 $27.00 54500................ T.................... ................... Biopsy of testis....

0037 9.8921 $539.72 $237.45 $107.94 54505................ T.................... ................... Biopsy of testis....

0183 21.6724 $1,182.47 ........... $236.49 54512................ T.................... ................... Excise lesion testis

0183 21.6724 $1,182.47 ........... $236.49 54520................ T.................... ................... Removal of testis...

0183 21.6724 $1,182.47 ........... $236.49 54522................ T.................... ................... Orchiectomy, partial

0183 21.6724 $1,182.47 ........... $236.49 54530................ T.................... ................... Removal of testis...

0154 26.9636 $1,471.16 $464.85 $294.23 54535................ C.................... ................... Extensive testis ........... ........... ........... ........... ........... surgery. 54550................ T.................... ................... Exploration for

0154 26.9636 $1,471.16 $464.85 $294.23 testis. 54560................ C.................... ................... Exploration for ........... ........... ........... ........... ........... testis. 54600................ T.................... ................... Reduce testis

0183 21.6724 $1,182.47 ........... $236.49 torsion. 54620................ T.................... ................... Suspension of testis

0183 21.6724 $1,182.47 ........... $236.49 54640................ T.................... ................... Suspension of testis

0154 26.9636 $1,471.16 $464.85 $294.23 54650................ C.................... ................... Orchiopexy (Fowler- ........... ........... ........... ........... ........... Stephens). 54660................ T.................... ................... Revision of testis..

0183 21.6724 $1,182.47 ........... $236.49 54670................ T.................... ................... Repair testis injury

0183 21.6724 $1,182.47 ........... $236.49 54680................ T.................... ................... Relocation of

0183 21.6724 $1,182.47 ........... $236.49 testis(es). 54690................ T.................... ................... Laparoscopy,

0131 40.8064 $2,226.44 $1,001.89 $445.29 orchiectomy. 54692................ T.................... ................... Laparoscopy,

0132 57.2045 $3,121.13 $1,239.22 $624.23 orchiopexy. 54699................ T.................... ................... Laparoscope proc,

0130 32.7724 $1,788.09 $659.53 $357.62 testis. 54700................ T.................... ................... Drainage of scrotum.

0183 21.6724 $1,182.47 ........... $236.49 54800................ T.................... ................... Biopsy of epididymis

0004 1.5882 $86.65 $22.36 $17.33 54820................ T.................... ................... Exploration of

0183 21.6724 $1,182.47 ........... $236.49 epididymis. 54830................ T.................... ................... Remove epididymis

0183 21.6724 $1,182.47 ........... $236.49 lesion. 54840................ T.................... ................... Remove epididymis

0183 21.6724 $1,182.47 ........... $236.49 lesion. 54860................ T.................... ................... Removal of

0183 21.6724 $1,182.47 ........... $236.49 epididymis. 54861................ T.................... ................... Removal of

0183 21.6724 $1,182.47 ........... $236.49 epididymis. 54900................ T.................... ................... Fusion of spermatic

0183 21.6724 $1,182.47 ........... $236.49 ducts. 54901................ T.................... ................... Fusion of spermatic

0183 21.6724 $1,182.47 ........... $236.49 ducts. 55000................ T.................... ................... Drainage of

0004 1.5882 $86.65 $22.36 $17.33 hydrocele. 55040................ T.................... ................... Removal of hydrocele

0154 26.9636 $1,471.16 $464.85 $294.23 55041................ T.................... ................... Removal of

0154 26.9636 $1,471.16 $464.85 $294.23 hydroceles. 55060................ T.................... ................... Repair of hydrocele.

0183 21.6724 $1,182.47 ........... $236.49 55100................ T.................... ................... Drainage of scrotum

0007 11.8633 $647.27 ........... $129.45 abscess. 55110................ T.................... ................... Explore scrotum.....

0183 21.6724 $1,182.47 ........... $236.49 55120................ T.................... ................... Removal of scrotum

0183 21.6724 $1,182.47 ........... $236.49 lesion. 55150................ T.................... ................... Removal of scrotum..

0183 21.6724 $1,182.47 ........... $236.49 55175................ T.................... ................... Revision of scrotum.

0183 21.6724 $1,182.47 ........... $236.49 55180................ T.................... ................... Revision of scrotum.

0183 21.6724 $1,182.47 ........... $236.49 55200................ T.................... ................... Incision of sperm

0183 21.6724 $1,182.47 ........... $236.49 duct. 55250................ T.................... ................... Removal of sperm

0183 21.6724 $1,182.47 ........... $236.49 duct(s).

W 55300................ N.................... ................... Prepare, sperm duct ........... ........... ........... ........... ........... x-ray. 55400................ T.................... ................... Repair of sperm duct

0183 21.6724 $1,182.47 ........... $236.49 55450................ T.................... ................... Ligation of sperm

0183 21.6724 $1,182.47 ........... $236.49 duct. 55500................ T.................... ................... Removal of hydrocele

0183 21.6724 $1,182.47 ........... $236.49 55520................ T.................... ................... Removal of sperm

0183 21.6724 $1,182.47 ........... $236.49 cord lesion. 55530................ T.................... ................... Revise spermatic

0183 21.6724 $1,182.47 ........... $236.49 cord veins. 55535................ T.................... ................... Revise spermatic

0154 26.9636 $1,471.16 $464.85 $294.23 cord veins. 55540................ T.................... ................... Revise hernia &

0154 26.9636 $1,471.16 $464.85 $294.23 sperm veins. 55550................ T.................... ................... Laparo ligate

0131 40.8064 $2,226.44 $1,001.89 $445.29 spermatic vein. 55559................ T.................... ................... Laparo proc,

0130 32.7724 $1,788.09 $659.53 $357.62 spermatic cord. 55600................ C.................... ................... Incise sperm duct ........... ........... ........... ........... ........... pouch. 55605................ C.................... ................... Incise sperm duct ........... ........... ........... ........... ........... pouch. 55650................ C.................... ................... Remove sperm duct ........... ........... ........... ........... ........... pouch. 55680................ T.................... ................... Remove sperm pouch

0183 21.6724 $1,182.47 ........... $236.49 lesion. 55700................ T.................... ................... Biopsy of prostate..

0184 3.8995 $212.76 $96.27 $42.55 55705................ T.................... ................... Biopsy of prostate..

0184 3.8995 $212.76 $96.27 $42.55 55720................ T.................... ................... Drainage of prostate

0162 21.9098 $1,195.42 ........... $239.08 abscess. 55725................ T.................... ................... Drainage of prostate

0162 21.9098 $1,195.42 ........... $239.08 abscess. 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. 55845................ C.................... ................... Extensive prostate ........... ........... ........... ........... ........... surgery. 55859................ T.................... ................... Percut/needle

0163 33.8805 $1,848.55 ........... $369.71 insert, pros. 55860................ T.................... ................... Surgical exposure,

0165 14.6838 $801.16 ........... $160.23 prostate.

[[Page 63548]]

55862................ C.................... ................... Extensive prostate ........... ........... ........... ........... ........... surgery. 55865................ C.................... ................... Extensive prostate ........... ........... ........... ........... ........... surgery. 55866................ C.................... ................... Laparo radical

........... ........... ........... ........... ........... prostatectomy. 55870................ T.................... ................... Vag hyst w/

0197 4.8280 $263.42 ........... $52.68 enterocele repair. 55873................ T.................... ................... Cryoablate prostate.

0674 119.9733 $6,545.86 ........... $1,309.17 55899................ T.................... ................... Genital surgery

0164 1.2021 $65.59 $17.59 $13.12 procedure. 55970................ E.................... ................... Sex transformation, ........... ........... ........... ........... ........... M to F. 55980................ E.................... ................... Sex transformation, ........... ........... ........... ........... ........... F to M. 56405................ T.................... ................... I & D of vulva/

0192 2.7121 $147.97 $39.11 $29.59 perineum. 56420................ T.................... ................... Drainage of gland

0192 2.7121 $147.97 $39.11 $29.59 abscess. 56440................ T.................... ................... Surgery for vulva

0194 18.4286 $1,005.48 $397.84 $201.10 lesion. 56441................ T.................... ................... Lysis of labial

0193 15.0453 $820.89 $171.13 $164.18 lesion(s). 56501................ T.................... ................... Destroy, vulva

0017 16.3697 $893.15 $227.84 $178.63 lesions, sim. 56515................ T.................... ................... Destroy vulva lesion/

0695 19.1849 $1,046.75 $266.59 $209.35 s compl. 56605................ T.................... ................... Biopsy of vulva/

0019 3.9493 $215.48 $71.87 $43.10 perineum. 56606................ T.................... ................... Biopsy of vulva/

0019 3.9493 $215.48 $71.87 $43.10 perineum. 56620................ T.................... ................... Partial removal of

0195 25.6950 $1,401.94 $483.80 $280.39 vulva. 56625................ T.................... ................... Complete removal of

0195 25.6950 $1,401.94 $483.80 $280.39 vulva. 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

0194 18.4286 $1,005.48 $397.84 $201.10 hymen. 56720................ T.................... ................... Incision of hymen...

0193 15.0453 $820.89 $171.13 $164.18 56740................ T.................... ................... Remove vagina gland

0194 18.4286 $1,005.48 $397.84 $201.10 lesion. 56800................ T.................... ................... Repair of vagina....

0194 18.4286 $1,005.48 $397.84 $201.10 56805................ T.................... ................... Repair clitoris.....

0194 18.4286 $1,005.48 $397.84 $201.10 56810................ T.................... ................... Repair of perineum..

0194 18.4286 $1,005.48 $397.84 $201.10 56820................ T.................... ................... Exam of vulva w/

0188 1.1365 $62.01 ........... $12.40 scope. 56821................ T.................... ................... Exam/biopsy of vulva

0189 1.4232 $77.65 $18.09 $15.53 w/scope. 57000................ T.................... ................... Exploration of

0194 18.4286 $1,005.48 $397.84 $201.10 vagina. 57010................ T.................... ................... Drainage of pelvic

0194 18.4286 $1,005.48 $397.84 $201.10 abscess. 57020................ T.................... ................... Drainage of pelvic

0192 2.7121 $147.97 $39.11 $29.59 fluid. 57022................ T.................... ................... I & d vaginal

0007 11.8633 $647.27 ........... $129.45 hematoma, pp. 57023................ T.................... ................... I & d vag hematoma,

0007 11.8633 $647.27 ........... $129.45 non-ob. 57061................ T.................... ................... Destroy vag lesions,

0194 18.4286 $1,005.48 $397.84 $201.10 simple. 57065................ T.................... ................... Destroy vag lesions,

0194 18.4286 $1,005.48 $397.84 $201.10 complex. 57100................ T.................... ................... Biopsy of vagina....

0192 2.7121 $147.97 $39.11 $29.59 57105................ T.................... ................... Biopsy of vagina....

0194 18.4286 $1,005.48 $397.84 $201.10 57106................ T.................... ................... Remove vagina wall,

0194 18.4286 $1,005.48 $397.84 $201.10 partial. 57107................ T.................... ................... Remove vagina

0195 25.6950 $1,401.94 $483.80 $280.39 tissue, part. 57109................ T.................... ................... Vaginectomy partial

0195 25.6950 $1,401.94 $483.80 $280.39 w/nodes. 57110................ C.................... ................... Remove vagina wall, ........... ........... ........... ........... ........... complete. 57111................ C.................... ................... Remove vagina

........... ........... ........... ........... ........... tissue, compl. 57112................ C.................... ................... Vaginectomy w/nodes, ........... ........... ........... ........... ........... compl. 57120................ T.................... ................... Closure of vagina...

0195 25.6950 $1,401.94 $483.80 $280.39 57130................ T.................... ................... Remove vagina lesion

0194 18.4286 $1,005.48 $397.84 $201.10 57135................ T.................... ................... Remove vagina lesion

0194 18.4286 $1,005.48 $397.84 $201.10 57150................ T.................... ................... Treat vagina

0191 0.1853 $10.11

$2.93

$2.02 infection. 57155................ T.................... ................... Insert uteri tandems/

0193 15.0453 $820.89 $171.13 $164.18 ovoids. 57160................ T.................... ................... Insert pessary/other

0188 1.1365 $62.01 ........... $12.40 device. 57170................ T.................... ................... Fitting of diaphragm/

0191 0.1853 $10.11

$2.93

$2.02 cap. 57180................ T.................... ................... Treat vaginal

0192 2.7121 $147.97 $39.11 $29.59 bleeding. 57200................ T.................... ................... Repair of vagina....

0194 18.4286 $1,005.48 $397.84 $201.10 57210................ T.................... ................... Repair vagina/

0194 18.4286 $1,005.48 $397.84 $201.10 perineum. 57220................ T.................... ................... Revision of urethra.

0195 25.6950 $1,401.94 $483.80 $280.39 57230................ T.................... ................... Repair of urethral

0195 25.6950 $1,401.94 $483.80 $280.39 lesion. 57240................ T.................... ................... Repair bladder &

0195 25.6950 $1,401.94 $483.80 $280.39 vagina. 57250................ T.................... ................... Repair rectum &

0195 25.6950 $1,401.94 $483.80 $280.39 vagina. 57260................ T.................... ................... Repair of vagina....

0195 25.6950 $1,401.94 $483.80 $280.39 57265................ T.................... ................... Extensive repair of

0195 25.6950 $1,401.94 $483.80 $280.39 vagina. 57268................ T.................... ................... Repair of bowel

0195 25.6950 $1,401.94 $483.80 $280.39 bulge. 57270................ C.................... ................... Repair of bowel ........... ........... ........... ........... ........... pouch. 57280................ C.................... ................... Suspension of vagina ........... ........... ........... ........... ........... 57282................ C.................... ................... Repair of vaginal ........... ........... ........... ........... ........... prolapse. 57284................ T.................... ................... Repair paravaginal

0195 25.6950 $1,401.94 $483.80 $280.39 defect. 57287................ T.................... ................... Revise/remove sling

0202 38.9821 $2,126.90 $1,042.18 $425.38 repair. 57288................ T.................... ................... Repair bladder

0202 38.9821 $2,126.90 $1,042.18 $425.38 defect. 57289................ T.................... ................... Repair bladder &

0195 25.6950 $1,401.94 $483.80 $280.39 vagina. 57291................ T.................... ................... Construction of

0195 25.6950 $1,401.94 $483.80 $280.39 vagina. 57292................ C.................... ................... Construct vagina ........... ........... ........... ........... ........... with graft. 57300................ T.................... ................... Repair rectum-vagina

0195 25.6950 $1,401.94 $483.80 $280.39 fistula.

[[Page 63549]]

57305................ C.................... ................... Repair rectum-vagina ........... ........... ........... ........... ........... fistula. 57307................ C.................... ................... Fistula repair & ........... ........... ........... ........... ........... colostomy. 57308................ C.................... ................... Fistula repair, ........... ........... ........... ........... ........... transperine. 57310................ T.................... ................... Repair

0195 25.6950 $1,401.94 $483.80 $280.39 urethrovaginal lesion. 57311................ C.................... ................... Repair

........... ........... ........... ........... ........... urethrovaginal lesion. 57320................ T.................... ................... Repair bladder-

0195 25.6950 $1,401.94 $483.80 $280.39 vagina lesion. 57330................ T.................... ................... Repair bladder-

0195 25.6950 $1,401.94 $483.80 $280.39 vagina lesion. 57335................ C.................... ................... Repair vagina....... ........... ........... ........... ........... ........... 57400................ T.................... ................... Dilation of vagina..

0194 18.4286 $1,005.48 $397.84 $201.10 57410................ T.................... ................... Pelvic examination..

0194 18.4286 $1,005.48 $397.84 $201.10 57415................ T.................... ................... Remove vaginal

0194 18.4286 $1,005.48 $397.84 $201.10 foreign body. 57420................ T.................... ................... Exam of vagina w/

0192 2.7121 $147.97 $39.11 $29.59 scope. 57421................ T.................... ................... Exam/biopsy of vag w/

0192 2.7121 $147.97 $39.11 $29.59 scope. 57425................ T.................... NI................. Laparoscopy, surg,

0130 32.7724 $1,788.09 $659.53 $357.62 colpopexy. 57452................ T.................... ................... Examination of

0189 1.4232 $77.65 $18.09 $15.53 vagina. 57454................ T.................... ................... Vagina examination &

0192 2.7121 $147.97 $39.11 $29.59 biopsy. 57455................ T.................... ................... Biopsy of cervix w/

0192 2.7121 $147.97 $39.11 $29.59 scope. 57456................ T.................... ................... Endocerv curettage w/

0192 2.7121 $147.97 $39.11 $29.59 scope. 57460................ T.................... ................... Cervix excision.....

0193 15.0453 $820.89 $171.13 $164.18 57461................ T.................... ................... Conz of cervix w/

0194 18.4286 $1,005.48 $397.84 $201.10 scope, leep. 57500................ T.................... ................... Biopsy of cervix....

0192 2.7121 $147.97 $39.11 $29.59 57505................ T.................... ................... Endocervical

0192 2.7121 $147.97 $39.11 $29.59 curettage. 57510................ T.................... ................... Cauterization of

0193 15.0453 $820.89 $171.13 $164.18 cervix. 57511................ T.................... ................... Cryocautery of

0189 1.4232 $77.65 $18.09 $15.53 cervix. 57513................ T.................... ................... Laser surgery of

0193 15.0453 $820.89 $171.13 $164.18 cervix. 57520................ T.................... ................... Conization of cervix

0194 18.4286 $1,005.48 $397.84 $201.10 57522................ T.................... ................... Conization of cervix

0195 25.6950 $1,401.94 $483.80 $280.39 57530................ T.................... ................... Removal of cervix...

0195 25.6950 $1,401.94 $483.80 $280.39 57531................ C.................... ................... Removal of cervix, ........... ........... ........... ........... ........... radical. 57540................ C.................... ................... Removal of residual ........... ........... ........... ........... ........... cervix. 57545................ C.................... ................... Remove cervix/repair ........... ........... ........... ........... ........... pelvis. 57550................ T.................... ................... Removal of residual

0195 25.6950 $1,401.94 $483.80 $280.39 cervix. 57555................ T.................... ................... Remove cervix/repair

0195 25.6950 $1,401.94 $483.80 $280.39 vagina. 57556................ T.................... ................... Remove cervix,

0195 25.6950 $1,401.94 $483.80 $280.39 repair bowel. 57700................ T.................... ................... Revision of cervix..

0194 18.4286 $1,005.48 $397.84 $201.10 57720................ T.................... ................... Revision of cervix..

0194 18.4286 $1,005.48 $397.84 $201.10 57800................ T.................... ................... Dilation of cervical

0193 15.0453 $820.89 $171.13 $164.18 canal. 57820................ T.................... ................... D & c of residual

0196 16.1219 $879.63 $338.23 $175.93 cervix. 58100................ T.................... ................... Biopsy of uterus

0188 1.1365 $62.01 ........... $12.40 lining. 58120................ T.................... ................... Dilation and

0196 16.1219 $879.63 $338.23 $175.93 curettage. 58140................ C.................... ................... Removal of uterus ........... ........... ........... ........... ........... lesion. 58145................ T.................... ................... Myomectomy vag

0195 25.6950 $1,401.94 $483.80 $280.39 method. 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. 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

0189 1.4232 $77.65 $18.09 $15.53 device. 58321................ T.................... ................... Artificial

0197 4.8280 $263.42 ........... $52.68 insemination. 58322................ T.................... ................... Artificial

0197 4.8280 $263.42 ........... $52.68 insemination. 58323................ T.................... ................... Sperm washing.......

0197 4.8280 $263.42 ........... $52.68 58340................ N.................... ................... Catheter for

........... ........... ........... ........... ........... hysterography. 58345................ T.................... ................... Reopen fallopian

0194 18.4286 $1,005.48 $397.84 $201.10 tube. 58346................ T.................... ................... Insert heyman uteri

0193 15.0453 $820.89 $171.13 $164.18 capsule. 58350................ T.................... ................... Reopen fallopian

0194 18.4286 $1,005.48 $397.84 $201.10 tube. 58353................ T.................... ................... Endometr ablate,

0195 25.6950 $1,401.94 $483.80 $280.39 thermal. 58400................ C.................... ................... Suspension of uterus ........... ........... ........... ........... ........... 58410................ C.................... ................... Suspension of uterus ........... ........... ........... ........... ........... 58520................ C.................... ................... Repair of ruptured ........... ........... ........... ........... ........... uterus.

[[Page 63550]]

58540................ C.................... ................... Revision of uterus.. ........... ........... ........... ........... ........... 58545................ T.................... ................... Laparoscopic

0130 32.7724 $1,788.09 $659.53 $357.62 myomectomy. 58546................ T.................... ................... Laparo-myomectomy,

0131 40.8064 $2,226.44 $1,001.89 $445.29 complex. 58550................ T.................... ................... Laparo-asst vag

0132 57.2045 $3,121.13 $1,239.22 $624.23 hysterectomy. 58552................ T.................... ................... Laparo-vag hyst incl

0131 40.8064 $2,226.44 $1,001.89 $445.29 t/o. 58553................ T.................... ................... Laparo-vag hyst,

0131 40.8064 $2,226.44 $1,001.89 $445.29 complex. 58554................ T.................... ................... Laparo-vag hyst w/t/

0131 40.8064 $2,226.44 $1,001.89 $445.29 o, compl. 58555................ T.................... ................... Hysteroscopy, dx,

0190 19.6922 $1,074.43 $424.28 $214.89 sep proc. 58558................ T.................... ................... Hysteroscopy, biopsy

0190 19.6922 $1,074.43 $424.28 $214.89 58559................ T.................... ................... Hysteroscopy, lysis.

0190 19.6922 $1,074.43 $424.28 $214.89 58560................ T.................... ................... Hysteroscopy, resect

0387 28.1480 $1,535.78 $655.55 $307.16 septum. 58561................ T.................... ................... Hysteroscopy, remove

0387 28.1480 $1,535.78 $655.55 $307.16 myoma. 58562................ T.................... ................... Hysteroscopy, remove

0190 19.6922 $1,074.43 $424.28 $214.89 fb. 58563................ T.................... ................... Hysteroscopy,

0387 28.1480 $1,535.78 $655.55 $307.16 ablation. 58578................ T.................... ................... Laparo proc, uterus.

0130 32.7724 $1,788.09 $659.53 $357.62 58579................ T.................... ................... Hysteroscope

0190 19.6922 $1,074.43 $424.28 $214.89 procedure. 58600................ T.................... ................... Division of

0195 25.6950 $1,401.94 $483.80 $280.39 fallopian tube. 58605................ C.................... ................... Division of

........... ........... ........... ........... ........... fallopian tube. 58611................ C.................... ................... Ligate oviduct(s) ........... ........... ........... ........... ........... add-on. 58615................ T.................... ................... Occlude fallopian

0194 18.4286 $1,005.48 $397.84 $201.10 tube(s). 58660................ T.................... ................... Laparoscopy, lysis..

0131 40.8064 $2,226.44 $1,001.89 $445.29 58661................ T.................... ................... Laparoscopy, remove

0131 40.8064 $2,226.44 $1,001.89 $445.29 adnexa. 58662................ T.................... ................... Laparoscopy, excise

0131 40.8064 $2,226.44 $1,001.89 $445.29 lesions. 58670................ T.................... ................... Laparoscopy, tubal

0131 40.8064 $2,226.44 $1,001.89 $445.29 cautery. 58671................ T.................... ................... Laparoscopy, tubal

0131 40.8064 $2,226.44 $1,001.89 $445.29 block. 58672................ T.................... ................... Laparoscopy,

0131 40.8064 $2,226.44 $1,001.89 $445.29 fimbrioplasty. 58673................ T.................... ................... Laparoscopy,

0131 40.8064 $2,226.44 $1,001.89 $445.29 salpingostomy. 58679................ T.................... ................... Laparo proc, oviduct-

0130 32.7724 $1,788.09 $659.53 $357.62 ovary. 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................ C.................... ................... Create new tubal ........... ........... ........... ........... ........... opening. 58800................ T.................... ................... Drainage of ovarian

0193 15.0453 $820.89 $171.13 $164.18 cyst(s). 58805................ C.................... ................... Drainage of ovarian ........... ........... ........... ........... ........... cyst(s). 58820................ T.................... ................... Drain ovary abscess,

0195 25.6950 $1,401.94 $483.80 $280.39 open. 58822................ C.................... ................... Drain ovary abscess, ........... ........... ........... ........... ........... percut. 58823................ T.................... ................... Drain pelvic

0193 15.0453 $820.89 $171.13 $164.18 abscess, percut. 58825................ C.................... ................... Transposition,

........... ........... ........... ........... ........... ovary(s). 58900................ T.................... ................... Biopsy of ovary(s)..

0193 15.0453 $820.89 $171.13 $164.18 58920................ T.................... ................... Partial removal of

0195 25.6950 $1,401.94 $483.80 $280.39 ovary(s). 58925................ T.................... ................... Removal of ovarian

0195 25.6950 $1,401.94 $483.80 $280.39 cyst(s). 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. 58960................ C.................... ................... Exploration of

........... ........... ........... ........... ........... abdomen. 58970................ T.................... ................... Retrieval of oocyte.

0194 18.4286 $1,005.48 $397.84 $201.10 58974................ T.................... ................... Transfer of embryo..

0197 4.8280 $263.42 ........... $52.68 58976................ T.................... ................... Transfer of embryo..

0197 4.8280 $263.42 ........... $52.68 58999................ T.................... ................... Genital surgery

0191 0.1853 $10.11

$2.93

$2.02 procedure. 59000................ T.................... ................... Amniocentesis,

0198 1.3578 $74.08 $32.19 $14.82 diagnostic. 59001................ T.................... ................... Amniocentesis,

0198 1.3578 $74.08 $32.19 $14.82 therapeutic. 59012................ T.................... ................... Fetal cord

0198 1.3578 $74.08 $32.19 $14.82 puncture,prenatal. 59015................ T.................... ................... Chorion biopsy......

0198 1.3578 $74.08 $32.19 $14.82 59020................ T.................... ................... Fetal contract

0198 1.3578 $74.08 $32.19 $14.82 stress test. 59025................ T.................... ................... Fetal non-stress

0198 1.3578 $74.08 $32.19 $14.82 test. 59030................ T.................... ................... Fetal scalp blood

0198 1.3578 $74.08 $32.19 $14.82 sample. 59050................ E.................... ................... Fetal monitor w/ ........... ........... ........... ........... ........... report. 59051................ B.................... ................... Fetal monitor/

........... ........... ........... ........... ........... interpret only. 59070................ T.................... NI................. Transabdom

0198 1.3578 $74.08 $32.19 $14.82 amnioinfus w/ us. 59072................ T.................... NI................. Umbilical cord

0198 1.3578 $74.08 $32.19 $14.82 occlud w/ us. 59074................ T.................... NI................. Fetal fluid drainage

0198 1.3578 $74.08 $32.19 $14.82 w/ us. 59076................ T.................... NI................. Fetal shunt

0198 1.3578 $74.08 $32.19 $14.82 placement, w/ us. 59100................ C.................... ................... Remove uterus lesion ........... ........... ........... ........... ........... 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.

[[Page 63551]]

59140................ C.................... ................... Treat ectopic

........... ........... ........... ........... ........... pregnancy. 59150................ T.................... ................... Treat ectopic

0131 40.8064 $2,226.44 $1,001.89 $445.29 pregnancy. 59151................ T.................... ................... Treat ectopic

0131 40.8064 $2,226.44 $1,001.89 $445.29 pregnancy. 59160................ T.................... ................... D & c after delivery

0196 16.1219 $879.63 $338.23 $175.93 59200................ T.................... ................... Insert cervical

0189 1.4232 $77.65 $18.09 $15.53 dilator. 59300................ T.................... ................... Episiotomy or

0193 15.0453 $820.89 $171.13 $164.18 vaginal repair. 59320................ T.................... ................... Revision of cervix..

0194 18.4286 $1,005.48 $397.84 $201.10 59325................ C.................... ................... Revision of cervix.. ........... ........... ........... ........... ........... 59350................ C.................... ................... Repair of uterus.... ........... ........... ........... ........... ........... 59400................ B.................... ................... Obstetrical care.... ........... ........... ........... ........... ........... 59409................ T.................... ................... Obstetrical care....

0199 17.2831 $942.98 ........... $188.60 59410................ B.................... ................... Obstetrical care.... ........... ........... ........... ........... ........... 59412................ T.................... ................... Antepartum

0700 2.4306 $132.62 $37.13 $26.52 manipulation. 59414................ T.................... ................... Deliver placenta....

0199 17.2831 $942.98 ........... $188.60 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..

0199 17.2831 $942.98 ........... $188.60 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

0201 16.8660 $920.23 $329.65 $184.05 miscarriage. 59820................ T.................... ................... Care of miscarriage.

0201 16.8660 $920.23 $329.65 $184.05 59821................ T.................... ................... Treatment of

0201 16.8660 $920.23 $329.65 $184.05 miscarriage. 59830................ C.................... ................... Treat uterus

........... ........... ........... ........... ........... infection. 59840................ T.................... ................... Abortion............

0200 17.9920 $981.66 $307.83 $196.33 59841................ T.................... ................... Abortion............

0200 17.9920 $981.66 $307.83 $196.33 59850................ C.................... ................... Abortion............ ........... ........... ........... ........... ........... 59851................ C.................... ................... Abortion............ ........... ........... ........... ........... ........... 59852................ C.................... ................... Abortion............ ........... ........... ........... ........... ........... 59855................ C.................... ................... Abortion............ ........... ........... ........... ........... ........... 59856................ C.................... ................... Abortion............ ........... ........... ........... ........... ........... 59857................ C.................... ................... Abortion............ ........... ........... ........... ........... ........... 59866................ T.................... ................... Abortion (mpr)......

0198 1.3578 $74.08 $32.19 $14.82 59870................ T.................... ................... Evacuate mole of

0201 16.8660 $920.23 $329.65 $184.05 uterus. 59871................ T.................... ................... Remove cerclage

0194 18.4286 $1,005.48 $397.84 $201.10 suture. 59897................ T.................... NI................. Fetal invas px w/ us

0198 1.3578 $74.08 $32.19 $14.82 59898................ T.................... ................... Laparo proc, ob care/

0130 32.7724 $1,788.09 $659.53 $357.62 deliver. 59899................ T.................... ................... Maternity care

0198 1.3578 $74.08 $32.19 $14.82 procedure. 60000................ T.................... ................... Drain thyroid/tongue

0252 6.4469 $351.75 $113.41 $70.35 cyst. 60001................ T.................... ................... Aspirate/inject

0004 1.5882 $86.65 $22.36 $17.33 thyriod cyst. 60100................ T.................... ................... Biopsy of thyroid...

0004 1.5882 $86.65 $22.36 $17.33 60200................ T.................... ................... Remove thyroid

0114 37.5963 $2,051.29 $485.91 $410.26 lesion. 60210................ T.................... ................... Partial thyroid

0114 37.5963 $2,051.29 $485.91 $410.26 excision. 60212................ T.................... ................... Partial thyroid

0114 37.5963 $2,051.29 $485.91 $410.26 excision. 60220................ T.................... ................... Partial removal of

0114 37.5963 $2,051.29 $485.91 $410.26 thyroid. 60225................ T.................... ................... Partial removal of

0114 37.5963 $2,051.29 $485.91 $410.26 thyroid. 60240................ T.................... ................... Removal of thyroid..

0114 37.5963 $2,051.29 $485.91 $410.26 60252................ T.................... ................... Removal of thyroid..

0256 35.1548 $1,918.08 ........... $383.62 60254................ C.................... ................... Extensive thyroid ........... ........... ........... ........... ........... surgery. 60260................ T.................... ................... Repeat thyroid

0256 35.1548 $1,918.08 ........... $383.62 surgery. 60270................ C.................... ................... Removal of thyroid.. ........... ........... ........... ........... ........... 60271................ C.................... ................... Removal of thyroid.. ........... ........... ........... ........... ........... 60280................ T.................... ................... Remove thyroid duct

0114 37.5963 $2,051.29 $485.91 $410.26 lesion. 60281................ T.................... ................... Remove thyroid duct

0114 37.5963 $2,051.29 $485.91 $410.26 lesion. 60500................ T.................... ................... Explore parathyroid

0256 35.1548 $1,918.08 ........... $383.62 glands. 60502................ C.................... ................... Re-explore

........... ........... ........... ........... ........... parathyroids. 60505................ C.................... ................... Explore parathyroid ........... ........... ........... ........... ........... glands. 60512................ T.................... ................... Autotransplant

0022 18.7932 $1,025.38 $354.45 $205.08 parathyroid. 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,

0130 32.7724 $1,788.09 $659.53 $357.62 endocrine. 60699................ T.................... ................... Endocrine surgery

0114 37.5963 $2,051.29 $485.91 $410.26 procedure.

[[Page 63552]]

61000................ T.................... ................... Remove cranial

0212 2.9739 $162.26 $74.67 $32.45 cavity fluid. 61001................ T.................... ................... Remove cranial

0212 2.9739 $162.26 $74.67 $32.45 cavity fluid. 61020................ T.................... ................... Remove brain cavity

0212 2.9739 $162.26 $74.67 $32.45 fluid. 61026................ T.................... ................... Injection into brain

0212 2.9739 $162.26 $74.67 $32.45 canal. 61050................ T.................... ................... Remove brain canal

0212 2.9739 $162.26 $74.67 $32.45 fluid. 61055................ T.................... ................... Injection into brain

0212 2.9739 $162.26 $74.67 $32.45 canal. 61070................ T.................... ................... Brain canal shunt

0212 2.9739 $162.26 $74.67 $32.45 procedure. 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

0224 34.1770 $1,864.73 $453.41 $372.95 device. 61250................ C.................... ................... Pierce skull &

........... ........... ........... ........... ........... explore. 61253................ C.................... ................... Pierce skull &

........... ........... ........... ........... ........... explore. 61304................ C.................... ................... Open skull for

........... ........... ........... ........... ........... exploration. 61305................ C.................... ................... Open skull for

........... ........... ........... ........... ........... exploration. 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

0256 35.1548 $1,918.08 ........... $383.62 socket. 61332................ C.................... ................... Explore/biopsy eye ........... ........... ........... ........... ........... socket. 61333................ C.................... ................... Explore orbit/remove ........... ........... ........... ........... ........... lesion. 61334................ C.................... ................... Explore orbit/remove ........... ........... ........... ........... ........... object. 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.................... NI................. Removal of brain ........... ........... ........... ........... ........... tissue. 61538................ C.................... ................... Removal of brain ........... ........... ........... ........... ........... tissue. 61539................ C.................... ................... Removal of brain ........... ........... ........... ........... ........... tissue. 61540................ C.................... NI................. 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.

[[Page 63553]]

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.................... NI................. Removal of brain ........... ........... ........... ........... ........... tissue. 61567................ C.................... NI................. Incision of brain ........... ........... ........... ........... ........... tissue. 61570................ C.................... ................... Remove foreign body, ........... ........... ........... ........... ........... brain. 61571................ C.................... ................... Incise skull for ........... ........... ........... ........... ........... brain wound. 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

1555 ........... $1,650.00 ........... $330.00 vessel occl. 61624................ C.................... ................... Occlusion/

........... ........... ........... ........... ........... embolization cath. 61626................ T.................... ................... Transcath occlusion,

0081 35.0285 $1,911.19 ........... $382.24 non-cns. 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

0220 16.5554 $903.28 ........... $180.66 nerve. 61791................ T.................... ................... Treat trigeminal

0204 2.1711 $118.46 $40.13 $23.69 tract. 61793................ E.................... ................... Focus radiation beam ........... ........... ........... ........... ........... 61795................ S.................... ................... Brain surgery using

0302 6.3268 $345.20 $130.77 $69.04 computer. 61850................ C.................... ................... Implant

........... ........... ........... ........... ........... neuroelectrodes. 61860................ C.................... ................... Implant

........... ........... ........... ........... ........... neuroelectrodes. 61862................ C.................... DG................. Implant neurostimul, ........... ........... ........... ........... ........... subcort.

[[Page 63554]]

61863................ C.................... NI................. Implant

........... ........... ........... ........... ........... neuroelectrode. 61864................ C.................... NI................. Implant

........... ........... ........... ........... ........... neuroelectrde, add'l. 61867................ C.................... NI................. Implant

........... ........... ........... ........... ........... neuroelectrode. 61868................ C.................... NI................. Implant

........... ........... ........... ........... ........... neuroelectrde, add'l. 61870................ C.................... ................... Implant

........... ........... ........... ........... ........... neuroelectrodes. 61875................ C.................... ................... Implant

........... ........... ........... ........... ........... neuroelectrodes. 61880................ T.................... ................... Revise/remove

0687 20.4416 $1,115.31 $513.05 $223.06 neuroelectrode. 61885................ S.................... ................... Implant neurostim

0039 235.1866 $12,832.02 ........... $2,566.40 one array. 61886................ T.................... ................... Implant neurostim

0222 232.2024 $12,669.20 ........... $2,533.84 arrays. 61888................ T.................... ................... Revise/remove

0688 46.7347 $2,549.89 $1,249.45 $509.98 neuroreceiver. 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................ C.................... ................... Neuroendoscopy add- ........... ........... ........... ........... ........... on. 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

0121 2.1189 $115.61 $43.80 $23.12 catheter. 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

0122 8.8621 $483.53 $99.16 $96.71 catheter. 62230................ T.................... ................... Replace/revise brain

0224 34.1770 $1,864.73 $453.41 $372.95 shunt. 62252................ S.................... ................... Csf shunt reprogram.

0691 2.8066 $153.13 $76.56 $30.63 62256................ C.................... ................... Remove brain cavity ........... ........... ........... ........... ........... shunt. 62258................ C.................... ................... Replace brain cavity ........... ........... ........... ........... ........... shunt. 62263................ T.................... ................... Lysis epidural

0203 11.5969 $632.74 $276.76 $126.55 adhesions. 62264................ T.................... ................... Epidural lysis on

0203 11.5969 $632.74 $276.76 $126.55 single day. 62268................ T.................... ................... Drain spinal cord

0212 2.9739 $162.26 $74.67 $32.45 cyst. 62269................ T.................... ................... Needle biopsy,

0005 3.2698 $178.40 $71.59 $35.68 spinal cord. 62270................ T.................... ................... Spinal fluid tap,

0206 5.2875 $288.49 $75.55 $57.70 diagnostic. 62272................ T.................... ................... Drain cerebro spinal

0206 5.2875 $288.49 $75.55 $57.70 fluid. 62273................ T.................... ................... Treat epidural spine

0206 5.2875 $288.49 $75.55 $57.70 lesion. 62280................ T.................... ................... Treat spinal cord

0207 6.4554 $352.21 $123.69 $70.44 lesion. 62281................ T.................... ................... Treat spinal cord

0207 6.4554 $352.21 $123.69 $70.44 lesion. 62282................ T.................... ................... Treat spinal canal

0207 6.4554 $352.21 $123.69 $70.44 lesion. 62284................ N.................... ................... Injection for

........... ........... ........... ........... ........... myelogram. 62287................ T.................... ................... Percutaneous

0220 16.5554 $903.28 ........... $180.66 diskectomy. 62290................ N.................... ................... Inject for spine ........... ........... ........... ........... ........... disk x-ray. 62291................ N.................... ................... Inject for spine ........... ........... ........... ........... ........... disk x-ray. 62292................ T.................... ................... Injection into disk

0212 2.9739 $162.26 $74.67 $32.45 lesion. 62294................ T.................... ................... Injection into

0212 2.9739 $162.26 $74.67 $32.45 spinal artery. 62310................ T.................... ................... Inject spine c/t....

0206 5.2875 $288.49 $75.55 $57.70 62311................ T.................... ................... Inject spine l/s

0206 5.2875 $288.49 $75.55 $57.70 (cd). 62318................ T.................... ................... Inject spine w/cath,

0206 5.2875 $288.49 $75.55 $57.70 c/t. 62319................ T.................... ................... Inject spine w/cath

0206 5.2875 $288.49 $75.55 $57.70 l/s (cd). 62350................ T.................... ................... Implant spinal canal

0223 26.7610 $1,460.11 ........... $292.02 cath. 62351................ T.................... ................... Implant spinal canal

0208 40.2830 $2,197.88 ........... $439.58 cath. 62355................ T.................... ................... Remove spinal canal

0203 11.5969 $632.74 $276.76 $126.55 catheter. 62360................ T.................... ................... Insert spine

0226 136.2989 $7,436.60 ........... $1,487.32 infusion device. 62361................ T.................... ................... Implant spine

0227 160.8363 $8,775.39 ........... $1,755.08 infusion pump. 62362................ T.................... ................... Implant spine

0227 160.8363 $8,775.39 ........... $1,755.08 infusion pump. 62365................ T.................... ................... Remove spine

0203 11.5969 $632.74 $276.76 $126.55 infusion device. 62367................ S.................... ................... Analyze spine

0691 2.8066 $153.13 $76.56 $30.63 infusion pump. 62368................ S.................... ................... Analyze spine

0691 2.8066 $153.13 $76.56 $30.63 infusion pump.

[[Page 63555]]

63001................ T.................... ................... Removal of spinal

0208 40.2830 $2,197.88 ........... $439.58 lamina. 63003................ T.................... ................... Removal of spinal

0208 40.2830 $2,197.88 ........... $439.58 lamina. 63005................ T.................... ................... Removal of spinal

0208 40.2830 $2,197.88 ........... $439.58 lamina. 63011................ T.................... ................... Removal of spinal

0208 40.2830 $2,197.88 ........... $439.58 lamina. 63012................ T.................... ................... Removal of spinal

0208 40.2830 $2,197.88 ........... $439.58 lamina. 63015................ T.................... ................... Removal of spinal

0208 40.2830 $2,197.88 ........... $439.58 lamina. 63016................ T.................... ................... Removal of spinal

0208 40.2830 $2,197.88 ........... $439.58 lamina. 63017................ T.................... ................... Removal of spinal

0208 40.2830 $2,197.88 ........... $439.58 lamina. 63020................ T.................... ................... Neck spine disk

0208 40.2830 $2,197.88 ........... $439.58 surgery. 63030................ T.................... ................... Low back disk

0208 40.2830 $2,197.88 ........... $439.58 surgery. 63035................ T.................... ................... Spinal disk surgery

0208 40.2830 $2,197.88 ........... $439.58 add-on. 63040................ T.................... ................... Laminotomy, single

0208 40.2830 $2,197.88 ........... $439.58 cervical. 63042................ T.................... ................... Laminotomy, single

0208 40.2830 $2,197.88 ........... $439.58 lumbar. 63043................ C.................... ................... Laminotomy, add'l ........... ........... ........... ........... ........... cervical. 63044................ C.................... ................... Laminotomy, add'l ........... ........... ........... ........... ........... lumbar. 63045................ T.................... ................... Removal of spinal

0208 40.2830 $2,197.88 ........... $439.58 lamina. 63046................ T.................... ................... Removal of spinal

0208 40.2830 $2,197.88 ........... $439.58 lamina. 63047................ T.................... ................... Removal of spinal

0208 40.2830 $2,197.88 ........... $439.58 lamina. 63048................ T.................... ................... Remove spinal lamina

0208 40.2830 $2,197.88 ........... $439.58 add-on. 63055................ T.................... ................... Decompress spinal

0208 40.2830 $2,197.88 ........... $439.58 cord. 63056................ T.................... ................... Decompress spinal

0208 40.2830 $2,197.88 ........... $439.58 cord. 63057................ T.................... ................... Decompress spine

0208 40.2830 $2,197.88 ........... $439.58 cord add-on. 63064................ T.................... ................... Decompress spinal

0208 40.2830 $2,197.88 ........... $439.58 cord. 63066................ T.................... ................... Decompress spine

0208 40.2830 $2,197.88 ........... $439.58 cord add-on. 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.................... NI................. Removal of vertebral ........... ........... ........... ........... ........... body. 63102................ C.................... NI................. Removal of vertebral ........... ........... ........... ........... ........... body. 63103................ C.................... NI................. 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. 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.

[[Page 63556]]

63287................ C.................... ................... Biopsy/excise spinal ........... ........... ........... ........... ........... tumor. 63290................ C.................... ................... Biopsy/excise spinal ........... ........... ........... ........... ........... tumor. 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

0220 16.5554 $903.28 ........... $180.66 lesion. 63610................ T.................... ................... Stimulation of

0220 16.5554 $903.28 ........... $180.66 spinal cord. 63615................ T.................... ................... Remove lesion of

0220 16.5554 $903.28 ........... $180.66 spinal cord. 63650................ S.................... ................... Implant

0040 52.1002 $2,842.64 ........... $568.53 neuroelectrodes. 63655................ S.................... ................... Implant

0225 206.0034 $11,239.75 ........... $2,247.95 neuroelectrodes. 63660................ T.................... ................... Revise/remove

0687 20.4416 $1,115.31 $513.05 $223.06 neuroelectrode. 63685................ T.................... ................... Implant

0222 232.2024 $12,669.20 ........... $2,533.84 neuroreceiver. 63688................ T.................... ................... Revise/remove

0688 46.7347 $2,549.89 $1,249.45 $509.98 neuroreceiver. 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 52.2880 $2,852.89 $639.03 $570.58 63744................ T.................... ................... Revision of spinal

0228 52.2880 $2,852.89 $639.03 $570.58 shunt. 63746................ T.................... ................... Removal of spinal

0109 7.4705 $407.60 $131.49 $81.52 shunt. 64400................ T.................... ................... N block inj,

0204 2.1711 $118.46 $40.13 $23.69 trigeminal. 64402................ T.................... ................... N block inj, facial.

0204 2.1711 $118.46 $40.13 $23.69 64405................ T.................... ................... N block inj,

0204 2.1711 $118.46 $40.13 $23.69 occipital. 64408................ T.................... ................... N block inj, vagus..

0204 2.1711 $118.46 $40.13 $23.69 64410................ T.................... ................... N block inj, phrenic

0204 2.1711 $118.46 $40.13 $23.69 64412................ T.................... ................... N block inj, spinal

0204 2.1711 $118.46 $40.13 $23.69 accessor. 64413................ T.................... ................... N block inj,

0204 2.1711 $118.46 $40.13 $23.69 cervical plexus. 64415................ T.................... ................... Injection for nerve

0204 2.1711 $118.46 $40.13 $23.69 block. 64416................ T.................... ................... N block cont infuse,

0204 2.1711 $118.46 $40.13 $23.69 b plex. 64417................ T.................... ................... N block inj,

0204 2.1711 $118.46 $40.13 $23.69 axillary. 64418................ T.................... ................... N block inj,

0204 2.1711 $118.46 $40.13 $23.69 suprascapular. 64420................ T.................... ................... N block inj,

0207 6.4554 $352.21 $123.69 $70.44 intercost, sng. 64421................ T.................... ................... N block inj,

0207 6.4554 $352.21 $123.69 $70.44 intercost, mlt. 64425................ T.................... ................... N block inj ilio-ing/

0204 2.1711 $118.46 $40.13 $23.69 hypogi. 64430................ T.................... ................... N block inj,

0204 2.1711 $118.46 $40.13 $23.69 pudendal. 64435................ T.................... ................... N block inj,

0204 2.1711 $118.46 $40.13 $23.69 paracervical. 64445................ T.................... ................... Injection for nerve

0204 2.1711 $118.46 $40.13 $23.69 block. 64446................ T.................... ................... N blk inj, sciatic,

0204 2.1711 $118.46 $40.13 $23.69 cont inf. 64447................ T.................... ................... N block inj fem,

0204 2.1711 $118.46 $40.13 $23.69 single. 64448................ T.................... ................... N block inj fem,

0204 2.1711 $118.46 $40.13 $23.69 cont inf. 64449................ T.................... NI................. N block inj, lumbar

0204 2.1711 $118.46 $40.13 $23.69 plexus. 64450................ T.................... ................... N block, other

0204 2.1711 $118.46 $40.13 $23.69 peripheral. 64470................ T.................... ................... Inj paravertebral c/

0207 6.4554 $352.21 $123.69 $70.44 t. 64472................ T.................... ................... Inj paravertebral c/

0207 6.4554 $352.21 $123.69 $70.44 t add-on. 64475................ T.................... ................... Inj paravertebral l/

0207 6.4554 $352.21 $123.69 $70.44 s. 64476................ T.................... ................... Inj paravertebral l/

0207 6.4554 $352.21 $123.69 $70.44 s add-on. 64479................ T.................... ................... Inj foramen epidural

0207 6.4554 $352.21 $123.69 $70.44 c/t. 64480................ T.................... ................... Inj foramen epidural

0207 6.4554 $352.21 $123.69 $70.44 add-on. 64483................ T.................... ................... Inj foramen epidural

0207 6.4554 $352.21 $123.69 $70.44 l/s. 64484................ T.................... ................... Inj foramen epidural

0207 6.4554 $352.21 $123.69 $70.44 add-on. 64505................ T.................... ................... N block,

0204 2.1711 $118.46 $40.13 $23.69 spenopalatine gangl. 64508................ T.................... ................... N block, carotid

0204 2.1711 $118.46 $40.13 $23.69 sinus s/p. 64510................ T.................... ................... N block, stellate

0207 6.4554 $352.21 $123.69 $70.44 ganglion. 64517................ T.................... NI................. N block inj, hypogas

0204 2.1711 $118.46 $40.13 $23.69 plxs. 64520................ T.................... ................... N block, lumbar/

0207 6.4554 $352.21 $123.69 $70.44 thoracic. 64530................ T.................... ................... N block inj, celiac

0207 6.4554 $352.21 $123.69 $70.44 pelus. 64550................ A.................... ................... Apply

........... ........... ........... ........... ........... neurostimulator. 64553................ S.................... ................... Implant

0225 206.0034 $11,239.75 ........... $2,247.95 neuroelectrodes. 64555................ S.................... ................... Implant

0040 52.1002 $2,842.64 ........... $568.53 neuroelectrodes. 64560................ S.................... ................... Implant

0040 52.1002 $2,842.64 ........... $568.53 neuroelectrodes. 64561................ S.................... ................... Implant

0040 52.1002 $2,842.64 ........... $568.53 neuroelectrodes. 64565................ S.................... ................... Implant

0040 52.1002 $2,842.64 ........... $568.53 neuroelectrodes. 64573................ S.................... ................... Implant

0225 206.0034 $11,239.75 ........... $2,247.95 neuroelectrodes. 64575................ S.................... ................... Implant

0040 52.1002 $2,842.64 ........... $568.53 neuroelectrodes. 64577................ S.................... ................... Implant

0225 206.0034 $11,239.75 ........... $2,247.95 neuroelectrodes.

[[Page 63557]]

64580................ S.................... ................... Implant

0225 206.0034 $11,239.75 ........... $2,247.95 neuroelectrodes. 64581................ S.................... ................... Implant

0040 52.1002 $2,842.64 ........... $568.53 neuroelectrodes. 64585................ T.................... ................... Revise/remove

0687 20.4416 $1,115.31 $513.05 $223.06 neuroelectrode. 64590................ T.................... ................... Implant

0222 232.2024 $12,669.20 ........... $2,533.84 neuroreceiver. 64595................ T.................... ................... Revise/remove

0688 46.7347 $2,549.89 $1,249.45 $509.98 neuroreceiver. 64600................ T.................... ................... Injection treatment

0203 11.5969 $632.74 $276.76 $126.55 of nerve. 64605................ T.................... ................... Injection treatment

0203 11.5969 $632.74 $276.76 $126.55 of nerve. 64610................ T.................... ................... Injection treatment

0203 11.5969 $632.74 $276.76 $126.55 of nerve. 64612................ T.................... ................... Destroy nerve, face

0204 2.1711 $118.46 $40.13 $23.69 muscle. 64613................ T.................... ................... Destroy nerve, spine

0204 2.1711 $118.46 $40.13 $23.69 muscle. 64614................ T.................... ................... Destroy nerve,

0204 2.1711 $118.46 $40.13 $23.69 extrem musc. 64620................ T.................... ................... Injection treatment

0203 11.5969 $632.74 $276.76 $126.55 of nerve. 64622................ T.................... ................... Destr paravertebrl

0203 11.5969 $632.74 $276.76 $126.55 nerve l/s. 64623................ T.................... ................... Destr paravertebral

0203 11.5969 $632.74 $276.76 $126.55 n add-on. 64626................ T.................... ................... Destr paravertebrl

0203 11.5969 $632.74 $276.76 $126.55 nerve c/t. 64627................ T.................... ................... Destr paravertebral

0203 11.5969 $632.74 $276.76 $126.55 n add-on. 64630................ T.................... ................... Injection treatment

0207 6.4554 $352.21 $123.69 $70.44 of nerve. 64640................ T.................... ................... Injection treatment

0207 6.4554 $352.21 $123.69 $70.44 of nerve. 64680................ T.................... ................... Injection treatment

0203 11.5969 $632.74 $276.76 $126.55 of nerve. 64681................ T.................... NI................. Injection treatment

0203 11.5969 $632.74 $276.76 $126.55 of nerve. 64702................ T.................... ................... Revise finger/toe

0220 16.5554 $903.28 ........... $180.66 nerve. 64704................ T.................... ................... Revise hand/foot

0220 16.5554 $903.28 ........... $180.66 nerve. 64708................ T.................... ................... Revise arm/leg nerve

0220 16.5554 $903.28 ........... $180.66 64712................ T.................... ................... Revision of sciatic

0220 16.5554 $903.28 ........... $180.66 nerve. 64713................ T.................... ................... Revision of arm

0220 16.5554 $903.28 ........... $180.66 nerve(s). 64714................ T.................... ................... Revise low back

0220 16.5554 $903.28 ........... $180.66 nerve(s). 64716................ T.................... ................... Revision of cranial

0220 16.5554 $903.28 ........... $180.66 nerve. 64718................ T.................... ................... Revise ulnar nerve

0220 16.5554 $903.28 ........... $180.66 at elbow. 64719................ T.................... ................... Revise ulnar nerve

0220 16.5554 $903.28 ........... $180.66 at wrist. 64721................ T.................... ................... Carpal tunnel

0220 16.5554 $903.28 ........... $180.66 surgery. 64722................ T.................... ................... Relieve pressure on

0220 16.5554 $903.28 ........... $180.66 nerve(s). 64726................ T.................... ................... Release foot/toe

0220 16.5554 $903.28 ........... $180.66 nerve. 64727................ T.................... ................... Internal nerve

0220 16.5554 $903.28 ........... $180.66 revision. 64732................ T.................... ................... Incision of brow

0220 16.5554 $903.28 ........... $180.66 nerve. 64734................ T.................... ................... Incision of cheek

0220 16.5554 $903.28 ........... $180.66 nerve. 64736................ T.................... ................... Incision of chin

0220 16.5554 $903.28 ........... $180.66 nerve. 64738................ T.................... ................... Incision of jaw

0220 16.5554 $903.28 ........... $180.66 nerve. 64740................ T.................... ................... Incision of tongue

0220 16.5554 $903.28 ........... $180.66 nerve. 64742................ T.................... ................... Incision of facial

0220 16.5554 $903.28 ........... $180.66 nerve. 64744................ T.................... ................... Incise nerve, back

0220 16.5554 $903.28 ........... $180.66 of head. 64746................ T.................... ................... Incise diaphragm

0220 16.5554 $903.28 ........... $180.66 nerve. 64752................ C.................... ................... Incision of vagus ........... ........... ........... ........... ........... nerve. 64755................ C.................... ................... Incision of stomach ........... ........... ........... ........... ........... nerves. 64760................ C.................... ................... Incision of vagus ........... ........... ........... ........... ........... nerve. 64761................ T.................... ................... Incision of pelvis

0220 16.5554 $903.28 ........... $180.66 nerve. 64763................ C.................... ................... Incise hip/thigh ........... ........... ........... ........... ........... nerve. 64766................ C.................... ................... Incise hip/thigh ........... ........... ........... ........... ........... nerve. 64771................ T.................... ................... Sever cranial nerve.

0220 16.5554 $903.28 ........... $180.66 64772................ T.................... ................... Incision of spinal

0220 16.5554 $903.28 ........... $180.66 nerve. 64774................ T.................... ................... Remove skin nerve

0220 16.5554 $903.28 ........... $180.66 lesion. 64776................ T.................... ................... Remove digit nerve

0220 16.5554 $903.28 ........... $180.66 lesion. 64778................ T.................... ................... Digit nerve surgery

0220 16.5554 $903.28 ........... $180.66 add-on. 64782................ T.................... ................... Remove limb nerve

0220 16.5554 $903.28 ........... $180.66 lesion. 64783................ T.................... ................... Limb nerve surgery

0220 16.5554 $903.28 ........... $180.66 add-on. 64784................ T.................... ................... Remove nerve lesion.

0220 16.5554 $903.28 ........... $180.66 64786................ T.................... ................... Remove sciatic nerve

0221 24.8875 $1,357.89 $463.62 $271.58 lesion. 64787................ T.................... ................... Implant nerve end...

0220 16.5554 $903.28 ........... $180.66 64788................ T.................... ................... Remove skin nerve

0220 16.5554 $903.28 ........... $180.66 lesion. 64790................ T.................... ................... Removal of nerve

0220 16.5554 $903.28 ........... $180.66 lesion. 64792................ T.................... ................... Removal of nerve

0221 24.8875 $1,357.89 $463.62 $271.58 lesion. 64795................ T.................... ................... Biopsy of nerve.....

0220 16.5554 $903.28 ........... $180.66 64802................ T.................... ................... Remove sympathetic

0220 16.5554 $903.28 ........... $180.66 nerves. 64804................ C.................... ................... Remove sympathetic ........... ........... ........... ........... ........... nerves. 64809................ C.................... ................... Remove sympathetic ........... ........... ........... ........... ........... nerves. 64818................ C.................... ................... Remove sympathetic ........... ........... ........... ........... ........... nerves. 64820................ T.................... ................... Remove sympathetic

0220 16.5554 $903.28 ........... $180.66 nerves. 64821................ T.................... ................... Remove sympathetic

0054 24.2456 $1,322.86 ........... $264.57 nerves. 64822................ T.................... ................... Remove sympathetic

0054 24.2456 $1,322.86 ........... $264.57 nerves. 64823................ T.................... ................... Remove sympathetic

0054 24.2456 $1,322.86 ........... $264.57 nerves. 64831................ T.................... ................... Repair of digit

0221 24.8875 $1,357.89 $463.62 $271.58 nerve. 64832................ T.................... ................... Repair nerve add-on.

0221 24.8875 $1,357.89 $463.62 $271.58 64834................ T.................... ................... Repair of hand or

0221 24.8875 $1,357.89 $463.62 $271.58 foot nerve. 64835................ T.................... ................... Repair of hand or

0221 24.8875 $1,357.89 $463.62 $271.58 foot nerve. 64836................ T.................... ................... Repair of hand or

0221 24.8875 $1,357.89 $463.62 $271.58 foot nerve. 64837................ T.................... ................... Repair nerve add-on.

0221 24.8875 $1,357.89 $463.62 $271.58

[[Page 63558]]

64840................ T.................... ................... Repair of leg nerve.

0221 24.8875 $1,357.89 $463.62 $271.58 64856................ T.................... ................... Repair/transpose

0221 24.8875 $1,357.89 $463.62 $271.58 nerve. 64857................ T.................... ................... Repair arm/leg nerve

0221 24.8875 $1,357.89 $463.62 $271.58 64858................ T.................... ................... Repair sciatic nerve

0221 24.8875 $1,357.89 $463.62 $271.58 64859................ T.................... ................... Nerve surgery.......

0221 24.8875 $1,357.89 $463.62 $271.58 64861................ T.................... ................... Repair of arm nerves

0221 24.8875 $1,357.89 $463.62 $271.58 64862................ T.................... ................... Repair of low back

0221 24.8875 $1,357.89 $463.62 $271.58 nerves. 64864................ T.................... ................... Repair of facial

0221 24.8875 $1,357.89 $463.62 $271.58 nerve. 64865................ T.................... ................... Repair of facial

0221 24.8875 $1,357.89 $463.62 $271.58 nerve. 64866................ C.................... ................... Fusion of facial/ ........... ........... ........... ........... ........... other nerve. 64868................ C.................... ................... Fusion of facial/ ........... ........... ........... ........... ........... other nerve. 64870................ T.................... ................... Fusion of facial/

0221 24.8875 $1,357.89 $463.62 $271.58 other nerve. 64872................ T.................... ................... Subsequent repair of

0221 24.8875 $1,357.89 $463.62 $271.58 nerve. 64874................ T.................... ................... Repair & revise

0221 24.8875 $1,357.89 $463.62 $271.58 nerve add-on. 64876................ T.................... ................... Repair nerve/shorten

0221 24.8875 $1,357.89 $463.62 $271.58 bone. 64885................ T.................... ................... Nerve graft, head or

0221 24.8875 $1,357.89 $463.62 $271.58 neck. 64886................ T.................... ................... Nerve graft, head or

0221 24.8875 $1,357.89 $463.62 $271.58 neck. 64890................ T.................... ................... Nerve graft, hand or

0221 24.8875 $1,357.89 $463.62 $271.58 foot. 64891................ T.................... ................... Nerve graft, hand or

0221 24.8875 $1,357.89 $463.62 $271.58 foot. 64892................ T.................... ................... Nerve graft, arm or

0221 24.8875 $1,357.89 $463.62 $271.58 leg. 64893................ T.................... ................... Nerve graft, arm or

0221 24.8875 $1,357.89 $463.62 $271.58 leg. 64895................ T.................... ................... Nerve graft, hand or

0221 24.8875 $1,357.89 $463.62 $271.58 foot. 64896................ T.................... ................... Nerve graft, hand or

0221 24.8875 $1,357.89 $463.62 $271.58 foot. 64897................ T.................... ................... Nerve graft, arm or

0221 24.8875 $1,357.89 $463.62 $271.58 leg. 64898................ T.................... ................... Nerve graft, arm or

0221 24.8875 $1,357.89 $463.62 $271.58 leg. 64901................ T.................... ................... Nerve graft add-on..

0221 24.8875 $1,357.89 $463.62 $271.58 64902................ T.................... ................... Nerve graft add-on..

0221 24.8875 $1,357.89 $463.62 $271.58 64905................ T.................... ................... Nerve pedicle

0221 24.8875 $1,357.89 $463.62 $271.58 transfer. 64907................ T.................... ................... Nerve pedicle

0221 24.8875 $1,357.89 $463.62 $271.58 transfer. 64999................ T.................... ................... Nervous system

0204 2.1711 $118.46 $40.13 $23.69 surgery. 65091................ T.................... ................... Revise eye..........

0242 29.4294 $1,605.70 $597.36 $321.14 65093................ T.................... ................... Revise eye with

0241 22.1969 $1,211.09 $384.47 $242.22 implant. 65101................ T.................... ................... Removal of eye......

0242 29.4294 $1,605.70 $597.36 $321.14 65103................ T.................... ................... Remove eye/insert

0242 29.4294 $1,605.70 $597.36 $321.14 implant. 65105................ T.................... ................... Remove eye/attach

0242 29.4294 $1,605.70 $597.36 $321.14 implant. 65110................ T.................... ................... Removal of eye......

0242 29.4294 $1,605.70 $597.36 $321.14 65112................ T.................... ................... Remove eye/revise

0242 29.4294 $1,605.70 $597.36 $321.14 socket. 65114................ T.................... ................... Remove eye/revise

0242 29.4294 $1,605.70 $597.36 $321.14 socket. 65125................ T.................... ................... Revise ocular

0240 17.4535 $952.28 $315.31 $190.46 implant. 65130................ T.................... ................... Insert ocular

0241 22.1969 $1,211.09 $384.47 $242.22 implant. 65135................ T.................... ................... Insert ocular

0241 22.1969 $1,211.09 $384.47 $242.22 implant. 65140................ T.................... ................... Attach ocular

0242 29.4294 $1,605.70 $597.36 $321.14 implant. 65150................ T.................... ................... Revise ocular

0241 22.1969 $1,211.09 $384.47 $242.22 implant. 65155................ T.................... ................... Reinsert ocular

0242 29.4294 $1,605.70 $597.36 $321.14 implant. 65175................ T.................... ................... Removal of ocular

0240 17.4535 $952.28 $315.31 $190.46 implant. 65205................ S.................... ................... Remove foreign body

0698 0.9599 $52.37 $18.72 $10.47 from eye. 65210................ S.................... ................... Remove foreign body

0231 2.1883 $119.40 $50.94 $23.88 from eye. 65220................ S.................... ................... Remove foreign body

0231 2.1883 $119.40 $50.94 $23.88 from eye. 65222................ S.................... ................... Remove foreign body

0231 2.1883 $119.40 $50.94 $23.88 from eye. 65235................ T.................... ................... Remove foreign body

0233 14.4205 $786.80 $266.33 $157.36 from eye. 65260................ T.................... ................... Remove foreign body

0236 18.6701 $1,018.66 ........... $203.73 from eye. 65265................ T.................... ................... Remove foreign body

0236 18.6701 $1,018.66 ........... $203.73 from eye. 65270................ T.................... ................... Repair of eye wound.

0240 17.4535 $952.28 $315.31 $190.46 65272................ T.................... ................... Repair of eye wound.

0233 14.4205 $786.80 $266.33 $157.36 65273................ C.................... ................... Repair of eye wound. ........... ........... ........... ........... ........... 65275................ T.................... ................... Repair of eye wound.

0233 14.4205 $786.80 $266.33 $157.36 65280................ T.................... ................... Repair of eye wound.

0234 21.4631 $1,171.05 $511.31 $234.21 65285................ T.................... ................... Repair of eye wound.

0234 21.4631 $1,171.05 $511.31 $234.21 65286................ T.................... ................... Repair of eye wound.

0233 14.4205 $786.80 $266.33 $157.36 65290................ T.................... ................... Repair of eye socket

0243 21.7323 $1,185.74 $431.39 $237.15 wound. 65400................ T.................... ................... Removal of eye

0233 14.4205 $786.80 $266.33 $157.36 lesion. 65410................ T.................... ................... Biopsy of cornea....

0233 14.4205 $786.80 $266.33 $157.36 65420................ T.................... ................... Removal of eye

0233 14.4205 $786.80 $266.33 $157.36 lesion. 65426................ T.................... ................... Removal of eye

0234 21.4631 $1,171.05 $511.31 $234.21 lesion. 65430................ S.................... ................... Corneal smear.......

0230 0.7619 $41.57 $14.97

$8.31 65435................ T.................... ................... Curette/treat cornea

0239 6.1331 $334.63 ........... $66.93 65436................ T.................... ................... Curette/treat cornea

0233 14.4205 $786.80 $266.33 $157.36 65450................ S.................... ................... Treatment of corneal

0231 2.1883 $119.40 $50.94 $23.88 lesion. 65600................ T.................... ................... Revision of cornea..

0240 17.4535 $952.28 $315.31 $190.46 65710................ T.................... ................... Corneal transplant..

0244 37.6284 $2,053.04 $803.26 $410.61 65730................ T.................... ................... Corneal transplant..

0244 37.6284 $2,053.04 $803.26 $410.61 65750................ T.................... ................... Corneal transplant..

0244 37.6284 $2,053.04 $803.26 $410.61 65755................ T.................... ................... Corneal transplant..

0244 37.6284 $2,053.04 $803.26 $410.61 65760................ E.................... ................... Revision of cornea.. ........... ........... ........... ........... ........... 65765................ E.................... ................... Revision of cornea.. ........... ........... ........... ........... ...........

[[Page 63559]]

65767................ E.................... ................... Corneal tissue

........... ........... ........... ........... ........... transplant. 65770................ T.................... ................... Revise cornea with

0244 37.6284 $2,053.04 $803.26 $410.61 implant. 65771................ E.................... ................... Radial keratotomy... ........... ........... ........... ........... ........... 65772................ T.................... ................... Correction of

0233 14.4205 $786.80 $266.33 $157.36 astigmatism. 65775................ T.................... ................... Correction of

0233 14.4205 $786.80 $266.33 $157.36 astigmatism. 65780................ T.................... NI................. Ocular reconst,

0244 37.6284 $2,053.04 $803.26 $410.61 transplant. 65781................ T.................... NI................. Ocular reconst,

0244 37.6284 $2,053.04 $803.26 $410.61 transplant. 65782................ T.................... NI................. Ocular reconst,

0244 37.6284 $2,053.04 $803.26 $410.61 transplant. 65800................ T.................... ................... Drainage of eye.....

0233 14.4205 $786.80 $266.33 $157.36 65805................ T.................... ................... Drainage of eye.....

0233 14.4205 $786.80 $266.33 $157.36 65810................ T.................... ................... Drainage of eye.....

0234 21.4631 $1,171.05 $511.31 $234.21 65815................ T.................... ................... Drainage of eye.....

0234 21.4631 $1,171.05 $511.31 $234.21 65820................ T.................... ................... Relieve inner eye

0232 4.9206 $268.47 $103.17 $53.69 pressure. 65850................ T.................... ................... Incision of eye.....

0234 21.4631 $1,171.05 $511.31 $234.21 65855................ T.................... ................... Laser surgery of eye

0247 4.9482 $269.98 $104.31 $54.00 65860................ T.................... ................... Incise inner eye

0247 4.9482 $269.98 $104.31 $54.00 adhesions. 65865................ T.................... ................... Incise inner eye

0233 14.4205 $786.80 $266.33 $157.36 adhesions. 65870................ T.................... ................... Incise inner eye

0234 21.4631 $1,171.05 $511.31 $234.21 adhesions. 65875................ T.................... ................... Incise inner eye

0234 21.4631 $1,171.05 $511.31 $234.21 adhesions. 65880................ T.................... ................... Incise inner eye

0233 14.4205 $786.80 $266.33 $157.36 adhesions. 65900................ T.................... ................... Remove eye lesion...

0233 14.4205 $786.80 $266.33 $157.36 65920................ T.................... ................... Remove implant of

0233 14.4205 $786.80 $266.33 $157.36 eye. 65930................ T.................... ................... Remove blood clot

0234 21.4631 $1,171.05 $511.31 $234.21 from eye. 66020................ T.................... ................... Injection treatment

0233 14.4205 $786.80 $266.33 $157.36 of eye. 66030................ T.................... ................... Injection treatment

0233 14.4205 $786.80 $266.33 $157.36 of eye. 66130................ T.................... ................... Remove eye lesion...

0234 21.4631 $1,171.05 $511.31 $234.21 66150................ T.................... ................... Glaucoma surgery....

0233 14.4205 $786.80 $266.33 $157.36 66155................ T.................... ................... Glaucoma surgery....

0234 21.4631 $1,171.05 $511.31 $234.21 66160................ T.................... ................... Glaucoma surgery....

0234 21.4631 $1,171.05 $511.31 $234.21 66165................ T.................... ................... Glaucoma surgery....

0234 21.4631 $1,171.05 $511.31 $234.21 66170................ T.................... ................... Glaucoma surgery....

0234 21.4631 $1,171.05 $511.31 $234.21 66172................ T.................... ................... Incision of eye.....

0673 26.8390 $1,464.36 $649.56 $292.87 66180................ T.................... ................... Implant eye shunt...

0673 26.8390 $1,464.36 $649.56 $292.87 66185................ T.................... ................... Revise eye shunt....

0673 26.8390 $1,464.36 $649.56 $292.87 66220................ T.................... ................... Repair eye lesion...

0236 18.6701 $1,018.66 ........... $203.73 66225................ T.................... ................... Repair/graft eye

0673 26.8390 $1,464.36 $649.56 $292.87 lesion. 66250................ T.................... ................... Follow-up surgery of

0233 14.4205 $786.80 $266.33 $157.36 eye. 66500................ T.................... ................... Incision of iris....

0232 4.9206 $268.47 $103.17 $53.69 66505................ T.................... ................... Incision of iris....

0232 4.9206 $268.47 $103.17 $53.69 66600................ T.................... ................... Remove iris and

0233 14.4205 $786.80 $266.33 $157.36 lesion. 66605................ T.................... ................... Removal of iris.....

0234 21.4631 $1,171.05 $511.31 $234.21 66625................ T.................... ................... Removal of iris.....

0233 14.4205 $786.80 $266.33 $157.36 66630................ T.................... ................... Removal of iris.....

0233 14.4205 $786.80 $266.33 $157.36 66635................ T.................... ................... Removal of iris.....

0234 21.4631 $1,171.05 $511.31 $234.21 66680................ T.................... ................... Repair iris &

0234 21.4631 $1,171.05 $511.31 $234.21 ciliary body. 66682................ T.................... ................... Repair iris &

0234 21.4631 $1,171.05 $511.31 $234.21 ciliary body. 66700................ T.................... ................... Destruction, ciliary

0233 14.4205 $786.80 $266.33 $157.36 body. 66710................ T.................... ................... Destruction, ciliary

0233 14.4205 $786.80 $266.33 $157.36 body. 66720................ T.................... ................... Destruction, ciliary

0233 14.4205 $786.80 $266.33 $157.36 body. 66740................ T.................... ................... Destruction, ciliary

0233 14.4205 $786.80 $266.33 $157.36 body. 66761................ T.................... ................... Revision of iris....

0247 4.9482 $269.98 $104.31 $54.00 66762................ T.................... ................... Revision of iris....

0247 4.9482 $269.98 $104.31 $54.00 66770................ T.................... ................... Removal of inner eye

0247 4.9482 $269.98 $104.31 $54.00 lesion. 66820................ T.................... ................... Incision, secondary

0232 4.9206 $268.47 $103.17 $53.69 cataract. 66821................ T.................... ................... After cataract laser

0247 4.9482 $269.98 $104.31 $54.00 surgery. 66825................ T.................... ................... Reposition

0234 21.4631 $1,171.05 $511.31 $234.21 intraocular lens. 66830................ T.................... ................... Removal of lens

0232 4.9206 $268.47 $103.17 $53.69 lesion. 66840................ T.................... ................... Removal of lens

0245 12.2973 $670.95 $222.22 $134.19 material. 66850................ T.................... ................... Removal of lens

0249 27.7406 $1,513.55 $524.67 $302.71 material. 66852................ T.................... ................... Removal of lens

0249 27.7406 $1,513.55 $524.67 $302.71 material. 66920................ T.................... ................... Extraction of lens..

0249 27.7406 $1,513.55 $524.67 $302.71 66930................ T.................... ................... Extraction of lens..

0249 27.7406 $1,513.55 $524.67 $302.71 66940................ T.................... ................... Extraction of lens..

0245 12.2973 $670.95 $222.22 $134.19 66982................ T.................... ................... Cataract surgery,

0246 22.9755 $1,253.57 $495.96 $250.71 complex. 66983................ T.................... ................... Cataract surg w/iol,

0246 22.9755 $1,253.57 $495.96 $250.71 1 stage. 66984................ T.................... ................... Cataract surg w/iol,

0246 22.9755 $1,253.57 $495.96 $250.71 1 stage. 66985................ T.................... ................... Insert lens

0246 22.9755 $1,253.57 $495.96 $250.71 prosthesis. 66986................ T.................... ................... Exchange lens

0246 22.9755 $1,253.57 $495.96 $250.71 prosthesis. 66990................ N.................... ................... Ophthalmic endoscope ........... ........... ........... ........... ........... add-on. 66999................ T.................... ................... Eye surgery

0232 4.9206 $268.47 $103.17 $53.69 procedure. 67005................ T.................... ................... Partial removal of

0237 34.1784 $1,864.81 $818.54 $372.96 eye fluid. 67010................ T.................... ................... Partial removal of

0237 34.1784 $1,864.81 $818.54 $372.96 eye fluid. 67015................ T.................... ................... Release of eye fluid

0237 34.1784 $1,864.81 $818.54 $372.96 67025................ T.................... ................... Replace eye fluid...

0236 18.6701 $1,018.66 ........... $203.73 67027................ T.................... ................... Implant eye drug

0237 34.1784 $1,864.81 $818.54 $372.96 system.

[[Page 63560]]

67028................ T.................... ................... Injection eye drug..

0235 5.0749 $276.89 $72.04 $55.38 67030................ T.................... ................... Incise inner eye

0236 18.6701 $1,018.66 ........... $203.73 strands. 67031................ T.................... ................... Laser surgery, eye

0247 4.9482 $269.98 $104.31 $54.00 strands. 67036................ T.................... ................... Removal of inner eye

0237 34.1784 $1,864.81 $818.54 $372.96 fluid. 67038................ T.................... ................... Strip retinal

0237 34.1784 $1,864.81 $818.54 $372.96 membrane. 67039................ T.................... ................... Laser treatment of

0237 34.1784 $1,864.81 $818.54 $372.96 retina. 67040................ T.................... ................... Laser treatment of

0672 38.9476 $2,125.02 $988.43 $425.00 retina. 67101................ T.................... ................... Repair detached

0235 5.0749 $276.89 $72.04 $55.38 retina. 67105................ T.................... ................... Repair detached

0248 4.8223 $263.11 $95.08 $52.62 retina. 67107................ T.................... ................... Repair detached

0672 38.9476 $2,125.02 $988.43 $425.00 retina. 67108................ T.................... ................... Repair detached

0672 38.9476 $2,125.02 $988.43 $425.00 retina. 67110................ T.................... ................... Repair detached

0236 18.6701 $1,018.66 ........... $203.73 retina. 67112................ T.................... ................... Rerepair detached

0672 38.9476 $2,125.02 $988.43 $425.00 retina. 67115................ T.................... ................... Release encircling

0236 18.6701 $1,018.66 ........... $203.73 material. 67120................ T.................... ................... Remove eye implant

0236 18.6701 $1,018.66 ........... $203.73 material. 67121................ T.................... ................... Remove eye implant

0237 34.1784 $1,864.81 $818.54 $372.96 material. 67141................ T.................... ................... Treatment of retina.

0235 5.0749 $276.89 $72.04 $55.38 67145................ T.................... ................... Treatment of retina.

0248 4.8223 $263.11 $95.08 $52.62 67208................ T.................... ................... Treatment of retinal

0235 5.0749 $276.89 $72.04 $55.38 lesion. 67210................ T.................... ................... Treatment of retinal

0248 4.8223 $263.11 $95.08 $52.62 lesion. 67218................ T.................... ................... Treatment of retinal

0236 18.6701 $1,018.66 ........... $203.73 lesion. 67220................ T.................... ................... Treatment of choroid

0235 5.0749 $276.89 $72.04 $55.38 lesion. 67221................ T.................... ................... Ocular photodynamic

0235 5.0749 $276.89 $72.04 $55.38 ther. 67225................ T.................... ................... Eye photodynamic

0235 5.0749 $276.89 $72.04 $55.38 ther add-on. 67227................ T.................... ................... Treatment of retinal

0235 5.0749 $276.89 $72.04 $55.38 lesion. 67228................ T.................... ................... Treatment of retinal

0248 4.8223 $263.11 $95.08 $52.62 lesion. 67250................ T.................... ................... Reinforce eye wall..

0240 17.4535 $952.28 $315.31 $190.46 67255................ T.................... ................... Reinforce/graft eye

0237 34.1784 $1,864.81 $818.54 $372.96 wall. 67299................ T.................... ................... Eye surgery

0235 5.0749 $276.89 $72.04 $55.38 procedure. 67311................ T.................... ................... Revise eye muscle...

0243 21.7323 $1,185.74 $431.39 $237.15 67312................ T.................... ................... Revise two eye

0243 21.7323 $1,185.74 $431.39 $237.15 muscles. 67314................ T.................... ................... Revise eye muscle...

0243 21.7323 $1,185.74 $431.39 $237.15 67316................ T.................... ................... Revise two eye

0243 21.7323 $1,185.74 $431.39 $237.15 muscles. 67318................ T.................... ................... Revise eye muscle(s)

0243 21.7323 $1,185.74 $431.39 $237.15 67320................ T.................... ................... Revise eye muscle(s)

0243 21.7323 $1,185.74 $431.39 $237.15 add-on. 67331................ T.................... ................... Eye surgery follow-

0243 21.7323 $1,185.74 $431.39 $237.15 up add-on. 67332................ T.................... ................... Rerevise eye muscles

0243 21.7323 $1,185.74 $431.39 $237.15 add-on. 67334................ T.................... ................... Revise eye muscle w/

0243 21.7323 $1,185.74 $431.39 $237.15 suture. 67335................ T.................... ................... Eye suture during

0243 21.7323 $1,185.74 $431.39 $237.15 surgery. 67340................ T.................... ................... Revise eye muscle

0243 21.7323 $1,185.74 $431.39 $237.15 add-on. 67343................ T.................... ................... Release eye tissue..

0243 21.7323 $1,185.74 $431.39 $237.15 67345................ T.................... ................... Destroy nerve of eye

0238 3.1954 $174.34 $58.96 $34.87 muscle. 67350................ T.................... ................... Biopsy eye muscle...

0699 2.2303 $121.69 $47.46 $24.34 67399................ T.................... ................... Eye muscle surgery

0243 21.7323 $1,185.74 $431.39 $237.15 procedure. 67400................ T.................... ................... Explore/biopsy eye

0241 22.1969 $1,211.09 $384.47 $242.22 socket. 67405................ T.................... ................... Explore/drain eye

0241 22.1969 $1,211.09 $384.47 $242.22 socket. 67412................ T.................... ................... Explore/treat eye

0241 22.1969 $1,211.09 $384.47 $242.22 socket. 67413................ T.................... ................... Explore/treat eye

0241 22.1969 $1,211.09 $384.47 $242.22 socket. 67414................ T.................... ................... Explr/decompress eye

0242 29.4294 $1,605.70 $597.36 $321.14 socket. 67415................ T.................... ................... Aspiration, orbital

0239 6.1331 $334.63 ........... $66.93 contents. 67420................ T.................... ................... Explore/treat eye

0242 29.4294 $1,605.70 $597.36 $321.14 socket. 67430................ T.................... ................... Explore/treat eye

0242 29.4294 $1,605.70 $597.36 $321.14 socket. 67440................ T.................... ................... Explore/drain eye

0242 29.4294 $1,605.70 $597.36 $321.14 socket. 67445................ T.................... ................... Explr/decompress eye

0242 29.4294 $1,605.70 $597.36 $321.14 socket. 67450................ T.................... ................... Explore/biopsy eye

0242 29.4294 $1,605.70 $597.36 $321.14 socket. 67500................ S.................... ................... Inject/treat eye

0231 2.1883 $119.40 $50.94 $23.88 socket. 67505................ T.................... ................... Inject/treat eye

0238 3.1954 $174.34 $58.96 $34.87 socket. 67515................ T.................... ................... Inject/treat eye

0239 6.1331 $334.63 ........... $66.93 socket. 67550................ T.................... ................... Insert eye socket

0242 29.4294 $1,605.70 $597.36 $321.14 implant. 67560................ T.................... ................... Revise eye socket

0241 22.1969 $1,211.09 $384.47 $242.22 implant. 67570................ T.................... ................... Decompress optic

0242 29.4294 $1,605.70 $597.36 $321.14 nerve. 67599................ T.................... ................... Orbit surgery

0239 6.1331 $334.63 ........... $66.93 procedure. 67700................ T.................... ................... Drainage of eyelid

0238 3.1954 $174.34 $58.96 $34.87 abscess. 67710................ T.................... ................... Incision of eyelid..

0239 6.1331 $334.63 ........... $66.93 67715................ T.................... ................... Incision of eyelid

0240 17.4535 $952.28 $315.31 $190.46 fold. 67800................ T.................... ................... Remove eyelid lesion

0238 3.1954 $174.34 $58.96 $34.87 67801................ T.................... ................... Remove eyelid

0239 6.1331 $334.63 ........... $66.93 lesions. 67805................ T.................... ................... Remove eyelid

0238 3.1954 $174.34 $58.96 $34.87 lesions. 67808................ T.................... ................... Remove eyelid

0240 17.4535 $952.28 $315.31 $190.46 lesion(s). 67810................ T.................... ................... Biopsy of eyelid....

0238 3.1954 $174.34 $58.96 $34.87 67820................ S.................... ................... Revise eyelashes....

0698 0.9599 $52.37 $18.72 $10.47 67825................ T.................... ................... Revise eyelashes....

0238 3.1954 $174.34 $58.96 $34.87 67830................ T.................... ................... Revise eyelashes....

0239 6.1331 $334.63 ........... $66.93 67835................ T.................... ................... Revise eyelashes....

0240 17.4535 $952.28 $315.31 $190.46 67840................ T.................... ................... Remove eyelid lesion

0239 6.1331 $334.63 ........... $66.93

[[Page 63561]]

67850................ T.................... ................... Treat eyelid lesion.

0239 6.1331 $334.63 ........... $66.93 67875................ T.................... ................... Closure of eyelid by

0239 6.1331 $334.63 ........... $66.93 suture. 67880................ T.................... ................... Revision of eyelid..

0233 14.4205 $786.80 $266.33 $157.36 67882................ T.................... ................... Revision of eyelid..

0240 17.4535 $952.28 $315.31 $190.46 67900................ T.................... ................... Repair brow defect..

0240 17.4535 $952.28 $315.31 $190.46 67901................ T.................... ................... Repair eyelid defect

0240 17.4535 $952.28 $315.31 $190.46 67902................ T.................... ................... Repair eyelid defect

0240 17.4535 $952.28 $315.31 $190.46 67903................ T.................... ................... Repair eyelid defect

0240 17.4535 $952.28 $315.31 $190.46 67904................ T.................... ................... Repair eyelid defect

0240 17.4535 $952.28 $315.31 $190.46 67906................ T.................... ................... Repair eyelid defect

0240 17.4535 $952.28 $315.31 $190.46 67908................ T.................... ................... Repair eyelid defect

0240 17.4535 $952.28 $315.31 $190.46 67909................ T.................... ................... Revise eyelid defect

0240 17.4535 $952.28 $315.31 $190.46 67911................ T.................... ................... Revise eyelid defect

0240 17.4535 $952.28 $315.31 $190.46 67912................ T.................... NI................. Correction eyelid w/

0239 6.1331 $334.63 ........... $66.93 implant. 67914................ T.................... ................... Repair eyelid defect

0240 17.4535 $952.28 $315.31 $190.46 67915................ T.................... ................... Repair eyelid defect

0239 6.1331 $334.63 ........... $66.93 67916................ T.................... ................... Repair eyelid defect

0240 17.4535 $952.28 $315.31 $190.46 67917................ T.................... ................... Repair eyelid defect

0240 17.4535 $952.28 $315.31 $190.46 67921................ T.................... ................... Repair eyelid defect

0240 17.4535 $952.28 $315.31 $190.46 67922................ T.................... ................... Repair eyelid defect

0240 17.4535 $952.28 $315.31 $190.46 67923................ T.................... ................... Repair eyelid defect

0240 17.4535 $952.28 $315.31 $190.46 67924................ T.................... ................... Repair eyelid defect

0240 17.4535 $952.28 $315.31 $190.46 67930................ T.................... ................... Repair eyelid wound.

0240 17.4535 $952.28 $315.31 $190.46 67935................ T.................... ................... Repair eyelid wound.

0240 17.4535 $952.28 $315.31 $190.46 67938................ S.................... ................... Remove eyelid

0698 0.9599 $52.37 $18.72 $10.47 foreign body. 67950................ T.................... ................... Revision of eyelid..

0240 17.4535 $952.28 $315.31 $190.46 67961................ T.................... ................... Revision of eyelid..

0240 17.4535 $952.28 $315.31 $190.46 67966................ T.................... ................... Revision of eyelid..

0240 17.4535 $952.28 $315.31 $190.46 67971................ T.................... ................... Reconstruction of

0241 22.1969 $1,211.09 $384.47 $242.22 eyelid. 67973................ T.................... ................... Reconstruction of

0241 22.1969 $1,211.09 $384.47 $242.22 eyelid. 67974................ T.................... ................... Reconstruction of

0241 22.1969 $1,211.09 $384.47 $242.22 eyelid. 67975................ T.................... ................... Reconstruction of

0240 17.4535 $952.28 $315.31 $190.46 eyelid. 67999................ T.................... ................... Revision of eyelid..

0240 17.4535 $952.28 $315.31 $190.46 68020................ T.................... ................... Incise/drain eyelid

0240 17.4535 $952.28 $315.31 $190.46 lining. 68040................ S.................... ................... Treatment of eyelid

0698 0.9599 $52.37 $18.72 $10.47 lesions. 68100................ T.................... ................... Biopsy of eyelid

0232 4.9206 $268.47 $103.17 $53.69 lining. 68110................ T.................... ................... Remove eyelid lining

0699 2.2303 $121.69 $47.46 $24.34 lesion. 68115................ T.................... ................... Remove eyelid lining

0239 6.1331 $334.63 ........... $66.93 lesion. 68130................ T.................... ................... Remove eyelid lining

0233 14.4205 $786.80 $266.33 $157.36 lesion. 68135................ T.................... ................... Remove eyelid lining

0239 6.1331 $334.63 ........... $66.93 lesion. 68200................ S.................... ................... Treat eyelid by

0698 0.9599 $52.37 $18.72 $10.47 injection. 68320................ T.................... ................... Revise/graft eyelid

0240 17.4535 $952.28 $315.31 $190.46 lining. 68325................ T.................... ................... Revise/graft eyelid

0242 29.4294 $1,605.70 $597.36 $321.14 lining. 68326................ T.................... ................... Revise/graft eyelid

0241 22.1969 $1,211.09 $384.47 $242.22 lining. 68328................ T.................... ................... Revise/graft eyelid

0241 22.1969 $1,211.09 $384.47 $242.22 lining. 68330................ T.................... ................... Revise eyelid lining

0233 14.4205 $786.80 $266.33 $157.36 68335................ T.................... ................... Revise/graft eyelid

0241 22.1969 $1,211.09 $384.47 $242.22 lining. 68340................ T.................... ................... Separate eyelid

0240 17.4535 $952.28 $315.31 $190.46 adhesions. 68360................ T.................... ................... Revise eyelid lining

0234 21.4631 $1,171.05 $511.31 $234.21 68362................ T.................... ................... Revise eyelid lining

0234 21.4631 $1,171.05 $511.31 $234.21 68371................ T.................... NI................. Harvest eye tissue,

0233 14.4205 $786.80 $266.33 $157.36 alograft. 68399................ T.................... ................... Eyelid lining

0239 6.1331 $334.63 ........... $66.93 surgery. 68400................ T.................... ................... Incise/drain tear

0238 3.1954 $174.34 $58.96 $34.87 gland. 68420................ T.................... ................... Incise/drain tear

0240 17.4535 $952.28 $315.31 $190.46 sac. 68440................ T.................... ................... Incise tear duct

0238 3.1954 $174.34 $58.96 $34.87 opening. 68500................ T.................... ................... Removal of tear

0241 22.1969 $1,211.09 $384.47 $242.22 gland. 68505................ T.................... ................... Partial removal,

0241 22.1969 $1,211.09 $384.47 $242.22 tear gland. 68510................ T.................... ................... Biopsy of tear gland

0240 17.4535 $952.28 $315.31 $190.46 68520................ T.................... ................... Removal of tear sac.

0241 22.1969 $1,211.09 $384.47 $242.22 68525................ T.................... ................... Biopsy of tear sac..

0240 17.4535 $952.28 $315.31 $190.46 68530................ T.................... ................... Clearance of tear

0240 17.4535 $952.28 $315.31 $190.46 duct. 68540................ T.................... ................... Remove tear gland

0241 22.1969 $1,211.09 $384.47 $242.22 lesion. 68550................ T.................... ................... Remove tear gland

0242 29.4294 $1,605.70 $597.36 $321.14 lesion. 68700................ T.................... ................... Repair tear ducts...

0241 22.1969 $1,211.09 $384.47 $242.22 68705................ T.................... ................... Revise tear duct

0238 3.1954 $174.34 $58.96 $34.87 opening. 68720................ T.................... ................... Create tear sac

0242 29.4294 $1,605.70 $597.36 $321.14 drain. 68745................ T.................... ................... Create tear duct

0241 22.1969 $1,211.09 $384.47 $242.22 drain. 68750................ T.................... ................... Create tear duct

0242 29.4294 $1,605.70 $597.36 $321.14 drain. 68760................ S.................... ................... Close tear duct

0698 0.9599 $52.37 $18.72 $10.47 opening. 68761................ S.................... ................... Close tear duct

0231 2.1883 $119.40 $50.94 $23.88 opening. 68770................ T.................... ................... Close tear system

0240 17.4535 $952.28 $315.31 $190.46 fistula. 68801................ S.................... ................... Dilate tear duct

0231 2.1883 $119.40 $50.94 $23.88 opening. 68810................ T.................... ................... Probe nasolacrimal

0699 2.2303 $121.69 $47.46 $24.34 duct. 68811................ T.................... ................... Probe nasolacrimal

0240 17.4535 $952.28 $315.31 $190.46 duct. 68815................ T.................... ................... Probe nasolacrimal

0240 17.4535 $952.28 $315.31 $190.46 duct.

[[Page 63562]]

68840................ T.................... ................... Explore/irrigate

0699 2.2303 $121.69 $47.46 $24.34 tear ducts. 68850................ N.................... ................... Injection for tear ........... ........... ........... ........... ........... sac x-ray. 68899................ T.................... ................... Tear duct system

0699 2.2303 $121.69 $47.46 $24.34 surgery. 69000................ T.................... ................... Drain external ear

0006 1.6527 $90.17 $23.26 $18.03 lesion. 69005................ T.................... ................... Drain external ear

0007 11.8633 $647.27 ........... $129.45 lesion. 69020................ T.................... ................... Drain outer ear

0006 1.6527 $90.17 $23.26 $18.03 canal lesion. 69090................ E.................... ................... Pierce earlobes..... ........... ........... ........... ........... ........... 69100................ T.................... ................... Biopsy of external

0019 3.9493 $215.48 $71.87 $43.10 ear. 69105................ T.................... ................... Biopsy of external

0253 15.2249 $830.69 $282.29 $166.14 ear canal. 69110................ T.................... ................... Remove external ear,

0021 14.3594 $783.46 $219.48 $156.69 partial. 69120................ T.................... ................... Removal of external

0254 21.8901 $1,194.35 $321.35 $238.87 ear. 69140................ T.................... ................... Remove ear canal

0254 21.8901 $1,194.35 $321.35 $238.87 lesion(s). 69145................ T.................... ................... Remove ear canal

0021 14.3594 $783.46 $219.48 $156.69 lesion(s). 69150................ T.................... ................... Extensive ear canal

0252 6.4469 $351.75 $113.41 $70.35 surgery. 69155................ C.................... ................... Extensive ear/neck ........... ........... ........... ........... ........... surgery. 69200................ X.................... ................... Clear outer ear

0340 0.6314 $34.45 ...........

$6.89 canal. 69205................ T.................... ................... Clear outer ear

0022 18.7932 $1,025.38 $354.45 $205.08 canal. 69210................ X.................... ................... Remove impacted ear

0340 0.6314 $34.45 ...........

$6.89 wax. 69220................ T.................... ................... Clean out mastoid

0012 0.7694 $41.98 $11.18

$8.40 cavity. 69222................ T.................... ................... Clean out mastoid

0253 15.2249 $830.69 $282.29 $166.14 cavity. 69300................ T.................... ................... Revise external ear.

0254 21.8901 $1,194.35 $321.35 $238.87 69310................ T.................... ................... Rebuild outer ear

0256 35.1548 $1,918.08 ........... $383.62 canal. 69320................ T.................... ................... Rebuild outer ear

0256 35.1548 $1,918.08 ........... $383.62 canal. 69399................ T.................... ................... Outer ear surgery

0251 1.7880 $97.56 ........... $19.51 procedure. 69400................ T.................... ................... Inflate middle ear

0251 1.7880 $97.56 ........... $19.51 canal. 69401................ T.................... ................... Inflate middle ear

0251 1.7880 $97.56 ........... $19.51 canal. 69405................ T.................... ................... Catheterize middle

0252 6.4469 $351.75 $113.41 $70.35 ear canal. 69410................ T.................... ................... Inset middle ear

0251 1.7880 $97.56 ........... $19.51 (baffle). 69420................ T.................... ................... Incision of eardrum.

0252 6.4469 $351.75 $113.41 $70.35 69421................ T.................... ................... Incision of eardrum.

0253 15.2249 $830.69 $282.29 $166.14 69424................ T.................... ................... Remove ventilating

0252 6.4469 $351.75 $113.41 $70.35 tube. 69433................ T.................... ................... Create eardrum

0252 6.4469 $351.75 $113.41 $70.35 opening. 69436................ T.................... ................... Create eardrum

0253 15.2249 $830.69 $282.29 $166.14 opening. 69440................ T.................... ................... Exploration of

0254 21.8901 $1,194.35 $321.35 $238.87 middle ear. 69450................ T.................... ................... Eardrum revision....

0256 35.1548 $1,918.08 ........... $383.62 69501................ T.................... ................... Mastoidectomy.......

0256 35.1548 $1,918.08 ........... $383.62 69502................ T.................... ................... Mastoidectomy.......

0254 21.8901 $1,194.35 $321.35 $238.87 69505................ T.................... ................... Remove mastoid

0256 35.1548 $1,918.08 ........... $383.62 structures. 69511................ T.................... ................... Extensive mastoid

0256 35.1548 $1,918.08 ........... $383.62 surgery. 69530................ T.................... ................... Extensive mastoid

0256 35.1548 $1,918.08 ........... $383.62 surgery. 69535................ C.................... ................... Remove part of

........... ........... ........... ........... ........... temporal bone. 69540................ T.................... ................... Remove ear lesion...

0253 15.2249 $830.69 $282.29 $166.14 69550................ T.................... ................... Remove ear lesion...

0256 35.1548 $1,918.08 ........... $383.62 69552................ T.................... ................... Remove ear lesion...

0256 35.1548 $1,918.08 ........... $383.62 69554................ C.................... ................... Remove ear lesion... ........... ........... ........... ........... ........... 69601................ T.................... ................... Mastoid surgery

0256 35.1548 $1,918.08 ........... $383.62 revision. 69602................ T.................... ................... Mastoid surgery

0256 35.1548 $1,918.08 ........... $383.62 revision. 69603................ T.................... ................... Mastoid surgery

0256 35.1548 $1,918.08 ........... $383.62 revision. 69604................ T.................... ................... Mastoid surgery

0256 35.1548 $1,918.08 ........... $383.62 revision. 69605................ T.................... ................... Mastoid surgery

0256 35.1548 $1,918.08 ........... $383.62 revision. 69610................ T.................... ................... Repair of eardrum...

0254 21.8901 $1,194.35 $321.35 $238.87 69620................ T.................... ................... Repair of eardrum...

0254 21.8901 $1,194.35 $321.35 $238.87 69631................ T.................... ................... Repair eardrum

0256 35.1548 $1,918.08 ........... $383.62 structures. 69632................ T.................... ................... Rebuild eardrum

0256 35.1548 $1,918.08 ........... $383.62 structures. 69633................ T.................... ................... Rebuild eardrum

0256 35.1548 $1,918.08 ........... $383.62 structures. 69635................ T.................... ................... Repair eardrum

0256 35.1548 $1,918.08 ........... $383.62 structures. 69636................ T.................... ................... Rebuild eardrum

0256 35.1548 $1,918.08 ........... $383.62 structures. 69637................ T.................... ................... Rebuild eardrum

0256 35.1548 $1,918.08 ........... $383.62 structures. 69641................ T.................... ................... Revise middle ear &

0256 35.1548 $1,918.08 ........... $383.62 mastoid. 69642................ T.................... ................... Revise middle ear &

0256 35.1548 $1,918.08 ........... $383.62 mastoid. 69643................ T.................... ................... Revise middle ear &

0256 35.1548 $1,918.08 ........... $383.62 mastoid. 69644................ T.................... ................... Revise middle ear &

0256 35.1548 $1,918.08 ........... $383.62 mastoid. 69645................ T.................... ................... Revise middle ear &

0256 35.1548 $1,918.08 ........... $383.62 mastoid. 69646................ T.................... ................... Revise middle ear &

0256 35.1548 $1,918.08 ........... $383.62 mastoid. 69650................ T.................... ................... Release middle ear

0254 21.8901 $1,194.35 $321.35 $238.87 bone. 69660................ T.................... ................... Revise middle ear

0256 35.1548 $1,918.08 ........... $383.62 bone. 69661................ T.................... ................... Revise middle ear

0256 35.1548 $1,918.08 ........... $383.62 bone. 69662................ T.................... ................... Revise middle ear

0256 35.1548 $1,918.08 ........... $383.62 bone. 69666................ T.................... ................... Repair middle ear

0256 35.1548 $1,918.08 ........... $383.62 structures. 69667................ T.................... ................... Repair middle ear

0256 35.1548 $1,918.08 ........... $383.62 structures. 69670................ T.................... ................... Remove mastoid air

0256 35.1548 $1,918.08 ........... $383.62 cells. 69676................ T.................... ................... Remove middle ear

0256 35.1548 $1,918.08 ........... $383.62 nerve. 69700................ T.................... ................... Close mastoid

0256 35.1548 $1,918.08 ........... $383.62 fistula. 69710................ E.................... ................... Implant/replace ........... ........... ........... ........... ........... hearing aid. 69711................ T.................... ................... Remove/repair

0256 35.1548 $1,918.08 ........... $383.62 hearing aid.

[[Page 63563]]

69714................ T.................... ................... Implant temple bone

0256 35.1548 $1,918.08 ........... $383.62 w/stimul. 69715................ T.................... ................... Temple bne implnt w/

0256 35.1548 $1,918.08 ........... $383.62 stimulat. 69717................ T.................... ................... Temple bone implant

0256 35.1548 $1,918.08 ........... $383.62 revision. 69718................ T.................... ................... Revise temple bone

0256 35.1548 $1,918.08 ........... $383.62 implant. 69720................ T.................... ................... Release facial nerve

0256 35.1548 $1,918.08 ........... $383.62 69725................ T.................... ................... Release facial nerve

0256 35.1548 $1,918.08 ........... $383.62 69740................ T.................... ................... Repair facial nerve.

0256 35.1548 $1,918.08 ........... $383.62 69745................ T.................... ................... Repair facial nerve.

0256 35.1548 $1,918.08 ........... $383.62 69799................ T.................... ................... Middle ear surgery

0253 15.2249 $830.69 $282.29 $166.14 procedure. 69801................ T.................... ................... Incise inner ear....

0256 35.1548 $1,918.08 ........... $383.62 69802................ T.................... ................... Incise inner ear....

0256 35.1548 $1,918.08 ........... $383.62 69805................ T.................... ................... Explore inner ear...

0256 35.1548 $1,918.08 ........... $383.62 69806................ T.................... ................... Explore inner ear...

0256 35.1548 $1,918.08 ........... $383.62 69820................ T.................... ................... Establish inner ear

0256 35.1548 $1,918.08 ........... $383.62 window. 69840................ T.................... ................... Revise inner ear

0256 35.1548 $1,918.08 ........... $383.62 window. 69905................ T.................... ................... Remove inner ear....

0256 35.1548 $1,918.08 ........... $383.62 69910................ T.................... ................... Remove inner ear &

0256 35.1548 $1,918.08 ........... $383.62 mastoid. 69915................ T.................... ................... Incise inner ear

0256 35.1548 $1,918.08 ........... $383.62 nerve. 69930................ T.................... ................... Implant cochlear

0259 392.8622 $21,434.95 $9,394.83 $4,286.99 device. 69949................ T.................... ................... Inner ear surgery

0253 15.2249 $830.69 $282.29 $166.14 procedure. 69950................ C.................... ................... Incise inner ear ........... ........... ........... ........... ........... nerve. 69955................ T.................... ................... Release facial nerve

0256 35.1548 $1,918.08 ........... $383.62 69960................ T.................... ................... Release inner ear

0256 35.1548 $1,918.08 ........... $383.62 canal. 69970................ C.................... ................... Remove inner ear ........... ........... ........... ........... ........... lesion. 69979................ T.................... ................... Temporal bone

0251 1.7880 $97.56 ........... $19.51 surgery. 69990................ N.................... ................... Microsurgery add-on. ........... ........... ........... ........... ........... 70010................ S.................... ................... Contrast x-ray of

0274 3.5931 $196.04 $93.63 $39.21 brain. 70015................ S.................... ................... Contrast x-ray of

0274 3.5931 $196.04 $93.63 $39.21 brain. 70030................ X.................... ................... X-ray eye for

0260 0.7802 $42.57 $21.28

$8.51 foreign body. 70100................ X.................... ................... X-ray exam of jaw...

0260 0.7802 $42.57 $21.28

$8.51 70110................ X.................... ................... X-ray exam of jaw...

0260 0.7802 $42.57 $21.28

$8.51 70120................ X.................... ................... X-ray exam of

0260 0.7802 $42.57 $21.28

$8.51 mastoids. 70130................ X.................... ................... X-ray exam of

0260 0.7802 $42.57 $21.28

$8.51 mastoids. 70134................ X.................... ................... X-ray exam of middle

0261 1.3176 $71.89 ........... $14.38 ear. 70140................ X.................... ................... X-ray exam of facial

0260 0.7802 $42.57 $21.28

$8.51 bones. 70150................ X.................... ................... X-ray exam of facial

0260 0.7802 $42.57 $21.28

$8.51 bones. 70160................ X.................... ................... X-ray exam of nasal

0260 0.7802 $42.57 $21.28

$8.51 bones. 70170................ X.................... ................... X-ray exam of tear

0263 2.1883 $119.40 $43.58 $23.88 duct. 70190................ X.................... ................... X-ray exam of eye

0260 0.7802 $42.57 $21.28

$8.51 sockets. 70200................ X.................... ................... X-ray exam of eye

0260 0.7802 $42.57 $21.28

$8.51 sockets. 70210................ X.................... ................... X-ray exam of

0260 0.7802 $42.57 $21.28

$8.51 sinuses. 70220................ X.................... ................... X-ray exam of

0260 0.7802 $42.57 $21.28

$8.51 sinuses. 70240................ X.................... ................... X-ray exam,

0260 0.7802 $42.57 $21.28

$8.51 pituitary saddle. 70250................ X.................... ................... X-ray exam of skull.

0260 0.7802 $42.57 $21.28

$8.51 70260................ X.................... ................... X-ray exam of skull.

0261 1.3176 $71.89 ........... $14.38 70300................ X.................... ................... X-ray exam of teeth.

0262 0.7540 $41.14

$9.82

$8.23 70310................ X.................... ................... X-ray exam of teeth.

0262 0.7540 $41.14

$9.82

$8.23 70320................ X.................... ................... Full mouth x-ray of

0262 0.7540 $41.14

$9.82

$8.23 teeth. 70328................ X.................... ................... X-ray exam of jaw

0260 0.7802 $42.57 $21.28

$8.51 joint. 70330................ X.................... ................... X-ray exam of jaw

0260 0.7802 $42.57 $21.28

$8.51 joints. 70332................ S.................... ................... X-ray exam of jaw

0275 3.2775 $178.82 $69.09 $35.76 joint. 70336................ S.................... ................... Magnetic image, jaw

0335 6.3499 $346.46 $151.46 $69.29 joint. 70350................ X.................... ................... X-ray head for

0260 0.7802 $42.57 $21.28

$8.51 orthodontia. 70355................ X.................... ................... Panoramic x-ray of

0260 0.7802 $42.57 $21.28

$8.51 jaws. 70360................ X.................... ................... X-ray exam of neck..

0260 0.7802 $42.57 $21.28

$8.51 70370................ X.................... ................... Throat x-ray &

0272 1.4166 $77.29 $38.36 $15.46 fluoroscopy. 70371................ X.................... ................... Speech evaluation,

0272 1.4166 $77.29 $38.36 $15.46 complex. 70373................ X.................... ................... Contrast x-ray of

0263 2.1883 $119.40 $43.58 $23.88 larynx. 70380................ X.................... ................... X-ray exam of

0260 0.7802 $42.57 $21.28

$8.51 salivary gland. 70390................ X.................... ................... X-ray exam of

0264 3.0287 $165.25 $79.41 $33.05 salivary duct. 70450................ S.................... ................... Ct head/brain w/o

0332 3.3936 $185.16 $91.27 $37.03 dye. 70460................ S.................... ................... Ct head/brain w/dye.

0283 4.6543 $253.94 $126.27 $50.79 70470................ S.................... ................... Ct head/brain w/o &

0333 5.4241 $295.94 $146.98 $59.19 w/ dye. 70480................ S.................... ................... Ct orbit/ear/fossa w/

0332 3.3936 $185.16 $91.27 $37.03 o dye. 70481................ S.................... ................... Ct orbit/ear/fossa w/

0283 4.6543 $253.94 $126.27 $50.79 dye. 70482................ S.................... ................... Ct orbit/ear/fossa w/

0333 5.4241 $295.94 $146.98 $59.19 o&w dye. 70486................ S.................... ................... Ct maxillofacial w/o

0332 3.3936 $185.16 $91.27 $37.03 dye. 70487................ S.................... ................... Ct maxillofacial w/

0283 4.6543 $253.94 $126.27 $50.79 dye. 70488................ S.................... ................... Ct maxillofacial w/o

0333 5.4241 $295.94 $146.98 $59.19 & w dye. 70490................ S.................... ................... Ct soft tissue neck

0332 3.3936 $185.16 $91.27 $37.03 w/o dye. 70491................ S.................... ................... Ct soft tissue neck

0283 4.6543 $253.94 $126.27 $50.79 w/dye. 70492................ S.................... ................... Ct sft tsue nck w/o

0333 5.4241 $295.94 $146.98 $59.19 & w/dye. 70496................ S.................... ................... Ct angiography, head

0662 5.8775 $320.68 $156.47 $64.14 70498................ S.................... ................... Ct angiography, neck

0662 5.8775 $320.68 $156.47 $64.14 70540................ S.................... ................... Mri orbit/face/neck

0336 6.3897 $348.63 $174.31 $69.73 w/o dye.

[[Page 63564]]

70542................ S.................... ................... Mri orbit/face/neck

0284 7.1165 $388.28 $194.13 $77.66 w/dye. 70543................ S.................... ................... Mri orbt/fac/nck w/o

0337 9.2075 $502.37 $240.77 $100.47 & w dye. 70544................ S.................... ................... Mr angiography head

0336 6.3897 $348.63 $174.31 $69.73 w/o dye. 70545................ S.................... ................... Mr angiography head

0284 7.1165 $388.28 $194.13 $77.66 w/dye. 70546................ S.................... ................... Mr angiograph head w/

0337 9.2075 $502.37 $240.77 $100.47 o&w dye. 70547................ S.................... ................... Mr angiography neck

0336 6.3897 $348.63 $174.31 $69.73 w/o dye. 70548................ S.................... ................... Mr angiography neck

0284 7.1165 $388.28 $194.13 $77.66 w/dye. 70549................ S.................... ................... Mr angiograph neck w/

0337 9.2075 $502.37 $240.77 $100.47 o&w dye. 70551................ S.................... ................... Mri brain w/o dye...

0336 6.3897 $348.63 $174.31 $69.73 70552................ S.................... ................... Mri brain w/ dye....

0284 7.1165 $388.28 $194.13 $77.66 70553................ S.................... ................... Mri brain w/o & w/

0337 9.2075 $502.37 $240.77 $100.47 dye. 70557................ S.................... NI................. Mri brain w/o dye...

0336 6.3897 $348.63 $174.31 $69.73 70558................ S.................... NI................. Mri brain w/ dye....

0284 7.1165 $388.28 $194.13 $77.66 70559................ S.................... NI................. Mri brain w/o & w/

0337 9.2075 $502.37 $240.77 $100.47 dye. 71010................ X.................... ................... Chest x-ray.........

0260 0.7802 $42.57 $21.28

$8.51 71015................ X.................... ................... Chest x-ray.........

0260 0.7802 $42.57 $21.28

$8.51 71020................ X.................... ................... Chest x-ray.........

0260 0.7802 $42.57 $21.28

$8.51 71021................ X.................... ................... Chest x-ray.........

0260 0.7802 $42.57 $21.28

$8.51 71022................ X.................... ................... Chest x-ray.........

0260 0.7802 $42.57 $21.28

$8.51 71023................ X.................... ................... Chest x-ray and

0272 1.4166 $77.29 $38.36 $15.46 fluoroscopy. 71030................ X.................... ................... Chest x-ray.........

0260 0.7802 $42.57 $21.28

$8.51 71034................ X.................... ................... Chest x-ray and

0272 1.4166 $77.29 $38.36 $15.46 fluoroscopy. 71035................ X.................... ................... Chest x-ray.........

0260 0.7802 $42.57 $21.28

$8.51 71040................ X.................... ................... Contrast x-ray of

0263 2.1883 $119.40 $43.58 $23.88 bronchi. 71060................ X.................... ................... Contrast x-ray of

0264 3.0287 $165.25 $79.41 $33.05 bronchi. 71090................ X.................... ................... X-ray & pacemaker

0272 1.4166 $77.29 $38.36 $15.46 insertion. 71100................ X.................... ................... X-ray exam of ribs..

0260 0.7802 $42.57 $21.28

$8.51 71101................ X.................... ................... X-ray exam of ribs/

0260 0.7802 $42.57 $21.28

$8.51 chest. 71110................ X.................... ................... X-ray exam of ribs..

0260 0.7802 $42.57 $21.28

$8.51 71111................ X.................... ................... X-ray exam of ribs/

0261 1.3176 $71.89 ........... $14.38 chest. 71120................ X.................... ................... X-ray exam of

0260 0.7802 $42.57 $21.28

$8.51 breastbone. 71130................ X.................... ................... X-ray exam of

0260 0.7802 $42.57 $21.28

$8.51 breastbone. 71250................ S.................... ................... Ct thorax w/o dye...

0332 3.3936 $185.16 $91.27 $37.03 71260................ S.................... ................... Ct thorax w/dye.....

0283 4.6543 $253.94 $126.27 $50.79 71270................ S.................... ................... Ct thorax w/o & w/

0333 5.4241 $295.94 $146.98 $59.19 dye. 71275................ S.................... ................... Ct angiography,

0662 5.8775 $320.68 $156.47 $64.14 chest. 71550................ S.................... ................... Mri chest w/o dye...

0336 6.3897 $348.63 $174.31 $69.73 71551................ S.................... ................... Mri chest w/dye.....

0284 7.1165 $388.28 $194.13 $77.66 71552................ S.................... ................... Mri chest w/o & w/

0337 9.2075 $502.37 $240.77 $100.47 dye. 71555................ B.................... ................... Mri angio chest w or ........... ........... ........... ........... ........... w/o dye. 72010................ X.................... ................... X-ray exam of spine.

0261 1.3176 $71.89 ........... $14.38 72020................ X.................... ................... X-ray exam of spine.

0260 0.7802 $42.57 $21.28

$8.51 72040................ X.................... ................... X-ray exam of neck

0260 0.7802 $42.57 $21.28

$8.51 spine. 72050................ X.................... ................... X-ray exam of neck

0261 1.3176 $71.89 ........... $14.38 spine. 72052................ X.................... ................... X-ray exam of neck

0261 1.3176 $71.89 ........... $14.38 spine. 72069................ X.................... ................... X-ray exam of trunk

0260 0.7802 $42.57 $21.28

$8.51 spine. 72070................ X.................... ................... X-ray exam of

0260 0.7802 $42.57 $21.28

$8.51 thoracic spine. 72072................ X.................... ................... X-ray exam of

0260 0.7802 $42.57 $21.28

$8.51 thoracic spine. 72074................ X.................... ................... X-ray exam of

0260 0.7802 $42.57 $21.28

$8.51 thoracic spine. 72080................ X.................... ................... X-ray exam of trunk

0260 0.7802 $42.57 $21.28

$8.51 spine. 72090................ X.................... ................... X-ray exam of trunk

0261 1.3176 $71.89 ........... $14.38 spine. 72100................ X.................... ................... X-ray exam of lower

0260 0.7802 $42.57 $21.28

$8.51 spine. 72110................ X.................... ................... X-ray exam of lower

0261 1.3176 $71.89 ........... $14.38 spine. 72114................ X.................... ................... X-ray exam of lower

0261 1.3176 $71.89 ........... $14.38 spine. 72120................ X.................... ................... X-ray exam of lower

0260 0.7802 $42.57 $21.28

$8.51 spine. 72125................ S.................... ................... Ct neck spine w/o

0332 3.3936 $185.16 $91.27 $37.03 dye. 72126................ S.................... ................... Ct neck spine w/dye.

0283 4.6543 $253.94 $126.27 $50.79 72127................ S.................... ................... Ct neck spine w/o &

0333 5.4241 $295.94 $146.98 $59.19 w/dye. 72128................ S.................... ................... Ct chest spine w/o

0332 3.3936 $185.16 $91.27 $37.03 dye. 72129................ S.................... ................... Ct chest spine w/dye

0283 4.6543 $253.94 $126.27 $50.79 72130................ S.................... ................... Ct chest spine w/o &

0333 5.4241 $295.94 $146.98 $59.19 w/dye. 72131................ S.................... ................... Ct lumbar spine w/o

0332 3.3936 $185.16 $91.27 $37.03 dye. 72132................ S.................... ................... Ct lumbar spine w/

0283 4.6543 $253.94 $126.27 $50.79 dye. 72133................ S.................... ................... Ct lumbar spine w/o

0333 5.4241 $295.94 $146.98 $59.19 & w/dye. 72141................ S.................... ................... Mri neck spine w/o

0336 6.3897 $348.63 $174.31 $69.73 dye. 72142................ S.................... ................... Mri neck spine w/dye

0284 7.1165 $388.28 $194.13 $77.66 72146................ S.................... ................... Mri chest spine w/o

0336 6.3897 $348.63 $174.31 $69.73 dye. 72147................ S.................... ................... Mri chest spine w/

0284 7.1165 $388.28 $194.13 $77.66 dye. 72148................ S.................... ................... Mri lumbar spine w/o

0336 6.3897 $348.63 $174.31 $69.73 dye. 72149................ S.................... ................... Mri lumbar spine w/

0284 7.1165 $388.28 $194.13 $77.66 dye. 72156................ S.................... ................... Mri neck spine w/o &

0337 9.2075 $502.37 $240.77 $100.47 w/dye. 72157................ S.................... ................... Mri chest spine w/o

0337 9.2075 $502.37 $240.77 $100.47 & w/dye. 72158................ S.................... ................... Mri lumbar spine w/o

0337 9.2075 $502.37 $240.77 $100.47 & w/dye. 72159................ E.................... ................... Mr angio spine w/o&w/ ........... ........... ........... ........... ........... dye. 72170................ X.................... ................... X-ray exam of pelvis

0260 0.7802 $42.57 $21.28

$8.51

[[Page 63565]]

72190................ X.................... ................... X-ray exam of pelvis

0260 0.7802 $42.57 $21.28

$8.51 72191................ S.................... ................... Ct angiograph pelv w/

0662 5.8775 $320.68 $156.47 $64.14 o&w/dye. 72192................ S.................... ................... Ct pelvis w/o dye...

0332 3.3936 $185.16 $91.27 $37.03 72193................ S.................... ................... Ct pelvis w/dye.....

0283 4.6543 $253.94 $126.27 $50.79 72194................ S.................... ................... Ct pelvis w/o & w/

0333 5.4241 $295.94 $146.98 $59.19 dye. 72195................ S.................... ................... Mri pelvis w/o dye..

0336 6.3897 $348.63 $174.31 $69.73 72196................ S.................... ................... Mri pelvis w/dye....

0284 7.1165 $388.28 $194.13 $77.66 72197................ S.................... ................... Mri pelvis w/o & w/

0337 9.2075 $502.37 $240.77 $100.47 dye. 72198................ E.................... ................... Mr angio pelvis w/o ........... ........... ........... ........... ........... & w/dye. 72200................ X.................... ................... X-ray exam

0260 0.7802 $42.57 $21.28

$8.51 sacroiliac joints. 72202................ X.................... ................... X-ray exam

0260 0.7802 $42.57 $21.28

$8.51 sacroiliac joints. 72220................ X.................... ................... X-ray exam of

0260 0.7802 $42.57 $21.28

$8.51 tailbone. 72240................ S.................... ................... Contrast x-ray of

0274 3.5931 $196.04 $93.63 $39.21 neck spine. 72255................ S.................... ................... Contrast x-ray,

0274 3.5931 $196.04 $93.63 $39.21 thorax spine. 72265................ S.................... ................... Contrast x-ray,

0274 3.5931 $196.04 $93.63 $39.21 lower spine. 72270................ S.................... ................... Contrast x-ray,

0274 3.5931 $196.04 $93.63 $39.21 spine. 72275................ S.................... ................... Epidurography.......

0274 3.5931 $196.04 $93.63 $39.21 72285................ S.................... ................... X-ray c/t spine disk

0388 11.6347 $634.80 $303.19 $126.96 72295................ S.................... ................... X-ray of lower spine

0388 11.6347 $634.80 $303.19 $126.96 disk. 73000................ X.................... ................... X-ray exam of collar

0260 0.7802 $42.57 $21.28

$8.51 bone. 73010................ X.................... ................... X-ray exam of

0260 0.7802 $42.57 $21.28

$8.51 shoulder blade. 73020................ X.................... ................... X-ray exam of

0260 0.7802 $42.57 $21.28

$8.51 shoulder. 73030................ X.................... ................... X-ray exam of

0260 0.7802 $42.57 $21.28

$8.51 shoulder. 73040................ S.................... ................... Contrast x-ray of

0275 3.2775 $178.82 $69.09 $35.76 shoulder. 73050................ X.................... ................... X-ray exam of

0260 0.7802 $42.57 $21.28

$8.51 shoulders. 73060................ X.................... ................... X-ray exam of

0260 0.7802 $42.57 $21.28

$8.51 humerus. 73070................ X.................... ................... X-ray exam of elbow.

0260 0.7802 $42.57 $21.28

$8.51 73080................ X.................... ................... X-ray exam of elbow.

0260 0.7802 $42.57 $21.28

$8.51 73085................ S.................... ................... Contrast x-ray of

0275 3.2775 $178.82 $69.09 $35.76 elbow. 73090................ X.................... ................... X-ray exam of

0260 0.7802 $42.57 $21.28

$8.51 forearm. 73092................ X.................... ................... X-ray exam of arm,

0260 0.7802 $42.57 $21.28

$8.51 infant. 73100................ X.................... ................... X-ray exam of wrist.

0260 0.7802 $42.57 $21.28

$8.51 73110................ X.................... ................... X-ray exam of wrist.

0260 0.7802 $42.57 $21.28

$8.51 73115................ S.................... ................... Contrast x-ray of

0275 3.2775 $178.82 $69.09 $35.76 wrist. 73120................ X.................... ................... X-ray exam of hand..

0260 0.7802 $42.57 $21.28

$8.51 73130................ X.................... ................... X-ray exam of hand..

0260 0.7802 $42.57 $21.28

$8.51 73140................ X.................... ................... X-ray exam of

0260 0.7802 $42.57 $21.28

$8.51 finger(s). 73200................ S.................... ................... Ct upper extremity w/

0332 3.3936 $185.16 $91.27 $37.03 o dye. 73201................ S.................... ................... Ct upper extremity w/

0283 4.6543 $253.94 $126.27 $50.79 dye. 73202................ S.................... ................... Ct uppr extremity w/

0333 5.4241 $295.94 $146.98 $59.19 o&w/dye. 73206................ S.................... ................... Ct angio upr extrm w/

0662 5.8775 $320.68 $156.47 $64.14 o&w/dye. 73218................ S.................... ................... Mri upper extremity

0336 6.3897 $348.63 $174.31 $69.73 w/o dye. 73219................ S.................... ................... Mri upper extremity

0284 7.1165 $388.28 $194.13 $77.66 w/dye. 73220................ S.................... ................... Mri uppr extremity w/

0337 9.2075 $502.37 $240.77 $100.47 o&w/dye. 73221................ S.................... ................... Mri joint upr extrem

0336 6.3897 $348.63 $174.31 $69.73 w/o dye. 73222................ S.................... ................... Mri joint upr extrem

0284 7.1165 $388.28 $194.13 $77.66 w/dye. 73223................ S.................... ................... Mri joint upr extr w/

0337 9.2075 $502.37 $240.77 $100.47 o&w/dye. 73225................ E.................... ................... Mr angio upr extr w/ ........... ........... ........... ........... ........... o&w/dye. 73500................ X.................... ................... X-ray exam of hip...

0260 0.7802 $42.57 $21.28

$8.51 73510................ X.................... ................... X-ray exam of hip...

0260 0.7802 $42.57 $21.28

$8.51 73520................ X.................... ................... X-ray exam of hips..

0260 0.7802 $42.57 $21.28

$8.51 73525................ S.................... ................... Contrast x-ray of

0275 3.2775 $178.82 $69.09 $35.76 hip. 73530................ X.................... ................... X-ray exam of hip...

0261 1.3176 $71.89 ........... $14.38 73540................ X.................... ................... X-ray exam of pelvis

0260 0.7802 $42.57 $21.28

$8.51 & hips. 73542................ S.................... ................... X-ray exam,

0275 3.2775 $178.82 $69.09 $35.76 sacroiliac joint. 73550................ X.................... ................... X-ray exam of thigh.

0260 0.7802 $42.57 $21.28

$8.51 73560................ X.................... ................... X-ray exam of knee,

0260 0.7802 $42.57 $21.28

$8.51 1 or 2. 73562................ X.................... ................... X-ray exam of knee,

0260 0.7802 $42.57 $21.28

$8.51 3. 73564................ X.................... ................... X-ray exam, knee, 4

0260 0.7802 $42.57 $21.28

$8.51 or more. 73565................ X.................... ................... X-ray exam of knees.

0260 0.7802 $42.57 $21.28

$8.51 73580................ S.................... ................... Contrast x-ray of

0275 3.2775 $178.82 $69.09 $35.76 knee joint. 73590................ X.................... ................... X-ray exam of lower

0260 0.7802 $42.57 $21.28

$8.51 leg. 73592................ X.................... ................... X-ray exam of leg,

0260 0.7802 $42.57 $21.28

$8.51 infant. 73600................ X.................... ................... X-ray exam of ankle.

0260 0.7802 $42.57 $21.28

$8.51 73610................ X.................... ................... X-ray exam of ankle.

0260 0.7802 $42.57 $21.28

$8.51 73615................ S.................... ................... Contrast x-ray of

0275 3.2775 $178.82 $69.09 $35.76 ankle. 73620................ X.................... ................... X-ray exam of foot..

0260 0.7802 $42.57 $21.28

$8.51 73630................ X.................... ................... X-ray exam of foot..

0260 0.7802 $42.57 $21.28

$8.51 73650................ X.................... ................... X-ray exam of heel..

0260 0.7802 $42.57 $21.28

$8.51 73660................ X.................... ................... X-ray exam of toe(s)

0260 0.7802 $42.57 $21.28

$8.51 73700................ S.................... ................... Ct lower extremity w/

0332 3.3936 $185.16 $91.27 $37.03 o dye. 73701................ S.................... ................... Ct lower extremity w/

0283 4.6543 $253.94 $126.27 $50.79 dye. 73702................ S.................... ................... Ct lwr extremity w/

0333 5.4241 $295.94 $146.98 $59.19 o&w/dye. 73706................ S.................... ................... Ct angio lwr extr w/

0662 5.8775 $320.68 $156.47 $64.14 o&w/dye. 73718................ S.................... ................... Mri lower extremity

0336 6.3897 $348.63 $174.31 $69.73 w/o dye.

[[Page 63566]]

73719................ S.................... ................... Mri lower extremity

0284 7.1165 $388.28 $194.13 $77.66 w/dye. 73720................ S.................... ................... Mri lwr extremity w/

0337 9.2075 $502.37 $240.77 $100.47 o&w/dye. 73721................ S.................... ................... Mri jnt of lwr extre

0336 6.3897 $348.63 $174.31 $69.73 w/o dye. 73722................ S.................... ................... Mri joint of lwr

0284 7.1165 $388.28 $194.13 $77.66 extr w/dye. 73723................ S.................... ................... Mri joint lwr extr w/

0337 9.2075 $502.37 $240.77 $100.47 o&w/dye. 73725................ B.................... ................... Mr ang lwr ext w or ........... ........... ........... ........... ........... w/o dye. 74000................ X.................... ................... X-ray exam of

0260 0.7802 $42.57 $21.28

$8.51 abdomen. 74010................ X.................... ................... X-ray exam of

0260 0.7802 $42.57 $21.28

$8.51 abdomen. 74020................ X.................... ................... X-ray exam of

0260 0.7802 $42.57 $21.28

$8.51 abdomen. 74022................ X.................... ................... X-ray exam series,

0261 1.3176 $71.89 ........... $14.38 abdomen. 74150................ S.................... ................... Ct abdomen w/o dye..

0332 3.3936 $185.16 $91.27 $37.03 74160................ S.................... ................... Ct abdomen w/dye....

0283 4.6543 $253.94 $126.27 $50.79 74170................ S.................... ................... Ct abdomen w/o &w /

0333 5.4241 $295.94 $146.98 $59.19 dye. 74175................ S.................... ................... Ct angio abdom w/o &

0662 5.8775 $320.68 $156.47 $64.14 w/dye. 74181................ S.................... ................... Mri abdomen w/o dye.

0336 6.3897 $348.63 $174.31 $69.73 74182................ S.................... ................... Mri abdomen w/dye...

0284 7.1165 $388.28 $194.13 $77.66 74183................ S.................... ................... Mri abdomen w/o & w/

0337 9.2075 $502.37 $240.77 $100.47 dye. 74185................ B.................... ................... Mri angio, abdom w ........... ........... ........... ........... ........... orw/o dye. 74190................ X.................... ................... X-ray exam of

0263 2.1883 $119.40 $43.58 $23.88 peritoneum. 74210................ S.................... ................... Contrst x-ray exam

0276 1.5906 $86.78 $41.72 $17.36 of throat. 74220................ S.................... ................... Contrast x-ray,

0276 1.5906 $86.78 $41.72 $17.36 esophagus. 74230................ S.................... ................... Cine/vid x-ray,

0276 1.5906 $86.78 $41.72 $17.36 throat/esoph. 74235................ S.................... ................... Remove esophagus

0296 2.8635 $156.24 $69.20 $31.25 obstruction. 74240................ S.................... ................... X-ray exam, upper gi

0276 1.5906 $86.78 $41.72 $17.36 tract. 74241................ S.................... ................... X-ray exam, upper gi

0276 1.5906 $86.78 $41.72 $17.36 tract. 74245................ S.................... ................... X-ray exam, upper gi

0277 2.4444 $133.37 $60.47 $26.67 tract. 74246................ S.................... ................... Contrst x-ray uppr

0276 1.5906 $86.78 $41.72 $17.36 gi tract. 74247................ S.................... ................... Contrst x-ray uppr

0276 1.5906 $86.78 $41.72 $17.36 gi tract. 74249................ S.................... ................... Contrst x-ray uppr

0277 2.4444 $133.37 $60.47 $26.67 gi tract. 74250................ S.................... ................... X-ray exam of small

0276 1.5906 $86.78 $41.72 $17.36 bowel. 74251................ S.................... ................... X-ray exam of small

0277 2.4444 $133.37 $60.47 $26.67 bowel. 74260................ S.................... ................... X-ray exam of small

0277 2.4444 $133.37 $60.47 $26.67 bowel. 74270................ S.................... ................... Contrast x-ray exam

0276 1.5906 $86.78 $41.72 $17.36 of colon. 74280................ S.................... ................... Contrast x-ray exam

0277 2.4444 $133.37 $60.47 $26.67 of colon. 74283................ S.................... ................... Contrast x-ray exam

0276 1.5906 $86.78 $41.72 $17.36 of colon. 74290................ S.................... ................... Contrast x-ray,

0276 1.5906 $86.78 $41.72 $17.36 gallbladder. 74291................ S.................... ................... Contrast x-rays,

0276 1.5906 $86.78 $41.72 $17.36 gallbladder. 74300................ X.................... ................... X-ray bile ducts/

0263 2.1883 $119.40 $43.58 $23.88 pancreas. 74301................ X.................... ................... X-rays at surgery

0263 2.1883 $119.40 $43.58 $23.88 add-on. 74305................ X.................... ................... X-ray bile ducts/

0263 2.1883 $119.40 $43.58 $23.88 pancreas. 74320................ X.................... ................... Contrast x-ray of

0264 3.0287 $165.25 $79.41 $33.05 bile ducts. 74327................ S.................... ................... X-ray bile stone

0296 2.8635 $156.24 $69.20 $31.25 removal. 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

0272 1.4166 $77.29 $38.36 $15.46 tube. 74350................ X.................... ................... X-ray guide, stomach

0263 2.1883 $119.40 $43.58 $23.88 tube. 74355................ X.................... ................... X-ray guide,

0263 2.1883 $119.40 $43.58 $23.88 intestinal tube. 74360................ S.................... ................... X-ray guide, GI

0296 2.8635 $156.24 $69.20 $31.25 dilation. 74363................ S.................... ................... X-ray, bile duct

0297 7.7145 $420.91 $172.51 $84.18 dilation. 74400................ S.................... ................... Contrst x-ray,

0278 2.7012 $147.38 $66.07 $29.48 urinary tract. 74410................ S.................... ................... Contrst x-ray,

0278 2.7012 $147.38 $66.07 $29.48 urinary tract. 74415................ S.................... ................... Contrst x-ray,

0278 2.7012 $147.38 $66.07 $29.48 urinary tract. 74420................ S.................... ................... Contrst x-ray,

0278 2.7012 $147.38 $66.07 $29.48 urinary tract. 74425................ S.................... ................... Contrst x-ray,

0278 2.7012 $147.38 $66.07 $29.48 urinary tract. 74430................ S.................... ................... Contrast x-ray,

0278 2.7012 $147.38 $66.07 $29.48 bladder. 74440................ S.................... ................... X-ray, male genital

0278 2.7012 $147.38 $66.07 $29.48 tract. 74445................ S.................... ................... X-ray exam of penis.

0278 2.7012 $147.38 $66.07 $29.48 74450................ S.................... ................... X-ray, urethra/

0278 2.7012 $147.38 $66.07 $29.48 bladder. 74455................ S.................... ................... X-ray, urethra/

0278 2.7012 $147.38 $66.07 $29.48 bladder. 74470................ X.................... ................... X-ray exam of kidney

0264 3.0287 $165.25 $79.41 $33.05 lesion. 74475................ S.................... ................... X-ray control, cath

0297 7.7145 $420.91 $172.51 $84.18 insert. 74480................ S.................... ................... X-ray control, cath

0296 2.8635 $156.24 $69.20 $31.25 insert. 74485................ S.................... ................... X-ray guide, GU

0296 2.8635 $156.24 $69.20 $31.25 dilation. 74710................ X.................... ................... X-ray measurement of

0260 0.7802 $42.57 $21.28

$8.51 pelvis. 74740................ X.................... ................... X-ray, female

0264 3.0287 $165.25 $79.41 $33.05 genital tract. 74742................ X.................... ................... X-ray, fallopian

0263 2.1883 $119.40 $43.58 $23.88 tube. 74775................ S.................... ................... X-ray exam of

0278 2.7012 $147.38 $66.07 $29.48 perineum. 75552................ S.................... ................... Heart mri for morph

0336 6.3897 $348.63 $174.31 $69.73 w/o dye. 75553................ S.................... ................... Heart mri for morph

0284 7.1165 $388.28 $194.13 $77.66 w/dye. 75554................ S.................... ................... Cardiac MRI/function

0335 6.3499 $346.46 $151.46 $69.29 75555................ S.................... ................... Cardiac MRI/limited

0335 6.3499 $346.46 $151.46 $69.29 study. 75556................ E.................... ................... Cardiac MRI/flow ........... ........... ........... ........... ........... mapping. 75600................ S.................... ................... Contrast x-ray exam

0280 19.1015 $1,042.20 $353.85 $208.44 of aorta. 75605................ S.................... ................... Contrast x-ray exam

0280 19.1015 $1,042.20 $353.85 $208.44 of aorta.

[[Page 63567]]

75625................ S.................... ................... Contrast x-ray exam

0280 19.1015 $1,042.20 $353.85 $208.44 of aorta. 75630................ S.................... ................... X-ray aorta, leg

0280 19.1015 $1,042.20 $353.85 $208.44 arteries. 75635................ S.................... ................... Ct angio abdominal

0662 5.8775 $320.68 $156.47 $64.14 arteries. 75650................ S.................... ................... Artery x-rays, head

0280 19.1015 $1,042.20 $353.85 $208.44 & neck. 75658................ S.................... ................... Artery x-rays, arm..

0280 19.1015 $1,042.20 $353.85 $208.44 75660................ S.................... ................... Artery x-rays, head

0279 10.7073 $584.20 $174.57 $116.84 & neck. 75662................ S.................... ................... Artery x-rays, head

0279 10.7073 $584.20 $174.57 $116.84 & neck. 75665................ S.................... ................... Artery x-rays, head

0280 19.1015 $1,042.20 $353.85 $208.44 & neck. 75671................ S.................... ................... Artery x-rays, head

0280 19.1015 $1,042.20 $353.85 $208.44 & neck. 75676................ S.................... ................... Artery x-rays, neck.

0280 19.1015 $1,042.20 $353.85 $208.44 75680................ S.................... ................... Artery x-rays, neck.

0280 19.1015 $1,042.20 $353.85 $208.44 75685................ S.................... ................... Artery x-rays, spine

0279 10.7073 $584.20 $174.57 $116.84 75705................ S.................... ................... Artery x-rays, spine

0279 10.7073 $584.20 $174.57 $116.84 75710................ S.................... ................... Artery x-rays, arm/

0280 19.1015 $1,042.20 $353.85 $208.44 leg. 75716................ S.................... ................... Artery x-rays, arms/

0280 19.1015 $1,042.20 $353.85 $208.44 legs. 75722................ S.................... ................... Artery x-rays,

0280 19.1015 $1,042.20 $353.85 $208.44 kidney. 75724................ S.................... ................... Artery x-rays,

0280 19.1015 $1,042.20 $353.85 $208.44 kidneys. 75726................ S.................... ................... Artery x-rays,

0280 19.1015 $1,042.20 $353.85 $208.44 abdomen. 75731................ S.................... ................... Artery x-rays,

0280 19.1015 $1,042.20 $353.85 $208.44 adrenal gland. 75733................ S.................... ................... Artery x-rays,

0280 19.1015 $1,042.20 $353.85 $208.44 adrenals. 75736................ S.................... ................... Artery x-rays,

0280 19.1015 $1,042.20 $353.85 $208.44 pelvis. 75741................ S.................... ................... Artery x-rays, lung.

0279 10.7073 $584.20 $174.57 $116.84 75743................ S.................... ................... Artery x-rays, lungs

0280 19.1015 $1,042.20 $353.85 $208.44 75746................ S.................... ................... Artery x-rays, lung.

0279 10.7073 $584.20 $174.57 $116.84 75756................ S.................... ................... Artery x-rays, chest

0279 10.7073 $584.20 $174.57 $116.84 75774................ S.................... ................... Artery x-ray, each

0668 10.2660 $560.12 $237.76 $112.02 vessel. 75790................ S.................... ................... Visualize A-V shunt.

0281 6.6031 $360.27 $115.16 $72.05 75801................ X.................... ................... Lymph vessel x-ray,

0264 3.0287 $165.25 $79.41 $33.05 arm/leg. 75803................ X.................... ................... Lymph vessel x-

0264 3.0287 $165.25 $79.41 $33.05 ray,arms/legs. 75805................ X.................... ................... Lymph vessel x-ray,

0264 3.0287 $165.25 $79.41 $33.05 trunk. 75807................ X.................... ................... Lymph vessel x-ray,

0264 3.0287 $165.25 $79.41 $33.05 trunk. 75809................ X.................... ................... Nonvascular shunt, x-

0263 2.1883 $119.40 $43.58 $23.88 ray. 75810................ S.................... ................... Vein x-ray, spleen/

0279 10.7073 $584.20 $174.57 $116.84 liver. 75820................ S.................... ................... Vein x-ray, arm/leg.

0281 6.6031 $360.27 $115.16 $72.05 75822................ S.................... ................... Vein x-ray, arms/

0281 6.6031 $360.27 $115.16 $72.05 legs. 75825................ S.................... ................... Vein x-ray, trunk...

0279 10.7073 $584.20 $174.57 $116.84 75827................ S.................... ................... Vein x-ray, chest...

0279 10.7073 $584.20 $174.57 $116.84 75831................ S.................... ................... Vein x-ray, kidney..

0287 6.4923 $354.23 $111.33 $70.85 75833................ S.................... ................... Vein x-ray, kidneys.

0279 10.7073 $584.20 $174.57 $116.84 75840................ S.................... ................... Vein x-ray, adrenal

0287 6.4923 $354.23 $111.33 $70.85 gland. 75842................ S.................... ................... Vein x-ray, adrenal

0287 6.4923 $354.23 $111.33 $70.85 glands. 75860................ S.................... ................... Vein x-ray, neck....

0287 6.4923 $354.23 $111.33 $70.85 75870................ S.................... ................... Vein x-ray, skull...

0287 6.4923 $354.23 $111.33 $70.85 75872................ S.................... ................... Vein x-ray, skull...

0287 6.4923 $354.23 $111.33 $70.85 75880................ S.................... ................... Vein x-ray, eye

0287 6.4923 $354.23 $111.33 $70.85 socket. 75885................ S.................... ................... Vein x-ray, liver...

0279 10.7073 $584.20 $174.57 $116.84 75887................ S.................... ................... Vein x-ray, liver...

0280 19.1015 $1,042.20 $353.85 $208.44 75889................ S.................... ................... Vein x-ray, liver...

0279 10.7073 $584.20 $174.57 $116.84 75891................ S.................... ................... Vein x-ray, liver...

0279 10.7073 $584.20 $174.57 $116.84 75893................ N.................... ................... Venous sampling by ........... ........... ........... ........... ........... catheter. 75894................ S.................... ................... X-rays, transcath

0297 7.7145 $420.91 $172.51 $84.18 therapy. 75896................ S.................... ................... X-rays, transcath

0297 7.7145 $420.91 $172.51 $84.18 therapy. 75898................ X.................... ................... Follow-up

0264 3.0287 $165.25 $79.41 $33.05 angiography. 75900................ C.................... ................... Arterial catheter ........... ........... ........... ........... ........... exchange. 75901................ X.................... ................... Remove cva device

0264 3.0287 $165.25 $79.41 $33.05 obstruct. 75902................ X.................... ................... Remove cva lumen

0263 2.1883 $119.40 $43.58 $23.88 obstruct. 75940................ X.................... ................... X-ray placement,

0187 4.4288 $241.64 $90.71 $48.33 vein filter. 75945................ S.................... ................... Intravascular us....

0267 2.4586 $134.14 $65.52 $26.83 75946................ S.................... ................... Intravascular us add-

0267 2.4586 $134.14 $65.52 $26.83 on. 75952................ C.................... ................... Endovasc repair ........... ........... ........... ........... ........... abdom aorta. 75953................ C.................... ................... Abdom aneurysm

........... ........... ........... ........... ........... endovas rpr. 75954................ C.................... ................... Iliac aneurysm

........... ........... ........... ........... ........... endovas rpr. 75960................ S.................... ................... Transcatheter intro,

0280 19.1015 $1,042.20 $353.85 $208.44 stent. 75961................ S.................... ................... Retrieval, broken

0280 19.1015 $1,042.20 $353.85 $208.44 catheter. 75962................ S.................... ................... Repair arterial

0280 19.1015 $1,042.20 $353.85 $208.44 blockage. 75964................ S.................... ................... Repair artery

0280 19.1015 $1,042.20 $353.85 $208.44 blockage, each. 75966................ S.................... ................... Repair arterial

0280 19.1015 $1,042.20 $353.85 $208.44 blockage. 75968................ S.................... ................... Repair artery

0280 19.1015 $1,042.20 $353.85 $208.44 blockage, each. 75970................ S.................... ................... Vascular biopsy.....

0280 19.1015 $1,042.20 $353.85 $208.44 75978................ S.................... ................... Repair venous

0668 10.2660 $560.12 $237.76 $112.02 blockage. 75980................ S.................... ................... Contrast xray exam

0296 2.8635 $156.24 $69.20 $31.25 bile duct. 75982................ S.................... ................... Contrast xray exam

0297 7.7145 $420.91 $172.51 $84.18 bile duct. 75984................ X.................... ................... Xray control

0264 3.0287 $165.25 $79.41 $33.05 catheter change. 75989................ N.................... ................... Abscess drainage ........... ........... ........... ........... ........... under x-ray. 75992................ S.................... ................... Atherectomy, x-ray

0280 19.1015 $1,042.20 $353.85 $208.44 exam.

[[Page 63568]]

75993................ S.................... ................... Atherectomy, x-ray

0280 19.1015 $1,042.20 $353.85 $208.44 exam. 75994................ S.................... ................... Atherectomy, x-ray

0280 19.1015 $1,042.20 $353.85 $208.44 exam. 75995................ S.................... ................... Atherectomy, x-ray

0280 19.1015 $1,042.20 $353.85 $208.44 exam. 75996................ S.................... ................... Atherectomy, x-ray

0280 19.1015 $1,042.20 $353.85 $208.44 exam. 75998................ N.................... NI................. Fluoroguide for vein ........... ........... ........... ........... ........... device. 76000................ X.................... ................... Fluoroscope

0272 1.4166 $77.29 $38.36 $15.46 examination. 76001................ N.................... ................... Fluoroscope exam, ........... ........... ........... ........... ........... extensive. 76003................ N.................... ................... Needle localization ........... ........... ........... ........... ........... by x-ray. 76005................ N.................... ................... Fluoroguide for ........... ........... ........... ........... ........... spine inject. 76006................ X.................... ................... X-ray stress view...

0260 0.7802 $42.57 $21.28

$8.51 76010................ X.................... ................... X-ray, nose to

0260 0.7802 $42.57 $21.28

$8.51 rectum. 76012................ S.................... ................... Percut

0274 3.5931 $196.04 $93.63 $39.21 vertebroplasty fluor. 76013................ S.................... ................... Percut

0274 3.5931 $196.04 $93.63 $39.21 vertebroplasty, ct. 76020................ X.................... ................... X-rays for bone age.

0260 0.7802 $42.57 $21.28

$8.51 76040................ X.................... ................... X-rays, bone

0260 0.7802 $42.57 $21.28

$8.51 evaluation. 76061................ X.................... ................... X-rays, bone survey.

0261 1.3176 $71.89 ........... $14.38 76062................ X.................... ................... X-rays, bone survey.

0261 1.3176 $71.89 ........... $14.38 76065................ X.................... ................... X-rays, bone

0261 1.3176 $71.89 ........... $14.38 evaluation. 76066................ X.................... ................... Joint survey, single

0260 0.7802 $42.57 $21.28

$8.51 view. 76070................ S.................... ................... CT scan, bone

0288 1.2726 $69.43 ........... $13.89 density study. 76071................ S.................... ................... Ct bone density,

0282 1.6834 $91.85 $44.51 $18.37 peripheral. 76075................ S.................... ................... Dexa, axial skeleton

0288 1.2726 $69.43 ........... $13.89 study. 76076................ S.................... ................... Dexa, peripheral

0665 0.7257 $39.59 ...........

$7.92 study. 76078................ X.................... ................... Radiographic

0261 1.3176 $71.89 ........... $14.38 absorptiometry. 76080................ X.................... ................... X-ray exam of

0263 2.1883 $119.40 $43.58 $23.88 fistula. 76082................ S.................... NI................. Computer mammogram

0410 0.1523

$8.31 ...........

$1.66 add-on. 76083................ A.................... NI................. Computer mammogram ........... ........... ........... ........... ........... add-on. 76085................ D.................... DNG................ Computer mammogram ........... ........... ........... ........... ........... add-on. 76086................ X.................... ................... X-ray of mammary

0263 2.1883 $119.40 $43.58 $23.88 duct. 76088................ X.................... ................... X-ray of mammary

0263 2.1883 $119.40 $43.58 $23.88 ducts. 76090................ S.................... ................... Mammogram, one

0271 0.6499 $35.46 $16.80

$7.09 breast. 76091................ S.................... ................... Mammogram, both

0271 0.6499 $35.46 $16.80

$7.09 breasts. 76092................ A.................... ................... Mammogram, screening ........... ........... ........... ........... ........... 76093................ E.................... ................... Magnetic image, ........... ........... ........... ........... ........... breast. 76094................ E.................... ................... Magnetic image, both ........... ........... ........... ........... ........... breasts. 76095................ X.................... ................... Stereotactic breast

0187 4.4288 $241.64 $90.71 $48.33 biopsy. 76096................ X.................... ................... X-ray of needle

0289 3.4900 $190.42 $44.80 $38.08 wire, breast. 76098................ X.................... ................... X-ray exam, breast

0260 0.7802 $42.57 $21.28

$8.51 specimen. 76100................ X.................... ................... X-ray exam of body

0261 1.3176 $71.89 ........... $14.38 section. 76101................ X.................... ................... Complex body section

0264 3.0287 $165.25 $79.41 $33.05 x-ray. 76102................ X.................... ................... Complex body section

0264 3.0287 $165.25 $79.41 $33.05 x-rays. 76120................ X.................... ................... Cine/video x-rays...

0272 1.4166 $77.29 $38.36 $15.46 76125................ X.................... ................... Cine/video x-rays

0260 0.7802 $42.57 $21.28

$8.51 add-on. 76140................ E.................... ................... X-ray consultation.. ........... ........... ........... ........... ........... 76150................ X.................... ................... X-ray exam, dry

0260 0.7802 $42.57 $21.28

$8.51 process. 76350................ N.................... ................... Special x-ray

........... ........... ........... ........... ........... contrast study. 76355................ S.................... ................... Ct scan for

0283 4.6543 $253.94 $126.27 $50.79 localization. 76360................ S.................... ................... Ct scan for needle

0283 4.6543 $253.94 $126.27 $50.79 biopsy. 76362................ S.................... ................... Ct guide for tissue

0332 3.3936 $185.16 $91.27 $37.03 ablation. 76370................ S.................... ................... Ct scan for therapy

0282 1.6834 $91.85 $44.51 $18.37 guide. 76375................ S.................... ................... 3d/holograph

0282 1.6834 $91.85 $44.51 $18.37 reconstr add-on. 76380................ S.................... ................... CAT scan follow-up

0282 1.6834 $91.85 $44.51 $18.37 study. 76390................ E.................... ................... Mr spectroscopy..... ........... ........... ........... ........... ........... 76393................ S.................... ................... Mr guidance for

0335 6.3499 $346.46 $151.46 $69.29 needle place. 76394................ S.................... ................... Mri for tissue

0335 6.3499 $346.46 $151.46 $69.29 ablation. 76400................ S.................... ................... Magnetic image, bone

0335 6.3499 $346.46 $151.46 $69.29 marrow. 76490................ S.................... DG................. Us for tissue

0268 1.3081 $71.37 ........... $14.27 ablation. 76496................ X.................... ................... Fluoroscopic

0272 1.4166 $77.29 $38.36 $15.46 procedure. 76497................ S.................... ................... Ct procedure........

0282 1.6834 $91.85 $44.51 $18.37 76498................ S.................... ................... Mri procedure.......

0335 6.3499 $346.46 $151.46 $69.29 76499................ X.................... ................... Radiographic

0260 0.7802 $42.57 $21.28

$8.51 procedure. 76506................ S.................... ................... Echo exam of head...

0266 1.6117 $87.94 $43.97 $17.59 76511................ S.................... ................... Echo exam of eye....

0266 1.6117 $87.94 $43.97 $17.59 76512................ S.................... ................... Echo exam of eye....

0266 1.6117 $87.94 $43.97 $17.59 76513................ S.................... ................... Echo exam of eye,

0265 1.0289 $56.14 $28.07 $11.23 water bath. 76514................ S.................... NI................. Echo exam of eye,

0265 1.0289 $56.14 $28.07 $11.23 thickness. 76516................ S.................... ................... Echo exam of eye....

0266 1.6117 $87.94 $43.97 $17.59 76519................ S.................... ................... Echo exam of eye....

0266 1.6117 $87.94 $43.97 $17.59 76529................ S.................... ................... Echo exam of eye....

0265 1.0289 $56.14 $28.07 $11.23 76536................ S.................... ................... Us exam of head and

0266 1.6117 $87.94 $43.97 $17.59 neck. 76604................ S.................... ................... Us exam, chest, b-

0266 1.6117 $87.94 $43.97 $17.59 scan. 76645................ S.................... ................... Us exam, breast(s)..

0265 1.0289 $56.14 $28.07 $11.23 76700................ S.................... ................... Us exam, abdom,

0266 1.6117 $87.94 $43.97 $17.59 complete. 76705................ S.................... ................... Echo exam of abdomen

0266 1.6117 $87.94 $43.97 $17.59 76770................ S.................... ................... Us exam abdo back

0266 1.6117 $87.94 $43.97 $17.59 wall, comp.

[[Page 63569]]

76775................ S.................... ................... Us exam abdo back

0266 1.6117 $87.94 $43.97 $17.59 wall, lim. 76778................ S.................... ................... Us exam kidney

0266 1.6117 $87.94 $43.97 $17.59 transplant. 76800................ S.................... ................... Us exam, spinal

0266 1.6117 $87.94 $43.97 $17.59 canal. 76801................ S.................... ................... Ob us 7 im. 90716................ K.................... ................... Chicken pox vaccine,

0355 0.2749 $15.00 ...........

$3.00 sc. 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................ K.................... ................... Dtap-hep b-ipv

0356 0.7698 $42.00 ...........

$8.40 vaccine, im. 90725................ K.................... ................... Cholera vaccine,

0355 0.2749 $15.00 ...........

$3.00 injectable. 90727................ N.................... ................... Plague vaccine, im.. ........... ........... ........... ........... ........... 90732................ L.................... ................... Pneumococcal vaccine ........... ........... ........... ........... ........... 90733................ N.................... ................... Meningococcal

........... ........... ........... ........... ........... vaccine, sc. 90734................ N.................... NI................. Meningococcal

........... ........... ........... ........... ........... vaccine, im. 90735................ N.................... ................... Encephalitis

........... ........... ........... ........... ........... vaccine, sc. 90740................ K.................... ................... Hepb vacc, ill pat 3

0356 0.7698 $42.00 ...........

$8.40 dose im. 90743................ K.................... ................... Hep b vacc, adol, 2

0356 0.7698 $42.00 ...........

$8.40 dose, im. 90744................ K.................... ................... Hepb vacc ped/adol 3

0356 0.7698 $42.00 ...........

$8.40 dose im. 90746................ K.................... ................... Hep b vaccine,

0356 0.7698 $42.00 ...........

$8.40 adult, im. 90747................ K.................... ................... Hepb vacc, ill pat 4

0356 0.7698 $42.00 ...........

$8.40 dose im. 90748................ K.................... ................... Hep b/hib vaccine,

0355 0.2749 $15.00 ...........

$3.00 im. 90749................ N.................... ................... Vaccine toxoid...... ........... ........... ........... ........... ........... 90780................ B.................... ................... IV infusion therapy, ........... ........... ........... ........... ........... 1 hour. 90781................ B.................... ................... IV infusion,

........... ........... ........... ........... ........... additional hour. 90782................ X.................... ................... Injection, sc/im....

0353 0.3982 $21.73 ...........

$4.35 90783................ X.................... ................... Injection, ia.......

0359 0.8000 $43.65 ...........

$8.73 90784................ X.................... ................... Injection, iv.......

0359 0.8000 $43.65 ...........

$8.73 90788................ X.................... ................... Injection of

0359 0.8000 $43.65 ...........

$8.73 antibiotic. 90799................ X.................... ................... Ther/prophylactic/dx

0352 0.1230

$6.71 ...........

$1.34 inject. 90801................ S.................... ................... Psy dx interview....

0323 1.8689 $101.97 $21.26 $20.39 90802................ S.................... ................... Intac psy dx

0323 1.8689 $101.97 $21.26 $20.39 interview. 90804................ S.................... ................... Psytx, office, 20-30

0322 1.2802 $69.85 ........... $13.97 min. 90805................ S.................... ................... Psytx, off, 20-30

0322 1.2802 $69.85 ........... $13.97 min w/e&m. 90806................ S.................... ................... Psytx, off, 45-50

0323 1.8689 $101.97 $21.26 $20.39 min. 90807................ S.................... ................... Psytx, off, 45-50

0323 1.8689 $101.97 $21.26 $20.39 min w/e&m. 90808................ S.................... ................... Psytx, office, 75-80

0323 1.8689 $101.97 $21.26 $20.39 min. 90809................ S.................... ................... Psytx, off, 75-80, w/

0323 1.8689 $101.97 $21.26 $20.39 e&m. 90810................ S.................... ................... Intac psytx, off, 20-

0322 1.2802 $69.85 ........... $13.97 30 min. 90811................ S.................... ................... Intac psytx, 20-30,

0322 1.2802 $69.85 ........... $13.97 w/e&m. 90812................ S.................... ................... Intac psytx, off, 45-

0323 1.8689 $101.97 $21.26 $20.39 50 min. 90813................ S.................... ................... Intac psytx, 45-50

0323 1.8689 $101.97 $21.26 $20.39 min w/e&m. 90814................ S.................... ................... Intac psytx, off, 75-

0323 1.8689 $101.97 $21.26 $20.39 80 min. 90815................ S.................... ................... Intac psytx, 75-80 w/

0323 1.8689 $101.97 $21.26 $20.39 e&m. 90816................ S.................... ................... Psytx, hosp, 20-30

0322 1.2802 $69.85 ........... $13.97 min. 90817................ S.................... ................... Psytx, hosp, 20-30

0322 1.2802 $69.85 ........... $13.97 min w/e&m. 90818................ S.................... ................... Psytx, hosp, 45-50

0323 1.8689 $101.97 $21.26 $20.39 min. 90819................ S.................... ................... Psytx, hosp, 45-50

0323 1.8689 $101.97 $21.26 $20.39 min w/e&m. 90821................ S.................... ................... Psytx, hosp, 75-80

0323 1.8689 $101.97 $21.26 $20.39 min. 90822................ S.................... ................... Psytx, hosp, 75-80

0323 1.8689 $101.97 $21.26 $20.39 min w/e&m. 90823................ S.................... ................... Intac psytx, hosp,

0322 1.2802 $69.85 ........... $13.97 20-30 min. 90824................ S.................... ................... Intac psytx, hsp 20-

0322 1.2802 $69.85 ........... $13.97 30 w/e&m. 90826................ S.................... ................... Intac psytx, hosp,

0323 1.8689 $101.97 $21.26 $20.39 45-50 min. 90827................ S.................... ................... Intac psytx, hsp 45-

0323 1.8689 $101.97 $21.26 $20.39 50 w/e&m. 90828................ S.................... ................... Intac psytx, hosp,

0323 1.8689 $101.97 $21.26 $20.39 75-80 min. 90829................ S.................... ................... Intac psytx, hsp 75-

0323 1.8689 $101.97 $21.26 $20.39 80 w/e&m. 90845................ S.................... ................... Psychoanalysis......

0323 1.8689 $101.97 $21.26 $20.39 90846................ S.................... ................... Family psytx w/o

0324 2.4473 $133.53 ........... $26.71 patient. 90847................ S.................... ................... Family psytx w/

0324 2.4473 $133.53 ........... $26.71 patient.

[[Page 63590]]

90849................ S.................... ................... Multiple family

0325 1.4865 $81.10 $18.27 $16.22 group psytx. 90853................ S.................... ................... Group psychotherapy.

0325 1.4865 $81.10 $18.27 $16.22 90857................ S.................... ................... Intac group psytx...

0325 1.4865 $81.10 $18.27 $16.22 90862................ X.................... ................... Medication

0374 1.1252 $61.39 ........... $12.28 management. 90865................ S.................... ................... Narcosynthesis......

0323 1.8689 $101.97 $21.26 $20.39 90870................ S.................... ................... Electroconvulsive

0320 5.3785 $293.46 $80.06 $58.69 therapy. 90871................ E.................... ................... Electroconvulsive ........... ........... ........... ........... ........... therapy. 90875................ E.................... ................... Psychophysiological ........... ........... ........... ........... ........... therapy. 90876................ E.................... ................... Psychophysiological ........... ........... ........... ........... ........... therapy. 90880................ S.................... ................... Hypnotherapy........

0323 1.8689 $101.97 $21.26 $20.39 90882................ E.................... ................... Environmental

........... ........... ........... ........... ........... manipulation. 90885................ N.................... ................... Psy evaluation of ........... ........... ........... ........... ........... records. 90887................ N.................... ................... Consultation with ........... ........... ........... ........... ........... family. 90889................ N.................... ................... Preparation of

........... ........... ........... ........... ........... report. 90899................ S.................... ................... Psychiatric service/

0322 1.2802 $69.85 ........... $13.97 therapy. 90901................ A.................... ................... Biofeedback train, ........... ........... ........... ........... ........... any meth. 90911................ S.................... ................... Biofeedback peri/uro/

0321 1.2387 $67.58 $21.78 $13.52 rectal. 90918................ A.................... ................... ESRD related

........... ........... ........... ........... ........... services, month. 90919................ A.................... ................... ESRD related

........... ........... ........... ........... ........... services, month. 90920................ A.................... ................... ESRD related

........... ........... ........... ........... ........... services, month. 90921................ A.................... ................... ESRD related

........... ........... ........... ........... ........... services, month. 90922................ A.................... ................... ESRD related

........... ........... ........... ........... ........... services, day. 90923................ A.................... ................... Esrd related

........... ........... ........... ........... ........... services, day. 90924................ A.................... ................... Esrd related

........... ........... ........... ........... ........... services, day. 90925................ A.................... ................... Esrd related

........... ........... ........... ........... ........... services, day. 90935................ S.................... ................... Hemodialysis, one

0170 5.9678 $325.61 ........... $65.12 evaluation. 90937................ E.................... ................... Hemodialysis,

........... ........... ........... ........... ........... repeated eval. 90939................ N.................... ................... Hemodialysis study, ........... ........... ........... ........... ........... transcut. 90940................ N.................... ................... Hemodialysis access ........... ........... ........... ........... ........... study. 90945................ S.................... ................... Dialysis, one

0170 5.9678 $325.61 ........... $65.12 evaluation. 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

0361 3.5510 $193.75 $83.23 $38.75 intubation. 91010................ X.................... ................... Esophagus motility

0361 3.5510 $193.75 $83.23 $38.75 study. 91011................ X.................... ................... Esophagus motility

0361 3.5510 $193.75 $83.23 $38.75 study. 91012................ X.................... ................... Esophagus motility

0361 3.5510 $193.75 $83.23 $38.75 study. 91020................ X.................... ................... Gastric motility....

0361 3.5510 $193.75 $83.23 $38.75 91030................ X.................... ................... Acid perfusion of

0361 3.5510 $193.75 $83.23 $38.75 esophagus. 91032................ X.................... ................... Esophagus, acid

0361 3.5510 $193.75 $83.23 $38.75 reflux test. 91033................ X.................... ................... Prolonged acid

0361 3.5510 $193.75 $83.23 $38.75 reflux test. 91052................ X.................... ................... Gastric analysis

0361 3.5510 $193.75 $83.23 $38.75 test. 91055................ X.................... ................... Gastric intubation

0360 1.7313 $94.46 $42.45 $18.89 for smear. 91060................ X.................... ................... Gastric saline load

0360 1.7313 $94.46 $42.45 $18.89 test. 91065................ X.................... ................... Breath hydrogen test

0360 1.7313 $94.46 $42.45 $18.89 91100................ X.................... ................... Pass intestine

0360 1.7313 $94.46 $42.45 $18.89 bleeding tube. 91105................ X.................... ................... Gastric intubation

0360 1.7313 $94.46 $42.45 $18.89 treatment. 91110................ S.................... NI................. Gi tract capsule

1508 ........... $650.00 ........... $130.00 endoscopy. 91122................ T.................... ................... Anal pressure record

0156 2.4747 $135.02 $40.52 $27.00 91123................ N.................... ................... Irrigate fecal

........... ........... ........... ........... ........... impaction. 91132................ X.................... ................... Electrogastrography.

0360 1.7313 $94.46 $42.45 $18.89 91133................ X.................... ................... Electrogastrography

0360 1.7313 $94.46 $42.45 $18.89 w/test. 91299................ X.................... ................... Gastroenterology

0360 1.7313 $94.46 $42.45 $18.89 procedure. 92002................ V.................... ................... Eye exam, new

0601 0.9816 $53.56 ........... $10.71 patient. 92004................ V.................... ................... Eye exam, new

0602 1.5041 $82.07 ........... $16.41 patient. 92012................ V.................... ................... Eye exam established

0600 0.9278 $50.62 ........... $10.12 pat. 92014................ V.................... ................... Eye exam & treatment

0602 1.5041 $82.07 ........... $16.41 92015................ E.................... ................... Refraction.......... ........... ........... ........... ........... ........... 92018................ T.................... ................... New eye exam &

0699 2.2303 $121.69 $47.46 $24.34 treatment. 92019................ S.................... ................... Eye exam & treatment

0699 2.2303 $121.69 $47.46 $24.34 92020................ S.................... ................... Special eye

0230 0.7619 $41.57 $14.97

$8.31 evaluation. 92060................ S.................... ................... Special eye

0230 0.7619 $41.57 $14.97

$8.31 evaluation. 92065................ S.................... ................... Orthoptic/pleoptic

0230 0.7619 $41.57 $14.97

$8.31 training. 92070................ N.................... ................... Fitting of contact ........... ........... ........... ........... ........... lens. 92081................ S.................... ................... Visual field

0230 0.7619 $41.57 $14.97

$8.31 examination(s). 92082................ S.................... ................... Visual field

0698 0.9599 $52.37 $18.72 $10.47 examination(s). 92083................ S.................... ................... Visual field

0698 0.9599 $52.37 $18.72 $10.47 examination(s). 92100................ N.................... ................... Serial tonometry ........... ........... ........... ........... ........... exam(s). 92120................ S.................... ................... Tonography & eye

0230 0.7619 $41.57 $14.97

$8.31 evaluation. 92130................ S.................... ................... Water provocation

0698 0.9599 $52.37 $18.72 $10.47 tonography. 92135................ S.................... ................... Opthalmic dx imaging

0230 0.7619 $41.57 $14.97

$8.31 92136................ S.................... ................... Ophthalmic biometry.

0230 0.7619 $41.57 $14.97

$8.31 92140................ S.................... ................... Glaucoma provocative

0698 0.9599 $52.37 $18.72 $10.47 tests.

[[Page 63591]]

92225................ S.................... ................... Special eye exam,

0698 0.9599 $52.37 $18.72 $10.47 initial. 92226................ S.................... ................... Special eye exam,

0698 0.9599 $52.37 $18.72 $10.47 subsequent. 92230................ T.................... ................... Eye exam with photos

0699 2.2303 $121.69 $47.46 $24.34 92235................ T.................... ................... Eye exam with photos

0699 2.2303 $121.69 $47.46 $24.34 92240................ S.................... ................... Icg angiography.....

0231 2.1883 $119.40 $50.94 $23.88 92250................ S.................... ................... Eye exam with photos

0230 0.7619 $41.57 $14.97

$8.31 92260................ S.................... ................... Ophthalmoscopy/

0230 0.7619 $41.57 $14.97

$8.31 dynamometry. 92265................ S.................... ................... Eye muscle

0231 2.1883 $119.40 $50.94 $23.88 evaluation. 92270................ S.................... ................... Electro-oculography.

0698 0.9599 $52.37 $18.72 $10.47 92275................ S.................... ................... Electroretinography.

0231 2.1883 $119.40 $50.94 $23.88 92283................ S.................... ................... Color vision

0230 0.7619 $41.57 $14.97

$8.31 examination. 92284................ S.................... ................... Dark adaptation eye

0698 0.9599 $52.37 $18.72 $10.47 exam. 92285................ S.................... ................... Eye photography.....

0230 0.7619 $41.57 $14.97

$8.31 92286................ S.................... ................... Internal eye

0698 0.9599 $52.37 $18.72 $10.47 photography. 92287................ S.................... ................... Internal eye

0231 2.1883 $119.40 $50.94 $23.88 photography. 92310................ E.................... ................... Contact lens fitting ........... ........... ........... ........... ........... 92311................ X.................... ................... Contact lens fitting

0362 2.6984 $147.23 ........... $29.45 92312................ X.................... ................... Contact lens fitting

0362 2.6984 $147.23 ........... $29.45 92313................ X.................... ................... Contact lens fitting

0362 2.6984 $147.23 ........... $29.45 92314................ E.................... ................... Prescription of ........... ........... ........... ........... ........... contact lens. 92315................ X.................... ................... Prescription of

0362 2.6984 $147.23 ........... $29.45 contact lens. 92316................ X.................... ................... Prescription of

0362 2.6984 $147.23 ........... $29.45 contact lens. 92317................ X.................... ................... Prescription of

0362 2.6984 $147.23 ........... $29.45 contact lens. 92325................ X.................... ................... Modification of

0362 2.6984 $147.23 ........... $29.45 contact lens. 92326................ X.................... ................... Replacement of

0362 2.6984 $147.23 ........... $29.45 contact lens. 92330................ S.................... ................... Fitting of

0230 0.7619 $41.57 $14.97

$8.31 artificial eye. 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

0362 2.6984 $147.23 ........... $29.45 fitting. 92353................ X.................... ................... Special spectacles

0362 2.6984 $147.23 ........... $29.45 fitting. 92354................ X.................... ................... Special spectacles

0362 2.6984 $147.23 ........... $29.45 fitting. 92355................ X.................... ................... Special spectacles

0362 2.6984 $147.23 ........... $29.45 fitting. 92358................ X.................... ................... Eye prosthesis

0362 2.6984 $147.23 ........... $29.45 service. 92370................ E.................... ................... Repair & adjust ........... ........... ........... ........... ........... spectacles. 92371................ X.................... ................... Repair & adjust

0362 2.6984 $147.23 ........... $29.45 spectacles. 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

0230 0.7619 $41.57 $14.97

$8.31 procedure. 92502................ T.................... ................... Ear and throat

0251 1.7880 $97.56 ........... $19.51 examination. 92504................ N.................... ................... Ear microscopy

........... ........... ........... ........... ........... examination. 92506................ A.................... ................... Speech/hearing

........... ........... ........... ........... ........... evaluation. 92507................ A.................... ................... Speech/hearing

........... ........... ........... ........... ........... therapy. 92508................ A.................... ................... Speech/hearing

........... ........... ........... ........... ........... therapy. 92510................ A.................... ................... Rehab for ear

........... ........... ........... ........... ........... implant. 92511................ T.................... ................... Nasopharyngoscopy...

0071 0.8799 $48.01 $12.89

$9.60 92512................ X.................... ................... Nasal function

0363 0.8641 $47.15 $17.44

$9.43 studies. 92516................ X.................... ................... Facial nerve

0660 1.7353 $94.68 $30.66 $18.94 function test. 92520................ X.................... ................... Laryngeal function

0660 1.7353 $94.68 $30.66 $18.94 studies. 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

0363 0.8641 $47.15 $17.44

$9.43 nystagmus test. 92542................ X.................... ................... Positional nystagmus

0363 0.8641 $47.15 $17.44

$9.43 test. 92543................ X.................... ................... Caloric vestibular

0363 0.8641 $47.15 $17.44

$9.43 test. 92544................ X.................... ................... Optokinetic

0363 0.8641 $47.15 $17.44

$9.43 nystagmus test. 92545................ X.................... ................... Oscillating tracking

0363 0.8641 $47.15 $17.44

$9.43 test. 92546................ X.................... ................... Sinusoidal

0660 1.7353 $94.68 $30.66 $18.94 rotational test. 92547................ X.................... ................... Supplemental

0363 0.8641 $47.15 $17.44

$9.43 electrical test. 92548................ X.................... ................... Posturography.......

0660 1.7353 $94.68 $30.66 $18.94 92551................ E.................... ................... Pure tone hearing ........... ........... ........... ........... ........... test, air. 92552................ X.................... ................... Pure tone

0364 0.4459 $24.33

$9.06

$4.87 audiometry, air. 92553................ X.................... ................... Audiometry, air &

0365 1.2132 $66.19 $18.95 $13.24 bone. 92555................ X.................... ................... Speech threshold

0364 0.4459 $24.33

$9.06

$4.87 audiometry. 92556................ X.................... ................... Speech audiometry,

0364 0.4459 $24.33

$9.06

$4.87 complete. 92557................ X.................... ................... Comprehensive

0365 1.2132 $66.19 $18.95 $13.24 hearing test. 92559................ E.................... ................... Group audiometric ........... ........... ........... ........... ........... testing. 92560................ E.................... ................... Bekesy audiometry, ........... ........... ........... ........... ........... screen.

[[Page 63592]]

92561................ X.................... ................... Bekesy audiometry,

0365 1.2132 $66.19 $18.95 $13.24 diagnosis. 92562................ X.................... ................... Loudness balance

0364 0.4459 $24.33

$9.06

$4.87 test. 92563................ X.................... ................... Tone decay hearing

0364 0.4459 $24.33

$9.06

$4.87 test. 92564................ X.................... ................... Sisi hearing test...

0364 0.4459 $24.33

$9.06

$4.87 92565................ X.................... ................... Stenger test, pure

0364 0.4459 $24.33

$9.06

$4.87 tone. 92567................ X.................... ................... Tympanometry........

0364 0.4459 $24.33

$9.06

$4.87 92568................ X.................... ................... Acoustic reflex

0364 0.4459 $24.33

$9.06

$4.87 testing. 92569................ X.................... ................... Acoustic reflex

0364 0.4459 $24.33

$9.06

$4.87 decay test. 92571................ X.................... ................... Filtered speech

0364 0.4459 $24.33

$9.06

$4.87 hearing test. 92572................ X.................... ................... Staggered spondaic

0364 0.4459 $24.33

$9.06

$4.87 word test. 92573................ X.................... ................... Lombard test........

0364 0.4459 $24.33

$9.06

$4.87 92575................ X.................... ................... Sensorineural acuity

0365 1.2132 $66.19 $18.95 $13.24 test. 92576................ X.................... ................... Synthetic sentence

0364 0.4459 $24.33

$9.06

$4.87 test. 92577................ X.................... ................... Stenger test, speech

0365 1.2132 $66.19 $18.95 $13.24 92579................ X.................... ................... Visual audiometry

0365 1.2132 $66.19 $18.95 $13.24 (vra). 92582................ X.................... ................... Conditioning play

0365 1.2132 $66.19 $18.95 $13.24 audiometry. 92583................ X.................... ................... Select picture

0364 0.4459 $24.33

$9.06

$4.87 audiometry. 92584................ X.................... ................... Electrocochleography

0660 1.7353 $94.68 $30.66 $18.94 92585................ S.................... ................... Auditor evoke

0216 2.8535 $155.69 $67.98 $31.14 potent, compre. 92586................ S.................... ................... Auditor evoke

0218 1.1404 $62.22 ........... $12.44 potent, limit. 92587................ X.................... ................... Evoked auditory test

0363 0.8641 $47.15 $17.44

$9.43 92588................ X.................... ................... Evoked auditory test

0363 0.8641 $47.15 $17.44

$9.43 92589................ X.................... ................... Auditory function

0364 0.4459 $24.33

$9.06

$4.87 test(s). 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

0365 1.2132 $66.19 $18.95 $13.24 evaluation. 92597................ A.................... ................... Voice Prosthetic ........... ........... ........... ........... ........... Evaluation. 92601................ X.................... NI................. Cochlear implt f/up

0365 1.2132 $66.19 $18.95 $13.24 exam . 92604................ X.................... NI................. Reprogram cochlear

0365 1.2132 $66.19 $18.95 $13.24 implt 7 . 92605................ A.................... ................... Eval for nonspeech ........... ........... ........... ........... ........... device rx. 92606................ A.................... ................... Non-speech device ........... ........... ........... ........... ........... service. 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. 92700................ X.................... ................... Ent procedure/

0364 0.4459 $24.33

$9.06

$4.87 service. 92950................ S.................... ................... Heart/lung

0094 2.6345 $143.74 $48.58 $28.75 resuscitation cpr. 92953................ S.................... ................... Temporary external

0094 2.6345 $143.74 $48.58 $28.75 pacing. 92960................ S.................... ................... Cardioversion

0679 5.4887 $299.47 $95.30 $59.89 electric, ext. 92961................ S.................... ................... Cardioversion,

0679 5.4887 $299.47 $95.30 $59.89 electric, int. 92970................ C.................... ................... Cardioassist,

........... ........... ........... ........... ........... internal. 92971................ C.................... ................... Cardioassist,

........... ........... ........... ........... ........... external. 92973................ T.................... ................... Percut coronary

1541 ........... $250.00 ........... $50.00 thrombectomy. 92974................ T.................... ................... Cath place, cardio

1559 ........... $2,250.00 ........... $450.00 brachytx. 92975................ C.................... ................... Dissolve clot, heart ........... ........... ........... ........... ........... vessel. 92977................ T.................... ................... Dissolve clot, heart

0676 2.7315 $149.03 $40.30 $29.81 vessel. 92978................ S.................... ................... Intravasc us, heart

0670 27.4483 $1,497.61 $542.37 $299.52 add-on. 92979................ S.................... ................... Intravasc us, heart

0670 27.4483 $1,497.61 $542.37 $299.52 add-on. 92980................ T.................... ................... Insert intracoronary

0104 82.6713 $4,510.63 ........... $902.13 stent. 92981................ T.................... ................... Insert intracoronary

0104 82.6713 $4,510.63 ........... $902.13 stent. 92982................ T.................... ................... Coronary artery

0083 59.2047 $3,230.27 ........... $646.05 dilation. 92984................ T.................... ................... Coronary artery

0083 59.2047 $3,230.27 ........... $646.05 dilation. 92986................ T.................... ................... Revision of aortic

0083 59.2047 $3,230.27 ........... $646.05 valve. 92987................ T.................... ................... Revision of mitral

0083 59.2047 $3,230.27 ........... $646.05 valve. 92990................ T.................... ................... Revision of

0083 59.2047 $3,230.27 ........... $646.05 pulmonary valve. 92992................ C.................... ................... Revision of heart ........... ........... ........... ........... ........... chamber. 92993................ C.................... ................... Revision of heart ........... ........... ........... ........... ........... chamber. 92995................ T.................... ................... Coronary atherectomy

0082 110.2196 $6,013.69 $1,293.59 $1,202.74 92996................ T.................... ................... Coronary atherectomy

0082 110.2196 $6,013.69 $1,293.59 $1,202.74 add-on. 92997................ T.................... ................... Pul art balloon

0081 35.0285 $1,911.19 ........... $382.24 repr, percut. 92998................ T.................... ................... Pul art balloon

0081 35.0285 $1,911.19 ........... $382.24 repr, percut. 93000................ B.................... ................... Electrocardiogram, ........... ........... ........... ........... ........... complete.

[[Page 63593]]

93005................ S.................... ................... Electrocardiogram,

0099 0.3703 $20.20 ...........

$4.04 tracing. 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

0100 1.5862 $86.54 $41.44 $17.31 stress test. 93018................ B.................... ................... Cardiovascular

........... ........... ........... ........... ........... stress test. 93024................ X.................... ................... Cardiac drug stress

0100 1.5862 $86.54 $41.44 $17.31 test. 93025................ X.................... ................... Microvolt t-wave

0100 1.5862 $86.54 $41.44 $17.31 assess. 93040................ B.................... ................... Rhythm ECG with ........... ........... ........... ........... ........... report. 93041................ S.................... ................... Rhythm ECG, tracing.

0099 0.3703 $20.20 ...........

$4.04 93042................ B.................... ................... Rhythm ECG, report.. ........... ........... ........... ........... ........... 93224................ B.................... ................... ECG monitor/report, ........... ........... ........... ........... ........... 24 hrs. 93225................ X.................... ................... ECG monitor/record,

0097 1.0635 $58.03 $23.80 $11.61 24 hrs. 93226................ X.................... ................... ECG monitor/report,

0097 1.0635 $58.03 $23.80 $11.61 24 hrs. 93227................ B.................... ................... ECG monitor/review, ........... ........... ........... ........... ........... 24 hrs. 93230................ B.................... ................... ECG monitor/report, ........... ........... ........... ........... ........... 24 hrs. 93231................ X.................... ................... Ecg monitor/record,

0097 1.0635 $58.03 $23.80 $11.61 24 hrs. 93232................ X.................... ................... ECG monitor/report,

0097 1.0635 $58.03 $23.80 $11.61 24 hrs. 93233................ B.................... ................... ECG monitor/review, ........... ........... ........... ........... ........... 24 hrs. 93235................ B.................... ................... ECG monitor/report, ........... ........... ........... ........... ........... 24 hrs. 93236................ X.................... ................... ECG monitor/report,

0097 1.0635 $58.03 $23.80 $11.61 24 hrs. 93237................ B.................... ................... ECG monitor/review, ........... ........... ........... ........... ........... 24 hrs. 93268................ B.................... ................... ECG record/review... ........... ........... ........... ........... ........... 93270................ X.................... ................... ECG recording.......

0097 1.0635 $58.03 $23.80 $11.61 93271................ X.................... ................... Ecg/monitoring and

0097 1.0635 $58.03 $23.80 $11.61 analysis. 93272................ B.................... ................... Ecg/review,

........... ........... ........... ........... ........... interpret only. 93278................ S.................... ................... ECG/signal-averaged.

0099 0.3703 $20.20 ...........

$4.04 93303................ S.................... ................... Echo transthoracic..

0269 3.2309 $176.28 $87.24 $35.26 93304................ S.................... ................... Echo transthoracic..

0697 1.4415 $78.65 $39.32 $15.73 93307................ S.................... ................... Echo exam of heart..

0269 3.2309 $176.28 $87.24 $35.26 93308................ S.................... ................... Echo exam of heart..

0697 1.4415 $78.65 $39.32 $15.73 93312................ S.................... ................... Echo transesophageal

0270 5.8546 $319.43 $146.79 $63.89 93313................ S.................... ................... Echo transesophageal

0270 5.8546 $319.43 $146.79 $63.89 93314................ N.................... ................... Echo transesophageal ........... ........... ........... ........... ........... 93315................ S.................... ................... Echo transesophageal

0270 5.8546 $319.43 $146.79 $63.89 93316................ S.................... ................... Echo transesophageal

0270 5.8546 $319.43 $146.79 $63.89 93317................ N.................... ................... Echo transesophageal ........... ........... ........... ........... ........... 93318................ S.................... ................... Echo transesophageal

0270 5.8546 $319.43 $146.79 $63.89 intraop. 93320................ S.................... ................... Doppler echo exam,

0671 1.6384 $89.39 $44.69 $17.88 heart. 93321................ S.................... ................... Doppler echo exam,

0697 1.4415 $78.65 $39.32 $15.73 heart. 93325................ S.................... ................... Doppler color flow

0697 1.4415 $78.65 $39.32 $15.73 add-on. 93350................ S.................... ................... Echo transthoracic..

0269 3.2309 $176.28 $87.24 $35.26 93501................ T.................... ................... Right heart

0080 36.0160 $1,965.07 $838.92 $393.01 catheterization. 93503................ T.................... ................... Insert/place heart

0103 11.6202 $634.01 $223.63 $126.80 catheter. 93505................ T.................... ................... Biopsy of heart

0103 11.6202 $634.01 $223.63 $126.80 lining. 93508................ T.................... ................... Cath placement,

0080 36.0160 $1,965.07 $838.92 $393.01 angiography. 93510................ T.................... ................... Left heart

0080 36.0160 $1,965.07 $838.92 $393.01 catheterization. 93511................ T.................... ................... Left heart

0080 36.0160 $1,965.07 $838.92 $393.01 catheterization. 93514................ T.................... ................... Left heart

0080 36.0160 $1,965.07 $838.92 $393.01 catheterization. 93524................ T.................... ................... Left heart

0080 36.0160 $1,965.07 $838.92 $393.01 catheterization. 93526................ T.................... ................... Rt & Lt heart

0080 36.0160 $1,965.07 $838.92 $393.01 catheters. 93527................ T.................... ................... Rt & Lt heart

0080 36.0160 $1,965.07 $838.92 $393.01 catheters. 93528................ T.................... ................... Rt & Lt heart

0080 36.0160 $1,965.07 $838.92 $393.01 catheters. 93529................ T.................... ................... Rt, lt heart

0080 36.0160 $1,965.07 $838.92 $393.01 catheterization. 93530................ T.................... ................... Rt heart cath,

0080 36.0160 $1,965.07 $838.92 $393.01 congenital. 93531................ T.................... ................... R & l heart cath,

0080 36.0160 $1,965.07 $838.92 $393.01 congenital. 93532................ T.................... ................... R & l heart cath,

0080 36.0160 $1,965.07 $838.92 $393.01 congenital. 93533................ T.................... ................... R & l heart cath,

0080 36.0160 $1,965.07 $838.92 $393.01 congenital. 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................ N.................... ................... Heart flow reserve ........... ........... ........... ........... ........... measure. 93572................ N.................... ................... Heart flow reserve ........... ........... ........... ........... ........... measure. 93580................ T.................... ................... Transcath closure of

1559 ........... $2,250.00 ........... $450.00 asd. 93581................ T.................... ................... Transcath closure of

1559 ........... $2,250.00 ........... $450.00 vsd.

[[Page 63594]]

93600................ T.................... ................... Bundle of His

0087 39.8161 $2,172.41 ........... $434.48 recording. 93602................ T.................... ................... Intra-atrial

0087 39.8161 $2,172.41 ........... $434.48 recording. 93603................ T.................... ................... Right ventricular

0087 39.8161 $2,172.41 ........... $434.48 recording. 93609................ T.................... ................... Map tachycardia, add-

0087 39.8161 $2,172.41 ........... $434.48 on. 93610................ T.................... ................... Intra-atrial pacing.

0087 39.8161 $2,172.41 ........... $434.48 93612................ T.................... ................... Intraventricular

0087 39.8161 $2,172.41 ........... $434.48 pacing. 93613................ T.................... ................... Electrophys map 3d,

0087 39.8161 $2,172.41 ........... $434.48 add-on. 93615................ T.................... ................... Esophageal recording

0087 39.8161 $2,172.41 ........... $434.48 93616................ T.................... ................... Esophageal recording

0087 39.8161 $2,172.41 ........... $434.48 93618................ T.................... ................... Heart rhythm pacing.

0087 39.8161 $2,172.41 ........... $434.48 93619................ T.................... ................... Electrophysiology

0085 35.4126 $1,932.15 $426.25 $386.43 evaluation. 93620................ T.................... ................... Electrophysiology

0085 35.4126 $1,932.15 $426.25 $386.43 evaluation. 93621................ T.................... ................... Electrophysiology

0085 35.4126 $1,932.15 $426.25 $386.43 evaluation. 93622................ T.................... ................... Electrophysiology

0085 35.4126 $1,932.15 $426.25 $386.43 evaluation. 93623................ T.................... ................... Stimulation, pacing

0087 39.8161 $2,172.41 ........... $434.48 heart. 93624................ S.................... ................... Electrophysiologic

0084 10.5226 $574.12 ........... $114.82 study. 93631................ T.................... ................... Heart pacing,

0087 39.8161 $2,172.41 ........... $434.48 mapping. 93640................ S.................... ................... Evaluation heart

0084 10.5226 $574.12 ........... $114.82 device. 93641................ S.................... ................... Electrophysiology

0084 10.5226 $574.12 ........... $114.82 evaluation. 93642................ S.................... ................... Electrophysiology

0084 10.5226 $574.12 ........... $114.82 evaluation. 93650................ T.................... ................... Ablate heart

0086 44.9389 $2,451.91 $833.33 $490.38 dysrhythm focus. 93651................ T.................... ................... Ablate heart

0086 44.9389 $2,451.91 $833.33 $490.38 dysrhythm focus. 93652................ T.................... ................... Ablate heart

0086 44.9389 $2,451.91 $833.33 $490.38 dysrhythm focus. 93660................ S.................... ................... Tilt table

0101 4.4040 $240.29 $105.27 $48.06 evaluation. 93662................ S.................... ................... Intracardiac ecg

0670 27.4483 $1,497.61 $542.37 $299.52 (ice). 93668................ E.................... ................... Peripheral vascular ........... ........... ........... ........... ........... rehab. 93701................ S.................... ................... Bioimpedance,

0099 0.3703 $20.20 ...........

$4.04 thoracic. 93720................ B.................... ................... Total body

........... ........... ........... ........... ........... plethysmography. 93721................ X.................... ................... Plethysmography

0368 0.9319 $50.85 $25.42 $10.17 tracing. 93722................ B.................... ................... Plethysmography ........... ........... ........... ........... ........... report. 93724................ S.................... ................... Analyze pacemaker

0690 0.4074 $22.23 $10.63

$4.45 system. 93727................ S.................... ................... Analyze ilr system..

0690 0.4074 $22.23 $10.63

$4.45 93731................ S.................... ................... Analyze pacemaker

0690 0.4074 $22.23 $10.63

$4.45 system. 93732................ S.................... ................... Analyze pacemaker

0690 0.4074 $22.23 $10.63

$4.45 system. 93733................ S.................... ................... Telephone analy,

0690 0.4074 $22.23 $10.63

$4.45 pacemaker. 93734................ S.................... ................... Analyze pacemaker

0690 0.4074 $22.23 $10.63

$4.45 system. 93735................ S.................... ................... Analyze pacemaker

0690 0.4074 $22.23 $10.63

$4.45 system. 93736................ S.................... ................... Telephonic analy,

0690 0.4074 $22.23 $10.63

$4.45 pacemaker. 93740................ X.................... ................... Temperature gradient

0367 0.5887 $32.12 $15.16

$6.42 studies. 93741................ S.................... ................... Analyze ht pace

0689 0.5533 $30.19 ...........

$6.04 device sngl. 93742................ S.................... ................... Analyze ht pace

0689 0.5533 $30.19 ...........

$6.04 device sngl. 93743................ S.................... ................... Analyze ht pace

0689 0.5533 $30.19 ...........

$6.04 device dual. 93744................ S.................... ................... Analyze ht pace

0689 0.5533 $30.19 ...........

$6.04 device dual. 93760................ E.................... ................... Cephalic thermogram. ........... ........... ........... ........... ........... 93762................ E.................... ................... Peripheral

........... ........... ........... ........... ........... thermogram. 93770................ N.................... ................... Measure venous

........... ........... ........... ........... ........... pressure. 93784................ E.................... ................... Ambulatory BP

........... ........... ........... ........... ........... monitoring. 93786................ X.................... ................... Ambulatory BP

0097 1.0635 $58.03 $23.80 $11.61 recording. 93788................ E.................... ................... Ambulatory BP

........... ........... ........... ........... ........... analysis. 93790................ B.................... ................... Review/report BP ........... ........... ........... ........... ........... recording. 93797................ S.................... ................... Cardiac rehab.......

0095 0.5994 $32.70 $16.35

$6.54 93798................ S.................... ................... Cardiac rehab/

0095 0.5994 $32.70 $16.35

$6.54 monitor. 93799................ S.................... ................... Cardiovascular

0096 1.7176 $93.71 $46.85 $18.74 procedure. 93875................ S.................... ................... Extracranial study..

0096 1.7176 $93.71 $46.85 $18.74 93880................ S.................... ................... Extracranial study..

0267 2.4586 $134.14 $65.52 $26.83 93882................ S.................... ................... Extracranial study..

0267 2.4586 $134.14 $65.52 $26.83 93886................ S.................... ................... Intracranial study..

0267 2.4586 $134.14 $65.52 $26.83 93888................ S.................... ................... Intracranial study..

0266 1.6117 $87.94 $43.97 $17.59 93922................ S.................... ................... Extremity study.....

0096 1.7176 $93.71 $46.85 $18.74 93923................ S.................... ................... Extremity study.....

0096 1.7176 $93.71 $46.85 $18.74 93924................ S.................... ................... Extremity study.....

0096 1.7176 $93.71 $46.85 $18.74 93925................ S.................... ................... Lower extremity

0267 2.4586 $134.14 $65.52 $26.83 study. 93926................ S.................... ................... Lower extremity

0267 2.4586 $134.14 $65.52 $26.83 study. 93930................ S.................... ................... Upper extremity

0267 2.4586 $134.14 $65.52 $26.83 study. 93931................ S.................... ................... Upper extremity

0266 1.6117 $87.94 $43.97 $17.59 study. 93965................ S.................... ................... Extremity study.....

0096 1.7176 $93.71 $46.85 $18.74 93970................ S.................... ................... Extremity study.....

0267 2.4586 $134.14 $65.52 $26.83 93971................ S.................... ................... Extremity study.....

0267 2.4586 $134.14 $65.52 $26.83 93975................ S.................... ................... Vascular study......

0267 2.4586 $134.14 $65.52 $26.83 93976................ S.................... ................... Vascular study......

0267 2.4586 $134.14 $65.52 $26.83 93978................ S.................... ................... Vascular study......

0267 2.4586 $134.14 $65.52 $26.83 93979................ S.................... ................... Vascular study......

0267 2.4586 $134.14 $65.52 $26.83 93980................ S.................... ................... Penile vascular

0267 2.4586 $134.14 $65.52 $26.83 study. 93981................ S.................... ................... Penile vascular

0267 2.4586 $134.14 $65.52 $26.83 study. 93990................ S.................... ................... Doppler flow testing

0267 2.4586 $134.14 $65.52 $26.83

[[Page 63595]]

94010................ X.................... ................... Breathing capacity

0368 0.9319 $50.85 $25.42 $10.17 test. 94014................ X.................... ................... Patient recorded

0367 0.5887 $32.12 $15.16

$6.42 spirometry. 94015................ X.................... ................... Patient recorded

0369 2.4984 $136.32 $44.18 $27.26 spirometry. 94016................ A.................... ................... Review patient

........... ........... ........... ........... ........... spirometry. 94060................ X.................... ................... Evaluation of

0368 0.9319 $50.85 $25.42 $10.17 wheezing. 94070................ X.................... ................... Evaluation of

0369 2.4984 $136.32 $44.18 $27.26 wheezing. 94150................ X.................... ................... Vital capacity test.

0367 0.5887 $32.12 $15.16

$6.42 94200................ X.................... ................... Lung function test

0367 0.5887 $32.12 $15.16

$6.42 (MBC/MVV). 94240................ X.................... ................... Residual lung

0368 0.9319 $50.85 $25.42 $10.17 capacity. 94250................ X.................... ................... Expired gas

0367 0.5887 $32.12 $15.16

$6.42 collection. 94260................ X.................... ................... Thoracic gas volume.

0368 0.9319 $50.85 $25.42 $10.17 94350................ X.................... ................... Lung nitrogen

0368 0.9319 $50.85 $25.42 $10.17 washout curve. 94360................ X.................... ................... Measure airflow

0367 0.5887 $32.12 $15.16

$6.42 resistance. 94370................ X.................... ................... Breath airway

0367 0.5887 $32.12 $15.16

$6.42 closing volume. 94375................ X.................... ................... Respiratory flow

0367 0.5887 $32.12 $15.16

$6.42 volume loop. 94400................ X.................... ................... CO2 breathing

0367 0.5887 $32.12 $15.16

$6.42 response curve. 94450................ X.................... ................... Hypoxia response

0367 0.5887 $32.12 $15.16

$6.42 curve. 94620................ X.................... ................... Pulmonary stress

0368 0.9319 $50.85 $25.42 $10.17 test/simple. 94621................ X.................... ................... Pulm stress test/

0369 2.4984 $136.32 $44.18 $27.26 complex. 94640................ S.................... ................... Airway inhalation

0077 0.2837 $15.48

$7.74

$3.10 treatment. 94642................ S.................... ................... Aerosol inhalation

0078 0.7917 $43.20 $14.55

$8.64 treatment. 94656................ S.................... ................... Initial ventilator

0079 2.1494 $117.27 ........... $23.45 mgmt. 94657................ S.................... ................... Continued ventilator

0079 2.1494 $117.27 ........... $23.45 mgmt. 94660................ S.................... ................... Pos airway pressure,

0068 1.0807 $58.96 $29.48 $11.79 CPAP. 94662................ S.................... ................... Neg press

0079 2.1494 $117.27 ........... $23.45 ventilation, cnp. 94664................ S.................... ................... Aerosol or vapor

0077 0.2837 $15.48

$7.74

$3.10 inhalations. 94667................ S.................... ................... Chest wall

0077 0.2837 $15.48

$7.74

$3.10 manipulation. 94668................ S.................... ................... Chest wall

0077 0.2837 $15.48

$7.74

$3.10 manipulation. 94680................ X.................... ................... Exhaled air

0367 0.5887 $32.12 $15.16

$6.42 analysis, o2. 94681................ X.................... ................... Exhaled air

0368 0.9319 $50.85 $25.42 $10.17 analysis, o2/co2. 94690................ X.................... ................... Exhaled air analysis

0367 0.5887 $32.12 $15.16

$6.42 94720................ X.................... ................... Monoxide diffusing

0368 0.9319 $50.85 $25.42 $10.17 capacity. 94725................ X.................... ................... Membrane diffusion

0368 0.9319 $50.85 $25.42 $10.17 capacity. 94750................ X.................... ................... Pulmonary compliance

0367 0.5887 $32.12 $15.16

$6.42 study. 94760................ N.................... ................... Measure blood oxygen ........... ........... ........... ........... ........... level. 94761................ N.................... ................... Measure blood oxygen ........... ........... ........... ........... ........... level. 94762................ N.................... ................... Measure blood oxygen ........... ........... ........... ........... ........... level. 94770................ X.................... ................... Exhaled carbon

0367 0.5887 $32.12 $15.16

$6.42 dioxide test. 94772................ X.................... ................... Breath recording,

0369 2.4984 $136.32 $44.18 $27.26 infant. 94799................ X.................... ................... Pulmonary service/

0367 0.5887 $32.12 $15.16

$6.42 procedure. 95004................ X.................... ................... Percut allergy skin

0370 0.9185 $50.11 $11.58 $10.02 tests. 95010................ X.................... ................... Percut allergy

0370 0.9185 $50.11 $11.58 $10.02 titrate test. 95015................ X.................... ................... Id allergy titrate-

0370 0.9185 $50.11 $11.58 $10.02 drug/bug. 95024................ X.................... ................... Id allergy test,

0370 0.9185 $50.11 $11.58 $10.02 drug/bug. 95027................ X.................... ................... Skin end point

0370 0.9185 $50.11 $11.58 $10.02 titration. 95028................ X.................... ................... Id allergy test-

0370 0.9185 $50.11 $11.58 $10.02 delayed type. 95044................ X.................... ................... Allergy patch tests.

0370 0.9185 $50.11 $11.58 $10.02 95052................ X.................... ................... Photo patch test....

0370 0.9185 $50.11 $11.58 $10.02 95056................ X.................... ................... Photosensitivity

0370 0.9185 $50.11 $11.58 $10.02 tests. 95060................ X.................... ................... Eye allergy tests...

0370 0.9185 $50.11 $11.58 $10.02 95065................ X.................... ................... Nose allergy test...

0370 0.9185 $50.11 $11.58 $10.02 95070................ X.................... ................... Bronchial allergy

0369 2.4984 $136.32 $44.18 $27.26 tests. 95071................ X.................... ................... Bronchial allergy

0369 2.4984 $136.32 $44.18 $27.26 tests. 95075................ X.................... ................... Ingestion challenge

0361 3.5510 $193.75 $83.23 $38.75 test. 95078................ X.................... ................... Provocative testing.

0370 0.9185 $50.11 $11.58 $10.02 95115................ X.................... ................... Immunotherapy, one

0352 0.1230

$6.71 ...........

$1.34 injection. 95117................ X.................... ................... Immunotherapy

0353 0.3982 $21.73 ...........

$4.35 injections. 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

0371 0.4105 $22.40 ...........

$4.48 services. 95145................ X.................... ................... Antigen therapy

0371 0.4105 $22.40 ...........

$4.48 services. 95146................ X.................... ................... Antigen therapy

0371 0.4105 $22.40 ...........

$4.48 services. 95147................ X.................... ................... Antigen therapy

0371 0.4105 $22.40 ...........

$4.48 services. 95148................ X.................... ................... Antigen therapy

0371 0.4105 $22.40 ...........

$4.48 services. 95149................ X.................... ................... Antigen therapy

0371 0.4105 $22.40 ...........

$4.48 services. 95165................ X.................... ................... Antigen therapy

0371 0.4105 $22.40 ...........

$4.48 services. 95170................ X.................... ................... Antigen therapy

0371 0.4105 $22.40 ...........

$4.48 services. 95180................ X.................... ................... Rapid

0370 0.9185 $50.11 $11.58 $10.02 desensitization. 95199................ X.................... ................... Allergy immunology

0370 0.9185 $50.11 $11.58 $10.02 services. 95250................ T.................... ................... Glucose monitoring,

1540 ........... $150.00 ........... $30.00 cont.

[[Continued on page 63597]]

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

[[pp. 63597-63646]] Medicare Program; Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2004 Payment Rates

[[Continued from page 63596]]

[[Page 63596]]

95805................ S.................... ................... Multiple sleep

0209 11.5435 $629.82 $280.58 $125.96 latency test. 95806................ S.................... ................... Sleep study,

0213 2.9055 $158.53 $65.74 $31.71 unattended. 95807................ S.................... ................... Sleep study,

0209 11.5435 $629.82 $280.58 $125.96 attended. 95808................ S.................... ................... Polysomnography, 1-3

0209 11.5435 $629.82 $280.58 $125.96 95810................ S.................... ................... Polysomnography, 4

0209 11.5435 $629.82 $280.58 $125.96 or more. 95811................ S.................... ................... Polysomnography w/

0209 11.5435 $629.82 $280.58 $125.96 cpap. 95812................ S.................... ................... Electroencephalogram

0213 2.9055 $158.53 $65.74 $31.71 (EEG). 95813................ S.................... ................... Eeg, over 1 hour....

0213 2.9055 $158.53 $65.74 $31.71 95816................ S.................... ................... Electroencephalogram

0214 2.2176 $120.99 $58.12 $24.20 (EEG). 95819................ S.................... ................... Electroencephalogram

0214 2.2176 $120.99 $58.12 $24.20 (EEG). 95822................ S.................... ................... Sleep

0214 2.2176 $120.99 $58.12 $24.20 electroencephalogra m. 95824................ S.................... ................... Eeg, cerebral death

0214 2.2176 $120.99 $58.12 $24.20 only. 95827................ S.................... ................... night

0209 11.5435 $629.82 $280.58 $125.96 electroencephalogra m. 95829................ S.................... ................... Surgery

0214 2.2176 $120.99 $58.12 $24.20 electrocorticogram. 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 1.1404 $62.22 ........... $12.44 95858................ S.................... ................... Tensilon test &

0215 0.6457 $35.23 $15.76

$7.05 myogram. 95860................ S.................... ................... Muscle test, one

0218 1.1404 $62.22 ........... $12.44 limb. 95861................ S.................... ................... Muscle test, 2 limbs

0218 1.1404 $62.22 ........... $12.44 95863................ S.................... ................... Muscle test, 3 limbs

0218 1.1404 $62.22 ........... $12.44 95864................ S.................... ................... Muscle test, 4 limbs

0218 1.1404 $62.22 ........... $12.44 95867................ S.................... ................... Muscle test, head or

0218 1.1404 $62.22 ........... $12.44 neck. 95868................ S.................... ................... Muscle test cran

0218 1.1404 $62.22 ........... $12.44 nerve bilat. 95869................ S.................... ................... Muscle test, thor

0215 0.6457 $35.23 $15.76

$7.05 paraspinal. 95870................ S.................... ................... Muscle test,

0215 0.6457 $35.23 $15.76

$7.05 nonparaspinal. 95872................ S.................... ................... Muscle test, one

0218 1.1404 $62.22 ........... $12.44 fiber. 95875................ S.................... ................... Limb exercise test..

0215 0.6457 $35.23 $15.76

$7.05 95900................ S.................... ................... Motor nerve

0215 0.6457 $35.23 $15.76

$7.05 conduction test. 95903................ S.................... ................... Motor nerve

0215 0.6457 $35.23 $15.76

$7.05 conduction test. 95904................ S.................... ................... Sense nerve

0215 0.6457 $35.23 $15.76

$7.05 conduction test. 95920................ S.................... ................... Intraop nerve test

0216 2.8535 $155.69 $67.98 $31.14 add-on. 95921................ S.................... ................... Autonomic nerv

0218 1.1404 $62.22 ........... $12.44 function test. 95922................ S.................... ................... Autonomic nerv

0218 1.1404 $62.22 ........... $12.44 function test. 95923................ S.................... ................... Autonomic nerv

0215 0.6457 $35.23 $15.76

$7.05 function test. 95925................ S.................... ................... Somatosensory

0216 2.8535 $155.69 $67.98 $31.14 testing. 95926................ S.................... ................... Somatosensory

0216 2.8535 $155.69 $67.98 $31.14 testing. 95927................ S.................... ................... Somatosensory

0216 2.8535 $155.69 $67.98 $31.14 testing. 95930................ S.................... ................... Visual evoked

0218 1.1404 $62.22 ........... $12.44 potential test. 95933................ S.................... ................... Blink reflex test...

0215 0.6457 $35.23 $15.76

$7.05 95934................ S.................... ................... H-reflex test.......

0215 0.6457 $35.23 $15.76

$7.05 95936................ S.................... ................... H-reflex test.......

0215 0.6457 $35.23 $15.76

$7.05 95937................ S.................... ................... Neuromuscular

0218 1.1404 $62.22 ........... $12.44 junction test. 95950................ S.................... ................... Ambulatory eeg

0213 2.9055 $158.53 $65.74 $31.71 monitoring. 95951................ S.................... ................... EEG monitoring/

0209 11.5435 $629.82 $280.58 $125.96 videorecord. 95953................ S.................... ................... EEG monitoring/

0209 11.5435 $629.82 $280.58 $125.96 computer. 95954................ S.................... ................... EEG monitoring/

0214 2.2176 $120.99 $58.12 $24.20 giving drugs. 95955................ S.................... ................... EEG during surgery..

0213 2.9055 $158.53 $65.74 $31.71 95956................ S.................... ................... Eeg monitoring,

0214 2.2176 $120.99 $58.12 $24.20 cable/radio. 95957................ S.................... ................... EEG digital analysis

0214 2.2176 $120.99 $58.12 $24.20 95958................ S.................... ................... EEG monitoring/

0213 2.9055 $158.53 $65.74 $31.71 function test. 95961................ S.................... ................... Electrode

0216 2.8535 $155.69 $67.98 $31.14 stimulation, brain. 95962................ S.................... ................... Electrode stim,

0216 2.8535 $155.69 $67.98 $31.14 brain add-on. 95965................ S.................... ................... Meg, spontaneous....

1528 ........... $5,250.00 ........... $1,050.00 95966................ S.................... ................... Meg, evoked, single.

1516 ........... $1,450.00 ........... $290.00 95967................ S.................... ................... Meg, evoked, each

1511 ........... $950.00 ........... $190.00 add'l. 95970................ S.................... ................... Analyze neurostim,

0692 1.1057 $60.33 $30.16 $12.07 no prog. 95971................ S.................... ................... Analyze neurostim,

0692 1.1057 $60.33 $30.16 $12.07 simple. 95972................ S.................... ................... Analyze neurostim,

0692 1.1057 $60.33 $30.16 $12.07 complex. 95973................ S.................... ................... Analyze neurostim,

0692 1.1057 $60.33 $30.16 $12.07 complex. 95974................ S.................... ................... Cranial neurostim,

0692 1.1057 $60.33 $30.16 $12.07 complex. 95975................ S.................... ................... Cranial neurostim,

0692 1.1057 $60.33 $30.16 $12.07 complex. 95990................ T.................... ................... Spin/brain pump

0125 2.1606 $117.88 ........... $23.58 refil & main. 95991................ T.................... NI................. Spin/brain pump

0125 2.1606 $117.88 ........... $23.58 refil & main. 95999................ S.................... ................... Neurological

0215 0.6457 $35.23 $15.76

$7.05 procedure. 96000................ S.................... ................... Motion analysis,

1503 ........... $150.00 ........... $30.00 video/3d. 96001................ S.................... ................... Motion test w/ft

1503 ........... $150.00 ........... $30.00 press meas. 96002................ S.................... ................... Dynamic surface emg.

1503 ........... $150.00 ........... $30.00 96003................ S.................... ................... Dynamic fine wire

1503 ........... $150.00 ........... $30.00 emg. 96004................ E.................... ................... Phys review of

........... ........... ........... ........... ........... motion tests.

[[Page 63597]]

96100................ X.................... ................... Psychological

0373 2.0899 $114.03 ........... $22.81 testing. 96105................ A.................... ................... Assessment of

........... ........... ........... ........... ........... aphasia. 96110................ X.................... ................... Developmental test,

0373 2.0899 $114.03 ........... $22.81 lim. 96111................ X.................... ................... Developmental test,

0373 2.0899 $114.03 ........... $22.81 extend. 96115................ X.................... ................... Neurobehavior status

0373 2.0899 $114.03 ........... $22.81 exam. 96117................ X.................... ................... Neuropsych test

0373 2.0899 $114.03 ........... $22.81 battery. 96150................ S.................... ................... Assess lth/behave,

0322 1.2802 $69.85 ........... $13.97 init. 96151................ S.................... ................... Assess hlth/behave,

0322 1.2802 $69.85 ........... $13.97 subseq. 96152................ S.................... ................... Intervene hlth/

0322 1.2802 $69.85 ........... $13.97 behave, indiv. 96153................ S.................... ................... Intervene hlth/

0322 1.2802 $69.85 ........... $13.97 behave, group. 96154................ S.................... ................... Interv hlth/behav,

0322 1.2802 $69.85 ........... $13.97 fam w/pt. 96155................ S.................... ................... Interv hlth/behav

0322 1.2802 $69.85 ........... $13.97 fam no pt. 96400................ B.................... ................... Chemotherapy, sc/im. ........... ........... ........... ........... ........... 96405................ B.................... ................... Intralesional chemo ........... ........... ........... ........... ........... admin. 96406................ B.................... ................... Intralesional chemo ........... ........... ........... ........... ........... admin. 96408................ B.................... ................... Chemotherapy, push ........... ........... ........... ........... ........... technique. 96410................ B.................... ................... Chemotherapy,infusio ........... ........... ........... ........... ........... n method. 96412................ B.................... ................... Chemo, infuse method ........... ........... ........... ........... ........... add-on. 96414................ B.................... ................... Chemo, infuse method ........... ........... ........... ........... ........... add-on. 96420................ B.................... ................... Chemotherapy, push ........... ........... ........... ........... ........... technique. 96422................ B.................... ................... Chemotherapy,infusio ........... ........... ........... ........... ........... n method. 96423................ B.................... ................... Chemo, infuse method ........... ........... ........... ........... ........... add-on. 96425................ B.................... ................... Chemotherapy,infusio ........... ........... ........... ........... ........... n method. 96440................ B.................... ................... Chemotherapy,

........... ........... ........... ........... ........... intracavitary. 96445................ B.................... ................... Chemotherapy,

........... ........... ........... ........... ........... intracavitary. 96450................ B.................... ................... Chemotherapy, into ........... ........... ........... ........... ........... CNS. 96520................ T.................... ................... Port pump refill &

0125 2.1606 $117.88 ........... $23.58 main. 96530................ T.................... ................... Pump refilling,

0125 2.1606 $117.88 ........... $23.58 maintenance. 96542................ B.................... ................... Chemotherapy

........... ........... ........... ........... ........... injection. 96545................ B.................... ................... Provide chemotherapy ........... ........... ........... ........... ........... agent. 96549................ B.................... ................... Chemotherapy,

........... ........... ........... ........... ........... unspecified. 96567................ T.................... ................... Photodynamic tx,

1540 ........... $150.00 ........... $30.00 skin. 96570................ T.................... ................... Photodynamic tx, 30

1541 ........... $250.00 ........... $50.00 min. 96571................ T.................... ................... Photodynamic tx,

1541 ........... $250.00 ........... $50.00 addl 15 min. 96900................ S.................... ................... Ultraviolet light

0001 0.4237 $23.12

$7.09

$4.62 therapy. 96902................ N.................... ................... Trichogram.......... ........... ........... ........... ........... ........... 96910................ S.................... ................... Photochemotherapy

0001 0.4237 $23.12

$7.09

$4.62 with UV-B. 96912................ S.................... ................... Photochemotherapy

0001 0.4237 $23.12

$7.09

$4.62 with UV-A. 96913................ S.................... ................... Photochemotherapy,

0683 1.5489 $84.51 $30.42 $16.90 UV-A or B. 96920................ T.................... ................... Laser tx, skin 500 sq cm. 96999................ T.................... ................... Dermatological

0010 0.6480 $35.36 $10.08

$7.07 procedure. 97001................ A.................... ................... Pt evaluation....... ........... ........... ........... ........... ........... 97002................ A.................... ................... Pt re-evaluation.... ........... ........... ........... ........... ........... 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. ........... ........... ........... ........... ...........

[[Page 63598]]

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. 97601................ A.................... ................... Wound(s) care,

........... ........... ........... ........... ........... selective. 97602................ N.................... ................... Wound(s) care non- ........... ........... ........... ........... ........... selective. 97703................ A.................... ................... Prosthetic checkout. ........... ........... ........... ........... ........... 97750................ A.................... ................... Physical performance ........... ........... ........... ........... ........... test. 97755................ A.................... NI................. Assistive technology ........... ........... ........... ........... ........... assess. 97780................ E.................... ................... Acupuncture w/o ........... ........... ........... ........... ........... stimul. 97781................ E.................... ................... Acupuncture w/stimul ........... ........... ........... ........... ........... 97799................ A.................... ................... Physical medicine ........... ........... ........... ........... ........... procedure. 97802................ A.................... ................... Medical nutrition, ........... ........... ........... ........... ........... indiv, in. 97803................ A.................... ................... Med nutrition,

........... ........... ........... ........... ........... indiv, subseq. 97804................ A.................... ................... Medical nutrition, ........... ........... ........... ........... ........... group. 98925................ S.................... ................... Osteopathic

0060 0.2788 $15.21 ...........

$3.04 manipulation. 98926................ S.................... ................... Osteopathic

0060 0.2788 $15.21 ...........

$3.04 manipulation. 98927................ S.................... ................... Osteopathic

0060 0.2788 $15.21 ...........

$3.04 manipulation. 98928................ S.................... ................... Osteopathic

0060 0.2788 $15.21 ...........

$3.04 manipulation. 98929................ S.................... ................... Osteopathic

0060 0.2788 $15.21 ...........

$3.04 manipulation. 98940................ S.................... ................... Chiropractic

0060 0.2788 $15.21 ...........

$3.04 manipulation. 98941................ S.................... ................... Chiropractic

0060 0.2788 $15.21 ...........

$3.04 manipulation. 98942................ S.................... ................... Chiropractic

0060 0.2788 $15.21 ...........

$3.04 manipulation. 98943................ E.................... ................... Chiropractic

........... ........... ........... ........... ........... manipulation. 99000................ B.................... ................... Specimen handling... ........... ........... ........... ........... ........... 99001................ B.................... ................... Specimen handling... ........... ........... ........... ........... ........... 99002................ E.................... ................... Device handling..... ........... ........... ........... ........... ........... 99024................ B.................... ................... Postop follow-up ........... ........... ........... ........... ........... visit. 99025................ B.................... DG................. Initial surgical ........... ........... ........... ........... ........... evaluation. 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................ E.................... ................... Emergency anesthesia ........... ........... ........... ........... ........... 99141................ N.................... ................... Sedation, iv/im or ........... ........... ........... ........... ........... inhalant. 99142................ N.................... ................... Sedation, oral/ ........... ........... ........... ........... ........... rectal/nasal. 99170................ T.................... ................... Anogenital exam,

0191 0.1853 $10.11

$2.93

$2.02 child. 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 0.5607 $30.59 $10.09

$6.12 99199................ B.................... ................... Special service/proc/ ........... ........... ........... ........... ........... report. 99201................ V.................... ................... Office/outpatient

0600 0.9278 $50.62 ........... $10.12 visit, new. 99202................ V.................... ................... Office/outpatient

0600 0.9278 $50.62 ........... $10.12 visit, new. 99203................ V.................... ................... Office/outpatient

0601 0.9816 $53.56 ........... $10.71 visit, new. 99204................ V.................... ................... Office/outpatient

0602 1.5041 $82.07 ........... $16.41 visit, new. 99205................ V.................... ................... Office/outpatient

0602 1.5041 $82.07 ........... $16.41 visit, new. 99211................ V.................... ................... Office/outpatient

0600 0.9278 $50.62 ........... $10.12 visit, est. 99212................ V.................... ................... Office/outpatient

0600 0.9278 $50.62 ........... $10.12 visit, est. 99213................ V.................... ................... Office/outpatient

0601 0.9816 $53.56 ........... $10.71 visit, est. 99214................ V.................... ................... Office/outpatient

0602 1.5041 $82.07 ........... $16.41 visit, est.

[[Page 63599]]

99215................ V.................... ................... Office/outpatient

0602 1.5041 $82.07 ........... $16.41 visit, est. 99217................ N.................... ................... Observation care ........... ........... ........... ........... ........... discharge. 99218................ N.................... ................... Observation care.... ........... ........... ........... ........... ........... 99219................ N.................... ................... Observation care.... ........... ........... ........... ........... ........... 99220................ N.................... ................... 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................ N.................... ................... Observ/hosp same ........... ........... ........... ........... ........... date. 99235................ N.................... ................... Observ/hosp same ........... ........... ........... ........... ........... date. 99236................ N.................... ................... Observ/hosp same ........... ........... ........... ........... ........... date. 99238................ E.................... ................... Hospital discharge ........... ........... ........... ........... ........... day. 99239................ E.................... ................... Hospital discharge ........... ........... ........... ........... ........... day. 99241................ V.................... ................... Office consultation.

0600 0.9278 $50.62 ........... $10.12 99242................ V.................... ................... Office consultation.

0600 0.9278 $50.62 ........... $10.12 99243................ V.................... ................... Office consultation.

0601 0.9816 $53.56 ........... $10.71 99244................ V.................... ................... Office consultation.

0602 1.5041 $82.07 ........... $16.41 99245................ V.................... ................... Office consultation.

0602 1.5041 $82.07 ........... $16.41 99251................ C.................... ................... Initial inpatient ........... ........... ........... ........... ........... consult. 99252................ C.................... ................... Initial inpatient ........... ........... ........... ........... ........... consult. 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

0600 0.9278 $50.62 ........... $10.12 consultation. 99272................ V.................... ................... Confirmatory

0600 0.9278 $50.62 ........... $10.12 consultation. 99273................ V.................... ................... Confirmatory

0601 0.9816 $53.56 ........... $10.71 consultation. 99274................ V.................... ................... Confirmatory

0602 1.5041 $82.07 ........... $16.41 consultation. 99275................ V.................... ................... Confirmatory

0602 1.5041 $82.07 ........... $16.41 consultation. 99281................ V.................... ................... Emergency dept visit

0610 1.3691 $74.70 $19.57 $14.94 99282................ V.................... ................... Emergency dept visit

0610 1.3691 $74.70 $19.57 $14.94 99283................ V.................... ................... Emergency dept visit

0611 2.3967 $130.77 $36.16 $26.15 99284................ V.................... ................... Emergency dept visit

0612 4.1476 $226.30 $54.12 $45.26 99285................ V.................... ................... Emergency dept visit

0612 4.1476 $226.30 $54.12 $45.26 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

0620 8.9992 $491.01 $142.30 $98.20 hour. 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.

[[Page 63600]]

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. 99377................ B.................... ................... Hospice care

........... ........... ........... ........... ........... supervision. 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

0600 0.9278 $50.62 ........... $10.12 newborn. 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

0094 2.6345 $143.74 $48.58 $28.75 resuscitation. 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. 99551................ E.................... DG................. Home infus, pain ........... ........... ........... ........... ........... mgmt, iv/sc. 99552................ E.................... DG................. Hm infus pain mgmt, ........... ........... ........... ........... ........... epid/ith. 99553................ E.................... DG................. Home infuse,

........... ........... ........... ........... ........... tocolytic tx. 99554................ E.................... DG................. Home infus, hormone/ ........... ........... ........... ........... ........... platelet. 99555................ E.................... DG................. Home infuse,

........... ........... ........... ........... ........... chemotheraphy. 99556................ E.................... DG................. Home infus, antibio/ ........... ........... ........... ........... ........... fung/vir. 99557................ E.................... DG................. Home infuse,

........... ........... ........... ........... ........... anticoagulant. 99558................ E.................... DG................. Home infuse,

........... ........... ........... ........... ........... immunotherapy. 99559................ E.................... DG................. Home infus, periton ........... ........... ........... ........... ........... dialysis. 99560................ E.................... DG................. Home infus, entero ........... ........... ........... ........... ........... nutrition. 99561................ E.................... DG................. Home infuse,

........... ........... ........... ........... ........... hydration tx. 99562................ E.................... DG................. Home infus, parent ........... ........... ........... ........... ........... nutrition. 99563................ E.................... DG................. Home admin,

........... ........... ........... ........... ........... pentamidine. 99564................ E.................... DG................. Hme infus,

........... ........... ........... ........... ........... antihemophil agnt. 99565................ E.................... DG................. Home infus,

........... ........... ........... ........... ........... proteinase inhib. 99566................ E.................... DG................. Home infuse, iv ........... ........... ........... ........... ........... therapy. 99567................ E.................... DG................. Home infuse, sympath ........... ........... ........... ........... ........... agent.

[[Page 63601]]

99568................ E.................... DG................. Home infus, misc ........... ........... ........... ........... ........... drug, daily. 99569................ E.................... DG................. Home infuse, each ........... ........... ........... ........... ........... addl tx. 99600................ E.................... ................... Home visit nos...... ........... ........... ........... ........... ........... 99601................ E.................... NI................. Home infusion/visit, ........... ........... ........... ........... ........... 2 hrs. 99602................ E.................... NI................. 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. 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................ A.................... ................... Amb trans 7pm-7am... ........... ........... ........... ........... ........... A0888................ E.................... ................... Noncovered ambulance ........... ........... ........... ........... ........... mileage. A0999................ A.................... ................... Unlisted ambulance ........... ........... ........... ........... ........... service. A4206................ A.................... ................... 1 CC sterile

........... ........... ........... ........... ........... syringe&needle. A4207................ A.................... ................... 2 CC sterile

........... ........... ........... ........... ........... syringe&needle. A4208................ A.................... ................... 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. ........... ........... ........... ........... ........... A4214................ A.................... DG................. 30 CC sterile water/ ........... ........... ........... ........... ........... saline. A4215................ E.................... ................... Sterile needle...... ........... ........... ........... ........... ........... A4216................ A.................... NI................. Sterile water/

........... ........... ........... ........... ........... saline, 10 ml. A4217................ A.................... NI................. Sterile water/

........... ........... ........... ........... ........... saline, 500 ml. A4220................ N.................... NI................. Infusion pump refill ........... ........... ........... ........... ........... kit. A4221................ A.................... ................... Maint drug infus ........... ........... ........... ........... ........... cath per wk. A4222................ A.................... ................... Drug infusion pump ........... ........... ........... ........... ........... supplies. A4230................ A.................... ................... Infus insulin pump ........... ........... ........... ........... ........... non needl. A4231................ A.................... ................... Infusion insulin ........... ........... ........... ........... ........... pump needle. A4232................ E.................... ................... 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................ A.................... ................... Blood glucose/

........... ........... ........... ........... ........... reagent strips. A4254................ A.................... ................... Battery for glucose ........... ........... ........... ........... ........... monitor. A4255................ A.................... ................... Glucose monitor ........... ........... ........... ........... ........... platforms. A4256................ A.................... ................... Calibrator solution/ ........... ........... ........... ........... ........... chips. A4257................ A.................... ................... Replace Lensshield ........... ........... ........... ........... ........... Cartridge.

[[Page 63602]]

A4258................ A.................... ................... Lancet device each.. ........... ........... ........... ........... ........... A4259................ A.................... ................... 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................ A.................... ................... 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. 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................ E.................... ................... 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[gE]. A4409................ A.................... ................... Ost skn barr w flng ........... ........... ........... ........... ........... 4sq[gE]. A4413................ A.................... ................... 2 pc drainable ost ........... ........... ........... ........... ........... pouch. A4414................ A.................... ................... Ostomy sknbarr w ........... ........... ........... ........... ........... flng 4sq[gE]. A4416................ A.................... NI................. Ost pch clsd w

........... ........... ........... ........... ........... barrier/filtr. A4417................ A.................... NI................. Ost pch w bar/

........... ........... ........... ........... ........... bltinconv/fltr. A4418................ A.................... NI................. Ost pch clsd w/o bar ........... ........... ........... ........... ........... w filtr. A4419................ A.................... NI................. Ost pch for bar w ........... ........... ........... ........... ........... flange/flt. A4420................ A.................... NI................. Ost pch clsd for bar ........... ........... ........... ........... ........... w lk fl. A4421................ A.................... ................... Ostomy supply misc.. ........... ........... ........... ........... ........... A4422................ A.................... ................... Ost pouch absorbent ........... ........... ........... ........... ........... material. A4424................ A.................... NI................. Ost pch drain w bar ........... ........... ........... ........... ........... & filter. A4425................ A.................... NI................. Ost pch drain for ........... ........... ........... ........... ........... barrier fl. A4426................ A.................... NI................. Ost pch drain 2 ........... ........... ........... ........... ........... piece system. A4427................ A.................... NI................. Ost pch drain/barr ........... ........... ........... ........... ........... lk flng/f. A4428................ A.................... NI................. Urine ost pouch w ........... ........... ........... ........... ........... faucet/tap. A4429................ A.................... NI................. Urine ost pch bar w ........... ........... ........... ........... ........... lock fln. A4430................ A.................... NI................. Ost pch urine w lock ........... ........... ........... ........... ........... flng/ft. A4431................ A.................... NI................. Urine ost pch bar w ........... ........... ........... ........... ........... lock fln. A4432................ A.................... NI................. Ost pch urine w lock ........... ........... ........... ........... ........... flng/ft. A4433................ A.................... NI................. Urine ost pch bar w ........... ........... ........... ........... ........... lock fln. A4434................ A.................... NI................. 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. A4521................ E.................... ................... Adult size diaper sm ........... ........... ........... ........... ........... each. A4522................ E.................... ................... Adult size diaper ........... ........... ........... ........... ........... med each. A4523................ E.................... ................... Adult size diaper lg ........... ........... ........... ........... ........... each. A4524................ E.................... ................... Adult size diaper xl ........... ........... ........... ........... ........... each. A4525................ E.................... ................... Adult size brief sm ........... ........... ........... ........... ........... each. A4526................ E.................... ................... Adult size brief med ........... ........... ........... ........... ........... each. A4527................ E.................... ................... Adult size brief lg ........... ........... ........... ........... ........... each. A4528................ E.................... ................... Adult size brief xl ........... ........... ........... ........... ........... each. A4529................ E.................... ................... Child size diaper sm/ ........... ........... ........... ........... ........... med ea.

[[Page 63604]]

A4530................ E.................... ................... Child size diaper lg ........... ........... ........... ........... ........... each. A4531................ E.................... ................... Child size brief sm/ ........... ........... ........... ........... ........... med each. A4532................ E.................... ................... Child size brief lg ........... ........... ........... ........... ........... each. A4533................ E.................... ................... Youth size diaper ........... ........... ........... ........... ........... each. A4534................ E.................... ................... Youth size brief ........... ........... ........... ........... ........... each. A4535................ E.................... ................... Disp incont liner/ ........... ........... ........... ........... ........... shield ea. A4536................ E.................... ................... Prot underwr wshbl ........... ........... ........... ........... ........... any sz ea. A4537................ E.................... ................... Under pad reusable ........... ........... ........... ........... ........... any sz ea. A4538................ E.................... ................... Reusable diaper from ........... ........... ........... ........... ........... dpr svc. A4550................ B.................... ................... Surgical trays...... ........... ........... ........... ........... ........... A4554................ E.................... ................... Disposable underpads ........... ........... ........... ........... ........... A4556................ A.................... ................... Electrodes, pair.... ........... ........... ........... ........... ........... A4557................ A.................... ................... Lead wires, pair.... ........... ........... ........... ........... ........... A4558................ A.................... ................... Conductive paste or ........... ........... ........... ........... ........... gel. 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................ A.................... ................... TENS suppl 2 lead ........... ........... ........... ........... ........... per month. A4606................ A.................... ................... Oxygen probe used w ........... ........... ........... ........... ........... oximeter. A4608................ A.................... ................... Transtracheal oxygen ........... ........... ........... ........... ........... cath. A4609................ A.................... ................... Trach suction cath ........... ........... ........... ........... ........... clsed sys. A4610................ A.................... ................... Trach sctn cath 72h ........... ........... ........... ........... ........... clsedsys. A4611................ A.................... ................... Heavy duty battery.. ........... ........... ........... ........... ........... A4612................ A.................... ................... Battery cables...... ........... ........... ........... ........... ........... A4613................ A.................... ................... Battery charger..... ........... ........... ........... ........... ........... A4614................ A.................... ................... Hand-held PEFR meter ........... ........... ........... ........... ........... A4615................ A.................... ................... Cannula nasal....... ........... ........... ........... ........... ........... A4616................ A.................... ................... Tubing (oxygen) per ........... ........... ........... ........... ........... foot. A4617................ A.................... ................... Mouth piece......... ........... ........... ........... ........... ........... A4618................ A.................... ................... Breathing circuits.. ........... ........... ........... ........... ........... A4619................ A.................... ................... Face tent........... ........... ........... ........... ........... ........... A4620................ A.................... ................... Variable

........... ........... ........... ........... ........... concentration mask. A4621................ A.................... DG................. Tracheotomy mask or ........... ........... ........... ........... ........... collar. A4622................ A.................... DG................. Tracheostomy or ........... ........... ........... ........... ........... larngectomy. A4623................ A.................... ................... Tracheostomy inner ........... ........... ........... ........... ........... cannula. A4624................ A.................... ................... Tracheal suction ........... ........... ........... ........... ........... tube. A4625................ A.................... ................... Trach care kit for ........... ........... ........... ........... ........... new trach. A4626................ A.................... ................... Tracheostomy

........... ........... ........... ........... ........... cleaning brush. A4627................ E.................... ................... Spacer bag/reservoir ........... ........... ........... ........... ........... A4628................ A.................... ................... Oropharyngeal

........... ........... ........... ........... ........... suction cath. A4629................ A.................... ................... Tracheostomy care ........... ........... ........... ........... ........... kit. A4630................ A.................... ................... Repl bat t.e.n.s. ........... ........... ........... ........... ........... own by pt. A4631................ A.................... DG................. Wheelchair battery.. ........... ........... ........... ........... ........... A4632................ E.................... ................... Infus pump rplcemnt ........... ........... ........... ........... ........... battery. A4633................ A.................... ................... Uvl replacement bulb ........... ........... ........... ........... ........... A4634................ A.................... ................... Replacement bulb th ........... ........... ........... ........... ........... lightbox. A4635................ A.................... ................... Underarm crutch pad. ........... ........... ........... ........... ........... A4636................ A.................... ................... Handgrip for cane ........... ........... ........... ........... ........... etc. A4637................ A.................... ................... Repl tip cane/crutch/ ........... ........... ........... ........... ........... walker. A4638................ Y.................... NI................. Repl batt pulse gen ........... ........... ........... ........... ........... sys. A4639................ A.................... ................... Infrared ht sys ........... ........... ........... ........... ........... replcmnt pad. A4640................ A.................... ................... Alternating pressure ........... ........... ........... ........... ........... pad. A4641................ N.................... ................... Diagnostic imaging ........... ........... ........... ........... ........... agent. A4642................ K.................... ................... Satumomab pendetide

0704 2.2811 $124.46 ........... $24.89 per dose. A4643................ N.................... ................... High dose contrast ........... ........... ........... ........... ........... MRI. A4644................ N.................... DG................. Contrast 100-199 MGs ........... ........... ........... ........... ........... iodine. A4645................ N.................... DG................. Contrast 200-299 MGs ........... ........... ........... ........... ........... iodine. A4646................ N.................... DG................. Contrast 300-399 MGs ........... ........... ........... ........... ........... iodine. A4647................ N.................... ................... 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................ E.................... NI................. Disposable cycler ........... ........... ........... ........... ........... set. A4672................ E.................... NI................. Drainage ext line, ........... ........... ........... ........... ........... dialysis. A4673................ E.................... NI................. Ext line w easy lock ........... ........... ........... ........... ........... connect.

[[Page 63605]]

A4674................ E.................... NI................. 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. A4712................ A.................... DG................. Sterile water inj ........... ........... ........... ........... ........... per 10 ml. A4714................ A.................... ................... Treated water per ........... ........... ........... ........... ........... gallon. A4719................ A.................... ................... [gE]Y set[gE] tubing ........... ........... ........... ........... ........... 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................ E.................... NI................. 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................ A.................... ................... Diab shoe for

........... ........... ........... ........... ........... density insert. A5501................ A.................... ................... Diabetic custom ........... ........... ........... ........... ........... molded shoe. A5503................ A.................... ................... Diabetic shoe w/ ........... ........... ........... ........... ........... roller/rockr. A5504................ A.................... ................... Diabetic shoe with ........... ........... ........... ........... ........... wedge. A5505................ A.................... ................... Diab shoe w/

........... ........... ........... ........... ........... metatarsal bar.

[[Page 63606]]

A5506................ A.................... ................... Diabetic shoe w/off ........... ........... ........... ........... ........... set heel. A5507................ A.................... ................... Modification

........... ........... ........... ........... ........... diabetic shoe. A5508................ A.................... ................... Diabetic deluxe shoe ........... ........... ........... ........... ........... A5509................ A.................... ................... Direct heat form ........... ........... ........... ........... ........... shoe insert. A5510................ A.................... ................... Compression form ........... ........... ........... ........... ........... shoe insert. A5511................ A.................... ................... 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 16........... ........... ........... ........... ........... 48 sq in w/o brdr. A6212................ A.................... ................... Foam drg 16........... ........... ........... ........... ........... 48 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.

[[Page 63607]]

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.................... NI................. Packing strips, non- ........... ........... ........... ........... ........... impreg. A6410................ A.................... ................... Sterile eye pad..... ........... ........... ........... ........... ........... A6411................ A.................... ................... Non-sterile eye pad. ........... ........... ........... ........... ........... A6412................ E.................... ................... Occlusive eye patch. ........... ........... ........... ........... ........... A6421................ A.................... DG................. Pad bandage =3 =3=5[gE]w / roll. A6426................ A.................... DG................. Conf bandage s =3=5[gE] w / roll. A6430................ A.................... DG................. Lt compres bdg =3=5[gE]w / roll. A6434................ A.................... DG................. Mo compres bdg =3=3=3=3=3[gE] =3[gE]=5[gE]/ yd. A6445................ A.................... NI................. Conform band s w ........... ........... ........... ........... ........... =3[gE] =5[gE]/yd. A6448................ A.................... NI................. Lt compres band ........... ........... ........... ........... ........... =3[gE] =5[gE]/yd. A6451................ A.................... NI................. Mod compres band ........... ........... ........... ........... ........... w=3[gE]=3[gE]=3[gE] =5[gE]/yd. A6456................ A.................... NI................. Zinc paste band w ........... ........... ........... ........... ........... =3[gE]. 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. C1010................ K.................... DG................. Blood, L/R, CMV-NEG.

1010 ........... $121.78 ........... $24.36 C1011................ K.................... DG................. Platelets, HLA-m, L/

1011 ........... $499.77 ........... $99.95 R, unit. C1015................ K.................... DG................. Plt, pher,L/R,CMV,

1020 ........... $495.22 ........... $99.04 irrad. C1016................ K.................... DG................. BLOOD,L/R,FROZ/DEGLY/

1016 ........... $301.68 ........... $60.34 Washed. C1017................ K.................... DG................. Plt, APH/PHER,L/

1017 ........... $393.15 ........... $78.63 R,CMV-NEG. C1018................ K.................... DG................. Blood, L/R,

1018 ........... $132.40 ........... $26.48 IRRADIATED. C1020................ K.................... DG................. RBC, frz/deg/wsh, L/

1021 ........... $336.04 ........... $67.21 R, irrad. C1021................ K.................... DG................. RBC, L/R, CMV neg,

1022 ........... $201.12 ........... $40.22 irrad. C1022................ K.................... DG................. Plasma, frz within

0955 ........... $95.00 ........... $19.00 24 hour. C1079................ K.................... ................... CO 57/58 per 0.5 uCi

1079 1.2556 $68.51 ........... $13.70 C1080................ K.................... NI................. I-131 tositumomab,

1080 ........... $2,260.00 ........... $452.00 dx. C1081................ K.................... NI................. I-131 tositumomab,

1081 ........... $19,565.00 ........... $3,913.00 tx. C1082................ K.................... NF................. In-111 ibritumomab

9118 ........... $2,260.00 ........... $452.00 tiuxetan. C1083................ K.................... NF................. Yttrium 90

9117 ........... $19,565.00 ........... $3,913.00 ibritumomab tiuxetan. C1088................ T.................... ................... LASER OPTIC TR Sys..

1557 ........... $1,850.00 ........... $370.00 C1091................ K.................... ................... IN111

1091 4.1151 $224.52 ........... $44.90 oxyquinoline,per0.5 mCi. C1092................ K.................... ................... IN 111 pentetate per

1092 3.9855 $217.45 ........... $43.49 0.5 mCi. C1122................ K.................... ................... Tc 99M ARCITUMOMAB

1122 9.8014 $534.77 ........... $106.95 PER VIAL. C1166................ K.................... DG................. CYTARABINE

1166 5.1134 $278.99 ........... $55.80 LIPOSOMAL, 10 mg. C1167................ K.................... DG................. EPIRUBICIN HCL, 2 mg

1167 0.3744 $20.43 ...........

$4.09 C1178................ K.................... ................... BUSULFAN IV, 6 Mg...

1178 5.4930 $299.70 ........... $59.94 C1200................ K.................... ................... TC 99M Sodium

1200 0.5550 $30.28 ...........

$6.06 Glucoheptonat. C1201................ K.................... ................... TC 99M SUCCIMER, PER

1201 1.4706 $80.24 ........... $16.05 Vial. C1300................ S.................... ................... HYPERBARIC Oxygen...

0659 3.0228 $164.93 ........... $32.99 C1305................ K.................... ................... Apligraf............

1305 15.0691 $822.19 ........... $164.44 C1713................ N.................... NF................. Anchor/screw bn/ ........... ........... ........... ........... ........... bn,tis/bn. C1714................ N.................... NF................. Cath, trans

........... ........... ........... ........... ........... atherectomy, dir. C1715................ N.................... NF................. Brachytherapy needle ........... ........... ........... ........... ........... C1716................ K.................... ................... Brachytx source,

1716 1.3811 $75.35 ........... $15.07 Gold 198. C1717................ N.................... NF................. Brachytx source, HDR ........... ........... ........... ........... ........... Ir-192. C1718................ K.................... ................... Brachytx source,

1718 0.6843 $37.34 ...........

$7.47 Iodine 125. C1719................ K.................... ................... Brachytx sour,Non-

1719 0.3187 $17.39 ...........

$3.48 HDR Ir-192. C1720................ K.................... ................... Brachytx sour,

1720 0.8187 $44.67 ...........

$8.93 Palladium 103. C1721................ N.................... NF................. AICD, dual chamber.. ........... ........... ........... ........... ........... C1722................ N.................... NF................. AICD, single chamber ........... ........... ........... ........... ........... C1724................ N.................... NF................. Cath, trans

........... ........... ........... ........... ........... atherec,rotation. C1725................ N.................... NF................. Cath, translumin non- ........... ........... ........... ........... ........... laser.

[[Page 63610]]

C1726................ N.................... NF................. Cath, bal dil, non- ........... ........... ........... ........... ........... vascular. C1727................ N.................... NF................. Cath, bal tis dis, ........... ........... ........... ........... ........... non-vas. C1728................ N.................... NF................. Cath, brachytx seed ........... ........... ........... ........... ........... adm. C1729................ N.................... NF................. Cath, drainage...... ........... ........... ........... ........... ........... C1730................ N.................... NF................. Cath, EP, 19 or few ........... ........... ........... ........... ........... elect. C1731................ N.................... NF................. Cath, EP, 20 or more ........... ........... ........... ........... ........... elec. C1732................ N.................... NF................. Cath, EP, diag/abl, ........... ........... ........... ........... ........... 3D/vect. C1733................ N.................... NF................. Cath, EP, othr than ........... ........... ........... ........... ........... cool-tip. C1750................ N.................... NF................. Cath,

........... ........... ........... ........... ........... hemodialysis,long- term. C1751................ N.................... NF................. Cath, inf, per/cent/ ........... ........... ........... ........... ........... midline. C1752................ N.................... NF................. Cath,hemodialysis,sh ........... ........... ........... ........... ........... ort-term. C1753................ N.................... NF................. Cath, intravas

........... ........... ........... ........... ........... ultrasound. C1754................ N.................... NF................. Catheter,

........... ........... ........... ........... ........... intradiscal. C1755................ N.................... NF................. Catheter,

........... ........... ........... ........... ........... intraspinal. C1756................ N.................... NF................. Cath, pacing,

........... ........... ........... ........... ........... transesoph. C1757................ N.................... NF................. Cath, thrombectomy/ ........... ........... ........... ........... ........... embolect. C1758................ N.................... NF................. Catheter, ureteral.. ........... ........... ........... ........... ........... C1759................ N.................... NF................. Cath, intra

........... ........... ........... ........... ........... echocardiography. C1760................ N.................... NF................. Closure dev, vasc... ........... ........... ........... ........... ........... C1762................ N.................... NF................. Conn tiss, human(inc ........... ........... ........... ........... ........... fascia). C1763................ N.................... NF................. Conn tiss, non-human ........... ........... ........... ........... ........... C1764................ N.................... NF................. Event recorder, ........... ........... ........... ........... ........... cardiac. C1765................ N.................... ................... Adhesion barrier.... ........... ........... ........... ........... ........... C1766................ N.................... NF................. Intro/

........... ........... ........... ........... ........... sheath,strble,non- peel. C1767................ N.................... NF................. Generator,

........... ........... ........... ........... ........... neurostim, imp. C1768................ N.................... NF................. Graft, vascular..... ........... ........... ........... ........... ........... C1769................ N.................... NF................. Guide wire.......... ........... ........... ........... ........... ........... C1770................ N.................... NF................. Imaging coil, MR, ........... ........... ........... ........... ........... insertable. C1771................ N.................... NF................. Rep dev, urinary, w/ ........... ........... ........... ........... ........... sling. C1772................ N.................... NF................. Infusion pump,

........... ........... ........... ........... ........... programmable. C1773................ N.................... NF................. Ret dev, insertable. ........... ........... ........... ........... ........... C1774................ K.................... DG................. Darbepoetin alfa, 1

0734 ...........

$3.24 ...........

$0.65 mcg. C1775................ K.................... ................... FDG, per dose (4-40

1775 5.9471 $324.48 ........... $64.90 mCi/ml). C1776................ N.................... NF................. Joint device

........... ........... ........... ........... ........... (implantable). C1777................ N.................... NF................. Lead, AICD, endo ........... ........... ........... ........... ........... single coil. C1778................ N.................... NF................. Lead,

........... ........... ........... ........... ........... neurostimulator. C1779................ N.................... NF................. Lead, pmkr,

........... ........... ........... ........... ........... transvenous VDD. C1780................ N.................... NF................. Lens, intraocular ........... ........... ........... ........... ........... (new tech). C1781................ N.................... NF................. Mesh (implantable).. ........... ........... ........... ........... ........... C1782................ N.................... NF................. Morcellator......... ........... ........... ........... ........... ........... C1783................ H.................... ................... Ocular imp, aqueous

1783 ........... ........... ........... ........... drain ev. C1784................ N.................... NF................. Ocular dev, intraop, ........... ........... ........... ........... ........... det ret. C1785................ N.................... NF................. Pmkr, dual, rate- ........... ........... ........... ........... ........... resp. C1786................ N.................... NF................. Pmkr, single, rate- ........... ........... ........... ........... ........... resp. C1787................ N.................... NF................. Patient progr,

........... ........... ........... ........... ........... neurostim. C1788................ N.................... NF................. Port, indwelling, ........... ........... ........... ........... ........... imp. C1789................ N.................... NF................. Prosthesis, breast, ........... ........... ........... ........... ........... imp. C1813................ N.................... NF................. Prosthesis, penile, ........... ........... ........... ........... ........... inflatab. C1814................ H.................... NF................. Retinal tamp,

1814 ........... ........... ........... ........... silicone oil. C1815................ N.................... NF................. Pros, urinary sph, ........... ........... ........... ........... ........... imp. C1816................ N.................... NF................. Receiver/

........... ........... ........... ........... ........... transmitter, neuro. C1817................ N.................... NF................. Septal defect imp ........... ........... ........... ........... ........... sys. C1818................ H.................... ................... Integrated

1818 ........... ........... ........... ........... keratoprosthesis. C1819................ H.................... NI................. Tissue localization-

1819 ........... ........... ........... ........... excision dev. C1874................ N.................... NF................. Stent, coated/cov w/ ........... ........... ........... ........... ........... del sys. C1875................ N.................... NF................. Stent, coated/cov w/ ........... ........... ........... ........... ........... o del sy. C1876................ N.................... NF................. Stent, non-coa/non- ........... ........... ........... ........... ........... cov w/del. C1877................ N.................... NF................. Stent, non-coat/cov ........... ........... ........... ........... ........... w/o del. C1878................ N.................... NF................. Matrl for vocal cord ........... ........... ........... ........... ........... C1879................ N.................... NF................. Tissue marker,

........... ........... ........... ........... ........... implantable. C1880................ N.................... NF................. Vena cava filter.... ........... ........... ........... ........... ........... C1881................ N.................... NF................. Dialysis access ........... ........... ........... ........... ........... system. C1882................ N.................... NF................. AICD, other than ........... ........... ........... ........... ........... sing/dual. C1883................ N.................... NF................. Adapt/ext, pacing/ ........... ........... ........... ........... ........... neuro lead. C1884................ H.................... NI................. Embolization Protect

1884 ........... ........... ........... ........... syst. C1885................ N.................... NF................. Cath, translumin ........... ........... ........... ........... ........... angio laser. C1887................ N.................... NF................. Catheter, guiding... ........... ........... ........... ........... ........... C1888................ H.................... ................... Catheter, ablation,

1888 ........... ........... ........... ........... non-cardiac, endovascular (implantable). C1891................ N.................... NF................. Infusion pump,non- ........... ........... ........... ........... ........... prog, perm. C1892................ N.................... NF................. Intro/

........... ........... ........... ........... ........... sheath,fixed,peel- away. C1893................ N.................... NF................. Intro/sheath,

........... ........... ........... ........... ........... fixed,non-peel. C1894................ N.................... NF................. Intro/sheath, non- ........... ........... ........... ........... ........... laser. C1895................ N.................... NF................. Lead, AICD, endo ........... ........... ........... ........... ........... dual coil. C1896................ N.................... NF................. Lead, AICD, non sing/ ........... ........... ........... ........... ........... dual.

[[Page 63611]]

C1897................ N.................... NF................. Lead, neurostim test ........... ........... ........... ........... ........... kit. C1898................ N.................... NF................. Lead, pmkr, other ........... ........... ........... ........... ........... than trans. C1899................ N.................... NF................. Lead, pmkr/AICD ........... ........... ........... ........... ........... combination. C1900................ H.................... ................... Lead coronary venous

1900 ........... ........... ........... ........... C2614................ H.................... ................... Probe, perc lumb

2614 ........... ........... ........... ........... disc. C2615................ N.................... NF................. Sealant, pulmonary, ........... ........... ........... ........... ........... liquid. C2616................ K.................... ................... Brachytx source,

2616 176.2339 $9,615.50 ........... $1,923.10 Yttrium-90. C2617................ N.................... NF................. Stent, non-cor, tem ........... ........... ........... ........... ........... w/o del. C2618................ N.................... ................... Probe, cryoablation. ........... ........... ........... ........... ........... C2619................ N.................... NF................. Pmkr, dual, non rate- ........... ........... ........... ........... ........... resp. C2620................ N.................... NF................. Pmkr, single, non ........... ........... ........... ........... ........... rate-resp. C2621................ N.................... NF................. Pmkr, other than ........... ........... ........... ........... ........... sing/dual. C2622................ N.................... NF................. Prosthesis, penile, ........... ........... ........... ........... ........... non-inf. C2625................ N.................... NF................. Stent, non-cor, tem ........... ........... ........... ........... ........... w/del sy. C2626................ N.................... NF................. Infusion pump, non- ........... ........... ........... ........... ........... prog,temp. C2627................ N.................... NF................. Cath, suprapubic/ ........... ........... ........... ........... ........... cystoscopic. C2628................ N.................... NF................. Catheter, occlusion. ........... ........... ........... ........... ........... C2629................ N.................... NF................. Intro/sheath, laser. ........... ........... ........... ........... ........... C2630................ N.................... NF................. Cath, EP, cool-tip.. ........... ........... ........... ........... ........... C2631................ N.................... NF................. Rep dev, urinary, w/ ........... ........... ........... ........... ........... o sling. C2632................ H.................... ................... Brachytx sol, I-125,

2632 ........... ........... ........... ........... per mCi. C2633................ K.................... NI................. Brachytx source,

2633 0.8187 $44.67 ...........

$8.93 Cesium-131. C8900................ S.................... ................... MRA w/cont, abd.....

0284 7.1165 $388.28 $194.13 $77.66 C8901................ S.................... ................... MRA w/o cont, abd...

0336 6.3897 $348.63 $174.31 $69.73 C8902................ S.................... ................... MRA w/o fol w/cont,

0337 9.2075 $502.37 $240.77 $100.47 abd. C8903................ S.................... ................... MRI w/cont, breast,

0284 7.1165 $388.28 $194.13 $77.66 uni. C8904................ S.................... ................... MRI w/o cont,

0336 6.3897 $348.63 $174.31 $69.73 breast, uni. C8905................ S.................... ................... MRI w/o fol w/cont,

0337 9.2075 $502.37 $240.77 $100.47 brst, un. C8906................ S.................... ................... MRI w/cont, breast,

0284 7.1165 $388.28 $194.13 $77.66 bi. C8907................ S.................... ................... MRI w/o cont,

0336 6.3897 $348.63 $174.31 $69.73 breast, bi. C8908................ S.................... ................... MRI w/o fol w/cont,

0337 9.2075 $502.37 $240.77 $100.47 breast,. C8909................ S.................... ................... MRA w/cont, chest...

0284 7.1165 $388.28 $194.13 $77.66 C8910................ S.................... ................... MRA w/o cont, chest.

0336 6.3897 $348.63 $174.31 $69.73 C8911................ S.................... ................... MRA w/o fol w/cont,

0337 9.2075 $502.37 $240.77 $100.47 chest. C8912................ S.................... ................... MRA w/cont, lwr ext.

0284 7.1165 $388.28 $194.13 $77.66 C8913................ S.................... ................... MRA w/o cont, lwr

0336 6.3897 $348.63 $174.31 $69.73 ext. C8914................ S.................... ................... MRA w/o fol w/cont,

0337 9.2075 $502.37 $240.77 $100.47 lwr ext. C8918................ S.................... NF................. MRA w/cont, pelvis..

0284 7.1165 $388.28 $194.13 $77.66 C8919................ S.................... NF................. MRA w/o cont, pelvis

0336 6.3897 $348.63 $174.31 $69.73 C8920................ S.................... NF................. MRA w/o fol w/cont,

0337 9.2075 $502.37 $240.77 $100.47 pelvis. C9000................ N.................... ................... Na chromateCr51, per ........... ........... ........... ........... ........... 0.25mCi. C9003................ K.................... ................... Palivizumab, per 50

9003 6.3077 $344.15 ........... $68.83 mg. C9007................ N.................... ................... Baclofen Intrathecal ........... ........... ........... ........... ........... kit-1am. C9008................ K.................... ................... Baclofen Refill Kit-

9008 0.1264

$6.90 ...........

$1.38 500mcg. C9009................ K.................... ................... Baclofen Refill Kit-

9009 0.7499 $40.92 ...........

$8.18 2000mcg. C9010................ K.................... DG................. Baclofen Refill Kit-

9010 0.7739 $42.22 ...........

$8.44 4000mcg. C9013................ K.................... ................... Co 57 cobaltous

9013 1.0386 $56.67 ........... $11.33 chloride. C9102................ N.................... ................... 51 Na Chromate, ........... ........... ........... ........... ........... 50mCi. C9103................ N.................... ................... Na Iothalamate I- ........... ........... ........... ........... ........... 125, 10 uCi. C9105................ K.................... ................... Hep B imm glob, per

9105 1.3074 $71.33 ........... $14.27 1 ml. C9109................ K.................... ................... Tirofiban hcl, 6.25

9109 2.1737 $118.60 ........... $23.72 mg. C9111................ D.................... DNG................ Inj, bivalirudin, ........... ........... ........... ........... ........... 250mg vial. C9112................ G.................... ................... Perflutren lipid

9112 ........... $148.20 ........... $22.15 micro, 2ml. C9113................ G.................... ................... Inj pantoprazole

9113 ........... $25.08 ...........

$3.75 sodium, via. C9116................ D.................... DNG................ Ertapenem sodium, ........... ........... $23.74 ........... ........... per 1 gm. C9119................ D.................... DNG................ Injection,

........... ........... ........... ........... ........... pegfilgrastim. C9120................ D.................... DNG................ Injection,

........... ........... ........... ........... ........... fulvestrant. C9121................ G.................... ................... Injection,

9121 ........... $16.35 ...........

$2.44 argatroban. C9123................ G.................... NF................. Transcyte, per 247

9123 ........... $770.93 ........... $115.23 sq cm. C9200................ G.................... ................... Orcel, per 36 cm2...

9200 ........... $1,135.25

$ $169.69 C9201................ G.................... ................... Dermagraft, per 37.5

9201 ........... $577.60 ........... $86.34 sq cm. C9202................ K.................... NF................. Octafluoropropane...

9202 2.1737 $118.60 ........... $23.72 C9203................ G.................... NF................. Perflexane lipid

9203 ........... $142.50 ........... $21.30 micro. C9204................ D.................... DNG................ Ziprasidone mesylate ........... ........... ........... ........... ........... C9205................ G.................... ................... Oxaliplatin.........

9205 ........... $94.46 ........... $14.12 C9207................ G.................... NI................. Injection,

9207 ........... $1,039.68 ........... $155.40 bortezomib. C9208................ G.................... NF................. Injection,

9208 ........... $123.78 ........... $18.50 agalsidase beta. C9209................ G.................... NF................. Injection,

9209 ........... $644.10 ........... $96.28 laronidase. C9210................ G.................... NI................. Injection,

9210 ........... $307.80 ........... $46.01 palonosetron HCL. C9211................ G.................... NI................. Inj, alefacept, IV..

9211 ........... $665.00 ........... $99.40 C9212................ G.................... NI................. Inj, alefacept, IM..

9212 ........... $472.63 ........... $70.65 C9503................ K.................... DG................. Fresh frozen plasma,

9503 ........... $69.74 ........... $13.95 ea unit. C9701................ T.................... ................... Stretta System......

1557 ........... $1,850.00 ........... $370.00 C9703................ T.................... ................... Bard Endoscopic

1555 ........... $1,650.00 ........... $330.00 Suturing Sys. C9704................ T.................... NI................. Inj inert subs upper

1556 ........... $1,750.00 ........... $350.00 GI.

[[Page 63612]]

C9711................ T.................... DG................. H.E.L.P. Apheresis

1552 ........... $1,350.00 ........... $270.00 System. D0120................ E.................... ................... Periodic oral

........... ........... ........... ........... ........... evaluation. D0140................ E.................... ................... Limit oral eval ........... ........... ........... ........... ........... problm focus. D0150................ S.................... ................... Comprehensve oral

0330 0.5745 $31.35 ...........

$6.27 evaluation. 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

0330 0.5745 $31.35 ...........

$6.27 film. D0250................ S.................... ................... Extraoral first film

0330 0.5745 $31.35 ...........

$6.27 D0260................ S.................... ................... Extraoral ea

0330 0.5745 $31.35 ...........

$6.27 additional film. D0270................ S.................... ................... Dental bitewing

0330 0.5745 $31.35 ...........

$6.27 single film. D0272................ S.................... ................... Dental bitewings two

0330 0.5745 $31.35 ...........

$6.27 films. D0274................ S.................... ................... Dental bitewings

0330 0.5745 $31.35 ...........

$6.27 four films. D0277................ S.................... ................... Vert bitewings-sev

0330 0.5745 $31.35 ...........

$6.27 to eight. 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. ........... ........... ........... ........... ........... D0425................ E.................... ................... Caries

........... ........... ........... ........... ........... susceptibility test. D0460................ S.................... ................... Pulp vitality test..

0330 0.5745 $31.35 ...........

$6.27 D0470................ E.................... ................... Diagnostic casts.... ........... ........... ........... ........... ........... D0472................ S.................... ................... Gross exam, prep &

0330 0.5745 $31.35 ...........

$6.27 report. D0473................ S.................... ................... Micro exam, prep &

0330 0.5745 $31.35 ...........

$6.27 report. D0474................ S.................... ................... Micro w exam of surg

0330 0.5745 $31.35 ...........

$6.27 margins. D0480................ S.................... ................... Cytopath smear prep

0330 0.5745 $31.35 ...........

$6.27 & report. D0502................ S.................... ................... Other oral pathology

0330 0.5745 $31.35 ...........

$6.27 procedu. D0999................ S.................... ................... Unspecified

0330 0.5745 $31.35 ...........

$6.27 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. 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

0330 0.5745 $31.35 ...........

$6.27 unilat. D1515................ S.................... ................... Fixed bilat space

0330 0.5745 $31.35 ...........

$6.27 maintainer. D1520................ S.................... ................... Remove unilat space

0330 0.5745 $31.35 ...........

$6.27 maintain. D1525................ S.................... ................... Remove bilat space

0330 0.5745 $31.35 ...........

$6.27 maintain. D1550................ S.................... ................... Recement space

0330 0.5745 $31.35 ...........

$6.27 maintainer. 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.

[[Page 63613]]

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. 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. D2799................ E.................... ................... Provisional crown... ........... ........... ........... ........... ........... D2910................ E.................... ................... Dental recement ........... ........... ........... ........... ........... inlay. D2920................ E.................... ................... Dental recement ........... ........... ........... ........... ........... crown. 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. 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. D2970................ S.................... ................... Temporary- fractured

0330 0.5745 $31.35 ...........

$6.27 tooth. D2980................ E.................... ................... Crown repair........ ........... ........... ........... ........... ........... D2999................ S.................... ................... Dental unspec

0330 0.5745 $31.35 ...........

$6.27 restorative pr. 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

0330 0.5745 $31.35 ...........

$6.27 endosseous implan. 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 0.5745 $31.35 ...........

$6.27

[[Page 63614]]

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

0330 0.5745 $31.35 ...........

$6.27 quadrant. D4261................ E.................... ................... Osseous surgl-

........... ........... ........... ........... ........... 3teethperquad. D4263................ S.................... ................... Bone replce graft

0330 0.5745 $31.35 ...........

$6.27 first site. D4264................ S.................... ................... Bone replce graft

0330 0.5745 $31.35 ...........

$6.27 each add. 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

0330 0.5745 $31.35 ...........

$6.27 procedure. D4270................ S.................... ................... Pedicle soft tissue

0330 0.5745 $31.35 ...........

$6.27 graft pr. D4271................ S.................... ................... Free soft tissue

0330 0.5745 $31.35 ...........

$6.27 graft proc. D4273................ S.................... ................... Subepithelial tissue

0330 0.5745 $31.35 ...........

$6.27 graft. 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

0330 0.5745 $31.35 ...........

$6.27 debridement. D4381................ S.................... ................... Localized chemo

0330 0.5745 $31.35 ...........

$6.27 delivery. 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. 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.

[[Page 63615]]

D5899................ E.................... ................... Removable

........... ........... ........... ........... ........... prosthodontic proc. D5911................ S.................... ................... Facial moulage

0330 0.5745 $31.35 ...........

$6.27 sectional. D5912................ S.................... ................... Facial moulage

0330 0.5745 $31.35 ...........

$6.27 complete. D5913................ E.................... ................... Nasal prosthesis.... ........... ........... ........... ........... ........... D5914................ E.................... ................... Auricular prosthesis ........... ........... ........... ........... ........... 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 0.5745 $31.35 ...........

$6.27 D5984................ S.................... ................... Radiation shield....

0330 0.5745 $31.35 ...........

$6.27 D5985................ S.................... ................... Radiation cone

0330 0.5745 $31.35 ...........

$6.27 locator. D5986................ E.................... ................... Fluoride applicator. ........... ........... ........... ........... ........... D5987................ S.................... ................... Commissure splint...

0330 0.5745 $31.35 ...........

$6.27 D5988................ E.................... ................... Surgical splint..... ........... ........... ........... ........... ........... D5999................ E.................... ................... Maxillofacial

........... ........... ........... ........... ........... prosthesis. D6010................ E.................... ................... Odontics endosteal ........... ........... ........... ........... ........... implant. D6020................ E.................... ................... Odontics abutment ........... ........... ........... ........... ........... placement. 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...... ........... ........... ........... ........... ........... D6095................ E.................... ................... Odontics repr

........... ........... ........... ........... ........... abutment. D6100................ E.................... ................... Removal of implant.. ........... ........... ........... ........... ........... D6199................ E.................... ................... Implant procedure... ........... ........... ........... ........... ...........

[[Page 63616]]

D6210................ E.................... ................... Prosthodont high ........... ........... ........... ........... ........... noble metal. D6211................ E.................... ................... Bridge base metal ........... ........... ........... ........... ........... cast. D6212................ E.................... ................... Bridge noble metal ........... ........... ........... ........... ........... cast. 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. 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. D6920................ S.................... ................... Dental connector bar

0330 0.5745 $31.35 ...........

$6.27 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. 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

0330 0.5745 $31.35 ...........

$6.27 deciduous t. D7140................ S.................... ................... Extraction erupted

0330 0.5745 $31.35 ...........

$6.27 tooth/exr. D7210................ S.................... ................... Rem imp tooth w

0330 0.5745 $31.35 ...........

$6.27 mucoper flp. D7220................ S.................... ................... Impact tooth remov

0330 0.5745 $31.35 ...........

$6.27 soft tiss. D7230................ S.................... ................... Impact tooth remov

0330 0.5745 $31.35 ...........

$6.27 part bony. D7240................ S.................... ................... Impact tooth remov

0330 0.5745 $31.35 ...........

$6.27 comp bony. D7241................ S.................... ................... Impact tooth rem

0330 0.5745 $31.35 ...........

$6.27 bony w/comp. D7250................ S.................... ................... Tooth root removal..

0330 0.5745 $31.35 ...........

$6.27 D7260................ S.................... ................... Oral antral fistula

0330 0.5745 $31.35 ...........

$6.27 closure. D7261................ S.................... ................... Primary closure

0330 0.5745 $31.35 ...........

$6.27 sinus perf. D7270................ E.................... ................... Tooth reimplantation ........... ........... ........... ........... ........... D7272................ E.................... ................... Tooth

........... ........... ........... ........... ........... transplantation. D7280................ E.................... ................... Exposure impact ........... ........... ........... ........... ........... tooth orthod. D7281................ E.................... ................... Exposure tooth aid ........... ........... ........... ........... ........... eruption. D7282................ E.................... ................... Mobilize erupted/ ........... ........... ........... ........... ........... malpos toot. D7285................ E.................... ................... Biopsy of oral

........... ........... ........... ........... ........... tissue hard. D7286................ E.................... ................... Biopsy of oral

........... ........... ........... ........... ........... tissue soft.

[[Page 63617]]

D7287................ E.................... ................... Cytology sample ........... ........... ........... ........... ........... collection. D7290................ E.................... ................... Repositioning of ........... ........... ........... ........... ........... teeth. D7291................ S.................... ................... Transseptal

0330 0.5745 $31.35 ...........

$6.27 fiberotomy. D7310................ E.................... ................... Alveoplasty w/

........... ........... ........... ........... ........... extraction. D7320................ E.................... ................... Alveoplasty w/o ........... ........... ........... ........... ........... extraction. D7340................ E.................... ................... Vestibuloplasty ........... ........... ........... ........... ........... ridge extens. D7350................ E.................... ................... Vestibuloplasty ........... ........... ........... ........... ........... exten graft. D7410................ E.................... ................... Rad exc lesion up to ........... ........... ........... ........... ........... 1.25 cm. D7411................ E.................... ................... Excision benign ........... ........... ........... ........... ........... lesion1. 25c. D7412................ E.................... ................... Excision benign ........... ........... ........... ........... ........... lesion compl. D7413................ E.................... ................... Excision malig

........... ........... ........... ........... ........... lesion1. 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. D7520................ E.................... ................... I&d abscess

........... ........... ........... ........... ........... extraoral. 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. 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

0330 0.5745 $31.35 ...........

$6.27 orthognathic.

[[Page 63618]]

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...... ........... ........... ........... ........... ........... D7955................ E.................... ................... Repair maxillofacial ........... ........... ........... ........... ........... defects. D7960................ E.................... ................... Frenulectomy/

........... ........... ........... ........... ........... frenulotomy. 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. 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/

0330 0.5745 $31.35 ...........

$6.27 medicaments. D9910................ E.................... ................... Dent appl

........... ........... ........... ........... ........... desensitizing med. D9911................ E.................... ................... Appl desensitizing ........... ........... ........... ........... ........... resin. D9920................ E.................... ................... Behavior management. ........... ........... ........... ........... ........... D9930................ S.................... ................... Treatment of

0330 0.5745 $31.35 ...........

$6.27 complications. D9940................ S.................... ................... Dental occlusal

0330 0.5745 $31.35 ...........

$6.27 guard. D9941................ E.................... ................... Fabrication athletic ........... ........... ........... ........... ........... guard. D9950................ S.................... ................... Occlusion analysis..

0330 0.5745 $31.35 ...........

$6.27 D9951................ S.................... ................... Limited occlusal

0330 0.5745 $31.35 ...........

$6.27 adjustment. D9952................ S.................... ................... Complete occlusal

0330 0.5745 $31.35 ...........

$6.27 adjustment. 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.

[[Page 63619]]

D9999................ E.................... ................... Adjunctive procedure ........... ........... ........... ........... ........... E0100................ A.................... ................... Cane adjust/fixed ........... ........... ........... ........... ........... with tip. E0105................ A.................... ................... Cane adjust/fixed ........... ........... ........... ........... ........... quad/3 pro. E0110................ A.................... ................... Crutch forearm pair. ........... ........... ........... ........... ........... E0111................ A.................... ................... Crutch forearm each. ........... ........... ........... ........... ........... E0112................ A.................... ................... Crutch underarm pair ........... ........... ........... ........... ........... wood. E0113................ A.................... ................... Crutch underarm each ........... ........... ........... ........... ........... wood. E0114................ A.................... ................... Crutch underarm pair ........... ........... ........... ........... ........... no wood. E0116................ A.................... ................... Crutch underarm each ........... ........... ........... ........... ........... no wood. E0117................ A.................... ................... Underarm

........... ........... ........... ........... ........... springassist crutch. E0118................ E.................... NI................. Crutch substitute... ........... ........... ........... ........... ........... E0130................ A.................... ................... Walker rigid adjust/ ........... ........... ........... ........... ........... fixed ht. E0135................ A.................... ................... Walker folding

........... ........... ........... ........... ........... adjust/fixed. E0140................ Y.................... NI................. Walker w trunk

........... ........... ........... ........... ........... support. E0141................ A.................... ................... Rigid walker wheeled ........... ........... ........... ........... ........... wo seat. E0142................ A.................... DG................. Walker rigid wheeled ........... ........... ........... ........... ........... with se. E0143................ A.................... ................... Walker folding

........... ........... ........... ........... ........... wheeled w/o s. E0144................ A.................... ................... Enclosed walker w ........... ........... ........... ........... ........... rear seat. E0145................ A.................... DG................. Walker whled seat/ ........... ........... ........... ........... ........... crutch att. E0146................ A.................... DG................. Folding walker

........... ........... ........... ........... ........... wheels w seat. E0147................ A.................... ................... Walker variable ........... ........... ........... ........... ........... wheel resist. E0148................ A.................... ................... Heavyduty walker no ........... ........... ........... ........... ........... wheels. E0149................ A.................... ................... Heavy duty wheeled ........... ........... ........... ........... ........... walker. E0153................ A.................... ................... Forearm crutch

........... ........... ........... ........... ........... platform atta. E0154................ A.................... ................... Walker platform ........... ........... ........... ........... ........... attachment. E0155................ A.................... ................... Walker wheel

........... ........... ........... ........... ........... attachment,pair. E0156................ A.................... ................... Walker seat

........... ........... ........... ........... ........... attachment. E0157................ A.................... ................... Walker crutch

........... ........... ........... ........... ........... attachment. E0158................ A.................... ................... Walker leg extenders ........... ........... ........... ........... ........... set of4. E0159................ A.................... ................... Brake for wheeled ........... ........... ........... ........... ........... walker. E0160................ A.................... ................... Sitz type bath or ........... ........... ........... ........... ........... equipment. E0161................ A.................... ................... Sitz bath/equipment ........... ........... ........... ........... ........... w/faucet. E0162................ A.................... ................... Sitz bath chair..... ........... ........... ........... ........... ........... E0163................ A.................... ................... Commode chair

........... ........... ........... ........... ........... stationry fxd. E0164................ A.................... ................... Commode chair mobile ........... ........... ........... ........... ........... fixed a. E0165................ A.................... DG................. Commode chair

........... ........... ........... ........... ........... stationry det. E0166................ A.................... ................... Commode chair mobile ........... ........... ........... ........... ........... detach. E0167................ A.................... ................... Commode chair pail ........... ........... ........... ........... ........... or pan. E0168................ A.................... ................... Heavyduty/wide

........... ........... ........... ........... ........... commode chair. E0169................ A.................... ................... Seatlift incorp ........... ........... ........... ........... ........... commodechair. E0175................ A.................... ................... Commode chair foot ........... ........... ........... ........... ........... rest. E0176................ A.................... ................... Air pressre pad/ ........... ........... ........... ........... ........... cushion nonp. E0177................ A.................... ................... Water press pad/ ........... ........... ........... ........... ........... cushion nonp. E0178................ A.................... ................... Gel pressre pad/ ........... ........... ........... ........... ........... cushion nonp. E0179................ A.................... ................... Dry pressre pad/ ........... ........... ........... ........... ........... cushion nonp. E0180................ A.................... ................... Press pad

........... ........... ........... ........... ........... alternating w pump. E0181................ A.................... ................... Press pad

........... ........... ........... ........... ........... alternating w/ pum. E0182................ A.................... ................... Pressure pad

........... ........... ........... ........... ........... alternating pum. E0184................ A.................... ................... Dry pressure

........... ........... ........... ........... ........... mattress. E0185................ A.................... ................... Gel pressure

........... ........... ........... ........... ........... mattress pad. E0186................ A.................... ................... Air pressure

........... ........... ........... ........... ........... mattress. E0187................ A.................... ................... Water pressure

........... ........... ........... ........... ........... mattress. E0188................ E.................... ................... Synthetic sheepskin ........... ........... ........... ........... ........... pad. E0189................ E.................... ................... Lambswool sheepskin ........... ........... ........... ........... ........... pad. E0190................ E.................... NI................. Positioning cushion. ........... ........... ........... ........... ........... E0191................ A.................... ................... Protector heel or ........... ........... ........... ........... ........... elbow. E0192................ A.................... ................... Pad wheelchr low ........... ........... ........... ........... ........... press/posit. E0193................ A.................... ................... Powered air

........... ........... ........... ........... ........... flotation bed. E0194................ A.................... ................... Air fluidized bed... ........... ........... ........... ........... ........... E0196................ A.................... ................... Gel pressure

........... ........... ........... ........... ........... mattress. E0197................ A.................... ................... Air pressure pad for ........... ........... ........... ........... ........... mattres. E0198................ A.................... ................... Water pressure pad ........... ........... ........... ........... ........... for mattr. E0199................ A.................... ................... Dry pressure pad for ........... ........... ........... ........... ........... mattres. E0200................ A.................... ................... Heat lamp without ........... ........... ........... ........... ........... stand. E0202................ A.................... ................... Phototherapy light w/ ........... ........... ........... ........... ........... photom. E0203................ A.................... ................... Therapeutic lightbox ........... ........... ........... ........... ........... tabletp. E0205................ A.................... ................... Heat lamp with stand ........... ........... ........... ........... ........... E0210................ A.................... ................... Electric heat pad ........... ........... ........... ........... ........... standard. E0215................ A.................... ................... Electric heat pad ........... ........... ........... ........... ........... moist. E0217................ A.................... ................... Water circ heat pad ........... ........... ........... ........... ........... w pump. E0218................ E.................... ................... Water circ cold pad ........... ........... ........... ........... ........... w pump. E0220................ A.................... ................... Hot water bottle.... ........... ........... ........... ........... ........... E0221................ A.................... ................... Infrared heating pad ........... ........... ........... ........... ........... system. E0225................ A.................... ................... Hydrocollator unit.. ........... ........... ........... ........... ........... E0230................ A.................... ................... Ice cap or collar... ........... ........... ........... ........... ...........

[[Page 63620]]

E0231................ E.................... ................... Wound warming device ........... ........... ........... ........... ........... E0232................ E.................... ................... Warming card for NWT ........... ........... ........... ........... ........... E0235................ A.................... ................... Paraffin bath unit ........... ........... ........... ........... ........... portable. E0236................ A.................... ................... Pump for water

........... ........... ........... ........... ........... circulating p. E0238................ A.................... ................... Heat pad non-

........... ........... ........... ........... ........... electric moist. E0239................ A.................... ................... Hydrocollator unit ........... ........... ........... ........... ........... portable. E0240................ E.................... NI................. 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.................... NI................. Trans bench w/wo ........... ........... ........... ........... ........... comm open. E0248................ E.................... NI................. HDtrans bench w/wo ........... ........... ........... ........... ........... comm open. E0249................ A.................... ................... Pad water

........... ........... ........... ........... ........... circulating heat u. E0250................ A.................... ................... Hosp bed fixed ht w/ ........... ........... ........... ........... ........... mattres. E0251................ A.................... ................... Hosp bed fixd ht w/o ........... ........... ........... ........... ........... mattres. E0255................ A.................... ................... Hospital bed var ht ........... ........... ........... ........... ........... w/ mattr. E0256................ A.................... ................... Hospital bed var ht ........... ........... ........... ........... ........... w/o matt. E0260................ A.................... ................... Hosp bed semi-electr ........... ........... ........... ........... ........... w/ matt. E0261................ A.................... ................... Hosp bed semi-electr ........... ........... ........... ........... ........... w/o mat. E0265................ A.................... ................... Hosp bed total

........... ........... ........... ........... ........... electr w/ mat. E0266................ A.................... ................... Hosp bed total elec ........... ........... ........... ........... ........... w/o matt. E0270................ E.................... ................... Hospital bed

........... ........... ........... ........... ........... institutional t. E0271................ A.................... ................... Mattress innerspring ........... ........... ........... ........... ........... E0272................ A.................... ................... Mattress foam rubber ........... ........... ........... ........... ........... E0273................ E.................... ................... Bed board........... ........... ........... ........... ........... ........... E0274................ E.................... ................... Over-bed table...... ........... ........... ........... ........... ........... E0275................ A.................... ................... Bed pan standard.... ........... ........... ........... ........... ........... E0276................ A.................... ................... Bed pan fracture.... ........... ........... ........... ........... ........... E0277................ A.................... ................... Powered pres-redu ........... ........... ........... ........... ........... air mattrs. E0280................ A.................... ................... Bed cradle.......... ........... ........... ........... ........... ........... E0290................ A.................... ................... Hosp bed fx ht w/o ........... ........... ........... ........... ........... rails w/m. E0291................ A.................... ................... Hosp bed fx ht w/o ........... ........... ........... ........... ........... rail w/o. E0292................ A.................... ................... Hosp bed var ht w/o ........... ........... ........... ........... ........... rail w/o. E0293................ A.................... ................... Hosp bed var ht w/o ........... ........... ........... ........... ........... rail w/. E0294................ A.................... ................... Hosp bed semi-elect ........... ........... ........... ........... ........... w/ mattr. E0295................ A.................... ................... Hosp bed semi-elect ........... ........... ........... ........... ........... w/o matt. E0296................ A.................... ................... Hosp bed total elect ........... ........... ........... ........... ........... w/ matt. E0297................ A.................... ................... Hosp bed total elect ........... ........... ........... ........... ........... w/o mat. E0300................ Y.................... NI................. Enclosed ped crib ........... ........... ........... ........... ........... hosp grade. E0301................ Y.................... NI................. HD hosp bed, 350-600 ........... ........... ........... ........... ........... lbs. E0302................ Y.................... NI................. Ex hd hosp bed 600 lbs. E0303................ Y.................... NI................. Hosp bed hvy dty ........... ........... ........... ........... ........... xtra wide. E0304................ Y.................... NI................. Hosp bed xtra hvy ........... ........... ........... ........... ........... dty x wide. E0305................ A.................... ................... Rails bed side half ........... ........... ........... ........... ........... length. E0310................ A.................... ................... Rails bed side full ........... ........... ........... ........... ........... length. E0315................ E.................... ................... Bed accessory brd/ ........... ........... ........... ........... ........... tbl/supprt. E0316................ A.................... ................... Bed safety enclosure ........... ........... ........... ........... ........... E0325................ A.................... ................... Urinal male jug-type ........... ........... ........... ........... ........... E0326................ A.................... ................... Urinal female jug- ........... ........... ........... ........... ........... type. E0350................ E.................... ................... Control unit bowel ........... ........... ........... ........... ........... system. E0352................ E.................... ................... Disposable pack w/ ........... ........... ........... ........... ........... bowel syst. E0370................ E.................... ................... Air elevator for ........... ........... ........... ........... ........... heel. E0371................ A.................... ................... Nonpower mattress ........... ........... ........... ........... ........... overlay. E0372................ A.................... ................... Powered air mattress ........... ........... ........... ........... ........... overlay. E0373................ A.................... ................... Nonpowered pressure ........... ........... ........... ........... ........... mattress. E0424................ A.................... ................... Stationary

........... ........... ........... ........... ........... compressed gas 02. E0425................ E.................... ................... Gas system

........... ........... ........... ........... ........... stationary compre. E0430................ E.................... ................... Oxygen system gas ........... ........... ........... ........... ........... portable. E0431................ A.................... ................... Portable gaseous 02. ........... ........... ........... ........... ........... E0434................ A.................... ................... Portable liquid 02.. ........... ........... ........... ........... ........... E0435................ E.................... ................... Oxygen system liquid ........... ........... ........... ........... ........... portabl. E0439................ A.................... ................... Stationary liquid 02 ........... ........... ........... ........... ........... E0440................ E.................... ................... Oxygen system liquid ........... ........... ........... ........... ........... station. E0441................ A.................... ................... Oxygen contents, ........... ........... ........... ........... ........... gaseous. E0442................ A.................... ................... Oxygen contents, ........... ........... ........... ........... ........... liquid. E0443................ A.................... ................... Portable 02

........... ........... ........... ........... ........... contents, gas. E0444................ A.................... ................... Portable 02

........... ........... ........... ........... ........... contents, liquid. E0445................ A.................... ................... Oximeter non-

........... ........... ........... ........... ........... invasive. E0450................ A.................... ................... Volume vent

........... ........... ........... ........... ........... stationary/porta. E0454................ A.................... ................... Pressure ventilator. ........... ........... ........... ........... ........... E0455................ A.................... ................... Oxygen tent excl ........... ........... ........... ........... ........... croup/ped t. E0457................ A.................... ................... Chest shell......... ........... ........... ........... ........... ...........

[[Page 63621]]

E0459................ A.................... ................... Chest wrap.......... ........... ........... ........... ........... ........... E0460................ A.................... ................... Neg press vent

........... ........... ........... ........... ........... portabl/statn. E0461................ A.................... ................... Vol vent noninvasive ........... ........... ........... ........... ........... interfa. E0462................ A.................... ................... Rocking bed w/ or w/ ........... ........... ........... ........... ........... o side r. E0470................ Y.................... NI................. RAD w/o backup non- ........... ........... ........... ........... ........... inv intfc. E0471................ Y.................... NI................. RAD w/backup non inv ........... ........... ........... ........... ........... intrfc. E0472................ Y.................... NI................. RAD w backup

........... ........... ........... ........... ........... invasive intrfc. E0480................ A.................... ................... Percussor elect/ ........... ........... ........... ........... ........... pneum home m. E0481................ E.................... ................... Intrpulmnry percuss ........... ........... ........... ........... ........... vent sys. E0482................ A.................... ................... Cough stimulating ........... ........... ........... ........... ........... device. E0483................ A.................... ................... Chest compression ........... ........... ........... ........... ........... gen system. E0484................ A.................... ................... Non-elec oscillatory ........... ........... ........... ........... ........... pep dvc. E0500................ A.................... ................... Ippb all types...... ........... ........... ........... ........... ........... E0550................ A.................... ................... Humidif extens

........... ........... ........... ........... ........... supple w ippb. E0555................ A.................... ................... Humidifier for use w/ ........... ........... ........... ........... ........... regula. E0560................ A.................... ................... Humidifier

........... ........... ........... ........... ........... supplemental w/ i. E0561................ Y.................... NI................. Humidifier nonheated ........... ........... ........... ........... ........... w PAP. E0562................ Y.................... NI................. Humidifier heated ........... ........... ........... ........... ........... used w PAP. E0565................ A.................... ................... Compressor air power ........... ........... ........... ........... ........... source. E0570................ A.................... ................... Nebulizer with

........... ........... ........... ........... ........... compression. E0571................ A.................... ................... Aerosol compressor ........... ........... ........... ........... ........... for svneb. E0572................ A.................... ................... Aerosol compressor ........... ........... ........... ........... ........... adjust pr. E0574................ A.................... ................... Ultrasonic generator ........... ........... ........... ........... ........... w svneb. E0575................ A.................... ................... Nebulizer ultrasonic ........... ........... ........... ........... ........... E0580................ A.................... ................... Nebulizer for use w/ ........... ........... ........... ........... ........... regulat. E0585................ A.................... ................... Nebulizer w/

........... ........... ........... ........... ........... compressor & he. E0590................ A.................... ................... Dispensing fee dme ........... ........... ........... ........... ........... neb drug. E0600................ A.................... ................... Suction pump portab ........... ........... ........... ........... ........... hom modl. E0601................ A.................... ................... Cont airway pressure ........... ........... ........... ........... ........... device. E0602................ E.................... ................... Manual breast pump.. ........... ........... ........... ........... ........... E0603................ A.................... ................... Electric breast pump ........... ........... ........... ........... ........... E0604................ A.................... ................... Hosp grade elec ........... ........... ........... ........... ........... breast pump. E0605................ A.................... ................... Vaporizer room type. ........... ........... ........... ........... ........... E0606................ A.................... ................... Drainage board

........... ........... ........... ........... ........... postural. E0607................ A.................... ................... Blood glucose

........... ........... ........... ........... ........... monitor home. E0610................ A.................... ................... Pacemaker monitr ........... ........... ........... ........... ........... audible/vis. E0615................ A.................... ................... Pacemaker monitr ........... ........... ........... ........... ........... digital/vis. E0616................ N.................... ................... Cardiac event

........... ........... ........... ........... ........... recorder. E0617................ A.................... ................... Automatic ext

........... ........... ........... ........... ........... defibrillator. E0618................ A.................... ................... Apnea monitor....... ........... ........... ........... ........... ........... E0619................ A.................... ................... Apnea monitor w ........... ........... ........... ........... ........... recorder. E0620................ A.................... ................... Cap bld skin

........... ........... ........... ........... ........... piercing laser. E0621................ A.................... ................... Patient lift sling ........... ........... ........... ........... ........... or seat. E0625................ E.................... ................... Patient lift

........... ........... ........... ........... ........... bathroom or toi. E0627................ A.................... ................... Seat lift incorp ........... ........... ........... ........... ........... lift-chair. E0628................ A.................... ................... Seat lift for pt ........... ........... ........... ........... ........... furn-electr. E0629................ A.................... ................... Seat lift for pt ........... ........... ........... ........... ........... furn-non-el. E0630................ A.................... ................... Patient lift

........... ........... ........... ........... ........... hydraulic. E0635................ A.................... ................... Patient lift

........... ........... ........... ........... ........... electric. E0636................ A.................... ................... PT support &

........... ........... ........... ........... ........... positioning sys. E0637................ Y.................... NI................. Sit-stand w seatlift ........... ........... ........... ........... ........... wheeled. E0638................ Y.................... NI................. Standing frame sys ........... ........... ........... ........... ........... wheeled. E0650................ A.................... ................... Pneuma compresor non- ........... ........... ........... ........... ........... segment. E0651................ A.................... ................... Pneum compressor ........... ........... ........... ........... ........... segmental. E0652................ A.................... ................... Pneum compres w/cal ........... ........... ........... ........... ........... pressure. E0655................ A.................... ................... Pneumatic appliance ........... ........... ........... ........... ........... half arm. E0660................ A.................... ................... Pneumatic appliance ........... ........... ........... ........... ........... full leg. E0665................ A.................... ................... Pneumatic appliance ........... ........... ........... ........... ........... full arm. E0666................ A.................... ................... Pneumatic appliance ........... ........... ........... ........... ........... half leg. E0667................ A.................... ................... Seg pneumatic appl ........... ........... ........... ........... ........... full leg. E0668................ A.................... ................... Seg pneumatic appl ........... ........... ........... ........... ........... full arm. E0669................ A.................... ................... Seg pneumatic appli ........... ........... ........... ........... ........... half leg. E0671................ A.................... ................... Pressure pneum appl ........... ........... ........... ........... ........... full leg. E0672................ A.................... ................... Pressure pneum appl ........... ........... ........... ........... ........... full arm. E0673................ A.................... ................... Pressure pneum appl ........... ........... ........... ........... ........... half leg. E0675................ Y.................... NI................. Pneumatic

........... ........... ........... ........... ........... compression device. E0691................ A.................... ................... Uvl pnl 2 sq ft or ........... ........... ........... ........... ........... less. E0692................ A.................... ................... Uvl sys panel 4 ft.. ........... ........... ........... ........... ........... E0693................ A.................... ................... Uvl sys panel 6 ft.. ........... ........... ........... ........... ........... E0694................ A.................... ................... Uvl md cabinet sys 6 ........... ........... ........... ........... ........... ft. E0700................ E.................... ................... Safety equipment.... ........... ........... ........... ........... ........... E0701................ A.................... ................... Helmet w face guard ........... ........... ........... ........... ........... prefab. E0710................ E.................... ................... Restraints any type. ........... ........... ........... ........... ........... E0720................ A.................... ................... Tens two lead....... ........... ........... ........... ........... ........... E0730................ A.................... ................... Tens four lead...... ........... ........... ........... ........... ...........

[[Page 63622]]

E0731................ A.................... ................... Conductive garment ........... ........... ........... ........... ........... for tens/. E0740................ E.................... ................... Incontinence

........... ........... ........... ........... ........... treatment systm. E0744................ A.................... ................... Neuromuscular stim ........... ........... ........... ........... ........... for scoli. E0745................ A.................... ................... Neuromuscular stim ........... ........... ........... ........... ........... for shock. E0746................ E.................... ................... Electromyograph ........... ........... ........... ........... ........... biofeedback. E0747................ A.................... ................... Elec osteogen stim ........... ........... ........... ........... ........... not spine. E0748................ A.................... ................... Elec osteogen stim ........... ........... ........... ........... ........... spinal. E0749................ N.................... ................... Elec osteogen stim ........... ........... ........... ........... ........... implanted. E0752................ N.................... ................... Neurostimulator ........... ........... ........... ........... ........... electrode. E0754................ A.................... ................... Pulsegenerator pt ........... ........... ........... ........... ........... programmer. E0755................ E.................... ................... Electronic salivary ........... ........... ........... ........... ........... reflex s. E0756................ N.................... ................... Implantable pulse ........... ........... ........... ........... ........... generator. E0757................ N.................... ................... Implantable RF

........... ........... ........... ........... ........... receiver. E0758................ A.................... ................... External RF

........... ........... ........... ........... ........... transmitter. E0759................ A.................... ................... Replace rdfrquncy ........... ........... ........... ........... ........... transmittr. E0760................ E.................... ................... Osteogen ultrasound ........... ........... ........... ........... ........... stimltor. E0761................ E.................... ................... Nontherm

........... ........... ........... ........... ........... electromgntc device. E0765................ E.................... ................... Nerve stimulator for ........... ........... ........... ........... ........... tx n&v. E0776................ A.................... ................... Iv pole............. ........... ........... ........... ........... ........... E0779................ A.................... ................... Amb infusion pump ........... ........... ........... ........... ........... mechanical. E0780................ A.................... ................... Mech amb infusion ........... ........... ........... ........... ........... pump =20[gE] 250 lbs. E2351................ Y.................... NI................. Electronic SGD

........... ........... ........... ........... ........... interface. E2360................ Y.................... NI................. 22nf nonsealed

........... ........... ........... ........... ........... leadacid. E2361................ Y.................... NI................. 22nf sealed leadacid ........... ........... ........... ........... ........... battery. E2362................ Y.................... NI................. Gr24 nonsealed

........... ........... ........... ........... ........... leadacid. E2363................ Y.................... NI................. Gr24 sealed leadacid ........... ........... ........... ........... ........... battery. E2364................ Y.................... NI................. U1nonsealed leadacid ........... ........... ........... ........... ........... battery. E2365................ Y.................... NI................. U1 sealed leadacid ........... ........... ........... ........... ........... battery. E2366................ Y.................... NI................. Battery charger, ........... ........... ........... ........... ........... single mode. E2367................ Y.................... NI................. Battery charger, ........... ........... ........... ........... ........... dual mode. E2399................ Y.................... NI................. Noc interface....... ........... ........... ........... ........... ........... E2402................ Y.................... NI................. Neg press wound ........... ........... ........... ........... ........... therapy pump. E2500................ Y.................... NI................. SGD digitized pre- ........... ........... ........... ........... ........... rec 8min 20min 40 min. E2508................ Y.................... NI................. SGD spelling phys ........... ........... ........... ........... ........... contact. E2510................ Y.................... NI................. SGD w multi methods ........... ........... ........... ........... ........... msg/accs. E2511................ Y.................... NI................. SGD sftwre prgrm for ........... ........... ........... ........... ........... PC/PDA. E2512................ Y.................... NI................. SGD accessory,

........... ........... ........... ........... ........... mounting sys. E2599................ Y.................... NI................. SGD accessory noc... ........... ........... ........... ........... ........... G0001................ A.................... ................... Drawing blood for ........... ........... ........... ........... ........... specimen. G0008................ L.................... ................... Admin influenza ........... ........... ........... ........... ........... virus vac.

[[Page 63626]]

G0009................ L.................... ................... Admin pneumococcal ........... ........... ........... ........... ........... vaccine. G0010................ K.................... ................... Admin hepatitis b

0355 0.2749 $15.00 ...........

$3.00 vaccine. G0025................ D.................... DNG................ Collagen skin test ........... ........... ........... ........... ........... kit. G0027................ A.................... NI................. Semen analysis...... ........... ........... ........... ........... ........... G0030................ S.................... ................... PET imaging prev PET

0285 14.1508 $772.08 $334.45 $154.42 single. G0031................ S.................... ................... PET imaging prev PET

0285 14.1508 $772.08 $334.45 $154.42 multple. G0032................ S.................... ................... PET follow SPECT

0285 14.1508 $772.08 $334.45 $154.42 78464 singl. G0033................ S.................... ................... PET follow SPECT

0285 14.1508 $772.08 $334.45 $154.42 78464 mult. G0034................ S.................... ................... PET follow SPECT

0285 14.1508 $772.08 $334.45 $154.42 76865 singl. G0035................ S.................... ................... PET follow SPECT

0285 14.1508 $772.08 $334.45 $154.42 78465 mult. G0036................ S.................... ................... PET follow cornry

0285 14.1508 $772.08 $334.45 $154.42 angio sing. G0037................ S.................... ................... PET follow cornry

0285 14.1508 $772.08 $334.45 $154.42 angio mult. G0038................ S.................... ................... PET follow myocard

0285 14.1508 $772.08 $334.45 $154.42 perf sing. G0039................ S.................... ................... PET follow myocard

0285 14.1508 $772.08 $334.45 $154.42 perf mult. G0040................ S.................... ................... PET follow stress

0285 14.1508 $772.08 $334.45 $154.42 echo singl. G0041................ S.................... ................... PET follow stress

0285 14.1508 $772.08 $334.45 $154.42 echo mult. G0042................ S.................... ................... PET follow

0285 14.1508 $772.08 $334.45 $154.42 ventriculogm sing. G0043................ S.................... ................... PET follow

0285 14.1508 $772.08 $334.45 $154.42 ventriculogm mult. G0044................ S.................... ................... PET following rest

0285 14.1508 $772.08 $334.45 $154.42 ECG singl. G0045................ S.................... ................... PET following rest

0285 14.1508 $772.08 $334.45 $154.42 ECG mult. G0046................ S.................... ................... PET follow stress

0285 14.1508 $772.08 $334.45 $154.42 ECG singl. G0047................ S.................... ................... PET follow stress

0285 14.1508 $772.08 $334.45 $154.42 ECG mult. G0101................ V.................... ................... CA screen;pelvic/

0600 0.9278 $50.62 ........... $10.12 breast exam. G0102................ N.................... ................... Prostate ca

........... ........... ........... ........... ........... screening; dre. G0103................ A.................... ................... Psa, total screening ........... ........... ........... ........... ........... G0104................ S.................... ................... CA screen;flexi

0159 2.7823 $151.81 ........... $37.95 sigmoidscope. G0105................ T.................... ................... Colorectal scrn; hi

0158 7.4244 $405.08 ........... $101.27 risk ind. G0106................ S.................... ................... Colon CA

0157 2.5693 $140.18 ........... $28.04 screen;barium enema. G0107................ A.................... ................... CA screen; fecal ........... ........... ........... ........... ........... blood test. G0108................ A.................... ................... Diab manage trn per ........... ........... ........... ........... ........... indiv. G0109................ A.................... ................... Diab manage trn ind/ ........... ........... ........... ........... ........... group. G0110................ A.................... DG................. Nett pulm-rehab ........... ........... ........... ........... ........... educ; ind. G0111................ A.................... DG................. Nett pulm-rehab ........... ........... ........... ........... ........... educ; group. G0112................ A.................... DG................. Nett;nutrition guid, ........... ........... ........... ........... ........... initial. G0113................ A.................... DG................. Nett;nutrition

........... ........... ........... ........... ........... guid,subseqnt. G0114................ A.................... DG................. Nett; psychosocial ........... ........... ........... ........... ........... consult. G0115................ A.................... DG................. Nett; psychological ........... ........... ........... ........... ........... testing. G0116................ A.................... DG................. Nett; psychosocial ........... ........... ........... ........... ........... counsel. G0117................ S.................... ................... Glaucoma scrn hgh

0230 0.7619 $41.57 $14.97

$8.31 risk direc. G0118................ S.................... ................... Glaucoma scrn hgh

0230 0.7619 $41.57 $14.97

$8.31 risk direc. G0120................ S.................... ................... Colon ca scrn;

0157 2.5693 $140.18 ........... $28.04 barium enema. G0121................ T.................... ................... Colon ca scrn not hi

0158 7.4244 $405.08 ........... $101.27 rsk ind. G0122................ E.................... ................... Colon ca scrn;

........... ........... ........... ........... ........... barium enema. G0123................ A.................... ................... Screen cerv/vag thin ........... ........... ........... ........... ........... layer. G0124................ A.................... ................... Screen c/v thin ........... ........... ........... ........... ........... layer by MD. G0125................ S.................... ................... PET img WhBD sgl

1516 ........... $1,450.00 ........... $290.00 pulm ring. G0127................ T.................... ................... Trim nail(s)........

0009 0.6652 $36.29

$8.34

$7.26 G0128................ B.................... ................... CORF skilled nursing ........... ........... ........... ........... ........... service. G0129................ P.................... ................... Partial hosp prog

0033 5.2569 $286.82 ........... $57.36 service. G0130................ X.................... ................... Single energy x-ray

0260 0.7802 $42.57 $21.28

$8.51 study. G0141................ E.................... ................... Scr c/v cyto,autosys ........... ........... ........... ........... ........... and md. G0143................ A.................... ................... Scr c/v

........... ........... ........... ........... ........... cyto,thinlayer,resc r. G0144................ A.................... ................... Scr c/v

........... ........... ........... ........... ........... cyto,thinlayer,resc r. G0145................ A.................... ................... Scr c/v

........... ........... ........... ........... ........... cyto,thinlayer,resc r. 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,

0678 2.0659 $112.72 ........... $22.54 per tx. G0167................ B.................... DG................. Hyperbaric oz tx;no ........... ........... ........... ........... ........... md reqrd. G0168................ X.................... ................... Wound closure by

0340 0.6314 $34.45 ...........

$6.89 adhesive. G0173................ S.................... ................... Stereo

1528 ........... $5,250.00 ........... $1,050.00 radoisurgery,comple te. G0175................ V.................... ................... OPPS Service,sched

0602 1.5041 $82.07 ........... $16.41 team conf. G0176................ P.................... ................... OPPS/PHP;activity

0033 5.2569 $286.82 ........... $57.36 therapy. G0177................ P.................... ................... OPPS/PHP; train &

0033 5.2569 $286.82 ........... $57.36 educ serv. 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

0235 5.0749 $276.89 $72.04 $55.38 vssl tech. G0202................ A.................... ................... Screeningmammography ........... ........... ........... ........... ........... digital.

[[Page 63627]]

G0204................ S.................... ................... Diagnosticmammograph

0669 0.9009 $49.15 ...........

$9.83 ydigital. G0206................ S.................... ................... Diagnosticmammograph

0669 0.9009 $49.15 ...........

$9.83 ydigital. G0210................ S.................... ................... PET img whbd ring

1516 ........... $1,450.00 ........... $290.00 dxlung ca. G0211................ S.................... ................... PET img whbd ring

1516 ........... $1,450.00 ........... $290.00 init lung. G0212................ S.................... ................... PET img whbd ring

1516 ........... $1,450.00 ........... $290.00 restag lun. G0213................ S.................... ................... PET img whbd ring dx

1516 ........... $1,450.00 ........... $290.00 colorec. G0214................ S.................... ................... PET img whbd ring

1516 ........... $1,450.00 ........... $290.00 init colre. G0215................ S.................... ................... PET img whbd restag

1516 ........... $1,450.00 ........... $290.00 col. G0216................ S.................... ................... PET img whbd ring dx

1516 ........... $1,450.00 ........... $290.00 melanom. G0217................ S.................... ................... PET img whbd ring

1516 ........... $1,450.00 ........... $290.00 init melan. G0218................ S.................... ................... PET img whbd ring

1516 ........... $1,450.00 ........... $290.00 restag mel. G0219................ E.................... ................... PET img whbd ring ........... ........... ........... ........... ........... noncov ind. G0220................ S.................... ................... PET img whbd ring dx

1516 ........... $1,450.00 ........... $290.00 lymphom. G0221................ S.................... ................... PET img whbd ring

1516 ........... $1,450.00 ........... $290.00 init lymph. G0222................ S.................... ................... PET img whbd ring

1516 ........... $1,450.00 ........... $290.00 resta lymp. G0223................ S.................... ................... PET img whbd reg

1516 ........... $1,450.00 ........... $290.00 ring dx hea. G0224................ S.................... ................... PETimg whbd reg ring

1516 ........... $1,450.00 ........... $290.00 ini hea. G0225................ S.................... ................... PET img whbd ring

1516 ........... $1,450.00 ........... $290.00 restag hea. G0226................ S.................... ................... PET img whbd dx

1516 ........... $1,450.00 ........... $290.00 esophag. G0227................ S.................... ................... PET img whbd ring

1516 ........... $1,450.00 ........... $290.00 ini esopha. G0228................ S.................... ................... PET img whbd ring

1516 ........... $1,450.00 ........... $290.00 restg esop. G0229................ S.................... ................... PET img metabolic

1516 ........... $1,450.00 ........... $290.00 brain ring. G0230................ S.................... ................... PET myocard

1516 ........... $1,450.00 ........... $290.00 viability ring. G0231................ S.................... ................... PET WhBD colorec;

1516 ........... $1,450.00 ........... $290.00 gamma cam. G0232................ S.................... ................... PET whbd lymphoma;

1516 ........... $1,450.00 ........... $290.00 gamma cam. G0233................ S.................... ................... PET whbd melanoma;

1516 ........... $1,450.00 ........... $290.00 gamma cam. G0234................ S.................... ................... PET WhBD pulm nod;

1516 ........... $1,450.00 ........... $290.00 gamma cam. G0236................ D.................... DNG................ Digital film convert ........... ........... ........... ........... ........... diag ma. G0237................ S.................... ................... Therapeutic procd

0411 0.4367 $23.83 ...........

$4.77 strg endur. G0238................ S.................... ................... Oth resp proc, indiv

0411 0.4367 $23.83 ...........

$4.77 G0239................ S.................... ................... Oth resp proc, group

0411 0.4367 $23.83 ...........

$4.77 G0242................ S.................... ................... Multisource photon

1516 ........... $1,450.00 ........... $290.00 ster plan. G0243................ S.................... ................... Multisour photon

1528 ........... $5,250.00 ........... $1,050.00 stero treat. G0244................ S.................... ................... Observ care by

0339 3.8356 $209.27 ........... $41.85 facility topt. G0245................ V.................... ................... Initial Foot Exam

0600 0.9278 $50.62 ........... $10.12 PTLOPS. G0246................ V.................... ................... Follow-up Eval of

0600 0.9278 $50.62 ........... $10.12 Foot PTLOPS. G0247................ T.................... ................... Routine footcare w

0009 0.6652 $36.29

$8.34

$7.26 LOPS. G0248................ S.................... ................... Demonstrate use home

1503 ........... $150.00 ........... $30.00 INR mon. G0249................ S.................... ................... Provide test

1503 ........... $150.00 ........... $30.00 material,equipm. G0250................ E.................... ................... MD review interpret ........... ........... ........... ........... ........... of test. G0251................ S.................... ................... Linear acc based

1513 ........... $1,150.00 ........... $230.00 stero radio. G0252................ E.................... ................... PET imaging initial ........... ........... ........... ........... ........... dx. G0253................ S.................... ................... PET image brst

1516 ........... $1,450.00 ........... $290.00 dection recur. G0254................ S.................... ................... PET image brst eval

1516 ........... $1,450.00 ........... $290.00 to tx. G0255................ E.................... ................... Current percep

........... ........... ........... ........... ........... threshold tst. G0256................ D.................... DNG................ Prostate brachy w ........... ........... ........... ........... ........... palladium. G0257................ S.................... ................... Unsched dialysis

0170 5.9678 $325.61 ........... $65.12 ESRD pt hos. G0259................ N.................... ................... Inject for

........... ........... ........... ........... ........... sacroiliac joint. G0260................ T.................... ................... Inj for sacroiliac

0204 2.1711 $118.46 $40.13 $23.69 jt anesth. G0261................ D.................... DNG................ Prostate brachy w ........... ........... ........... ........... ........... iodine see. G0262................ S.................... DG................. Sm intestinal image

1508 ........... $650.00 ........... $130.00 capsule. G0263................ N.................... ................... Adm with CHF, CP, ........... ........... ........... ........... ........... asthma. G0264................ V.................... ................... Assmt otr CHF, CP,

0600 0.9278 $50.62 ........... $10.12 asthma. G0265................ A.................... ................... Cryopresevation ........... ........... ........... ........... ........... Freeze+stora. G0266................ A.................... ................... Thawing + expansion ........... ........... ........... ........... ........... froz cel. G0267................ S.................... ................... Bone marrow or psc

0110 3.6718 $200.34 ........... $40.07 harvest. G0268................ X.................... ................... Removal of impacted

0340 0.6314 $34.45 ...........

$6.89 wax md. G0269................ N.................... ................... Occlusive device in ........... ........... ........... ........... ........... vein art. G0270................ A.................... ................... MNT subs tx for ........... ........... ........... ........... ........... change dx. G0271................ A.................... ................... Group MNT 2 or more ........... ........... ........... ........... ........... 30 mins. G0272................ X.................... DG................. Naso/oro gastric

0272 1.4166 $77.29 $38.36 $15.46 tube pl MD. G0273................ D.................... DNG................ Pretx planning, non- ........... ........... ........... ........... ........... Hodgkins. G0274................ D.................... DNG................ Radiopharm tx, non- ........... ........... ........... ........... ........... Hodgkins. 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................ A.................... ................... Elect stim wound ........... ........... ........... ........... ........... care not pd. G0283................ A.................... ................... Elec stim other than ........... ........... ........... ........... ........... wound. G0288................ S.................... ................... Recon, CTA for pre &

1506 ........... $450.00 ........... $90.00 post sug. G0289................ N.................... ................... Arthro, loose body + ........... ........... ........... ........... ........... chondro. G0290................ T.................... ................... Drug-eluting stents,

0656 103.4907 $5,646.56 ........... $1,129.31 single. G0291................ T.................... ................... Drug-eluting

0656 103.4907 $5,646.56 ........... $1,129.31 stents,each add. G0292................ S.................... ................... Adm exp

1503 ........... $150.00 ........... $30.00 drugs,clinical trial.

[[Page 63628]]

G0293................ S.................... ................... Non-cov surg

1505 ........... $350.00 ........... $70.00 proc,clin trial. G0294................ S.................... ................... Non-cov proc,

1502 ........... $75.00 ........... $15.00 clinical trial. G0295................ E.................... ................... Electromagnetic ........... ........... ........... ........... ........... therapy onc. G0296................ S.................... NF................. PET imge restag

1516 ........... $1,450.00 ........... $290.00 thyrod cance. G0297................ T.................... NF................. Insert single

0107 337.1304 $18,394.17 $3,699.14 $3,678.83 chamber/cd. G0298................ T.................... NF................. Insert dual chamber/

0107 337.1304 $18,394.17 $3,699.14 $3,678.83 cd. G0299................ T.................... NF................. Inser/repos single

0108 433.2998 $23,641.27 ........... $4,728.25 icd+leads. G0300................ T.................... NF................. Insert reposit lead

0108 433.2998 $23,641.27 ........... $4,728.25 dual+gen. G0302................ S.................... NI................. Pre-op service LVRS

1509 ........... $750.00 ........... $150.00 complete. G0303................ S.................... NI................. Pre-op service LVRS

1507 ........... $550.00 ........... $110.00 10-15dos. G0304................ S.................... NI................. Pre-op service LVRS

1504 ........... $250.00 ........... $50.00 1-9 dos. G0305................ S.................... NI................. Post op service LVRS

1504 ........... $250.00 ........... $50.00 min 6. G0306................ A.................... NI................. CBC/diffwbc w/o ........... ........... ........... ........... ........... platelet. G0307................ A.................... NI................. CBC without platelet ........... ........... ........... ........... ........... G0323................ A.................... NI................. ESRD related svs ........... ........... ........... ........... ........... home mo 20+. G0324................ A.................... NI................. ESRD related svs ........... ........... ........... ........... ........... home/dy/2y. G0325................ A.................... NI................. ESRD relate home/dy ........... ........... ........... ........... ........... 2-11yr. G0326................ A.................... NI................. ESRD relate home/dy ........... ........... ........... ........... ........... 12-19y. G0327................ A.................... NI................. ESRD relate home/dy ........... ........... ........... ........... ........... 20+yrs. G0338................ S.................... NI................. Linear accelerator

1516 ........... $1,450.00 ........... $290.00 stero pln. G0339................ S.................... NI................. Robot lin-radsurg

1528 ........... $5,250.00 ........... $1,050.00 com, first. G0340................ S.................... NI................. Robot lin-radsurg

1525 ........... $3,750.00 ........... $750.00 fractx 2-5. G3001................ S.................... NI................. Admin + supply,

1522 ........... $2,250.00 ........... $450.00 tositumomab. 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. G9016................ E.................... ................... Demo-smoking

........... ........... ........... ........... ........... cessation coun. J0120................ N.................... ................... Tetracyclin

........... ........... ........... ........... ........... injection. J0130................ K.................... ................... Abciximab injection.

1605 5.3048 $289.44 ........... $57.89 J0150................ K.................... ................... Injection adenosine

0379 0.2078 $11.34 ...........

$2.27 6 MG. J0151................ D.................... DNG................ Adenosine injection. ........... ........... ........... ........... ........... J0152................ K.................... NI................. Adenosine injection.

0917 1.0393 $56.71 ........... $11.34 J0170................ N.................... ................... Adrenalin epinephrin ........... ........... ........... ........... ........... inject. J0190................ N.................... ................... Inj biperiden

........... ........... ........... ........... ........... lactate/5 mg. J0200................ N.................... ................... Alatrofloxacin

........... ........... ........... ........... ........... mesylate. J0205................ K.................... ................... Alglucerase

0900 ........... $37.13 ...........

$7.43 injection. J0207................ K.................... ................... Amifostine..........

7000 5.3041 $289.40 ........... $57.88 J0210................ N.................... ................... Methyldopate hcl ........... ........... ........... ........... ........... injection. J0215................ B.................... ................... Alefacept........... ........... ........... ........... ........... ........... J0256................ K.................... ................... Alpha 1 proteinase

0901 ...........

$3.43 ...........

$0.69 inhibitor. J0270................ B.................... ................... Alprostadil for ........... ........... ........... ........... ........... injection. J0275................ B.................... ................... Alprostadil urethral ........... ........... ........... ........... ........... suppos. J0280................ N.................... ................... Aminophyllin 250 MG ........... ........... ........... ........... ........... inj. J0282................ N.................... ................... Amiodarone HCl...... ........... ........... ........... ........... ........... J0285................ N.................... ................... Amphotericin B...... ........... ........... ........... ........... ........... J0287................ K.................... ................... Amphotericin b lipid

9024 0.3823 $20.86 ...........

$4.17 complex. J0288................ K.................... ................... Ampho b cholesteryl

9024 0.3823 $20.86 ...........

$4.17 sulfate. J0289................ K.................... ................... Amphotericin b

9024 0.3823 $20.86 ...........

$4.17 liposome inj. 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................ K.................... ................... Injection

1606 27.7939 $1,516.46 ........... $303.29 anistreplase 30 u. J0360................ N.................... ................... Hydralazine hcl ........... ........... ........... ........... ........... injection. J0380................ N.................... ................... Inj metaraminol ........... ........... ........... ........... ........... bitartrate. J0390................ N.................... ................... Chloroquine

........... ........... ........... ........... ........... injection. J0395................ N.................... ................... Arbutamine HCl

........... ........... ........... ........... ........... injection. J0456................ N.................... ................... Azithromycin........ ........... ........... ........... ........... ........... J0460................ N.................... ................... Atropine sulfate ........... ........... ........... ........... ........... injection. J0470................ N.................... ................... Dimecaprol injection ........... ........... ........... ........... ........... J0475................ N.................... ................... Baclofen 10 MG

........... ........... ........... ........... ........... injection. 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.

[[Page 63629]]

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................ N.................... ................... Penicillin g

........... ........... ........... ........... ........... benzathine inj. J0583................ G.................... NI................. Bivalirudin.........

9111 ...........

$1.60 ...........

$0.04 J0585................ K.................... ................... Botulinum toxin a

0902 0.0588

$3.21 ...........

$0.64 per unit. J0587................ K.................... ................... Botulinum toxin type

9018 0.1279

$6.98 ...........

$1.40 B. J0592................ N.................... ................... Buprenorphine

........... ........... ........... ........... ........... hydrochloride. J0595................ N.................... NI................. Butorphanol tartrate ........... ........... ........... ........... ........... 1 mg. J0600................ N.................... ................... Edetate calcium ........... ........... ........... ........... ........... disodium inj. J0610................ N.................... ................... Calcium gluconate ........... ........... ........... ........... ........... injection. J0620................ N.................... ................... Calcium glycer & ........... ........... ........... ........... ........... lact/10 ML. J0630................ N.................... ................... Calcitonin salmon ........... ........... ........... ........... ........... injection. J0636................ N.................... ................... Inj calcitriol per ........... ........... ........... ........... ........... 0.1 mcg. J0637................ K.................... ................... Caspofungin acetate.

9019 0.5432 $29.64 ...........

$5.93 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. J0698................ N.................... ................... Cefotaxime sodium ........... ........... ........... ........... ........... injection. J0702................ N.................... ................... Betamethasone

........... ........... ........... ........... ........... acet&sod phosp. J0704................ N.................... ................... Betamethasone sod ........... ........... ........... ........... ........... phosp/4 MG. J0706................ N.................... ................... Caffeine citrate ........... ........... ........... ........... ........... injection. 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................ N.................... ................... Clonidine

........... ........... ........... ........... ........... hydrochloride. J0740................ N.................... ................... Cidofovir injection. ........... ........... ........... ........... ........... 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................ N.................... ................... Corticotropin

........... ........... ........... ........... ........... injection. J0835................ N.................... ................... Inj cosyntropin per ........... ........... ........... ........... ........... 0.25 MG. J0850................ K.................... ................... Cytomegalovirus imm

0903 5.3368 $291.18 ........... $58.24 IV /vial. J0880................ E.................... ................... Darbepoetin alfa ........... ........... ........... ........... ........... injection. J0895................ N.................... ................... Deferoxamine

........... ........... ........... ........... ........... mesylate inj. 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

........... ........... ........... ........... ........... contraceptiveinject ion. 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................ N.................... ................... Inj

........... ........... ........... ........... ........... dihydroergotamine mesylt. J1120................ N.................... ................... Acetazolamid sodium ........... ........... ........... ........... ........... injectio. J1160................ N.................... ................... Digoxin injection... ........... ........... ........... ........... ........... J1165................ N.................... ................... Phenytoin sodium ........... ........... ........... ........... ........... injection. J1170................ N.................... ................... Hydromorphone

........... ........... ........... ........... ........... injection. J1180................ N.................... ................... Dyphylline injection ........... ........... ........... ........... ........... J1190................ K.................... ................... Dexrazoxane HCl

0726 2.0616 $112.48 ........... $22.50 injection. 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................ K.................... ................... Dipyridamole

0380 0.2525 $13.78 ...........

$2.76 injection. J1250................ N.................... ................... Inj dobutamine HCL/ ........... ........... ........... ........... ........... 250 mg. J1260................ N.................... ................... Dolasetron mesylate. ........... ........... ........... ........... ...........

[[Page 63630]]

J1270................ N.................... ................... Injection,

........... ........... ........... ........... ........... doxercalciferol. J1320................ N.................... ................... Amitriptyline

........... ........... ........... ........... ........... injection. J1325................ N.................... ................... Epoprostenol

........... ........... ........... ........... ........... injection. J1327................ K.................... ................... Eptifibatide

1607 0.1465

$7.99 ...........

$1.60 injection. J1330................ N.................... ................... Ergonovine maleate ........... ........... ........... ........... ........... injection. J1335................ G.................... NI................. Ertapenem injection.

9116 ........... $23.74 ...........

$3.55 J1364................ N.................... ................... Erythro lactobionate ........... ........... ........... ........... ........... /500 MG. J1380................ N.................... ................... Estradiol valerate ........... ........... ........... ........... ........... 10 MG inj. J1390................ N.................... ................... Estradiol valerate ........... ........... ........... ........... ........... 20 MG inj. J1410................ N.................... ................... Inj estrogen

........... ........... ........... ........... ........... conjugate 25 MG. J1435................ N.................... ................... Injection estrone ........... ........... ........... ........... ........... per 1 MG. J1436................ N.................... ................... Etidronate disodium ........... ........... ........... ........... ........... inj. J1438................ K.................... ................... Etanercept injection

1608 1.8762 $102.37 ........... $20.47 J1440................ K.................... ................... Filgrastim 300 mcg

0728 2.2631 $123.48 ........... $24.70 injection. J1441................ K.................... ................... Filgrastim 480 mcg

7049 3.2251 $175.96 ........... $35.19 injection. J1450................ N.................... ................... Fluconazole......... ........... ........... ........... ........... ........... J1452................ N.................... ................... Intraocular

........... ........... ........... ........... ........... Fomivirsen na. J1455................ N.................... ................... Foscarnet sodium ........... ........... ........... ........... ........... injection. 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................ K.................... ................... Immune globulin, 1 g

0905 0.8057 $43.96 ...........

$8.79 J1564................ K.................... ................... Immune globulin 10

9021 0.0080

$0.44 ...........

$0.09 mg. J1565................ K.................... ................... RSV-ivig............

0906 0.8910 $48.61 ...........

$9.72 J1570................ K.................... ................... Ganciclovir sodium

0907 0.5918 $32.29 ...........

$6.46 injection. J1580................ N.................... ................... Garamycin gentamicin ........... ........... ........... ........... ........... inj. J1590................ N.................... ................... Gatifloxacin

........... ........... ........... ........... ........... injection. J1595................ N.................... ................... Injection glatiramer ........... ........... ........... ........... ........... acetate. J1600................ N.................... ................... Gold sodium

........... ........... ........... ........... ........... thiomaleate inj. J1610................ N.................... ................... Glucagon

........... ........... ........... ........... ........... hydrochloride/1 MG. J1620................ N.................... ................... Gonadorelin hydroch/ ........... ........... ........... ........... ........... 100 mcg. J1626................ K.................... ................... Granisetron HCl

0764 0.1044

$5.70 ...........

$1.14 injection. 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................ N.................... ................... Tinzaparin sodium ........... ........... ........... ........... ........... injection. J1670................ N.................... ................... Tetanus immune

........... ........... ........... ........... ........... globulin inj. J1700................ N.................... ................... Hydrocortisone

........... ........... ........... ........... ........... acetate inj. J1710................ N.................... ................... Hydrocortisone

........... ........... ........... ........... ........... sodium ph inj. J1720................ N.................... ................... Hydrocortisone

........... ........... ........... ........... ........... sodium succ i. J1730................ N.................... ................... Diazoxide injection. ........... ........... ........... ........... ........... J1742................ N.................... ................... Ibutilide fumarate ........... ........... ........... ........... ........... injection. J1745................ K.................... ................... Infliximab injection

7043 0.7122 $38.86 ...........

$7.77 J1750................ N.................... ................... Iron dextran........ ........... ........... ........... ........... ........... J1756................ N.................... ................... Iron sucrose

........... ........... ........... ........... ........... injection. J1785................ K.................... ................... Injection

0916 ...........

$3.71 ...........

$0.74 imiglucerase /unit. 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................ K.................... ................... Interferon beta-1a..

0909 3.3868 $184.79 ........... $36.96 J1830................ K.................... ................... Interferon beta-1b /

0910 1.8421 $100.51 ........... $20.10 .25 MG. J1835................ N.................... ................... Itraconazole

........... ........... ........... ........... ........... injection. J1840................ N.................... ................... Kanamycin sulfate ........... ........... ........... ........... ........... 500 MG inj. J1850................ N.................... ................... Kanamycin sulfate 75 ........... ........... ........... ........... ........... MG inj. J1885................ N.................... ................... Ketorolac

........... ........... ........... ........... ........... tromethamine inj. J1890................ N.................... ................... Cephalothin sodium ........... ........... ........... ........... ........... injection. J1910................ N.................... DG................. Kutapressin

........... ........... ........... ........... ........... injection. J1940................ N.................... ................... Furosemide injection ........... ........... ........... ........... ........... J1950................ K.................... ................... Leuprolide acetate /

0800 3.3525 $182.92 ........... $36.58 3.75 MG. J1955................ B.................... ................... Inj levocarnitine ........... ........... ........... ........... ........... per 1 gm. J1956................ N.................... ................... Levofloxacin

........... ........... ........... ........... ........... injection.

[[Page 63631]]

J1960................ N.................... ................... Levorphanol tartrate ........... ........... ........... ........... ........... inj. J1980................ N.................... ................... Hyoscyamine sulfate ........... ........... ........... ........... ........... inj. J1990................ N.................... ................... Chlordiazepoxide ........... ........... ........... ........... ........... injection. J2000................ N.................... DG................. Lidocaine injection. ........... ........... ........... ........... ........... J2001................ N.................... NI................. Lidocaine injection. ........... ........... ........... ........... ........... J2010................ N.................... ................... Lincomycin injection ........... ........... ........... ........... ........... J2020................ K.................... ................... Linezolid injection.

9001 0.2771 $15.12 ...........

$3.02 J2060................ N.................... ................... Lorazepam injection. ........... ........... ........... ........... ........... J2150................ N.................... ................... Mannitol injection.. ........... ........... ........... ........... ........... J2175................ N.................... ................... Meperidine hydrochl / ........... ........... ........... ........... ........... 100 MG. J2180................ N.................... ................... Meperidine/

........... ........... ........... ........... ........... promethazine inj. J2185................ N.................... NI................. Meropenem........... ........... ........... ........... ........... ........... J2210................ N.................... ................... Methylergonovin ........... ........... ........... ........... ........... maleate inj. J2250................ N.................... ................... Inj midazolam

........... ........... ........... ........... ........... hydrochloride. J2260................ K.................... ................... Inj milrinone

7007 0.2129 $11.62 ...........

$2.32 lactate, per 5 mg. J2270................ N.................... ................... Morphine sulfate ........... ........... ........... ........... ........... injection. J2271................ N.................... ................... Morphine so4

........... ........... ........... ........... ........... injection 100mg. J2275................ N.................... ................... Morphine sulfate ........... ........... ........... ........... ........... injection. J2280................ N.................... NI................. 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................ G.................... ................... Nesiritide, per 0.5

9114 ........... $151.62 ........... $22.66 mg vial. J2352................ D.................... DNG................ Octreotide acetate ........... ........... ........... ........... ........... injection. J2353................ K.................... NI................. Octreotide

1207 1.2049 $65.74 ........... $13.15 injection, depot. J2354................ K.................... NI................. Octreotide inj, non-

7031 0.0264

$1.44 ...........

$0.29 depot. J2355................ K.................... ................... Oprelvekin injection

7011 ........... $248.16 ........... $49.63 J2360................ N.................... ................... Orphenadrine

........... ........... ........... ........... ........... injection. J2370................ N.................... ................... Phenylephrine hcl ........... ........... ........... ........... ........... injection. J2400................ N.................... ................... Chloroprocaine hcl ........... ........... ........... ........... ........... injection. J2405................ N.................... ................... Ondansetron hcl ........... ........... ........... ........... ........... injection. J2410................ N.................... ................... Oxymorphone hcl ........... ........... ........... ........... ........... injection. J2430................ K.................... ................... Pamidronate disodium

0730 3.1949 $174.32 ........... $34.86 /30 MG. J2440................ N.................... ................... Papaverin hcl

........... ........... ........... ........... ........... injection. J2460................ N.................... ................... Oxytetracycline ........... ........... ........... ........... ........... injection. J2501................ N.................... ................... Paricalcitol........ ........... ........... ........... ........... ........... J2505................ G.................... NI................. Injection,

9119 ........... $2,802.50 ........... $418.90 pegfilgrastim 6mg. 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................ N.................... ................... Pralidoxime chloride ........... ........... ........... ........... ........... inj. J2760................ N.................... ................... Phentolaine mesylate ........... ........... ........... ........... ........... inj. J2765................ N.................... ................... Metoclopramide hcl ........... ........... ........... ........... ........... injection. J2770................ N.................... ................... Quinupristin/

........... ........... ........... ........... ........... dalfopristin. J2780................ N.................... ................... Ranitidine

........... ........... ........... ........... ........... hydrochloride inj. J2783................ N.................... NI................. Rasburicase......... ........... ........... ........... ........... ........... J2788................ K.................... ................... Rho d immune

9023 0.0310

$1.69 ...........

$0.34 globulin 50 mcg. J2790................ K.................... ................... Rho d immune

0884 0.1863 $10.16 ...........

$2.03 globulin inj. J2792................ K.................... ................... Rho(D) immune

1609 0.1789

$9.76 ...........

$1.95 globulin h, sd. J2795................ N.................... ................... Ropivacaine HCl ........... ........... ........... ........... ........... injection. J2800................ N.................... ................... Methocarbamol

........... ........... ........... ........... ........... injection. J2810................ N.................... ................... Inj theophylline per ........... ........... ........... ........... ........... 40 MG. J2820................ K.................... ................... Sargramostim

0731 0.2991 $16.32 ...........

$3.26 injection. J2910................ N.................... ................... Aurothioglucose ........... ........... ........... ........... ........... injeciton. J2912................ N.................... ................... Sodium chloride ........... ........... ........... ........... ........... injection. J2916................ N.................... ................... Na ferric gluconate ........... ........... ........... ........... ........... complex. J2920................ N.................... ................... Methylprednisolone ........... ........... ........... ........... ........... injection. J2930................ N.................... ................... Methylprednisolone ........... ........... ........... ........... ........... injection.

[[Page 63632]]

J2940................ N.................... ................... Somatrem injection.. ........... ........... ........... ........... ........... J2941................ K.................... ................... Somatropin injection

7034 0.7547 $41.18 ...........

$8.24 J2950................ N.................... ................... Promazine hcl

........... ........... ........... ........... ........... injection. J2993................ K.................... ................... Reteplase injection.

9005 10.4165 $568.33 ........... $113.67 J2995................ K.................... ................... Inj streptokinase /

0911 1.5733 $85.84 ........... $17.17 250000 IU. J2997................ K.................... ................... Alteplase

7048 0.2856 $15.58 ...........

$3.12 recombinant. J3000................ N.................... ................... Streptomycin

........... ........... ........... ........... ........... injection. J3010................ N.................... ................... Fentanyl citrate ........... ........... ........... ........... ........... injeciton. J3030................ N.................... ................... Sumatriptan

........... ........... ........... ........... ........... succinate / 6 MG. J3070................ N.................... ................... Pentazocine hcl ........... ........... ........... ........... ........... injection. J3100................ K.................... ................... Tenecteplase

9002 23.7669 $1,296.75 ........... $259.35 injection. J3105................ N.................... ................... Terbutaline sulfate ........... ........... ........... ........... ........... inj. 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

9108 ........... $572.00 ........... $114.40 injection. J3245................ K.................... ................... Tirofiban

7041

4.176 $227.85 ........... $45.57 hydrochloride. 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

7045 1.1246 $61.36 ........... $12.27 glucoronate. J3310................ N.................... ................... Perphenazine

........... ........... ........... ........... ........... injeciton. J3315................ G.................... ................... Triptorelin pamoate.

9122 ........... $398.62 ........... $59.58 J3320................ N.................... ................... Spectinomycn di-hcl ........... ........... ........... ........... ........... inj. J3350................ N.................... ................... Urea injection...... ........... ........... ........... ........... ........... J3360................ N.................... ................... Diazepam injection.. ........... ........... ........... ........... ........... J3364................ N.................... ................... Urokinase 5000 IU ........... ........... ........... ........... ........... injection. J3365................ K.................... ................... Urokinase 250,000 IU

7036 3.7855 $206.54 ........... $41.31 inj. J3370................ N.................... ................... Vancomycin hcl

........... ........... ........... ........... ........... injection. J3395................ K.................... ................... Verteporfin

1203 16.4439 $897.20 ........... $179.44 injection. J3400................ N.................... ................... Triflupromazine hcl ........... ........... ........... ........... ........... inj. J3410................ N.................... ................... Hydroxyzine hcl ........... ........... ........... ........... ........... injection. J3411................ N.................... NI................. Thiamine hcl 100 mg. ........... ........... ........... ........... ........... J3415................ N.................... NI................. Pyridoxine hcl 100 ........... ........... ........... ........... ........... mg. J3420................ N.................... ................... Vitamin b12

........... ........... ........... ........... ........... injection. J3430................ N.................... ................... Vitamin k

........... ........... ........... ........... ........... phytonadione inj. J3465................ N.................... NI................. Injection,

........... ........... ........... ........... ........... voriconazole. J3470................ N.................... ................... Hyaluronidase

........... ........... ........... ........... ........... injection. J3475................ N.................... ................... Inj magnesium

........... ........... ........... ........... ........... sulfate. J3480................ N.................... ................... Inj potassium

........... ........... ........... ........... ........... chloride. J3485................ N.................... ................... Zidovudine.......... ........... ........... ........... ........... ........... J3486................ G.................... NI................. Ziprasidone mesylate

9204 ........... $20.79 ...........

$3.11 J3487................ G.................... ................... Zoledronic acid.....

9115 ........... $217.43 ........... $32.50 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. 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

0926 ...........

$1.52 ...........

$0.30 (porcine). J7192................ K.................... ................... Factor viii

0927 ...........

$1.01 ...........

$0.20 recombinant. J7193................ K.................... ................... Factor IX non-

0931 ...........

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

$0.10 recombinant. J7194................ K.................... ................... Factor ix complex...

0928 ...........

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

$0.10 J7195................ K.................... ................... Factor IX

0932 ...........

$1.01 ...........

$0.20 recombinant. J7197................ N.................... ................... Antithrombin iii ........... ........... ........... ........... ........... injection. J7198................ K.................... ................... Anti-inhibitor......

0929 ...........

$1.01 ...........

$0.20 J7199................ B.................... ................... Hemophilia clot ........... ........... ........... ........... ........... factor noc.

[[Page 63633]]

J7300................ E.................... ................... Intraut copper

........... ........... ........... ........... ........... contraceptive. J7302................ E.................... ................... Levonorgestrel iu ........... ........... ........... ........... ........... contracept. J7303................ E.................... NI................. Contraceptive

........... ........... ........... ........... ........... vaginal ring. J7308................ N.................... ................... Aminolevulinic acid ........... ........... ........... ........... ........... hcl top. J7310................ K.................... ................... Ganciclovir long act

0913 1.5861 $86.54 ........... $17.31 implant. J7317................ K.................... ................... Sodium hyaluronate

7316 2.5436 $138.78 ........... $27.76 injection. J7320................ K.................... ................... Hylan G-F 20

1611 2.2628 $123.46 ........... $24.69 injection. J7330................ E.................... ................... Cultured

........... ........... ........... ........... ........... chondrocytes implnt. J7340................ E.................... ................... Metabolic active D/E ........... ........... ........... ........... ........... tissue. J7342................ N.................... ................... Metabolically active ........... ........... ........... ........... ........... tissue. J7350................ N.................... ................... Injectable human ........... ........... ........... ........... ........... tissue. J7500................ N.................... ................... Azathioprine oral ........... ........... ........... ........... ........... 50mg. J7501................ N.................... ................... Azathioprine

........... ........... ........... ........... ........... parenteral. J7502................ K.................... ................... Cyclosporine oral

0888 0.0470

$2.56 ...........

$0.51 100 mg. J7504................ K.................... ................... Lymphocyte immune

0890 2.3439 $127.89 ........... $25.58 globulin. J7505................ K.................... ................... Monoclonal

7038 5.8803 $320.84 ........... $64.17 antibodies. J7506................ N.................... ................... Prednisone oral..... ........... ........... ........... ........... ........... J7507................ K.................... ................... Tacrolimus oral per

0891 0.0246

$1.34 ...........

$0.27 1 MG. J7508................ B.................... DG................. Tacrolimus oral per ........... ........... ........... ........... ........... 5 MG. J7509................ N.................... ................... Methylprednisolone ........... ........... ........... ........... ........... oral. J7510................ N.................... ................... Prednisolone oral ........... ........... ........... ........... ........... per 5 mg. J7511................ K.................... ................... Antithymocyte

9104 2.9978 $163.56 ........... $32.71 globuln rabbit. J7513................ K.................... ................... Daclizumab,

1612 ........... $393.78 ........... $78.76 parenteral. J7515................ N.................... ................... Cyclosporine oral 25 ........... ........... ........... ........... ........... mg. J7516................ N.................... ................... Cyclosporin

........... ........... ........... ........... ........... parenteral 250mg. J7517................ K.................... ................... Mycophenolate

9015 0.0374

$2.04 ...........

$0.41 mofetil oral. J7520................ K.................... ................... Sirolimus, oral.....

9020 0.0529

$2.89 ...........

$0.58 J7525................ K.................... ................... Tacrolimus injection

9006 0.1048

$5.72 ...........

$1.14 J7599................ N.................... ................... Immunosuppressive ........... ........... ........... ........... ........... drug noc. J7608................ Y.................... ................... Acetylcysteine inh ........... ........... ........... ........... ........... sol u d. J7618................ Y.................... ................... Albuterol inh sol ........... ........... ........... ........... ........... con. J7619................ Y.................... ................... Albuterol inh sol u ........... ........... ........... ........... ........... d. J7621................ Y.................... NI................. (Levo)albuterol/Ipra- ........... ........... ........... ........... ........... bromide. 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. 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. 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. J8510................ K.................... ................... Oral busulfan.......

7015 0.0288

$1.57 ...........

$0.31 J8520................ K.................... ................... Capecitabine, oral,

7042 0.0302

$1.65 ...........

$0.33 150 mg. J8521................ E.................... ................... Capecitabine, oral, ........... ........... ........... ........... ........... 500 mg. J8530................ N.................... ................... Cyclophosphamide ........... ........... ........... ........... ........... oral 25 MG. J8560................ K.................... ................... Etoposide oral 50 MG

0802 0.5016 $27.37 ...........

$5.47 J8600................ N.................... ................... Melphalan oral 2 MG. ........... ........... ........... ........... ........... J8610................ N.................... ................... Methotrexate oral ........... ........... ........... ........... ........... 2.5 MG. J8700................ K.................... ................... Temozolmide.........

1086 0.0690

$3.76 ...........

$0.75 J8999................ B.................... ................... Oral prescription ........... ........... ........... ........... ........... drug chemo. J9000................ K.................... ................... Doxorubic hcl 10 MG

0847 0.1212

$6.61 ...........

$1.32 vl chemo. J9001................ K.................... ................... Doxorubicin hcl

7046 4.6982 $256.34 ........... $51.27 liposome inj. J9010................ K.................... ................... Alemtuzumab

9110 7.7873 $424.88 ........... $84.98 injection.

[[Page 63634]]

J9015................ K.................... ................... Aldesleukin/single

0807 ........... $680.35 ........... $136.07 use vial. J9017................ K.................... ................... Arsenic trioxide....

9012 0.4933 $26.91 ...........

$5.38 J9020................ K.................... ................... Asparaginase

0814 0.2957 $16.13 ...........

$3.23 injection. J9031................ K.................... ................... Bcg live

0809 1.9015 $103.75 ........... $20.75 intravesical vac. J9040................ K.................... ................... Bleomycin sulfate

0857 2.9427 $160.56 ........... $32.11 injection. J9045................ K.................... ................... Carboplatin

0811 1.5849 $86.47 ........... $17.29 injection. J9050................ N.................... ................... Carmus bischl nitro ........... ........... ........... ........... ........... inj. J9060................ K.................... ................... Cisplatin 10 MG

0813 0.3985 $21.74 ...........

$4.35 injection. J9062................ B.................... ................... Cisplatin 50 MG ........... ........... ........... ........... ........... injection. J9065................ K.................... ................... Inj cladribine per 1

0858 0.6931 $37.82 ...........

$7.56 MG. J9070................ K.................... ................... Cyclophosphamide 100

0815 0.0868

$4.74 ...........

$0.95 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................ K.................... ................... Cyclophosphamide

0816 0.0825

$4.50 ...........

$0.90 lyophilized. J9094................ B.................... ................... Cyclophosphamide ........... ........... ........... ........... ........... lyophilized. J9095................ B.................... ................... Cyclophosphamide ........... ........... ........... ........... ........... lyophilized. J9096................ B.................... ................... Cyclophosphamide ........... ........... ........... ........... ........... lyophilized. J9097................ B.................... ................... Cyclophosphamide ........... ........... ........... ........... ........... lyophilized. J9098................ K.................... NI................. Cytarabine liposome.

1166 5.1134 $278.99 ........... $55.80 J9100................ K.................... ................... Cytarabine hcl 100

0817 0.0930

$5.07 ...........

$1.01 MG inj. J9110................ B.................... ................... Cytarabine hcl 500 ........... ........... ........... ........... ........... MG inj. J9120................ N.................... ................... Dactinomycin

........... ........... ........... ........... ........... actinomycin d. J9130................ K.................... ................... Dacarbazine 100 mg

0819 0.0974

$5.31 ...........

$1.06 inj. J9140................ B.................... ................... Dacarbazine 200 MG ........... ........... ........... ........... ........... inj. J9150................ K.................... ................... Daunorubicin........

0820 1.3557 $73.97 ........... $14.79 J9151................ K.................... ................... Daunorubicin citrate

0821 2.9976 $163.55 ........... $32.71 liposom. J9160................ K.................... ................... Denileukin diftitox,

1084 ........... $1,232.88 ........... $246.58 300 mcg. J9165................ N.................... ................... Diethylstilbestrol ........... ........... ........... ........... ........... injection. J9170................ K.................... ................... Docetaxel...........

0823 4.0499 $220.97 ........... $44.19 J9178................ K.................... NI................. Inj, epirubicin hcl,

1167 0.3744 $20.43 ...........

$4.09 2 mg. J9180................ B.................... DG................. Epirubicin HCl

........... ........... ........... ........... ........... injection. J9181................ K.................... ................... Etoposide 10 MG inj.

0824 0.0836

$4.56 ...........

$0.91 J9182................ B.................... ................... Etoposide 100 MG inj ........... ........... ........... ........... ........... J9185................ K.................... ................... Fludarabine

0842 3.7708 $205.74 ........... $41.15 phosphate inj. J9190................ N.................... ................... Fluorouracil

........... ........... ........... ........... ........... injection. J9200................ K.................... ................... Floxuridine

0827 2.0928 $114.19 ........... $22.84 injection. J9201................ K.................... ................... Gemcitabine HCl.....

0828 1.4742 $80.43 ........... $16.09 J9202................ K.................... ................... Goserelin acetate

0810 5.2265 $285.16 ........... $57.03 implant. J9206................ K.................... ................... Irinotecan injection

0830 1.8428 $100.55 ........... $20.11 J9208................ K.................... ................... Ifosfomide injection

0831 1.9435 $106.04 ........... $21.21 J9209................ K.................... ................... Mesna injection.....

0732 0.5211 $28.43 ...........

$5.69 J9211................ K.................... ................... Idarubicin hcl

0832 3.2663 $178.21 ........... $35.64 injection. J9212................ N.................... ................... Interferon alfacon-1 ........... ........... ........... ........... ........... J9213................ K.................... ................... Interferon alfa-2a

0834 0.3777 $20.61 ...........

$4.12 inj. J9214................ K.................... ................... Interferon alfa-2b

0836 0.2003 $10.93 ...........

$2.19 inj. J9215................ K.................... ................... Interferon alfa-n3

0865 1.4598 $79.65 ........... $15.93 inj. J9216................ K.................... ................... Interferon gamma 1-b

0838 ........... $180.15 ........... $36.03 inj. J9217................ K.................... ................... Leuprolide acetate

9217 5.7252 $312.37 ........... $62.47 suspnsion. J9218................ K.................... ................... Leuprolide acetate

0861 0.7991 $43.60 ...........

$8.72 injeciton. J9219................ K.................... ................... Leuprolide acetate

7051 67.2039 $3,666.71 ........... $733.34 implant. J9230................ N.................... ................... Mechlorethamine hcl ........... ........... ........... ........... ........... inj. J9245................ K.................... ................... Inj melphalan

0840 4.6719 $254.90 ........... $50.98 hydrochl 50 MG. J9250................ N.................... ................... Methotrexate sodium ........... ........... ........... ........... ........... inj. J9260................ B.................... ................... Methotrexate sodium ........... ........... ........... ........... ........... inj. J9263................ B.................... NI................. Oxaliplatin......... ........... ........... ........... ........... ........... J9265................ K.................... ................... Paclitaxel injection

0863 2.0553 $112.14 ........... $22.43 J9266................ N.................... ................... Pegaspargase/singl ........... ........... ........... ........... ........... dose vial. J9268................ K.................... ................... Pentostatin

0844 17.7045 $965.98 ........... $193.20 injection. J9270................ K.................... ................... Plicamycin

0860 0.2826 $15.42 ...........

$3.08 (mithramycin) inj. J9280................ K.................... ................... Mitomycin 5 MG inj..

0862 0.9719 $53.03 ........... $10.61 J9290................ B.................... ................... Mitomycin 20 MG inj. ........... ........... ........... ........... ........... J9291................ B.................... ................... Mitomycin 40 MG inj. ........... ........... ........... ........... ........... J9293................ K.................... ................... Mitoxantrone

0864 3.1832 $173.68 ........... $34.74 hydrochl / 5 MG. J9300................ K.................... ................... Gemtuzumab

9004 ........... $2,022.90 ........... $404.58 ozogamicin. J9310................ K.................... ................... Rituximab cancer

0849 5.6158 $306.40 ........... $61.28 treatment. J9320................ K.................... ................... Streptozocin

0850 1.1948 $65.19 ........... $13.04 injection. J9340................ K.................... ................... Thiotepa injection..

0851 1.0984 $59.93 ........... $11.99 J9350................ K.................... ................... Topotecan...........

0852 7.9435 $433.41 ........... $86.68 J9355................ K.................... ................... Trastuzumab.........

1613 0.7434 $40.56 ...........

$8.11 J9357................ K.................... ................... Valrubicin, 200 mg..

1614 8.4635 $461.78 ........... $92.36 J9360................ N.................... ................... Vinblastine sulfate ........... ........... ........... ........... ........... inj. J9370................ N.................... ................... Vincristine sulfate ........... ........... ........... ........... ........... 1 MG inj. J9375................ B.................... ................... Vincristine sulfate ........... ........... ........... ........... ........... 2 MG inj.

[[Page 63635]]

J9380................ B.................... ................... Vincristine sulfate ........... ........... ........... ........... ........... 5 MG inj. J9390................ K.................... ................... Vinorelbine tartrate/

0855 1.1874 $64.79 ........... $12.96 10 mg. J9395................ G.................... NI................. Injection,

9120 ........... $87.58 ........... $87.58 Fulvestrant. J9600................ K.................... ................... Porfimer sodium.....

0856 29.2205 $1,594.30 ........... $318.86 J9999................ N.................... ................... Chemotherapy drug... ........... ........... ........... ........... ........... K0001................ A.................... ................... Standard wheelchair. ........... ........... ........... ........... ........... K0002................ A.................... ................... Stnd hemi (low seat) ........... ........... ........... ........... ........... whlchr. K0003................ A.................... ................... Lightweight

........... ........... ........... ........... ........... wheelchair. K0004................ A.................... ................... High strength ltwt ........... ........... ........... ........... ........... whlchr. K0005................ A.................... ................... Ultralightweight ........... ........... ........... ........... ........... wheelchair. K0006................ A.................... ................... Heavy duty

........... ........... ........... ........... ........... wheelchair. K0007................ A.................... ................... Extra heavy duty ........... ........... ........... ........... ........... wheelchair. K0009................ A.................... ................... Other manual

........... ........... ........... ........... ........... wheelchair/base. K0010................ A.................... ................... Stnd wt frame power ........... ........... ........... ........... ........... whlchr. K0011................ A.................... ................... Stnd wt pwr whlchr w ........... ........... ........... ........... ........... control. K0012................ A.................... ................... Ltwt portbl power ........... ........... ........... ........... ........... whlchr. K0014................ A.................... ................... Other power whlchr ........... ........... ........... ........... ........... base. K0015................ A.................... ................... Detach non-adjus ........... ........... ........... ........... ........... hght armrst. K0016................ A.................... DG................. Detach adjust armrst ........... ........... ........... ........... ........... cmplete. K0017................ A.................... ................... Detach adjust

........... ........... ........... ........... ........... armrest base. K0018................ A.................... ................... Detach adjust armrst ........... ........... ........... ........... ........... upper. K0019................ A.................... ................... Arm pad each........ ........... ........... ........... ........... ........... K0020................ A.................... ................... Fixed adjust armrest ........... ........... ........... ........... ........... pair. K0022................ A.................... DG................. Reinforced back ........... ........... ........... ........... ........... upholstery. K0023................ A.................... ................... Planr back insrt ........... ........... ........... ........... ........... foam w/strp. K0024................ A.................... ................... Plnr back insrt foam ........... ........... ........... ........... ........... w/hrdwr. K0025................ A.................... DG................. Hook-on headrest ........... ........... ........... ........... ........... extension. K0026................ A.................... DG................. Back upholst lgtwt ........... ........... ........... ........... ........... whlchr. K0027................ A.................... DG................. Back upholst other ........... ........... ........... ........... ........... whlchr. K0028................ A.................... DG................. Manual fully

........... ........... ........... ........... ........... reclining back. K0029................ A.................... DG................. Reinforced seat ........... ........... ........... ........... ........... upholstery. K0030................ A.................... DG................. Solid plnr seat sngl ........... ........... ........... ........... ........... dnsfoam. K0031................ A.................... DG................. Safety belt/pelvic ........... ........... ........... ........... ........... strap. K0032................ A.................... DG................. Seat uphols lgtwt ........... ........... ........... ........... ........... whlchr. K0033................ A.................... DG................. Seat upholstery ........... ........... ........... ........... ........... other whlchr. K0035................ A.................... DG................. Heel loop with ankle ........... ........... ........... ........... ........... strap. K0036................ A.................... DG................. Toe loop each....... ........... ........... ........... ........... ........... K0037................ A.................... ................... High mount flip-up ........... ........... ........... ........... ........... footrest. K0038................ A.................... ................... Leg strap each...... ........... ........... ........... ........... ........... K0039................ A.................... ................... Leg strap h style ........... ........... ........... ........... ........... each. K0040................ A.................... ................... Adjustable angle ........... ........... ........... ........... ........... footplate. K0041................ A.................... ................... Large size footplate ........... ........... ........... ........... ........... each. K0042................ A.................... ................... Standard size

........... ........... ........... ........... ........... footplate each. K0043................ A.................... ................... Ftrst lower

........... ........... ........... ........... ........... extension tube. K0044................ A.................... ................... Ftrst upper hanger ........... ........... ........... ........... ........... bracket. K0045................ A.................... ................... Footrest complete ........... ........... ........... ........... ........... assembly. K0046................ A.................... ................... Elevat legrst low ........... ........... ........... ........... ........... extension. K0047................ A.................... ................... Elevat legrst up ........... ........... ........... ........... ........... hangr brack. K0048................ A.................... DG................. Elevate legrest ........... ........... ........... ........... ........... complete. K0049................ A.................... DG................. Calf pad each....... ........... ........... ........... ........... ........... K0050................ A.................... ................... Ratchet assembly.... ........... ........... ........... ........... ........... K0051................ A.................... ................... Cam relese assem ........... ........... ........... ........... ........... ftrst/lgrst. K0052................ A.................... ................... Swingaway detach ........... ........... ........... ........... ........... footrest. K0053................ A.................... ................... Elevate footrest ........... ........... ........... ........... ........... articulate. K0054................ A.................... DG................. Seat wdth 10-12/15/ ........... ........... ........... ........... ........... 17/20 wc. K0055................ A.................... DG................. Seat dpth 15/17/18 ........... ........... ........... ........... ........... ltwt wc. K0056................ A.................... ................... Seat ht 17 or 21 ........... ........... ........... ........... ........... ltwt wc. K0057................ A.................... DG................. Seat wdth 19/20 hvy ........... ........... ........... ........... ........... dty wc. K0058................ A.................... DG................. Seat dpth 17/18 ........... ........... ........... ........... ........... power wc. K0059................ A.................... ................... Plastic coated

........... ........... ........... ........... ........... handrim each. K0060................ A.................... ................... Steel handrim each.. ........... ........... ........... ........... ........... K0061................ A.................... ................... Aluminum handrim ........... ........... ........... ........... ........... each. K0062................ A.................... DG................. Handrim 8-10 vert/ ........... ........... ........... ........... ........... obliq proj. K0063................ A.................... DG................. Hndrm 12-16 vert/ ........... ........... ........... ........... ........... obliq proj. K0064................ A.................... ................... Zero pressure tube ........... ........... ........... ........... ........... flat free. K0065................ A.................... ................... Spoke protectors.... ........... ........... ........... ........... ........... K0066................ A.................... ................... Solid tire any size ........... ........... ........... ........... ........... each. K0067................ A.................... ................... Pneumatic tire any ........... ........... ........... ........... ........... size each. K0068................ A.................... ................... Pneumatic tire tube ........... ........... ........... ........... ........... each. K0069................ A.................... ................... Rear whl complete ........... ........... ........... ........... ........... solid tire. K0070................ A.................... ................... Rear whl compl pneum ........... ........... ........... ........... ........... tire. K0071................ A.................... ................... Front castr compl ........... ........... ........... ........... ........... pneum tire. K0072................ A.................... ................... Frnt cstr cmpl sem- ........... ........... ........... ........... ........... pneum tir. K0073................ A.................... ................... Caster pin lock each ........... ........... ........... ........... ........... K0074................ A.................... ................... Pneumatic caster ........... ........... ........... ........... ........... tire each.

[[Page 63636]]

K0075................ A.................... ................... Semi-pneumatic

........... ........... ........... ........... ........... caster tire. K0076................ A.................... ................... Solid caster tire ........... ........... ........... ........... ........... each. K0077................ A.................... ................... Front caster assem ........... ........... ........... ........... ........... complete. K0078................ A.................... ................... Pneumatic caster ........... ........... ........... ........... ........... tire tube. K0079................ A.................... DG................. Wheel lock extension ........... ........... ........... ........... ........... pair. K0080................ A.................... DG................. Anti-rollback device ........... ........... ........... ........... ........... pair. K0081................ A.................... ................... Wheel lock assembly ........... ........... ........... ........... ........... complete. K0082................ A.................... DG................. 22 nf deep cycl acid ........... ........... ........... ........... ........... battery. K0083................ A.................... DG................. 22 nf gel cell

........... ........... ........... ........... ........... battery each. K0084................ A.................... DG................. Grp 24 deep cycl ........... ........... ........... ........... ........... acid battry. K0085................ A.................... DG................. Group 24 gel cell ........... ........... ........... ........... ........... battery. K0086................ A.................... DG................. U-1 lead acid

........... ........... ........... ........... ........... battery each. K0087................ A.................... DG................. U-1 gel cell battery ........... ........... ........... ........... ........... each. K0088................ A.................... DG................. Battry chrgr acid/ ........... ........... ........... ........... ........... gel cell. K0089................ A.................... DG................. Battery charger dual ........... ........... ........... ........... ........... mode. K0090................ A.................... ................... Rear tire power ........... ........... ........... ........... ........... wheelchair. K0091................ A.................... ................... Rear tire tube power ........... ........... ........... ........... ........... whlchr. K0092................ A.................... ................... Rear assem cmplt ........... ........... ........... ........... ........... powr whlchr. K0093................ A.................... ................... Rear zero pressure ........... ........... ........... ........... ........... tire tube. K0094................ A.................... ................... Wheel tire for power ........... ........... ........... ........... ........... base. K0095................ A.................... ................... Wheel tire tube each ........... ........... ........... ........... ........... base. K0096................ A.................... ................... Wheel assem powr ........... ........... ........... ........... ........... base complt. K0097................ A.................... ................... Wheel zero presure ........... ........... ........... ........... ........... tire tube. K0098................ A.................... ................... Drive belt power ........... ........... ........... ........... ........... wheelchair. K0099................ A.................... ................... Pwr wheelchair front ........... ........... ........... ........... ........... caster. K0100................ A.................... DG................. Amputee adapter pair ........... ........... ........... ........... ........... K0102................ A.................... ................... Crutch and cane ........... ........... ........... ........... ........... holder. K0103................ A.................... DG................. Transfer board 8 min. K0543................ A.................... DG................. SGD msg formed by ........... ........... ........... ........... ........... spelling. K0544................ A.................... DG................. SGD w multi methods ........... ........... ........... ........... ........... msg/accs. K0545................ A.................... DG................. SGD sftwre prgrm for ........... ........... ........... ........... ........... PC/PDA. K0546................ A.................... DG................. SGD

........... ........... ........... ........... ........... accessory,mounting systm. K0547................ A.................... DG................. SGD accessory NOC... ........... ........... ........... ........... ........... K0548................ N.................... NI................. Insulin lispro...... ........... ........... ........... ........... ........... K0549................ A.................... DG................. Hosp bed hvy dty ........... ........... ........... ........... ........... xtra wide. K0550................ A.................... DG................. Hosp bed xtra hvy ........... ........... ........... ........... ........... dty x wide. K0552................ Y.................... NF................. Supply/Ext inf pump ........... ........... ........... ........... ........... syr type. K0556................ A.................... DG................. Socket insert w lock ........... ........... ........... ........... ........... mech. K0557................ A.................... DG................. Socket insert w/o ........... ........... ........... ........... ........... lock mech. K0558................ A.................... DG................. Intl custm cong/atyp ........... ........... ........... ........... ........... insert. K0559................ A.................... DG................. Initial custom

........... ........... ........... ........... ........... socket insert. K0560................ N.................... DG................. Mcp joint 2-piece ........... ........... ........... ........... ........... for implant. K0581................ A.................... DG................. Ost pch clsd w

........... ........... ........... ........... ........... barrier/filtr. K0582................ A.................... DG................. Ost pch w bar/

........... ........... ........... ........... ........... bltinconv/fltr. K0583................ A.................... DG................. Ost pch clsd w/o bar ........... ........... ........... ........... ........... w filtr. K0584................ A.................... DG................. Ost pch for bar w ........... ........... ........... ........... ........... flange/flt. K0585................ A.................... DG................. Ost pch clsd for bar ........... ........... ........... ........... ........... w lk fl.

[[Page 63637]]

K0586................ A.................... DG................. Ost pch for bar w lk ........... ........... ........... ........... ........... fl/fltr. K0587................ A.................... DG................. Ost pch drain w bar ........... ........... ........... ........... ........... & filter. K0588................ A.................... DG................. Ost pch drain for ........... ........... ........... ........... ........... barrier fl. K0589................ A.................... DG................. Ost pch drain 2 ........... ........... ........... ........... ........... piece system. K0590................ A.................... DG................. Ost pch drain/barr ........... ........... ........... ........... ........... lk flng/f. K0591................ A.................... DG................. Urine ost pouch w ........... ........... ........... ........... ........... faucet/tap. K0592................ A.................... DG................. Urine ost pouch w ........... ........... ........... ........... ........... bltinconv. K0593................ A.................... DG................. Ost urine pch w b/ ........... ........... ........... ........... ........... bltin conv. K0594................ A.................... DG................. Ost pch urine w ........... ........... ........... ........... ........... barrier/tapv. K0595................ A.................... DG................. Os pch urine w bar/ ........... ........... ........... ........... ........... fange/tap. K0596................ A.................... DG................. Urine ost pch bar w ........... ........... ........... ........... ........... lock fln. K0597................ A.................... DG................. Ost pch urine w lock ........... ........... ........... ........... ........... flng/ft. K0600................ Y.................... NF................. Functional

........... ........... ........... ........... ........... neuromuscular stim. K0601................ Y.................... NF................. Repl batt silver ........... ........... ........... ........... ........... oxide 1.5 v. K0602................ Y.................... NF................. Repl batt silver ........... ........... ........... ........... ........... oxide 3 v. K0603................ Y.................... NF................. Repl batt alkaline ........... ........... ........... ........... ........... 1.5 v. K0604................ Y.................... NF................. Repl batt lithium ........... ........... ........... ........... ........... 3.6 v. K0605................ Y.................... NF................. Repl batt lithium ........... ........... ........... ........... ........... 4.5 v. K0606................ Y.................... NF................. AED garment w/elec ........... ........... ........... ........... ........... analysis. K0607................ Y.................... NF................. Repl batt for AED ........... ........... ........... ........... ........... device. K0608................ Y.................... NF................. Repl garment for AED ........... ........... ........... ........... ........... K0609................ Y.................... NF................. Repl electrode for ........... ........... ........... ........... ........... AED. K0610................ E.................... DG................. Peritoneal dialysis ........... ........... ........... ........... ........... clamp. K0611................ E.................... DG................. Disposable cycler ........... ........... ........... ........... ........... set. K0612................ E.................... DG................. Drainage ext line, ........... ........... ........... ........... ........... dialysis. K0613................ E.................... DG................. Ext line w/easy lock ........... ........... ........... ........... ........... connect. K0614................ E.................... DG................. Chem/antiseptic ........... ........... ........... ........... ........... solution, 8oz. K0615................ Y.................... DG................. SGD prerec mes 8min 20min 40min. K0618................ A.................... ................... TLSO 2 piece rigid ........... ........... ........... ........... ........... shell. K0619................ A.................... ................... TLSO 3 piece rigid ........... ........... ........... ........... ........... shell. K0620................ A.................... ................... Tubular elastic ........... ........... ........... ........... ........... dressing. K0621................ A.................... DG................. Gauze, non-impreg ........... ........... ........... ........... ........... pack strip. K0622................ A.................... DG................. Confrm band non str ........... ........... ........... ........... ........... 3in/roll. K0624................ A.................... DG................. Lite compress

........... ........... ........... ........... ........... wdth=5 in, roll. L0100................ A.................... ................... Cranial orthosis/ ........... ........... ........... ........... ........... helmet mold. L0110................ A.................... ................... Cranial orthosis/ ........... ........... ........... ........... ........... helmet nonm. L0112................ A.................... NI................. 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. 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. L0474................ A.................... ................... TLSO rigid frame pre ........... ........... ........... ........... ........... pelvic. L0476................ A.................... ................... TLSO flexion compres ........... ........... ........... ........... ........... jac pre. L0478................ A.................... ................... TLSO flexion compres ........... ........... ........... ........... ........... jac cus. 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.

[[Page 63638]]

L0490................ A.................... ................... TLSO rigid plastic ........... ........... ........... ........... ........... pre one. L0500................ A.................... ................... Lso flex surgical ........... ........... ........... ........... ........... support. L0510................ A.................... ................... Lso flexible custom ........... ........... ........... ........... ........... fabricat. L0515................ A.................... ................... Lso flex elas w/ rig ........... ........... ........... ........... ........... post pa. L0520................ A.................... ................... Lso a-p-l control ........... ........... ........... ........... ........... with apron. L0530................ A.................... ................... Lso ant-pos control ........... ........... ........... ........... ........... w apron. L0540................ A.................... ................... Lso lumbar flexion a- ........... ........... ........... ........... ........... p-l. L0550................ A.................... ................... Lso a-p-l control ........... ........... ........... ........... ........... molded. L0560................ A.................... ................... Lso a-p-l w

........... ........... ........... ........... ........... interface. L0561................ A.................... ................... Prefab lso.......... ........... ........... ........... ........... ........... L0565................ A.................... ................... Lso a-p-l control ........... ........... ........... ........... ........... custom. L0600................ A.................... ................... Sacroiliac flex surg ........... ........... ........... ........... ........... support. L0610................ A.................... ................... Sacroiliac flexible ........... ........... ........... ........... ........... custm fa. L0620................ A.................... ................... Sacroiliac semi-rig ........... ........... ........... ........... ........... w apron. L0700................ A.................... ................... Ctlso a-p-l control ........... ........... ........... ........... ........... molded. L0710................ A.................... ................... Ctlso a-p-l control ........... ........... ........... ........... ........... w/ inter. L0810................ A.................... ................... Halo cervical into ........... ........... ........... ........... ........... jckt vest. L0820................ A.................... ................... Halo cervical into ........... ........... ........... ........... ........... body jack. L0830................ A.................... ................... Halo cerv into

........... ........... ........... ........... ........... milwaukee typ. L0860................ A.................... ................... Magnetic resonanc ........... ........... ........... ........... ........... image comp. L0861................ A.................... NI................. Halo repl liner/ ........... ........... ........... ........... ........... interface. L0960................ A.................... ................... 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.

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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. 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.................... NI................. 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. L1885................ A.................... DG................. Knee upright w/ ........... ........... ........... ........... ........... resistance. 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.................... NI................. AFO supramalleolar ........... ........... ........... ........... ........... custom. L1910................ A.................... ................... Afo sing bar clasp ........... ........... ........... ........... ........... attach sh. L1920................ A.................... ................... Afo sing upright w/ ........... ........... ........... ........... ........... adjust s. L1930................ A.................... ................... Afo plastic......... ........... ........... ........... ........... ........... 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.................... NI................. AFO spiral

........... ........... ........... ........... ........... prefabricated. L1960................ A.................... ................... Afo pos solid ank ........... ........... ........... ........... ........... plastic mo. L1970................ A.................... ................... Afo plastic molded w/ ........... ........... ........... ........... ........... ankle j. L1971................ A.................... NI................. 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. 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. L2102................ E.................... DG................. Afo tibial fx cast ........... ........... ........... ........... ........... plstr mol. L2104................ E.................... DG................. Afo tib fx cast ........... ........... ........... ........... ........... synthetic mo. 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. L2122................ E.................... DG................. Kafo fem fx cast ........... ........... ........... ........... ........... plaster mol. L2124................ E.................... DG................. Kafo fem fx cast ........... ........... ........... ........... ........... synthet mol. 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.

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L2136................ A.................... ................... Kafo femoral fx cast ........... ........... ........... ........... ........... rigid. L2180................ A.................... ................... Plas shoe insert w ........... ........... ........... ........... ........... ank joint. 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. 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. L2435................ A.................... ................... Knee joint

........... ........... ........... ........... ........... polycentric joint. 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. 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.

[[Page 63641]]

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.................... NI................. 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.................... ................... Woman's shoe oxford ........... ........... ........... ........... ........... brace. L3225................ A.................... ................... Man's 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. L3340................ B.................... ................... Shoe wedge sach..... ........... ........... ........... ........... ........... L3350................ E.................... ................... 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.

[[Page 63642]]

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. L3901................ A.................... ................... Hinge ext/flex wrist ........... ........... ........... ........... ........... finger. L3902................ A.................... ................... 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.................... NI................. 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........ ........... ........... ........... ........... ...........

[[Page 63643]]

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................ A.................... ................... Seo mobile arm sup ........... ........... ........... ........... ........... att to wc. L3965................ A.................... ................... Arm supp att to wc ........... ........... ........... ........... ........... rancho ty. L3966................ A.................... ................... Mobile arm supports ........... ........... ........... ........... ........... reclinin. L3968................ A.................... ................... Friction dampening ........... ........... ........... ........... ........... arm supp. L3969................ A.................... ................... Monosuspension arm/ ........... ........... ........... ........... ........... hand supp. L3970................ A.................... ................... Elevat proximal arm ........... ........... ........... ........... ........... support. L3972................ A.................... ................... Offset/lat rocker ........... ........... ........... ........... ........... arm w/ ela. L3974................ A.................... ................... 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. 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. 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.................... ................... Pneumatic ankle ........... ........... ........... ........... ........... cntrl splint. L4360................ A.................... ................... Pneumatic walking ........... ........... ........... ........... ........... splint. L4370................ A.................... ................... Pneumatic full leg ........... ........... ........... ........... ........... splint. L4380................ A.................... ................... Pneumatic knee

........... ........... ........... ........... ........... splint. L4386................ A.................... ................... Non-pneumatic

........... ........... ........... ........... ........... walking splint. 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.

[[Page 63644]]

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. 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 air

........... ........... ........... ........... ........... cushion socke. L5647................ A.................... ................... Below knee suction ........... ........... ........... ........... ........... socket. L5648................ A.................... ................... Above knee air

........... ........... ........... ........... ........... cushion socke. 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.................... NI................. Socket insert w lock ........... ........... ........... ........... ........... mech. L5674................ A.................... ................... Bk suspension sleeve ........... ........... ........... ........... ........... L5675................ A.................... ................... Bk heavy duty susp ........... ........... ........... ........... ........... sleeve. L5676................ A.................... ................... Bk knee joints

........... ........... ........... ........... ........... single axis p. L5677................ A.................... ................... Bk knee joints

........... ........... ........... ........... ........... polycentric p. L5678................ A.................... ................... Bk joint covers pair ........... ........... ........... ........... ........... L5679................ A.................... NI................. Socket insert w/o ........... ........... ........... ........... ........... lock mech. L5680................ A.................... ................... Bk thigh lacer non- ........... ........... ........... ........... ........... molded. L5681................ A.................... NI................. Intl custm cong/ ........... ........... ........... ........... ........... latyp insert. L5682................ A.................... ................... Bk thigh lacer glut/ ........... ........... ........... ........... ........... ischia m. L5683................ A.................... NI................. Initial custom

........... ........... ........... ........... ........... socket insert.

[[Page 63645]]

L5684................ A.................... ................... Bk fork strap....... ........... ........... ........... ........... ........... 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. 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. L5846................ A.................... ................... Knee-shin sys

........... ........... ........... ........... ........... microprocessor. L5847................ A.................... ................... Microprocessor cntrl ........... ........... ........... ........... ........... feature. L5848................ A.................... ................... Knee-shin sys

........... ........... ........... ........... ........... hydraul stance. L5850................ A.................... ................... Endo ak/hip knee ........... ........... ........... ........... ........... extens assi. L5855................ A.................... ................... Mech hip extension ........... ........... ........... ........... ........... assist. 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.

[[Continued on page 63647]]

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

[[pp. 63647-63690]] Medicare Program; Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2004 Payment Rates

[[Continued from page 63646]]

[[Page 63646]]

L5986................ A.................... ................... Multi-axial rotation ........... ........... ........... ........... ........... unit. L5987................ A.................... ................... Shank ft w vert load ........... ........... ........... ........... ........... pylon. L5988................ A.................... ................... Vertical shock

........... ........... ........... ........... ........... reducing pylo. L5989................ A.................... ................... Pylon w elctrnc ........... ........... ........... ........... ........... force sensor. 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. 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.

[[Page 63647]]

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. L6692................ A.................... ................... Silicone gel insert ........... ........... ........... ........... ........... or equal. L6693................ A.................... ................... Lockingelbow forearm ........... ........... ........... ........... ........... cntrbal. 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 ........... ........... ........... ........... ........... model555. 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 ........... ........... ........... ........... W= 40. R0070................ N.................... ................... Transport portable x- ........... ........... ........... ........... ........... ray. 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. V2116................ A.................... DG................. Nonaspheric lens ........... ........... ........... ........... ........... bifocal. V2117................ A.................... DG................. Aspheric lens

........... ........... ........... ........... ........... bifocal. V2118................ A.................... ................... Lens aniseikonic ........... ........... ........... ........... ........... single. V2121................ A.................... NI................. 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. V2216................ A.................... DG................. Lens lenticular ........... ........... ........... ........... ........... nonaspheric. V2217................ A.................... DG................. Lens lenticular ........... ........... ........... ........... ........... aspheric bif. V2218................ A.................... ................... Lens aniseikonic ........... ........... ........... ........... ........... bifocal. V2219................ A.................... ................... Lens bifocal seg ........... ........... ........... ........... ........... width over. V2220................ A.................... ................... Lens bifocal add ........... ........... ........... ........... ........... over 3.25d. V2221................ A.................... NI................. Lenticular lens, ........... ........... ........... ........... ........... bifocal. V2299................ A.................... ................... Lens bifocal

........... ........... ........... ........... ........... speciality. V2300................ A.................... ................... Lens sphere trifocal ........... ........... ........... ........... ........... 4.00d.

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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. V2316................ A.................... DG................. Lens lenticular ........... ........... ........... ........... ........... nonaspheric. V2317................ A.................... DG................. Lens lenticular ........... ........... ........... ........... ........... aspheric tri. V2318................ A.................... ................... Lens aniseikonic ........... ........... ........... ........... ........... trifocal. V2319................ A.................... ................... Lens trifocal seg ........... ........... ........... ........... ........... width 28. V2320................ A.................... ................... Lens trifocal add ........... ........... ........... ........... ........... over 3.25d. V2321................ A.................... NI................. Lenticular lens, ........... ........... ........... ........... ........... trifocal. V2399................ A.................... ................... Lens trifocal

........... ........... ........... ........... ........... speciality. V2410................ A.................... ................... Lens variab

........... ........... ........... ........... ........... asphericity sing. 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........ ........... ........... ........... ........... ........... V2710................ A.................... ................... Glass/plastic slab ........... ........... ........... ........... ........... off prism. V2715................ A.................... ................... Prism lens/es....... ........... ........... ........... ........... ........... V2718................ A.................... ................... Fresnell prism press- ........... ........... ........... ........... ........... on lens. V2730................ A.................... ................... Special base curve.. ........... ........... ........... ........... ........... V2740................ A.................... DG................. Rose tint plastic... ........... ........... ........... ........... ........... V2741................ A.................... DG................. Non-rose tint

........... ........... ........... ........... ........... plastic. V2742................ A.................... DG................. Rose tint glass..... ........... ........... ........... ........... ........... V2743................ A.................... DG................. Non-rose tint glass. ........... ........... ........... ........... ........... V2744................ A.................... ................... Tint photochromatic ........... ........... ........... ........... ........... lens/es. V2745................ A.................... NI................. Tint, any color/ ........... ........... ........... ........... ........... solid/grad. V2750................ A.................... ................... Anti-reflective ........... ........... ........... ........... ........... coating. V2755................ A.................... ................... UV lens/es.......... ........... ........... ........... ........... ........... V2756................ E.................... NI................. Eye glass case...... ........... ........... ........... ........... ........... V2760................ A.................... ................... Scratch resistant ........... ........... ........... ........... ........... coating. V2761................ E.................... NI................. Mirror coating...... ........... ........... ........... ........... ........... V2762................ A.................... NI................. Polarization, any ........... ........... ........... ........... ........... lens. V2770................ A.................... ................... Occluder lens/es.... ........... ........... ........... ........... ........... V2780................ A.................... ................... Oversize lens/es.... ........... ........... ........... ........... ........... V2781................ B.................... ................... Progressive lens per ........... ........... ........... ........... ........... lens. V2782................ A.................... NI................. Lens, 1.54-1.65 p/ ........... ........... ........... ........... ........... 1.60-1.79g. V2783................ A.................... NI................. Lens, = ........... ........... ........... ........... ........... 1.66 p/=1.80 g.

[[Page 63654]]

V2784................ A.................... NI................. Lens polycarb or ........... ........... ........... ........... ........... equal. V2785................ F.................... ................... Corneal tissue

........... ........... ........... ........... ........... processing. V2786................ A.................... NI................. Occupational

........... ........... ........... ........... ........... multifocal lens. V2790................ N.................... ................... Amniotic membrane... ........... ........... ........... ........... ........... V2797................ A.................... NI................. 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. 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.. ........... ........... ........... ........... ...........

[[Page 63655]]

V5364................ E.................... ................... Dysphagia screening. ........... ........... ........... ........... ...........

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 63655]]

[[Page 63656]]

Addendum D1.--Payment Status Indicators for the Hospital Outpatient Prospective Payment System

Indicator

Item/code/service

Status

A................. Services furnished to a Not paid under OPPS. Paid Hospital Outpatient that by Intermediaries under are paid under a Fee a Fee Schedule/Payment Schedule/Payment System System other than OPPS. other than OPPS, e.g.: [sbull] Ambulance Services. [sbull] Clinical Diagnostic Laboratory Services. [sbull] Non-Implantable Prosthetic and Orthotic Devices. [sbull] EPO for ESRD Patients. [sbull] Physical, Occupational, and Speech Therapy. [sbull] Routine Dialysis Services for ESRD Patients Provided in a Certified Dialysis Unit of a Hospital. [sbull] Screening Mammography. B................. Codes that are not

Not paid under OPPS. recognized by OPPS when [sbull] May be paid by submitted on an

Intermediaries when Outpatient Hospital Part submitted on a different B bill type (12x, 13x, bill type, e.g., 75x and 14x).

(CORF), but not paid under OPPS. [sbull] An alternate code that is recognized by OPPS when submitted on an Outpatient Hospital Part B bill type (12x, 13x, and 14x) may be available. C................. Inpatient Procedures..... Not paid under OPPS. Admit patient; Bill as Inpatient. D................. Deleted Codes............ Not paid under OPPS. Not paid under Medicare. E................. Items, Codes, and

Not paid under OPPS. Services:. [sbull] That are not covered by Medicare based on Statutory Exclusion. [sbull] That are not covered by Medicare for reasons other than Statutory Exclusion. [sbull] That are not recognized by Medicare but for which an alternate code for the same item or service may be available. [sbull] For which separate payment is not provided by Medicare. F................. Corneal Tissue

Not paid under OPPS. Paid Acquisition; Certain at reasonable cost. CRNA Services. G................. Drug/Biological Pass- Paid under OPPS; Separate Through.

APC payment includes Pass-Through amount. H................. Device Category Pass- Paid under OPPS; Separate Through.

cost-based Pass-Through payment. K................. Non Pass-Through Drugs Paid under OPPS; Separate and Biologicals;

APC payment. Radiopharmaceutical Agents; Certain Brachytherapy Sources. L................. Influenza Vaccine;

Not paid under OPPS. Paid Pneumococcal Pneumonia at reasonable cost; Not Vaccine.

subject to deductible or coinsurance. N................. Items and Services

Paid under OPPS. However, packaged into APC Rates. payment is packaged into payment for other services, including Outliers. Therefore, there is no separate APC payment. P................. Partial Hospitalization.. Paid under OPPS; Per diem APC payment. S................. Significant Procedure, Paid under OPPS; Separate Not Discounted when

APC payment. Multiple. T................. Significant Procedure, Paid under OPPS; Separate Multiple Procedure

APC payment. Reduction Applies. V................. Clinic or Emergency

Paid under OPPS; Separate Department Visit.

APC payment. Y................. Non-Implantable Durable Not paid under OPPS. All Medical Equipment.

institutional providers other than Home Health Agencies bill to DMERC. X................. Ancillary Service........ Paid under OPPS; Separate APC payment.

Addendum D2.--Code Conditions

Code condition

Descriptor

DG............................ Deleted code with a grace period; Payment will be made under the deleted code during the 90-day grace period. DNG........................... Deleted code with no grace period; Payment will not be made under the deleted code after December 31, 2003. NF............................ New code final APC assignment; Comments were accepted on a proposed APC assignment in the Proposed Rule; APC assignment is no longer open to comment. NI............................ New code interim APC assignment; Comments will be accepted on the interim APC assignment for the new code.

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 63656]]

Addendum E.--CPT Codes Which Would Be Paid Only As Inpatient Procedures [Calendar Year 2004]

CPT/HCPCS

NPRM SI

Description

0001T................................. C........................... Endovas repr abdo ao aneurys 0001T................................. C........................... Endovas repr abdo ao aneurys 0005T................................. C........................... Perc cath stent/brain cv art

[[Page 63657]]

0006T................................. C........................... Perc cath stent/brain cv art 0007T................................. C........................... Perc cath stent/brain cv art 00174................................. C........................... Anesth, pharyngeal surgery 00176................................. C........................... Anesth, pharyngeal surgery 00192................................. C........................... Anesth, facial bone surgery 00214................................. C........................... Anesth, skull drainage 00215................................. C........................... Anesth, skull repair/fract 0021T................................. C........................... Fetal oximetry, trnsvag/cerv 0024T................................. C........................... Transcath cardiac reduction 0033T................................. C........................... Endovasc taa repr incl subcl 0034T................................. C........................... Endovasc taa repr w/o subcl 0035T................................. C........................... Insert endovasc prosth, taa 0036T................................. C........................... Endovasc prosth, taa, add-on 0037T................................. C........................... Artery transpose/endovas taa 0038T................................. C........................... Rad endovasc taa rpr w/cover 0039T................................. C........................... Rad s/i, endovasc taa repair 00404................................. C........................... Anesth, surgery of breast 00406................................. C........................... Anesth, surgery of breast 0040T................................. C........................... Rad s/i, endovasc taa prosth 00452................................. C........................... Anesth, surgery of shoulder 00474................................. C........................... Anesth, surgery of rib(s) 0048T................................. C........................... Implant ventricular device 0049T................................. C........................... External circulation assist 0050T................................. C........................... Removal circulation assist 0051T................................. C........................... Implant total heart system 00524................................. C........................... Anesth, chest drainage 0052T................................. C........................... Replace component heart syst 0053T................................. C........................... Replace component heart syst 00540................................. C........................... Anesth, chest surgery 00542................................. C........................... Anesth, release of lung 00580................................. C........................... Anesth, heart/lung transplnt 00604................................. C........................... Anesth, sitting procedure 00622................................. C........................... Anesth, removal of nerves 00632................................. C........................... Anesth, removal of nerves 00634................................. C........................... Anesth for chemonucleolysis 00670................................. C........................... Anesth, spine, cord surgery 00792................................. C........................... Anesth, hemorr/excise liver 00794................................. C........................... Anesth, pancreas removal 00796................................. C........................... Anesth, for liver transplant 00802................................. C........................... Anesth, fat layer removal 00844................................. C........................... Anesth, pelvis surgery 00846................................. C........................... Anesth, hysterectomy 00848................................. C........................... Anesth, pelvic organ surg 00864................................. C........................... Anesth, removal of bladder 00865................................. C........................... Anesth, removal of prostate 00866................................. C........................... Anesth, removal of adrenal 00868................................. C........................... Anesth, kidney transplant 00882................................. C........................... Anesth, major vein ligation 00904................................. C........................... Anesth, perineal surgery 00908................................. C........................... Anesth, removal of prostate 00928................................. C........................... Anesth, removal of testis 00932................................. C........................... Anesth, amputation of penis 00934................................. C........................... Anesth, penis, nodes removal 00936................................. C........................... Anesth, penis, nodes removal 00944................................. C........................... Anesth, vaginal hysterectomy 01140................................. C........................... Anesth, amputation at pelvis 01150................................. C........................... Anesth, pelvic tumor surgery 01190................................. C........................... Anesth, pelvis nerve removal 01212................................. C........................... Anesth, hip disarticulation 01214................................. C........................... Anesth, hip arthroplasty 01232................................. C........................... Anesth, amputation of femur 01234................................. C........................... Anesth, radical femur surg 01272................................. C........................... Anesth, femoral artery surg 01274................................. C........................... Anesth, femoral embolectomy 01402................................. C........................... Anesth, knee arthroplasty 01404................................. C........................... Anesth, amputation at knee

[[Page 63658]]

01442................................. C........................... Anesth, knee artery surg 01444................................. C........................... Anesth, knee artery repair 01486................................. C........................... Anesth, ankle replacement 01502................................. C........................... Anesth, lwr leg embolectomy 01632................................. C........................... Anesth, surgery of shoulder 01634................................. C........................... Anesth, shoulder joint amput 01636................................. C........................... Anesth, forequarter amput 01638................................. C........................... Anesth, shoulder replacement 01652................................. C........................... Anesth, shoulder vessel surg 01654................................. C........................... Anesth, shoulder vessel surg 01656................................. C........................... Anesth, arm-leg vessel surg 01756................................. C........................... Anesth, radical humerus surg 01990................................. C........................... Support for organ donor 15756................................. C........................... Free muscle flap, microvasc 15757................................. C........................... Free skin flap, microvasc 15758................................. C........................... Free fascial flap, microvasc 16035................................. C........................... Incision of burn scab, initi 16036................................. C........................... Incise burn scab, addl incis 19200................................. C........................... Removal of breast 19220................................. C........................... Removal of breast 19271................................. C........................... Revision of chest wall 19272................................. C........................... Extensive chest wall surgery 19361................................. C........................... Breast reconstruction 19364................................. C........................... Breast reconstruction 19367................................. C........................... Breast reconstruction 19368................................. C........................... Breast reconstruction 19369................................. C........................... Breast reconstruction 20660................................. C........................... Apply, rem fixation device 20661................................. C........................... Application of head brace 20662................................. C........................... Application of pelvis brace 20663................................. C........................... Application of thigh brace 20664................................. C........................... Halo brace application 20802................................. C........................... Replantation, arm, complete 20805................................. C........................... Replant forearm, complete 20808................................. C........................... Replantation hand, complete 20816................................. C........................... Replantation digit, complete 20822................................. C........................... Replantation digit, complete 20824................................. C........................... Replantation thumb, complete 20827................................. C........................... Replantation thumb, complete 20838................................. C........................... Replantation foot, complete 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 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................................. C........................... Bone/skin graft, metatarsal 20973................................. C........................... Bone/skin graft, great toe 21045................................. C........................... Extensive jaw surgery 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................................. C........................... Reconstruct midface, lefort 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

[[Page 63659]]

21172................................. C........................... Reconstruct orbit/forehead 21175................................. C........................... Reconstruct orbit/forehead 21179................................. C........................... Reconstruct entire forehead 21180................................. C........................... Reconstruct entire forehead 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................................. C........................... Reconst lwr jaw w/o fixation 21196................................. C........................... Reconst lwr jaw w/fixation 21247................................. C........................... Reconstruct lower jaw bone 21255................................. C........................... Reconstruct lower jaw bone 21256................................. C........................... Reconstruction of orbit 21268................................. C........................... Revise eye sockets 21343................................. C........................... Treatment of sinus fracture 21344................................. C........................... Treatment of sinus fracture 21346................................. C........................... Treat nose/jaw fracture 21347................................. C........................... Treat nose/jaw fracture 21348................................. C........................... Treat nose/jaw fracture 21356................................. C........................... Treat cheek bone fracture 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 21395................................. C........................... Treat eye socket fracture 21408................................. C........................... Treat eye socket fracture 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 21495................................. C........................... Treat hyoid bone fracture 21510................................. C........................... Drainage of bone lesion 21557................................. C........................... Remove tumor, neck/chest 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 21632................................. C........................... Extensive sternum surgery 21705................................. C........................... Revision of neck muscle/rib 21740................................. C........................... Reconstruction of sternum 21750................................. C........................... Repair of sternum separation 21810................................. C........................... Treatment of rib fracture(s) 21825................................. C........................... Treat sternum fracture 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................................. C........................... Revision of thorax spine 22224................................. C........................... Revision of lumbar spine 22226................................. C........................... Revise, extra spine segment 22318................................. C........................... Treat odontoid fx w/o graft 22319................................. C........................... Treat odontoid fx w/graft 22325................................. C........................... Treat spine fracture

[[Page 63660]]

22326................................. C........................... Treat neck spine fracture 22327................................. C........................... Treat thorax spine fracture 22328................................. C........................... Treat each add spine fx 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 22630................................. C........................... Lumbar spine fusion 22632................................. C........................... Spine fusion, extra segment 22800................................. C........................... Fusion of spine 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 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 23332................................. C........................... Remove shoulder foreign body 23472................................. C........................... Reconstruct shoulder joint 23900................................. C........................... Amputation of arm & girdle 23920................................. C........................... Amputation at shoulder joint 24149................................. C........................... Radical resection of elbow 24900................................. C........................... Amputation of upper arm 24920................................. C........................... Amputation of upper arm 24930................................. C........................... Amputation follow-up surgery 24931................................. C........................... Amputate upper arm & implant 24940................................. C........................... Revision of upper arm 25900................................. C........................... Amputation of forearm 25905................................. C........................... Amputation of forearm 25909................................. C........................... Amputation follow-up surgery 25915................................. C........................... Amputation of forearm 25920................................. C........................... Amputate hand at wrist 25924................................. C........................... Amputation follow-up surgery 25927................................. C........................... Amputation of hand 25931................................. C........................... Amputation follow-up surgery 26551................................. C........................... Great toe-hand transfer 26553................................. C........................... Single transfer, toe-hand 26554................................. C........................... Double transfer, toe-hand

[[Page 63661]]

26556................................. C........................... Toe joint transfer 26992................................. C........................... Drainage of bone lesion 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 27036................................. C........................... Excision of hip joint/muscle 27054................................. C........................... Removal of hip joint lining 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 27090................................. C........................... Removal of hip prosthesis 27091................................. C........................... Removal of hip prosthesis 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 27215................................. C........................... Treat pelvic fracture(s) 27217................................. C........................... Treat pelvic ring fracture 27218................................. C........................... Treat pelvic ring fracture 27222................................. C........................... Treat hip socket fracture 27226................................. C........................... Treat hip wall fracture 27227................................. C........................... Treat hip fracture(s) 27228................................. C........................... Treat hip fracture(s) 27232................................. C........................... Treat thigh fracture 27236................................. C........................... Treat thigh fracture 27240................................. C........................... Treat thigh fracture 27244................................. C........................... Treat thigh fracture 27245................................. C........................... Treat thigh fracture 27248................................. C........................... Treat thigh fracture 27253................................. C........................... Treat hip dislocation 27254................................. C........................... Treat hip dislocation 27258................................. C........................... Treat hip dislocation 27259................................. C........................... Treat hip dislocation 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 27303................................. C........................... Drainage of bone lesion

[[Page 63662]]

27365................................. C........................... Extensive leg surgery 27445................................. C........................... Revision of knee joint 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................................. C........................... Surgery to stop leg growth 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 27506................................. C........................... Treatment of thigh fracture 27507................................. C........................... Treatment of thigh fracture 27511................................. C........................... Treatment of thigh fracture 27513................................. C........................... Treatment of thigh fracture 27514................................. C........................... Treatment of thigh fracture 27519................................. C........................... Treat thigh fx growth plate 27535................................. C........................... Treat knee fracture 27536................................. C........................... Treat knee fracture 27540................................. C........................... Treat knee fracture 27556................................. C........................... Treat knee dislocation 27557................................. C........................... Treat knee dislocation 27558................................. C........................... Treat knee dislocation 27580................................. C........................... Fusion of knee 27590................................. C........................... Amputate leg at thigh 27591................................. C........................... Amputate leg at thigh 27592................................. C........................... Amputate leg at thigh 27596................................. C........................... Amputation follow-up surgery 27598................................. C........................... Amputate lower leg at knee 27645................................. C........................... Extensive lower leg surgery 27646................................. C........................... Extensive lower leg surgery 27702................................. C........................... Reconstruct ankle joint 27703................................. C........................... Reconstruction, ankle joint 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 27880................................. C........................... Amputation of lower leg 27881................................. C........................... Amputation of lower leg 27882................................. C........................... Amputation of lower leg 27886................................. C........................... Amputation follow-up surgery 27888................................. C........................... Amputation of foot at ankle 28800................................. C........................... Amputation of midfoot 28805................................. C........................... Amputation thru metatarsal 31225................................. C........................... Removal of upper jaw 31230................................. C........................... Removal of upper jaw 31290................................. C........................... Nasal/sinus endoscopy, surg 31291................................. C........................... Nasal/sinus endoscopy, surg 31292................................. C........................... Nasal/sinus endoscopy, surg 31293................................. C........................... Nasal/sinus endoscopy, surg 31294................................. C........................... Nasal/sinus endoscopy, surg 31360................................. C........................... Removal of larynx 31365................................. C........................... Removal of larynx

[[Page 63663]]

31367................................. C........................... Partial removal of larynx 31368................................. C........................... Partial removal of larynx 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 31584................................. C........................... Treat larynx fracture 31587................................. C........................... Revision of larynx 31725................................. C........................... Clearance of airways 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 31786................................. C........................... Remove windpipe lesion 31800................................. C........................... Repair of windpipe injury 31805................................. C........................... Repair of windpipe injury 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 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 32402................................. C........................... Open biopsy chest lining 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 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

[[Page 63664]]

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 32900................................. C........................... Removal of rib(s) 32905................................. C........................... Revise & repair chest wall 32906................................. C........................... Revise & repair chest wall 32940................................. C........................... Revision of lung 32997................................. C........................... Total lung lavage 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) 33141................................. C........................... Heart tmr w/other procedure 33200................................. C........................... Insertion of heart pacemaker 33201................................. C........................... Insertion of heart pacemaker 33236................................. C........................... Remove electrode/thoracotomy 33237................................. C........................... Remove electrode/thoracotomy 33238................................. C........................... Remove electrode/thoracotomy 33243................................. C........................... Remove eltrd/thoracotomy 33245................................. C........................... Insert epic eltrd pace-defib 33246................................. C........................... Insert epic eltrd/generator 33250................................. C........................... Ablate heart dysrhythm focus 33251................................. C........................... Ablate heart dysrhythm focus 33253................................. C........................... Reconstruct atria 33261................................. C........................... Ablate heart dysrhythm focus 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 63665]]

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 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 33694................................. C........................... Repair of heart defects

[[Page 63666]]

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 33935................................. C........................... Transplantation, heart/lung 33940................................. C........................... Removal of donor heart 33945................................. C........................... Transplantation of heart 33960................................. C........................... External circulation assist 33961................................. C........................... External circulation assist 33967................................. C........................... Insert ia percut device 33968................................. C........................... Remove aortic assist device 33970................................. C........................... Aortic circulation assist 33971................................. C........................... Aortic circulation assist

[[Page 63667]]

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 34001................................. C........................... Removal of artery clot 34051................................. C........................... Removal of artery clot 34151................................. C........................... Removal of artery clot 34401................................. C........................... Removal of vein clot 34451................................. C........................... Removal of vein clot 34502................................. C........................... Reconstruct vena cava 34800................................. C........................... Endovasc abdo repair w/tube 34802................................. C........................... Endovasc abdo repr w/device 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, addl 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 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 35141................................. C........................... Repair defect of artery 35142................................. C........................... Repair artery rupture, thigh 35151................................. C........................... Repair defect of artery 35152................................. C........................... Repair artery rupture, knee 35161................................. C........................... Repair defect of artery 35162................................. C........................... Repair artery rupture 35182................................. C........................... Repair blood vessel lesion 35189................................. C........................... Repair blood vessel lesion 35211................................. C........................... Repair blood vessel lesion 35216................................. C........................... Repair blood vessel lesion 35221................................. C........................... Repair blood vessel lesion 35241................................. C........................... Repair blood vessel lesion 35246................................. C........................... Repair blood vessel lesion 35251................................. C........................... Repair blood vessel lesion 35271................................. C........................... Repair blood vessel lesion 35276................................. C........................... Repair blood vessel lesion 35281................................. C........................... Repair blood vessel lesion

[[Page 63668]]

35301................................. C........................... Rechanneling of artery 35311................................. C........................... Rechanneling of artery 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 35480................................. C........................... Atherectomy, open 35481................................. C........................... Atherectomy, open 35482................................. C........................... Atherectomy, open 35483................................. C........................... Atherectomy, open 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 35582................................. C........................... Vein bypass graft 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

[[Page 63669]]

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 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 35800................................. C........................... Explore neck vessels 35820................................. C........................... Explore chest vessels 35840................................. C........................... Explore abdominal vessels 35870................................. C........................... Repair vessel graft defect 35901................................. C........................... Excision, graft, neck 35905................................. C........................... Excision, graft, thorax 35907................................. C........................... Excision, graft, abdomen 36510................................. C........................... Insertion of catheter, vein 36660................................. C........................... Insertion catheter, artery 36822................................. C........................... Insertion of cannula(s) 36823................................. C........................... Insertion of cannula(s) 37140................................. C........................... Revision of circulation 37145................................. C........................... Revision of circulation 37160................................. C........................... Revision of circulation 37180................................. C........................... Revision of circulation 37181................................. C........................... Splice spleen/kidney veins 37182................................. C........................... Insert hepatic shunt (tips) 37183................................. C........................... Remove hepatic shunt (tips) 37195................................. C........................... Thrombolytic therapy, stroke 37616................................. C........................... Ligation of chest artery 37617................................. C........................... Ligation of abdomen artery 37618................................. C........................... Ligation of extremity artery 37660................................. C........................... Revision of major vein 37788................................. C........................... Revascularization, penis 38100................................. C........................... Removal of spleen, total 38101................................. C........................... Removal of spleen, partial 38102................................. C........................... Removal of spleen, total 38115................................. C........................... Repair of ruptured spleen 38380................................. C........................... Thoracic duct procedure 38381................................. C........................... Thoracic duct procedure 38382................................. C........................... Thoracic duct procedure 38562................................. C........................... Removal, pelvic lymph nodes 38564................................. C........................... Removal, abdomen lymph nodes 38724................................. C........................... Removal of lymph nodes, neck 38746................................. C........................... Remove thoracic lymph nodes 38747................................. C........................... Remove abdominal lymph nodes 38765................................. C........................... Remove groin lymph nodes 38770................................. C........................... Remove pelvis lymph nodes 38780................................. C........................... Remove abdomen lymph nodes 39000................................. C........................... Exploration of chest 39010................................. C........................... Exploration of chest

[[Page 63670]]

39200................................. C........................... Removal chest lesion 39220................................. C........................... Removal chest lesion 39499................................. C........................... Chest procedure 39501................................. C........................... Repair diaphragm laceration 39502................................. C........................... Repair paraesophageal hernia 39503................................. C........................... Repair of diaphragm hernia 39520................................. C........................... Repair of diaphragm hernia 39530................................. C........................... Repair of diaphragm hernia 39531................................. C........................... Repair of diaphragm hernia 39540................................. C........................... Repair of diaphragm hernia 39541................................. C........................... Repair of diaphragm hernia 39545................................. C........................... Revision of diaphragm 39560................................. C........................... Resect diaphragm, simple 39561................................. C........................... Resect diaphragm, complex 39599................................. C........................... Diaphragm surgery procedure 41130................................. C........................... Partial removal of tongue 41135................................. C........................... Tongue and neck surgery 41140................................. C........................... Removal of tongue 41145................................. C........................... Tongue removal, neck surgery 41150................................. C........................... Tongue, mouth, jaw surgery 41153................................. C........................... Tongue, mouth, neck surgery 41155................................. C........................... Tongue, jaw, & neck surgery 42426................................. C........................... Excise parotid gland/lesion 42845................................. C........................... Extensive surgery of throat 42894................................. C........................... Revision of pharyngeal walls 42953................................. C........................... Repair throat, esophagus 42961................................. C........................... Control throat bleeding 42971................................. C........................... Control nose/throat bleeding 43045................................. C........................... Incision of esophagus 43100................................. C........................... Excision of esophagus lesion 43101................................. C........................... Excision of esophagus lesion 43107................................. C........................... Removal of esophagus 43108................................. C........................... Removal of esophagus 43112................................. C........................... Removal of esophagus 43113................................. C........................... Removal of esophagus 43116................................. C........................... Partial removal of esophagus 43117................................. C........................... Partial removal of esophagus 43118................................. C........................... Partial removal of esophagus 43121................................. C........................... Partial removal of esophagus 43122................................. C........................... Partial removal of esophagus 43123................................. C........................... Partial removal of esophagus 43124................................. C........................... Removal of esophagus 43135................................. C........................... Removal of esophagus pouch 43300................................. C........................... Repair of esophagus 43305................................. C........................... Repair esophagus and fistula 43310................................. C........................... Repair of esophagus 43312................................. C........................... Repair esophagus and fistula 43313................................. C........................... Esophagoplasty congenital 43314................................. C........................... Tracheo-esophagoplasty cong 43320................................. C........................... Fuse esophagus & stomach 43324................................. C........................... Revise esophagus & stomach 43325................................. C........................... Revise esophagus & stomach 43326................................. C........................... Revise esophagus & stomach 43330................................. C........................... Repair of esophagus 43331................................. C........................... Repair of esophagus 43340................................. C........................... Fuse esophagus & intestine 43341................................. C........................... Fuse esophagus & intestine 43350................................. C........................... Surgical opening, esophagus 43351................................. C........................... Surgical opening, esophagus 43352................................. C........................... Surgical opening, esophagus 43360................................. C........................... Gastrointestinal repair 43361................................. C........................... Gastrointestinal repair 43400................................. C........................... Ligate esophagus veins 43401................................. C........................... Esophagus surgery for veins 43405................................. C........................... Ligate/staple esophagus 43410................................. C........................... Repair esophagus wound

[[Page 63671]]

43415................................. C........................... Repair esophagus wound 43420................................. C........................... Repair esophagus opening 43425................................. C........................... Repair esophagus opening 43460................................. C........................... Pressure treatment esophagus 43496................................. C........................... Free jejunum flap, microvasc 43500................................. C........................... Surgical opening of stomach 43501................................. C........................... Surgical repair of stomach 43502................................. C........................... Surgical repair of stomach 43510................................. C........................... Surgical opening of stomach 43520................................. C........................... Incision of pyloric muscle 43605................................. C........................... Biopsy of stomach 43610................................. C........................... Excision of stomach lesion 43611................................. C........................... Excision of stomach lesion 43620................................. C........................... Removal of stomach 43621................................. C........................... Removal of stomach 43622................................. C........................... Removal of stomach 43631................................. C........................... Removal of stomach, partial 43632................................. C........................... Removal of stomach, partial 43633................................. C........................... Removal of stomach, partial 43634................................. C........................... Removal of stomach, partial 43635................................. C........................... Removal of stomach, partial 43638................................. C........................... Removal of stomach, partial 43639................................. C........................... Removal of stomach, partial 43640................................. C........................... Vagotomy & pylorus repair 43641................................. C........................... Vagotomy & pylorus repair 43800................................. C........................... Reconstruction of pylorus 43810................................. C........................... Fusion of stomach and bowel 43820................................. C........................... Fusion of stomach and bowel 43825................................. C........................... Fusion of stomach and bowel 43832................................. C........................... Place gastrostomy tube 43840................................. C........................... Repair of stomach lesion 43842................................. C........................... Gastroplasty for obesity 43843................................. C........................... Gastroplasty for obesity 43846................................. C........................... Gastric bypass for obesity 43847................................. C........................... Gastric bypass for obesity 43848................................. C........................... Revision gastroplasty 43850................................. C........................... Revise stomach-bowel fusion 43855................................. C........................... Revise stomach-bowel fusion 43860................................. C........................... Revise stomach-bowel fusion 43865................................. C........................... Revise stomach-bowel fusion 43880................................. C........................... Repair stomach-bowel fistula 44005................................. C........................... Freeing of bowel adhesion 44010................................. C........................... Incision of small bowel 44015................................. C........................... Insert needle cath bowel 44020................................. C........................... Explore small intestine 44021................................. C........................... Decompress small bowel 44025................................. C........................... Incision of large bowel 44050................................. C........................... Reduce bowel obstruction 44055................................. C........................... Correct malrotation of bowel 44110................................. C........................... Excise intestine lesion(s) 44111................................. C........................... Excision of bowel lesion(s) 44120................................. C........................... Removal of small intestine 44121................................. C........................... Removal of small intestine 44125................................. C........................... Removal of small intestine 44126................................. C........................... Enterectomy w/o taper, cong 44127................................. C........................... Enterectomy w/taper, cong 44128................................. C........................... Enterectomy cong, add-on 44130................................. C........................... Bowel to bowel fusion 44132................................. C........................... Enterectomy, cadaver donor 44133................................. C........................... Enterectomy, live donor 44135................................. C........................... Intestine transplnt, cadaver 44136................................. C........................... Intestine transplant, live 44139................................. C........................... Mobilization of colon 44140................................. C........................... Partial removal of colon 44141................................. C........................... Partial removal of colon 44143................................. C........................... Partial removal of colon

[[Page 63672]]

44144................................. C........................... Partial removal of colon 44145................................. C........................... Partial removal of colon 44146................................. C........................... Partial removal of colon 44147................................. C........................... Partial removal of colon 44150................................. C........................... Removal of colon 44151................................. C........................... Removal of colon/ileostomy 44152................................. C........................... Removal of colon/ileostomy 44153................................. C........................... Removal of colon/ileostomy 44155................................. C........................... Removal of colon/ileostomy 44156................................. C........................... Removal of colon/ileostomy 44160................................. C........................... Removal of colon 44202................................. C........................... Lap resect s/intestine singl 44203................................. C........................... Lap resect s/intestine, addl 44204................................. C........................... Laparo partial colectomy 44205................................. C........................... Lap colectomy part w/ileum 44210................................. C........................... Laparo total proctocolectomy 44211................................. C........................... Laparo total proctocolectomy 44212................................. C........................... Laparo total proctocolectomy 44300................................. C........................... Open bowel to skin 44310................................. C........................... Ileostomy/jejunostomy 44314................................. C........................... Revision of ileostomy 44316................................. C........................... Devise bowel pouch 44320................................. C........................... Colostomy 44322................................. C........................... Colostomy with biopsies 44345................................. C........................... Revision of colostomy 44346................................. C........................... Revision of colostomy 44602................................. C........................... Suture, small intestine 44603................................. C........................... Suture, small intestine 44604................................. C........................... Suture, large intestine 44605................................. C........................... Repair of bowel lesion 44615................................. C........................... Intestinal stricturoplasty 44620................................. C........................... Repair bowel opening 44625................................. C........................... Repair bowel opening 44626................................. C........................... Repair bowel opening 44640................................. C........................... Repair bowel-skin fistula 44650................................. C........................... Repair bowel fistula 44660................................. C........................... Repair bowel-bladder fistula 44661................................. C........................... Repair bowel-bladder fistula 44680................................. C........................... Surgical revision, intestine 44700................................. C........................... Suspend bowel w/prosthesis 44800................................. C........................... Excision of bowel pouch 44820................................. C........................... Excision of mesentery lesion 44850................................. C........................... Repair of mesentery 44899................................. C........................... Bowel surgery procedure 44900................................. C........................... Drain app abscess, open 44901................................. C........................... Drain app abscess, percut 44950................................. C........................... Appendectomy 44955................................. C........................... Appendectomy add-on 44960................................. C........................... Appendectomy 45110................................. C........................... Removal of rectum 45111................................. C........................... Partial removal of rectum 45112................................. C........................... Removal of rectum 45113................................. C........................... Partial proctectomy 45114................................. C........................... Partial removal of rectum 45116................................. C........................... Partial removal of rectum 45119................................. C........................... Remove rectum w/reservoir 45120................................. C........................... Removal of rectum 45121................................. C........................... Removal of rectum and colon 45123................................. C........................... Partial proctectomy 45126................................. C........................... Pelvic exenteration 45130................................. C........................... Excision of rectal prolapse 45135................................. C........................... Excision of rectal prolapse 45136................................. C........................... Excise ileoanal reservior 45540................................. C........................... Correct rectal prolapse 45541................................. C........................... Correct rectal prolapse 45550................................. C........................... Repair rectum/remove sigmoid

[[Page 63673]]

45562................................. C........................... Exploration/repair of rectum 45563................................. C........................... Exploration/repair of rectum 45800................................. C........................... Repair rect/bladder fistula 45805................................. C........................... Repair fistula w/colostomy 45820................................. C........................... Repair rectourethral fistula 45825................................. C........................... Repair fistula w/colostomy 46705................................. C........................... Repair of anal stricture 46715................................. C........................... Repair of anovaginal fistula 46716................................. C........................... Repair of anovaginal fistula 46730................................. C........................... Construction of absent anus 46735................................. C........................... Construction of absent anus 46740................................. C........................... Construction of absent anus 46742................................. C........................... Repair of imperforated anus 46744................................. C........................... Repair of cloacal anomaly 46746................................. C........................... Repair of cloacal anomaly 46748................................. C........................... Repair of cloacal anomaly 46751................................. C........................... Repair of anal sphincter 47010................................. C........................... Open drainage, liver lesion 47015................................. C........................... Inject/aspirate liver cyst 47100................................. C........................... Wedge biopsy of liver 47120................................. C........................... Partial removal of liver 47122................................. C........................... Extensive removal of liver 47125................................. C........................... Partial removal of liver 47130................................. C........................... Partial removal of liver 47133................................. C........................... Removal of donor liver 47140................................. C........................... Partial removal, donor liver 47141................................. C........................... Partial removal, donor liver 47142................................. C........................... Partial removal, donor liver 47360................................. C........................... Repair liver wound 47361................................. C........................... Repair liver wound 47362................................. C........................... Repair liver wound 47380................................. C........................... Open ablate liver tumor rf 47381................................. C........................... Open ablate liver tumor cryo 47400................................. C........................... Incision of liver duct 47420................................. C........................... Incision of bile duct 47425................................. C........................... Incision of bile duct 47460................................. C........................... Incise bile duct sphincter 47480................................. C........................... Incision of gallbladder 47550................................. C........................... Bile duct endoscopy add-on 47570................................. C........................... Laparo cholecystoenterostomy 47600................................. C........................... Removal of gallbladder 47605................................. C........................... Removal of gallbladder 47610................................. C........................... Removal of gallbladder 47612................................. C........................... Removal of gallbladder 47620................................. C........................... Removal of gallbladder 47700................................. C........................... Exploration of bile ducts 47701................................. C........................... Bile duct revision 47711................................. C........................... Excision of bile duct tumor 47712................................. C........................... Excision of bile duct tumor 47715................................. C........................... Excision of bile duct cyst 47716................................. C........................... Fusion of bile duct cyst 47720................................. C........................... Fuse gallbladder & bowel 47721................................. C........................... Fuse upper gi structures 47740................................. C........................... Fuse gallbladder & bowel 47741................................. C........................... Fuse gallbladder & bowel 47760................................. C........................... Fuse bile ducts and bowel 47765................................. C........................... Fuse liver ducts & bowel 47780................................. C........................... Fuse bile ducts and bowel 47785................................. C........................... Fuse bile ducts and bowel 47800................................. C........................... Reconstruction of bile ducts 47801................................. C........................... Placement, bile duct support 47802................................. C........................... Fuse liver duct & intestine 47900................................. C........................... Suture bile duct injury 48000................................. C........................... Drainage of abdomen 48001................................. C........................... Placement of drain, pancreas 48005................................. C........................... Resect/debride pancreas

[[Page 63674]]

48020................................. C........................... Removal of pancreatic stone 48100................................. C........................... Biopsy of pancreas, open 48120................................. C........................... Removal of pancreas lesion 48140................................. C........................... Partial removal of pancreas 48145................................. C........................... Partial removal of pancreas 48146................................. C........................... Pancreatectomy 48148................................. C........................... Removal of pancreatic duct 48150................................. C........................... Partial removal of pancreas 48152................................. C........................... Pancreatectomy 48153................................. C........................... Pancreatectomy 48154................................. C........................... Pancreatectomy 48155................................. C........................... Removal of pancreas 48180................................. C........................... Fuse pancreas and bowel 48400................................. C........................... Injection, intraop add-on 48500................................. C........................... Surgery of pancreatic cyst 48510................................. C........................... Drain pancreatic pseudocyst 48520................................. C........................... Fuse pancreas cyst and bowel 48540................................. C........................... Fuse pancreas cyst and bowel 48545................................. C........................... Pancreatorrhaphy 48547................................. C........................... Duodenal exclusion 48556................................. C........................... Removal, allograft pancreas 49000................................. C........................... Exploration of abdomen 49002................................. C........................... Reopening of abdomen 49010................................. C........................... Exploration behind abdomen 49020................................. C........................... Drain abdominal abscess 49021................................. C........................... Drain abdominal abscess 49040................................. C........................... Drain, open, abdom abscess 49041................................. C........................... Drain, percut, abdom abscess 49060................................. C........................... Drain, open, retrop abscess 49061................................. C........................... Drain, percut, retroper absc 49062................................. C........................... Drain to peritoneal cavity 49201................................. C........................... Remove abdom lesion, complex 49215................................. C........................... Excise sacral spine tumor 49220................................. C........................... Multiple surgery, abdomen 49255................................. C........................... Removal of omentum 49425................................. C........................... Insert abdomen-venous drain 49428................................. C........................... Ligation of shunt 49605................................. C........................... Repair umbilical lesion 49606................................. C........................... Repair umbilical lesion 49610................................. C........................... Repair umbilical lesion 49611................................. C........................... Repair umbilical lesion 49900................................. C........................... Repair of abdominal wall 49904................................. C........................... Omental flap, extra-abdom 49905................................. C........................... Omental flap 49906................................. C........................... Free omental flap, microvasc 50010................................. C........................... Exploration of kidney 50020................................. C........................... Renal abscess, open drain 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 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 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

[[Page 63675]]

50290................................. C........................... Removal of kidney lesion 50300................................. C........................... Removal of donor kidney 50320................................. C........................... Removal of donor kidney 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 50400................................. C........................... Revision of kidney/ureter 50405................................. C........................... Revision of kidney/ureter 50500................................. C........................... Repair of kidney wound 50520................................. C........................... Close kidney-skin fistula 50525................................. C........................... Repair renal-abdomen fistula 50526................................. C........................... Repair renal-abdomen fistula 50540................................. C........................... Revision of horseshoe kidney 50545................................. C........................... Laparo radical nephrectomy 50546................................. C........................... Laparoscopic nephrectomy 50547................................. C........................... Laparo removal donor kidney 50548................................. C........................... Laparo remove k/ureter 50570................................. C........................... Kidney endoscopy 50572................................. C........................... Kidney endoscopy 50574................................. C........................... Kidney endoscopy & biopsy 50575................................. C........................... Kidney endoscopy 50576................................. C........................... Kidney endoscopy & treatment 50578................................. C........................... Renal endoscopy/radiotracer 50580................................. C........................... Kidney endoscopy & treatment 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 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 51060................................. C........................... Removal of ureter stone 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

[[Page 63676]]

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 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 51860................................. C........................... Repair of bladder wound 51865................................. C........................... Repair of bladder wound 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 53085................................. C........................... Drainage of urinary leakage 53415................................. C........................... Reconstruction of urethra 53448................................. C........................... Remov/replc ur sphinctr comp 54125................................. C........................... Removal of penis 54130................................. C........................... Remove penis & nodes 54135................................. C........................... Remove penis & nodes 54332................................. C........................... Revise penis/urethra 54336................................. C........................... Revise penis/urethra 54390................................. C........................... Repair penis and bladder 54411................................. C........................... Remov/replc penis pros, comp 54417................................. C........................... Remv/replc penis pros, compl 54430................................. C........................... Revision of penis 54535................................. C........................... Extensive testis surgery 54560................................. C........................... Exploration for testis 54650................................. C........................... Orchiopexy (Fowler-Stephens) 55600................................. C........................... Incise sperm duct pouch 55605................................. C........................... Incise sperm duct pouch 55650................................. C........................... Remove sperm duct pouch 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 55845................................. C........................... Extensive prostate surgery 55862................................. C........................... Extensive prostate surgery 55865................................. C........................... Extensive prostate surgery 55866................................. C........................... Laparo radical prostatectomy 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 57110................................. C........................... Remove vagina wall, complete 57111................................. C........................... Remove vagina tissue, compl 57112................................. C........................... Vaginectomy w/nodes, compl 57270................................. C........................... Repair of bowel pouch 57280................................. C........................... Suspension of vagina 57282................................. C........................... Repair of vaginal prolapse 57292................................. C........................... Construct vagina with graft

[[Page 63677]]

57305................................. C........................... Repair rectum-vagina fistula 57307................................. C........................... Fistula repair & colostomy 57308................................. C........................... Fistula repair, transperine 57311................................. C........................... Repair urethrovaginal lesion 57335................................. C........................... Repair vagina 57531................................. C........................... Removal of cervix, radical 57540................................. C........................... Removal of residual cervix 57545................................. C........................... Remove cervix/repair pelvis 58140................................. C........................... Removal of uterus lesion 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 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 58400................................. C........................... Suspension of uterus 58410................................. C........................... Suspension of uterus 58520................................. C........................... Repair of ruptured uterus 58540................................. C........................... Revision of uterus 58605................................. C........................... Division of fallopian tube 58611................................. C........................... Ligate oviduct(s) add-on 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................................. C........................... Create new tubal opening 58805................................. C........................... Drainage of ovarian cyst(s) 58822................................. C........................... Drain ovary abscess, percut 58825................................. C........................... Transposition, ovary(s) 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 58960................................. C........................... Exploration of abdomen 59100................................. C........................... Remove uterus lesion 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 59325................................. C........................... Revision of cervix 59350................................. C........................... Repair of uterus 59514................................. C........................... Cesarean delivery only 59525................................. C........................... Remove uterus after cesarean 59620................................. C........................... Attempted vbac delivery only 59830................................. C........................... Treat uterus infection

[[Page 63678]]

59850................................. C........................... Abortion 59851................................. C........................... Abortion 59852................................. C........................... Abortion 59855................................. C........................... Abortion 59856................................. C........................... Abortion 59857................................. C........................... Abortion 60254................................. C........................... Extensive thyroid surgery 60270................................. C........................... Removal of thyroid 60271................................. C........................... Removal of thyroid 60502................................. C........................... Re-explore parathyroids 60505................................. C........................... Explore parathyroid glands 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 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 61250................................. C........................... Pierce skull & explore 61253................................. C........................... Pierce skull & explore 61304................................. C........................... Open skull for exploration 61305................................. C........................... Open skull for exploration 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 61332................................. C........................... Explore/biopsy eye socket 61333................................. C........................... Explore orbit/remove lesion 61334................................. C........................... Explore orbit/remove object 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

[[Page 63679]]

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 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 61624................................. C........................... Occlusion/embolization cath 61680................................. C........................... Intracranial vessel surgery 61682................................. C........................... Intracranial vessel surgery

[[Page 63680]]

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 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 61875................................. C........................... Implant neuroelectrodes 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 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 62200................................. C........................... Establish brain cavity shunt 62201................................. C........................... Establish brain cavity shunt 62220................................. C........................... Establish brain cavity shunt 62223................................. C........................... Establish brain cavity shunt 62256................................. C........................... Remove brain cavity shunt 62258................................. C........................... Replace brain cavity shunt 63043................................. C........................... Laminotomy, addl cervical 63044................................. C........................... Laminotomy, addl lumbar 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

[[Page 63681]]

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 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 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 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 64752................................. C........................... Incision of vagus nerve 64755................................. C........................... Incision of stomach nerves

[[Page 63682]]

64760................................. C........................... Incision of vagus nerve 64763................................. C........................... Incise hip/thigh nerve 64766................................. C........................... Incise hip/thigh nerve 64804................................. C........................... Remove sympathetic nerves 64809................................. C........................... Remove sympathetic nerves 64818................................. C........................... Remove sympathetic nerves 64866................................. C........................... Fusion of facial/other nerve 64868................................. C........................... Fusion of facial/other nerve 65273................................. C........................... Repair of eye wound 69155................................. C........................... Extensive ear/neck surgery 69535................................. C........................... Remove part of temporal bone 69554................................. C........................... Remove ear lesion 69950................................. C........................... Incise inner ear nerve 69970................................. C........................... Remove inner ear lesion 75900................................. C........................... Arterial catheter exchange 75952................................. C........................... Endovasc repair abdom aorta 75953................................. C........................... Abdom aneurysm endovas rpr 75954................................. C........................... Iliac aneurysm endovas rpr 92970................................. C........................... Cardioassist, internal 92971................................. C........................... Cardioassist, external 92975................................. C........................... Dissolve clot, heart vessel 92992................................. C........................... Revision of heart chamber 92993................................. C........................... Revision of heart chamber 99190................................. C........................... Special pump services 99191................................. C........................... Special pump services 99192................................. C........................... Special pump services 99251................................. C........................... Initial inpatient consult 99252................................. C........................... Initial inpatient consult 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 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 99356................................. C........................... Prolonged service, inpatient 99357................................. C........................... Prolonged service, inpatient 99433................................. C........................... Normal newborn care/hospital

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 63682]]

Addendum H--Wage Index for Urban Areas

Wage Urban area (constituent counties)

index

0040 \2\ Abilene, TX.......................................... 0.7780 Taylor, TX 0060 Aguadilla, PR............................................ 0.4306 Aguada, PR Aguadilla, PR Moca, PR 0080 Akron, OH................................................ 0.9442 Portage, OH Summit, OH 0120 Albany, GA............................................... 1.0863 Dougherty, GA Lee, GA 0160 \2\ Albany-Schenectady-Troy, NY.......................... 0.8526 Albany, NY Montgomery, NY Rensselaer, NY Saratoga, NY Schenectady, NY Schoharie, NY 0200 Albuquerque, NM.......................................... 0.9300 Bernalillo, NM Sandoval, NM Valencia, NM 0220 Alexandria, LA........................................... 0.8037 Rapides, LA 0240 Allentown-Bethlehem-Easton, PA........................... 0.9721 Carbon, PA Lehigh, PA Northampton, PA 0280 Altoona, PA.............................................. 0.8827 Blair, PA 0320 Amarillo, TX............................................. 0.8986 Potter, TX Randall, TX 0380 Anchorage, AK............................................ 1.2351 Anchorage, AK 0440 Ann Arbor, MI............................................ 1.1074 Lenawee, MI Livingston, MI Washtenaw, MI 0450 Anniston, AL............................................. 0.8090 Calhoun, AL 0460 \2\ Appleton-Oshkosh-Neenah, WI.......................... 0.9304 Calumet, WI Outagamie, WI Winnebago, WI 0470 Arecibo, PR.............................................. 0.4155 Arecibo, PR Camuy, PR

[[Page 63683]]

Hatillo, PR 0480 Asheville, NC............................................ 0.9720 Buncombe, NC Madison, NC 0500 Athens, GA............................................... 0.9818 Clarke, GA Madison, GA Oconee, GA 0520 \1\ Atlanta, GA.......................................... 1.0130 Barrow, GA Bartow, GA Carroll, GA Cherokee, GA Clayton, GA Cobb, GA Coweta, GA DeKalb, GA Douglas, GA Fayette, GA Forsyth, GA Fulton, GA Gwinnett, GA Henry, GA Newton, GA Paulding, GA Pickens, GA Rockdale, GA Spalding, GA Walton, GA 0560 Atlantic-Cape May, NJ.................................... 1.0795 Atlantic, NJ Cape May, NJ 0580 Auburn-Opelika, AL....................................... 0.8494 Lee, AL 0600 Augusta-Aiken, GA-SC..................................... 0.9625 Columbia, GA McDuffie, GA Richmond, GA Aiken, SC Edgefield, SC 0640 \1\ Austin-San Marcos, TX................................ 0.9609 Bastrop, TX Caldwell, TX Hays, TX Travis, TX Williamson, TX 0680 \2\ Bakersfield, CA...................................... 0.9967 Kern, CA 0720 \1\ Baltimore, MD........................................ 0.9919 Anne Arundel, MD Baltimore, MD Baltimore City, MD Carroll, MD Harford, MD Howard, MD Queen Anne's, MD 0733 Bangor, ME............................................... 0.9904 Penobscot, ME 0743 Barnstable-Yarmouth, MA.................................. 1.2956 Barnstable, MA 0760 Baton Rouge, LA.......................................... 0.8406 Ascension, LA East Baton Rouge, LA Livingston, LA West Baton Rouge, LA 0840 Beaumont-Port Arthur, TX................................. 0.8424 Hardin, TX Jefferson, TX Orange, TX 0860 Bellingham, WA........................................... 1.1757 Whatcom, WA 0870 Benton Harbor, MI........................................ 0.8935 Berrien, MI 0875 \1\ Bergen-Passaic, NJ................................... 1.1731 Bergen, NJ Passaic, NJ 0880 Billings, MT............................................. 0.8961 Yellowstone, MT 0920 Biloxi-Gulfport-Pascagoula, MS........................... 0.9029 Hancock, MS Harrison, MS Jackson, MS 0960 \2\ Binghamton, NY....................................... 0.8526 Broome, NY Tioga, NY1000 Birmingham, AL

0.9212 Blount, AL Jefferson, AL St. Clair, AL Shelby, AL1010 Bismarck, ND

0.8033 Burleigh, ND Morton, ND 1020 \2\ Bloomington, IN...................................... 0.8824 Monroe, IN 1040 Bloomington-Normal, IL................................... 0.8832 McLean, IL 1080 Boise City, ID........................................... 0.9232 Ada, ID Canyon, ID 1123 \1\ Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH..... 1.1233 Bristol, MA Essex, MA Middlesex, MA Norfolk, MA Plymouth, MA Suffolk, MA Worcester, MA Hillsborough, NH Merrimack, NH Rockingham, NH Strafford, NH 1125 Boulder-Longmont, CO..................................... 1.0049 Boulder, CO 1145 Brazoria, TX............................................. 0.8137 Brazoria, TX 1150 Bremerton, WA............................................ 1.0580 Kitsap, WA 1240 Brownsville-Harlingen-San Benito, TX..................... 1.0303 Cameron, TX 1260 Bryan-College Station, TX................................ 0.9019 Brazos, TX 1280 \1\ Buffalo-Niagara Falls, NY............................ 0.9604 Erie, NY Niagara, NY 1303 Burlington, VT........................................... 0.9704 Chittenden, VT Franklin, VT Grand Isle, VT 1310 Caguas, PR............................................... 0.4201 Caguas, PR Cayey, PR Cidra, PR Gurabo, PR San Lorenzo, PR 1320 Canton-Massillon, OH..................................... 0.9071 Carroll, OH Stark, OH 1350 Casper, WY............................................... 0.9209 Natrona, WY 1360 Cedar Rapids, IA......................................... 0.8874 Linn, IA 1400 Champaign-Urbana, IL..................................... 0.9907 Champaign, IL 1440 Charleston-North Charleston, SC.......................... 0.9332 Berkeley, SC Charleston, SC Dorchester, SC 1480 Charleston, WV........................................... 0.8880 Kanawha, WV Putnam, WV 1520 \1\ Charlotte-Gastonia-Rock Hill, NC-SC.................. 0.9730 Cabarrus, NC Gaston, NC Lincoln, NC Mecklenburg, NC Rowan, NC Stanly, NC Union, NC York, SC 1540 Charlottesville, VA...................................... 1.0025 Albemarle, VA Charlottesville City, VA Fluvanna, VA Greene, VA 1560 Chattanooga, TN-GA....................................... 0.9086 Catoosa, GA Dade, GA Walker, GA Hamilton, TN Marion, TN 1580 \2\ Cheyenne, WY......................................... 0.9110 Laramie, WY 1600 \1\ Chicago, IL.......................................... 1.0892 Cook, IL DeKalb, IL DuPage, IL Grundy, IL Kane, IL Kendall, IL Lake, IL McHenry, IL Will, IL 1620 Chico-Paradise, CA....................................... 1.0193 Butte, CA 1640 \1\ Cincinnati, OH-KY-IN................................. 0.9413 Dearborn, IN Ohio, IN Boone, KY Campbell, KY Gallatin, KY Grant, KY Kenton, KY Pendleton, KY Brown, OH Clermont, OH Hamilton, OH Warren, OH 1660 Clarksville-Hopkinsville, TN-KY.......................... 0.8354 Christian, KY Montgomery, TN 1680 \1\ Cleveland-Lorain-Elyria, OH.......................... 0.9671 Ashtabula, OH Cuyahoga, OH Geauga, OH

[[Page 63684]]

Lake, OH Lorain, OH Medina, OH 1720 Colorado Springs, CO..................................... 0.9833 El Paso, CO 1740 Columbia, MO............................................. 0.8695 Boone, MO 1760 Columbia, SC............................................. 0.8902 Lexington, SC Richland, SC 1800 Columbus, GA-AL.......................................... 0.8694 Russell, AL Chattahoochee, GA Harris, GA Muscogee, GA 1840 \1\ Columbus, OH......................................... 0.9648 Delaware, OH Fairfield, OH Franklin, OH Licking, OH Madison, OH Pickaway, OH 1880 Corpus Christi, TX....................................... 0.8521 Nueces, TX San Patricio, TX 1890 Corvallis, OR............................................ 1.1516 Benton, OR 1900 \2\ Cumberland, MD-WV (MD Hospitals)..................... 0.9125 Allegany, MD Mineral, WV 1900 Cumberland, MD-WV (WV Hospitals)......................... 0.8200 Allegany, MD Mineral, WV 1920 \1\ Dallas, TX........................................... 0.9974 Collin, TX Dallas, TX Denton, TX Ellis, TX Henderson, TX Hunt, TX Kaufman, TX Rockwall, TX 1950 Danville, VA............................................. Danville City, VA Pittsylvania, VA

0.9035 1960 Davenport-Moline-Rock Island, IA-IL...................... 0.8985 Scott, IA Henry, IL Rock Island, IL 2000 Dayton-Springfield, OH................................... 0.9529 Clark, OH Greene, OH Miami, OH Montgomery, OH 2020 Daytona Beach, FL........................................ 0.9060 Flagler, FL Volusia, FL 2030 Decatur, AL.............................................. 0.8828 Lawrence, AL Morgan, AL 2040 \2\ Decatur, IL.......................................... 0.8254 Macon, IL 2080 \1\ Denver, CO........................................... 1.0837 Adams, CO Arapahoe, CO Broomfield, CO Denver, CO Douglas, CO Jefferson, CO 2120 Des Moines, IA........................................... 0.9106 Dallas, IA Polk, IA Warren, IA 2160 \1\ Detroit, MI.......................................... 1.0101 Lapeer, MI Macomb, MI Monroe, MI Oakland, MI St. Clair, MI Wayne, MI 2180 Dothan, AL............................................... 0.7765 Dale, AL Houston, AL 2190 Dover, DE................................................ 0.9805 Kent, DE 2200 Dubuque, IA.............................................. 0.8886 Dubuque, IA 2240 Duluth-Superior, MN-WI................................... 1.0171 St. Louis, MN Douglas, WI 2281 Dutchess County, NY...................................... 1.0934 Dutchess, NY 2290 \2\ Eau Claire, WI....................................... 0.9304 Chippewa, WI Eau Claire, WI 2320 El Paso, TX.............................................. 0.9196 El Paso, TX 2330 Elkhart-Goshen, IN....................................... 0.9783 Elkhart, IN 2335 \2\ Elmira, NY........................................... 0.8526 Chemung, NY 2340 Enid, OK................................................. 0.8559 Garfield, OK 2360 Erie, PA................................................. 0.8601 Erie, PA 2400 Eugene-Springfield, OR................................... 1.1456 Lane, OR 2440 \2\ Evansville-Henderson, IN-KY (IN Hospitals)........... 0.8824 Posey, IN Vanderburgh, IN Warrick, IN Henderson, KY 2440 Evansville-Henderson, IN-KY (KY Hospitals)............... 0.8429 Posey, IN Vanderburgh, IN Warrick, IN Henderson, KY 2520 Fargo-Moorhead, ND-MN.................................... 0.9797 Clay, MN Cass, ND 2560 Fayetteville, NC......................................... 0.8986 Cumberland, NC 2580 Fayetteville-Springdale-Rogers, AR....................... 0.8396 Benton, AR Washington, AR 2620 Flagstaff, AZ-UT......................................... 1.1333 Coconino, AZ Kane, UT 2640 Flint, MI................................................ 1.0858 Genesee, MI 2650 Florence, AL............................................. 0.7797 Colbert, AL Lauderdale, AL 2655 Florence, SC............................................. 0.8709 Florence, SC 2670 Fort Collins-Loveland, CO................................ 1.0148 Larimer, CO 2680 \1\ Ft. Lauderdale, FL................................... 1.0479 Broward, FL 2700 Fort Myers-Cape Coral, FL................................ 0.9816 Lee, FL 2710 Fort Pierce-Port St. Lucie, FL........................... 1.0124 Martin, FL St. Lucie, FL 2720 Fort Smith, AR-OK........................................ 0.8424 Crawford, AR Sebastian, AR Sequoyah, OK 2750 Fort Walton Beach, FL.................................... 0.8966 Okaloosa, FL 2760 Fort Wayne, IN........................................... 0.9585 Adams, IN Allen, IN De Kalb, IN Huntington, IN Wells, IN Whitley, IN 2800 \1\ Forth Worth-Arlington, TX............................ 0.9359 Hood, TX Johnson, TX Parker, TX Tarrant, TX 2840 Fresno, CA............................................... 1.0142 Fresno, CA Madera, CA 2880 Gadsden, AL.............................................. 0.8229 Etowah, AL 2900 Gainesville, FL.......................................... 0.9693 Alachua, FL 2920 Galveston-Texas City, TX................................. 0.9279 Galveston, TX 2960 Gary, IN................................................. 0.9410 Lake, IN Porter, IN 2975 \2\ Glens Falls, NY...................................... 0.8526 Warren, NY Washington, NY 2980 Goldsboro, NC............................................ 0.8622 Wayne, NC 2985 Grand Forks, ND-MN (ND Hospitals)........................ 0.8636 Polk, MN Grand Forks, ND 2985 \2\ Grand Forks, ND-MN (MN Hospitals).................... 0.9345 Polk, MN Grand Forks, ND 2995 Grand Junction, CO....................................... 0.9921 Mesa, CO 3000 \1\ Grand Rapids-Muskegon-Holland, MI.................... 0.9469 Allegan, MI Kent, MI Muskegon, MI Ottawa, MI 3040 Great Falls, MT.......................................... 0.8918 Cascade, MT 3060 Greeley, CO.............................................. 0.9453 Weld, CO 3080 Green Bay, WI............................................ 0.9518 Brown, WI 3120 \1\ Greensboro-Winston-Salem-High Point, NC.............. 0.9166

[[Page 63685]]

Alamance, NC Davidson, NC Davie, NC Forsyth, NC Guilford, NC Randolph, NC Stokes, NC Yadkin, NC 3150 Greenville, NC........................................... 0.9167 Pitt, NC 3160 Greenville-Spartanburg-Anderson, SC...................... 0.9335 Anderson, SC Cherokee, SC Greenville, SC Pickens, SC Spartanburg, SC 3180 Hagerstown, MD........................................... 0.9172 Washington, MD 3200 Hamilton-Middletown, OH.................................. 0.9214 Butler, OH 3240 Harrisburg-Lebanon-Carlisle, PA.......................... 0.9164 Cumberland, PA Dauphin, PA Lebanon, PA Perry, PA 3283 \1\ \2\ Hartford, CT..................................... 1.2183 Hartford, CT Litchfield, CT Middlesex, CT Tolland, CT 3285 \2\ Hattiesburg, MS...................................... 0.7778 Forrest, MS Lamar, MS 3290 Hickory-Morganton-Lenoir, NC............................. 0.9242 Alexander, NC Burke, NC Caldwell, NC Catawba, NC 3320 Honolulu, HI............................................. 1.1116 Honolulu, HI 3350 Houma, LA................................................ 0.7771 Lafourche, LA Terrebonne, LA 3360 \1\ Houston, TX.......................................... 0.9834 Chambers, TX Fort Bend, TX Harris, TX Liberty, TX Montgomery, TX Waller, TX 3400 Huntington-Ashland, WV-KY-OH............................. 0.9595 Boyd, KY Carter, KY Greenup, KY Lawrence, OH Cabell, WV Wayne, WV 3440 Huntsville, AL........................................... 0.9245 Limestone, AL Madison, AL 3480 \1\ Indianapolis, IN..................................... 0.9916 Boone, IN Hamilton, IN Hancock, IN Hendricks, IN Johnson, IN Madison, IN Marion, IN Morgan, IN Shelby, IN 3500 Iowa City, IA............................................ 0.9548 Johnson, IA 3520 Jackson, MI.............................................. 0.8986 Jackson, MI 3560 Jackson, MS.............................................. 0.8399 Hinds, MS Madison, MS Rankin, MS 3580 Jackson, TN.............................................. 0.8984 Madison, TN Chester, TN 3600 \1\ Jacksonville, FL..................................... 0.9563 Clay, FL Duval, FL Nassau, FL St. Johns, FL 3605 Jacksonville, NC......................................... 0.8544 Onslow, NC 3610 \2\ Jamestown, NY........................................ 0.8526 Chautauqua, NY 3620 \2\ Janesville-Beloit, WI................................ 0.9304 Rock, WI 3640 Jersey City, NJ.......................................... 1.1115 Hudson, NJ 3660 Johnson City-Kingsport-Bristol, TN-VA (TN Hospitals)..... 0.8256 Carter, TN Hawkins, TN Sullivan, TN Unicoi, TN Washington, TN Bristol City, VA Scott, VA Washington, VA 3660 \2\ Johnson City-Kingsport-Bristol, TN-VA (VA Hospitals). 0.8498 Carter, TN Hawkins, TN Sullivan, TN Unicoi, TN Washington, TN Bristol City, VA Scott, VA Washington, VA 3680 \2\ Johnstown, PA........................................ 0.8378 Cambria, PA Somerset, PA 3700 Jonesboro, AR............................................ 0.7809 Craighead, AR 3710 Joplin, MO............................................... 0.8681 Jasper, MO Newton, MO 3720 Kalamazoo-Battlecreek, MI................................ 1.0500 Calhoun, MI Kalamazoo, MI Van Buren, MI 3740 Kankakee, IL............................................. 1.0419 Kankakee, IL 3760 \1\ Kansas City, KS-MO................................... 0.9715 Johnson, KS Leavenworth, KS Miami, KS Wyandotte, KS Cass, MO Clay, MO Clinton, MO Jackson, MO Lafayette, MO Platte, MO Ray, MO 3800 Kenosha, WI.............................................. 0.9761 Kenosha, WI 3810 Killeen-Temple, TX....................................... 0.9159 Bell, TX Coryell, TX 3840 Knoxville, TN............................................ 0.8820 Anderson, TN Blount, TN Knox, TN Loudon, TN Sevier, TN Union, TN 3850 Kokomo, IN............................................... 0.9045 Howard, IN Tipton, IN 3870 \2\ La Crosse, WI-MN..................................... 0.9304 Houston, MN La Crosse, WI 3880 Lafayette, LA............................................ 0.8225 Acadia, LA Lafayette, LA St. Landry, LA St. Martin, LA 3920 \2\ Lafayette, IN........................................ 0.8824 Clinton, IN Tippecanoe, IN 3960 Lake Charles, LA......................................... 0.7841 Calcasieu, LA 3980 \2\ Lakeland-Winter Haven, FL............................ 0.8855 Polk, FL 4000 Lancaster, PA............................................ 0.9282 Lancaster, PA 4040 Lansing-East Lansing, MI................................. 0.9714 Clinton, MI Eaton, MI Ingham, MI 4080 Laredo, TX............................................... 0.8091 Webb, TX 4100 Las Cruces, NM........................................... 0.8688 Dona Ana, NM 4120 \1\ Las Vegas, NV-AZ..................................... 1.1528 Mohave, AZ Clark, NV Nye, NV 4150 \2\ Lawrence, KS......................................... 0.8074 Douglas, KS 4200 Lawton, OK............................................... 0.8267 Comanche, OK 4243 Lewiston-Auburn, ME...................................... 0.9383 Androscoggin, ME 4280 Lexington, KY............................................ 0.8685 Bourbon, KY Clark, KY Fayette, KY Jessamine, KY Madison, KY Scott, KY Woodford, KY 4320 Lima, OH................................................. 0.9522 Allen, OH Auglaize, OH 4360 Lincoln, NE.............................................. 1.0033 Lancaster, NE 4400 Little Rock-North Little Rock, AR........................ 0.8923

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Faulkner, AR Lonoke, AR Pulaski, AR Saline, AR 4420 Longview-Marshall, TX.................................... 0.9113 Gregg, TX Harrison, TX Upshur, TX 4480 \1\ Los Angeles-Long Beach, CA........................... 1.1832 Los Angeles, CA 4520 \1\ Louisville, KY-IN.................................... 0.9242 Clark, IN Floyd, IN Harrison, IN Scott, IN Bullitt, KY Jefferson, KY Oldham, KY 4600 Lubbock, TX.............................................. 0.8272 Lubbock, TX 4640 Lynchburg, VA............................................ 0.9134 Amherst, VA Bedford, VA Bedford City, VA Campbell, VA Lynchburg City, VA 4680 Macon, GA................................................ 0.8975 Bibb, GA Houston, GA Jones, GA Peach, GA Twiggs, GA 4720 Madison, WI.............................................. 1.0264 Dane, WI 4800 Mansfield, OH............................................ 0.9180 Crawford, OH Richland, OH 4840 Mayaguez, PR............................................. 0.4795 Anasco, PR Cabo Rojo, PR Hormigueros, PR Mayaguez, PR Sabana Grande, PR San German, PR 4880 McAllen-Edinburg-Mission, TX............................. 0.8381 Hidalgo, TX 4890 Medford-Ashland, OR...................................... 1.0772 Jackson, OR 4900 Melbourne-Titusville-Palm Bay, FL........................ 0.9776 Brevard, Fl 4920 \1\ Memphis, TN-AR-MS.................................... 0.9009 Crittenden, AR DeSoto, MS Fayette, TN Shelby, TN Tipton, TN 4940 \2\ Merced, CA........................................... 0.9967 Merced, CA 5000 \1\ Miami, FL............................................ 0.9894 Dade, FL 5015 \1\ Middlesex-Somerset-Hunterdon, NJ..................... 1.1366 Hunterdon, NJ Middlesex, NJ Somerset, NJ 5080 \1\ Milwaukee-Waukesha, WI............................... 0.9988 Milwaukee, WI Ozaukee, WI Washington, WI Waukesha, WI 5120 \1\ Minneapolis-St. Paul, MN-WI.......................... 1.1001 Anoka, MN Carver, MN Chisago, MN Dakota, MN Hennepin, MN Isanti, MN Ramsey, MN Scott, MN Sherburne, MN Washington, MN Wright, MN Pierce, WI St. Croix, WI 5140 Missoula, MT............................................. 0.8884 Missoula, MT 5160 Mobile, AL............................................... 0.7994 Baldwin, AL Mobile, AL 5170 Modesto, CA.............................................. 1.1275 Stanislaus, CA 5190 \1\ Monmouth-Ocean, NJ................................... 1.1083 Monmouth, NJ Ocean, NJ 5200 Monroe, LA............................................... 0.7922 Ouachita, LA 5240 Montgomery, AL........................................... 0.7907 Autauga, AL Elmore, AL Montgomery, AL 5280 \2\ Muncie, IN........................................... 0.8824 Delaware, IN 5330 Myrtle Beach, SC......................................... 0.9112 Horry, SC 5345 Naples, FL............................................... 0.9790 Collier, FL 5360 \1\ Nashville, TN........................................ 0.9855 Cheatham, TN Davidson, TN Dickson, TN Robertson, TN Rutherford TN Sumner, TN Williamson, TN Wilson, TN 5380 \1\ Nassau-Suffolk, NY................................... 1.3140 Nassau, NY Suffolk, NY 5483 \1\ New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT.. 1.2468 Fairfield, CT New Haven, CT 5523 \2\ New London-Norwich, CT............................... 1.2183 New London, CT 5560 \1\ New Orleans, LA...................................... 0.9174 Jefferson, LA Orleans, LA Plaquemines, LA St. Bernard, LA St. Charles, LA St. James, LA St. John The Baptist, LA St. Tammany, LA 5600 \1\ New York, NY......................................... 1.4018 Bronx, NY Kings, NY New York, NY Putnam, NY Queens, NY Richmond, NY Rockland, NY Westchester, NY 5640 \1\ Newark, NJ........................................... 1.1518 Essex, NJ Morris, NJ Sussex, NJ Union, NJ Warren, NJ 5660 Newburgh, NY-PA.......................................... 1.1509 Orange, NY Pike, PA 5720 \1\ Norfolk-Virginia Beach-Newport News, VA-NC........... 0.8619 Currituck, NC Chesapeake City, VA Gloucester, VA Hampton City, VA Isle of Wight, VA James City, VA Mathews, VA Newport News City, VA Norfolk City, VA Poquoson City, VA Portsmouth City, VA Suffolk City, VA Virginia Beach City VA Williamsburg City, VA York, VA 5775 \1\ Oakland, CA.......................................... 1.5119 Alameda, CA Contra Costa, CA 5790 Ocala, FL................................................ 0.9728 Marion, FL 5800 Odessa-Midland, TX....................................... 0.9327 Ector, TX Midland, TX 5880 \1\ Oklahoma City, OK.................................... 0.8984 Canadian, OK Cleveland, OK Logan, OK McClain, OK Oklahoma, OK Pottawatomie, OK 5910 Olympia, WA.............................................. 1.0963 Thurston, WA 5920 Omaha, NE-IA............................................. 0.9745 Pottawattamie, IA Cass, NE Douglas, NE Sarpy, NE Washington, NE 5945 \1\ Orange County, CA.................................... 1.1492 Orange, CA 5960 \1\ Orlando, FL.......................................... 0.9654 Lake, FL Orange, FL Osceola, FL Seminole, FL 5990 Owensboro, KY............................................ 0.8374 Daviess, KY 6015 \2\ Panama City, FL...................................... 0.8855 Bay, FL 6020 Parkersburg-Marietta, WV-OH (WV Hospitals)............... 0.8039 Washington, OH

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Wood, WV 6020 \2\ Parkersburg-Marietta, WV-OH (OH Hospitals)........... 0.8820 Washington, OH Wood, WV 6080 \2\ Pensacola, FL........................................ 0.8855 Escambia, FL Santa Rosa, FL 6120 Peoria-Pekin, IL......................................... 0.8734 Peoria, IL Tazewell, IL Woodford, IL 6160 \1\ Philadelphia, PA-NJ.................................. 1.0883 Burlington, NJ Camden, NJ Gloucester, NJ Salem, NJ Bucks, PA Chester, PA Delaware, PA Montgomery, PA Philadelphia, PA 6200 \1\ Phoenix-Mesa, AZ..................................... 1.0129 Maricopa, AZ Pinal, AZ 6240 Pine Bluff, AR........................................... 0.7865 Jefferson, AR 6280 \1\ Pittsburgh, PA....................................... 0.8901 Allegheny, PA Beaver, PA Butler, PA Fayette, PA Washington, PA Westmoreland, PA 6323 \2\ Pittsfield, MA....................................... 1.0432 Berkshire, MA 6340 Pocatello, ID............................................ 0.9249 Bannock, ID 6360 Ponce, PR................................................ 0.4708 Guayanilla, PR Juana Diaz, PR Penuelas, PR Ponce, PR Villalba, PR Yauco, PR 6403 Portland, ME............................................. 0.9949 Cumberland, ME Sagadahoc, ME York, ME 6440 \1\ Portland-Vancouver, OR-WA............................ 1.1213 Clackamas, OR Columbia, OR Multnomah, OR Washington, OR Yamhill, OR Clark, WA 6483 \1\ Providence-Warwick-Pawtucket, RI..................... 1.0977 Bristol, RI Kent, RI Newport, RI Providence, RI Washington, RI 6520 Provo-Orem, UT........................................... 0.9976 Utah, UT 6560 \2\ Pueblo, CO........................................... 0.9328 Pueblo, CO 6580 Punta Gorda, FL.......................................... 0.9510 Charlotte, FL 6600 \2\ Racine, WI........................................... 0.9304 Racine, WI 6640 \1\ Raleigh-Durham-Chapel Hill, NC....................... 0.9959 Chatham, NC Durham, NC Franklin, NC Johnston, NC Orange, NC Wake, NC 6660 Rapid City, SD........................................... 0.8806 Pennington, SD 6680 Reading, PA.............................................. 0.9133 Berks, PA 6690 Redding, CA.............................................. 1.1352 Shasta, CA 6720 Reno, NV................................................. 1.0682 Washoe, NV 6740 Richland-Kennewick-Pasco, WA............................. 1.0609 Benton, WA Franklin, WA 6760 Richmond-Petersburg, VA.................................. 0.9349 Charles City County, VA Chesterfield, VA Colonial Heights City, VA Dinwiddie, VA Goochland, VA Hanover, VA Henrico, VA Hopewell City, VA New Kent, VA Petersburg City, VA Powhatan, VA Prince George, VA Richmond City, VA 6780 \1\ Riverside-San Bernardino, CA......................... 1.1348 Riverside, CA San Bernardino, CA 6800 Roanoke, VA.............................................. 0.8700 Botetourt, VA Roanoke, VA Roanoke City, VA Salem City, VA 6820 Rochester, MN............................................ 1.1739 Olmsted, MN 6840 \1\ Rochester, NY........................................ 0.9430 Genesee, NY Livingston, NY Monroe, NY Ontario, NY Orleans, NY Wayne, NY 6880 Rockford, IL............................................. 0.9666 Boone, IL Ogle, IL Winnebago, IL 6895 Rocky Mount, NC.......................................... 0.9076 Edgecombe, NC Nash, NC 6920 \1\ Sacramento, CA....................................... 1.1845 El Dorado, CA Placer, CA Sacramento, CA 6960 Saginaw-Bay City-Midland, MI............................. 1.0032 Bay, MI Midland, MI Saginaw, MI 6980 St. Cloud, MN............................................ 0.9679 Benton, MN Stearns, MN 7000 \2\ St. Joseph, MO....................................... 0.8056 Andrew, MO Buchanan, MO 7040 \1\ St. Louis, MO-IL..................................... 0.9033 Clinton, IL Jersey, IL Madison, IL Monroe, IL St. Clair, IL Franklin, MO Jefferson, MO Lincoln, MO St. Charles, MO St. Louis, MO St. Louis City, MO Warren, MO 7080 Salem, OR................................................ 1.0482 Marion, OR Polk, OR 7120 Salinas, CA.............................................. 1.4339 Monterey, CA 7160 \1\ Salt Lake City-Ogden, UT............................. 0.9913 Davis, UT Salt Lake, UT Weber, UT 7200 San Angelo, TX........................................... 0.8535 Tom Green, TX 7240 \1\ San Antonio, TX...................................... 0.8870 Bexar, TX Comal, TX Guadalupe, TX Wilson, TX 7320 \1\ San Diego, CA........................................ 1.1147 San Diego, CA 7360 \1\ San Francisco, CA.................................... 1.4514 Marin, CA San Francisco, CA San Mateo, CA 7400 \1\ San Jose, CA......................................... 1.4626 Santa Clara, CA 7440 \1\ San Juan-Bayamon, PR................................. 0.4909 Aguas Buenas, PR Barceloneta, PR Bayamon, PR Canovanas, PR Carolina, PR Catano, PR Ceiba, PR Comerio, PR Corozal, PR Dorado, PR Fajardo, PR Florida, PR Guaynabo, PR Humacao, PR Juncos, PR Los Piedras, PR Loiza, PR Luguillo, PR Manati, PR Morovis, PR Naguabo, PR Naranjito, PR Rio Grande, PR San Juan, PR Toa Alta, PR Toa Baja, PR

[[Page 63688]]

Trujillo Alto, PR Vega Alta, PR Vega Baja, PR Yabucoa, PR 7460 San Luis Obispo-Atascadero-Paso Robles, CA............... 1.1429 San Luis Obispo, CA 7480 Santa Barbara-Santa Maria-Lompoc, CA..................... 1.0441 Santa Barbara, CA 7485 Santa Cruz-Watsonville, CA............................... 1.2942 Santa Cruz, CA 7490 Santa Fe, NM............................................. 1.0653 Los Alamos, NM Santa Fe, NM 7500 Santa Rosa, CA........................................... 1.2877 Sonoma, CA 7510 Sarasota-Bradenton, FL................................... 0.9971 Manatee, FL Sarasota, FL 7520 Savannah, GA............................................. 0.9488 Bryan, GA Chatham, GA Effingham, GA 7560 Scranton--Wilkes-Barre--Hazleton, PA..................... 0.8412 Columbia, PA Lackawanna, PA Luzerne, PA Wyoming, PA 7600 \1\ Seattle-Bellevue-Everett, WA......................... 1.1562 Island, WA King, WA Snohomish, WA 7610 \2\ Sharon, PA........................................... 0.8378 Mercer, PA 7620 \2\ Sheboygan, WI........................................ 0.9304 Sheboygan, WI 7640 Sherman-Denison, TX...................................... 0.9700 Grayson, TX 7680 Shreveport-Bossier City, LA.............................. 0.9083 Bossier, LA Caddo, LA Webster, LA 7720 Sioux City, IA-NE........................................ 0.8993 Woodbury, IA Dakota, NE 7760 Sioux Falls, SD.......................................... 0.9309 Lincoln, SD Minnehaha, SD 7800 South Bend, IN........................................... 0.9821 St. Joseph, IN 7840 Spokane, WA.............................................. 1.0901 Spokane, WA 7880 Springfield, IL.......................................... 0.8944 Menard, IL Sangamon, IL 7920 Springfield, MO.......................................... 0.8457 Christian, MO Greene, MO Webster, MO 8003 Springfield, MA.......................................... 1.0543 Hampden, MA Hampshire, MA 8050 State College, PA........................................ 0.8740 Centre, PA 8080 \2\ Steubenville-Weirton, OH-WV (OH Hospitals)........... 0.8820 Jefferson, OH Brooke, WV Hancock, WV 8080 Steubenville-Weirton, OH-WV (WV Hospitals)............... 0.8398 Jefferson, OH Brooke, WV Hancock, WV 8120 Stockton-Lodi, CA........................................ 1.0404 San Joaquin, CA 8140 \2\ Sumter, SC........................................... 0.8498 Sumter, SC 8160 Syracuse, NY............................................. 0.9412 Cayuga, NY Madison, NY Onondaga, NY Oswego, NY 8200 Tacoma, WA............................................... 1.1116 Pierce, WA 8240 \2\ Tallahassee, FL...................................... 0.8855 Gadsden, FL Leon, FL 8280 \1\ Tampa-St. Petersburg-Clearwater, FL.................. 0.9103 Hernando, FL Hillsborough, FL Pasco, FL Pinellas, FL 8320 \2\ Terre Haute, IN...................................... 0.8824 Clay, IN Vermillion, IN Vigo, IN 8360 Texarkana, AR-Texarkana, TX.............................. 0.8150 Miller, AR Bowie, TX 8400 Toledo, OH............................................... 0.9397 Fulton, OH Lucas, OH Wood, OH 8440 Topeka, KS............................................... 0.9108 Shawnee, KS 8480 Trenton, NJ.............................................. 1.0517 Mercer, NJ 8520 \2\ Tucson, AZ........................................... 0.9270 Pima, AZ 8560 Tulsa, OK................................................ Creek, OK Osage, OK Rogers, OK Tulsa, OK Wagoner, OK

0.9185 8600 Tuscaloosa, AL........................................... 0.8212 Tuscaloosa, AL 8640 Tyler, TX................................................ 0.9404 Smith, TX 8680 \2\ Utica-Rome, NY....................................... 0.8526 Herkimer, NY Oneida, NY 8720 Vallejo-Fairfield-Napa, CA............................... 1.3425 Napa, CA Solano, CA 8735 Ventura, CA.............................................. 1.1064 Ventura, CA 8750 Victoria, TX............................................. 0.8184 Victoria, TX 8760 Vineland-Millville-Bridgeton, NJ......................... 1.0405 Cumberland, NJ 8780 \2\ Visalia-Tulare-Porterville, CA....................... 0.9967 Tulare, CA 8800 Waco, TX................................................. 0.8394 McLennan, TX 8840 \1\ Washington, DC-MD-VA-WV.............................. 1.0904 District of Columbia, DC Calvert, MD Charles, MD Frederick, MD Montgomery, MD Prince Georges, MD Alexandria City, VA Arlington, VA Clarke, VA Culpeper, VA Fairfax, VA Fairfax City, VA Falls Church City, VA Fauquier, VA Fredericksburg City, VA King George, VA Loudoun, VA Manassas City, VA Manassas Park City, VA Prince William, VA Spotsylvania, VA Stafford, VA Warren, VA Berkeley, WV Jefferson, WV 8920 \2\ Waterloo-Cedar Falls, IA............................. 0.8416 Black Hawk, IA 8940 Wausau, WI............................................... 0.9783 Marathon, WI 8960 \1\ West Palm Beach-Boca Raton, FL....................... 0.9798 Palm Beach, FL 9000 \2\ Wheeling, WV-OH (WV Hospitals)....................... 0.8018 Belmont, OH Marshall, WV Ohio, WV 9000 \2\ Wheeling, WV-OH (OH Hospitals)....................... 0.8820 Belmont, OH Marshall, WV Ohio, WV 9040 Wichita, KS.............................................. 0.9238 Butler, KS Harvey, KS Sedgwick, KS 9080 Wichita Falls, TX........................................ 0.8341 Archer, TX Wichita, TX 9140 \2\ Williamsport, PA..................................... 0.8378 Lycoming, PA 9160 Wilmington-Newark, DE-MD................................. 1.0882 New Castle, DE Cecil, MD 9200 Wilmington, NC........................................... 0.9563 New Hanover, NC Brunswick, NC 9260 \2\ Yakima, WA........................................... 1.0388 Yakima, WA 9270 \2\ Yolo, CA............................................. 0.9967 Yolo, CA 9280 York, PA................................................. 0.9119 York, PA 9320 Youngstown-Warren, OH.................................... 0.9214 Columbiana, OH

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Mahoning, OH Trumbull, OH 9340 Yuba City, CA............................................ 1.0196 Sutter, CA Yuba, CA 9360 \2\ Yuma, AZ............................................. 0.9270 Yuma, AZ

\1\ Large Urban Area \2\ Hospitals geographically located in the area are assigned the statewide rural wage index for FY 2004.

Addendum I.--Wage Index for Rural Areas

Wage Nonurban area

Index

Alabama....................................................... 0.7492 Alaska........................................................ 1.1886 Arizona....................................................... 0.9270 Arkansas...................................................... 0.7734 California.................................................... 0.9967 Colorado...................................................... 0.9328 Connecticut................................................... 1.2183 Delaware...................................................... 0.9595 Florida....................................................... 0.8855 Georgia....................................................... 0.8595 Hawaii........................................................ 0.9958 Idaho......................................................... 0.8974 Illinois...................................................... 0.8254 Indiana....................................................... 0.8824 Iowa.......................................................... 0.8416 Kansas........................................................ 0.8074 Kentucky...................................................... 0.7974 Louisiana..................................................... 0.7467 Maine......................................................... 0.8812 Maryland...................................................... 0.9125 Massachusetts................................................. 1.0432 Michigan...................................................... 0.8877 Minnesota..................................................... 0.9345 Mississippi................................................... 0.7778 Missouri...................................................... 0.8056 Montana....................................................... 0.8800 Nebraska...................................................... 0.8822 Nevada........................................................ 0.9806 New Hampshire................................................. 1.0030 New Jersey \1\................................................ ........ New Mexico.................................................... 0.8270 New York...................................................... 0.8526 North Carolina................................................ 0.8456 North Dakota.................................................. 0.7778 Ohio.......................................................... 0.8820 Oklahoma...................................................... 0.7537 Oregon........................................................ 0.9994 Pennsylvania.................................................. 0.8378 Puerto Rico................................................... 0.4018 Rhode Island \1\.............................................. ........ South Carolina................................................ 0.8498 South Dakota.................................................. 0.8195 Tennessee..................................................... 0.7886 Texas......................................................... 0.7780 Utah.......................................................... 0.8974 Vermont....................................................... 0.9534 Virginia...................................................... 0.8498 Washington.................................................... 1.0388 West Virginia................................................. 0.8018 Wisconsin..................................................... 0.9304 Wyoming....................................................... 0.9110

\1\ All counties within the State are classified as urban.

Addendum J.--Wage Index for Hospitals That Are Reclassified

Wage Area

index

Akron, OH..................................................... 0.9442 Albany, GA.................................................... 1.0664 Albuquerque, NM (NM hospitals)................................ 0.9300 Albuquerque, NM (CO hospitals)................................ 0.9328 Alexandria, LA................................................ 0.8037 Allentown-Bethlehem-Easton, PA................................ 0.9721 Altoona, PA................................................... 0.8827 Amarillo, TX.................................................. 0.8858 Anchorage, AK................................................. 1.2351 Ann Arbor, MI................................................. 1.0846 Anniston, AL.................................................. 0.7975 Asheville, NC................................................. 0.9477 Athens, GA.................................................... 0.9564 Atlanta, GA................................................... 0.9990 Atlantic-Cape May, NJ......................................... 1.0531 Augusta-Aiken, GA-SC.......................................... 0.9433 Austin-San Marcos, TX......................................... 0.9609 Bangor, ME.................................................... 0.9904 Barnstable-Yarmouth, MA....................................... 1.2720 Baton Rouge, LA............................................... 0.8406 Bellingham, WA................................................ 1.1305 Benton Harbor, MI............................................. 0.8935 Bergen-Passaic, NJ............................................ 1.1731 Billings, MT.................................................. 0.8961 Biloxi-Gulfport-Pascagoula, MS................................ 0.8407 Binghamton, NY................................................ 0.8428 Birmingham, AL................................................ 0.9212 Bismarck, ND.................................................. 0.8033 Bloomington-Normal, IL........................................ 0.8832 Boise City, ID................................................ 0.9232 Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH.............. 1.1233 Burlington, VT................................................ 0.9332 Caguas, PR.................................................... 0.4201 Casper, WY.................................................... 0.9209 Champaign-Urbana, IL.......................................... 0.9460 Charleston-North Charleston, SC............................... 0.9332 Charleston, WV (WV Hospitals)................................. 0.8568 Charleston, WV (OH Hospitals)................................. 0.8820 Charlotte-Gastonia-Rock Hill, NC-SC........................... 0.9730 Charlottesville, VA........................................... 0.9877 Chattanooga, TN-GA............................................ 0.9086 Chicago, IL................................................... 1.0752 Cincinnati, OH-KY-IN.......................................... 0.9413 Clarksville-Hopkinsville, TN-KY............................... 0.8354 Cleveland-Lorain-Elyria, OH................................... 0.9671 Columbia, MO.................................................. 0.8557 Columbia, SC.................................................. 0.8902 Columbus, GA-AL............................................... 0.8595 Columbus, OH.................................................. 0.9648 Corpus Christi, TX............................................ 0.8521 Corvallis, OR................................................. 1.1241 Dallas, TX.................................................... 0.9974 Davenport-Moline-Rock Island, IA-IL........................... 0.8985 Dayton-Springfield, OH........................................ 0.9529 Decatur, AL................................................... 0.8580 Denver, CO.................................................... 1.0664 Des Moines, IA................................................ 0.9106 Detroit, MI................................................... 1.0101 Dothan, AL.................................................... 0.7765 Duluth-Superior, MN-WI........................................ 1.0171 Elkhart-Goshen, IN............................................ 0.9554 Erie, PA...................................................... 0.8526 Eugene-Springfield, OR........................................ 1.0977 Fargo-Moorhead, ND-MN......................................... 0.9501 Fayetteville, NC.............................................. 0.8817 Flagstaff, AZ-UT.............................................. 1.1079 Flint, MI..................................................... 1.0703 Florence, AL.................................................. 0.7797 Fort Collins-Loveland, CO..................................... 1.0148 Ft. Lauderdale, FL............................................ 1.0479 Fort Pierce-Port St. Lucie, FL................................ 1.0124 Fort Smith, AR-OK............................................. 0.8077 Fort Walton Beach, FL......................................... 0.8804 Forth Worth-Arlington, TX..................................... 0.9359 Gadsden, AL................................................... 0.8229 Gainesville, FL............................................... 0.9693 Grand Forks, ND-MN............................................ 0.8636 Grand Junction, CO............................................ 0.9921 Grand Rapids-Muskegon-Holland, MI............................. 0.9469 Great Falls, MT............................................... 0.8918 Greeley, CO................................................... 0.9453 Green Bay, WI................................................. 0.9518 Greensboro-Winston-Salem-High Point, NC....................... 0.9058 Greenville, NC................................................ 0.9167 Hamilton-Middletown, OH....................................... 0.9214 Harrisburg-Lebanon-Carlisle, PA............................... 0.9164 Hartford, CT.................................................. 1.1359 Hickory-Morganton-Lenoir, NC.................................. 0.9113 Honolulu, HI.................................................. 1.1116 Houston, TX................................................... 0.9834 Huntington-Ashland, WV-KY-OH.................................. 0.9076 Huntsville, AL................................................ 0.9120 Indianapolis, IN.............................................. 0.9916 Iowa City, IA................................................. 0.9404 Jackson, MS................................................... 0.8399 Jackson, TN................................................... 0.8819 Jacksonville, FL.............................................. 0.9563 Johnson City-Kingsport-Bristol, TN-VA (VA Hospitals).......... 0.8498 Johnson City-Kingsport-Bristol, TN-VA (KY Hospitals).......... 0.8256 Jonesboro, AR (AR Hospitals).................................. 0.7809 Jonesboro, AR (MO Hospitals).................................. 0.8056 Joplin, MO.................................................... 0.8558 Kalamazoo-Battlecreek, MI..................................... 1.0500 Kansas City, KS-MO............................................ 0.9715 Knoxville, TN................................................. 0.8820 Kokomo, IN.................................................... 0.9045 Lafayette, LA................................................. 0.8225 Lakeland-Winter Haven, FL..................................... 0.8855 Las Vegas, NV-AZ.............................................. 1.1401 Lawton, OK.................................................... 0.8140 Lexington, KY................................................. 0.8475 Lima, OH...................................................... 0.9522 Lincoln, NE................................................... 0.9597 Little Rock-North Little Rock, AR............................. 0.8923 Longview-Marshall, TX......................................... 0.8943 Los Angeles-Long Beach, CA.................................... 1.1832 Louisville, KY-IN............................................. 0.9118 Lubbock, TX................................................... 0.8272 Lynchburg, VA................................................. 0.8941 Macon, GA..................................................... 0.8975 Madison, WI................................................... 1.0117

[[Page 63690]]

Medford-Ashland, OR........................................... 1.0425 Melbourne-Titusville-Palm Bay, FL............................. 0.9776 Memphis, TN-AR-MS............................................. 0.8786 Miami, FL..................................................... 0.9894 Milwaukee-Waukesha, WI........................................ 0.9829 Minneapolis-St. Paul, MN-WI................................... 1.1001 Missoula, MT.................................................. 0.8884 Mobile, AL.................................................... 0.7994 Modesto, CA................................................... 1.1148 Monmouth-Ocean, NJ............................................ 1.1083 Monroe, LA.................................................... 0.7922 Montgomery, AL................................................ 0.7907 Nashville, TN................................................. 0.9591 New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT........... 1.2468 New Orleans, LA............................................... 0.9174 New York, NY.................................................. 1.4018 Newark, NJ.................................................... 1.1518 Newburgh, NY-PA............................................... 1.1048 Oakland, CA................................................... 1.5119 Odessa-Midland, TX............................................ 0.9076 Oklahoma City, OK............................................. 0.8984 Olympia, WA................................................... 1.0963 Omaha, NE-IA.................................................. 0.9745 Orange County, CA............................................. 1.1492 Orlando, FL................................................... 0.9654 Peoria-Pekin, IL.............................................. 0.8734 Philadelphia, PA-NJ........................................... 1.0883 Phoenix-Mesa, AZ.............................................. 1.0129 Pittsburgh, PA................................................ 0.8901 Pittsfield, MA................................................ 0.9795 Pocatello, ID................................................. 0.9249 Portland, ME.................................................. 0.9658 Portland-Vancouver, OR-WA..................................... 1.1213 Provo-Orem, UT................................................ 0.9976 Raleigh-Durham-Chapel Hill, NC................................ 0.9725 Rapid City, SD................................................ 0.8806 Reading, PA................................................... 0.8998 Redding, CA................................................... 1.1352 Reno, NV...................................................... 1.0682 Richland-Kennewick-Pasco, WA (WA Hospitals)................... 1.0388 Richland-Kennewick-Pasco, WA (ID Hospitals)................... 1.0215 Richmond-Petersburg, VA....................................... 0.9349 Roanoke, VA................................................... 0.8700 Rochester, MN................................................. 1.1739 Rockford, IL.................................................. 0.9441 Sacramento, CA................................................ 1.1845 Saginaw-Bay City-Midland, MI.................................. 0.9751 St. Cloud, MN................................................. 0.9679 St. Joseph, MO................................................ 0.8578 St. Louis, MO-IL.............................................. 0.9033 Salinas, CA................................................... 1.4339 Salt Lake City-Ogden, UT...................................... 0.9913 San Antonio, TX............................................... 0.8870 Santa Fe, NM.................................................. 0.9524 Santa Rosa, CA................................................ 1.2877 Sarasota-Bradenton, FL........................................ 0.9971 Savannah, GA.................................................. 0.9488 Seattle-Bellevue-Everett, WA.................................. 1.1562 Sherman-Denison, TX........................................... 0.9203 Shreveport-Bossier City, LA................................... 0.8937 Sioux City, IA-NE (NE Hospitals).............................. 0.8822 Sioux City, IA-NE (SD Hospitals).............................. 0.8785 Sioux Falls, SD............................................... 0.9184 South Bend, IN................................................ 0.9715 Spokane, WA................................................... 1.0717 Springfield, IL............................................... 0.8944 Springfield, MO............................................... 0.8259 Syracuse, NY.................................................. 0.9412 Tampa-St. Petersburg-Clearwater, FL........................... 0.9103 Texarkana, AR-Texarkana, TX................................... 0.7969 Toledo, OH.................................................... 0.9397 Topeka, KS.................................................... 0.9108 Tucson, AZ.................................................... 0.9270 Tulsa, OK..................................................... 0.8938 Tuscaloosa, AL................................................ 0.8101 Tyler, TX..................................................... 0.9155 Vallejo-Fairfield-Napa, CA.................................... 1.3425 Victoria, TX.................................................. 0.8184 Waco, TX...................................................... 0.8394 Washington, DC-MD-VA-WV....................................... 1.0904 Waterloo-Cedar Falls, IA...................................... 0.8416 Wausau, WI.................................................... 0.9783 West Palm Beach-Boca Raton, FL................................ 0.9798 Wichita, KS................................................... 0.9004 Wichita Falls, TX............................................. 0.8341 Wilmington-Newark, DE-MD...................................... 1.0710 Wilmington, NC................................................ 0.9424 Youngstown-Warren, OH......................................... 0.9214 Rural Florida................................................. 0.8699 Rural Illinois (IA Hospitals)................................. 0.8416 Rural Illinois (MO Hospitals)................................. 0.8254 Rural Kentucky................................................ 0.7974 Rural Louisiana............................................... 0.7467 Rural Minnesota............................................... 0.9345 Rural Missouri................................................ 0.8056 Rural Nebraska................................................ 0.8822 Rural Nevada.................................................. 0.9276 Rural New Hampshire........................................... 1.0030 Rural Texas................................................... 0.7780 Rural Washington.............................................. 1.0388 Rural Wyoming................................................. 0.8984

[FR Doc. 03-27791 Filed 10-31-03; 11:55 am]

BILLING CODE 4120-01-P

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