Medicare: Hospital outpatient prospective payment system and 2004 CY payment rates,

[Federal Register: August 12, 2003 (Volume 68, Number 155)]

[Proposed Rules]

[Page 47965-48248]

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

[DOCID:fr12au03-21]

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Part II

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; Proposed Rule

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 410 and 419

[CMS-1471-P]

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: Proposed rule.

SUMMARY: This proposed rule would revise 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 would describe proposed 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 would be applicable to services furnished on or after January 1, 2004.

DATES: We will consider comments if we receive them at the appropriate address, as provided below, no later than 5 p.m. on October 6, 2003.

ADDRESSES: In commenting, please refer to file code CMS-1471-P. 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-P, 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.

We encourage commenters submitting as comments information that contains beneficiary specific information (for example, medical records, or invoices with beneficiary identification) to remove any individually identifiable information, such as information that identifies an individual, diagnoses, addresses, telephone numbers, attending physician, medical record number, or Medicare or other insurance number. Moreover, individually identifiable beneficiary medical records, including progress notes, medical orders, test results, consultation reports, and photocopies of checks from hospitals or other documents that contain bank routing numbers should not be submitted to us. Persons or organizations submitting proprietary information as public comments must designate in writing if part or all of the information contained in such comments should be considered as exempt from disclosure under Exemption 4 of the Freedom of Information Act (FOIA). Generally, Exemption 4 of the FOIA protects trade secrets and commercial or financial information that is privileged or confidential, and affords the same protections as the Trade Secrets Act, which is also applicable. We will attempt to keep confidential and protect from disclosure information that qualifies under Exemption 4. However, only data that can be available for public inspection would be used for the final rule. For information on viewing public comments, see the beginning of the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT: Dana Burley, (410) 786-4532-- 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) 786-7197.

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 II. Proposed 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. The Panel's Meetings

3. Establishment of an Observation Subcommittee

4. 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. APC Assignment for New Codes Created During Calendar Year (CY) 2003

5. Creation of APCs for Combinations of Device Procedures

6. New APC for Antepartum Care III. Recalibration of APC Weights for CY 2004

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A. Data Issues

1. Period of Claims Data Used

2. Treatment of ``Multiple Procedure'' Claims

3. Adjustment of Median Costs for CY 2003 OPPS

B. Description of How We Propose To Calculate Weights for CY 2004 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. Other Policy Issues Relating to Pass-Through Device Categories VI. Payment for Drugs, Biologicals, Radiopharmaceutical Agents, Blood, and Blood Products

A. Pass-Through Drugs and Biologicals

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

1. Background

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

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

4. Proposed Payment Methodology for Drug Administration

5. Generic Drugs and Radiopharmaceuticals

6. Orphan Drugs

7. Vaccines

8. Blood and Blood Products

9. Intravenous Immune Globulin

10. Drug and Device Coding

11. Payment for Split Unit of Blood

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

A. Proposed Outlier Policy for CY 2004

B. Elimination of Transitional Corridor Payments for CY 2004 XI. Other Policy Decisions and Proposed 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. Summary of and Responses to MedPAC Recommendations XIII. Summary of Proposed Changes for 2004

A. Changes Required by Statute

B. Additional Changes XIV. Collection of Information Requirements XV. Response to Public Comments XVI. Regulatory Impact Analysis

A. General

B. Changes in This Proposed Rule

C. Limitations of Our Analysis

D. Estimated Impacts of This Proposed Rule on Hospitals

E. Projected Distribution of Outlier Payments

F. Estimated Impacts of This Proposed 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 the Proposed Rule

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

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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. On June 30, 1999, we published a correction notice (64 FR 35258) to correct a number of technical and typographic errors in the September 1998 proposed rule including the proposed amounts and factors used to determine the payment rates.

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

[sbull] On June 30, 2000, we published a notice (65 FR 40535) announcing a delay in implementation of the OPPS from July 1, 2000 to August 1, 2000. We implemented the OPPS on 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 August 3, 2000 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). This rule provided for 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. In addition, it 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.

II. Proposed 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 601, Mid-Level Clinic Visits. The APC weights are scaled to APC 601 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

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unusual cases, such as low volume items and services.''

For purposes of this proposed 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 Act requires that we consult with an outside panel of experts, the Advisory Panel on APC Groups (the Panel), to review the clinical integrity of the groups and 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 will be identified on the CMS Web site. 2. The Panel's Meetings

The first Panel meeting was held on February 27, February 28, and March 1, 2001. During the 2001 meeting, the Panel members felt that requiring consistency for all presentations with regard to format, data submission, and general information would assist them in analyzing the submissions and presentations and making recommendations. Therefore, upon the Panel's recommendation, the Research Subcommittee was established during the 2001 meeting.

The Panel began its 2002 meeting on January 22, 2002, by considering the Research Subcommittee's recommendation to the Panel on requirements for written submissions and oral presentations. The Research Subcommittee recommended that all future oral presentations and written submissions contain the following:

[sbull] Name, address, and telephone number of the proposed presenter.

[sbull] Financial relationship(s), if any, with any company whose products, services, or procedures are under consideration.

[sbull] CPT ([Physicians'] Current Procedural Technology) codes involved.

[sbull] APC(s) affected.

[sbull] Description of the issue.

[sbull] Clinical description of the service under discussion, with comparison to other services within the APC.

[sbull] Description of the resource inputs associated with the service under discussion, with a comparison to resource inputs for other services within the APC.

[sbull] Recommendations and rationale for change.

[sbull] Expected outcome of change and potential consequences of no change.

The Panel adopted these Subcommittee recommendations.

The third Panel meeting was held on January 21 and 22, 2003, to discuss the APCs of the newly implemented 2003 OPPS. We published a notice in the Federal Register on December 27, 2002 (67 FR 79107), to announce the following: The location and time of the third Panel meeting; a list of agenda items; and that the meeting was open to the public. In that document, we solicited public comment specifically on the items included on the agenda for the January 2003 Panel meeting. In this section, ``commenter'' refers to entities that provided comments in response to that Federal Register notice. We also provided additional information about the Panel meeting through a press release and on the CMS Web site. Presentations for the 2003 meeting met, at a minimum, the adopted guidelines for presentations referred to above. 3. Establishment of an Observation Subcommittee

At the third annual meeting in January 2003, the Panel suggested numerous changes to the APCs (listed below) and that a subcommittee be established to review observation issues, such as allowable International Classification of Diseases, clinical modification codes, and operational issues. Therefore, before the close of the third annual meeting, the Observation Subcommittee was established. Other Panel members that are not currently participating in this subcommittee are welcome to take part in this subcommittee, which is tasked with reviewing International Classification of Disease Codes, clinical modification codes, and operational issues related to observation. This subcommittee will report its findings to the Panel in 1 year. 4. Recommendations of the Advisory Panel and Our Responses

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 proposed 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 believe violate 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 this preamble, we discuss our proposals regarding the 2 times rule based on the April 1, 2002 through December 31, 2002 data that we used to determine the proposed 2004 APC relative weights. Section II.B also details the criteria we used when deciding to propose exceptions to the 2 times 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.

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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 propose to accept the Panel's recommendation.

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.

(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. We propose to accept the Panel's recommendation that we make no changes to the structure of these APCs for 2004. 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 following changes:

Move the following HCPCS codes as described below:

Table 1.--HCPCS Codes Proposed To Be Redistributed From APCs 0071 and 0072 to APCs 0071, 0072, and 0073

HCPCS

Description

2003 APC

2004 APC

31505......................................... Diagnostic laryngoscopy.........

0072

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

0071

0072 31720......................................... Clearance of airways............

0072

0073

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

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 propose to accept the Panel's recommendation that we make no changes to APC 0097 for 2004. We 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 felt, however, that the structure of APC 0099 should not be changed at this time based on clinical homogeneity considerations. We propose 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 felt the data presented are insufficient to merit moving the code and recommends that CPT code 93025 remain in APC 0100 until more data are available for review. We propose to accept the Panel's recommendation that CPT code 93025 remain in APC 0100 until more claims data become available for review.

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 propose 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.

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

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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 propose to accept the Panel's recommendation that we make no changes to APCs 0146 and 0147. 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 propose to accept the Panel's recommendation.

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:

HCPCS

Description

APC 0385: 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: 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 propose to accept the Panel's recommendation to eliminate APCs 0179 and 0182 and create two new APCs, 0644 and 0645, 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 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 propose to split APC 0190 (Surgical Hysteroscopy) into 2 APCs that are more clinically homogeneous. We propose 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 propose 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 propose to move the following HCPCS codes as described below:

Table 2.--HCPCS Codes Proposed To Be Redistributed to APCs 0130, 0195, and 0190

HCPCS

Description

2003 APC

2004 APC

58578......................................... Laparoscopic procedure, uterus..

0190

0130 58353......................................... Endometrial ablate, thermal.....

0193

0195 58555......................................... Hysteroscopy, diagnostic, sep.

0194

0190 procedure.

We believe these proposed 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.

l. 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 propose to accept the Panel's recommendation to move CPT codes

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57109, 58920, and 58925 from APC 0202 to APC 0195.

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 propose to accept the Panel's recommendation that we make no changes to the structure of these APCs until more data become available for review.

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 felt 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 propose to accept the Panel's recommendation that CPT code 62351 remain in APC 0208 until more claims data become available for review.

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 propose 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 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 propose 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: one for implantation of programmable spine infusion pumps, 62362, and for 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 227 does not violate the 2 times rule, the Panel recommended that CPT codes 62361 and 62362 remain in APC 0227. We propose to accept the Panel's recommendation.

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 propose to accept the Panel's recommendation and monitor the data for APC 0235 for possible review next year. 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 propose 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.

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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 propose to accept the Panel's recommendation to move CPT codes 92543 and 92588 from APC 0660 to APC 0363.

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 propose to accept the Panel's recommendation to move CPT codes 47530, 50688, 51710, and 62225 from APC 0121 to APC 0122.

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 propose to accept the Panel's recommendation to move CPT codes 72285 and 72295 from APC 0274 to new APC 0388.

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 CMS 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 propose to accept the Panel's recommendation that we make no CPT code changes to APCs 0296 and 0297.

x. Vascular Procedures; Cannula/Access Device Procedures.

APC 0103: Miscellaneous Vascular Procedures

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 recommends that CPT code 36860 remain in APC 0103 until more data are available for review. We propose to accept the Panel's recommendation that CPT code 36860 remain in APC 0103 until more claims data become available for review.

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 280. The Panel felt that APCs 0279, 0280, and 0668 were clinically homogenous and recommended that we only make changes after consulting with experts in the field. We propose to accept the Panel's recommendation to make no changes to APCs 0279, 0280, and 0668 until consulting 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 felt 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 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 Proposed To Be Designated as Separately Payable

HCPCS

Description

2003 status 2004 APC

76362.......... CT scan for tissue Packaged........

0332 ablation. 76394.......... MRI for tissue

Packaged........

0335 ablation. 76490.......... US for tissue

Packaged........

0268 ablation.

We propose 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.

aa. Magnetic Resonance Imaging and Magnetic Resonance Angiography Without Contrast.

[[Page 47974]]

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 propose 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 propose to accept the Panel's recommendation.

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 would 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 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 would be used to determine whether to change the APC structure for chemotherapy administration.

We propose not to accept the Panel's recommendations to split APC 0116 into 3 APCs and to use CPT codes for administration of chemotherapy. We would consider such a split in the future but would like to first address the administration of drugs issue. We believe that making a change in APC 116 would be too complicated for hospitals given the changes for administration in general that we are considering in this proposed rule for implementation in CY 2004. We will consider such a split for APC 116 for CY 2005. We also believe the use of CPT codes would be burdensome to hospitals, would require extensive education, and would 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 is 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 would 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. Please see section VI of this proposed rule for further discussion on payments for drugs and drug administration.

dd. Capturing the Costs of Drugs and Biologicals 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.

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 said 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 would have no incentive to code, and thereby, identify, packaged drugs.

Pass-through payments for 236 drugs, biologicals, and radiopharmaceuticals expired as of 2003, and these items are now 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 will not provide specific cost information for packaged items. We requested input from the Panel for methods to determine drug costs.

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 radionucliides 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

[[Page 47975]]

radiopharmaceuticals and believe that reorganizing the APCs for nuclear medicine would result in greater clinical and resource homogeneity. Therefore, we propose to eliminate APCs 0286, 0290, 0291, 0292, 0294, 0666 and create 20 new APCs for nuclear medicine that contain the following CPT codes:

HCPCS

Description

APC 0389: 78000............................ Thyroid, single uptake. 78001............................ Thyroid, multiple uptakes. 78003............................ Thyroid suppress/stimul. 78020............................ Thyroid met uptake. 78099............................ Endocrine nuclear procedure. 78190............................ Platelet survival, kinetics. 78191............................ Platelet survival. 78199............................ Blood/lymph nuclear exam. 78299............................ GI nuclear procedure. 78399............................ Musculoskeletal nuclear exam. 78499............................ Cardiovascular nuclear exam. 78599............................ Respiratory nuclear exam. 78699............................ Nervous system nuclear exam. 78725............................ Kidney function study. 78799............................ Genitourinary nuclear exam. 78999............................ Nuclear diagnostic exam. 79999............................ Nuclear medicine therapy. APC 0390: 78006............................ Thyroid imaging with uptake. 78010............................ Thyroid imaging. 78015............................ Thyroid met imaging. 78016............................ Thyroid met imaging/studies. APC 0391: 78007............................ Thyroid image, mult uptakes. 78011............................ Thyroid imaging with flow. 78018............................ Thyroid met imaging, body. 78070............................ Parathyroid nuclear imaging. APC 0392: 78075............................ Adrenal nuclear imaging. APC 0393: 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 0400: 78102............................ Bone marrow imaging, ltd. 78103............................ Bone marrow imaging, mult. 78104............................ Bone marrow imaging, body. 78185............................ Spleen imaging. 78195............................ Lymph system imaging. APC 0394: 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: 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. 78290............................ Meckel's divert exam. 78291............................ Leveen/shunt patency exam. 78270............................ Vit B-12 absorption exam. 78271............................ Vit b-12 absrp exam, int fac. 78272............................ Vit B-12 absorp, combined. 78282............................ GI protein loss exam. APC 0396: 78300............................ Bone imaging, limited area. 78305............................ Bone imaging, multiple areas. 78306............................ Bone imaging, whole body. 78315............................ Bone imaging, 3 phase. 78320............................ Bone imaging (3D). APC 0397: 78414............................ Non-imaging heart function. 78445............................ Venous thrombosis study. 78455............................ Venous thrombosis study. 78456............................ Acute venous thrombus image. 78457............................ Venous thrombosis imaging. 78458............................ Ven thrombosis images, bilat. APC 0398: 78428............................ Cardiac shunt imaging. 78460............................ Heart muscle blood, single. 78461............................ Heart muscle blood, multiple. 78464............................ Heart image (3d), single. 78465............................ Heart image (3d), multiple. 78466............................ Heart infarct image. 78468............................ Heart infarct image (ef). 78469............................ Heart infarct image (3D). 78472............................ Gated heart, planar, single. 78473............................ Gated heart, multiple. 78481............................ Heart first pass, single. 78483............................ Heart first pass, multiple. 78494............................ Heart image, spect. APC 0399: 78478............................ Heart wall motion add-on. 78480............................ Heart function add-on. 78496............................ Heart first pass add-on. APC 0401: 78580............................ Lung perfusion imaging. 78584............................ Lung V/Q image single breath. 78585............................ Lung V/Q imaging. 78586............................ Aerosol lung image, single. 78587............................ Aerosol lung image, multiple. 78588............................ Perfusion lung image. 78591............................ Vent image, 1 breath, 1 proj. 78593............................ Vent image, 1 proj, gas. 78594............................ Vent image, mult proj, gas. 78596............................ Lung differential function. APC 0402: 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. APC 0403: 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: 78700............................ Kidney imaging, static. 78701............................ Kidney imaging with flow. 78704............................ Imaging renogram. 78707............................ Kidney flow/function image. 78708............................ Kidney flow/function image. 78709............................ Kidney flow/function image. 78710............................ Kidney imaging (3D). 78715............................ Renal vascular flow exam. APC 0405: 78730............................ Urinary bladder retention. 78740............................ Ureteral reflux study. 78760............................ Testicular imaging. 78761............................ Testicular imaging/flow. APC 0406: 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. G0273............................ Pretx planning, non-Hodgkins. APC 0407: 79000............................ Init hyperthyroid therapy. 79001............................ Repeat hyperthyroid therapy. 79020............................ Thyroid ablation. 79030............................ Thyroid ablation, carcinoma. 79035............................ Thyroid metastatic therapy. APC 0408: 79100............................ Hematopoetic nuclear therapy. 79200............................ Intracavitary nuclear trmt. 79300............................ Interstitial nuclear therapy. 79400............................ Nonhemato nuclear therapy. 79420............................ Thyroid metastatic therapy. 79440............................ Nuclear joint therapy. G0274............................ Radiopharm tx, non-Hodgkins.

We believe that the proposed 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.

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 are proposing to make payment for ``zevalin'' (Ibritumomab Tiuxetan) separately from payment for the procedures with which ``zevalin'' (Ibritumomab Tiuxetan) is used.

We propose 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 would place HCPCS A9522 in 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

[[Page 47976]]

portion of the payment is attributed to labor-related costs.

Because we propose that payment for G0273 and G0274 no longer include payment for ``zevalin,'' we also propose 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.

Please see section VI of this proposed rule for further discussion on payments for drugs, biologicals, and radiopharmaceuticals.

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

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 would 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 0646

HCPCS

Description

2003 APC 2004 APC

43219................ Esophagus endoscopy........ 0141 0384 43256................ Upper GI endoscopy w/stent. 0141 0384 44370................ Small bowel endoscopy w/

0142 0384 stent. 44379................ Small bowel endoscopy w/

0142 0384 stent. 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 propose 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, and 45345 (from APC 0147).

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 V.C of this proposed rule, 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

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modeling a variety of possible dollar amounts). In addition, the Panel recommended that we create no 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. Please see section V.C of this proposed rule for our discussion of the use of multiple procedure claims for developing payment rates for procedures that use devices.

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 proposed rule and the use of 2002 claims data to calculate the 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 APCs that we propose to 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.--Table of APCs Exempted From 2 Times Rule

Proposed rule APC

Description

0004...................................... Level I Needle Biopsy/ Aspiration Except Bone Marrow. 0018...................................... Biopsy of Skin/Puncture of Lesion. 0019...................................... Level I Excision/Biopsy. 0020...................................... Level II Excision/Biopsy. 0032...................................... Insertion of Central Venous/ Arterial Catheter. 0043...................................... Closed Treatment Fracture Finger/Toe/Trunk. 0046...................................... Open/Percutaneous Treatment Fracture or Dislocation. 0048...................................... Arthroplasty with Prosthesis. 0055...................................... Level I Foot Musculoskeletal Procedures. 0058...................................... Level I Strapping and Cast Application. 0060...................................... Manipulation Therapy. 0072...................................... Level II Endoscopy Upper Airway. 0073...................................... Level III Endoscopy Upper Airway. 0080...................................... Diagnostic Cardiac Catheterization. 0084...................................... Level I Electrophysiologic Evaluation. 0097...................................... Cardiac and Ambulatory Blood Pressure Monitoring. 0099...................................... Electrocardiograms. 0105...................................... Revision/Removal of Pacemakers, AICD, or Vascular. 0130...................................... Level I Laparoscopy. 0147...................................... Level II Sigmoidoscopy. 0148...................................... Level I Anal/Rectal Procedure. 0155...................................... Level II Anal/Rectal Procedure. 0164...................................... Level I Urinary and Anal Procedures. 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. 0303...................................... Treatment Device Construction. 0330...................................... Dental Procedures. 0340...................................... Minor Ancillary Procedures.

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0341...................................... Skin Tests. 0344...................................... Level III Pathology. 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. 0385...................................... Urinary Incontinence Procedures. 0397...................................... Vascular Imaging. 0408...................................... Non-thyroid Radionucliide Treatment. 0409...................................... Red Blood Cell Tests. 0600...................................... Low Level Clinic Visits. 0668...................................... Level I Angiography and Venography except Extremity. 0692...................................... Electronic Analysis of Neurostimulator Pulse Generators. 0698...................................... Level II Eye Tests & Treatments.

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. The April 7, 2000 final rule initially established the time frame that new technology APCs would be in effect (65 FR 18457). Beginning in 2002, we 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 in more detail below, we propose to delete four HCPCS codes that are currently paid in new technology APCs. 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, there exist, or soon will exist, CPT codes to describe 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 we propose to delete effective January 1, 2004 are:

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.

These codes were created and assigned to New Technology APCs when it was CMS policy to create a C code to describe an item of equipment for which there was no other means of making payment for the service in which the equipment was used. In the November 30, 2001 final rule, we announced that we would not use New Technology APCs to pay for drugs, devices, and equipment that are used in the performance of a procedure, but which are not in and of themselves a complete service. It is due to an oversight on our part that we did not delete these codes at that time. We stopped using C codes to describe specific devices in April 2001 and no longer create C codes to describe items of equipment. Moreover, we have found that there are existing CPT codes or, in the case of C9701, there will soon be a CPT tracking code, that will accurately report the services being furnished, and under which the hospital should report the charges for providing the services, including charges related to the equipment needed to furnish the service. Therefore, payment will be appropriate regardless of whether there are separate codes for these items of equipment.

HCPCS code C1088, the Laser Optic Treatment System, Indigo Laseroptic Treatment System, now paid under APC 0980 is no longer needed because our review of data shows that the equipment it describes is appropriately reported under CPT codes 52647 and 52648. The procedures described by these CPT codes may be performed by using several types of equipment, one of which is the type described by C1088. In fact, most of the claims containing line items for C1088 are accompanied by line items for 52647 or 52648. This means that hospitals are appropriately reporting these services under the applicable CPT codes and that any charges associated with C1088 are likely duplicate charges for the service provided. Therefore, we propose to delete C1088 and to have hospitals continue to report these services under CPT codes 52647 and 52648, which are in APC 0163.

HCPCS code C9701, the Stretta System, now paid under APC 0980, is used in a procedure that will soon be given a CPT Category Three Tracking Code by the American Medical Association's CPT Editorial Panel. We propose to use the CPT tracking code to report services using the Stretta System and to delete HCPCS code C9701. We propose to assign the new CPT tracking code in APC 1557.

HCPCS code C9703, the Bard Endoscopic Suturing System, now paid under APC 0979, is used in a procedure that has been granted a CPT Category Three Tracking Code, 0008T, which describes the procedure for which this equipment is used. We propose to delete C9703 and to require hospitals to use 0008T to report services using this equipment. We propose to assign CPT code 0008T to APC 1555 for 2004.

HCPCS code C9711, the H.E.L.P. Apheresis System, now paid under APC

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0978, is used to provide apheresis, which is appropriately reported using CPT codes 36511 through 36516. Therefore, we propose to delete C9711 and to require hospitals to report the service in which this equipment is used by using CPT codes 36511 through 36516. 3. Revision of Cost Bands and Payment Amounts for New Technology APCs

In the April 7, 2000 final rule (68 FR 18477), we created 15 new technology APCs (APCs 0970 through 0984) to pay for certain new technology services under the OPPS. As discussed in both the April 7, 2000 and November 30, 2001 final rules, new technology APCs are intended to pay for new or rarely performed procedures for which we lack sufficient cost data to make an assignment to a clinical APC. New technology APCs are defined on the basis of costs, not the clinical characteristics of a service. The payment rate for each new technology APC is based on the midpoint of a range of costs.

In the November 30, 2001 final rule (66 FR 59856), we revised several of the cost bands, added a payment level to the original group of new technology APCs, and assigned status indicator ``T'' to APCs 0970 through 0985. We also created a parallel set of new technology APCs (APCs 0706 through 0721), each of which was assigned status indicator ``S.'' In addition, we changed the definition of what is appropriately paid for under a new technology APC; we refined the criteria for determining assignment of a procedure or service to a new technology APC; we clarified the information that must be supplied for a request for new technology status to be considered; and we removed the restrictions on how long a procedure can be assigned to a new technology APC. These changes, which are discussed in detail in the November 30, 2001 final rule, were implemented effective April 1, 2002.

In the November 1, 2002 final rule, we established two additional new technology APCs, APC 989, and APC 725; as these APCs were not discussed in the proposed rule, they were considered interim with comment.

In this proposed rule, we are proposing 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 significant mispayment 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 are proposing 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 propose 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 invite comments on the hierarchy of cost levels of the restructured new technology APCs.

We would reassign current new technology procedures to the level in the restructured new technology APCs so that the payment amount for the procedure in 2004 closely approximates the current payment amount. As we explained in the November 30, 2001 final rule, we generally keep a procedure in the new technology APC to which it is initially assigned until we have collected data sufficient to enable us to move the procedure to a clinically appropriate APC. However, in cases where we find that our original new technology APC assignment was based on inaccurate or inadequate information, we may, based on more recent information (including claims data), reassign the procedure or service to a different new technology APC that more appropriately reflects its cost.

The proposed restructured new technology APCs are listed in Addendum A. 4. APC Assignment for New Codes Created During Calendar Year (CY) 2003

During CY 2003, we created several HCPCS codes to describe services payable under the hospital OPPS. These codes have already been assigned to APCs for CY 2003. In this proposed rule, we solicit comment on the APC assignment of these services. In addition, in this proposed rule, we propose to create a new HCPCS code with an effective date of July 1, 2003. Table 6 includes a new procedural HCPCS code created for implementation in July 2003.

Table 6 does not include new codes for drugs and devices for which we established or intend to establish pass-through payment eligibility effective July or October 2003. Furthermore, neither the new procedural HCPCS nor the new pass-through codes proposed for implementation beginning October 2003, or later, are included in Addendum B of this proposed rule.

Table 6--New G Code for 2003

Effective HCPCS code

Long descriptor SI date

APC

G0296........... PET imaging, full and S 07/01/03

0714 partial ring PET scanner only, for restaging of previously treated thyroid cancer of follicular cell origin following negative I-131 whole body scan.

5. Creation of APCs for Combinations of Device Procedures

In the course of developing the proposed rule for the 2004 OPPS, we wanted to ensure that the claims we use to set payment rates for APCs into which we package medical devices accurately reflect the costs of both the device and non-device portions of the service. As discussed in section III of this proposed rule, we have made a number of changes to our methodology for the creation of single procedure claims used to set relative weights. These changes enabled us to use charge data from more claims to set relative weights. However, we have noted that in spite of our new methodology, we were unable to significantly increase the number of single procedure claims used to set relative weights for several APCs that use high cost devices. One reason for this is that these APCs are often billed in combination with several other major procedures so that we are unable to generate single procedure claims for these APCs.

In the past, commenters have alleged that without using multiple procedure claims, we will be unable to capture the

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costs of the more complex cases in which multiple procedures are performed and multiple devices are used. These commenters further requested that we change the status indicator of certain APCs from ``T'' to ``S'' in order to appropriately capture the cost of high cost devices when multiple procedures, each using devices, were billed. In addition to attempting to find a way to use multiple procedure claims, we also decided to examine our claims data to investigate whether our current payments for multiple procedures performed on the same date, each using high cost devices accurately captured the costs of the device and non-device portion of each procedure.

In order to do this, we reviewed claims from APCs that required high cost devices and from which we were unable to use the majority of claims to set a relative weight for the APC (for example, APCs for insertion of pacemakers, defibrillators, and neurostimulators). We determined the frequency with which other APCs were billed with the high cost device APCs. We then selected those claims where two APCs using high cost devices, or one APC using high cost devices and one high cost, non-device-requiring APC, were billed together with a frequency of more than 100 for the time period April 1, 2002 through September 30, 2002. This number was chosen in order to ensure that we had enough claims to determine reliable median costs. We included the APC combination 0081/0104 unintentionally and performed the analysis without realizing until after the data were developed that it had fewer than 100 claims and therefore should not have been selected. We expected that the data being used to set the 2004 weights would have a similar number of each combination to the number we found in the April 2002 to September 2002 claims. Review of Table 7, Combination APCs Used in Analysis, shows that even starting with 100 claims, we frequently had to determine median costs with very few claims. Additionally, Table 7 reveals that only a few combinations of two high cost device- requiring APCs are billed together 100 or more times. Six of the twelve combinations we analyzed (for example, claims for insertion of pacemakers and defibrillators) contained APC 0105 (Removal of pacemaker defibrillator), which is not a high cost, device-requiring APC. As the data show, APC 0105 is frequently found on multiple procedure claims, but because it is not a high cost device-requiring APC, when it is billed with these APCs, the multiple procedure reductions are applied to APC 0105. Therefore, we have determined that the vast majority of claims for APCs, such as ``insertion of Cardioverter Defibrillators,'' were not usable multiple procedure claims for the purpose of determining relative weights under our single claim process because they were billed with APC 0105.

After selecting the combinations to review, we determined the hospital costs associated with providing these ``combination'' procedures using the following methodology:

1. We selected claims where the two APCs of interest both appeared on the claim with the same date of service, and subjected them to the same trimming methodology we use for single procedure claims.

2. We then required that each APC appear on the claim only once. (For example, if two HCPCS codes from APC 0081 appeared on a claim with one HCPCS code from APC 0229, we did not use the claim. Many claims were discarded because of this requirement.)

3. From the claims in step two, we selected only those claims that included the device category codes for the devices required to perform the service. This is similar to our methodology for using single procedure claims where the procedure requires the use of a device with a category code (for example, for claims involving APCs 0222/0225, we used only claims that contained C codes for both a neurostimulator pulse generator and neuroelectrodes).

4. We ignored any line items for separately payable services under OPPS or the lab fee schedule and any line items with revenue centers containing HCPCS other than those in the APCs of interest.

5. At this point, we were left with claims where the only separately payable services were the line items for the HCPCS in the APCs of interest.

6. We packaged into the payable HCPCS codes all device category codes, all packaged HCPCS codes, and all revenue center codes without HCPCS.

7. We then determined the median cost for each APC pair using the remaining claims.

We believe the median cost estimate determined by this methodology should, if anything, overestimate the costs of the procedure combinations studied since all packaged line items were attributed to the APCs of interest unless they were clearly identified as being associated with other procedures. For example, if line items for a clinic visit and a medical or surgical supply revenue center appeared on the claim, we packaged the charges associated with the revenue center entirely into the APCs of interest and not into the APC for clinic visits.

We also determined the median costs for these APCs using our usual single claims methodology (these medians are contained in Addendum A). We then determined a summed median cost of each APC pair using our current payment policy, which allows payment at 100 percent for the most expensive APC with ``T'' status indicator and 50 percent for each additional APC with ``T'' status indicator. That is, we added the median cost of the more expensive APC and 50 percent of the median cost of the less expensive APC as a proxy for the total median cost (and payment) using our current payment policy. We then compared this figure with the median cost for the ``combination APC.'' (See Table 7.) We believe this comparison is an indicator of whether our current payment policy accurately pays for the costs of these APCs when they are billed together on the same date of service.

Our comparison reveals that, of the 12 ``combination APCs'' created, 7 had higher median costs than the median costs obtained with the multiple procedure methodology (we note that because APC 222 has a status indicator of ``S'', we did not apply the multiple procedure reduction for the APC 0222/0225 combination).

For three of these seven combinations, we consider the data unreliable because we were able to use very few claims to determine the ``combination'' median cost. Specifically, for APC combination 0085/ 0655, we were able to use only 37 claims; for APC combination 0105/ 0089, we were to use only 16 claims; and for APC combination 0105/0655, we were able to use only 12 claims. This is in distinction to the number of claims we used to determine the median costs for APCs 0655 and 0089 alone (1,170 and 303 respectively). Further, two of these combinations contain only one APC using high cost devices because APC 0105 does not require the use of high cost devices. This means that the multiple procedure reduction was applied to APC 0105. In such cases, we believe the reduction is appropriate because when a pacemaker or defibrillator is removed and replaced, the patient is only anesthetized once, the room only needs to be prepared once, and the time for replacement is usually less than the time for insertion due to the existence of a subcutaneous pocket.

Three other APC combinations, 0105/0090, 0105/0107, and 0105/0654, also contain only one APC requiring the use of high cost devices and therefore

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should not pose the problem of underpayment due to the multiple procedure reduction, which was applied to APC 0105. Furthermore, in these three cases, the difference in median costs between the combination median and the median determined by our multiple procedure reduction methodology was, in our view, insignificant (all much less than 5 percent).

For APC combination 0222/0225, the difference in median cost could be considered significant at slightly under 5 percent, but only 74 claims were used to determine the combination median. Because we used approximately 600 claims to determine the median costs for APCs 0222 and APC 0225 individually, we consider the combination median cost comparatively unreliable.

Lastly, we note that for the other five combinations, our current payment policy pays more than the ``combination'' payment methodology.

Based on this comparison we considered several options for payment of these APCs when billed together:

1. Maintain our current payment policy.

2. Change the status indicators of certain APCs requiring the use of high cost devices to ``S.''

3. Create ``combination APCs'' with relative weights calculated using the methodology described above in order to make a single payment when the two APCs in the combination are billed together.

The third option need not result in creation of new HCPCS codes and APCs for hospitals to report. Instead, we could make changes in the logic of the outpatient code editor (OCE) so that when hospitals bill the two APCs in a combination, the OCE would ``map'' the payment to a single amount rather than paying the more expensive APC at 100 percent and the less expensive at 50 percent. The following is an example of how combination APCs might work: If a unit of a code in APC 0081 was billed with a unit of a code in APC 0104 on the same date, the multiple procedure discount would not be applied, so payment would no longer be made at 100 percent of the payment for APC 0104 (the highest paid APC in the pair) and 50 percent of the payment for APC 0081. Instead, if we were to implement combination APCs for this pair, the combination of codes would be mapped to a new ``combination'' APC, and we would make a single payment for both services. The payment rate for the new ``combination'' APC would be based upon a scaled weight calculated from the median cost for all claims containing one unit of a code from APC 0081 and one unit of a code from APC 0104 (using the methodology described above). If either of the APCs were billed without the partner APC for that established ``combination'' APC, then the APC would map to the current APC that contains the code.

Based on our analysis, we are proposing option one: Maintaining our current payment policy. We believe that our analysis shows that our current payments for these APCs adequately reflect the costs of the procedures, even when billed in combination.

We note that only a few APCs requiring the use of high cost devices are billed in combination. Thus, we do not believe there are compelling reasons to establish a new, or special, payment policy in situations where two APCs requiring high cost devices are billed together fewer than 100 times. Even when APCs are billed together, we have shown that frequently the data are unreliable due to the low number of claims we can actually use to determine the total median cost of the ``combined'' procedure. Furthermore, even where the number of usable claims is large enough to give us some assurance that the data are reliable, the median costs as determined by the two methodologies do not support any changes in our current payment policy. In some instances, adoption of the new payment policy would actually reduce payments for these services, and, in most other cases, any increase in payments would be negligible.

One commenter has brought to our attention the fact that, rarely, correct coding does not allow hospitals to bill for two APCs requiring high cost devices. One example is APC 0082 (Coronary Atherectomy) and APC 0104 (Transcoronary Stent Placement) because atherectomy is considered to be a component of stent placement when both are performed together. In those cases, we would expect hospitals to bill for all the devices used to accomplish the atherectomy and the stent placement. To the extent that both were performed, the median cost of stent placement should reflect the cost of performing an atherectomy. Therefore, we do not believe there is a compelling reason to create new payment policy for these rare situations. (See also the discussion below on ``case rate'' purchasing by hospitals.)

It could be reasoned that our analysis of the costs of ``combined'' procedures is faulty because hospital coding and billing inaccuracies may apply to these claims as well as single procedure claims (and may even be magnified). However, that reasoning would undercut, and be contrary to, the repeated comments that we need to use more multiple procedure claims to set relative weights because single procedure claims do not capture the true costs of complex procedures or episodes of care. Our investigation was performed precisely to address these concerns, determine how we might use multiple procedure claims, and what effect use of those claims would have on payment rates. Even with use of a methodology that overestimated the costs of combination procedures, we were unable to show that the median costs (and payments) using our current payment policy do not accurately reflect the costs for performing these procedures.

Other possible factors affecting our analysis include charge compression and/or inadequate charges for these procedures or the devices associated with them. However, it is not possible for us to know the magnitude of how charge compression or inadequate charges might affect costs or what methodologic or payment adjustment would be appropriate to address the problem. Furthermore, we point out that charge compression and inadequate charges should affect our cost data for these APCs when billed alone and when these APCs are billed in combination. It is unknown whether the effects would be similar in each instance but we have no reason to believe they would be different. Therefore, we do not believe that adjusting for charge compression or inadequate charges would change the ``relative'' median costs of the APCs when billed alone or in combination. Finally, we believe that the median costs of the APCs billed in combination support the concept that economies of scale are achieved in those cases. There are at least two reasons why this might occur: First, many hospitals purchase devices on a case rate or capitated basis, which means that the hospitals' device cost ``per case'' is fixed (with quarterly adjustments made based on volume and actual device use in the previous quarter(s)). For example, inserting a stent or cardioverter defibrillator requires the use of multiple devices in addition to the stent or defibrillator. A hospital may agree to pay $XXXX ``per case'' for all the devices used to insert a stent (for example, guidewires, introducers, catheters, rotablators etc.). This ``per case'' payment means that the hospital has the same cost irrespective of whether a rotablator, two catheters, or four catheters were used for a specific patient. Second, even if hospitals purchase devices on a ``per device'' basis, it is possible that no extra catheters, guidewires, and/or

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introducers, for example, are used when a second related procedure is performed (for example, an electrophysiology study and a defibrillator lead placement, or an angioplasty and a stent placement).

In summary, we have concluded that there is no compelling reason to change our current payment policy for APCs requiring the use of high cost devices.

We solicit public comments on our methodology, analysis, and payment options for these APCs. We particularly solicit comments on how our analysis should affect any use of external data sources in the final rule. Specifically, we ask commenters to explain why submitted external data should be used in preference to our single or multiple claim data for APCs requiring the use of high cost devices.

We also note that creation of ``combination APCs'' would allow us to set relative weights using a number of claims that we otherwise would not be able to use. Therefore we solicit comments on this approach to using more claims to set relative weights and specifically request comments on how to use those claims even if we do not create ``combination APCs.''

Table 7.--Combination APCs Used in Analysis

Sum of

Percent single APC Frequency Frequency

difference medians

of of claims Median cost median for Descriptions of both adjusted combination used for of services both APCs Combination of APCs

APCs in the

for APC billed median cost in both to sum of combination

multiple on the same of services APCs adjusted procedure date in both

single policy

APCs

medians

0081/0104.............. Noncoronary

$5,760.50

55

2 $5,589.14

-2.97 Angioplasty/Athectomy & Transcatheter Placement of Intracoronary Stent. 0081/0229.............. Noncoronary

4,507.09

6177

135 4,116.50

-8.67 Angioplasty/Athectomy & Transcatheter Placement of Iintravascular Stent. 0085/0108.............. Level II

29,749.68

502

63 20,438.99 -31.30 Electrophysiologic Evaluation & Insertion/Replacement/ Convert of Cardioverter Defibrillator. 0085/0655.............. Level II

9,398.45

268

37 10,832.16

15.25 Electrophysiologic Evaluation & Insertion/Replacement/ Conversion of Permanent Dual Chamber Pacemaker. 0105/0089.............. Revision/Removal of

7,360.80

221

16 12,268.96

66.68 Pacemakers, AICD, or Vascular & Insertion/ replacement of Permanent Pacemaker and Electrodes. 0105/0090.............. Revision/Removal of

5,668.72

1426

516 5,751.30

1.46 Pacemakers, AICD, or Vascular & Insertion/ replacement of Permanent Pacemaker Pulse Generator. 0105/0107.............. Revision/Removal of 17,579.21

1106

235 18,294.85

4.07 Pacemakers, AICD, or Vascular & Insertion of Cardioverter- Defibrillator. 0105/0108.............. Revision/Removal of 29,239.29

294

8 26,843.72

-8.19 Pacemakers, AICD, or Vascular & Insertion/ Replacement/Repair of Cardioverter- Defibrillator Leads. 0105/0654.............. Revision/Removal of

6,639.65

3653

1475 7,014.00

5.64 Pacemakers, AICD, or Vascular & Insertion/ Replacement of a permanent dual chamber pacemaker. 0105/0655.............. Revision/Removal of

8,888.06

237

12 10,290.88

15.78 Pacemakers, AICD, or Vascular & Insertion/ Replacement/ Conversion of a Permanent Dual Chamber Pacemaker. 0222/0225.............. Implantation of

14,345.41

368

74 15,002.40

4.58 Neurological Device & Implantation of Neurostimulator Electrodes. 0223/0227.............. Implantation of Pain 10,350.16

222

65 9,815.08 -5.17 Management Device & Implantation of Drug Infusion Device.

Table 7 lists the combinations that we investigated, abbreviated titles for the single APCs in the pair, the number of times the APCs were billed together, the number of claims used to set the combination APC median, a combined median cost for claims in which both the APCs appeared (derived from the methodology discussed above), the median cost for the two APCs using the multiple procedure reduction policy, and the difference in median costs (expressed in percent).

6. New APC for Antepartum Care

We propose to split APC 0199, Obstetrical Care Service into two APCs. New APC 0700, Antepartum Care Service, would be created and 59412 (external cephalic version) would be assigned there. The two remaining HCPCS code 59409 (vaginal delivery only) and 59612 (vaginal delivery only, after previous cesarean delivery) would remain in APC 0199, Obstetrical Care Service. We propose to make this change because of the great difference in cost between vaginal delivery and the external cephalic version procedures. We believe that inclusion of the lower cost procedure in the APC with vaginal deliveries may have an affect on the median cost for the APC that results in less accurate payment.

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 are proposing to use the same basic methodology that we

[[Page 47983]]

described in the April 7, 2000 final rule. That is, we would recalibrate the weights based on claims and cost report data for outpatient services. We propose to use 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 115 million final action claims for hospital outpatient department services furnished on or after January 1, 2002 and before January 1, 2003. We then eliminated the following 45.7 million claims because many of these claims were for services that are not paid under OPPS: Claims in the first quarter of calendar year 2002; claims for bill types other than OPPS bill types; claims for services furnished in Maryland, Guam, and the Virgin Islands. We matched the 69.3 million claims that were paid under the OPPS to the most recent cost report filed by the individual hospitals represented in our claims data. The APC relative weights would 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 propose to use claims for the period beginning April 1, 2002 through and including December 31, 2002 as the base 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.

The claims base used to calculate the proposed payment weights and payment rates in this proposed rule is not the totality of claims on which the final weights and rates will be based. The use of this claims base is due to (1) a lag in claims submission by providers; (2) a statutory limit on the date before which no claim can be paid; and (3) the additional processing time it takes for the claims data to be included in the national claims history, which is the source of our claims data. For these reasons, the claims data used for this proposed rule are for the period of services furnished between April 1, 2002 and November 1, 2002. However, when the final weights and rates are calculated, we will have access to approximately 95 percent of the claims data for services furnished from April 1, 2002 through December 1, 2002. 2. Treatment of ``Multiple Procedure'' Claims

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 CY 2004 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 procedures, particularly those commonly performed in combination with other procedures.

We agree that optimally, it is desirable to use the data from as many claims as possible to recalibrate the relative payment weights, including those with multiple procedures. We identified certain multiple-procedure claims that could be treated as single-procedure claims, enabling us to greatly increase the number of services used to develop the APC payment weights for CY 2003. However, several inherent features of multiple procedure claims prevented 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).

For the CY 2004 OPPS, we propose several changes to how we handle and use claims data to enable us to use more claims in the creation of median costs on which our payment weights and rates are based. Specifically, we propose to expand the number of HCPCS codes that we ignore for purposes of creating a pseudo single claim 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 propose, where possible, to attribute the charges to major, separately payable HCPCS codes based on the codes' dates of service. Our complete discussion of the use of data to set the weights for CY 2004 OPPS follows in section III.B of this proposed rule.

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 one remaining separately paid, major HCPCS code on the claim. This enabled us to attribute the costs of packaged HCPCS codes and packaged revenue centers to the remaining separately paid HCPCS codes and, therefore, to use the charge data on the claim. We did this based on our belief that these three separately payable HCPCS codes would not have charges related to them that would be placed in packaged HCPCS codes or packaged revenue centers. Instead, we believe 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 when these codes are ignored.

For CY 2004 OPPS, we propose to expand the list of HCPCS codes that we would ignore for purposes of creating pseudo single claims. On claims that contain other separately payable HCPCS, we propose to ignore the HCPCS codes in the APCs identified in Table 9. As with HCPCS codes 93005, 71010, and 71020, we believe that these codes are highly unlikely to have charges that are found in packaged HCPCS or in packaged revenue centers. Therefore, we believe that they can be ignored for the purpose of creating a pseudo single claim from the remaining charges on the claim. We solicit comments on the proposed methodology to create pseudo single claims, on the list of codes in Table 9 that we propose to ignore, and whether there are other low cost services that we could ignore in using this methodology. We also request comments on whether we should use the charges for the codes in the APCs in Table 9 to create pseudo single claims to be used in setting the median costs for these APCs.

Use of dates of service to create single claims. For CY 2003, we did not use dates of service to attribute charges on packaged HCPCS and packaged revenue centers to major separately payable HCPCS codes. For CY 2004, we propose to use 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 can 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 cannot use this approach because there is no way to tell to which major payable HCPCS code the charges from the packaged HCPCS or packaged revenue center belong. Moreover, where the hospital does not provide dates for all packaged revenue centers, we cannot attribute charges based on the date of service.

We believe that this methodology yields more single claims than if we did not use dates of service. However,

[[Page 47984]]

because hospitals are not required to put dates of service for line items with only a revenue center but no HCPCS code, we will not be able to perform this analysis routinely for each claim. Therefore, the claims from hospitals that do provide those dates are more likely to be used for weight-setting than claims of hospitals that do not provide those dates on the claim. We are unable to determine what impact, if any, this methodology has on the weights for the services and we solicit comments on the approach.

We invite comments on whether we should require hospitals to enter a line item date of service for every OPPS charge. We are interested in receiving comments regarding the implications the policy would have for hospitals, including potential obstacles and estimates on the amount of time that would be required to implement this change. 3. Adjustment of Median Costs for CY 2003 OPPS

The relative weights of several APCs, especially APCs requiring the use of high cost devices, that were developed for the 2003 OPPS fee schedule, using claims data from April 1, 2001 to March 31, 2002, showed a significant decrease from the relative weights that were established for the 2002 OPPS fee schedule. The 2002 OPPS relative weights were based on both claims data and packaging of 75 percent of the manufacturer submitted costs for devices into the APC cost. Using our April 1, 2001, through March 31, 2002 claims data resulted in significant decreases in payment for many blood products and separately payable drugs. In order to minimize any beneficiary access problems related to the reduction in payment for blood products, separately payable drugs, and certain device-related APCs, we created a limit for any payment reductions as follows: Device and Procedural APCs

For APCs requiring the use of one or more devices receiving pass- through payments, we determined the median cost of the APC using only claims that contained device category ``C'' codes. For selected APCs, we used only claims containing the device ``C'' code specific to the service furnished (for example, we used only claims containing the ``C'' codes for cardioverter defibrillators to determine the median cost for the APC for inserting cardioverter defibrillators).

We then compared the median costs established for the 2002 OPPS fee schedule and the median costs based on our April 1, 2001, through March 31, 2002 claims data and limited decreases in median costs (from the 2002 fee schedule) by 15 percent plus half the amount of any reduction beyond 15 percent (for example, if the claims data showed the median cost of an APC decreased 45 percent, the amount of allowed reduction would have been 15 percent + \1/2\ x (45 percent-15 percent) = 30 percent). For a few APCs where device costs accounted for more than 80 percent of the total cost of the APC, we also incorporated external data into our calculation of the median cost. Blood and Blood Products

We limited reductions in median costs to 11 percent as compared to the 2002 median costs so that the reduction in payments, after other adjustments, for these items would generally not exceed 15 percent. Separately Payable Drugs

We noted in the November 1, 2002 final rule that the reason our April 1, 2001, through March 31, 2002 claims data resulted in lower median costs for many drugs was that the payment rates for 2002 were based on 95 percent of average wholesale price (AWP) as required by law for pass-through drugs. We believed, and continue to believe, that the acquisition cost for many drugs is considerably less than 95 percent of AWP. However, we limited reductions in median costs for separately payable drugs and for administration of packaged drugs using the same methodology as described above for device and procedural APCs. Procedural and Device Intense APCs for 2004 OPPS

Comparison of procedural APC medians for 2004 OPPS to adjusted medians for 2003 OPPS. Our analysis of the April 1, 2002, through December 31, 2002 claims data, which is the basis for the proposed median costs for the 2004 OPPS, reveals a distribution of changes in median costs that are not unusual. Compared to the adjusted median costs used for the 2003 OPPS, most of the median cost increases and decreases were for nondevice-related APCs. Very few device-related APCs saw their median costs decrease significantly. We also note that, with a few exceptions, the median cost increases and decreases were not unusually distributed; we believe that the fluctuations should not be unexpected in a new payment system. For example, the cost of providing items and services changes yearly and, in a new payment system, the accuracy of coding services will improve year to year. We also compared the actual median costs from the April 1, 2001 through March 31, 2002 claims data with the actual median costs from the April 1, 2002 through December 31, 2002 claims data. Given the level of consistency we see in our claims data, we believe that adjustment of median costs last year may have resulted in payment amounts for some APCs that were too high.

The medians we propose to use to set weights for the 2004 OPPS for APCs in Table 8 have decreased more than 10 percent in median cost when compared to the adjusted median costs for 2003 OPPS. For reference, we also provide the actual median cost from the claims data we used to set 2003 OPPS payment rates. Some changes appear to be the result of normal fluctuation in the costs of services. In other cases the actual median cost in the April through December 2002 data (the 2004 OPPS medians) is consistent with the actual median cost in the April 1, 2001 through March 31, 2002 data (used for the 2003 OPPS medians), but decreased significantly only in comparison to the adjusted 2001 medians used for 2003 OPPS. In general, where there is consistency between the 2001 (2003 OPPS) and 2002 (2004 OPPS) unadjusted medians or where a change appears to represent normal fluctuations in costs, and we know of no special circumstances that would cause us to believe that there are problems in the claims data, we conclude that the claims data accurately represent the cost of the service. After reviewing the data, we believe that there is no sound basis for making an across-the-board adjustment to our April through December 2002 median costs, notwithstanding that using the unadjusted 2004 median may result in a reduced payment compared to the payment that was based on adjusted medians under 2003 OPPS.

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Table 8.--APCs With Median Cost Decreases of 10 Percent or More

% diff APC median cost Final 2003 2004

(2003 Final APC

Description

SI dampened proposed dampened median cost rule APC vs. 2004 median cost proposed rule)

0312............................ Radioelement Applications....... S $3,141.77 $216.18 -93.12 0330............................ Dental Procedures............... S

284.02

32.87 -88.43 0692............................ Electronic Analysis of

S

371.55

56.40 -84.82 Neurostimulator Pulse Generators. 0651............................ Complex Interstitial Radiation S 3,250.63 588.67 -81.89 Source Application. 0225............................ Implantation of Neurostimulator S 8,277.07 3,283.68 -60.33 Electrodes. 0352............................ Level I Injections.............. X

13.10

6.31 -51.83 0068............................ CPAP Initiation................. S

123.29

65.83 -46.61 0124............................ Revision of Implanted Infusion T 2,975.12 1,608.78 -45.93 Pump. 0688............................ Revision/Removal of

T 4,429.71 2,495.57 -43.66 Neurostimulator Pulse Generator Receiver. 1719............................ Brachytx seed, Non-HDR Ir-192... K

31.04

17.89 -42.36 0699............................ Level IV Eye Tests & Treatments. T

223.07 130.15 -41.65 0199............................ Obstetrical Care Service........ T

232.46 142.74 -38.59 0313............................ Brachytherapy................... S 1,249.57 769.14 -38.45 0236............................ Level II Posterior Segment Eye T 1,873.66 1,153.59 -38.43 Procedures. 0123............................ Bone Marrow Harvesting and Bone S

380.54 234.84 -38.29 Marrow/Stem Cell Transplant. 0223............................ Implantation or Revision of Pain T 2,437.21 1,525.61 -37.40 Management Catheter. 0385............................ Level I Prosthetic Urological

T 6,199.09 3,895.76 -37.16 Procedures. 0681............................ Knee Arthroplasty............... T 8,780.47 5,669.25 -35.43 0302............................ Level III Radiation Therapy..... S

548.35 363.26 -33.75 0301............................ Level II Radiation Therapy...... S

187.53 125.03 -33.33 0094............................ Level I Resuscitation and

S

228.18 154.77 -32.17 Cardioversion. 0671............................ Level II Echocardiogram Except S

140.57

96.05 -31.67 Transesophageal. 0098............................ Injection of Sclerosing Solution T

99.06

68.15 -31.20 0346............................ Level II Transfusion Laboratory X

30.59

22.72 -25.73 Procedures. 0043............................ Closed Treatment Fracture Finger/ T

148.63 112.70 -24.17 Toe/Trunk. 0687............................ Revision/Removal of

T 1,535.37 1,171.45 -23.70 Neurostimulator Electrodes. 0359............................ Level II Injections............. X

67.50

51.53 -23.66 0122............................ Level II Tube changes and

T

638.40 494.56 -22.53 Repositioning. 0363............................ Level I Otorhinolaryngologic

X

64.56

50.02 -22.52 Function Tests. 0081............................ Non-Coronary Angioplasty or

T 2,584.47 2,041.29 -21.02 Atherectomy. 0191............................ Level I Female Reproductive Proc T

12.27

9.84 -19.80 0685............................ Level III Needle Biopsy/

T

355.90 286.61 -19.47 Aspiration Except Bone Marrow. 0371............................ Level I Allergy Injections...... X

29.69

23.93 -19.39 0152............................ Percutaneous Abdominal and

T

595.64 486.01 -18.41 Biliary Procedures. 0222............................ Implantation of Neurological

T 13,528.13 11,061.74 -18.23 Device. 0118............................ Chemotherapy Administration by S

325.75 267.63 -17.84 Both Infusion and Other Technique. 0086............................ Ablate Heart Dysrhythm Focus.... T 3,138.30 2,611.43 -16.79 0202............................ Level VIII Female Reproductive T 2,706.38 2,273.91 -15.98 Proc. 0228............................ Creation of Lumbar Subarachnoid T 3,541.71 2,996.28 -15.40 Shunt. 0347............................ Level III Transfusion Laboratory X

66.49

56.52 -14.99 Procedures. 0245............................ Level I Cataract Procedures

T

863.71 736.87 -14.69 without IOL Insert. 0189............................ Level III Female Reproductive

T

90.69

77.39 -14.67 Proc. 0085............................ Level II Electrophysiologic

T 2,478.31 2,128.77 -14.10 Evaluation. 0665............................ Bone Density:

S

49.02

42.34 -13.63 AppendicularSkeleton. 0670............................ Intravenous and Intracardiac

S 1,796.55 1,555.61 -13.41 Ultrasound. 0368............................ Level II Pulmonary Tests........ X

62.61

54.62 -12.76 0107............................ Insertion of Cardioverter-

T 19,378.60 17,025.21 -12.14 Defibrillator. 0362............................ Level III Otorhinolaryngologic X

168.41 148.74 -11.68 Function Tests. 0287............................ Complex Venography.............. S

415.06 368.16 -11.30 0120............................ Infusion Therapy Except

T

129.56 115.11 -11.15 Chemotherapy. 0212............................ Nervous System Injections....... T

196.63 175.73 -10.63 0004............................ Level I Needle Biopsy/

T

103.36

92.43 -10.57 Aspiration Except Bone Marrow. 0676............................ Level II Transcatheter

T

245.24 219.77 -10.39 Thrombolysis. 0268............................ Ultrasound Guidance Procedures.. S

82.47

74.07 -10.19 0106............................ Insertion/Replacement/Repair of T 3,256.61 2,927.17 -10.12 Pacemaker and/or Electrodes.

We solicit comments on the proposed weights for all APCs and for the APC placement of all HCPCS codes. However, because we believe the public may be interested in commenting on APCs where the payment rate decreases, we discuss several APCs whose payment rates decrease by more than 10 percent. We are particularly interested in comments, including the submission of external data (as discussed below) regarding these APCs. Discussion of Selected APCs

APC 312 Radioelement Applications--The proposed median for this APC falls 93.12 percent in comparison with the 2003 adjusted median (from $3,141.77 to $216.18). The 2003 OPPS median was adjusted against

[[Page 47986]]

the 2002 OPPS median ($7,080.00) into which we packaged the cost of brachytherapy seeds. However, for 2003 and 2004, we are making separate payment for bracytherapy seeds (with the exception of prostate brachytherapy) and, therefore, the costs of those seeds is not packaged into the APC payment (except for prostate brachytherapy). The 2003 OPPS unadjusted median was $265.53, which is comparable to the proposed 2004 OPPS median. Hence, we think the 2003 OPPS median reflects the costs of brachytherapy, with seeds paid separately.

APC 692 Electronic Analysis of Neurostimulator Pulse Generators-- The proposed median for this APC falls 84.82 percent in comparison with the 2003 OPPS adjusted median (from $371.55 to $56.40). The 2003 OPPS median was adjusted against the 2002 OPPS median ($819.00), which contained costs for devices that should not have been packaged. Moreover, the 2003 OPPS unadjusted median for the service was $46.95, and this is comparable to the 2004 OPPS median of $56.40. Hence, we believe that the proposed 2004 OPPS median reflects the cost of the service.

APC 651 Complex Interstitial Radiation Source Application--The proposed median for this APC falls 81.89 percent in comparison with the 2003 OPPS adjusted median (from $3,250.63 to $588.67). The 2003 OPPS median was adjusted against the 2002 OPPS median ($7,080.00), which contained costs for brachytherapy seeds that are currently paid separately. Moreover, the 2003 OPPS unadjusted median for the service was $483.25, and this is comparable to the proposed 2004 OPPS median of $588.67. Hence, we believe that the proposed 2004 OPPS median reflects the cost of the service because brachytherapy seeds are paid separately.

APC 225 Implantation of Neurostimulator Electrodes--The proposed median for this APC fell 60.33 percent (from $8,277.07 to $3,283.68) as compared to the adjusted median used for the 2003 OPPS. The 2003 OPPS median was adjusted against the 2002 OPPS median ($15,286.00), which reflected the manufacturer(s) price(s) for the devices packaged into the APC. However, the proposed 2004 OPPS median ($3,283.68) is very close to the unadjusted 2003 OPPS median ($3,561.03), causing us to believe that the 2004 proposed median accurately reflects the costs of the procedure. Because this APC is commonly performed with implantation of a neurostimulator pulse generator (APC 222), we changed the status indicator of APC 225 to ``S'' so that it would not be subjected to the multiple procedure reduction when it is performed with implantation of a neurological device. We do not propose to change the status indicator this year, and the multiple procedure reductions would not be applied in CY 2004 to APC 0225.

We determined the proposed 2004 OPPS median for APC 225, using only claims that contained the C codes for the neurostimulator leads (either C1778 Lead, neurostimulator, or C1897 Lead, neurostimulator test kit) in order to ensure that we captured the costs for the leads in the data used to calculate the median. We solicit comments concerning the accuracy of our data and whether they appropriately reflect the cost of neurostimulator electrodes, as well as submission of data on the acquisition cost of neurostimulator electrodes (both permanent and test electrodes).

APC 352 Level 1 Injections--The proposed 2004 OPPS median for this APC fell 51.83 percent (from $13.10 to $6.31) as compared to the adjusted 2003 OPPS median. The 2003 OPPS median was adjusted against the 2002 OPPS median ($23.00). However, the 2003 OPPS median ($6.65) is very close to the proposed 2004 OPPS median ($6.31), and this leads us to believe that the proposed 2004 median reflects the cost of the service.

APC 313 Brachytherapy.--The proposed median for this APC falls 38.45 percent in comparison with the 2003 OPPS adjusted median (from $1,249.57 to $769.14) because the 2003 OPPS median was adjusted against the 2002 OPPS median ($2,030.00), which contained costs for brachytherapy seeds that should not have been included because the radioelement sources used in this APC are not single use seeds. Moreover, the 2003 OPPS unadjusted median for the service was $773.63, and this is comparable to the proposed 2004 OPPS median of $769.14. Hence, we believe that the proposed 2004 OPPS median reflects the cost of the service.

APC 223 Implantation or Revision of Pain Management Catheter.--The proposed median for this APC falls 37.40 percent in comparison with the 2003 OPPS adjusted median (from $2,437.21 to $1,525.61). The single CPT code in this APC describes three procedures: revision, repositioning, and insertion of a pain management catheter. Therefore, the median cost of this APC should reflect the relative frequencies with which these three procedures are performed. Furthermore, the descriptor makes it inappropriate to use only claims containing ``C'' codes to determine the median cost for this APC because a device is not always used when this procedure is performed. To require that a ``C'' code be on claims for this procedure would result in inaccurate median costs. We believe the decrease in median cost is due to the packaging of 75 percent of the cost of the catheter into the APC amount for the 2002 OPPS fee schedule.

APC 385 Level 1 Prosthetic Urological Procedures.--The proposed median for this APC fell 37.16 percent compared to the adjusted median for this APC in 2003 OPPS ($3895.76 compared to $6,199.09). This occurred because we removed the more expensive inflatable penile prosthesis and prosthetic urinary sphincters from APC 179 and placed them in a new APC (APC 386 with proposed 2004 OPPS median of $6,298.89). Hence, we believe that the proposed medians for both APCs reflect the costs of the services that they now contain.

APC 687 Revision/Removal of Neurostimulator Electrodes--The proposed median costs of this APC decreased 23.7 percent as compared to the adjusted median used for the 2003 OPPS fee schedule ($1,171.45 compared to $1,535.37). (See Table 8.) However, none of the procedures in this APC require the use of high cost devices, and we believe the change in median cost reflects fluctuation in the costs of providing these services.

APC 359 Level II Injections--See section VI.B.4 of this proposed rule for the discussion of administration of drugs.

APC 81 Non Coronary Angioplasty or Atherectomy--The median for this APC fell 21.02 percent in comparison with the actual median cost used in the 2003 OPPS fee schedule (from $2,584.47 to $2,041.29). The median cost used for OPPS 2003 was significantly higher than the median cost used for the 2002 OPPS, which included packaging of 75 percent of the devices used in this APC. We believe the decrease this year, which is still substantially higher than the median used for 2002, reflects the fluctuating costs of providing this service.

APC 222 Implantation of Neurological Device--The proposed median for this APC fell 18.23 percent in comparison with the 2003 OPPS adjusted median (from $13,528.13 to $11.528.13). The 2003 OPPS adjusted median was adjusted against the 2002 OPPS median, which packaged 75 percent of the cost (based on manufacturer submitted data) of the devices ($17,284.00) into the APC. However, the proposed 2004 OPPS median of $11,061.74 compares favorably with the unadjusted 2003 OPPS median of $9,146.22. Because we

[[Page 47987]]

developed the proposed 2004 median for APC 222 using only claims that contained charges for device code C1767, we believe our current cost data better reflect the cost of these devices. We solicit comments on the accuracy of our data as well as the submission of data on the acquisition cost of these devices.

APC 118 Chemotherapy Administration by Both Infusion and Other Technique--See section VI.B.4 of this proposed rule for the discussion of administration of drugs.

APC 86 Ablate Heart Dysrhythm Focus--The proposed median for this APC fell 16.79 percent for 2004 OPPS when compared to the adjusted median for 2003 (from $3,138.30 to $2,611.43). The proposed 2004 OPPS median is comparable to the unadjusted median for 2003 OPPS of $2,745.69. Because this APC requires the use of a device, we required that the claims used to set the median for this APC contain a device code to qualify. We believe that our cost data accurately reflect the cost of providing this service. We note that the high payment rate for 2003 was adjusted against the 2002 median, which reflected packaging 75 percent of the device cost (based on manufacturer submitted costs) into the APC.

APC 202 Level VIII Female Reproductive Procedure--We made several changes to the structure of this APC and the proposed median for this APC fell 15.98 percent for 2004 OPPS when compared to the adjusted median for the 2003 (from $2,706.38 to $2,273.91). The proposed 2004 OPPS median is comparable to the unadjusted median for 2003 OPPS of $2,327.25. This APC requires the use of a device and, therefore, we required that the claims used to set the median for this APC must contain one or more specified device codes to qualify (C1771 Repair device, urinary incontinence, with sling graft, C2631 Repair device, urinary incontinence, without sling graft). We believe our cost data accurately reflect the costs of providing this service.

APC 670 Intravenous and Intracardiac Ultrasound--The proposed median for this APC fell 13.41 percent for the 2004 OPPS when compared to the median for 2003 OPPS (from $1,796.55 to $1,555.61). This APC requires the use of a device and therefore we required that the claims used to set the median for this APC must contain a device code to qualify. We believe that our cost data accurately reflect the cost of providing this service and that any change in median cost is due to fluctuations in hospital costs.

APC 107 Insertion of Cardioverter-Defibrillator--The proposed 2004 OPPS median for this APC fell 12.14 percent (from $19,378.60 to $17,025.21) as compared to the adjusted median cost for the 2003 OPPS fee schedule. The 2003 OPPS median was adjusted against the 2002 OPPS median ($21,679.00) which reflected packaging 75 percent of the manufacturer submitted prices for the devices used in this APC. The proposed 2004 OPPS median is much closer to the adjusted median than it is to the unadjusted 2003 OPPS median ($13,572.62).

We acquired the proposed 2004 OPPS median for APC 107 by using only claims that contained the C codes for cardioverter-defibrillators (either C1721 Cardioverter-defibrillator dual chamber, C1722 Cardioverter-defibrillator, single chamber, or C1882 Cardioverter- defibrillator, other than single or dual chamber) in order to ensure that we captured the costs for the device in the data used to calculate the median. Although the proposed median cost of this APC is lower than the adjusted median used last year, it is considerably higher than the actual median from last year, and we have confidence that it reflects the cost of the devices used in the procedure. We would also note that the proposed median cost for APC 108 also rose dramatically and is higher than the adjusted median used for the 2003 OPPS fee schedule. Assuming that the proposed median cost for APC 108 accurately reflects the cost of inserting a cardioverter-defibrillator with leads, we would expect that the proposed median cost of APC 107, which also rose significantly as compared to the actual median cost used for OPPS 2003, accurately reflects the cost of inserting a cardioverter-defibrillator without leads.

APC 120 Infusion Therapy Except Chemotherapy--See section VI.B.4 of this proposed rule for a discussion of infusion therapy other than chemotherapy.

APC 106 Insertion/Replacement/Repair of Pacemaker and/or Electrodes--The proposed 2004 OPPS median for this APC fell 10.12 percent compared to the 2003 OPPS median (from a final 2003 OPPS median of $3,256.61 to a proposed 2004 Median of $2,927.17). This APC contains both CPT codes for insertion of temporary pacemaker leads (CPT codes 33210 and 33211) and repair and revision of pacemaker leads (33216, 33217, 33218, and 33220). This APC contains a mixture of services and, therefore, its median cost should reflect the mixture of services provided. We solicit comments on whether the proposed median cost for this APC reflects the cost of providing these services as well as the submission of data on the acquisition costs of the leads used for each service in this APC.

Preferred Characteristics of External Data Submitted in Comments. We will consider external data on devices that are provided to the extent that they enable us to verify or adjust claims data where we are convinced that an adjustment is appropriate. All data we use to create payment amounts for the final rule will be available for public inspection.

External data must meet the following criterion:

[sbull] Be available for public inspection.

External data that are likely to be of optimal use should meet the following criteria:

[sbull] Represent a diverse group of hospitals both by location (for example, rural, urban) and by type (for example, community, teaching). We would prefer that commenters identify each hospital including location with city and State, nonprofit vs. for profit status, teaching vs. nonteaching status, and the percent of Medicare vs. non-Medicare patients receiving the service; a pseudo identifier could be used for the hospital identification. Data should be submitted both ``per hospital'' and in the aggregate.

[sbull] Identify the number of devices billed to Medicare by each hospital as well as any rebates or reductions for bulk purchase or similar discounts and identify the characteristics of providers to which any such price rebates or reductions apply.

[sbull] Identify all HCPCS codes with which each item would be used.

[sbull] Identify the source of the data.

[sbull] Include both the charges and costs for each hospital, by quarter for the last 3 quarters of 2002. Cost data for 2003 are not compatible with 2002 claims data.

This information would enable us to compare our claims data to the external data and help us determine whether the submitted data are representative of hospitals that submit claims under OPPS.

Please note that information that contains beneficiary-specific information (for example, medical records, invoices with beneficiary identification on it) should be altered, if necessary, to remove any individually identifiable information, such as information that identifies an individual, diagnoses, addresses, telephone numbers, attending physician, medical record number, Medicare or other insurance number, etc. Moreover, individually identifiable beneficiary medical records, including progress notes, medical orders, test results, consultation reports, etc. should

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not be submitted to us. Similarly, photocopies of checks from hospitals or other documents that contain bank routing numbers should not be submitted to us. Blood and Blood Products

See section VI.B.8 of this proposed rule for our discussion of the analysis of data for blood and blood products and our proposal. Separately Paid Drugs

See section VI.B.3 of this proposed rule for our discussion of the analysis of data for separately paid drugs and our proposal.

B. Description of How We Propose To Calculate 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 325 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, only 166 hospitals had claims data.

[sbull] We eliminated from our data claims for critical access hospitals that are not 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 29 hospitals whose total operating CCR deviated from the geometric mean by more than three standard deviations.

[sbull] We excluded from our data approximately 2.1 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 66.345 million 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. Thus, dividing the claims yielded approximately 21.92 million single- procedure claims and 14.8 million multiple-procedure claims. Approximately 19.57 million claims without at least one covered OPPS service were set aside.

We converted 8.47 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 9. These are services with payment amounts below $50 (under 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 9) 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 9. If only one HCPCS code remained, we treated the claim as a single-procedure claim.

Table 9.--APCS That Were Ignored To Create Pseudo Single Procedure Claims

0001............................ Level I

S Photochemotherapy. 0060............................ Manipulation Therapy.... S 0077............................ Level I Pulmonary

S Treatment. 0099............................ Electrocardiograms...... S 0215............................ Level I Nerve and Muscle S Tests. 0215............................ Level I Nerve and Muscle S Tests. 0230............................ Level I Eye Tests & S Treatments. 0260............................ Level I Plain Film

X Except Teeth. 0262............................ Plain Film of Teeth..... X 0271............................ Mammography............. S 0341............................ Skin Tests and

X Miscellaneous Red Blood Cell Tests. 0342............................ Level I Pathology....... X 0343............................ Level II Pathology...... X 0344............................ Level III Pathology..... X 0345............................ Level I Transfusion X Laboratory Procedures. 0364............................ Level I Audiometry...... X 0367............................ Level I Pulmonary Test.. X 0669............................ Digital Mammography..... S 0690............................ Electronic Analysis of S Pacemakers and other Cardiac Devices. 0706............................ New Technology--Level I S ($0-$50).

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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. We created an additional 23.58 million single-procedure bills through this process, which enabled us to use these data from multiple-procedure claims in calculation of the APC relative payment weights.

[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 except as described otherwise. 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 proposed 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 10, 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 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 10.--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 T Venous/Arterial Catheter. 0048............................ Arthroplasty with

T Prosthesis. 0080............................ Diagnostic Cardiac

T Catheterization. 0081............................ Non-Coronary Angioplasty T or Atherectomy. 0082............................ Coronary Atherectomy.... T 0083............................ Coronary Angioplasty and T Percutaneous Valvuloplasty. 0085............................ Level II

T Electrophysiologic Evaluation. 0086............................ Ablate Heart Dysrhythm T Focus. 0087............................ Cardiac

T Electrophysiologic Recording/Mapping. 0089............................ Insertion/Replacement of T Permanent Pacemaker and Electrodes. 0090............................ Insertion/Replacement of T Pacemaker Pulse Generator. 0104............................ Transcatheter Placement T of Intracoronary Stents. 0106............................ Insertion/Replacement/ T Repair of Pacemaker and/ or Electrodes. 0107............................ Insertion of

T Cardioverter- Defibrillator. 0108............................ Insertion/Replacement/ T Repair of Cardioverter- Defibrillator Leads. 0115............................ Cannula/Access Device T Procedures. 0119............................ Implantation of Devices. T 0122............................ Level II Tube Changes T and Repositioning. 0167............................ Level III Urethral

T Procedures. 0182............................ Insertion of Penile T Prosthesis. 0202............................ Level VIII Female

T Reproductive Proc. 0222............................ Implantation of

T Neurological Device. 0225............................ Implantation of

S Neurostimulator Electrodes. 0226............................ Implantation of Drug T Infusion Reservoir. 0227............................ Implantation of Drug T Infusion Device. 0229............................ Transcatheter Placement T of Intravascular Shunts. 0259............................ Level VI ENT Procedures. T 0313............................ Brachytherapy........... S 0384............................ GI Procedures with

T Stents. 0385............................ Level I Prosthetic

T Urological Procedures. 0386............................ Level II Prosthetic T Urological Procedures. 0648............................ Breast Reconstruction T with Prosthesis. 0652............................ Insertion of

T Intraperitoneal Catheters. 0653............................ Vascular Reconstruction/ T Fistula Repair with Device. 0654............................ Insertion/Replacement of T a permanent dual chamber pacemaker. 0655............................ Insertion/Replacement/ T Conversion of a permanent dual chamber pacemaker. 0670............................ Intravenous and

S Intracardiac Ultrasound. 0674............................ Prostate Cryoablation... T 0680............................ Insertion of Patient S Activated Event Recorders. 0681............................ Knee Arthroplasty....... T

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[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 11 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 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. We propose to convert these categories to a single set of revenue codes (see Table 11) 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 11 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 11.--Packaged Services by Revenue Code

Revenue Code

Description

250....................................... PHARMACY 251....................................... GENERIC 252....................................... NONGENERIC 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

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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.

To calculate the weights for APCs 649 (Prostate Brachytherapy with Palladium seeds) and 684 (Prostate Brachytherapy with Iodine seeds) into which the cost of brachytherapy seeds are packaged, we selected claims that contained HCPCS codes 77778 and 55859 where the lines containing codes 77778 and 55859 have the same date of service and the claim contained either HCPCS code C1720 (Palladium seeds) or C1718 (Iodine seeds) (which need not be the same date of service as 77778 and 55859). We ignored line items for services paid on the laboratory fee schedule and lines with separately payable HCPCS (even if multiple majors). We packaged all remaining costs from allowable revenue centers and packaged HCPCS into the claim (regardless of date of service). We separated the claims with Palladium seeds from claims with Iodine seeds. We then created a median cost for prostate brachytherapy with Palladium seeds (APC 0649; G0256) from the claims containing 77778, 55859, and C1720 (Palladium seeds), and we created a median cost for prostate brachytherapy with Iodine seeds (APC 0684; G0261) from claims containing 77778, 55859, and C1718 (Iodine seeds).

[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 are proposing to make an adjustment of 1.003107132 to the weights. The weights that we are proposing for CY 2004, which incorporate the recalibration adjustments explained in this section, are listed in Addendum A and Addendum B.

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, Public Law 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), Public Law 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

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 device category codes in effect as of July 1, 2003, can be found in Transmittal A-03-051, which was issued on June 13, 2003. This PM can be accessed on our Web site at http://www.cms.gov .

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. 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.

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.

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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 propose 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.

For devices, making an estimate of pass-through spending in 2004 entails estimating spending for two groups of items. The first group consists of those items for which we have claims data (that is, items that were eligible in 2002 and that will continue to be eligible in 2004). The second group consists of those items for which we have no direct claims data (that is, items that became, or will become, eligible in 2003 and will retain pass-through status and items that will be newly eligible beginning in 2004).

To estimate 2004 pass-through spending for device categories in the first group, we would use volume and hospital cost (derived from charges on claims using cost-to-charge ratios) information from 2002 claims data. This information would be projected forward to 2004 levels using appropriate inflation and utilization factors. For existing categories with no claims data in 2002 that are, or will be, active in 2004, we would follow the method described in the November 2, 2001 final rule (66 FR 55857). We would use price information from manufacturers and volume estimates from claims related to procedures that use the devices in question. This information would be projected forward to 2004 using appropriate inflation and utilization factors to estimate 2004 pass-through spending for this group of categories. For categories that become eligible in 2004, we would use the same method as described for categories that were newly active in 2002. We anticipate that any new categories for January 1, 2004 will be announced after the publication of this proposed rule but before the publication of the final rule. Therefore, the estimate of pass-through spending would incorporate pass-through spending for categories made effective January 1, 2004.

To estimate 2004 pass-through spending for drugs and biological agents, we would make estimates of utilization, collect data on average wholesale price (AWP) and combine these with ratios used to represent hospital acquisition costs for these drugs. We would collect drug- specific information on Medicare use from the pharmaceutical manufacturer where possible and rely on other sources (such as peer- reviewed clinical studies) as needed. In the past, we relied upon the AWP published in the Redbook to establish the AWP of pass-through drugs payable under the OPPS. As described elsewhere in this preamble, we plan to adopt and apply the provisions outlined in the Payment Reform for Part B drugs. For the purpose of calculating payments for transitional pass-through items, we would determine 95 percent of the drug's average wholesale price based on the newly established AWP. We would use published ratios on hospital acquisition costs reported in our proposed rule of August 9, 2002 (67 FR 52129). For sole source drugs the ratio of acquisition cost to AWP equals 0.71; for multi- source drugs, the ratio is 0.68; and for multi-source drugs with generic competitors, the ratio equals 0.46.

For drugs and biological agents that may receive pass-through status effective January 1, 2004, we propose to use the same methodology as described for drugs and biological agents that received pass-through status in 2003. Any new pass-through drugs and biological agents effective beginning in 2004 would be announced after the publication of this proposed rule but before the publication of the final rule. Therefore, the estimate of pass-through spending would incorporate pass-through spending for these drugs and biological agents made effective January 1, 2004.

After using the methodologies described above 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 will be required.

Table 12 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 are uncertain whether estimated pass-through spending in 2004 will exceed $456 million (2.0 percent of total estimated OPPS spending). We have not yet completed the estimate of pass-through spending for a number of drugs and devices. In particular, we do 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 invite comments on the methodology as described above and the estimates for utilization that appear in the table below.

Table 12.--Estimates for 2004 Transitional Pass-Through Spending

2004 pass-

2004 through 2004 estimated anticipated New HCPC

APC Drug biological

payment utilization pass-through portion

payments

......... Existing Pass- through Drugs/ Biologicals C9111........................... 9111 Injection

$100.50

21,007 2,111,200 Bivalrudin, 250 mg per vial. C9112........................... 9112 Perflutren lipid

$37.44

67,000 2,508,480 microsphere, per 2 ml.

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C9113........................... 9113 Inj Pantoprazole

$5.76

20,000

115,200 sodium, per vial. C9116........................... 9116 Ertapenum sodium,

$11.45

7,200

82,440 per 1 gm vial. Q4053........................... 9119 Pegfilgrastim, per

$118.00

662,062 78,123,329 1 mg single dose vial. C9120........................... 9120 Faslodex, per 50 mg

$44.25

137,078 6,065,702 injection. C9121........................... 9121 Argatroban, per 5

$3.60

50,000

180,000 mg. C9200........................... 9200 Orcel, per 36 cm2..

$286.80

1,000

286,800 C9203........................... 9203 Perflexane lipid

$36.00

82,400 2,966,400 microspheres, per single use vial. J2324........................... 9114 Nesiritide, per 0.5

$36.48

60,000 2,188,800 mg vial. J3315........................... 9122 Triptorelin

$104.90

219,600 23,036,040 pamoate, per 3.75 mg. J3487........................... 9115 Zoledronic acid, 1

$51.38

539,000 27,693,820 mg. C9204........................... 9204 Ziprasidone

$10.50

117,143 1,230,000 mesylate, per 20 mg. C9205........................... 9205 Oxaliplatin, per 5

$23.86

280,756 6,698,845 mg.

2004 HCPCS

APC

Description

2004 estimated anticipated utilization payment

......... Existing Pass- through Devices C1783........................... 1783 Ocular implant, ..............

323

159,756 aqueous drainage assist device. C1814........................... 1814 Retinal tamponade ..............

35106 13,649,018 device, silicone oil. C1884........................... 1884 Embolization

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

25000 38,601,544 Protective System. C1888........................... 1888 Catheter, ablation, ..............

214

129,128 non-cardiac, endovascular (implantable). C1900........................... 1900 Lead, left

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

2091 2,814,528 ventricular coronary venous system. C2614........................... 2614 Probe, percutaneous ..............

899 1,748,555 lumbar discectomy. C2632........................... 2632 Brachytherapy

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

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

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

4

27,800 keratoprosthesis.

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 propose 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 13, 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. These proposed device category expiration dates are listed in Table 13. We propose 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 over 2 1/2 years as of December 31, 2003, and we propose that they would not be eligible for pass-through payments effective January 1, 2004. The two categories we propose for expiration are C1765 and C2618, as indicated in Table 13. Each category includes devices for which pass-through payment was first made under OPPS in 2000 or 2001.

A comprehensive list of all pass-through device categories effective on or before July 2003 is displayed in Table 13. Also displayed are the dates the devices described by the category were populated and their respective proposed expiration dates.

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 continue to be paid in 2003) is found in the November 1, 2002 final rule (67 FR 66761 through 66763).

Table 13.--List of Current Pass-Through Device Categories With Proposed Expiration Dates

Category long

Date(s) Expiration HCPCS codes

descriptor

populated

date

C1765................ Adhesion Barrier..... 10/1/00-3/31/

12/31/03 01; 7/1/01 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.

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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.

The methodology that we propose to use to package 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, we propose 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 propose 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 propose would no longer be eligible for pass-through payment in 2004 into the HCPCS codes with which the devices were billed.

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 procedures with which the devices were billed in 2001. There were very few exceptions to the policy (for example, brachytherapy seed for other than prostate brachytherapy), and we propose to continue this policy. Therefore, we propose that the payment for the devices that populate C1765 and C2618, which we propose will 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.

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

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 the median APC costs, 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. Therefore, we propose to modify our policy for applying offsets. Specifically, we would apply an offset to a new device category only when we can determine that an APC contains costs associated with the device. At this time, we propose to continue our existing methodology for determining the offset amount, described above. However, we solicit comments for alternative methodologies for determining the offset amounts that potentially could be applied to the payment amounts for new device categories.

We can 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 would 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 proposed rule for further discussion.

We propose 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

[[Page 47995]]

categories are packaged into the existing APCs. For the categories existing as of publication of this proposed rule, we have 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 are proposing 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 propose, if any offsets apply, for new categories, to announce the offsets in the program memorandum that announces the information regarding the new category.

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

A. Pass-Through Drugs and Biologicals

Section 1833(t)(6)(D)(i) of the Act requires us to make transitional pass-through payment for new drugs equal to the amount by which 95 percent of the average wholesale price (AWP) of the drug exceeds the proposed payment rate. In the past, we have used the AWP published in the Red Book to determine payment amounts for pass-through drugs as we explain in the correction notice issued on February 10, 2003 (68 FR 6637). However, we are concerned about the extent to which Medicare pays more for 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. When the AWP regulations are made final, we propose 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 propose to make those changes on a prospective payment basis through our regular OPPS PM and PRICER quarterly updates. We further propose 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.

An AWP final rule could be published before 2004. However, 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 propose to use 95 percent of the AWP listed in the most recent quarterly update of the Single Drug Pricer (SDP). In the past, we have relied solely on the Red Book to determine the AWP for a pass-through drug, as we explain in the correction notice issued on February 10, 2003 (68 FR 6637). However, on January 1, 2003, we introduced for the first time a single pricing source for approximately 400 drugs and biologicals for which the Medicare payment allowance is based on 95 percent of their AWP. We established the SDP to address apparent discrepancies in drug pricing that were the unintended result of delegating calculation of AWP to multiple contractors, whose application of the pricing methodology established under 42 CFR 405.517 sometimes varied. The SDP continues to rely on published compilations such as the Red Book and First Data Bank to identify wholesale drug prices. However, using the SDP enables us to establish a uniform Medicare payment allowance for drugs whose payment is based on 95 percent of their AWP, which results in greater consistency in Medicare drug pricing nationally. If a drug with pass-through status is not included in the SDP, we propose to forward to the SDP contractor the AWP information submitted as part of the pass-through application.

Because the January SDP would not be available in time, we propose 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 propose 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.

Additional information regarding the SDP can be found on the CMS Web site in Program Memorandum AB-02-174, issued December 3, 2002.

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.

Packaging costs into a single aggregate payment for a service, procedure, or episode of care is a fundamental principle that distinguishes a prospective payment system from a fee schedule. In general, packaging the costs of items and services into the payment for the primary procedure or service with which they are associated encourages hospital efficiencies and also enables hospitals to manage their resources with maximum flexibility. Notwithstanding our commitment to package as many costs as possible, we are aware that packaging payments for certain drugs and radiopharmaceuticals, especially those that are particularly expensive or rarely used, might result in insufficient payments to hospitals, which could adversely affect beneficiary access to medically necessary services.

As discussed in the November 1, 2002 final rule (67 FR 66774), we packaged payment for drugs and radiopharmaceuticals into the APCs with which they were billed if the median cost per line for the drug or radiopharmaceutical was less than $150, and we established a separate APC payment for drugs and radiopharmaceuticals for which the median cost per line exceeded than $150. This supported our general view that payment for drugs and radiopharmaceuticals should be made as part of the payment for the services in which they are used in order to encourage efficient purchase and use of drugs and radiopharmaceuticals provided in the hospital outpatient department.

[[Page 47996]]

Payment Rates for 2003

To limit the dramatic reduction in payment rates for many of the separately payable drugs and radiopharmaceuticals from 2002 to 2003, we limited the decrease in their median costs from 2002 median costs to 15 percent plus half of the difference between the total proposed reduction and 15 percent reduction. (For example, for a drug whose cost decreased by 35 percent from the applicable 2002 median cost, the allowed reduction from 2002 to 2003 was 15 percent plus (\1/2\ times 35-15) percent = 25 percent.) For each blood and blood product, we provide separate payment in an individual APC and limited any decrease in payment rate from 2002 to 2003 to 15 percent. In 2003, we also excluded from OPPS certain vaccines and orphan drugs (that met our orphan criteria) and paid for these items at reasonable cost. Our intent in implementing these policies was to avoid adversely affecting beneficiary access to needed treatment.

Drugs for Which We Propose 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 than 2 years nor any longer than 3 years. The drugs that are due to expire December 31, 2003 meet that criterion. Table 14 lists the drugs and biologicals for which we propose pass-through status will expire on December 31, 2003.

Table 14.--Proposed List of Drugs and Biologicals for Which Pass-Through Status Expires CY 2004

Proposed pass- through HCPCS

APC

Long descriptor

Trade name

Expiration date

A9700............................... 9016 Injection,

Optison (single

12-31-03 Octafluoropropane, per source). 3 ml. J0587............................... 9018 Injection, Botulinum Myobloc (single

12-31-03 toxin, type B, per 100 source). units. J0637............................... 9019 Injection, Caspofungin Cancidas (single

12-31-03 acetate, 5 mg.

source). J7517............................... 9015 Mycophenolate mofetil, CellCept (single

12-31-03 oral per 250 mg.

source). J9010............................... 9110 Injection, Alemtuzumab, Campath (single

12-31-03 per 10 mg.

source). J9017............................... 9012 Injection, Arsenic Trisenox (single

12-31-03 trioxide, per 1 mg. source). J9219............................... 7051 Implant, Leuprolide Viadur (single source)

12-31-03 acetate, per 65 mg implant. C9201............................... 9201 Dermagraft, per 37.5 Dermagraft (single

12-31-03 sq. centimeters.

source).

2. Proposed 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. We considered several options for packaging in 2004 and propose the following policy:

For 2004, we propose 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.

As discussed in the November 1, 2002 final rule, we received several comments on our methodology of analyzing single line items on drug claims for the 2003 OPPS (67 FR 66772). Commenters stated that our methodology was not consistent with how hospitals bill for certain drugs, biologicals, and radiopharmaceuticals. They believe that this inconsistency affected whether or not a drug, biological, or radiopharmaceutical fell below the $150 median cost per line threshold. Commenters claimed that we incorrectly assumed ``that a single administration of a drug was billed as a single line item on a claim.'' These commenters alleged that hospitals often bill for certain drugs administered during a single patient encounter using multiple lines on a claim. For example, if 10 units of a drug were administered at a cost of $100 but the hospital billed 2 line items of 5 units at a cost of $50 each, then a methodology that determines median costs on a per line basis would incorporate 2 line items at $50 when the real cost was one line item at $100. If a significant percentage of administrations for this drug was billed in this manner, it would result in median costs that underestimate the true cost of the drug. We agree with this comment. Therefore, we propose to change our packaging methodology to account for such hospital billing practices.

We calculated the median cost per day using claims data from April 1, 2002 to December 31, 2002 for all drugs and radiopharmaceuticals paid under the OPPS that had a HCPCS code during this time period including drugs for which transitional pass-through payment ended on January 1, 2003. Although we included orphan drugs in this methodology, we discuss them separately below. We excluded from these calculations vaccines and blood and blood products that are discussed below. In order to calculate the median cost per day for the drugs, biologicals, and radiopharmaceuticals, we took the following steps:

[sbull] After application of the cost-to-charge ratios, we aggregated all line items for a single date of service on a single claim for each drug or radiopharmaceutical. This resulted in creating a single line item with the total number of units and the total cost of a drug or radiopharmaceutical given to a patient in a single day.

[sbull] A separate record was then created for each drug or radiopharmaceutical by date of service, regardless of the number of lines the drug or radiopharmaceutical was billed in each claim. For example, drug X is billed on a claim with two different dates of service, and for each date of service, the drug is billed on 2 line items with costs of $10 and 5 units in each line item. In this case, the computer program would have created two records for this drug, and each record would have a total cost of $20 and 10 units.

[sbull] For each record created for a drug or radiopharmaceutical, the cost per unit of the drug was calculated. If drug X's descriptor is ``per 1 mg'' and one record was created for a total of 10 mg (as indicated by the total number of units for the drug on the claim for each unique date of service), then the computer program divided the total cost for the record by 10 to give a per unit cost. This unit cost was then weighted by the total number of units in the record. This was done by generating a number of line items equivalent to the number of units in that particular claim. Thus, a claim with 100 units and a total cost of $200 would be given 100 line items each with a cost of $2 while a

[[Page 47997]]

claim of 50 units with a cost of $50 would be given 50 line items each with a cost of $1.

[sbull] The unit records with cost per unit greater or less than 3 standard deviations from the geometric mean were then trimmed.

[sbull] The remaining unit observations were arrayed and the median cost per unit of the drug or radiopharmaceutical was established.

[sbull] Next, the total number of units billed on all claims for the drug or radiopharmaceutical was divided by the total number of unique per-day records for the drug or radiopharmaceutical to arrive at an average number of units per day.

[sbull] The average number of units per day for each drug or radiopharmaceutical was then multiplied by the median cost per unit to arrive at its ``median cost'' per day.

[sbull] We then arrayed the median cost per day for all drugs and radiopharmaceuticals in ascending order and examined the distribution.

Many commenters have alleged that hospitals do not accurately bill the number of units for drugs and radiopharmaceuticals. Because this methodology assumes that hospitals bill the number of units accurately, we compared the median cost per day obtained by the above methodology with the median cost per day derived as follows: We aggregated line items as above and created records for each drug and radiopharmaceutical based on date of service. However, instead of calculating costs on a per-unit basis, we simply reduced total charges to total costs for each record and determined the median. This methodology assumes that hospitals record charges more accurately than units. We believed that calculating median costs using the second methodology would address the concerns of commenters and would help us determine whether our median cost per unit calculation accurately reflected the costs of drugs and radiopharmaceuticals.

In most cases, the median costs determined by the two methodologies were similar. Based on this comparison, we believe that calculating median costs per unit accurately reflects the actual cost of the drug or radiopharmaceutical. Furthermore, given the wide variability of doses used for many drugs, we believe that it is important to pay on a ``per unit'' basis for separately payable drugs and radiopharmaceuticals. For example, many chemotherapy agents are dosed based on both body area and frequency of administration. Thus, a patient with a body area of 2 m squared could receive 600 mg of a drug every 3 weeks, 400 mg every 2 weeks, or 200 mg every week depending on the chemotherapy regimen.

Based on our analyses, we believe that it is reasonable to continue our current policy of packaging drugs and radiopharmaceuticals with a median cost of less than $150 per day. This means that approximately 52 percent of the drugs and radiopharmaceuticals will be packaged and 48 percent of the drugs and radiopharmaceuticals will be paid separately.

We noticed that several drugs and radiopharmaceuticals with median cost per line that were under $150 for the 2003 OPPS have median costs per day that are equal to or greater than $150 based on the data used for the 2004 OPPS. For some other drugs and radiopharmaceuticals, we saw that their median costs per line were equal to or greater than $150 for 2003 OPPS; however, using the 2002 data, their median costs per day fell below $150. These shifts from 2003 to 2004 would affect packaging decisions for a number of drugs.

Given that these variations exist, we propose 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 and a different methodology. As we explain elsewhere in this proposed rule, we expect to use additional 2002 claims data for the establishment of our final policies for CY 2004. Based on this additional data and comments from the public, we intend to re-evaluate whether to package or pay separately for drugs for which the per-day median cost would cross the threshold from 2003 to 2004. For 2004, we propose that:

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

[sbull] Currently separately payable drugs and radiopharmaceuticals with median costs per day that are 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 request comments on the methodology we used to determine the median cost per day, on the threshold we propose 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.

Although in the future we expect to expand packaging the costs of drugs and radiopharmaceuticals into the APCs for the services with which they are billed, we request comments on alternatives to packaging. 3. Payment for Drugs, Biologicals, and Radiopharmaceuticals That Are Not Packaged

For the 2003 OPPS, the APC payment rate for separately payable drugs and radiopharmaceuticals with status indicator ``K'' is based on a relative weight calculated in the same way that the relative weights for procedural APCs are calculated. As with procedural APCs, we observed a decrease in the proposed payment rates for many separately payable drugs and radiopharmaceuticals; therefore, we dampened the payment reduction for APCs whose median costs decreased by more than 15 percent from 2002 to 2003.

In order to establish payment rates for separately payable drugs and radiopharmaceuticals for the 2004 OPPS, we first determined each drug's and radiopharmaceutical's median cost as described above. 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.

CY 2004 median costs decreased more than 15 percent from the corresponding 2003 median cost for many of the separately payable drugs and radiopharmaceuticals. Many of these decreases affected low-volume drugs and radiopharmaceuticals and may be the result of inaccurate coding. Similarly, the 2004 median costs increased by more than 15 percent from the corresponding 2003 median cost for approximately 12 (mostly low volume) drugs and radiopharmaceuticals. For many of the high-volume, separately payable drugs and radiopharmaceuticals, the 2004 median costs increased or decreased by less than 15 percent as compared to the corresponding 2003 median cost. We solicit comments concerning the reasons for the fluctuations in median costs from 2003 to 2004. We are interested 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

[[Page 47998]]

charges) that we use for setting payment rates.

We considered several options to address the fluctuations in median costs for separately payable drugs and radiopharmaceuticals. One option was to base payment on our 2002 claims data without modification. A second option was to adopt for 2004 the same methodology that we used to moderate payment decreases in 2003.

A third option was to create drug and radiopharmaceutical cost bands for separately payable drugs and radiopharmaceuticals (for example, all drugs with median costs per unit of $60.01 to $70 would be assigned a proxy median of $70), which would be based on their median costs calculated using 2002 claims data. We considered adopting two sets of cost bands: one for separately payable drugs and biologicals other than radiopharmaceutical agents and one for separately payable radiopharmaceutical agents. The cost bands for drugs and radiopharmaceuticals would be assigned based solely on cost, with no consideration given to the therapeutic use or chemical composition of the drug.

When we applied the dampening methodology used for the 2003 OPPS to drugs and radiopharmaceuticals that will be separately payable in 2004, we observed that this methodology did not sufficiently limit payment reductions for many of the drugs and radiopharmaceuticals with large decreases in median cost from 2003 to 2004. Therefore, a fourth option that we considered and are proposing for 2004 is 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 propose 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 propose to establish their payment rates using the median costs derived from the 2002 claims data. We believe that it is appropriate to determine payment rates based on our claims data where those data show the cost of drugs and radiopharmaceuticals to be stable over 2 years. In cases where costs show significant fluctuation, we believe it is appropriate to mitigate the potential for underpayment. We believe our proposal bases payment rates on our claims data as required by statute and addresses the potential for making underpayments. However, based on more complete claims data we expect to have for the final rule and on the comments from the public, we will re-evaluate the appropriateness of adjusting median costs for drugs for which median costs would decline in 2004.

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

We solicit comment on both our proposed methodology and payment rates for separately payable drugs and radiopharmaceuticals for 2004. Commenters who disagree with the proposed rate for a drug or radiopharmaceutical should submit verifiable information that shows our payment rate does not reflect the price that is widely available to the hospital market. Thus, information should demonstrate actual, market- based pricing of drugs and radiopharmaceuticals and should be prices at which a broadly based, national sample of hospitals are routinely able to procure the drug or radiopharmaceutical. We do not consider the published average wholesale price (AWP) for a drug to be an indication of its market-based price. 4. Proposed Payment Methodology for Drug Administration

Currently, payment for drug administration is made separately using HCPCS codes Q0081, Q0083, Q0084, Q0085, 90782, 90783, 90784, and 90788 with certain drugs packaged into the median cost for administration. The amount packaged should reflect the costs of the packaged drugs in relation to the frequency with which they are administered. Each of these codes is to be reported once per visit no matter how many drugs are administered. When a hospital administers only packaged drug(s), the appropriate HCPCS code is reported once and no separate payment is made for the drugs. When a hospital administers only separately payable drug(s) the appropriate HCPCS code is reported once; in addition, separate payment is made for the drugs. Because the payment for administration includes payment for packaged drugs, a hospital receives inappropriate reimbursement every time it administers a separately payable drug.

In order to facilitate accurate payments for drugs and drug administration, we are considering whether to make several changes in our current payment policy with regard to payment for Q0081, Q0083, Q0084, and Q0085. We are not considering changes to payment policy for HCPCS codes 90782, 90783, 90784, and 90788 at this time, although we are interested in receiving comments regarding payment for these codes.

We are proposing 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).

We are considering whether and how to make different payments to hospitals for administration of packaged drugs and administration of unpackaged drugs. We would like to ensure that when a hospital administers a separately paid drug, it would receive payment for the drug and the drug administration, but not for any drugs packaged into the administration. We also would like to ensure that the payments that are made for administration of packaged drugs are appropriate for the costs of the drugs as well as the cost of the administration.

In order to achieve the above objectives, we considered several coding and payment options and analyzed our claims data for the period April 1, 2002 through December 31, 2002. Summary of Findings and Alternatives

As explained in greater detail below, we carefully examined data for administration of packaged and separately paid drugs billed under Q0081, Q0083, Q0084 and Q0085. We found that the data showed that paying based on a median cost for the APC for each of the current four 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 sections that follow, we discuss our data analysis in detail. We also discuss four alternatives to the current codes and APC payments in detail. In summary, those alternatives are:

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

[[Page 47999]]

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. Claims Data Analysis

Using our methodology for creating single procedure claims, we looked at all single claims for HCPCS codes Q0081, Q0083, Q0084, and Q0085. We created separate files for each HCPCS code and further subdivided those into four subgroups for each code. The subgroups were for the HCPCS code billed (1) without any HCPCS for drugs; (2) with HCPCS only for packaged drugs; (3) with HCPCS only for separately payable drugs; and (4) with HCPCS for both packaged and separately packaged drugs.

We then reviewed the median costs for each of these subgroups and determined that we could use these subgroups to create two median costs for each existing administration HCPCS code (Q0081, Q0083, Q0084, and Q0085). See Table 15 for median cost data for HCPCS subgroups. We used claims where packaged drugs appeared (subgroups W and X) to create a median cost for administration of packaged drugs. We used claims without HCPCS codes for drugs and claims with HCPCS for only separately payable drugs (subgroups Y and Z) to create a median cost for the administration of separately payable drugs.

We believe that the resultant median costs accurately reflect the costs of packaged drugs and the costs of administration of separately payable drugs. It is obvious that there are significant differences in median costs of services within the same drug administration code, depending on whether a packaged or separately paid drug was administered, the type of drug administered (chemotherapy versus non- chemotherapy) and the route of administration (infusion versus other route or both).

Table 15.--Median Costs by Types of Drugs on the Claim

Neither With packaged No packaged Both packaged packaged nor drug but no drug but with drug and HCPCS

Description separate drug separate drug separate drug separate drug (W)

(X)

(Y)

(Z)

Q0081......................... Infusion therapy

$104.97

$276.98

$117.89

$231.56 other than chemo. Q0083......................... Chemotherapy

35.16

119.88

42.26

188.98 other than infusion. Q0084......................... Chemotherapy by

127.34

250.97

159.01

265.46 infusion. Q0085......................... Chemotherapy by

97.11

154.01

203.43

318.05 both infusion and other.

We then calculated medians for circumstances in which there were neither packaged nor separately paid drugs on the claim, and there were no packaged drugs, but there were separately paid drugs on the claim (both W and Y). We also calculated medians for circumstances in which there were packaged drugs on the claim (both X and Z). The resultant medians and the number of claims used to set the medians appear in Table 16 below with the HCPCS medians for all claims (packaged and separately paid drugs together).

Table 16.--Numbers of Claims and Medians by Code

Number of Median for Number of Median of claims with no claims with no HCPCS Median HCPCS code

claims with claims with drug or

drug or for all claims packaged drugs packaged drugs separately separately for 2004 paid drug paid drug

Q0081...........................

19,116

$274.47

280,939

$107.93

$115.11 Q0083...........................

8,681

125.86

24,710

39.10

48.25 Q0084...........................

34,085

257.57

23,933

142.38

205.70 Q0085...........................

17,749

303.87

3,242

126.55

267.63

Review of the data reveals that the median costs for all claims for Q0081 and Q0083 more closely reflect the median cost of claims where no drug or only separately payable drugs were on the claim because that subset of claims represents the vast majority of claims for Q0081 and Q0083. Therefore, if we do not differentiate payment for Q0081 and Q0083 based on whether or not a packaged drug was administered, we would underpay the cases in which a packaged drug was administered. The opposite is true of Q0084 and Q0085 in which more claims reflect packaged drugs than separately paid drugs, and, therefore, the claims with packaged drugs will determine the median cost for the code, thus overpaying cases in which the drug is separately paid.

[[Page 48000]]

We also examined the mean and median number of drugs billed with each of the Q codes when only packaged drugs were billed, only separately paid drugs were billed, and both packaged and separately payable drugs were billed (see Table 17). With the exception of Q0085, we believe the data on the number of drugs billed per claim is consistent with the cost data in Table 15. Again, with the exception of Q0085, we are confident that the cost of packaged drugs is accurately reflected in the median cost of the codes for administration of packaged drugs. We are also confident that the median cost for administration of separately payable drugs is appropriate.

Table 17.--Numbers of Drugs Billed per Specified Codes

Mean number of Median number Mean number of Median number drugs

of drugs HCPCS

drugs

of drugs separately separately packaged

packaged

paid

paid

Q0081...........................................

1.05

1

1.01

1 Q0083...........................................

1.77

2

1.02

1 Q0084...........................................

1.68

1

1.10

1 Q0085...........................................

2.33

2

1.19

1

We have some concerns about the cost data for Q0085. The cost for administration of only separately payable drugs is less than the comparable cost for Q0084 ($126 vs. $142). This is counterintuitive as Q0085 describes administration of, at minimum, two drugs, while Q0084 describes administration of one or more drugs. These cost data for Q0085 also raise the concern that proper usage of the code is not understood by hospitals and, therefore, the data are not being used properly.

We believe our analysis supports the need for creating different payment amounts for the administration of packaged drugs and for the administration of separately payable drugs (and, in the case of Q0081, the administration of no drug).

While reviewing options for coding and payment for drug administration we kept five major considerations in mind:

1. Ensuring beneficiary access to drugs.

2. Making accurate payment for both packaged and separately payable drugs.

3. Collecting sufficient data on drugs and drug administration to ensure that future policy development in this area will be properly informed.

4. Facilitating proper coding by hospitals.

5. Avoiding complicated billing rules and hospital burden to the extent possible.

We thought that three basic coding and payment options were available:

1. Continuing the current coding structure and payment policy (for example, a single payment for drug administration per day no matter how many drugs were administered). (Option 1 below).

2. Creation of new codes and new payment policy to describe drug administration (for example, different sets of codes for administration of packaged and separately payable drugs along with allowance for more than one payment for drug administration per day). (Options 2 and 3 below).

3. Continuation of the current drug administration codes but creating new payment policy (for example, allowance for more than one payment for drug administration per day).

After reviewing these three basic options, we developed more fully four specific options. Under all of these options, hospitals would be required to bill all drugs using the HCPCS code for the drug.

Moreover, although we have included an expanded option for Q0085 (Chemotherapy by both infusion and other technique) in option 2, and have retained Q0085 in option 1, we have serious concerns about the extent to which Q0085 is used correctly and about the extent to which the data for this code validly reflect the costs of an identifiable service. Hence, we are particularly interested in comments regarding whether we should eliminate Q0085. (Option 4 below).

Option 1--Retain the current codes and continue to pay on a per- visit basis, based on median costs for each code regardless of whether or not packaged or separately paid drugs are administered.

We would retain the current codes, use all claims for these services to set a relative weight, and make a single payment based on the median costs for the code regardless of whether or not packaged or separately paid drugs are administered. This would result in significant underpayment for administration of packaged drugs because the largest volume of claims with this code are either for administration of no drug (Q0081) or for drugs that are separately paid (and have no packaged drug costs). See Table 16 for the median costs determined on the basis of all claims for the existing codes. We would require hospitals to report HCPCS codes for both packaged and separately payable drugs in order to inform future policy decisions in this area.

We do not propose payment amounts for this option because the budget neutrality scalar would be different under this proposal than under option 2 (which was used in the scalar and impact analysis).

Option 2--Create eight new drug administration codes to enable hospitals to report administration of both packaged and separately payable drugs.

We would create two new sets of HCPCS codes to describe administration of packaged and separately payable drugs. Each of the eight codes would have its own APC payment. The descriptions and median costs for these proposed codes would be as follows:

Table 18.--Median Costs of Proposed G Codes Under Option 2

HCPCS

2004 APC

2004 SI

Description

Median costs

GXXX1.............................

0382 S

Infusion of packaged non-

$274.47 cancer chemotherapy drug(s), per day. GXXX3.............................

0376 S

Administration of

125.86 packaged cancer chemotherapy drug(s) by other than infusion, per day.

[[Page 48001]]

GXXX4.............................

0378 S

Administration of

257.57 packaged cancer chemotherapy drug(s) by infusion, per day. GXXX5.............................

0380 S

Administration of

303.87 packaged cancer chemotherapy drugs by both infusion and other than infusion, per day. GYYY1.............................

0383 S

Infusion of separately

107.93 payable non-cancer chemotherapy drug(s) or non-drug infusion therapy, per day. GYYY3.............................

0377 S

Administration of

39.10 separately payable cancer chemotherapy drug(s) by other than infusion, per day. GYYY4.............................

0379 S

Administration of

142.38 separately payable cancer chemotherapy drug(s) by infusion, per day. GYYY5.............................

0381 S

Administration of

126.55 separately payable cancer chemotherapy drugs by both infusion and other than infusion, per day.

The median costs for administration of packaged drugs would be determined from claims that contain at least one packaged drug and the median costs for administration of separately payable drugs (or no drugs in the case of Q0081) would be determined from claims that contained only separately payable (or no) drugs.

Although payment would not depend on accurate reporting of HCPCS codes for drugs, we would require hospitals to use HCPCS codes for both packaged and separately payable drugs in order to ensure that we had reliable data upon which to base future relative weights for these services. As described under option 4, we would create six lists of drugs in order to facilitate proper payment in the future.

Hospitals would report the appropriate code for the type of drug administered and the route(s) of administration. In this option, hospitals could bill for administration of both chemotherapy agents and administration of non-chemotherapy agents (or non-drug infusions). We would permit a maximum of one chemotherapy and one non-chemotherapy administration per day.

We are concerned that creation of these codes could require complicated billing rules and cause burden to hospitals. We would need to specify how to bill different combinations of route and category of drug (for example, two infused drugs, one pushed drug, antiemetics, and hydration). Because hospital billers would have to review both the type of administration and the type of drug administered to determine the correct code to bill, we are concerned about the potential for miscoding (with resultant mispayment) under this option, and we solicit comments on both of these issues. In some cases, this additional coding burden might result in less payment for administration (particularly Q0081).

Under this option, all codes would have a status indicator of S, and no multiple procedure reductions would apply.

This option is modeled for purposes of the budget neutrality scalar and the impact analysis (see Table 18).

Option 3--Create six new drug administration codes to enable hospitals to report administration of both packaged and separately payable drugs.

This option is similar to option 2 except that we would eliminate the codes used to describe administration of chemotherapy by both infusion and other techniques. Where a code is billed with a packaged drug suitable for the code, we would pay the APC for the packaged drug. Where both a packaged drug and a separately paid drug were administered via the same route of administration (and therefore only one code was billed), we would pay the APC only for the administration of the packaged drug and would pay separately for the separately paid drug and would not pay the APC for administration of the separately paid drug. Under this option, we would allow up to three payments for administration of drugs or infusions. We would allow one payment for non-chemotherapy drugs/infusions (for example, antiemetics, fluids), one payment for chemotherapy administered by infusion, and one payment for chemotherapy administered by ``other than infusion.'' As stated above, we would not allow payment for administration of packaged chemotherapy drugs by infusion and payment for administration of separately payable chemotherapy by infusion. This coding scheme would allow us to more accurately recognize the true costs of administering multiple drugs. For example, there are some economies of scale when infusing two or more drugs (for example, only one I. V. line needed), but each drug requires its own mixing and nursing care. This option would allow up to three payments for administration of drugs or non- drug infusion, thereby recognizing the unique costs of administering each drug while not making duplicate payment. In order to ensure that we do not make duplicate payment for patients receiving chemotherapy drugs and non-chemotherapy drugs (and/or hydration), we would pay GXXX1 and GYYY1 at 50 percent of their payment when one of these codes is paid in addition to chemotherapy administration (GXXX3, GXXX4, GYYY3, and GYYY4). This is because we believe there are economies of scale achieved for multiple drug administrations and that the additional resources used to provide non-chemotherapy treatment are minimal.

Following are examples of how payment would be made:

[sbull] When both packaged and separately payable chemotherapy drugs are infused, we would make payment for GXXX4--Administration of packaged chemotherapy drugs by infusion and for each separately payable chemotherapy drug, but we would not make payment for GYYY4--Infusion of separately payable chemotherapy drugs.

[sbull] When packaged chemotherapy drugs are pushed and infused, and separately payable chemotherapy drugs are infused, we would make payment for GXXX3 and GXXX4 and for each separately payable chemotherapy drug, but we would not make payment for GYYY4.

[sbull] When packaged chemotherapy drugs are infused and pushed; separately payable chemotherapy drugs are infused and packaged; and separately payable non-chemotherapy drugs are infused (for example, antiemetics), and hydration is given; we would make payment for GXXX3, GXXX4, each separately infused chemotherapy drug, GXXX1, and each separately payable non-chemotherapy drug. We would not make payment for GYYY1 or GYYY3. Note that payment for GXXX1 in this case would be made at 50 percent because it was billed with chemotherapy (if it was billed without

[[Page 48002]]

chemotherapy, then payment would be made at 100 percent).

Medians for these codes would be as follows:

Table 19.--Median Costs Under Option 3

HCPCS

2004 APC

2004 SI

Description

Median costs

GXXX1.............................

XXX1 T

Infusion of packaged non-

$274.47 cancer chemotherapy drug(s), per day. GXXX3.............................

XXX3 S

Administration of

125.86 packaged cancer chemotherapy drug(s) by other than infusion, per day. GXXX4.............................

XXX4 S

Administration of

257.57 packaged cancer chemotherapy drug(s) by infusion, per day. GYYY1.............................

YYY1 T

Infusion of separately

107.93 payable non-cancer chemotherapy drug(s) or non-drug infusion therapy, per day. GYYY3.............................

YYY3 S

Administration of

39.10 separately payable cancer chemotherapy drug(s) by other than infusion, per day. GYYY4.............................

YYY4 S

Administration of

142.38 separately payable cancer chemotherapy drug(s) by infusion, per day.

As modeled, these codes would have status indicator S (except as described above for GXXX1 and GYYY1).

Similar to option 2, we would require hospitals to report HCPCS codes for packaged and separately payable drugs to ensure that we have reliable data upon which to base future relative weights for these services. As described under option 4, we would create six lists of drugs in order to facilitate proper coding and payment in the future.

We do not propose payment amounts for this option because the budget neutrality scalar would be different under this proposal than under option 2 (which was used in the scalar and impact analysis).

Option 4--Use of codes Q0081, Q0083, and Q0084 and deletion of Q0085 with creation of logic in the outpatient code editor (OCE) to enable differential payment for administration of packaged and separately payable drugs.

This option is similar to option 3 in terms of payment policy. However, instead of creating six new codes, hospitals would continue to report codes Q0081, Q0083, Q0084, and the HCPCS codes for all packaged and separately payable drugs. We would delete Q0085 in order to simplify hospital reporting and to facilitate creation of payment logic in the OCE.

We would create six lists of drugs (see Addenda L, M, N, O, P, Q): packaged chemotherapy agents administered by other than infusion, separately payable chemotherapy agents administered by other than infusion, packaged chemotherapy agents administered by infusion, separately payable chemotherapy agents administered by infusion, packaged non-chemotherapy agents administered by infusion, and separately payable non-chemotherapy agents administered by infusion. These lists would be coded into the OCE, and would be updated quarterly by program memoranda. We realize that a few drugs may be administered by both infusion and other techniques. In these lists, we would assign each drug to its predominant form of administration in a hospital outpatient setting. If we could not determine whether a drug was infused or administered by a technique other than infusion (for example, we receive a claim with Q0083 and Q0084 and two drugs that may be administered by either infusion or another technique), we would associate each drug with its predominant administration code.

We would create logic in the OCE that would base payment on the combination of administration and drug codes on the claim but would only allow one unit of each administration type as described in option 3. The medians for the APCs to which OCE would assign the codes are described in Table 20.

Table 20.--Medians for APCS Under Option 4

Nonchemo drug, Nonchemo drug, Chemo drug, separately paid Chemo drug, Drug administration codes on the packaged list packaged list list or no separately paid Admin APC APC median Applicable claim

(subgroup X) (subgroup W) drug billed list (subgroup

addenda (subgroup Z)

Y)

Q0081...........................

X ............... ............... ............... A

$274.47 L Q0081........................... ............... ...............

X ............... B

107.93 M Q0083........................... ...............

X ............... ............... C

125.86 N Q0083........................... ............... ............... ...............

X D

39.10 O Q0084........................... ...............

X ............... ............... E

257.57 P Q0084........................... ............... ............... ...............

X F

149.38 Q

The payment policy is identical to the policy described in option 3 including the discount for Q0081 when billed with Q0083 and/or Q0084. Although this option would not require hospitals to change coding of drug administration it would, unlike options 2 and 3, require accurate coding of HCPCS codes for drugs in order to ensure proper payment. Additionally, we would revise the definitions of the administration codes to ``per day'' instead of ``per visit.''

Similar to option 3, we would make payment for up to three drug administrations per day, if appropriate. Where a code is billed with a packaged drug suitable for the code, we would pay the APC for the packaged drug. Where both a packaged drug and a

[[Page 48003]]

separately paid drug were administered via the same route of administration (and therefore only one code was billed), we would pay the APC only for the administration of the packaged drug and would pay separately for the separately paid drug and would not pay the APC for administration of the separately paid drug. In no case would we pay for more than one unit of an administration code.

Under options 2, 3, and 4, we would return a claim to the provider when a chemotherapy administration code was reported without a HCPCS code for a chemotherapy drug. Therefore, it is very important that commenters advise us as to whether there are any cancer chemotherapy drugs that are not included in Addenda L, M, N, O, P, or Q. Specifically, we solicit comments as to whether there are any cancer chemotherapy drugs that do not have HCPCS codes.

We do not propose payment amounts for this option because the budget neutrality scalar would be different under this proposal than under option 2 (which was used in the scalar and impact analysis). We solicit comment on each option described above. General Billing Instructions

Any previous regulatory or sub-regulatory guidance notwithstanding, we propose to implement the following billing rules under any of the above payment options:

(1) Q0081 may not be used to bill separately for the hanging of a bag of solution for which the sole purpose is to administer chemotherapy drugs; that charge should be billed as part of the charge for Q0084 or Q0085.

(2) Q0081 may not be billed when it is an integral part of another procedure. In those cases, the charge for the procedure should reflect the costs of the infusion therapy, either as part of the charge for the HCPCS code or as a revenue code charge (for example, hydration or drug administration during a surgical procedure performed under general anesthesia).

(3) Q0081, Q0083, and Q0084 should not be used to bill for the administration of radiopharmaceuticals that are administered as part of diagnostic or therapeutic nuclear medicine procedures. In those cases, the radionucliide should be billed with the appropriate nuclear medicine HCPCS code.

(4) Q0081, Q0083, and Q0084 may not be used to report the transfusion of blood, platelets, or any other blood products. Those transfusions should be reported by use of the appropriate HCPCS code(s) in APC 0110. 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 are proposing 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 when we determine our claims data do not reflect the costs of the 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 propose to adopt the following methodology to price the affected drugs, biologicals, and radiopharmaceuticals under the OPPS.

We would first identify items approved for generic availability by the FDA during the 6 months before the first day of the claims period we would 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 propose to base our payment rate on 43 percent of the AWP for the drug, biological, or radiopharmaceutical. As described in the 2003 OPPS rule (67 FR 66768), the ratio of hospital acquisition cost, on average, to AWP for multisource drugs with generic competitors equals 0.43. We believe that using this ratio would allow us to appropriately calculate the costs that hospitals incur when purchasing generic drugs or radiopharmaceuticals. When we determine that our claims data accurately reflect the cost of the generic alternative(s), we would use the claims data to set payment rates in preference to 43 percent of AWP for the drug or radiopharmaceutical.

We considered another payment option where we would base our payment rate on the lower of: (1) The median cost (with dampening if applicable) based on claims data; or (2) the Federal Supply Schedule price. We are not proposing this policy because we believe we would not be able to calculate payment rates that are close to the actual hospital acquisition costs of generic alternatives since the Federal Supply Schedule represents prices that are lower than the prices paid by most hospitals. Also, median costs from the claims data would not reflect the actual cost of generics because of the time lag described above.

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 propose 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 understand that there is a wide range of utilization for these drugs in the OPPS and that price reductions for generic drugs will depend on their utilization and the types of illnesses for which they are used. However, we would not expect claims data from April 1, 2002 through December 31, 2002 to reflect fully the availability of the generic alternatives.

Table 21 shows the median cost for these six drugs as determined by claims data (with any adjustments for APCs that decreased in median cost by more than 15 percent from 2003 to 2004) and their costs at 43 percent of AWP as determined under the July 2003 update of the Medicare Single Drug Pricer.

We solicit comments on this proposed method of calculating payment for drugs, biologicals, and radiopharmaceuticals for which generic alternatives have recently been approved. Specifically, we are 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.

[[Page 48004]]

Table 21.--Proposed List of Separately Payable OPPS Drugs With Generic Alternatives Approved Between October 2001 and December 2002

2004 Median Date of Generic

cost (with APC

Description

Approval by the FDA 43% of AWP dampening if applicable)

0832.............................. Idarubicin hcl

May 2002.............

$190.08

$188.25 injection. 0831.............................. Ifosfomide injection. May 2002.............

68.07

115.46 0863.............................. Paclitaxel injection. May 2002.............

74.27

116.61 0730.............................. Pamidronate disodium. May 2002.............

120.34

184.40 0857.............................. Bleomycin sulfate October 2001.........

130.98

169.28 injection. 0820.............................. Daunorubicin hcl November 2001........

35.46

89.65 injection.

6. Orphan Drugs

In response to last year's proposed rule, many commenters explained that many orphan drugs were life-saving therapies used solely for the treatment of rare disorders where no other treatment was available. They further stated that many of these drugs would be received by very few Medicare beneficiaries and that if we packaged these drugs into other procedures, our payment rates would be insufficient to recognize their high cost, thus impairing the access of beneficiaries who needed the drugs. These commenters also stated that the claims data we used to set payment rates for 2003 did not accurately reflect the cost of these drugs. We shared these concerns, and in the November 1, 2002 final rule (67 FR 66772), we set forth the following payment policy:

We identified orphan drugs that are used solely for orphan conditions by applying the following criteria:

[sbull] The drug is designated as an orphan drug by the FDA and approved by the FDA for treatment of only one or more orphan condition(s).

[sbull] The current United States Pharmacopoeia Drug Information (USPDI) shows that the drug has neither an approved use nor an off- label use for other than the orphan condition(s). Payment for drugs that met these criteria was made outside of OPPS under reasonable cost.

In that same rule, we identified four orphan drugs (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) as meeting these criteria. Therefore, we excluded them from payment under OPPS and paid for them at reasonable cost in 2003.

We received several comments in response to the final rule, stating that we had not identified all drugs that qualified for special payment as orphans under our criteria. After reviewing these comments, we have identified 7 additional drugs that meet our criteria. These drugs are: J2355 Injection, oprelvekin, 5 mg; J3240 Injection, thyrotropin alpha, 0.9 mg; 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 have now identified a total of 11 drugs that meet our orphan drug criteria, and we expect to identify more such drugs in the future. Last year's policy was intended to narrowly target a very small number of drugs received by very few Medicare beneficiaries in order to ensure beneficiary access to life saving therapies. The aggregate number of Medicare beneficiaries who will receive the 11 drugs that meet our criteria for orphans is significantly higher than the number who receive the 4 we identified last year. Furthermore, as we identify more drugs that meet our criteria, we expect the number of beneficiaries who receive these drugs to grow. As the number of beneficiaries who receive these drugs increases, so do total payments for the drugs. Therefore, we no longer believe that paying for these drugs at reasonable cost, outside of OPPS, is appropriate. Our goal is to pay for as many hospital outpatient department (OPD) services as possible under the OPPS system. We believe that any payments made outside of OPPS should remain relatively small and, as in the case of vaccines, be made because it is unlikely our claims data will reflect the cost of the item or service (see discussion of vaccines below).

In the case of orphan drugs, we believe that our claims data for April 1, 2002 through December 31, 2002 do reflect the cost of orphan drugs, and we are concerned about the potential of making ever increasing payments for these drugs outside of the OPPS. Furthermore, we believe that many of the concerns expressed by commenters would be addressed if we continue to make separate payment for these drugs.

Therefore, we propose the following payment policy for orphan drugs:

[sbull] We propose to continue using the same criteria to identify orphan drugs used solely for an orphan condition under the OPPS.

[sbull] We propose to discontinue retrospective cost payments and to make prospective payments under the OPPS for those identified orphan drugs.

[sbull] We propose 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 propose to make separate payment for orphan drugs and place them in APCs.

We solicit comment on each of these proposals and request that commenters submit information meeting the same criteria as comments for other drugs (as discussed above). 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 with this concern 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,

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which were paid for these vaccines under OPPS in 2002 are being paid at reasonable cost for these vaccines in 2003. We are aware that access concerns continue to exist for these vaccines; therefore, we propose to continue paying for influenza and pneumococcal pneumonia vaccines under reasonable cost methodology. 8. Blood and Blood Products

From the onset of the OPPS, we have made separate payment for blood and blood products in APCs rather than packaging them into payment for the procedures with which they were administered. As we explained in the April 7, 2000 final rule (65 FR 18449), wide variations in patient requirements convinced us that we should pay for these items separately rather than packaging their costs into the procedural APCs. Moreover, the Secretary's Advisory Council on Blood Safety and Access recommended that blood and blood products be paid separately to ensure that we did not create any incentives that were inconsistent with the promotion of blood safety and access. Therefore, we propose to continue to pay separately for blood and blood products.

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 believe 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 propose to limit the decrease in payment rates for blood and blood products from 2003 to 2004 by approximately 10 percent.

This is different than the amount by which we limited payment decreases last year because when we applied the dampening methodology used for the 2003 OPPS to blood and blood products, we observed that it did not sufficiently limit payment reductions for the blood and blood products with large decreases in median cost from 2003 to 2004. Therefore, we are proposing for 2004 a variation of the methodology used for the 2003 OPPS because we believe that a 10 percent limit in the decrease in payment rates for blood and blood products would better reflect hospital acquisition costs, ensure appropriate reimbursement to hospitals, and enable continued beneficiary access to 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.

We solicit comment on this proposal especially from hospitals. We are especially interested in comments that include verifiable information about the widely available acquisition cost of commonly used blood and blood products. 9. Intravenous Immune Globulin

Following publication of the proposed rule on August 9, 2002, we received comments urging us to reclassify intravenous immune globulin (IVIG) as a blood product. After carefully reviewing these comments with our medical advisors, we decided to make final our proposal to classify immune globulin as a biological, subject to the same payment policy we implemented for other drugs and biologicals. Our reasons were set forth in the November 1, 2002 final rule (67 FR 66774). Since implementation of the 2003 OPPS update, we have received further comments on this decision. These commenters continue to assert that we should make special payment provisions for IVIG and reclassify IVIG as a blood and blood product. They have expressed particular concern about the potentially negative impact of our payment policy for IVIG on patient access, especially for those individuals who have primary immune deficiency diseases.

We appreciate the concerns regarding our decision to pay for IVIG in accordance with the payment methodology we applied to other drugs and biologicals in the 2003 update of the OPPS. We have reviewed the claims data that are the basis for the payment rates in this proposed rule, and our analysis reveals that IVIG would be separately payable in 2004. The claims data for IVIG are robust, and the most recent claims data, when compared with claims data used in earlier updates of the OPPS suggest that hospital costs are consistent and that hospitals are billing accurately for these products. Therefore, we believe that payment for these products is appropriate using the methodology we propose to implement for other drugs and biologicals. Therefore, we propose to continue to classify IVIG as a biologic. We solicit comments on this proposal. 10. Drug and Device Coding

We propose to require hospitals to report individual codes for all drugs and devices used during the episode, including those that are packaged.

Last year (CY 2003), the pass-through status of many drugs and devices expired. These drugs and devices were packaged, consistent with the fundamental principles of a prospective payment system. By packaging the costs of items and services into the payment for the primary procedure or service with which they are associated, we encourage hospital efficiency and provide hospitals with the ability to manage their resources with maximum flexibility. We believed that an additional advantage of increased packaging would be that hospitals would no longer need to report codes for the individual items and services included in the package. While we continue to support packaging to the greatest extent possible, the loss of coding information on claims creates some obstacles to accurate rate-setting.

The data for 2002 that we are using for CY 2004 rate-setting still have considerable drug and device coding information. However, for the CY 2005 OPPS update, for which 2003 data would be used, there will be much less information regarding specific drug and device costs. We do not expect to have as much Medicare claims information on which to base certain decisions such as which drugs to remove from packaged status and pay separately.

This concerns us and has led us to consider the need for drug and device coding. Even though payment is not directly related to that information, we believe that reporting the codes may be in hospitals' best interest because it may result in the most accurate payments. For example, in setting the weights of certain device-related APCs, we discovered that the median costs of those APCs were higher when we used only claims on which the device codes appeared. Similarly, certain drug administration APCs have higher median costs when separate HCPCS for drugs are reported on the claims.

If we are to continue to price drugs and devices using up-to-date median costs from claims data, we need information on the costs of the items, even when packaged. We propose to require the separate coding of individual drugs and device categories,

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even where their costs are packaged, to address this need. We would like comments on whether or not to require coding of devices. We also solicit comments regarding our proposal to report drug codes on claims and alternative methods for rate-setting if codes for drugs and/or devices are no longer present on the claims. We are particularly interested in receiving comments from hospitals on this proposal. 11. 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 propose 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 propose to assign P9010 to APC 0957 (Platelet concentrate) with a payment rate of $37.30. We invite comments on this proposed change in the status indicator and payment amount for P9010. 12. Other Issues

We propose 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. The current conversion ratio is based on the best information available at the time we developed the final rule for calendar year 2003. In the final rule, we explained that we based our conclusion regarding the appropriate conversion ratio on the FDA labeling for each product and the body of available clinical evidence contained in published and unpublished articles and abstracts and in materials provided by the products' manufacturers. 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.

Consistent with our statements in the final rule, we have continued to gather information regarding an appropriate conversion ratio by reviewing recent published studies and data from alternative sources. We have met with the manufacturers of the products and consulted with clinicians. We are continuing to evaluate this additional data and information. However, we have not yet determined whether the data would support a change to the current policy. 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 propose to continue with the current policy regarding payment for Procrit and Aranesp, including the current conversion ratio. We solicit comments on this issue and are especially interested in submission of articles in peer-reviewed publications and other clinical data concerning the frequency of administration and the dosage amounts of these agents. Submission of prospective, randomized, controlled trials comparing the dosage amounts, frequency of administration, and clinical outcomes of these agents are preferred. All data submitted would be available to the public. 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.

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 this proposed rule. The proposed FY 2004 hospital inpatient wage index published in the May 19, 2003 Federal Register (68 FR 27154) is reprinted in this proposed 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 propose to use the final FY 2004 hospital inpatient wage index to calculate the payment rates and coinsurance amounts that we will publish in the final rule implementing the OPPS for CY 2004.

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. For example, rules 2 and 3 refer to payment rate changes resulting from the recalibration of relative payment weights but do not clearly apply to payment rate changes resulting from the reclassification of HCPCS codes from one APC group to another APC group. Therefore, we propose 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; to situations in which reclassification of HCPCS codes from an existing APC to another APC results in a change in the APC payment; and to payment rates for newly created APCs that are comprised of HCPCS codes from existing APCs.

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 coinsurance rate for an APC group lower than 20 percent or greater than 50 percent of the payment rate.

We propose 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

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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 rate 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 rate of the codes being added to the reconfigured APC.

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.

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 is 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 are proposing 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 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, result in a proposed conversion factor for 2004 of 54.289.

X. Proposed Outlier Policy and Elimination of Transitional Corridor Payments for CY 2004

A. Proposed 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 will 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 propose to continue to set the target for outlier payments at 2.0 percent, as we did for CYs 2001, 2002, and 2003. 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 are proposing to establish two separate outlier thresholds, one for community mental health centers (CMHCs) and one for hospitals. For CY 2004, we propose 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 propose 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 propose 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.

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 under the transitional corridor provisions of the statute.

We are concerned that small rural hospitals are not able to achieve the same level of operating efficiencies as larger rural hospitals and urban hospitals, and we are concerned that the decrease in payments these hospitals may experience once they stop receiving transitional corridor payments will 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.

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In light of these concerns, 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. We invite comments on whether we should provide an adjustment, such as the one described above, for small rural hospitals.

XI. Other Policy Decisions and Proposed 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). An example to illustrate the services that are billed using E/M codes in the hospital outpatient department follows:

An adult male patient presents to a clinic after a fall while working in his yard. As a result, he has scraped off the top layer of skin covering his entire back. The physician examines the patient, finds a dirty and possibly infected wound, which is the only injury. The physician orders the nurse to clean the wound, apply antiseptic medication, and dress the wound. In addition, the physician orders an intramuscular antibiotic and a tetanus injection.

The nurse will spend a considerable amount of time cleaning and dressing the wound with large amounts of sterile supplies (because of the large body surface area) as well as administering medications. The nurse also will give the patient discharge instructions regarding the care of the wound.

Although the physician services are captured using existing E/M codes, the additional staff and supplies integral to the outpatient department services are not. The low level E/M code that describes the physician services in the example is not reflective of the services provided by the nurse (and any other staff that may have become involved) or of the quantity of supplies used in the treatment.

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 should 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. APC Panel Recommendations

During its January 2002 meeting, the APC Panel made the following recommendations regarding coding for evaluation and management services:

1. Propose, and make final, facility coding guidelines for E/M services for CY 2004.

2. Create a series of G codes with appropriate descriptors for facility E/M services.

3. Maintain a single set of codes, with five levels of service, for emergency department visits.

4. Develop a single set of codes, with five levels of service, for clinic visits. The Panel specifically recommended that we not differentiate among visit types (for example, new, established, and consultation visits) for the purposes of facility coding of clinic visits.

5. Adopt the American College of Emergency Physicians (ACEP) facility coding guidelines as the national guidelines for facility coding of emergency department visits.

6. Develop guidelines for clinic visits that are modeled on the ACEP guidelines but are appropriate for clinic visits.

7. Implement these guidelines as interim and continue to work with appropriate organizations and stakeholders to develop final guidelines.

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. We wanted to ensure that definitions and guidelines were developed using an open process involving a variety of experts in the field. We stated that it is critically important to the development, acceptance, and implementation of facility visit code definitions and guidelines that the organizations that develop the guidelines also maintain and update the guidelines and provide ongoing education to providers on use of the codes. 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. Furthermore, we stated that the process should provide adequate time for the education of clinicians and coders and for hospitals to make the necessary changes in their systems to accommodate the new codes and guidelines.

On their own initiative, the AHA and the AHIMA convened an independent expert panel of individuals from various

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organizations to develop code descriptions and guidelines for hospital emergency department and clinic visits and 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 APC 600, GXXX6 to APC 601, GXXX7 to APC 602, and GXXX8 to APC 620. These crosswalks and code descriptions are listed in Table 22 below.

Table 22.--Crosswalks of 2003 HCPCS Codes to the Proposed G Codes

2004 G code

2003 2004 Proposed G

Payment 2003 HCPCS description

description

HCPCS

codes

APC amount

Emergency department visit........ Level 1 Emergency

99281 GXXX1............... 0610 $76.80 Visit.

99282 Emergency department visit........ Level 2 Emergency

99283 GXXX2............... 0611 $135.08 Visit. Emergency department visit........ Level 3 Emergency

99284 GXXX3............... 0612 $234.72 Visit.

99285 Critical care..................... Level 4 Critical Care 99291 GXXX4............... 0620 $503.03 provided in the

99292 emergency department. Office/outpatient visit, new...... Level 1 Clinic Visit. 99201 GXXX5............... 0600 $50.90 99202 Office/outpatient visit, new...... Level 2 Clinic Visit. 99203 GXXX6............... 0601 $54.46 Office/outpatient visit, new...... Level 3 Clinic Visit. 99204 GXXX7............... 0602 $84.71 99205 Office/outpatient visit,

Level 1 Clinic Visit. 99211 GXXX5............... 0600 $50.90 established.

99212 Office/outpatient visit,

Level 2 Clinic Visit. 99213 GXXX6............... 0601 $54.46 established. Office/outpatient visit,

Level 3 Clinic Visit. 99214 GXXX7............... 0602 $84.71 established.

99215 Office consultation............... Level 1 Clinic Visit. 99241 GXXX5............... 0600 $50.90 99242 Office consultation............... Level 2 Clinic Visit. 99243 GXXX6............... 0601 $54.46 Office consultation............... Level 3 Clinic Visit. 99244 GXXX7............... 0602 $84.71 99245 .................... ......... ......... Critical care..................... Level 4 Critical Care 99291 GXXX8............... 0620 $503.03 provided in the

99292 clinic.

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 propose 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 propose 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

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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 implementation of the codes and coding guidelines, adequate time will be provided for the education of clinicians and coders and for hospitals to make the necessary changes in their systems to accommodate the codes and guidelines. We are requesting comments on the amount of time hospitals believe would be adequate to implement these new codes and guidelines. 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.

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 a 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 proposed status indicator (SI) assignments for APCs in Addendum A, HCPCS codes in Addendum B, and definitions of the status indicators in Addendum D.

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 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 the establishment of a system of status indicators with specific meanings. Addendum D defines the meaning of each status indicator for purposes of the OPPS.

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.

Specifically, in 2004 we propose to use the status indicators in the following manner:

[sbull] We use ``A'' to indicate services that are paid under some payment method other than OPPS, such as the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) fee schedule or the physician fee schedule. Some but not all of these other payment systems are identified in Addendum D.

[sbull] We use ``C'' to indicate inpatient services that are not payable under the OPPS.

[sbull] We use ``D'' to indicate a code that was deleted effective with the beginning of the calendar year.

[sbull] We use ``E'' to indicate services for which payment is not allowed under the OPPS or that are not covered by Medicare.

[sbull] We use ``F'' to indicate acquisition of corneal tissue, which is paid at reasonable cost. (In 2003, we also use ``F'' to indicate those orphan drugs that are paid at reasonable cost.) In 2004, we propose to revise the definition of ``F'' solely to indicate acquisition of corneal tissue paid at reasonable cost.

[sbull] We use ``G'' to indicate drugs and biologicals that are paid under OPPS transitional pass-through rules.

[sbull] We use ``H'' to indicate devices that are paid under OPPS transitional pass-through rules.

[sbull] We use ``K'' to indicate drugs, biologicals (including blood and blood products), radiopharmaceutical agents, and certain brachytherapy seeds that are paid in separate APCs under the OPPS but that are not paid under OPPS transitional pass-through rules.

[sbull] We use ``L'' to indicate flu and pneumococcal immunizations which are paid at reasonable cost but to which no coinsurance or copayment apply.

[sbull] We use ``N'' to indicate services that are paid under the OPPS but for which payment is packaged into another service or APC group.

[sbull] We use ``P'' to indicate services that are paid under the OPPS but only in partial hospitalization programs.

[sbull] We use ``S'' to indicate significant procedures that are paid under OPPS but to which the multiple procedure reduction does not apply.

[sbull] We use ``T'' to indicate significant services that are paid under the OPPS and to which the multiple procedure payment discount under OPPS applies.

[sbull] We use ``V'' to indicate medical visits (including clinic or emergency department visits) that are paid under the OPPS.

[sbull] We use ``X'' to indicate ancillary services that are paid under the OPPS.

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.

We are proposing the status indicators identified for each HCPCS code and each APC in Addenda A and B and are requesting comments on the appropriateness of the indicators we have assigned.

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 this proposed rule, we are neither proposing anything new with regard to observation services, nor are we seeking public comment on observation issues at this time. As we have in the past, we will update by Program Memorandum any changes in the list of ICD-9-CM codes required for payment of HCPCS code G0244 resulting from October 1 annual update of ICD-9-CM. Any such changes will be included in the 2004 final OPPS rule with comment period and the public will have an opportunity to comment at that time.

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 provide only in the inpatient setting and

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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 postoperative recovery time or monitoring before the patient can be safely discharged, or the underlying physical condition of the patient. As we 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 we are not proposing to make any of the procedures that are currently on the inpatient list in Addendum E payable under the OPPS in 2004. We solicit comments on whether any procedures in Addendum E should be paid under the OPPS. We ask 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 solicit 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 propose either to assign a CPT code to an APC for payment under the OPPS or, if the comments do 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.

Proposed 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 status indicator ``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 status indicator ``C'' and modifier -CA, is currently made under APC 977.

We reviewed this policy and determined that assigning payment for these services to APC 977, 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 propose 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 status indicator ``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 375 instead of APC 977 for services furnished on the same date of service that a procedure with status indicator ``C'' and modifier -CA is billed. We propose at the outset to set the payment rate for APC 375 in the amount of $1,150, which is the payment amount for the newly structured New Technology APC that would replace APC 977. 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. We invite comments on these proposed changes.

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 PHP per diem amount was based solely on hospital data. Section 1833(t)(2)(C) of the Act required that we initially establish relative payment weights based on median (or mean, at the discretion of the Secretary) hospital costs determined by 1996 claims and cost report data. We analyzed the service components billed by hospitals over the course of a billing period and determined the median hospital cost of furnishing a day of partial hospitalization. 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.

Although we did not use CMHC data in establishing the initial APC amount

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for partial hospitalization, in the April 7, 2000 final rule, we committed to analyzing future data from hospitals and CMHCs to determine whether refinements to the per diem were warranted. As a result, for payment rates presented in the proposed and final rules in 2002, we used data from both hospitals and CMHCs to compute the CY 2003 per diem rate. A description of the methodology we followed in developing the CY 2003 PHP payment rate is presented below.

We based the CY 2003 per diem amount on hospital and CMHC claims data for services furnished from April 1, 2001 through March 31, 2002. We used data from all the hospital bills reporting condition code 41, which identifies the claim as partial hospitalization, and all bills from CMHCs, since CMHCs are Medicare providers only for the purpose of providing partial hospitalization services. We used cost-to-charge ratios from the most recently available hospital and CMHC cost reports to convert each provider's line item charges as reported on bills, to estimate the provider's cost for a day of PHP. Unlike hospitals, CMHCs do not file cost reports electronically and the cost report information is not included in the Hospital Cost Report Information System (HCRIS). The CMHC cost reports are held by the Medicare fiscal intermediaries (FIs). As a result, we requested that the FIs forward to us the most recently available CMHC cost-to-charge ratios so that we could apply the ratio to the CMHC's billed charges and approximate the CMHC's per diem cost for PHP.

Per diem costs are computed by summing the line item costs on each bill and dividing by the number of days on the bill. Using this method of computing costs, preliminary per diem cost estimates for CMHCs were much higher than expected, in many cases more than twice the average per diem for inpatient psychiatric care. Closer examination of the CMHC cost report data summaries showed that costs from CMHC settled cost reports were considerably lower than costs from ``as submitted'' CMHC cost reports. To account for the difference between settled and as submitted cost report data, we computed the ratio of total settled costs to total as submitted costs over a 3-year period (CMHC FYs 1998 through 2000) and calculated an average adjustment factor (0.583), which we applied to the costs on each claim. As stated in the 2002 proposed and final OPPS rules, we thought that an adjustment factor of 0.583 was adequate to account for the difference between settled and ``as submitted'' CMHC cost reports and was more reflective of CMHC costs for PHP. However, we did not have an opportunity to examine the data in depth before publishing the OPPS final rule on November 1, 2002.

The adjusted CMHC per diem costs on each claim were summed, then divided by the number of days on the claim. We then combined the CMHC and hospital PHP data files and determined the median per diem cost for PHP. Effective January 1, 2003, the PHP APC amount was $240.03, of which $48.17 is the beneficiary's coinsurance. 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, including the adjustment factor, as we used to compute the CY 2003 PHP median cost per day. However, when we applied the adjustment factor to the CMHC claims to compute the CY 2004 per diem, the CMHC median cost per day was determined to be $605. Without the adjustment, the median cost per day for CMHCs to provide partial hospitalization services is $1,038. The median cost per day for hospital outpatient departments to provide the same benefit is $225. We do not believe it is reasonable for CMHCs to incur costs that are more than double those incurred by hospital outpatient departments providing PHP services. In addition, the median CMHC cost for a day of outpatient PHP services exceeds the average per diem cost for inpatient psychiatric facilities, which provide a full 24 hours of care, medications, and other ancillary services. We do not believe it is appropriate for Medicare to pay more for a day of outpatient treatment than for a day of inpatient psychiatric care.

In addition to the vast difference in median costs between CMHCs and hospital outpatient departments, we are concerned that this difference has grown significantly larger since last year. The median per diem cost for hospitals is about the same for 2003 and 2004 ($224 for CY 2003 compared to $225 for the proposed CY 2004 update), while the median per diem cost for CMHCs (after adjustment) has increased by 58 percent ($384 for CY 2003 compared to $605 for the proposed CY 2004 update). We believe that the increase in the median CMHC per diem cost is primarily due to large increases in CMHC charges, coupled with the application of outdated cost-to-charge ratios to determine the per diem cost. In a Program Memorandum issued on January 17, 2003 (Transmittal A-03-004), we directed FIs to recalculate hospital and CMHC cost-to- charge ratios using the most recently settled or tentatively settled cost reports by April 30, 2003. However, we did not receive the updated CMHC cost-to-charge ratios in time to use in our data analysis for this proposed rule.

Therefore, we are proposing a per diem rate for PHP services furnished during CY 2004 based solely on hospital PHP data. The resulting PHP APC 0033 amount, after scaling, is $208.95, of which $41.69 is the beneficiary's coinsurance. We are not inclined to use the CMHC data in computing the per diem amount until the data discrepancies can be more fully resolved. We anticipate receipt of the revised CMHC cost-to-charge ratios this summer and will analyze the updated CMHC cost data. To the extent we believe the updated cost-to-charge ratios result in a more reasonable median per diem rate, we propose to use the CMHC data in developing the final rate for CY 2004. 3. Outlier Payments to CMHCs

In a related matter, the use of outdated 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. Of the approximately 660 hospital programs with claims for PHP in CY 2001, 25 hospitals received approximately $9,000 in outlier payments. By contrast, almost half of the 155 CMHCs in our CY 2001 data file were paid outlier payments, totaling approximately $48 million.

Based on preliminary analysis of the 125 CMHCs with claims in the CY 2002 data files, that is, April 1, 2002 through December 31, 2002, we have determined that CMHCs received approximately $37 million in outlier payments, compared to approximately $13,000 for all hospitals in the PHP data file. The $37 million in outlier payments to CMHCs almost equals the total amount paid to CMHCs in regular APC payments.

CMHCs have indicated that they are unable to reduce their costs to the per diem payment amount and that outlier payments are needed to cover operating expenses. This use of outlier payments is contrary to the intent of an outlier policy. Establishing an outlier policy allows us to ensure beneficiary access to services by sharing in the loss

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associated with services for specific patients that are extraordinarily expensive. Through a comparison of the median per diem costs, we have determined that CMHCs dramatically increased their charges between CY 2001 and CY 2002. During this period, the median per diem cost for CMHCs increased by 58 percent. We believe that in most cases, these increases in charges were not related to a corresponding increase in costs. Since the CMHC cost-to-charge ratios used to calculate outlier payments remained constant during this period, we believe that the 58 percent increase in computed cost is attributable to artificial increases in charges designed to enhance outlier payments. Approximately two-thirds of outlier payments made to PHP providers were paid to 20 of the 125 CMHCs. The charges reported by these providers, on average, were over 10 times more than hospital per diem charges.

Given the difference in PHP charges between hospitals and CMHCs, we no longer believe it is appropriate to make outlier payments to CMHCs using the outlier percentage target amount and threshold established for hospitals. Therefore, we are proposing 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. CMHCs are projected to receive 0.36 percent of total OPPS payments in CY 2004, excluding outlier payments. Therefore, we are proposing 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 are proposing to set the threshold for CY 2004 at 11.75 times the PHP APC payment amount. We believe that this approach would neutralize the impact of inflated CMHC charges on outlier payments. We are proposing to apply the same outlier payment percentage that applies to hospitals. Therefore, for CY 2004, we are proposing to pay 50 percent of CMHC per diem costs over the threshold. To the extent charges remain relatively constant, CMHCs would qualify for outlier payments in CY 2004 only for truly high cost patients.

As noted previously, we expect to receive updated cost-to-charge ratios from the FIs this summer. Many of the cost-to-charge ratios are expected to be considerably lower than those currently used to determine a provider's cost for the purpose of outlier and transitional pass-through or corridor payments. For example, we are aware of a number of situations where the updated cost-to-charge ratios have declined by more than 50 percent.

We specifically request public comments on this proposed outlier policy. We intend to monitor the extent to which the current pattern of escalating charges continues. CMS and the Office of the Inspector General will be further examining the excessive outlier payments to CMHCs.

XII. Summary of and Responses to MedPAC Recommendations

The Medicare Payment Advisory Commission (MedPAC) in its March 2002 Report to the Congress: ``Medicare Payment Policy,'' makes a number of recommendations relating to the OPPS. This section provides responses to those recommendations.

Recommendation: The Congress should increase payment rates for the OPPS by the rate of increase in the hospital market basket, less 0.9 percent, for CY 2004.

Response: Section 1833(t)(3)(C)(ii) of the Act requires the Secretary to update the conversion factor annually. Under section 1833(t)(3)(C)(iv) of the Act, the update must be equal to the hospital market basket percentage increase applicable under the hospital inpatient PPS. For years 2000 and 2002 only, the statute required the update to be determined by reducing the increase by one percentage point, but current law specifies such a reduction only for those 2 years. For 2004, we propose to increase the conversion factor by the rate of increase in the hospital market basket.

Recommendation: The Secretary should introduce clinical criteria for eligibility of drugs and biologicals to receive pass-through payments under the outpatient PPS.

Response: In accordance with section 402 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act (BIPA), pass-through payments for medical devices is made on the basis of categories of devices. On November 2, 2001, we published in the Federal Register (66 FR 55850) a rule that specified the criteria for establishment of a new category of devices for purposes of pass-through payments. Among these is the requirement that the devices to be included in a possible category must demonstrate a substantial improvement in medical benefits for Medicare beneficiaries compared to benefits obtained by devices in previously established categories or other available treatments. We elaborated further about this criterion in the final rule updating the OPPS for CY 2003, published in the Federal Register on November 1, 2002. As we stated at that time, ``We established this criterion because it is important for hospitals to receive pass-through payments for devices that offer substantial clinical improvement in the treatment of Medicare beneficiaries to facilitate access by beneficiaries to the advantages of the new technology. Conversely, the need for additional payments for devices that offer little or no clinical improvement over a previously existing device is less apparent.'' (67 FR 66782)

At present, pass-through payment for drugs and biologicals is not made on the basis of categories, and no comparable criterion applies to them. Whether we should apply such a requirement to drugs and biologicals is an important question. On the one hand, as noted above, limiting extra payment to those items that have the potential to make a significant difference in treatment of Medicare beneficiaries appears useful. On the other hand, developing an appropriate mechanism for identifying which drugs or biologicals might qualify is difficult. Because the clinical characteristics of particular cases that are relevant for drug use may vary substantially, we believe that this challenge is more difficult than in the case of devices. Consequently, we have not developed a proposal in this area, and we are not prepared to advance one at this time.

XIII. Summary of Proposed Changes for 2004

A. Changes Required By Statute

We are proposing 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.

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B. Additional Changes

We are proposing 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 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 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 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.

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 proposed 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 a proposed rule, we are not able to acknowledge or respond to them individually. However, in preparing the final rule, we will consider all comments concerning the provisions of this proposed rule that we receive by the date and time specified in the DATES section of this preamble and respond to those comments in the preamble to that rule.

XVI. Regulatory Impact Analysis

A. General

We have examined the impacts of this 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 would be implemented by this proposed rule would result in expenditures exceeding $100 million in any 1 year. We estimate the total increase (from changes in the proposed 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 $0.457 billion. Therefore, this proposed 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 would 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 would 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 would 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 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 proposed rule would 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 proposed rule would 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 proposed rule would not mandate any requirements for State,

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[[Page 48015]]

local, or tribal governments. This proposed rule would 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 proposed rule (and subsequent final rule) that imposes substantial direct costs on State and local governments, preempts State law, or otherwise has Federalism implications.

We have examined this proposed rule in accordance with Executive Order 13132, Federalism, and have determined that it would not have an impact on the rights, roles, and responsibilities of State, local or tribal governments. The impact analysis (see Table 23) shows that payments to governmental hospitals (including State, local, and tribal governmental hospitals) would increase by 3.9 percent under the proposed rule.

B. Changes in This Proposed Rule

We are proposing 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 proposed rule, we are proposing to update 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 proposed rule. We are also proposing to revise the relative APC payment weights based on claims data from April 1, 2002 through December 31, 2002. Finally, we are proposing to remove two devices and eight drugs and biologicals from pass-through payment status. Alternatives to the changes we are proposing and why we did not accept them are discussed throughout this proposed 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 proposed rule, the change to the conversion factor as provided by statute would increase total OPPS payments by 3.8 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) would not increase OPPS payments because the OPPS is budget neutral. However, the wage index and APC weight changes would change the distribution of payments within the budget neutral system as shown in Table 23 and described in more detail in this section. Alternatives Considered

Alternatives to the changes we are proposing and the reasons that we are proposing not to make them are discussed throughout this final rule. Below we discuss options we considered when analyzing methodologies to appropriately recognize the costs of former pass- through items. For a more detailed discussion, see section V.B of this proposed rule regarding the expiration of pass-through payment for devices and section VI.B of this proposed rule regarding the expiration of pass-through payment for drugs and biological agents. Payment for the Administration of Drugs

As discussed in detail in section VI.B of this proposed rule, we considered the following alternatives with regard to payment for administration of packaged and separately paid drugs:

[sbull] Continue to pay under the current drug administration codes (Q0081, Q0083, Q0084, and Q0085). This alternative would pay the same amount for administration of packaged or separately paid drugs, although the data show that the costs are considerably more when packaged drugs are administered and considerably less if separately paid drugs are administered.

[sbull] Create eight new HCPCS codes (based on the existing Q codes listed above), with one set of codes for packaged drugs and one set for separately paid drugs. Establish an APC for each. This alternative permits more accurate payment for packaged and separately paid drugs than use of the current codes but imposes a significant burden on hospitals to bill correctly.

[sbull] Create six new HCPCS codes (based on the existing Q codes with deletion of Q0085). Establish an APC for each. This alternative permits more accurate payment for packaged and separately paid drugs than use of the current codes and imposes slightly less burden on hospital billing than the eight-code alternative.

[sbull] Delete Q0085 and revise the definitions of the other Q codes to once per day. Crosswalk each code billed to one of two APCs that would be paid dependent on the drugs billed on the same date of service. This alternative permits more accurate payment for packaged and separately paid drugs. It also simplifies hospital billing for drug administration. Under this option, however, hospitals would be required to bill for all drugs they administer, whether packaged or separately paid so that the outpatient code editor (OCE) could properly assign the APC that applies in the case. The systems changes required for this alternative are much more substantial than under any of the other alternatives, and we are considering whether we can implement this change before January 2005.

We modeled the second alternative for purposes of budget neutrality and impact analysis. We await comments before determining what alternative we will undertake for the 2004 OPPS. Payment for Drugs That Are Not Packaged

As a result of marked and erratic fluctuations in median costs for drugs, biologicals, and radiopharmaceutical agents that are paid separately under the OPPS, we explored several options to determine how best to provide accurate payment for CY 2004. One option was to pay based on our 2002 claims data without any adjustment. We were certain that this would not result in accurate payments because of the magnitude of some of the fluctuations in median costs seen in the data.

Another option considered, to create cost bands similar to those used for New Technology APCs, was rejected because unless very narrow bands were created, this option also would result in inaccurate payments.

Finally, we looked at using the same methodology for moderating payment decreases that we used last year, to limit median cost decreases of 15 percent or more to 50 percent of the difference between the median cost and the amount of decrease greater than 15 percent. This option would enable us to moderate the decreased payment amount on an individual drug, biological, or radiopharmaceutical agent level, which is important in light of the great variations in the data; but the 50 percent adjustment level was not adequate for the level of moderation we believed was required for CY 2004.

The adjustment we put forth in this proposed rule is a 75 percent moderation of decreases of 15 percent or more. Thus, for separately payable drugs, biologicals, and radiopharmaceutical agents for which median costs decreased by 15 percent or more, we are proposing to limit the reduction in median costs to 15 percent plus 25 percent of the difference

[[Page 48016]]

between the value derived from claims data and any decrease of 15 percent or more.

Our analyses indicate that application of this method of adjustment would result in payment levels that will be fair and accurate. However, based on more complete claims data we expect to have for the final rule and on the comments from the public, we will re-evaluate the appropriateness of adjusting median costs for drugs for which median costs would decline in 2004. Conclusion

It is clear that the changes in this proposed rule would 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 proposed rule, constitutes a regulatory impact analysis.

The OPPS rates for CY 2004 would have, overall, a positive effect for every category of hospital with the exception of cancer hospitals and children's hospitals, which are held harmless under the OPPS. These changes in the OPPS for 2004 would result in an overall 3.8 percent increase in Medicare payments to hospitals, exclusive of outlier and transitional pass-through payments and transitional corridor payments. 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. The impact of the wage and recalibration changes does vary somewhat by hospital group. Estimates of these impacts are displayed on Table 23.

The overall projected increase in payments for urban hospitals is slightly lower (3.7 percent) than the average increase for all hospitals (3.8 percent) while the increase for rural hospitals is slightly greater (4.0 percent) than the average increase. The introduction of a new wage index combined with changes to the APC structure would result in small distributional changes for all categories of hospitals. Rural hospitals would gain 0.1 percent from the wage index change but show no gains from APC changes. Large urban hospitals would lose 0.1 percent from the wage index change, whereas ``other'' urban hospitals show a decrease of -0.2 percent from the APC changes. A discussion of the distribution of outlier payments that we project under this proposed rule can be found under section XV.E below. Table 24 presents the outlier distribution that we expect to see under this proposed rule.

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 are not proposing to make adjustments for future changes in variables such as service volume, service mix, or number of encounters.

D. Estimated Impacts of This Proposed 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 proposed rule, hospitals would receive more total payment than in 2003 while in other cases they would receive less total payment than they received in 2003. The impact of this proposed rule would 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 would change) and the impact of the wage index changes on the hospital.

Column 4 in Table 23 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 proposed 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 proposed 2004 OPPS rates that is summarized in Table 23. For that reason, the total number of hospitals included in Table 23 (4,352) is lower than in previous years. CAHs are excluded from the OPPS.

To a very limited extent, wage index changes favor all hospital categories with the exception of large urban hospitals with 500 or more beds that show a -0.3 percentage change. Rural hospitals show modest increases of 0.1 percent for most bed sizes but show the largest gains for categories with 200 or more beds, a 0.3 percent increase. Rural hospitals located in Puerto Rico show the largest negative impact (-2.2 percent) due to changes in the wage index. Hospitals located in the Middle Atlantic, South Atlantic, and in the East North Central part of the country experience a negative impact 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 (-1.2 percent). Conversely, urban hospitals with 200 to 299 beds (-0.1 percent decrease), and urban hospitals with 300 to 499 beds (-0.5 percent) show a decrease attributed to APC recalibration. Urban hospitals in excess of 500 beds show a 0.1 percent increase 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 of fewer than 5,000 services are projected to experience an increase in payments (4.4 percent). Urban hospitals that provide low-volume services experience an even larger increase (5.0 percent) in payments attributable to both wage index and APC changes. Conversely, urban and rural hospitals providing more than 21,000 services are projected to lose as a result of APC recalibration but gain from the introduction of the new wage index for a combined effect in the range of 3.4 to 3.9 percent.

Major teaching hospitals are projected to experience a smaller increase in payments (3.4 percent) than the aggregate for all hospitals (3.8 percent) due to negative impacts of the wage index (-0.4 percent). Hospitals with less intensive teaching programs are projected to experience an overall increase (3.7 percent) that is smaller than the average for all hospitals. There is little difference in impact among hospitals that serve low-income patients where increases in payments range from 3.4 to 4.2 percent higher than in 2003.

[[Page 48017]]

Table 23.--Impact of Changes for CY2004 Hospital Outpatient Prospective Payment System

(Percent change in total payments to hospitals (program and beneficiary); does not include hold harmless, corridor, outlier, or transitional pass-through payments)

Number of New wage index APC changes All CY2003 hospitals (1)

(2)

(3)

changes (4)

ALL HOSPITALS...................................

4,352

0.0

0.0

3.8 NON-TEFRA HOSPITALS.............................

3,849

0.0

0.0

3.8 URBAN HOSPS.....................................

2,390

0.0

0.0

3.7 LARGE URBAN (GT 1 MILL.)........................

1,377

-0.1

0.0

3.8 OTHER URBAN (LE 1 MILL.)........................

1,013

0.0

-0.2

3.7 RURAL HOSPS.....................................

1,459

0.1

0.0

4.0 BEDS (URBAN):

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

546

0.2

0.4

4.4

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

875

0.0

0.2

4.1

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

456

0.0

-0.1

3.7

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

364

0.1

-0.5

3.4

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

149

-0.3

0.1

3.6 BEDS (RURAL):

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

694

0.1

1.0

4.9

50-99 BEDS..................................

449

0.1

0.2

4.1

100-149 BEDS................................

190

0.1

0.0

3.9

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

65

0.1

0.1

4.0

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

61

0.3

-1.2

2.9 VOLUME (URBAN):

LT 5,000....................................

225

0.0

1.1

5.0

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

396

0.0

1.0

4.9

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

529

-0.2

0.8

4.5

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

736

0.1

-0.1

3.9

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

504

-0.1

-0.3

3.4 VOLUME (RURAL):

LT 5,000....................................

419

0.1

0.4

4.4

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

483

0.1

0.9

4.9

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

318

0.0

0.4

4.3

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

191

0.2

-0.6

3.5

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

48

0.3

-0.7

3.4 REGION (URBAN):

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

128

0.0

-0.7

3.1

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

367

-0.6

-0.5

2.7

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

355

-0.1

-0.1

3.7

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

401

-0.1

0.4

4.1

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

152

0.6

-0.2

4.3

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

166

0.3

0.1

4.2

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

293

-0.1

0.1

3.9

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

122

0.6

0.0

4.5

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

366

0.1

0.0

3.9

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

40

0.3

2.1

6.3 REGION (RURAL):

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

36

0.8

-0.1

4.6

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

66

-0.2

0.2

3.8

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

213

-0.2

-0.1

3.5

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

192

-0.1

-0.5

3.3

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

225

0.4

0.2

4.4

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

244

0.6

0.0

4.4

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

267

0.2

0.5

4.6

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

123

0.1

0.0

3.9

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

88

0.3

0.7

4.8

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

5

-2.2

1.4

3.0 TEACHING STATUS:

NON-TEACHING................................

2,803

0.1

0.1

4.0

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

758

0.1

-0.2

3.7

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

288

-0.4

0.0

3.4 DSH PATIENT PERCENT:

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

11

2.7

3.0

9.8

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

862

-0.1

-0.3

3.4

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

845

0.0

-0.2

3.6

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

778

0.1

0.4

4.2

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

757

0.0

0.0

3.8

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

596

0.0

0.2

4.0 URBAN IME/DSH:

IME & DSH...................................

963

-0.1

-0.1

3.6

IME/NO DSH..................................

1

0.0

-1.3

2.4

NO IME/DSH..................................

1,417

0.0

0.1

3.9

NO IME/NO DSH...............................

9

2.8

3.0

10.0 RURAL HOSP. TYPES:

[[Page 48018]]

NO SPECIAL STATUS...........................

481

-0.2

0.3

4.0

RRC.........................................

159

0.3

-0.6

3.5

SCH/EACH....................................

483

0.2

0.6

4.7

MDH.........................................

249

0.1

0.7

4.7

SCH AND RRC.................................

78

0.3

-0.5

3.6 TYPE OF OWNERSHIP:

VOLUNTARY...................................

2,362

0.0

-0.1

3.6

PROPRIETARY.................................

696

0.1

0.6

4.6

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

791

0.1

0.0

3.9 SPECIALTY HOSPITALS:

EYE AND EAR.................................

13

-0.4

1.7

5.2

CANCER......................................

11

-0.3

-4.7

-1.3 TEFRA HOSPITALS (NOT INCLUDED ON OTHER LINES):

REHAB.......................................

159

0.5

0.3

4.6

PSYCH.......................................

167

0.8

7.2

12.2

LTC.........................................

135

1.8

4.3

10.3

CHILDREN....................................

42

0.0

-1.1

2.7

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 FY2004 hospital inpatient wage index after geographic reclassification by the Medicare Geographic Classification Review Board. The hospital inpatient proposed rule for FY2004 was published in the Federal Register on May 19, 2003. 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 CY2003 to CY2004, 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.

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. In Table 24 below, we provide a table that 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 would be paid under the OPPS in 2004, that most hospitals would receive outlier payments--approximately 94 percent would receive outlier payments. 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 24.--Distribution of Outlier Payments for CY 2004 Hospital Outpatient Prospective Payment

Outlier payments Number of Percent of total Number of as a percent of hospitals

hospitals

hospitals with total payments outliers

(percent)

ALL HOSPITALS.......................

4,352

96.4

4,097

2.0 NON-TEFRA HOSPITALS.................

3,849

85.2

3,831

2.0 URBAN HOSPS.........................

2,390

52.8

2,376

2.1 LARGE URBAN (GT 1 MILL.)............

1,377

30.4

1,368

2.3 OTHER URBAN (LE 1 MILL.)............

1,013

22.4

1,008

1.9 RURAL HOSPS.........................

1,459

32.2

1,455

1.7 BEDS (URBAN):

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

546

12.0

534

2.6

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

875

19.4

874

1.8

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

456

10.0

455

2.0

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

364

8.0

364

2.0

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

149

3.2

149

2.6 BEDS (RURAL):

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

694

15.4

691

2.2

50-99 BEDS......................

449

10.0

448

1.8

100-149 BEDS....................

190

4.2

190

1.4

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

65

1.4

65

1.7

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

61

1.4

61

1.4 VOLUME (URBAN):

LT 5,000........................

225

5.0

212

3.0

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

396

8.8

395

3.4

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

529

11.8

529

2.1

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

736

16.2

736

1.9

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

504

11.2

504

2.1

[[Page 48019]]

VOLUME (RURAL):

LT 5,000........................

419

9.2

416

2.7

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

483

10.6

482

2.1

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

318

7.0

318

1.7

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

191

4.2

191

1.4

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

48

1.0

48

1.5 REGION (URBAN):

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

128

2.8

127

1.9

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

367

8.2

367

3.2

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

355

7.8

355

1.9

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

401

8.8

398

1.7

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

152

3.4

150

1.4

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

166

3.6

166

1.8

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

293

6.4

292

2.6

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

122

2.6

120

1.8

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

366

8.0

363

2.0

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

40

0.8

38

0.6 REGION (RURAL):

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

36

0.8

36

2.4

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

66

1.4

66

1.4

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

213

4.8

212

1.6

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

192

4.2

192

1.5

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

225

5.0

225

1.2

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

244

5.4

243

1.8

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

267

6.0

266

1.7

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

123

2.8

123

2.8

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

88

2.0

87

2.2

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

5

0.2

5

0.9 TEACHING STATUS:

NON-TEACHING....................

2,803

62.0

2,786

1.8

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

758

16.8

757

1.7

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

288

6.4

288

3.1 DSH PATIENT PERCENT:

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

11

0.2

10

6.7

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

862

19.0

853

1.9

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

845

18.6

845

1.7

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

778

17.2

777

1.8

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

757

16.8

752

2.2

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

596

13.2

594

3.1 URBAN IME/DSH:

IME & DSH.......................

963

21.4

963

2.3

IME/NO DSH......................

1

0.0

0

0.0

NO IME/DSH......................

1,417

31.4

1,404

1.9

NO IME/NO DSH...................

9

0.2

9

6.8 RURAL HOSP. TYPES:

NO SPECIAL STATUS...............

481

10.6

478

1.8

RRC.............................

159

3.6

159

1.4

SCH/EACH........................

483

10.6

483

2.1

MDH.............................

249

5.6

249

1.8

SCH AND RRC.....................

78

1.8

78

1.4 TYPE OF OWNERSHIP:

VOLUNTARY.......................

2,362

52.2

2,359

1.9

PROPRIETARY.....................

696

15.4

685

2.4

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

791

17.6

787

2.5 SPECIALTY HOSPITALS:

EYE AND EAR.....................

13

0.2

13

2.5

TRAUMA..........................

151

3.4

151

2.6

CANCER..........................

11

0.2

11

5.2 TEFRA HOSPITALS (NOT INCLUDED ON OTHER LINES):

REHAB...........................

159

3.6

94

5.8

PSYCH...........................

167

3.6

46

0.6

LTC.............................

135

3.0

88

2.7

CHILDREN........................

42

1.0

38

11.8

[[Page 48020]]

F. Estimated Impacts of This Proposed Rule on Beneficiaries

For services for which the beneficiary pays a coinsurance of 20 percent of the payment rate, the beneficiary share of payment would increase for services for which OPPS payments would rise and would decrease for services for which OPPS payments would fall. For example, for a mid level office visit (APC 0601), the minimum unadjusted copayment in 2003 was $10.11; under this proposed rule, the minimum unadjusted copayment for APC 601 would be $10.89 because the OPPS payment for the service would increase under this proposed rule. For some services (those services for which a national unadjusted copayment amount is shown in Addendum B), however, the beneficiary copayment is frozen based on historic data and would not change, therefore not presenting any potential impact on beneficiaries.

However, in all cases, the statute limits beneficiary liability for copayment for a service to the inpatient hospital deductible for the applicable year. This amount was $840 for 2003, but is not yet determined for 2004. In general, the impact of this proposed rule on beneficiaries would vary based on the service the beneficiary receives and whether the copayment 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.

Dated: July 16, 2003. (Catalog of Federal Domestic Assistance Program No. 93.773, Medicare--Hospital Insurance; and Program No. 93.774, Medicare-- Supplementary Medical Insurance Program) Thomas A. Scully, Administrator, Centers for Medicare & Medicaid Services.

Approved: July 22, 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................. 0.3940 $21.39

$7.09

$4.28 Photochemotherapy. 0002............. Fine needle Biopsy/ T................. 1.0937 $59.38 ........... $11.88 Aspiration. 0003............. Bone Marrow Biopsy/ T................. 2.2627 $122.84 ........... $24.57 Aspiration. 0004............. Level I Needle Biopsy/ T................. 1.5774 $85.64 $22.10 $17.13 Aspiration Except Bone Marrow. 0005............. Level II Needle

T................. 3.3675 $182.82 $71.59 $36.56 Biopsy /Aspiration Except Bone Marrow. 0006............. Level I Incision & T................. 1.7487 $94.94 $24.12 $18.99 Drainage. 0007............. Level II Incision & T................. 11.4943 $624.01 ........... $124.80 Drainage. 0008............. Level III Incision T................. 16.8303 $913.70 ........... $182.74 and Drainage. 0009............. Nail Procedures...... T................. 0.6597 $35.81

$8.34

$7.16 0010............. Level I Destruction T................. 0.6806 $36.95 $10.08

$7.39 of Lesion. 0011............. Level II Destruction T................. 2.1800 $118.35 $27.88 $23.67 of Lesion. 0012............. Level I Debridement & T................. 0.8203 $44.53 $11.18

$8.91 Destruction. 0013............. Level II Debridement T................. 1.1420 $62.00 $14.20 $12.40 & Destruction. 0015............. Level III Debridement T................. 1.5832 $85.95 $20.35 $17.19 & Destruction. 0016............. Level IV Debridement T................. 2.7343 $148.44 $57.31 $29.69 & Destruction. 0017............. Level VI Debridement T................. 16.7332 $908.43 $227.84 $181.69 & Destruction. 0018............. Biopsy of Skin/

T................. 0.9567 $51.94 $16.04 $10.39 Puncture of Lesion. 0019............. Level I Excision/ T................. 3.9807 $216.11 $71.87 $43.22 Biopsy. 0020............. Level II Excision/ T................. 7.3105 $396.88 $113.25 $79.38 Biopsy. 0021............. Level III Excision/ T................. 14.5749 $791.26 $219.48 $158.25 Biopsy. 0022............. Level IV Excision/ T................. 18.6725 $1,013.71 $354.45 $202.74 Biopsy. 0023............. Exploration

T................. 3.1587 $171.48 $40.37 $34.30 Penetrating Wound. 0024............. Level I Skin Repair.. T................. 1.7847 $96.89 $34.75 $19.38 0025............. Level II Skin Repair. T................. 6.2703 $340.41 $115.49 $68.08 0027............. Level IV Skin Repair. T................. 15.8319 $859.50 $329.72 $171.90 0028............. Level I Breast

T................. 17.7459 $963.41 $303.74 $192.68 Surgery. 0029............. Level II Breast

T................. 29.2783 $1,589.49 $632.64 $317.90 Surgery. 0030............. Level III Breast T................. 37.2809 $2,023.94 $763.55 $404.79 Surgery. 0032............. Insertion of Central T................. 11.5584 $627.49 ........... $125.50 Venous/Arterial Catheter. 0033............. Partial

P................. 3.8397 $208.45 $41.83 $41.69 Hospitalization. 0035............. Placement of Arterial T................. 0.2236 $12.14

$3.51

$2.43 or Central Venous Catheter. 0041............. Level I Arthroscopy.. T................. 27.2538 $1,479.58 ........... $295.92 0042............. Level II Arthroscopy. T................. 42.8551 $2,326.56 $804.74 $465.31 0043............. Closed Treatment T................. 1.9233 $104.41 ........... $20.88 Fracture Finger/Toe/ Trunk. 0045............. Bone/Joint

T................. 13.5546 $735.87 $268.47 $147.17 Manipulation Under Anesthesia. 0046............. Open/Percutaneous T................. 31.9719 $1,735.72 $535.76 $347.14 Treatment Fracture or Dislocation. 0047............. Arthroplasty without T................. 30.3786 $1,649.22 $537.03 $329.84 Prosthesis. 0048............. Arthroplasty with T................. 47.4707 $2,577.14 $695.60 $515.43 Prosthesis. 0049............. Level I

T................. 19.9376 $1,082.39 ........... $216.48 Musculoskeletal Procedures Except Hand and Foot. 0050............. Level II

T................. 25.1166 $1,363.56 ........... $272.71 Musculoskeletal Procedures Except Hand and Foot. 0051............. Level III

T................. 34.9381 $1,896.75 ........... $379.35 Musculoskeletal Procedures Except Hand and Foot. 0052............. Level IV

T................. 42.6430 $2,315.05 ........... $463.01 Musculoskeletal Procedures Except Hand and Foot. 0053............. Level I Hand

T................. 14.8188 $804.50 $253.49 $160.90 Musculoskeletal Procedures. 0054............. Level II Hand

T................. 24.2685 $1,317.51 ........... $263.50 Musculoskeletal Procedures. 0055............. Level I Foot

T................. 18.8851 $1,025.25 $355.34 $205.05 Musculoskeletal Procedures. 0056............. Level II Foot

T................. 25.1591 $1,365.86 $405.81 $273.17 Musculoskeletal Procedures. 0057............. Bunion Procedures.... T................. 25.4248 $1,380.29 $475.91 $276.06 0058............. Level I Strapping and S................. 1.0785 $58.55 ........... $11.71 Cast Application.

[[Page 48021]]

0060............. Manipulation Therapy. S................. 0.3151 $17.11

$3.43

$3.42 0068............. CPAP Initiation...... S................. 1.1234 $60.99 $30.49 $12.20 0069............. Thoracoscopy......... T................. 28.6334 $1,554.48 $591.64 $310.90 0070............. Thoracentesis/Lavage T................. 3.1393 $170.43 ........... $34.09 Procedures. 0071............. Level I Endoscopy T................. 0.9012 $48.93 $12.89

$9.79 Upper Airway. 0072............. Level II Endoscopy T................. 1.6987 $92.22 $26.68 $18.44 Upper Airway. 0073............. Level III Endoscopy T................. 3.4396 $186.73 $73.38 $37.35 Upper Airway. 0074............. Level IV Endoscopy T................. 14.4952 $786.93 $295.70 $157.39 Upper Airway. 0075............. Level V Endoscopy T................. 20.4113 $1,108.11 $445.92 $221.62 Upper Airway. 0076............. Level I Endoscopy T................. 9.3560 $507.93 $189.82 $101.59 Lower Airway. 0077............. Level I Pulmonary S................. 0.2772 $15.05

$7.52

$3.01 Treatment. 0078............. Level II Pulmonary S................. 0.7731 $41.97 $14.55

$8.39 Treatment. 0079............. Ventilation

S................. 2.2837 $123.98 ........... $24.80 Initiation and Management. 0080............. Diagnostic Cardiac T................. 36.0982 $1,959.74 $838.92 $391.95 Catheterization. 0081............. Non-Coronary

T................. 34.8355 $1,891.18 ........... $378.24 Angioplasty or Atherectomy. 0082............. Coronary Atherectomy. T................. 100.3996 $5,450.59 $1,293.59 $1,090.12 0083............. Coronary Angioplasty T................. 59.3417 $3,221.60 ........... $644.32 and Percutaneous Valvuloplasty. 0084............. Level I

S................. 10.3392 $561.30 ........... $112.26 Electrophysiologic Evaluation. 0085............. Level II

T................. 36.3284 $1,972.23 $435.09 $394.45 Electrophysiologic Evaluation. 0086............. Ablate Heart

T................. 44.5652 $2,419.40 $822.28 $483.88 Dysrhythm Focus. 0087............. Cardiac

T................. 40.4579 $2,196.42 ........... $439.28 Electrophysiologic Recording/Mapping. 0088............. Thrombectomy......... T................. 34.6065 $1,878.75 $655.22 $375.75 0089............. Insertion/Replacement T................. 116.1611 $6,306.27 $1,722.59 $1,261.25 of Permanent Pacemaker and Electrodes. 0090............. Insertion/Replacement T................. 87.2850 $4,738.62 $1,705.90 $947.72 of Pacemaker Pulse Generator. 0091............. Level II Vascular T................. 28.5187 $1,548.25 $348.23 $309.65 Ligation. 0092............. Level I Vascular T................. 25.1347 $1,364.54 $505.37 $272.91 Ligation. 0093............. Vascular

T................. 20.6662 $1,121.95 $277.34 $224.39 Reconstruction/ Fistula Repair without Device. 0094............. Level I Resuscitation S................. 2.6412 $143.39 $48.46 $28.68 and Cardioversion. 0095............. Cardiac

S................. 0.5984 $32.49 $16.24

$6.50 Rehabilitation. 0096............. Non-Invasive Vascular S................. 1.7332 $94.09 $47.05 $18.82 Studies. 0097............. Cardiac and

X................. 1.0565 $57.36 $23.80 $11.47 Ambulatory Blood Pressure Monitoring. 0098............. Injection of

T................. 1.1630 $63.14 $15.17 $12.63 Sclerosing Solution. 0099............. Electrocardiograms... S................. 0.3708 $20.13 ...........

$4.03 0100............. Cardiac Stress Tests. X................. 1.6726 $90.80 $41.44 $18.16 0101............. Tilt Table Evaluation S................. 4.3675 $237.11 $105.27 $47.42 0103............. Miscellaneous

T................. 12.1256 $658.29 $223.63 $131.66 Vascular Procedures. 0104............. Transcatheter

T................. 80.8877 $4,391.31 ........... $878.26 Placement of Intracoronary Stents. 0105............. Revision/Removal of T................. 18.9084 $1,026.52 $370.40 $205.30 Pacemakers, AICD, or Vascular. 0106............. Insertion/Replacement/ T................. 49.9534 $2,711.92 $542.39 $542.38 Repair of Pacemaker and/or Electrodes. 0107............. Insertion of

T................. 290.5429 $15,773.28 $3,429.62 $3,154.66 Cardioverter- Defibrillator. 0108............. Insertion/Replacement/ T................. 489.5275 $26,575.96 ........... $5,315.19 Repair of Cardioverter- Defibrillator Leads. 0109............. Removal of Implanted T................. 7.7075 $418.43 $131.49 $83.69 Devices. 0110............. Transfusion.......... S................. 3.7128 $201.56 ........... $40.31 0111............. Blood Product

S................. 14.0169 $760.96 $211.96 $152.19 Exchange. 0112............. Apheresis,

S................. 34.8318 $1,890.98 $609.71 $378.20 Photopheresis, and Plasmapheresis. 0113............. Excision Lymphatic T................. 19.9529 $1,083.22 ........... $216.64 System. 0114............. Thyroid/

T................. 37.3583 $2,028.14 $485.91 $405.63 Lymphadenectomy Procedures. 0115............. Cannula/Access Device T................. 25.6233 $1,391.06 $459.35 $278.21 Procedures. 0119............. Implantation of

T................. 129.8988 $7,052.08 ........... $1,410.42 Infusion Pump. 0121............. Level I Tube changes T................. 2.2058 $119.75 $43.80 $23.95 and Repositioning. 0122............. Level II Tube changes T................. 8.4398 $458.19 $93.97 $91.64 and Repositioning. 0123............. Bone Marrow

S................. 4.0076 $217.57 ........... $43.51 Harvesting and Bone Marrow/Stem Cell Transplant. 0124............. Revision of Implanted T................. 27.4545 $1,490.48 $298.10 $298.10 Infusion Pump. 0125............. Refilling of Infusion T................. 2.5105 $136.29 ........... $27.26 Pump. 0130............. Level I Laparoscopy.. T................. 32.5959 $1,769.60 $659.53 $353.92 0131............. Level II Laparoscopy. T................. 40.8955 $2,220.18 $1,001.89 $444.04 0132............. Level III Laparoscopy T................. 56.6318 $3,074.48 $1,239.22 $614.90 0140............. Esophageal Dilation T................. 6.3480 $344.63 $107.24 $68.93 without Endoscopy. 0141............. Upper GI Procedures.. T................. 7.8542 $426.40 $143.38 $85.28 0142............. Small Intestine

T................. 9.0138 $489.35 $152.78 $97.87 Endoscopy. 0143............. Lower GI Endoscopy... T................. 8.3227 $451.83 $186.06 $90.37 0146............. Level I Sigmoidoscopy T................. 3.9986 $217.08 $64.40 $43.42 0147............. Level II

T................. 7.5876 $411.92 ........... $82.38 Sigmoidoscopy. 0148............. Level I Anal/Rectal T................. 4.1171 $223.51 $63.38 $44.70 Procedure. 0149............. Level III Anal/Rectal T................. 16.8557 $915.08 $293.06 $183.02 Procedure.

[[Page 48022]]

0150............. Level IV Anal/Rectal T................. 22.2565 $1,208.28 $437.12 $241.66 Procedure. 0151............. Endoscopic Retrograde T................. 18.8763 $1,024.78 $245.46 $204.96 Cholangio- Pancreatography (ERCP). 0152............. Percutaneous

T................. 8.2940 $450.27 $113.02 $90.05 Abdominal and Biliary Procedures. 0153............. Peritoneal and

T................. 21.2745 $1,154.97 $410.87 $230.99 Abdominal Procedures. 0154............. Hernia/Hydrocele T................. 26.8861 $1,459.62 $464.85 $291.92 Procedures. 0155............. Level II Anal/Rectal T................. 9.9148 $538.26 $188.89 $107.65 Procedure. 0156............. Level II Urinary and T................. 3.1438 $170.67 $46.55 $34.13 Anal Procedures. 0157............. Colorectal Cancer S................. 2.4771 $134.48 ........... $26.90 Screening: Barium Enema. 0158............. Colorectal Cancer T................. 7.4187 $402.75 $100.69 $80.55 Screening: Colonoscopy. 0159............. Colorectal Cancer S................. 2.7168 $147.49 $36.87 $29.50 Screening: Flexible Sigmoidoscopy. 0160............. Level I

T................. 6.8152 $369.99 $105.06 $74.00 Cystourethroscopy and other Genitourinary Procedures. 0161............. Level II

T................. 16.5822 $900.23 $249.36 $180.05 Cystourethroscopy and other Genitourinary Procedures. 0162............. Level III

T................. 21.8578 $1,186.64 ........... $237.33 Cystourethroscopy and other Genitourinary Procedures. 0163............. Level IV

T................. 33.6435 $1,826.47 ........... $365.29 Cystourethroscopy and other Genitourinary Procedures. 0164............. Level I Urinary and T................. 1.2115 $65.77 $17.59 $13.15 Anal Procedures. 0165............. Level III Urinary and T................. 14.0780 $764.28 ........... $152.86 Anal Procedures. 0166............. Level I Urethral T................. 16.8401 $914.23 $218.73 $182.85 Procedures. 0167............. Level III Urethral T................. 30.1066 $1,634.46 $555.84 $326.89 Procedures. 0168............. Level II Urethral T................. 30.3485 $1,647.59 $405.60 $329.52 Procedures. 0169............. Lithotripsy.......... T................. 44.5329 $2,417.65 $1,115.69 $483.53 0170............. Dialysis............. S................. 5.9427 $322.62 ........... $64.52 0180............. Circumcision......... T................. 18.4967 $1,004.17 $304.87 $200.83 0181............. Penile Procedures.... T................. 29.0094 $1,574.89 $621.82 $314.98 0183............. Testes/Epididymis T................. 21.7612 $1,181.39 ........... $236.28 Procedures. 0184............. Prostate Biopsy...... T................. 3.8073 $206.69 $96.27 $41.34 0187............. Miscellaneous

X................. 4.4274 $240.36 $90.71 $48.07 Placement/ Repositioning. 0188............. Level II Female

T................. 1.1079 $60.15 ........... $12.03 Reproductive Proc. 0189............. Level III Female T................. 1.3207 $71.70 $16.70 $14.34 Reproductive Proc. 0190............. Level I Hysteroscopy. T................. 19.8088 $1,075.40 $424.28 $215.08 0191............. Level I Female

T................. 0.1679

$9.12

$2.65

$1.82 Reproductive Proc. 0192............. Level IV Female

T................. 2.6966 $146.40 $39.11 $29.28 Reproductive Proc. 0193............. Level V Female

T................. 15.7365 $854.32 $171.13 $170.86 Reproductive Proc. 0194............. Level VI Female

T................. 18.8194 $1,021.69 $397.84 $204.34 Reproductive Proc. 0195............. Level VII Female T................. 25.3207 $1,374.64 $483.80 $274.93 Reproductive Proc. 0196............. Dilation and

T................. 16.1823 $878.52 $338.23 $175.70 Curettage. 0197............. Infertility

T................. 5.1958 $282.07 ........... $56.41 Procedures. 0198............. Pregnancy and

T................. 1.3718 $74.47 $32.19 $14.89 Neonatal Care Procedures. 0199............. Obstetrical Care T................. 16.8630 $915.48 ........... $183.10 Service. 0200............. Therapeutic Abortion. T................. 18.3633 $996.93 $307.83 $199.39 0201............. Spontaneous Abortion. T................. 17.2803 $938.13 $329.65 $187.63 0202............. Level VIII Female T................. 38.8053 $2,106.70 $1,032.28 $421.34 Reproductive Proc. 0203............. Level IV Nerve

T................. 11.8511 $643.38 $276.76 $128.68 Injections. 0204............. Level I Nerve

T................. 2.2209 $120.57 $40.13 $24.11 Injections. 0206............. Level II Nerve

T................. 5.2584 $285.47 $75.55 $57.09 Injections. 0207............. Level III Nerve

T................. 6.5998 $358.30 $123.69 $71.66 Injections. 0208............. Laminotomies and T................. 40.6521 $2,206.96 ........... $441.39 Laminectomies. 0209............. Extended EEG Studies S................. 11.5352 $626.23 $280.58 $125.25 and Sleep Studies, Level II. 0212............. Nervous System

T................. 2.9989 $162.81 $74.92 $32.56 Injections. 0213............. Extended EEG Studies S................. 3.2422 $176.02 $70.41 $35.20 and Sleep Studies, Level I. 0214............. Electroencephalogram. S................. 2.2459 $121.93 $58.12 $24.39 0215............. Level I Nerve and S................. 0.6390 $34.69 $15.76

$6.94 Muscle Tests. 0216............. Level III Nerve and S................. 2.8332 $153.81 $67.98 $30.76 Muscle Tests. 0218............. Level II Nerve and S................. 1.1296 $61.32 ........... $12.26 Muscle Tests. 0220............. Level I Nerve

T................. 16.5293 $897.36 ........... $179.47 Procedures. 0221............. Level II Nerve

T................. 25.8194 $1,401.71 $463.62 $280.34 Procedures. 0222............. Implantation of

T................. 188.7735 $10,248.32 ........... $2,049.66 Neurological Device. 0223............. Implantation or

T................. 26.0352 $1,413.42 ........... $282.68 Revision of Pain Management Catheter. 0224............. Implantation of

T................. 34.0161 $1,846.70 $453.41 $369.34 Reservoir/Pump/Shunt. 0225............. Implantation of

S................. 56.0375 $3,042.22 ........... $608.44 Neurostimulator Electrodes. 0226............. Implantation of Drug T................. 159.6795 $8,668.84 ........... $1,733.77 Infusion Reservoir. 0227............. Implantation of Drug T................. 163.6124 $8,882.35 ........... $1,776.47 Infusion Device. 0228............. Creation of Lumbar T................. 51.1329 $2,775.95 $621.80 $555.19 Subarachnoid Shunt. 0229............. Transcatherter

T................. 59.4977 $3,230.07 $771.23 $646.01 Placement of Intravascular Shunts. 0230............. Level I Eye Tests & S................. 0.7379 $40.06 $14.97

$8.01 Treatments. 0231............. Level III Eye Tests & S................. 2.0880 $113.36 $50.94 $22.67 Treatments.

[[Page 48023]]

0232............. Level I Anterior T................. 4.9739 $270.03 $103.17 $54.01 Segment Eye Procedures. 0233............. Level II Anterior T................. 14.5435 $789.55 $266.33 $157.91 Segment Eye Procedures. 0234............. Level III Anterior T................. 21.5482 $1,169.83 $511.31 $233.97 Segment Eye Procedures. 0235............. Level I Posterior T................. 4.9900 $270.90 $72.04 $54.18 Segment Eye Procedures. 0236............. Level II Posterior T................. 19.6866 $1,068.77 ........... $213.75 Segment Eye Procedures. 0237............. Level III Posterior T................. 34.0324 $1,847.58 $818.54 $369.52 Segment Eye Procedures. 0238............. Level I Repair and T................. 3.2016 $173.81 $58.96 $34.76 Plastic Eye Procedures. 0239............. Level II Repair and T................. 6.2432 $338.94 $110.62 $67.79 Plastic Eye Procedures. 0240............. Level III Repair and T................. 17.3397 $941.35 $315.31 $188.27 Plastic Eye Procedures. 0241............. Level IV Repair and T................. 21.9830 $1,193.44 $384.47 $238.69 Plastic Eye Procedures. 0242............. Level V Repair and T................. 29.2193 $1,586.29 $597.36 $317.26 Plastic Eye Procedures. 0243............. Strabismus/Muscle T................. 21.1035 $1,145.69 $431.39 $229.14 Procedures. 0244............. Corneal Transplant... T................. 37.4885 $2,035.21 $803.26 $407.04 0245............. Level I Cataract T................. 12.5751 $682.69 $226.11 $136.54 Procedures without IOL Insert. 0246............. Cataract Procedures T................. 22.8428 $1,240.11 $495.96 $248.02 with IOL Insert. 0247............. Laser Eye Procedures T................. 5.0192 $272.49 $104.31 $54.50 Except Retinal. 0248............. Laser Retinal

T................. 4.7544 $258.11 $95.08 $51.62 Procedures. 0249............. Level II Cataract T................. 28.3307 $1,538.05 $524.67 $307.61 Procedures without IOL Insert. 0250............. Nasal Cauterization/ T................. 1.5381 $83.50 $29.23 $16.70 Packing. 0251............. Level I ENT

T................. 1.8643 $101.21 ........... $20.24 Procedures. 0252............. Level II ENT

T................. 6.5416 $355.14 $113.41 $71.03 Procedures. 0253............. Level III ENT

T................. 15.1698 $823.55 $282.29 $164.71 Procedures. 0254............. Level IV ENT

T................. 21.4368 $1,163.78 $321.35 $232.76 Procedures. 0256............. Level V ENT

T................. 35.0866 $1,904.82 ........... $380.96 Procedures. 0258............. Tonsil and Adenoid T................. 21.0273 $1,141.55 $437.25 $228.31 Procedures. 0259............. Level VI ENT

T................. 389.1764 $21,128.00 $9,394.83 $4,225.60 Procedures. 0260............. Level I Plain Film X................. 0.7845 $42.59 $21.29

$8.52 Except Teeth. 0261............. Level II Plain Film X................. 1.3238 $71.87 ........... $14.37 Except Teeth Including Bone Density Measurement. 0262............. Plain Film of Teeth.. X................. 0.7851 $42.62

$9.82

$8.52 0263............. Level I Miscellaneous X................. 2.1875 $118.76 $43.58 $23.75 Radiology Procedures. 0264............. Level II

X................. 3.0022 $162.99 $79.41 $32.60 Miscellaneous Radiology Procedures. 0265............. Level I Diagnostic S................. 1.0245 $55.62 $27.81 $11.12 Ultrasound Except Vascular. 0266............. Level II Diagnostic S................. 1.6234 $88.13 $44.07 $17.63 Ultrasound Except Vascular. 0267............. Level III Diagnostic S................. 2.4805 $134.66 $65.52 $26.93 Ultrasound Except Vascular. 0268............. Ultrasound Guidance S................. 1.2640 $68.62 ........... $13.72 Procedures. 0269............. Level III

S................. 3.2517 $176.53 $87.24 $35.31 Echocardiogram Except Transesophageal. 0270............. Transesophageal

S................. 5.9057 $320.61 $146.79 $64.12 Echocardiogram. 0271............. Mammography.......... S................. 0.6548 $35.55 $16.80

$7.11 0272............. Level I Fluoroscopy.. X................. 1.4086 $76.47 $38.24 $15.29 0274............. Myelography.......... S................. 3.5837 $194.56 $92.92 $38.91 0275............. Arthrography......... S................. 3.2967 $178.97 $69.09 $35.79 0276............. Level I Digestive S................. 1.6025 $87.00 $41.72 $17.40 Radiology. 0277............. Level II Digestive S................. 2.4462 $132.80 $60.47 $26.56 Radiology. 0278............. Diagnostic Urography. S................. 2.7365 $148.56 $66.07 $29.71 0279............. Level II Angiography S................. 11.0678 $600.86 $174.57 $120.17 and Venography except Extremity. 0280............. Level III Angiography S................. 19.0237 $1,032.78 $353.85 $206.56 and Venography except Extremity. 0281............. Venography of

S................. 6.6888 $363.13 $115.16 $72.63 Extremity. 0282............. Miscellaneous

S................. 1.6813 $91.28 $44.51 $18.26 Computerized Axial Tomography. 0283............. Computerized Axial S................. 4.6121 $250.39 $125.19 $50.08 Tomography with Contrast Material. 0284............. Magnetic Resonance S................. 7.0207 $381.15 $190.57 $76.23 Imaging and Magnetic Resonance Angiography with Contras. 0285............. Myocardial Positron S................. 19.5044 $1,058.87 $409.56 $211.77 Emission Tomography (PET). 0287............. Complex Venography... S................. 6.2829 $341.09 $107.20 $68.22 0288............. Bone Density:Axial S................. 1.2854 $69.78 ........... $13.96 Skeleton. 0289............. Needle Localization X................. 3.6386 $197.54 $44.80 $39.51 for Breast Biopsy. 0296............. Level I Therapeutic S................. 3.1381 $170.36 $69.20 $34.07 Radiologic Procedures. 0297............. Level II Therapeutic S................. 8.1532 $442.63 $172.51 $88.53 Radiologic Procedures. 0299............. Miscellaneous

S................. 5.7427 $311.77 $62.36 $62.35 Radiation Treatment. 0300............. Level I Radiation S................. 1.5112 $82.04 ........... $16.41 Therapy. 0301............. Level II Radiation S................. 2.1337 $115.84 $23.17 $23.17 Therapy. 0302............. Level III Radiation S................. 6.1992 $336.55 $127.49 $67.31 Therapy. 0303............. Treatment Device X................. 2.8636 $155.46 $66.95 $31.09 Construction. 0304............. Level I Therapeutic X................. 1.6599 $90.11 $41.52 $18.02 Radiation Treatment Preparation. 0305............. Level II Therapeutic X................. 3.6649 $198.96 $91.38 $39.79 Radiation Treatment Preparation. 0310............. Level III Therapeutic X................. 13.7085 $744.22 $325.27 $148.84 Radiation Treatment Preparation. 0312............. Radioelement

S................. 3.6892 $200.28 $40.06 $40.06 Applications. 0313............. Brachytherapy........ S................. 13.1258 $712.59 ........... $142.52 0314............. Hyperthermic

S................. 5.0930 $276.49 $101.77 $55.30 Therapies.

[[Page 48024]]

0320............. Electroconvulsive S................. 5.4480 $295.77 $80.06 $59.15 Therapy. 0321............. Biofeedback and Other S................. 1.2462 $67.65 $21.78 $13.53 Training. 0322............. Brief Individual S................. 1.3091 $71.07 ........... $14.21 Psychotherapy. 0323............. Extended Individual S................. 1.7955 $97.48 $21.26 $19.50 Psychotherapy. 0324............. Family Psychotherapy. S................. 2.8219 $153.20 ........... $30.64 0325............. Group Psychotherapy.. S................. 1.5820 $85.89 $18.27 $17.18 0330............. Dental Procedures.... S................. 0.5609 $30.45

$6.09

$6.09 0332............. Computerized Axial S................. 3.3916 $184.13 $91.27 $36.83 Tomography and Computerized Angiography without Contras. 0333............. Computerized Axial S................. 5.4299 $294.78 $146.98 $58.96 Tomography and Computerized Angio. w/o Contrast Material. 0335............. Magnetic Resonance S................. 6.4453 $349.91 $151.46 $69.98 Imaging, Miscellaneous. 0336............. Magnetic Resonance S................. 6.4817 $351.89 $175.94 $70.38 Imaging and Magnetic Resonance Angiography without Cont. 0337............. MRI and Magnetic S................. 9.3215 $506.05 $240.77 $101.21 Resonance Angiography without Contrast Material followed. 0339............. Observation.......... S................. 7.2016 $390.97 ........... $78.19 0340............. Minor Ancillary

X................. 0.6232 $33.83 ...........

$6.77 Procedures. 0341............. Skin Tests........... X................. 0.1468

$7.97

$3.08

$1.59 0342............. Level I Pathology.... X................. 0.2169 $11.78

$5.88

$2.36 0343............. Level II Pathology... X................. 0.4662 $25.31 $12.55

$5.06 0344............. Level III Pathology.. X................. 0.6278 $34.08 $17.04

$6.82 0345............. Level I Transfusion X................. 0.2589 $14.06

$3.10

$2.81 Laboratory Procedures. 0346............. Level II Transfusion X................. 0.3877 $21.05

$5.31

$4.21 Laboratory Procedures. 0347............. Level III Transfusion X................. 0.9646 $52.37 $13.19 $10.47 Laboratory Procedures. 0348............. Fertility Laboratory X................. 1.2207 $66.27 ........... $13.25 Procedures. 0352............. Level I Injections... X................. 0.1076

$5.84 ...........

$1.17 0353............. Level II Allergy X................. 0.4106 $22.29 ...........

$4.46 Injections. 0355............. Level III

K................. 0.2667 $14.48 ...........

$2.90 Immunizations. 0356............. Level IV

K................. 0.4353 $23.63 ...........

$4.73 Immunizations. 0359............. Level II Injections.. X................. 0.8794 $47.74 ...........

$9.55 0360............. Level I Alimentary X................. 1.7088 $92.77 $42.45 $18.55 Tests. 0361............. Level II Alimentary X................. 3.5574 $193.13 $83.23 $38.63 Tests. 0362............. Level III

X................. 2.5384 $137.81 ........... $27.56 Otorhinolaryngologic Function Tests. 0363............. Level I

X................. 0.8536 $46.34 $17.15

$9.27 Otorhinolaryngologic Function Tests. 0364............. Level I Audiometry... X................. 0.4415 $23.97

$9.06

$4.79 0365............. Level II Audiometry.. X................. 1.1915 $64.69 $18.95 $12.94 0367............. Level I Pulmonary X................. 0.5828 $31.64 $15.16

$6.33 Test. 0368............. Level II Pulmonary X................. 0.9321 $50.60 $25.30 $10.12 Tests. 0369............. Level III Pulmonary X................. 2.5282 $137.25 $44.18 $27.45 Tests. 0370............. Allergy Tests........ X................. 0.8858 $48.09 $11.58

$9.62 0371............. Level I Allergy

X................. 0.4084 $22.17

$4.44

$4.43 Injections. 0372............. Therapeutic

X................. 0.5529 $30.02 $10.09

$6.00 Phlebotomy. 0373............. Neuropsychological X................. 2.1165 $114.90 $22.98 $22.98 Testing. 0374............. Monitoring

X................. 1.1062 $60.05 ........... $12.01 Psychiatric Drugs. 0375............. Ancillary Outpatient T................. ........... $1,150.00 ........... $230.00 Services when Patient Expires. 0376............. Pkgd cancer chemo, S................. 2.1479 $116.61 ........... $23.32 other. 0377............. Sep cancer chemo, S................. 0.6673 $36.23 ...........

$7.25 other. 0378............. Infusion of pkgd S................. 4.3955 $238.63 ........... $47.73 cancer. 0379............. Infusion, separate S................. 2.4298 $131.91 ........... $26.38 cancer. 0380............. Pkgd cancer chemo, S................. 5.1857 $281.53 ........... $56.31 both. 0381............. Sep cancer chemo, S................. 2.1596 $117.24 ........... $23.45 both. 0382............. Infusion, pkgd

S................. 4.6839 $254.28 ........... $50.86 noncancer. 0383............. Infusion, separate S................. 1.8419 $99.99 ........... $20.00 noncancer. 0384............. GI Procedures with T................. 36.0040 $1,954.62 $424.53 $390.92 Stents. 0385............. Level I Prosthetic T................. 66.4829 $3,609.29 ........... $721.86 Urological Procedures. 0386............. Level II Prosthetic T................. 118.8122 $6,450.20 ........... $1,290.04 Urological Procedures. 0387............. Level II Hysteroscopy T................. 28.5174 $1,548.18 $660.84 $309.64 0388............. Discography.......... S................. 11.7450 $637.62 $304.54 $127.52 0389............. Non-imaging Nuclear S................. 1.6475 $89.44 $44.72 $17.89 Medicine. 0390............. Level I Thyroid

S................. 2.8434 $154.37 $77.18 $30.87 Imaging. 0391............. Level II Thyroid S................. 3.7174 $201.81 $100.91 $40.36 Imaging. 0392............. Adrenal Imaging...... S................. 6.7081 $364.18 $182.09 $72.84 0393............. Red Cell/Plasma

S................. 4.0720 $221.06 $110.53 $44.21 Studies. 0394............. Hepatobiliary Imaging S................. 4.4370 $240.88 $120.44 $48.18 0395............. GI Tract and B12 S................. 3.9372 $213.75 $106.87 $42.75 Studies. 0396............. Bone Imaging......... S................. 4.2445 $230.43 $115.21 $46.09 0397............. Vascular Imaging..... S................. 2.4737 $134.29 $67.15 $26.86 0398............. Cardiac Imaging...... S................. 6.6521 $361.14 $180.57 $72.23

[[Page 48025]]

0399............. Cardiac Add-on

S................. 1.6033 $87.04 $43.52 $17.41 Imaging. 0400............. Hematopoietic Imaging S................. 3.8691 $210.05 $105.02 $42.01 0401............. Pulmonary Imaging.... S................. 4.9130 $266.72 $133.36 $53.34 0402............. Brain Imaging........ S................. 5.4818 $297.60 $148.80 $59.52 0403............. CSF Imaging.......... S................. 3.9265 $213.17 $106.58 $42.63 0404............. Renal Imaging........ S................. 5.1538 $279.79 $139.90 $55.96 0405............. Non-renal GU Studies. S................. 0.7739 $42.01 $21.01

$8.40 0406............. Tumor/Infection

S................. 4.7542 $258.10 ........... $51.62 Imaging. 0407............. Thyroid Radionucliide S................. 4.2797 $232.34 $116.17 $46.47 treatment. 0408............. Non-thyroid

S................. 4.0000 $217.16 ........... $43.43 Radionucliide treatment. 0409............. Red Blood Cell Tests. X................. 0.1385

$7.52

$2.31

$1.50 0410............. Mammogram Add On..... S................. 0.1473

$8.00 ...........

$1.60 0411............. Respiratory

S................. 0.4207 $22.84 ...........

$4.57 Procedures. 0412............. IMRT Treatment

S................. 5.2832 $286.82 ........... $57.36 Delivery. 0413............. IMRT Treatment Plan.. S................. 6.0369 $327.74 ........... $65.55 0414............. Reconstruction CT S................. 4.8012 $260.65 ........... $52.13 Angiography of Aorta. 0415............. Level II Endoscopy T................. 20.9920 $1,139.63 $463.30 $227.93 Lower Airway. 0600............. Low Level Clinic V................. 0.9376 $50.90 ........... $10.18 Visits. 0601............. Mid Level Clinic V................. 1.0031 $54.46 ........... $10.89 Visits. 0602............. High Level Clinic V................. 1.5603 $84.71 ........... $16.94 Visits. 0610............. Low Level Emergency V................. 1.4146 $76.80 $19.57 $15.36 Visits. 0611............. Mid Level Emergency V................. 2.4881 $135.08 $36.47 $27.02 Visits. 0612............. High Level Emergency V................. 4.3235 $234.72 $54.14 $46.94 Visits. 0620............. Critical Care........ S................. 9.2657 $503.03 $145.78 $100.61 0648............. Breast Reconstruction T................. 55.5345 $3,014.91 ........... $602.98 with Prosthesis. 0649............. Prostate

T................. 119.0281 $6,461.92 ........... $1,292.38 Brachytherapy Palladium Seeds. 0651............. Complex Interstitial S................. 10.0459 $545.38 $109.08 $109.08 Radiation Source Application. 0652............. Insertion of

T................. 28.0692 $1,523.85 ........... $304.77 Intraperitoneal Catheters. 0653............. Vascular

T................. 32.4880 $1,763.74 ........... $352.75 Reconstruction/ Fistula Repair with Device. 0654............. Insertion/Replacement T................. 103.8544 $5,638.15 ........... $1,127.63 of a permanent dual chamber pacemaker. 0655............. Insertion/Replacement/ T................. 142.2244 $7,721.22 ........... $1,544.24 Conversion of a permanent dual chamber pacemaker. 0656............. Transcatheter

T................. 101.3662 $5,503.07 ........... $1,100.61 Placement of Intracoronary Drug- Eluting Stents. 0657............. Placement of Tissue S................. 1.5630 $84.85 ........... $16.97 Clips. 0658............. Percutaneous Breast T................. 5.6035 $304.21 ........... $60.84 Biopsies. 0659............. Hyperbaric Oxygen.... S................. 3.2220 $174.92 ........... $34.98 0660............. Level II

X................. 1.7330 $94.08 $30.66 $18.82 Otorhinolaryngologic Function Tests. 0661............. Level IV Pathology... X................. 3.3215 $180.32 $90.16 $36.06 0662............. CT Angiography....... S................. 5.8751 $318.95 $156.47 $63.79 0664............. Proton Beam Radiation S................. 9.6828 $525.67 ........... $105.13 Therapy. 0665............. Bone

S................. 0.7225 $39.22 ...........

$7.84 Density:Appendicular Skeleton. 0668............. Level I Angiography S................. 10.4896 $569.47 $237.76 $113.89 and Venography except Extremity. 0669............. Digital Mammography.. S................. 0.9111 $49.46 ...........

$9.89 0670............. Intravenous and

S................. 26.5472 $1,441.22 $521.95 $288.24 Intracardiac Ultrasound. 0671............. Level II

S................. 1.6392 $88.99 $44.50 $17.80 Echocardiogram Except Transesophageal. 0672............. Level IV Posterior T................. 39.1363 $2,124.67 $988.43 $424.93 Segment Procedures. 0673............. Level IV Anterior T................. 26.7626 $1,452.91 $649.56 $290.58 Segment Eye Procedures. 0674............. Prostate Cryoablation T................. 101.1198 $5,489.69 ........... $1,097.94 0675............. Prostatic

T................. 49.3613 $2,679.78 ........... $535.96 Thermotherapy. 0676............. Level II

T................. 3.7505 $203.61 $55.06 $40.72 Transcatheter Thrombolysis. 0677............. Level I Transcatheter T................. 3.0769 $167.04 ........... $33.41 Thrombolysis. 0678............. External

T................. 2.0622 $111.95 ........... $22.39 Counterpulsation. 0679............. Level II

S................. 5.4862 $297.84 $95.30 $59.57 Resuscitation and Cardioversion. 0680............. Insertion of Patient S................. 61.4222 $3,334.55 ........... $666.91 Activated Event Recorders. 0681............. Knee Arthroplasty.... T................. 96.7483 $5,252.37 $2,090.21 $1,050.47 0682............. Level V Debridement & T................. 7.6815 $417.02 $174.57 $83.40 Destruction. 0683............. Level II

S................. 1.7915 $97.26 $35.01 $19.45 Photochemotherapy. 0684............. Prostate

T................. 104.7194 $5,685.11 ........... $1,137.02 Brachytherapy Iodine Seeds. 0685............. Level III Needle T................. 4.8912 $265.54 $116.83 $53.11 Biopsy/Aspiration Except Bone Marrow. 0686............. Level III Skin Repair T................. 17.0868 $927.63 $341.70 $185.53 0687............. Revision/Removal of T................. 19.9913 $1,085.31 $499.24 $217.06 Neurostimulator Electrodes. 0688............. Revision/Removal of T................. 42.5880 $2,312.06 $1,132.91 $462.41 Neurostimulator Pulse Generator Receiver. 0689............. Electronic Analysis S................. 0.5427 $29.46 ...........

$5.89 of Cardioverter- defibrillators. 0690............. Electronic Analysis S................. 0.3986 $21.64 $10.35

$4.33 of Pacemakers and other Cardiac Devices. 0691............. Electronic Analysis S................. 2.9894 $162.29 $81.15 $32.46 of Programmable Shunts/Pumps. 0692............. Electronic Analysis S................. 0.9625 $52.25 $26.13 $10.45 of Neurostimulator Pulse Generators. 0693............. Level II Breast

T................. 38.6469 $2,098.10 $798.17 $419.62 Reconstruction.

[[Page 48026]]

0694............. Mohs Surgery......... T................. 3.3272 $180.63 $72.25 $36.13 0695............. Level VII Debridement T................. 19.1377 $1,038.97 $266.59 $207.79 & Destruction. 0697............. Level I

S................. 1.4621 $79.38 $39.69 $15.88 Echocardiogram Except Transesophageal. 0698............. Level II Eye Tests & S................. 0.9355 $50.79 $18.72 $10.16 Treatments. 0699............. Level IV Eye Tests & T................. 2.2211 $120.58 $54.26 $24.12 Treatments. 0700............. Antepartum

T................. 2.4359 $132.24 $37.03 $26.45 Manipulation. 0701............. SR 89 chloride, per K................. 7.4586 $404.92 ........... $80.98 mCi. 0702............. SM 153 lexidronam, 50 K................. 16.1415 $876.31 ........... $175.26 mCi. 0704............. IN 111 Satumomab K................. 2.9212 $158.59 ........... $31.72 pendetide per dose. 0726............. Dexrazoxane hcl

K................. 1.9860 $107.82 ........... $21.56 injection, 250 mg. 0728............. Filgrastim 300 mcg K................. 2.2544 $122.39 ........... $24.48 injection. 0730............. Pamidronate disodium K................. 1.5359 $83.38 ........... $16.68 , 30 mg. 0732............. Mesna injection 200 K................. 0.4908 $26.65 ...........

$5.33 mg. 0733............. Non esrd epoetin K................. 0.1782

$9.67 ...........

$1.93 alpha inj, 1000 u. 0734............. Injection,

K................. 0.0463

$2.51 ...........

$.50 darbepoetin alfa (for non-ESRD use), pre 1 mcg. 0800............. Leuprolide acetate, K................. 3.3020 $179.26 ........... $35.85 3.75 mg. 0802............. Etoposide oral 50 mg. K................. 0.4830 $26.22 ...........

$5.24 0807............. Aldesleukin/single K................. 7.0936 $385.10 ........... $77.02 use vial. 0810............. Goserelin acetate K................. 4.9549 $269.00 ........... $53.80 implant 3.6 mg. 0811............. Carboplatin injection K................. 1.5475 $84.01 ........... $16.80 50 mg. 0812............. Carmustine, 100 mg... K................. 0.9972 $54.14 ........... $10.83 0813............. Cisplatin 10 mg

K................. 0.3594 $19.51 ...........

$3.90 injection. 0820............. Daunorubicin 10 mg... K.................

0.60 $32.86 ...........

$6.57 0821............. Daunorubicin citrate K................. 2.9697 $161.22 ........... $32.24 liposom 10 mg. 0822............. Diethylstilbestrol K................. 1.3274 $72.06 ........... $14.41 injection 250 mg. 0823............. Docetaxel, 20 mg..... K................. 4.0041 $217.38 ........... $43.48 0827............. Floxuridine injection K................. 2.1836 $118.55 ........... $23.71 500 mg. 0828............. Gemcitabine HCL 200 K................. 1.4523 $78.84 ........... $15.77 mg. 0830............. Irinotecan injection K................. 1.8626 $101.12 ........... $20.22 20 mg. 0831............. Ifosfomide injection K................. 1.1616 $63.06 ........... $12.61 1 gm. 0832............. Idarubicin hcl

K................. 3.2438 $176.10 ........... $35.22 injection 5 mg. 0836............. Interferon alfa-2b K................. 0.2000 $10.86 ...........

$2.17 inj recombinant, 1 million. 0838............. Interferon gamma 1-b K................. 2.4742 $134.32 ........... $26.86 inj, 3 million u. 0840............. Melphalan hydrochl 50 K................. 4.4072 $239.26 ........... $47.85 mg. 0842............. Fludarabine phosphate K................. 3.6854 $200.08 ........... $40.02 inj 50 mg. 0843............. Pegaspargase, singl K................. 5.7621 $312.82 ........... $62.56 dose vial. 0844............. Pentostatin

K................. 17.4201 $945.72 ........... $189.14 injection, 10 mg. 0849............. Rituximab, 100 mg.... K................. 5.5636 $302.04 ........... $60.41 0850............. Streptozocin

K................. 1.3942 $75.69 ........... $15.14 injection, 1 gm. 0852............. Topotecan, 4 mg...... K................. 7.9075 $429.29 ........... $85.86 0855............. Vinorelbine tartrate, K................. 1.1683 $63.43 ........... $12.69 10 mg. 0856............. Porfimer sodium, 75 K................. 25.3788 $1,377.79 ........... $275.56 mg. 0857............. Bleomycin sulfate K................. 2.2352 $121.35 ........... $24.27 injection 15 u. 0858............. Cladribine, 1mg...... K................. 0.7031 $38.17 ...........

$7.63 0861............. Leuprolide acetate K................. 0.8223 $44.64 ...........

$8.93 injection 1 mg. 0862............. Mitomycin 5 mg inj... K................. 0.9557 $51.88 ........... $10.38 0863............. Paclitaxel injection, K................. 1.2674 $68.81 ........... $13.76 30 mg. 0864............. Mitoxantrone hcl, 5 K................. 3.1513 $171.08 ........... $34.22 mg. 0865............. Interferon alfa-n3 K................. 1.5823 $85.90 ........... $17.18 inj, human leukocyte derived, 2. 0884............. Rho d immune globulin K................. 0.2312 $12.55 ...........

$2.51 inj, 1 dose pkg. 0888............. Cyclosporine oral 100 K................. 0.0482

$2.62 ...........

$.52 mg. 0890............. Lymphocyte immune K................. 2.1958 $119.21 ........... $23.84 globulin 250 mg. 0891............. Tacrolimus oral per 1 K................. 0.0236

$1.28 ...........

$.26 mg. 0900............. Alglucerase

K................. 0.5473 $29.71 ...........

$5.94 injection, per 10 u. 0901............. Alpha 1 proteinase K................. 0.0214

$1.16 ...........

$.23 inhibitor, 10 mg. 0902............. Botulinum toxin a, K................. 0.0460

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

$.50 per unit. 0903............. Cytomegalovirus imm K................. 5.0754 $275.54 ........... $55.11 IV/vial. 0905............. Immune globulin, 1g.. K................. 0.8103 $43.99 ...........

$8.80 0906............. RSV-ivig, 50 mg...... K................. 6.0142 $326.50 ........... $65.30 0909............. Interferon beta-1a, K................. 2.8010 $152.06 ........... $30.41 33 mcg. 0910............. Interferon beta-1b / K................. 1.9843 $107.73 ........... $21.55 0.25 mg. 0911............. Streptokinase per K................. 1.6055 $87.16 ........... $17.43 250,000 iu. 0916............. Imiglucerase

K................. 0.0531

$2.88 ...........

$.58 injection/unit. 0917............. Inj, Adenosine, 90 mg K................. 2.3474 $127.44 ........... $25.49 0925............. Factor viii per iu... K................. 0.0085

$.46 ...........

$.09 0926............. Factor VIII (porcine) K................. 0.0253

$1.37 ...........

$.27 per iu. 0927............. Factor viii

K................. 0.0168

$.91 ...........

$.18 recombinant per iu. 0928............. Factor ix complex per K................. 0.0085

$.46 ...........

$.09 iu. 0929............. Anti-inhibitor per iu K................. 0.0168

$.91 ...........

$.18

[[Page 48027]]

0930............. Antithrombin iii K................. 0.0117

$.64 ...........

$.13 injection per iu. 0931............. Factor IX non-

K................. 0.0104

$.56 ...........

$.11 recombinant, per iu. 0932............. Factor IX

K................. 0.0168

$.91 ...........

$.18 recombinant, per iu. 0949............. Plasma, Pooled

K................. 2.0608 $111.88 ........... $22.38 Multiple Donor, Solvent/Detergent T. 0950............. Blood (Whole) For K................. 1.4575 $79.13 ........... $15.83 Transfusion. 0952............. Cryoprecipitate...... K................. 0.4860 $26.38 ...........

$5.28 0954............. RBC leukocytes

K................. 1.9770 $107.33 ........... $21.47 reduced. 0955............. Plasma, Fresh Frozen. K................. 1.5750 $85.51 ........... $17.10 0956............. Plasma Protein

K................. 1.5414 $83.68 ........... $16.74 Fraction. 0957............. Platelet Concentrate. K................. 0.6870 $37.30 ...........

$7.46 0958............. Platelet Rich Plasma. K................. 1.1296 $61.32 ........... $12.26 0959............. Red Blood Cells...... K................. 1.4326 $77.77 ........... $15.55 0960............. Washed Red Blood K................. 2.6638 $144.62 ........... $28.92 Cells. 0961............. Infusion, Albumin K................. 0.7319 $39.73 ...........

$7.95 (Human) 5%, 50 ml. 0963............. Albumin (human), 5%, K................. 3.4713 $188.45 ........... $37.69 250 ml. 0964............. Albumin (human), 25%, K................. 0.7911 $42.95 ...........

$8.59 20 ml. 0965............. Albumin (human), 25%, K................. 1.9432 $105.49 ........... $21.10 50ml. 0966............. Plasmaprotein

K................. 7.7071 $418.41 ........... $83.68 fract,5%,250ml. 1009............. Cryoprecip reduced K................. 0.9447 $51.29 ........... $10.26 plasma. 1010............. Blood, L/R, CMV-neg.. K................. 2.1361 $115.97 ........... $23.19 1011............. Platelets, HLA-m, L/ K................. 8.2851 $449.79 ........... $89.96 R, unit. 1013............. Platelet concentrate, K................. 0.9101 $49.41 ...........

$9.88 L/R, unit. 1016............. Blood, L/R, froz/ K................. 5.0012 $271.51 ........... $54.30 deglycerol/washed. 1017............. Platelets, aph/pher, K................. 6.5175 $353.83 ........... $70.77 L/R, CMV-neg, unit. 1018............. Blood, L/R,

K................. 2.1950 $119.16 ........... $23.83 irradiated. 1019............. Platelets, aph/pher, K................. 6.7353 $365.65 ........... $73.13 L/R, irradiated, unit. 1020............. Pit, pher,L/

K................. 9.6266 $522.62 ........... $104.52 R,CMV,irrad. 1021............. RBC, frz/deg/wsh, L/ K................. 6.5287 $354.44 ........... $70.89 R, irrad. 1022............. RBC, L/R, CMV neg, K................. 3.9139 $212.48 ........... $42.50 irrad. 1045............. Iobenguane sulfate I- K................. 2.9293 $159.03 ........... $31.81 131per 0.5 mCi. 1064............. I-131 sodium iodide K................. 0.1007

$5.47 ...........

$1.09 capsule. 1065............. I-131 sodium iodide K................. 0.0002

$.01 ...........

$.00 solution. 1084............. Denileukin diftitox, K................. 15.0913 $819.29 ........... $163.86 300 MCG. 1086............. Temozolomide,oral 5 K................. 0.0643

$3.49 ...........

$.70 mg. 1091............. IN 111 Oxyquinoline, K................. 4.0535 $220.06 ........... $44.01 per .5 mCi. 1092............. IN 111 Pentetate, per K................. 4.0824 $221.63 ........... $44.33 0.5 mCi. 1095............. Technetium TC 99M K................. 3.7042 $201.10 ........... $40.22 Depreotide. 1096............. TC 99M Exametazime, K................. 3.8103 $206.86 ........... $41.37 per dose. 1122............. TC 99M arcitumomab, K................. 9.6556 $524.19 ........... $104.84 per vial. 1167............. Epirubicin hcl, 2 mg. K................. 0.3597 $19.53 ...........

$3.91 1178............. Busulfan IV, 6 mg.... K................. 6.0245 $327.06 ........... $65.41 1203............. Verteporfin for

K................. 16.1946 $879.19 ........... $175.84 injection. 1207............. Octreotide injection, K................. 1.1849 $64.33 ........... $12.87 depot. 1305............. Apligraf............. K................. 11.2075 $608.44 ........... $121.69 1409............. Factor viia

K................. 17.9693 $975.54 ........... $195.11 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). 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 - S................. ........... $1,250.00 ........... $250.00 Level 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 XX ($1500- $1600). 1518............. New Technology - S................. ........... $1,650.00 ........... $330.00 Level XX ($1600- $1700). 1519............. New Technology - S................. ........... $1,750.00 ........... $350.00 Level XX ($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 XX ($1900- $2000). 1522............. New Technology - S................. ........... $2,250.00 ........... $450.00 Level XX ($2000- $2500). 1523............. New Technology - S................. ........... $2,750.00 ........... $550.00 Level XX ($2500- $3000). 1524............. New Technology - S................. ........... $3,250.00 ........... $650.00 Level XX ($3000- $3500).

[[Page 48028]]

1525............. New Technology - S................. ........... $3,750.00 ........... $750.00 Level XX ($3500- $4000). 1526............. New Technology - S................. ........... $4,250.00 ........... $850.00 Level XX ($4000- $4500). 1527............. New Technology - S................. ........... $4,750.00 ........... $950.00 Level XX ($4500- $5000). 1528............. New Technology - S................. ........... $5,250.00 ........... $1,050.00 Level XX ($5000- $5500). 1529............. New Technology - S................. ........... $5,750.00 ........... $1,150.00 Level XX ($5500- $6000). 1530............. New Technology - S................. ........... $6,250.00 ........... $1,250.00 Level XX ($6000- $6500). 1531............. New Technology - S................. ........... $6,750.00 ........... $1,350.00 Level XX ($6500- $7000). 1532............. New Technology - S................. ........... $7,250.00 ........... $1,450.00 Level XX ($7000- $7500). 1533............. New Technology - S................. ........... $7,750.00 ........... $1,550.00 Level XX ($7500- $8000). 1534............. New Technology - S................. ........... $8,250.00 ........... $1,650.00 Level XX ($8000- $8500). 1535............. New Technology - S................. ........... $8,750.00 ........... $1,750.00 Level XX ($8500- $9000). 1536............. New Technology - S................. ........... $9,250.00 ........... $1,850.00 Level XX ($9000- $9500). 1537............. New Technology - S................. ........... $9,750.00 ........... $1,950.00 Level XX ($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 - T................. ........... $1,250.00 ........... $250.00 Level 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 XX ($1500- $1600). 1555............. New Technology - T................. ........... $1,650.00 ........... $330.00 Level XX ($1600- $1700). 1556............. New Technology - T................. ........... $1,750.00 ........... $350.00 Level XX ($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 XX ($1900- $2000). 1559............. New Technology - T................. ........... $2,250.00 ........... $450.00 Level XX ($2000- $2500). 1560............. New Technology - T................. ........... $2,750.00 ........... $550.00 Level XX ($2500- $3000). 1561............. New Technology - T................. ........... $3,250.00 ........... $650.00 Level XX ($3000- $3500). 1562............. New Technology - T................. ........... $3,750.00 ........... $750.00 Level XX ($3500- $4000). 1563............. New Technology - T................. ........... $4,250.00 ........... $850.00 Level XX ($4000- $4500). 1564............. New Technology - T................. ........... $4,750.00 ........... $950.00 Level XX ($4500- $5000). 1565............. New Technology - T................. ........... $5,250.00 ........... $1,050.00 Level XX ($5000- $5500). 1566............. New Technology - T................. ........... $5,750.00 ........... $1,150.00 Level XX ($5500- $6000). 1567............. New Technology - T................. ........... $6,250.00 ........... $1,250.00 Level XX ($6000- $6500). 1568............. New Technology - T................. ........... $6,750.00 ........... $1,350.00 Level XX ($6500- $7000). 1569............. New Technology - T................. ........... $7,250.00 ........... $1,450.00 Level XX ($7000- $7500). 1570............. New Technology - T................. ........... $7,750.00 ........... $1,550.00 Level XX ($7500- $8000). 1571............. New Technology - T................. ........... $8,250.00 ........... $1,650.00 Level XX ($8000- $8500). 1572............. New Technology - T................. ........... $8,750.00 ........... $1,750.00 Level XX ($8500- $9000). 1573............. New Technology - T................. ........... $9,250.00 ........... $1,850.00 Level XX ($9000- $9500). 1574............. New Technology - T................. ........... $9,750.00 ........... $1,950.00 Level XX ($9500- $10000). 1604............. IN 111 capromab

K................. 12.4029 $673.34 ........... $134.67 pendetide, per dose. 1605............. Abciximab injection, K................. 5.2806 $286.68 ........... $57.34 10 mg. 1606............. Anistreplase, 30 u... K................. 25.3116 $1,374.14 ........... $274.83 1607............. Eptifibatide

K................. 0.1426

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

$1.55 injection, 5mg. 1609............. Rho(D) immune

K................. 0.1863 $10.11 ...........

$2.02 globulin h, sd, 100 iu. 1611............. Hylan G-F 20

K................. 2.1566 $117.08 ........... $23.42 injection, 16 mg. 1612............. Daclizumab,

K................. 3.7304 $202.52 ........... $40.50 parenteral, 25 mg. 1613............. Trastuzumab, 10 mg... K................. 0.7384 $40.09 ...........

$8.02 1614............. Valrubicin, 200 mg... K................. 9.6183 $522.17 ........... $104.43 1615............. Basiliximab, 20 mg... K................. 11.2007 $608.07 ........... $121.61 1618............. Vonwillebrandfactrcmp K................. 0.0168

$.91 ...........

$.18 lx, per iu. 1620............. Technetium tc99m K................. 3.3106 $179.73 ........... $35.95 bicisate. 1625............. Indium 111-in

K................. 6.8170 $370.09 ........... $74.02 pentetreotide. 1628............. Chromic phosphate p32 K................. 2.0103 $109.14 ........... $21.83 1716............. Brachytx source, Gold K................. 1.3399 $72.74 ........... $14.55 198. 1718............. Brachytx source, K................. 0.6695 $36.35 ...........

$7.27 Iodine 125. 1719............. Brachytx source, Non- K................. 0.3053 $16.57 ...........

$3.31 HDR Ir-192. 1720............. Brachytx source, K................. 0.8104 $44.00 ...........

$8.80 Palladium 103. 1775............. FDG, per dose (4-40 K................. 5.8606 $318.17 ........... $63.63 mCi/ml).

[[Page 48029]]

1783............. Ocular implant,

H................. ........... ........... ........... ........... aqueous drain device. 1814............. Retinal Tamp,

H................. ........... ........... ........... ........... silicone oil. 1818............. Integrated

H................. ........... ........... ........... ........... keratoprosthesis. 1900............. Lead coronary venous. H................. ........... ........... ........... ........... 2614............. Probe, percutaneous H................. ........... ........... ........... ........... lumbar disc. 2616............. Brachytx source, K................. 163.4011 $8,870.88 ........... $1,774.18 Yttrium-90. 2632............. Brachytx sol, I-125, H................. ........... ........... ........... ........... per mCi. 7000............. Amifostine, 500 mg... K................. 3.9932 $216.79 ........... $43.36 7011............. Oprelvekin injection, K................. 2.7246 $147.92 ........... $29.58 5 mg. 7015............. Busulfan, oral, 2 mg. K................. 0.0263

$1.43 ...........

$.29 7024............. Corticorelin ovine K................. 3.4880 $189.36 ........... $37.87 triflutat. 7025............. Digoxin immune FAB K................. 4.4789 $243.16 ........... $48.63 (ovine). 7027............. Fomepizole, 15mg..... K................. 0.2215 $12.03 ...........

$2.41 7030............. Hemin, per 1 mg...... K................. 0.0119

$.65 ...........

$.13 7031............. Octreotide acetate K................. 1.0339 $56.13 ........... $11.23 injection. 7034............. Somatropin injection. K................. 0.9206 $49.98 ........... $10.00 7035............. Teniposide, 50 mg.... K................. 1.5530 $84.31 ........... $16.86 7036............. Urokinase 250,000 iu K................. 5.1032 $277.05 ........... $55.41 inj. 7037............. Urofollitropin, 75 iu K................. 1.1321 $61.46 ........... $12.29 7038............. Muromonab-CD3, 5 mg.. K................. 5.8452 $317.33 ........... $63.47 7041............. Tirofiban

K................. 4.2976 $233.31 ........... $46.66 hydrochloride 12.5 mg. 7042............. Capecitabine, oral, K................. 0.0290

$1.57 ...........

$.31 150 mg. 7043............. Infliximab injection K................. 0.6841 $37.14 ...........

$7.43 10 mg. 7045............. Trimetrexate

K................. 1.2099 $65.68 ........... $13.14 glucoronate. 7046............. Doxorubicin hcl

K................. 4.6362 $251.69 ........... $50.34 liposome inj 10 mg. 7049............. Filgrastim 480 mcg K................. 3.1998 $173.71 ........... $34.74 injection. 7051............. Leuprolide acetate K................. 68.9392 $3,742.64 ........... $748.53 implant, 65 mg. 9000............. Na chromate Cr51, per K................. 1.2631 $68.57 ........... $13.71 0.25mCi. 9002............. Tenecteplase, 50mg/ K................. 23.2303 $1,261.15 ........... $252.23 vial. 9003............. Palivizumab, per 50mg K................. 6.3850 $346.64 ........... $69.33 9004............. Gemtuzumab ozogamicin K................. 17.5020 $950.17 ........... $190.03 inj,5mg. 9005............. Reteplase injection.. K................. 10.1332 $550.12 ........... $110.02 9009............. Baclofen refill kit - K................. 0.7478 $40.60 ...........

$8.12 per 2000 mcg. 9010............. Baclofen refill kit - K................. 0.7340 $39.85 ...........

$7.97 per 4000 mcg. 9012............. Arsenic Trioxide..... K................. 0.4837 $26.26 ...........

$5.25 9015............. Mycophenolate mofetil K................. 0.0373

$2.02 ...........

$.40 oral 250 mg. 9018............. Botulinum toxin B, K................. 0.1272

$6.91 ...........

$1.38 per 100 u. 9019............. Caspofungin acetate, K................. 0.5334 $28.96 ...........

$5.79 5 mg. 9020............. Sirolimus tablet, K................. 0.0520

$2.82 ...........

$.56 oral 1 mg. 9021............. Immune globulin 10 mg K................. 0.0080

$.43 ...........

$.09 9022............. IM inj interferon K................. 0.9417 $51.12 ........... $10.22 beta 1-a. 9023............. Rho d immune globulin K................. 0.0523

$2.84 ...........

$.57 50 mcg. 9024............. Amphotericin b lipid K................. 0.4174 $22.66 ...........

$4.53 complex. 9025............. Rubidium-Rb-82....... K................. 2.5939 $140.82 ........... $28.16 9100............. Iodinated I-

K................. 0.0071

$.39 ...........

$.08 131albumin, per 5 uci. 9104............. Anti-thymocycte

K................. 2.9801 $161.79 ........... $32.36 globulin rabbit. 9105............. Hep B imm glob, per 1 K................. 1.5621 $84.80 ........... $16.96 ml. 9108............. Thyrotropin alfa, per K................. 6.6059 $358.63 ........... $71.73 1.1 mg. 9109............. Tirofiban hcl, per K................. 2.2328 $121.22 ........... $24.24 6.25 mg. 9110............. Alemtuzumab, per 10 K................. 7.6422 $414.89 ........... $82.98 mg. 9111............. Inj, bivalirudin, per G................. ........... $397.81 ........... $59.46 250 mg vial. 9112............. Perflutren lipid G................. ........... $148.20 ........... $22.15 micro, per 2ml. 9113............. Inj, pantoprazole G................. ........... $22.80 ...........

$3.41 sodium, vial. 9114............. Nesiritide, per 0.5 G................. ........... $144.40 ........... $21.58 mg vial. 9115............. Inj, zoledronic acid, G................. ........... $203.40 ........... $30.40 per 1 mg. 9116............. Inj, Ertapenem

G................. ........... $45.31 ...........

$6.77 sodium, per 1 gm vial. 9117............. Y-90 ibritumomab K................. 332.7763 $18,066.09 ........... $3,613.22 tiuxetan. 9118............. IN-111 ibritumomab K................. 38.3972 $2,084.55 ........... $416.91 tiuxetan. 9119............. Pegfilgrastim, per 1 G................. ........... $467.09 ........... $69.82 mg. 9120............. Inj, Fulvestrant, per G................. ........... $175.16 ........... $26.18 50 mg. 9121............. Inj, Argatroban, per G................. ........... $14.25 ...........

$2.13 5 mg. 9122............. Inj, Triptorelin G................. ........... $415.24 ........... $62.07 pamoate, per 3.75 mg. 9200............. Orcel, per 36 cm2.... G................. ........... $1,135.25 ........... $169.69 9201............. Dermagraft, per 37.5 K................. 7.9288 $430.45 ........... $86.09 sq cm. 9202............. Octafluoropropane.... K................. 2.1253 $115.38 ........... $23.08 9203............. Perflexane lipid G................. ........... $142.50 ........... $21.30 micro. 9204............. Ziprasidone mesylate. G................. ........... $41.56 ...........

$6.21 9205............. Oxaliplatin.......... G................. ........... $94.46 ........... $14.12 9217............. Leuprolide acetate K................. 5.5128 $299.28 ........... $59.86 suspnsion, 7.5 mg.

[[Page 48030]]

9500............. Platelets, irradiated K................. 1.2398 $67.31 ........... $13.46 9501............. Platelets, pheresis.. K................. 6.7772 $367.93 ........... $73.59 9502............. Platelet pheresis K................. 7.3552 $399.31 ........... $79.86 irradiated. 9503............. Fresh frozen plasma, K................. 1.1560 $62.76 ........... $12.55 ea unit. 9504............. RBC deglycerolized... K................. 3.9764 $215.87 ........... $43.17 9505............. RBC irradiated....... K................. 1.8011 $97.78 ........... $19.56 9506............. Granulocytes,

K................. 20.7004 $1,123.80 ........... $224.76 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 48030]]

Addendum B.--Payment Status by HCPCS Code and Related Information Calendar Year 2004

National Minimum CPT/HCPCS

Status indicator

Condition

Description

APC Relative Payment unadjusted unadjusted weight rate copayment copayment

0001T................. C.................... ..................... Endovas repr abdo ao ..... ......... ........... ............ ............ aneurys. 0002T................. C.................... ..................... Endovas repr abdo ao ..... ......... ........... ............ ............ aneurys. 0003T................. S.................... ..................... Cervicography.......... 1501 ......... $25.00 ............

$5.00 0005T................. C.................... ..................... Perc cath stent/brain ..... ......... ........... ............ ............ cv art. 0006T................. C.................... ..................... Perc cath stent/brain ..... ......... ........... ............ ............ cv art. 0007T................. C.................... ..................... Perc cath stent/brain ..... ......... ........... ............ ............ cv art. 0008T................. E.................... ..................... Upper gi endoscopy w/ ..... ......... ........... ............ ............ suture. 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... ..... ......... ........... ............ ............ 0010T................. A.................... ..................... Tb test, gamma

..... ......... ........... ............ ............ interferon. 00120................. N.................... ..................... Anesth, ear surgery.... ..... ......... ........... ............ ............ 00124................. N.................... ..................... Anesth, ear exam....... ..... ......... ........... ............ ............ 00126................. N.................... ..................... Anesth, tympanotomy.... ..... ......... ........... ............ ............ 0012T................. T.................... ..................... Osteochondral knee

0041 27.2538 $1,479.58 ............ $295.92 autograft. 0013T................. T.................... ..................... Osteochondral knee

0041 27.2538 $1,479.58 ............ $295.92 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 27.2538 $1,479.58 ............ $295.92 knee. 00160................. N.................... ..................... Anesth, nose/sinus ..... ......... ........... ............ ............ surgery. 00162................. N.................... ..................... Anesth, nose/sinus ..... ......... ........... ............ ............ surgery. 00164................. N.................... ..................... Anesth, biopsy of nose. ..... ......... ........... ............ ............ 0016T................. T.................... ..................... Thermotx choroid vasc 0235 4.9900 $270.90

$72.04

$54.18 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 magnetic 0215 0.6390 $34.69

$15.76

$6.94 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.

[[Page 48031]]

0025T................. S.................... ..................... Ultrasonic pachymetry.. 0230 0.7379 $40.06

$14.97

$8.01 0026T................. A.................... ..................... Measure remnant

..... ......... ........... ............ ............ lipoproteins. 0027T................. T.................... ..................... Endoscopic epidural 1547 ......... $850.00 ............ $170.00 lysis. 0028T................. N.................... ..................... Dexa body composition ..... ......... ........... ............ ............ study. 0029T................. N.................... ..................... Magnetic tx for

..... ......... ........... ............ ............ incontinence. 00300................. N.................... ..................... Anesth, head/neck/ ..... ......... ........... ............ ............ ptrunk. 0030T................. A.................... ..................... Antiprothrombin

..... ......... ........... ............ ............ antibody. 0031T................. N.................... ..................... Speculoscopy........... ..... ......... ........... ............ ............ 00320................. N.................... ..................... Anesth, neck organ ..... ......... ........... ............ ............ surgery. 00322................. N.................... ..................... Anesth, biopsy of

..... ......... ........... ............ ............ thyroid. 00326................. N.................... ..................... Anesth, larynx/trach, 3. 20600................. T.................... ..................... Drain/inject, joint/ 0204 2.2209 $120.57

$40.13

$24.11 bursa. 20605................. T.................... ..................... Drain/inject, joint/ 0204 2.2209 $120.57

$40.13

$24.11 bursa. 20610................. T.................... ..................... Drain/inject, joint/ 0204 2.2209 $120.57

$40.13

$24.11 bursa.

[[Page 48041]]

20612................. T.................... ..................... Aspirate/inj ganglion 0204 2.2209 $120.57

$40.13

$24.11 cyst. 20615................. T.................... ..................... Treatment of bone cyst. 0004 1.5774 $85.64

$22.10

$17.13 20650................. T.................... ..................... Insert and remove bone 0049 19.9376 $1,082.39 ............ $216.48 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 0.6232 $33.83 ............

$6.77 device. 20670................. T.................... ..................... Removal of support

0021 14.5749 $791.26 $219.48 $158.25 implant. 20680................. T.................... ..................... Removal of support

0022 18.6725 $1,013.71 $354.45 $202.74 implant. 20690................. T.................... ..................... Apply bone fixation 0050 25.1166 $1,363.56 ............ $272.71 device. 20692................. T.................... ..................... Apply bone fixation 0050 25.1166 $1,363.56 ............ $272.71 device. 20693................. T.................... ..................... Adjust bone fixation 0049 19.9376 $1,082.39 ............ $216.48 device. 20694................. T.................... ..................... Remove bone fixation 0049 19.9376 $1,082.39 ............ $216.48 device. 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. 20900................. T.................... ..................... Removal of bone for 0050 25.1166 $1,363.56 ............ $272.71 graft. 20902................. T.................... ..................... Removal of bone for 0050 25.1166 $1,363.56 ............ $272.71 graft. 20910................. T.................... ..................... Remove cartilage for 0027 15.8319 $859.50 $329.72 $171.90 graft. 20912................. T.................... ..................... Remove cartilage for 0027 15.8319 $859.50 $329.72 $171.90 graft. 20920................. T.................... ..................... Removal of fascia for 0027 15.8319 $859.50 $329.72 $171.90 graft. 20922................. T.................... ..................... Removal of fascia for 0027 15.8319 $859.50 $329.72 $171.90 graft. 20924................. T.................... ..................... Removal of tendon for 0050 25.1166 $1,363.56 ............ $272.71 graft. 20926................. T.................... ..................... Removal of tissue for 0027 15.8319 $859.50 $329.72 $171.90 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, muscle. 0006 1.7487 $94.94

$24.12

$18.99 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 19.9376 $1,082.39 ............ $216.48 stimulation. 20979................. A.................... ..................... Us bone stimulation.... ..... ......... ........... ............ ............ 20999................. T.................... ..................... Musculoskeletal surgery 0049 19.9376 $1,082.39 ............ $216.48 21010................. T.................... ..................... Incision of jaw joint.. 0254 21.4368 $1,163.78 $321.35 $232.76 21015................. T.................... ..................... Resection of facial 0253 15.1698 $823.55 $282.29 $164.71 tumor. 21025................. T.................... ..................... Excision of bone, lower 0256 35.0866 $1,904.82 ............ $380.96 jaw. 21026................. T.................... ..................... Excision of facial

0256 35.0866 $1,904.82 ............ $380.96 bone(s). 21029................. T.................... ..................... Contour of face bone 0256 35.0866 $1,904.82 ............ $380.96 lesion. 21030................. T.................... ..................... Removal of face bone 0254 21.4368 $1,163.78 $321.35 $232.76 lesion. 21031................. T.................... ..................... Remove exostosis,

0254 21.4368 $1,163.78 $321.35 $232.76 mandible. 21032................. T.................... ..................... Remove exostosis,

0254 21.4368 $1,163.78 $321.35 $232.76 maxilla. 21034................. T.................... ..................... Removal of face bone 0256 35.0866 $1,904.82 ............ $380.96 lesion. 21040................. T.................... ..................... Removal of jaw bone 0254 21.4368 $1,163.78 $321.35 $232.76 lesion. 21044................. T.................... ..................... Removal of jaw bone 0256 35.0866 $1,904.82 ............ $380.96 lesion. 21045................. C.................... ..................... Extensive jaw surgery.. ..... ......... ........... ............ ............ 21046................. T.................... ..................... Remove mandible cyst 0256 35.0866 $1,904.82 ............ $380.96 complex. 21047................. T.................... ..................... Excise lwr jaw cyst w/ 0256 35.0866 $1,904.82 ............ $380.96 repair. 21048................. T.................... ..................... Remove maxilla cyst 0256 35.0866 $1,904.82 ............ $380.96 complex. 21049................. T.................... ..................... Excis uppr jaw cyst w/ 0256 35.0866 $1,904.82 ............ $380.96 repair. 21050................. T.................... ..................... Removal of jaw joint... 0256 35.0866 $1,904.82 ............ $380.96

[[Page 48042]]

21060................. T.................... ..................... Remove jaw joint

0256 35.0866 $1,904.82 ............ $380.96 cartilage. 21070................. T.................... ..................... Remove coronoid process 0256 35.0866 $1,904.82 ............ $380.96 21076................. T.................... ..................... Prepare face/oral

0254 21.4368 $1,163.78 $321.35 $232.76 prosthesis. 21077................. T.................... ..................... Prepare face/oral

0256 35.0866 $1,904.82 ............ $380.96 prosthesis. 21079................. T.................... ..................... Prepare face/oral

0256 35.0866 $1,904.82 ............ $380.96 prosthesis. 21080................. T.................... ..................... Prepare face/oral

0256 35.0866 $1,904.82 ............ $380.96 prosthesis. 21081................. T.................... ..................... Prepare face/oral

0256 35.0866 $1,904.82 ............ $380.96 prosthesis. 21082................. T.................... ..................... Prepare face/oral

0256 35.0866 $1,904.82 ............ $380.96 prosthesis. 21083................. T.................... ..................... Prepare face/oral

0256 35.0866 $1,904.82 ............ $380.96 prosthesis. 21084................. T.................... ..................... Prepare face/oral

0256 35.0866 $1,904.82 ............ $380.96 prosthesis. 21085................. T.................... ..................... Prepare face/oral

0253 15.1698 $823.55 $282.29 $164.71 prosthesis. 21086................. T.................... ..................... Prepare face/oral

0256 35.0866 $1,904.82 ............ $380.96 prosthesis. 21087................. T.................... ..................... Prepare face/oral

0256 35.0866 $1,904.82 ............ $380.96 prosthesis. 21088................. T.................... ..................... Prepare face/oral

0256 35.0866 $1,904.82 ............ $380.96 prosthesis. 21089................. T.................... ..................... Prepare face/oral

0253 15.1698 $823.55 $282.29 $164.71 prosthesis. 21100................. T.................... ..................... Maxillofacial fixation. 0256 35.0866 $1,904.82 ............ $380.96 21110................. T.................... ..................... Interdental fixation... 0252 6.5416 $355.14 $113.41

$71.03 21116................. N.................... ..................... Injection, jaw joint x- ..... ......... ........... ............ ............ ray. 21120................. T.................... ..................... Reconstruction of chin. 0254 21.4368 $1,163.78 $321.35 $232.76 21121................. T.................... ..................... Reconstruction of chin. 0254 21.4368 $1,163.78 $321.35 $232.76 21122................. T.................... ..................... Reconstruction of chin. 0254 21.4368 $1,163.78 $321.35 $232.76 21123................. T.................... ..................... Reconstruction of chin. 0254 21.4368 $1,163.78 $321.35 $232.76 21125................. T.................... ..................... Augmentation, lower jaw 0254 21.4368 $1,163.78 $321.35 $232.76 bone. 21127................. T.................... ..................... Augmentation, lower jaw 0256 35.0866 $1,904.82 ............ $380.96 bone. 21137................. T.................... ..................... Reduction of forehead.. 0254 21.4368 $1,163.78 $321.35 $232.76 21138................. T.................... ..................... Reduction of forehead.. 0256 35.0866 $1,904.82 ............ $380.96 21139................. T.................... ..................... Reduction of forehead.. 0256 35.0866 $1,904.82 ............ $380.96 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 21.4368 $1,163.78 $321.35 $232.76 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 35.0866 $1,904.82 ............ $380.96 segment. 21199................. T.................... ..................... Reconstr lwr jaw w/ 0256 35.0866 $1,904.82 ............ $380.96 advance. 21206................. T.................... ..................... Reconstruct upper jaw 0256 35.0866 $1,904.82 ............ $380.96 bone. 21208................. T.................... ..................... Augmentation of facial 0256 35.0866 $1,904.82 ............ $380.96 bones. 21209................. T.................... ..................... Reduction of facial 0256 35.0866 $1,904.82 ............ $380.96 bones. 21210................. T.................... ..................... Face bone graft........ 0256 35.0866 $1,904.82 ............ $380.96 21215................. T.................... ..................... Lower jaw bone graft... 0256 35.0866 $1,904.82 ............ $380.96 21230................. T.................... ..................... Rib cartilage graft.... 0256 35.0866 $1,904.82 ............ $380.96 21235................. T.................... ..................... Ear cartilage graft.... 0254 21.4368 $1,163.78 $321.35 $232.76 21240................. T.................... ..................... Reconstruction of jaw 0256 35.0866 $1,904.82 ............ $380.96 joint. 21242................. T.................... ..................... Reconstruction of jaw 0256 35.0866 $1,904.82 ............ $380.96 joint. 21243................. T.................... ..................... Reconstruction of jaw 0256 35.0866 $1,904.82 ............ $380.96 joint. 21244................. T.................... ..................... Reconstruction of lower 0256 35.0866 $1,904.82 ............ $380.96 jaw. 21245................. T.................... ..................... Reconstruction of jaw.. 0256 35.0866 $1,904.82 ............ $380.96

[[Page 48043]]

21246................. T.................... ..................... Reconstruction of jaw.. 0256 35.0866 $1,904.82 ............ $380.96 21247................. C.................... ..................... Reconstruct lower jaw ..... ......... ........... ............ ............ bone. 21248................. T.................... ..................... Reconstruction of jaw.. 0256 35.0866 $1,904.82 ............ $380.96 21249................. T.................... ..................... Reconstruction of jaw.. 0256 35.0866 $1,904.82 ............ $380.96 21255................. C.................... ..................... Reconstruct lower jaw ..... ......... ........... ............ ............ bone. 21256................. C.................... ..................... Reconstruction of orbit ..... ......... ........... ............ ............ 21260................. T.................... ..................... Revise eye sockets..... 0256 35.0866 $1,904.82 ............ $380.96 21261................. T.................... ..................... Revise eye sockets..... 0256 35.0866 $1,904.82 ............ $380.96 21263................. T.................... ..................... Revise eye sockets..... 0256 35.0866 $1,904.82 ............ $380.96 21267................. T.................... ..................... Revise eye sockets..... 0256 35.0866 $1,904.82 ............ $380.96 21268................. C.................... ..................... Revise eye sockets..... ..... ......... ........... ............ ............ 21270................. T.................... ..................... Augmentation, cheek 0256 35.0866 $1,904.82 ............ $380.96 bone. 21275................. T.................... ..................... Revision, orbitofacial 0256 35.0866 $1,904.82 ............ $380.96 bones. 21280................. T.................... ..................... Revision of eyelid..... 0256 35.0866 $1,904.82 ............ $380.96 21282................. T.................... ..................... Revision of eyelid..... 0253 15.1698 $823.55 $282.29 $164.71 21295................. T.................... ..................... Revision of jaw muscle/ 0252 6.5416 $355.14 $113.41

$71.03 bone. 21296................. T.................... ..................... Revision of jaw muscle/ 0254 21.4368 $1,163.78 $321.35 $232.76 bone. 21299................. T.................... ..................... Cranio/maxillofacial 0253 15.1698 $823.55 $282.29 $164.71 surgery. 21300................. T.................... ..................... Treatment of skull

0253 15.1698 $823.55 $282.29 $164.71 fracture. 21310................. X.................... ..................... Treatment of nose

0340 0.6232 $33.83 ............

$6.77 fracture. 21315................. X.................... ..................... Treatment of nose

0340 0.6232 $33.83 ............

$6.77 fracture. 21320................. X.................... ..................... Treatment of nose

0340 0.6232 $33.83 ............

$6.77 fracture. 21325................. T.................... ..................... Treatment of nose

0254 21.4368 $1,163.78 $321.35 $232.76 fracture. 21330................. T.................... ..................... Treatment of nose

0254 21.4368 $1,163.78 $321.35 $232.76 fracture. 21335................. T.................... ..................... Treatment of nose

0254 21.4368 $1,163.78 $321.35 $232.76 fracture. 21336................. T.................... ..................... Treat nasal septal

0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 21337................. T.................... ..................... Treat nasal septal

0253 15.1698 $823.55 $282.29 $164.71 fracture. 21338................. T.................... ..................... Treat nasoethmoid

0254 21.4368 $1,163.78 $321.35 $232.76 fracture. 21339................. T.................... ..................... Treat nasoethmoid

0254 21.4368 $1,163.78 $321.35 $232.76 fracture. 21340................. T.................... ..................... Treatment of nose

0256 35.0866 $1,904.82 ............ $380.96 fracture. 21343................. C.................... ..................... Treatment of sinus ..... ......... ........... ............ ............ fracture. 21344................. C.................... ..................... Treatment of sinus ..... ......... ........... ............ ............ fracture. 21345................. T.................... ..................... Treat nose/jaw fracture 0254 21.4368 $1,163.78 $321.35 $232.76 21346................. C.................... ..................... Treat nose/jaw fracture ..... ......... ........... ............ ............ 21347................. C.................... ..................... Treat nose/jaw fracture ..... ......... ........... ............ ............ 21348................. C.................... ..................... Treat nose/jaw fracture ..... ......... ........... ............ ............ 21355................. T.................... ..................... Treat cheek bone

0256 35.0866 $1,904.82 ............ $380.96 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 35.0866 $1,904.82 ............ $380.96 fracture. 21395................. C.................... ..................... Treat eye socket

..... ......... ........... ............ ............ fracture. 21400................. T.................... ..................... Treat eye socket

0252 6.5416 $355.14 $113.41

$71.03 fracture. 21401................. T.................... ..................... Treat eye socket

0253 15.1698 $823.55 $282.29 $164.71 fracture. 21406................. T.................... ..................... Treat eye socket

0256 35.0866 $1,904.82 ............ $380.96 fracture. 21407................. T.................... ..................... Treat eye socket

0256 35.0866 $1,904.82 ............ $380.96 fracture. 21408................. C.................... ..................... Treat eye socket

..... ......... ........... ............ ............ fracture. 21421................. T.................... ..................... Treat mouth roof

0254 21.4368 $1,163.78 $321.35 $232.76 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 21.4368 $1,163.78 $321.35 $232.76 fracture. 21445................. T.................... ..................... Treat dental ridge

0254 21.4368 $1,163.78 $321.35 $232.76 fracture. 21450................. T.................... ..................... Treat lower jaw

0251 1.8643 $101.21 ............

$20.24 fracture. 21451................. T.................... ..................... Treat lower jaw

0252 6.5416 $355.14 $113.41

$71.03 fracture. 21452................. T.................... ..................... Treat lower jaw

0253 15.1698 $823.55 $282.29 $164.71 fracture. 21453................. T.................... ..................... Treat lower jaw

0256 35.0866 $1,904.82 ............ $380.96 fracture. 21454................. T.................... ..................... Treat lower jaw

0254 21.4368 $1,163.78 $321.35 $232.76 fracture.

[[Page 48044]]

21461................. T.................... ..................... Treat lower jaw

0256 35.0866 $1,904.82 ............ $380.96 fracture. 21462................. T.................... ..................... Treat lower jaw

0256 35.0866 $1,904.82 ............ $380.96 fracture. 21465................. T.................... ..................... Treat lower jaw

0256 35.0866 $1,904.82 ............ $380.96 fracture. 21470................. T.................... ..................... Treat lower jaw

0256 35.0866 $1,904.82 ............ $380.96 fracture. 21480................. T.................... ..................... Reset dislocated jaw... 0251 1.8643 $101.21 ............

$20.24 21485................. T.................... ..................... Reset dislocated jaw... 0253 15.1698 $823.55 $282.29 $164.71 21490................. T.................... ..................... Repair dislocated jaw.. 0256 35.0866 $1,904.82 ............ $380.96 21493................. T.................... ..................... Treat hyoid bone

0252 6.5416 $355.14 $113.41

$71.03 fracture. 21494................. T.................... ..................... Treat hyoid bone

0252 6.5416 $355.14 $113.41

$71.03 fracture. 21495................. C.................... ..................... Treat hyoid bone

..... ......... ........... ............ ............ fracture. 21497................. T.................... ..................... Interdental wiring..... 0253 15.1698 $823.55 $282.29 $164.71 21499................. T.................... ..................... Head surgery procedure. 0253 15.1698 $823.55 $282.29 $164.71 21501................. T.................... ..................... Drain neck/chest lesion 0008 16.8303 $913.70 ............ $182.74 21502................. T.................... ..................... Drain chest lesion..... 0049 19.9376 $1,082.39 ............ $216.48 21510................. C.................... ..................... Drainage of bone lesion ..... ......... ........... ............ ............ 21550................. T.................... ..................... Biopsy of neck/chest... 0021 14.5749 $791.26 $219.48 $158.25 21555................. T.................... ..................... Remove lesion, neck/ 0022 18.6725 $1,013.71 $354.45 $202.74 chest. 21556................. T.................... ..................... Remove lesion, neck/ 0022 18.6725 $1,013.71 $354.45 $202.74 chest. 21557................. C.................... ..................... Remove tumor, neck/ ..... ......... ........... ............ ............ chest. 21600................. T.................... ..................... Partial removal of rib. 0050 25.1166 $1,363.56 ............ $272.71 21610................. T.................... ..................... Partial removal of rib. 0050 25.1166 $1,363.56 ............ $272.71 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. 21700................. T.................... ..................... Revision of neck muscle 0049 19.9376 $1,082.39 ............ $216.48 21705................. C.................... ..................... Revision of neck muscle/ ..... ......... ........... ............ ............ rib. 21720................. T.................... ..................... Revision of neck muscle 0049 19.9376 $1,082.39 ............ $216.48 21725................. T.................... ..................... Revision of neck muscle 0006 1.7487 $94.94

$24.12

$18.99 21740................. C.................... ..................... Reconstruction of

..... ......... ........... ............ ............ sternum. 21742................. T.................... ..................... Repair stern/nuss w/o 0051 34.9381 $1,896.75 ............ $379.35 scope. 21743................. T.................... ..................... Repair sternum/nuss w/ 0051 34.9381 $1,896.75 ............ $379.35 scope. 21750................. C.................... ..................... Repair of sternum

..... ......... ........... ............ ............ separation. 21800................. T.................... ..................... Treatment of rib

0043 1.9233 $104.41 ............

$20.88 fracture. 21805................. T.................... ..................... Treatment of rib

0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 21810................. C.................... ..................... Treatment of rib

..... ......... ........... ............ ............ fracture(s). 21820................. T.................... ..................... Treat sternum fracture. 0043 1.9233 $104.41 ............

$20.88 21825................. C.................... ..................... Treat sternum fracture. ..... ......... ........... ............ ............ 21899................. T.................... ..................... Neck/chest surgery

0252 6.5416 $355.14 $113.41

$71.03 procedure. 21920................. T.................... ..................... Biopsy soft tissue of 0020 7.3105 $396.88 $113.25

$79.38 back. 21925................. T.................... ..................... Biopsy soft tissue of 0022 18.6725 $1,013.71 $354.45 $202.74 back. 21930................. T.................... ..................... Remove lesion, back or 0022 18.6725 $1,013.71 $354.45 $202.74 flank. 21935................. T.................... ..................... Remove tumor, back..... 0022 18.6725 $1,013.71 $354.45 $202.74 22100................. T.................... ..................... Remove part of neck 0208 40.6521 $2,206.96 ............ $441.39 vertebra. 22101................. T.................... ..................... Remove part, thorax 0208 40.6521 $2,206.96 ............ $441.39 vertebra. 22102................. T.................... ..................... Remove part, lumbar 0208 40.6521 $2,206.96 ............ $441.39 vertebra. 22103................. T.................... ..................... Remove extra spine

0208 40.6521 $2,206.96 ............ $441.39 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 1.9233 $104.41 ............

$20.88 fracture. 22310................. T.................... ..................... Treat spine fracture... 0043 1.9233 $104.41 ............

$20.88 22315................. T.................... ..................... Treat spine fracture... 0043 1.9233 $104.41 ............

$20.88 22318................. C.................... ..................... Treat odontoid fx w/o ..... ......... ........... ............ ............ graft. 22319................. C.................... ..................... Treat odontoid fx w/ ..... ......... ........... ............ ............ graft.

[[Page 48045]]

22325................. C.................... ..................... Treat spine fracture... ..... ......... ........... ............ ............ 22326................. C.................... ..................... Treat neck spine

..... ......... ........... ............ ............ fracture. 22327................. C.................... ..................... Treat thorax spine ..... ......... ........... ............ ............ fracture. 22328................. C.................... ..................... Treat each add spine fx ..... ......... ........... ............ ............ 22505................. T.................... ..................... Manipulation of spine.. 0045 13.5546 $735.87 $268.47 $147.17 22520................. T.................... ..................... Percut vertebroplasty 0050 25.1166 $1,363.56 ............ $272.71 thor. 22521................. T.................... ..................... Percut vertebroplasty 0050 25.1166 $1,363.56 ............ $272.71 lumb. 22522................. T.................... ..................... Percut vertebroplasty 0050 25.1166 $1,363.56 ............ $272.71 addl. 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 40.6521 $2,206.96 ............ $441.39 22614................. T.................... ..................... Spine fusion, extra 0208 40.6521 $2,206.96 ............ $441.39 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 procedure 0043 1.9233 $104.41 ............

$20.88 22900................. T.................... ..................... Remove abdominal wall 0022 18.6725 $1,013.71 $354.45 $202.74 lesion. 22999................. T.................... ..................... Abdomen surgery

0022 18.6725 $1,013.71 $354.45 $202.74 procedure. 23000................. T.................... ..................... Removal of calcium

0021 14.5749 $791.26 $219.48 $158.25 deposits. 23020................. T.................... ..................... Release shoulder joint. 0051 34.9381 $1,896.75 ............ $379.35 23030................. T.................... ..................... Drain shoulder lesion.. 0008 16.8303 $913.70 ............ $182.74 23031................. T.................... ..................... Drain shoulder bursa... 0008 16.8303 $913.70 ............ $182.74 23035................. T.................... ..................... Drain shoulder bone 0049 19.9376 $1,082.39 ............ $216.48 lesion. 23040................. T.................... ..................... Exploratory shoulder 0050 25.1166 $1,363.56 ............ $272.71 surgery. 23044................. T.................... ..................... Exploratory shoulder 0050 25.1166 $1,363.56 ............ $272.71 surgery. 23065................. T.................... ..................... Biopsy shoulder tissues 0021 14.5749 $791.26 $219.48 $158.25 23066................. T.................... ..................... Biopsy shoulder tissues 0022 18.6725 $1,013.71 $354.45 $202.74 23075................. T.................... ..................... Removal of shoulder 0021 14.5749 $791.26 $219.48 $158.25 lesion. 23076................. T.................... ..................... Removal of shoulder 0022 18.6725 $1,013.71 $354.45 $202.74 lesion. 23077................. T.................... ..................... Remove tumor of

0022 18.6725 $1,013.71 $354.45 $202.74 shoulder. 23100................. T.................... ..................... Biopsy of shoulder

0049 19.9376 $1,082.39 ............ $216.48 joint. 23101................. T.................... ..................... Shoulder joint surgery. 0050 25.1166 $1,363.56 ............ $272.71 23105................. T.................... ..................... Remove shoulder joint 0050 25.1166 $1,363.56 ............ $272.71 lining. 23106................. T.................... ..................... Incision of collarbone 0050 25.1166 $1,363.56 ............ $272.71 joint. 23107................. T.................... ..................... Explore treat shoulder 0050 25.1166 $1,363.56 ............ $272.71 joint. 23120................. T.................... ..................... Partial removal, collar 0051 34.9381 $1,896.75 ............ $379.35 bone. 23125................. T.................... ..................... Removal of collar bone. 0051 34.9381 $1,896.75 ............ $379.35

[[Page 48046]]

23130................. T.................... ..................... Remove shoulder bone, 0051 34.9381 $1,896.75 ............ $379.35 part. 23140................. T.................... ..................... Removal of bone lesion. 0049 19.9376 $1,082.39 ............ $216.48 23145................. T.................... ..................... Removal of bone lesion. 0050 25.1166 $1,363.56 ............ $272.71 23146................. T.................... ..................... Removal of bone lesion. 0050 25.1166 $1,363.56 ............ $272.71 23150................. T.................... ..................... Removal of humerus

0050 25.1166 $1,363.56 ............ $272.71 lesion. 23155................. T.................... ..................... Removal of humerus

0050 25.1166 $1,363.56 ............ $272.71 lesion. 23156................. T.................... ..................... Removal of humerus

0050 25.1166 $1,363.56 ............ $272.71 lesion. 23170................. T.................... ..................... Remove collar bone

0050 25.1166 $1,363.56 ............ $272.71 lesion. 23172................. T.................... ..................... Remove shoulder blade 0050 25.1166 $1,363.56 ............ $272.71 lesion. 23174................. T.................... ..................... Remove humerus lesion.. 0050 25.1166 $1,363.56 ............ $272.71 23180................. T.................... ..................... Remove collar bone

0050 25.1166 $1,363.56 ............ $272.71 lesion. 23182................. T.................... ..................... Remove shoulder blade 0050 25.1166 $1,363.56 ............ $272.71 lesion. 23184................. T.................... ..................... Remove humerus lesion.. 0050 25.1166 $1,363.56 ............ $272.71 23190................. T.................... ..................... Partial removal of

0050 25.1166 $1,363.56 ............ $272.71 scapula. 23195................. T.................... ..................... Removal of head of

0050 25.1166 $1,363.56 ............ $272.71 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 foreign 0020 7.3105 $396.88 $113.25

$79.38 body. 23331................. T.................... ..................... Remove shoulder foreign 0022 18.6725 $1,013.71 $354.45 $202.74 body. 23332................. C.................... ..................... Remove shoulder foreign ..... ......... ........... ............ ............ body. 23350................. N.................... ..................... Injection for shoulder ..... ......... ........... ............ ............ x-ray. 23395................. T.................... ..................... Muscle

0051 34.9381 $1,896.75 ............ $379.35 transfer,shoulder/arm. 23397................. T.................... ..................... Muscle transfers....... 0052 42.6430 $2,315.05 ............ $463.01 23400................. T.................... ..................... Fixation of shoulder 0050 25.1166 $1,363.56 ............ $272.71 blade. 23405................. T.................... ..................... Incision of tendon & 0050 25.1166 $1,363.56 ............ $272.71 muscle. 23406................. T.................... ..................... Incise tendon(s) &

0050 25.1166 $1,363.56 ............ $272.71 muscle(s). 23410................. T.................... ..................... Repair of tendon(s).... 0052 42.6430 $2,315.05 ............ $463.01 23412................. T.................... ..................... Repair rotator cuff, 0052 42.6430 $2,315.05 ............ $463.01 chronic. 23415................. T.................... ..................... Release of shoulder 0051 34.9381 $1,896.75 ............ $379.35 ligament. 23420................. T.................... ..................... Repair of shoulder..... 0052 42.6430 $2,315.05 ............ $463.01 23430................. T.................... ..................... Repair biceps tendon... 0052 42.6430 $2,315.05 ............ $463.01 23440................. T.................... ..................... Remove/transplant

0052 42.6430 $2,315.05 ............ $463.01 tendon. 23450................. T.................... ..................... Repair shoulder capsule 0052 42.6430 $2,315.05 ............ $463.01 23455................. T.................... ..................... Repair shoulder capsule 0052 42.6430 $2,315.05 ............ $463.01 23460................. T.................... ..................... Repair shoulder capsule 0052 42.6430 $2,315.05 ............ $463.01 23462................. T.................... ..................... Repair shoulder capsule 0052 42.6430 $2,315.05 ............ $463.01 23465................. T.................... ..................... Repair shoulder capsule 0052 42.6430 $2,315.05 ............ $463.01 23466................. T.................... ..................... Repair shoulder capsule 0052 42.6430 $2,315.05 ............ $463.01 23470................. T.................... ..................... Reconstruct shoulder 0048 47.4707 $2,577.14 $695.60 $515.43 joint. 23472................. C.................... ..................... Reconstruct shoulder ..... ......... ........... ............ ............ joint. 23480................. T.................... ..................... Revision of collar bone 0051 34.9381 $1,896.75 ............ $379.35 23485................. T.................... ..................... Revision of collar bone 0051 34.9381 $1,896.75 ............ $379.35 23490................. T.................... ..................... Reinforce clavicle..... 0051 34.9381 $1,896.75 ............ $379.35 23491................. T.................... ..................... Reinforce shoulder

0051 34.9381 $1,896.75 ............ $379.35 bones. 23500................. T.................... ..................... Treat clavicle fracture 0043 1.9233 $104.41 ............

$20.88 23505................. T.................... ..................... Treat clavicle fracture 0043 1.9233 $104.41 ............

$20.88 23515................. T.................... ..................... Treat clavicle fracture 0046 31.9719 $1,735.72 $535.76 $347.14 23520................. T.................... ..................... Treat clavicle

0043 1.9233 $104.41 ............

$20.88 dislocation. 23525................. T.................... ..................... Treat clavicle

0043 1.9233 $104.41 ............

$20.88 dislocation. 23530................. T.................... ..................... Treat clavicle

0046 31.9719 $1,735.72 $535.76 $347.14 dislocation. 23532................. T.................... ..................... Treat clavicle

0046 31.9719 $1,735.72 $535.76 $347.14 dislocation. 23540................. T.................... ..................... Treat clavicle

0043 1.9233 $104.41 ............

$20.88 dislocation. 23545................. T.................... ..................... Treat clavicle

0043 1.9233 $104.41 ............

$20.88 dislocation. 23550................. T.................... ..................... Treat clavicle

0046 31.9719 $1,735.72 $535.76 $347.14 dislocation. 23552................. T.................... ..................... Treat clavicle

0046 31.9719 $1,735.72 $535.76 $347.14 dislocation. 23570................. T.................... ..................... Treat shoulder blade fx 0043 1.9233 $104.41 ............

$20.88 23575................. T.................... ..................... Treat shoulder blade fx 0043 1.9233 $104.41 ............

$20.88 23585................. T.................... ..................... Treat scapula fracture. 0046 31.9719 $1,735.72 $535.76 $347.14 23600................. T.................... ..................... Treat humerus fracture. 0043 1.9233 $104.41 ............

$20.88 23605................. T.................... ..................... Treat humerus fracture. 0043 1.9233 $104.41 ............

$20.88 23615................. T.................... ..................... Treat humerus fracture. 0046 31.9719 $1,735.72 $535.76 $347.14 23616................. T.................... ..................... Treat humerus fracture. 0046 31.9719 $1,735.72 $535.76 $347.14 23620................. T.................... ..................... Treat humerus fracture. 0043 1.9233 $104.41 ............

$20.88

[[Page 48047]]

23625................. T.................... ..................... Treat humerus fracture. 0043 1.9233 $104.41 ............

$20.88 23630................. T.................... ..................... Treat humerus fracture. 0046 31.9719 $1,735.72 $535.76 $347.14 23650................. T.................... ..................... Treat shoulder

0043 1.9233 $104.41 ............

$20.88 dislocation. 23655................. T.................... ..................... Treat shoulder

0045 13.5546 $735.87 $268.47 $147.17 dislocation. 23660................. T.................... ..................... Treat shoulder

0046 31.9719 $1,735.72 $535.76 $347.14 dislocation. 23665................. T.................... ..................... Treat dislocation/

0043 1.9233 $104.41 ............

$20.88 fracture. 23670................. T.................... ..................... Treat dislocation/

0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 23675................. T.................... ..................... Treat dislocation/

0043 1.9233 $104.41 ............

$20.88 fracture. 23680................. T.................... ..................... Treat dislocation/

0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 23700................. T.................... ..................... Fixation of shoulder... 0045 13.5546 $735.87 $268.47 $147.17 23800................. T.................... ..................... Fusion of shoulder

0051 34.9381 $1,896.75 ............ $379.35 joint. 23802................. T.................... ..................... Fusion of shoulder

0051 34.9381 $1,896.75 ............ $379.35 joint. 23900................. C.................... ..................... Amputation of arm & ..... ......... ........... ............ ............ girdle. 23920................. C.................... ..................... Amputation at shoulder ..... ......... ........... ............ ............ joint. 23921................. T.................... ..................... Amputation follow-up 0025 6.2703 $340.41 $115.49

$68.08 surgery. 23929................. T.................... ..................... Shoulder surgery

0043 1.9233 $104.41 ............

$20.88 procedure. 23930................. T.................... ..................... Drainage of arm lesion. 0008 16.8303 $913.70 ............ $182.74 23931................. T.................... ..................... Drainage of arm bursa.. 0006 1.7487 $94.94

$24.12

$18.99 23935................. T.................... ..................... Drain arm/elbow bone 0049 19.9376 $1,082.39 ............ $216.48 lesion. 24000................. T.................... ..................... Exploratory elbow

0050 25.1166 $1,363.56 ............ $272.71 surgery. 24006................. T.................... ..................... Release elbow joint.... 0050 25.1166 $1,363.56 ............ $272.71 24065................. T.................... ..................... Biopsy arm/elbow soft 0021 14.5749 $791.26 $219.48 $158.25 tissue. 24066................. T.................... ..................... Biopsy arm/elbow soft 0021 14.5749 $791.26 $219.48 $158.25 tissue. 24075................. T.................... ..................... Remove arm/elbow lesion 0021 14.5749 $791.26 $219.48 $158.25 24076................. T.................... ..................... Remove arm/elbow lesion 0022 18.6725 $1,013.71 $354.45 $202.74 24077................. T.................... ..................... Remove tumor of arm/ 0022 18.6725 $1,013.71 $354.45 $202.74 elbow. 24100................. T.................... ..................... Biopsy elbow joint

0049 19.9376 $1,082.39 ............ $216.48 lining. 24101................. T.................... ..................... Explore/treat elbow 0050 25.1166 $1,363.56 ............ $272.71 joint. 24102................. T.................... ..................... Remove elbow joint

0050 25.1166 $1,363.56 ............ $272.71 lining. 24105................. T.................... ..................... Removal of elbow bursa. 0049 19.9376 $1,082.39 ............ $216.48 24110................. T.................... ..................... Remove humerus lesion.. 0049 19.9376 $1,082.39 ............ $216.48 24115................. T.................... ..................... Remove/graft bone

0050 25.1166 $1,363.56 ............ $272.71 lesion. 24116................. T.................... ..................... Remove/graft bone

0050 25.1166 $1,363.56 ............ $272.71 lesion. 24120................. T.................... ..................... Remove elbow lesion.... 0049 19.9376 $1,082.39 ............ $216.48 24125................. T.................... ..................... Remove/graft bone

0050 25.1166 $1,363.56 ............ $272.71 lesion. 24126................. T.................... ..................... Remove/graft bone

0050 25.1166 $1,363.56 ............ $272.71 lesion. 24130................. T.................... ..................... Removal of head of

0050 25.1166 $1,363.56 ............ $272.71 radius. 24134................. T.................... ..................... Removal of arm bone 0050 25.1166 $1,363.56 ............ $272.71 lesion. 24136................. T.................... ..................... Remove radius bone

0050 25.1166 $1,363.56 ............ $272.71 lesion. 24138................. T.................... ..................... Remove elbow bone

0050 25.1166 $1,363.56 ............ $272.71 lesion. 24140................. T.................... ..................... Partial removal of arm 0050 25.1166 $1,363.56 ............ $272.71 bone. 24145................. T.................... ..................... Partial removal of

0050 25.1166 $1,363.56 ............ $272.71 radius. 24147................. T.................... ..................... Partial removal of

0050 25.1166 $1,363.56 ............ $272.71 elbow. 24149................. C.................... ..................... Radical resection of ..... ......... ........... ............ ............ elbow. 24150................. T.................... ..................... Extensive humerus

0052 42.6430 $2,315.05 ............ $463.01 surgery. 24151................. T.................... ..................... Extensive humerus

0052 42.6430 $2,315.05 ............ $463.01 surgery. 24152................. T.................... ..................... Extensive radius

0052 42.6430 $2,315.05 ............ $463.01 surgery. 24153................. T.................... ..................... Extensive radius

0052 42.6430 $2,315.05 ............ $463.01 surgery. 24155................. T.................... ..................... Removal of elbow joint. 0051 34.9381 $1,896.75 ............ $379.35 24160................. T.................... ..................... Remove elbow joint

0050 25.1166 $1,363.56 ............ $272.71 implant. 24164................. T.................... ..................... Remove radius head

0050 25.1166 $1,363.56 ............ $272.71 implant. 24200................. T.................... ..................... Removal of arm foreign 0019 3.9807 $216.11

$71.87

$43.22 body. 24201................. T.................... ..................... Removal of arm foreign 0021 14.5749 $791.26 $219.48 $158.25 body. 24220................. N.................... ..................... Injection for elbow x- ..... ......... ........... ............ ............ ray. 24300................. T.................... ..................... Manipulate elbow w/ 0045 13.5546 $735.87 $268.47 $147.17 anesth. 24301................. T.................... ..................... Muscle/tendon transfer. 0050 25.1166 $1,363.56 ............ $272.71 24305................. T.................... ..................... Arm tendon lengthening. 0050 25.1166 $1,363.56 ............ $272.71 24310................. T.................... ..................... Revision of arm tendon. 0049 19.9376 $1,082.39 ............ $216.48 24320................. T.................... ..................... Repair of arm tendon... 0051 34.9381 $1,896.75 ............ $379.35 24330................. T.................... ..................... Revision of arm muscles 0051 34.9381 $1,896.75 ............ $379.35 24331................. T.................... ..................... Revision of arm muscles 0051 34.9381 $1,896.75 ............ $379.35 24332................. T.................... ..................... Tenolysis, triceps..... 0049 19.9376 $1,082.39 ............ $216.48 24340................. T.................... ..................... Repair of biceps tendon 0051 34.9381 $1,896.75 ............ $379.35 24341................. T.................... ..................... Repair arm tendon/

0051 34.9381 $1,896.75 ............ $379.35 muscle. 24342................. T.................... ..................... Repair of ruptured

0051 34.9381 $1,896.75 ............ $379.35 tendon. 24343................. T.................... ..................... Repr elbow lat ligmnt w/ 0050 25.1166 $1,363.56 ............ $272.71 tiss.

[[Page 48048]]

24344................. T.................... ..................... Reconstruct elbow lat 0051 34.9381 $1,896.75 ............ $379.35 ligmnt. 24345................. T.................... ..................... Repr elbw med ligmnt w/ 0050 25.1166 $1,363.56 ............ $272.71 tissu. 24346................. T.................... ..................... Reconstruct elbow med 0051 34.9381 $1,896.75 ............ $379.35 ligmnt. 24350................. T.................... ..................... Repair of tennis elbow. 0050 25.1166 $1,363.56 ............ $272.71 24351................. T.................... ..................... Repair of tennis elbow. 0050 25.1166 $1,363.56 ............ $272.71 24352................. T.................... ..................... Repair of tennis elbow. 0050 25.1166 $1,363.56 ............ $272.71 24354................. T.................... ..................... Repair of tennis elbow. 0050 25.1166 $1,363.56 ............ $272.71 24356................. T.................... ..................... Revision of tennis

0050 25.1166 $1,363.56 ............ $272.71 elbow. 24360................. T.................... ..................... Reconstruct elbow joint 0047 30.3786 $1,649.22 $537.03 $329.84 24361................. T.................... ..................... Reconstruct elbow joint 0048 47.4707 $2,577.14 $695.60 $515.43 24362................. T.................... ..................... Reconstruct elbow joint 0048 47.4707 $2,577.14 $695.60 $515.43 24363................. T.................... ..................... Replace elbow joint.... 0048 47.4707 $2,577.14 $695.60 $515.43 24365................. T.................... ..................... Reconstruct head of 0047 30.3786 $1,649.22 $537.03 $329.84 radius. 24366................. T.................... ..................... Reconstruct head of 0048 47.4707 $2,577.14 $695.60 $515.43 radius. 24400................. T.................... ..................... Revision of humerus.... 0050 25.1166 $1,363.56 ............ $272.71 24410................. T.................... ..................... Revision of humerus.... 0050 25.1166 $1,363.56 ............ $272.71 24420................. T.................... ..................... Revision of humerus.... 0051 34.9381 $1,896.75 ............ $379.35 24430................. T.................... ..................... Repair of humerus...... 0051 34.9381 $1,896.75 ............ $379.35 24435................. T.................... ..................... Repair humerus with 0051 34.9381 $1,896.75 ............ $379.35 graft. 24470................. T.................... ..................... Revision of elbow joint 0051 34.9381 $1,896.75 ............ $379.35 24495................. T.................... ..................... Decompression of

0050 25.1166 $1,363.56 ............ $272.71 forearm. 24498................. T.................... ..................... Reinforce humerus...... 0051 34.9381 $1,896.75 ............ $379.35 24500................. T.................... ..................... Treat humerus fracture. 0043 1.9233 $104.41 ............

$20.88 24505................. T.................... ..................... Treat humerus fracture. 0043 1.9233 $104.41 ............

$20.88 24515................. T.................... ..................... Treat humerus fracture. 0046 31.9719 $1,735.72 $535.76 $347.14 24516................. T.................... ..................... Treat humerus fracture. 0046 31.9719 $1,735.72 $535.76 $347.14 24530................. T.................... ..................... Treat humerus fracture. 0043 1.9233 $104.41 ............

$20.88 24535................. T.................... ..................... Treat humerus fracture. 0043 1.9233 $104.41 ............

$20.88 24538................. T.................... ..................... Treat humerus fracture. 0046 31.9719 $1,735.72 $535.76 $347.14 24545................. T.................... ..................... Treat humerus fracture. 0046 31.9719 $1,735.72 $535.76 $347.14 24546................. T.................... ..................... Treat humerus fracture. 0046 31.9719 $1,735.72 $535.76 $347.14 24560................. T.................... ..................... Treat humerus fracture. 0043 1.9233 $104.41 ............

$20.88 24565................. T.................... ..................... Treat humerus fracture. 0043 1.9233 $104.41 ............

$20.88 24566................. T.................... ..................... Treat humerus fracture. 0046 31.9719 $1,735.72 $535.76 $347.14 24575................. T.................... ..................... Treat humerus fracture. 0046 31.9719 $1,735.72 $535.76 $347.14 24576................. T.................... ..................... Treat humerus fracture. 0043 1.9233 $104.41 ............

$20.88 24577................. T.................... ..................... Treat humerus fracture. 0043 1.9233 $104.41 ............

$20.88 24579................. T.................... ..................... Treat humerus fracture. 0046 31.9719 $1,735.72 $535.76 $347.14 24582................. T.................... ..................... Treat humerus fracture. 0046 31.9719 $1,735.72 $535.76 $347.14 24586................. T.................... ..................... Treat elbow fracture... 0046 31.9719 $1,735.72 $535.76 $347.14 24587................. T.................... ..................... Treat elbow fracture... 0046 31.9719 $1,735.72 $535.76 $347.14 24600................. T.................... ..................... Treat elbow dislocation 0043 1.9233 $104.41 ............

$20.88 24605................. T.................... ..................... Treat elbow dislocation 0045 13.5546 $735.87 $268.47 $147.17 24615................. T.................... ..................... Treat elbow dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 24620................. T.................... ..................... Treat elbow fracture... 0043 1.9233 $104.41 ............

$20.88 24635................. T.................... ..................... Treat elbow fracture... 0046 31.9719 $1,735.72 $535.76 $347.14 24640................. T.................... ..................... Treat elbow dislocation 0043 1.9233 $104.41 ............

$20.88 24650................. T.................... ..................... Treat radius fracture.. 0043 1.9233 $104.41 ............

$20.88 24655................. T.................... ..................... Treat radius fracture.. 0043 1.9233 $104.41 ............

$20.88 24665................. T.................... ..................... Treat radius fracture.. 0046 31.9719 $1,735.72 $535.76 $347.14 24666................. T.................... ..................... Treat radius fracture.. 0046 31.9719 $1,735.72 $535.76 $347.14 24670................. T.................... ..................... Treat ulnar fracture... 0043 1.9233 $104.41 ............

$20.88 24675................. T.................... ..................... Treat ulnar fracture... 0043 1.9233 $104.41 ............

$20.88 24685................. T.................... ..................... Treat ulnar fracture... 0046 31.9719 $1,735.72 $535.76 $347.14 24800................. T.................... ..................... Fusion of elbow joint.. 0051 34.9381 $1,896.75 ............ $379.35 24802................. T.................... ..................... Fusion/graft of elbow 0051 34.9381 $1,896.75 ............ $379.35 joint. 24900................. C.................... ..................... Amputation of upper arm ..... ......... ........... ............ ............ 24920................. C.................... ..................... Amputation of upper arm ..... ......... ........... ............ ............ 24925................. T.................... ..................... Amputation follow-up 0049 19.9376 $1,082.39 ............ $216.48 surgery. 24930................. C.................... ..................... Amputation follow-up ..... ......... ........... ............ ............ surgery. 24931................. C.................... ..................... Amputate upper arm & ..... ......... ........... ............ ............ implant. 24935................. T.................... ..................... Revision of amputation. 0052 42.6430 $2,315.05 ............ $463.01 24940................. C.................... ..................... Revision of upper arm.. ..... ......... ........... ............ ............ 24999................. T.................... ..................... Upper arm/elbow surgery 0043 1.9233 $104.41 ............

$20.88 25000................. T.................... ..................... Incision of tendon

0049 19.9376 $1,082.39 ............ $216.48 sheath. 25001................. T.................... ..................... Incise flexor carpi 0049 19.9376 $1,082.39 ............ $216.48 radialis.

[[Page 48049]]

25020................. T.................... ..................... Decompress forearm 1 0049 19.9376 $1,082.39 ............ $216.48 space. 25023................. T.................... ..................... Decompress forearm 1 0050 25.1166 $1,363.56 ............ $272.71 space. 25024................. T.................... ..................... Decompress forearm 2 0050 25.1166 $1,363.56 ............ $272.71 spaces. 25025................. T.................... ..................... Decompress forarm 2 0050 25.1166 $1,363.56 ............ $272.71 spaces. 25028................. T.................... ..................... Drainage of forearm 0049 19.9376 $1,082.39 ............ $216.48 lesion. 25031................. T.................... ..................... Drainage of forearm 0049 19.9376 $1,082.39 ............ $216.48 bursa. 25035................. T.................... ..................... Treat forearm bone

0049 19.9376 $1,082.39 ............ $216.48 lesion. 25040................. T.................... ..................... Explore/treat wrist 0050 25.1166 $1,363.56 ............ $272.71 joint. 25065................. T.................... ..................... Biopsy forearm soft 0021 14.5749 $791.26 $219.48 $158.25 tissues. 25066................. T.................... ..................... Biopsy forearm soft 0022 18.6725 $1,013.71 $354.45 $202.74 tissues. 25075................. T.................... ..................... Removel forearm lesion 0021 14.5749 $791.26 $219.48 $158.25 subcu. 25076................. T.................... ..................... Removel forearm lesion 0022 18.6725 $1,013.71 $354.45 $202.74 deep. 25077................. T.................... ..................... Remove tumor, forearm/ 0022 18.6725 $1,013.71 $354.45 $202.74 wrist. 25085................. T.................... ..................... Incision of wrist

0049 19.9376 $1,082.39 ............ $216.48 capsule. 25100................. T.................... ..................... Biopsy of wrist joint.. 0049 19.9376 $1,082.39 ............ $216.48 25101................. T.................... ..................... Explore/treat wrist 0050 25.1166 $1,363.56 ............ $272.71 joint. 25105................. T.................... ..................... Remove wrist joint

0050 25.1166 $1,363.56 ............ $272.71 lining. 25107................. T.................... ..................... Remove wrist joint

0050 25.1166 $1,363.56 ............ $272.71 cartilage. 25110................. T.................... ..................... Remove wrist tendon 0049 19.9376 $1,082.39 ............ $216.48 lesion. 25111................. T.................... ..................... Remove wrist tendon 0053 14.8188 $804.50 $253.49 $160.90 lesion. 25112................. T.................... ..................... Reremove wrist tendon 0053 14.8188 $804.50 $253.49 $160.90 lesion. 25115................. T.................... ..................... Remove wrist/forearm 0049 19.9376 $1,082.39 ............ $216.48 lesion. 25116................. T.................... ..................... Remove wrist/forearm 0049 19.9376 $1,082.39 ............ $216.48 lesion. 25118................. T.................... ..................... Excise wrist tendon 0050 25.1166 $1,363.56 ............ $272.71 sheath. 25119................. T.................... ..................... Partial removal of ulna 0050 25.1166 $1,363.56 ............ $272.71 25120................. T.................... ..................... Removal of forearm

0050 25.1166 $1,363.56 ............ $272.71 lesion. 25125................. T.................... ..................... Remove/graft forearm 0050 25.1166 $1,363.56 ............ $272.71 lesion. 25126................. T.................... ..................... Remove/graft forearm 0050 25.1166 $1,363.56 ............ $272.71 lesion. 25130................. T.................... ..................... Removal of wrist lesion 0050 25.1166 $1,363.56 ............ $272.71 25135................. T.................... ..................... Remove & graft wrist 0050 25.1166 $1,363.56 ............ $272.71 lesion. 25136................. T.................... ..................... Remove & graft wrist 0050 25.1166 $1,363.56 ............ $272.71 lesion. 25145................. T.................... ..................... Remove forearm bone 0050 25.1166 $1,363.56 ............ $272.71 lesion. 25150................. T.................... ..................... Partial removal of ulna 0050 25.1166 $1,363.56 ............ $272.71 25151................. T.................... ..................... Partial removal of

0050 25.1166 $1,363.56 ............ $272.71 radius. 25170................. T.................... ..................... Extensive forearm

0052 42.6430 $2,315.05 ............ $463.01 surgery. 25210................. T.................... ..................... Removal of wrist bone.. 0054 24.2685 $1,317.51 ............ $263.50 25215................. T.................... ..................... Removal of wrist bones. 0054 24.2685 $1,317.51 ............ $263.50 25230................. T.................... ..................... Partial removal of

0050 25.1166 $1,363.56 ............ $272.71 radius. 25240................. T.................... ..................... Partial removal of ulna 0050 25.1166 $1,363.56 ............ $272.71 25246................. N.................... ..................... Injection for wrist x- ..... ......... ........... ............ ............ ray. 25248................. T.................... ..................... Remove forearm foreign 0049 19.9376 $1,082.39 ............ $216.48 body. 25250................. T.................... ..................... Removal of wrist

0050 25.1166 $1,363.56 ............ $272.71 prosthesis. 25251................. T.................... ..................... Removal of wrist

0050 25.1166 $1,363.56 ............ $272.71 prosthesis. 25259................. T.................... ..................... Manipulate wrist w/ 0043 1.9233 $104.41 ............

$20.88 anesthes. 25260................. T.................... ..................... Repair forearm tendon/ 0050 25.1166 $1,363.56 ............ $272.71 muscle. 25263................. T.................... ..................... Repair forearm tendon/ 0050 25.1166 $1,363.56 ............ $272.71 muscle. 25265................. T.................... ..................... Repair forearm tendon/ 0050 25.1166 $1,363.56 ............ $272.71 muscle. 25270................. T.................... ..................... Repair forearm tendon/ 0050 25.1166 $1,363.56 ............ $272.71 muscle. 25272................. T.................... ..................... Repair forearm tendon/ 0050 25.1166 $1,363.56 ............ $272.71 muscle. 25274................. T.................... ..................... Repair forearm tendon/ 0050 25.1166 $1,363.56 ............ $272.71 muscle. 25275................. T.................... ..................... Repair forearm tendon 0050 25.1166 $1,363.56 ............ $272.71 sheath. 25280................. T.................... ..................... Revise wrist/forearm 0050 25.1166 $1,363.56 ............ $272.71 tendon. 25290................. T.................... ..................... Incise wrist/forearm 0050 25.1166 $1,363.56 ............ $272.71 tendon. 25295................. T.................... ..................... Release wrist/forearm 0049 19.9376 $1,082.39 ............ $216.48 tendon. 25300................. T.................... ..................... Fusion of tendons at 0050 25.1166 $1,363.56 ............ $272.71 wrist. 25301................. T.................... ..................... Fusion of tendons at 0050 25.1166 $1,363.56 ............ $272.71 wrist. 25310................. T.................... ..................... Transplant forearm

0051 34.9381 $1,896.75 ............ $379.35 tendon. 25312................. T.................... ..................... Transplant forearm

0051 34.9381 $1,896.75 ............ $379.35 tendon. 25315................. T.................... ..................... Revise palsy hand

0051 34.9381 $1,896.75 ............ $379.35 tendon(s). 25316................. T.................... ..................... Revise palsy hand

0051 34.9381 $1,896.75 ............ $379.35 tendon(s). 25320................. T.................... ..................... Repair/revise wrist 0051 34.9381 $1,896.75 ............ $379.35 joint. 25332................. T.................... ..................... Revise wrist joint..... 0047 30.3786 $1,649.22 $537.03 $329.84 25335................. T.................... ..................... Realignment of hand.... 0051 34.9381 $1,896.75 ............ $379.35 25337................. T.................... ..................... Reconstruct ulna/

0051 34.9381 $1,896.75 ............ $379.35 radioulnar. 25350................. T.................... ..................... Revision of radius..... 0051 34.9381 $1,896.75 ............ $379.35 25355................. T.................... ..................... Revision of radius..... 0051 34.9381 $1,896.75 ............ $379.35

[[Page 48050]]

25360................. T.................... ..................... Revision of ulna....... 0050 25.1166 $1,363.56 ............ $272.71 25365................. T.................... ..................... Revise radius & ulna... 0050 25.1166 $1,363.56 ............ $272.71 25370................. T.................... ..................... Revise radius or ulna.. 0051 34.9381 $1,896.75 ............ $379.35 25375................. T.................... ..................... Revise radius & ulna... 0051 34.9381 $1,896.75 ............ $379.35 25390................. T.................... ..................... Shorten radius or ulna. 0050 25.1166 $1,363.56 ............ $272.71 25391................. T.................... ..................... Lengthen radius or ulna 0051 34.9381 $1,896.75 ............ $379.35 25392................. T.................... ..................... Shorten radius & ulna.. 0050 25.1166 $1,363.56 ............ $272.71 25393................. T.................... ..................... Lengthen radius & ulna. 0051 34.9381 $1,896.75 ............ $379.35 25394................. T.................... ..................... Repair carpal bone, 0053 14.8188 $804.50 $253.49 $160.90 shorten. 25400................. T.................... ..................... Repair radius or ulna.. 0050 25.1166 $1,363.56 ............ $272.71 25405................. T.................... ..................... Repair/graft radius or 0050 25.1166 $1,363.56 ............ $272.71 ulna. 25415................. T.................... ..................... Repair radius & ulna... 0050 25.1166 $1,363.56 ............ $272.71 25420................. T.................... ..................... Repair/graft radius & 0051 34.9381 $1,896.75 ............ $379.35 ulna. 25425................. T.................... ..................... Repair/graft radius or 0051 34.9381 $1,896.75 ............ $379.35 ulna. 25426................. T.................... ..................... Repair/graft radius & 0051 34.9381 $1,896.75 ............ $379.35 ulna. 25430................. T.................... ..................... Vasc graft into carpal 0054 24.2685 $1,317.51 ............ $263.50 bone. 25431................. T.................... ..................... Repair nonunion carpal 0054 24.2685 $1,317.51 ............ $263.50 bone. 25440................. T.................... ..................... Repair/graft wrist bone 0051 34.9381 $1,896.75 ............ $379.35 25441................. T.................... ..................... Reconstruct wrist joint 0048 47.4707 $2,577.14 $695.60 $515.43 25442................. T.................... ..................... Reconstruct wrist joint 0048 47.4707 $2,577.14 $695.60 $515.43 25443................. T.................... ..................... Reconstruct wrist joint 0048 47.4707 $2,577.14 $695.60 $515.43 25444................. T.................... ..................... Reconstruct wrist joint 0048 47.4707 $2,577.14 $695.60 $515.43 25445................. T.................... ..................... Reconstruct wrist joint 0048 47.4707 $2,577.14 $695.60 $515.43 25446................. T.................... ..................... Wrist replacement...... 0048 47.4707 $2,577.14 $695.60 $515.43 25447................. T.................... ..................... Repair wrist joint(s).. 0047 30.3786 $1,649.22 $537.03 $329.84 25449................. T.................... ..................... Remove wrist joint

0047 30.3786 $1,649.22 $537.03 $329.84 implant. 25450................. T.................... ..................... Revision of wrist joint 0051 34.9381 $1,896.75 ............ $379.35 25455................. T.................... ..................... Revision of wrist joint 0051 34.9381 $1,896.75 ............ $379.35 25490................. T.................... ..................... Reinforce radius....... 0051 34.9381 $1,896.75 ............ $379.35 25491................. T.................... ..................... Reinforce ulna......... 0051 34.9381 $1,896.75 ............ $379.35 25492................. T.................... ..................... Reinforce radius and 0051 34.9381 $1,896.75 ............ $379.35 ulna. 25500................. T.................... ..................... Treat fracture of

0043 1.9233 $104.41 ............

$20.88 radius. 25505................. T.................... ..................... Treat fracture of

0043 1.9233 $104.41 ............

$20.88 radius. 25515................. T.................... ..................... Treat fracture of

0046 31.9719 $1,735.72 $535.76 $347.14 radius. 25520................. T.................... ..................... Treat fracture of

0043 1.9233 $104.41 ............

$20.88 radius. 25525................. T.................... ..................... Treat fracture of

0046 31.9719 $1,735.72 $535.76 $347.14 radius. 25526................. T.................... ..................... Treat fracture of

0046 31.9719 $1,735.72 $535.76 $347.14 radius. 25530................. T.................... ..................... Treat fracture of ulna. 0043 1.9233 $104.41 ............

$20.88 25535................. T.................... ..................... Treat fracture of ulna. 0043 1.9233 $104.41 ............

$20.88 25545................. T.................... ..................... Treat fracture of ulna. 0046 31.9719 $1,735.72 $535.76 $347.14 25560................. T.................... ..................... Treat fracture radius & 0043 1.9233 $104.41 ............

$20.88 ulna. 25565................. T.................... ..................... Treat fracture radius & 0043 1.9233 $104.41 ............

$20.88 ulna. 25574................. T.................... ..................... Treat fracture radius & 0046 31.9719 $1,735.72 $535.76 $347.14 ulna. 25575................. T.................... ..................... Treat fracture radius/ 0046 31.9719 $1,735.72 $535.76 $347.14 ulna. 25600................. T.................... ..................... Treat fracture radius/ 0043 1.9233 $104.41 ............

$20.88 ulna. 25605................. T.................... ..................... Treat fracture radius/ 0043 1.9233 $104.41 ............

$20.88 ulna. 25611................. T.................... ..................... Treat fracture radius/ 0046 31.9719 $1,735.72 $535.76 $347.14 ulna. 25620................. T.................... ..................... Treat fracture radius/ 0046 31.9719 $1,735.72 $535.76 $347.14 ulna. 25622................. T.................... ..................... Treat wrist bone

0043 1.9233 $104.41 ............

$20.88 fracture. 25624................. T.................... ..................... Treat wrist bone

0043 1.9233 $104.41 ............

$20.88 fracture. 25628................. T.................... ..................... Treat wrist bone

0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 25630................. T.................... ..................... Treat wrist bone

0043 1.9233 $104.41 ............

$20.88 fracture. 25635................. T.................... ..................... Treat wrist bone

0043 1.9233 $104.41 ............

$20.88 fracture. 25645................. T.................... ..................... Treat wrist bone

0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 25650................. T.................... ..................... Treat wrist bone

0043 1.9233 $104.41 ............

$20.88 fracture. 25651................. T.................... ..................... Pin ulnar styloid

0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 25652................. T.................... ..................... Treat fracture ulnar 0046 31.9719 $1,735.72 $535.76 $347.14 styloid. 25660................. T.................... ..................... Treat wrist dislocation 0043 1.9233 $104.41 ............

$20.88 25670................. T.................... ..................... Treat wrist dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 25671................. T.................... ..................... Pin radioulnar

0046 31.9719 $1,735.72 $535.76 $347.14 dislocation. 25675................. T.................... ..................... Treat wrist dislocation 0043 1.9233 $104.41 ............

$20.88 25676................. T.................... ..................... Treat wrist dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 25680................. T.................... ..................... Treat wrist fracture... 0043 1.9233 $104.41 ............

$20.88 25685................. T.................... ..................... Treat wrist fracture... 0046 31.9719 $1,735.72 $535.76 $347.14 25690................. T.................... ..................... Treat wrist dislocation 0043 1.9233 $104.41 ............

$20.88 25695................. T.................... ..................... Treat wrist dislocation 0046 31.9719 $1,735.72 $535.76 $347.14

[[Page 48051]]

25800................. T.................... ..................... Fusion of wrist joint.. 0051 34.9381 $1,896.75 ............ $379.35 25805................. T.................... ..................... Fusion/graft of wrist 0051 34.9381 $1,896.75 ............ $379.35 joint. 25810................. T.................... ..................... Fusion/graft of wrist 0051 34.9381 $1,896.75 ............ $379.35 joint. 25820................. T.................... ..................... Fusion of hand bones... 0053 14.8188 $804.50 $253.49 $160.90 25825................. T.................... ..................... Fuse hand bones with 0054 24.2685 $1,317.51 ............ $263.50 graft. 25830................. T.................... ..................... Fusion, radioulnar jnt/ 0051 34.9381 $1,896.75 ............ $379.35 ulna. 25900................. C.................... ..................... Amputation of forearm.. ..... ......... ........... ............ ............ 25905................. C.................... ..................... Amputation of forearm.. ..... ......... ........... ............ ............ 25907................. T.................... ..................... Amputation follow-up 0049 19.9376 $1,082.39 ............ $216.48 surgery. 25909................. C.................... ..................... Amputation follow-up ..... ......... ........... ............ ............ surgery. 25915................. C.................... ..................... Amputation of forearm.. ..... ......... ........... ............ ............ 25920................. C.................... ..................... Amputate hand at wrist. ..... ......... ........... ............ ............ 25922................. T.................... ..................... Amputate hand at wrist. 0049 19.9376 $1,082.39 ............ $216.48 25924................. C.................... ..................... Amputation follow-up ..... ......... ........... ............ ............ surgery. 25927................. C.................... ..................... Amputation of hand..... ..... ......... ........... ............ ............ 25929................. T.................... ..................... Amputation follow-up 0027 15.8319 $859.50 $329.72 $171.90 surgery. 25931................. C.................... ..................... Amputation follow-up ..... ......... ........... ............ ............ surgery. 25999................. T.................... ..................... Forearm or wrist

0043 1.9233 $104.41 ............

$20.88 surgery. 26010................. T.................... ..................... Drainage of finger

0006 1.7487 $94.94

$24.12

$18.99 abscess. 26011................. T.................... ..................... Drainage of finger

0007 11.4943 $624.01 ............ $124.80 abscess. 26020................. T.................... ..................... Drain hand tendon

0053 14.8188 $804.50 $253.49 $160.90 sheath. 26025................. T.................... ..................... Drainage of palm bursa. 0053 14.8188 $804.50 $253.49 $160.90 26030................. T.................... ..................... Drainage of palm

0053 14.8188 $804.50 $253.49 $160.90 bursa(s). 26034................. T.................... ..................... Treat hand bone lesion. 0053 14.8188 $804.50 $253.49 $160.90 26035................. T.................... ..................... Decompress fingers/hand 0053 14.8188 $804.50 $253.49 $160.90 26037................. T.................... ..................... Decompress fingers/hand 0053 14.8188 $804.50 $253.49 $160.90 26040................. T.................... ..................... Release palm

0054 24.2685 $1,317.51 ............ $263.50 contracture. 26045................. T.................... ..................... Release palm

0054 24.2685 $1,317.51 ............ $263.50 contracture. 26055................. T.................... ..................... Incise finger tendon 0053 14.8188 $804.50 $253.49 $160.90 sheath. 26060................. T.................... ..................... Incision of finger

0053 14.8188 $804.50 $253.49 $160.90 tendon. 26070................. T.................... ..................... Explore/treat hand

0053 14.8188 $804.50 $253.49 $160.90 joint. 26075................. T.................... ..................... Explore/treat finger 0053 14.8188 $804.50 $253.49 $160.90 joint. 26080................. T.................... ..................... Explore/treat finger 0053 14.8188 $804.50 $253.49 $160.90 joint. 26100................. T.................... ..................... Biopsy hand joint

0053 14.8188 $804.50 $253.49 $160.90 lining. 26105................. T.................... ..................... Biopsy finger joint 0053 14.8188 $804.50 $253.49 $160.90 lining. 26110................. T.................... ..................... Biopsy finger joint 0053 14.8188 $804.50 $253.49 $160.90 lining. 26115................. T.................... ..................... Removel hand lesion 0022 18.6725 $1,013.71 $354.45 $202.74 subcut. 26116................. T.................... ..................... Removel hand lesion, 0022 18.6725 $1,013.71 $354.45 $202.74 deep. 26117................. T.................... ..................... Remove tumor, hand/ 0022 18.6725 $1,013.71 $354.45 $202.74 finger. 26121................. T.................... ..................... Release palm

0054 24.2685 $1,317.51 ............ $263.50 contracture. 26123................. T.................... ..................... Release palm

0054 24.2685 $1,317.51 ............ $263.50 contracture. 26125................. T.................... ..................... Release palm

0054 24.2685 $1,317.51 ............ $263.50 contracture. 26130................. T.................... ..................... Remove wrist joint

0053 14.8188 $804.50 $253.49 $160.90 lining. 26135................. T.................... ..................... Revise finger joint, 0054 24.2685 $1,317.51 ............ $263.50 each. 26140................. T.................... ..................... Revise finger joint, 0053 14.8188 $804.50 $253.49 $160.90 each. 26145................. T.................... ..................... Tendon excision, palm/ 0053 14.8188 $804.50 $253.49 $160.90 finger. 26160................. T.................... ..................... Remove tendon sheath 0053 14.8188 $804.50 $253.49 $160.90 lesion. 26170................. T.................... ..................... Removal of palm tendon, 0053 14.8188 $804.50 $253.49 $160.90 each. 26180................. T.................... ..................... Removal of finger

0053 14.8188 $804.50 $253.49 $160.90 tendon. 26185................. T.................... ..................... Remove finger bone..... 0053 14.8188 $804.50 $253.49 $160.90 26200................. T.................... ..................... Remove hand bone lesion 0053 14.8188 $804.50 $253.49 $160.90 26205................. T.................... ..................... Remove/graft bone

0054 24.2685 $1,317.51 ............ $263.50 lesion. 26210................. T.................... ..................... Removal of finger

0053 14.8188 $804.50 $253.49 $160.90 lesion. 26215................. T.................... ..................... Remove/graft finger 0053 14.8188 $804.50 $253.49 $160.90 lesion. 26230................. T.................... ..................... Partial removal of hand 0053 14.8188 $804.50 $253.49 $160.90 bone. 26235................. T.................... ..................... Partial removal, finger 0053 14.8188 $804.50 $253.49 $160.90 bone. 26236................. T.................... ..................... Partial removal, finger 0053 14.8188 $804.50 $253.49 $160.90 bone. 26250................. T.................... ..................... Extensive hand surgery. 0053 14.8188 $804.50 $253.49 $160.90 26255................. T.................... ..................... Extensive hand surgery. 0054 24.2685 $1,317.51 ............ $263.50 26260................. T.................... ..................... Extensive finger

0053 14.8188 $804.50 $253.49 $160.90 surgery. 26261................. T.................... ..................... Extensive finger

0053 14.8188 $804.50 $253.49 $160.90 surgery. 26262................. T.................... ..................... Partial removal of

0053 14.8188 $804.50 $253.49 $160.90 finger. 26320................. T.................... ..................... Removal of implant from 0021 14.5749 $791.26 $219.48 $158.25 hand. 26340................. T.................... ..................... Manipulate finger w/ 0043 1.9233 $104.41 ............

$20.88 anesth. 26350................. T.................... ..................... Repair finger/hand

0054 24.2685 $1,317.51 ............ $263.50 tendon. 26352................. T.................... ..................... Repair/graft hand

0054 24.2685 $1,317.51 ............ $263.50 tendon.

[[Page 48052]]

26356................. T.................... ..................... Repair finger/hand

0054 24.2685 $1,317.51 ............ $263.50 tendon. 26357................. T.................... ..................... Repair finger/hand

0054 24.2685 $1,317.51 ............ $263.50 tendon. 26358................. T.................... ..................... Repair/graft hand

0054 24.2685 $1,317.51 ............ $263.50 tendon. 26370................. T.................... ..................... Repair finger/hand

0054 24.2685 $1,317.51 ............ $263.50 tendon. 26372................. T.................... ..................... Repair/graft hand

0054 24.2685 $1,317.51 ............ $263.50 tendon. 26373................. T.................... ..................... Repair finger/hand

0054 24.2685 $1,317.51 ............ $263.50 tendon. 26390................. T.................... ..................... Revise hand/finger

0054 24.2685 $1,317.51 ............ $263.50 tendon. 26392................. T.................... ..................... Repair/graft hand

0054 24.2685 $1,317.51 ............ $263.50 tendon. 26410................. T.................... ..................... Repair hand tendon..... 0053 14.8188 $804.50 $253.49 $160.90 26412................. T.................... ..................... Repair/graft hand

0054 24.2685 $1,317.51 ............ $263.50 tendon. 26415................. T.................... ..................... Excision, hand/finger 0054 24.2685 $1,317.51 ............ $263.50 tendon. 26416................. T.................... ..................... Graft hand or finger 0054 24.2685 $1,317.51 ............ $263.50 tendon. 26418................. T.................... ..................... Repair finger tendon... 0053 14.8188 $804.50 $253.49 $160.90 26420................. T.................... ..................... Repair/graft finger 0054 24.2685 $1,317.51 ............ $263.50 tendon. 26426................. T.................... ..................... Repair finger/hand

0054 24.2685 $1,317.51 ............ $263.50 tendon. 26428................. T.................... ..................... Repair/graft finger 0054 24.2685 $1,317.51 ............ $263.50 tendon. 26432................. T.................... ..................... Repair finger tendon... 0053 14.8188 $804.50 $253.49 $160.90 26433................. T.................... ..................... Repair finger tendon... 0053 14.8188 $804.50 $253.49 $160.90 26434................. T.................... ..................... Repair/graft finger 0054 24.2685 $1,317.51 ............ $263.50 tendon. 26437................. T.................... ..................... Realignment of tendons. 0053 14.8188 $804.50 $253.49 $160.90 26440................. T.................... ..................... Release palm/finger 0053 14.8188 $804.50 $253.49 $160.90 tendon. 26442................. T.................... ..................... Release palm & finger 0054 24.2685 $1,317.51 ............ $263.50 tendon. 26445................. T.................... ..................... Release hand/finger 0053 14.8188 $804.50 $253.49 $160.90 tendon. 26449................. T.................... ..................... Release forearm/hand 0054 24.2685 $1,317.51 ............ $263.50 tendon. 26450................. T.................... ..................... Incision of palm tendon 0053 14.8188 $804.50 $253.49 $160.90 26455................. T.................... ..................... Incision of finger

0053 14.8188 $804.50 $253.49 $160.90 tendon. 26460................. T.................... ..................... Incise hand/finger

0053 14.8188 $804.50 $253.49 $160.90 tendon. 26471................. T.................... ..................... Fusion of finger

0053 14.8188 $804.50 $253.49 $160.90 tendons. 26474................. T.................... ..................... Fusion of finger

0053 14.8188 $804.50 $253.49 $160.90 tendons. 26476................. T.................... ..................... Tendon lengthening..... 0053 14.8188 $804.50 $253.49 $160.90 26477................. T.................... ..................... Tendon shortening...... 0053 14.8188 $804.50 $253.49 $160.90 26478................. T.................... ..................... Lengthening of hand 0053 14.8188 $804.50 $253.49 $160.90 tendon. 26479................. T.................... ..................... Shortening of hand

0053 14.8188 $804.50 $253.49 $160.90 tendon. 26480................. T.................... ..................... Transplant hand tendon. 0054 24.2685 $1,317.51 ............ $263.50 26483................. T.................... ..................... Transplant/graft hand 0054 24.2685 $1,317.51 ............ $263.50 tendon. 26485................. T.................... ..................... Transplant palm tendon. 0054 24.2685 $1,317.51 ............ $263.50 26489................. T.................... ..................... Transplant/graft palm 0054 24.2685 $1,317.51 ............ $263.50 tendon. 26490................. T.................... ..................... Revise thumb tendon.... 0054 24.2685 $1,317.51 ............ $263.50 26492................. T.................... ..................... Tendon transfer with 0054 24.2685 $1,317.51 ............ $263.50 graft. 26494................. T.................... ..................... Hand tendon/muscle

0054 24.2685 $1,317.51 ............ $263.50 transfer. 26496................. T.................... ..................... Revise thumb tendon.... 0054 24.2685 $1,317.51 ............ $263.50 26497................. T.................... ..................... Finger tendon transfer. 0054 24.2685 $1,317.51 ............ $263.50 26498................. T.................... ..................... Finger tendon transfer. 0054 24.2685 $1,317.51 ............ $263.50 26499................. T.................... ..................... Revision of finger..... 0054 24.2685 $1,317.51 ............ $263.50 26500................. T.................... ..................... Hand tendon

0053 14.8188 $804.50 $253.49 $160.90 reconstruction. 26502................. T.................... ..................... Hand tendon

0054 24.2685 $1,317.51 ............ $263.50 reconstruction. 26504................. T.................... ..................... Hand tendon

0054 24.2685 $1,317.51 ............ $263.50 reconstruction. 26508................. T.................... ..................... Release thumb

0053 14.8188 $804.50 $253.49 $160.90 contracture. 26510................. T.................... ..................... Thumb tendon transfer.. 0054 24.2685 $1,317.51 ............ $263.50 26516................. T.................... ..................... Fusion of knuckle joint 0054 24.2685 $1,317.51 ............ $263.50 26517................. T.................... ..................... Fusion of knuckle

0054 24.2685 $1,317.51 ............ $263.50 joints. 26518................. T.................... ..................... Fusion of knuckle

0054 24.2685 $1,317.51 ............ $263.50 joints. 26520................. T.................... ..................... Release knuckle

0053 14.8188 $804.50 $253.49 $160.90 contracture. 26525................. T.................... ..................... Release finger

0053 14.8188 $804.50 $253.49 $160.90 contracture. 26530................. T.................... ..................... Revise knuckle joint... 0047 30.3786 $1,649.22 $537.03 $329.84 26531................. T.................... ..................... Revise knuckle with 0048 47.4707 $2,577.14 $695.60 $515.43 implant. 26535................. T.................... ..................... Revise finger joint.... 0047 30.3786 $1,649.22 $537.03 $329.84 26536................. T.................... ..................... Revise/implant finger 0048 47.4707 $2,577.14 $695.60 $515.43 joint. 26540................. T.................... ..................... Repair hand joint...... 0053 14.8188 $804.50 $253.49 $160.90 26541................. T.................... ..................... Repair hand joint with 0054 24.2685 $1,317.51 ............ $263.50 graft. 26542................. T.................... ..................... Repair hand joint with 0053 14.8188 $804.50 $253.49 $160.90 graft. 26545................. T.................... ..................... Reconstruct finger

0054 24.2685 $1,317.51 ............ $263.50 joint. 26546................. T.................... ..................... Repair nonunion hand... 0054 24.2685 $1,317.51 ............ $263.50 26548................. T.................... ..................... Reconstruct finger

0054 24.2685 $1,317.51 ............ $263.50 joint. 26550................. T.................... ..................... Construct thumb

0054 24.2685 $1,317.51 ............ $263.50 replacement. 26551................. C.................... ..................... Great toe-hand transfer ..... ......... ........... ............ ............

[[Page 48053]]

26553................. C.................... ..................... Single transfer, toe- ..... ......... ........... ............ ............ hand. 26554................. C.................... ..................... Double transfer, toe- ..... ......... ........... ............ ............ hand. 26555................. T.................... ..................... Positional change of 0054 24.2685 $1,317.51 ............ $263.50 finger. 26556................. C.................... ..................... Toe joint transfer..... ..... ......... ........... ............ ............ 26560................. T.................... ..................... Repair of web finger... 0053 14.8188 $804.50 $253.49 $160.90 26561................. T.................... ..................... Repair of web finger... 0054 24.2685 $1,317.51 ............ $263.50 26562................. T.................... ..................... Repair of web finger... 0054 24.2685 $1,317.51 ............ $263.50 26565................. T.................... ..................... Correct metacarpal flaw 0054 24.2685 $1,317.51 ............ $263.50 26567................. T.................... ..................... Correct finger

0054 24.2685 $1,317.51 ............ $263.50 deformity. 26568................. T.................... ..................... Lengthen metacarpal/ 0054 24.2685 $1,317.51 ............ $263.50 finger. 26580................. T.................... ..................... Repair hand deformity.. 0054 24.2685 $1,317.51 ............ $263.50 26587................. T.................... ..................... Reconstruct extra

0053 14.8188 $804.50 $253.49 $160.90 finger. 26590................. T.................... ..................... Repair finger deformity 0054 24.2685 $1,317.51 ............ $263.50 26591................. T.................... ..................... Repair muscles of hand. 0054 24.2685 $1,317.51 ............ $263.50 26593................. T.................... ..................... Release muscles of hand 0053 14.8188 $804.50 $253.49 $160.90 26596................. T.................... ..................... Excision constricting 0054 24.2685 $1,317.51 ............ $263.50 tissue. 26600................. T.................... ..................... Treat metacarpal

0043 1.9233 $104.41 ............

$20.88 fracture. 26605................. T.................... ..................... Treat metacarpal

0043 1.9233 $104.41 ............

$20.88 fracture. 26607................. T.................... ..................... Treat metacarpal

0043 1.9233 $104.41 ............

$20.88 fracture. 26608................. T.................... ..................... Treat metacarpal

0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 26615................. T.................... ..................... Treat metacarpal

0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 26641................. T.................... ..................... Treat thumb dislocation 0043 1.9233 $104.41 ............

$20.88 26645................. T.................... ..................... Treat thumb fracture... 0043 1.9233 $104.41 ............

$20.88 26650................. T.................... ..................... Treat thumb fracture... 0046 31.9719 $1,735.72 $535.76 $347.14 26665................. T.................... ..................... Treat thumb fracture... 0046 31.9719 $1,735.72 $535.76 $347.14 26670................. T.................... ..................... Treat hand dislocation. 0043 1.9233 $104.41 ............

$20.88 26675................. T.................... ..................... Treat hand dislocation. 0043 1.9233 $104.41 ............

$20.88 26676................. T.................... ..................... Pin hand dislocation... 0046 31.9719 $1,735.72 $535.76 $347.14 26685................. T.................... ..................... Treat hand dislocation. 0046 31.9719 $1,735.72 $535.76 $347.14 26686................. T.................... ..................... Treat hand dislocation. 0046 31.9719 $1,735.72 $535.76 $347.14 26700................. T.................... ..................... Treat knuckle

0043 1.9233 $104.41 ............

$20.88 dislocation. 26705................. T.................... ..................... Treat knuckle

0043 1.9233 $104.41 ............

$20.88 dislocation. 26706................. T.................... ..................... Pin knuckle dislocation 0043 1.9233 $104.41 ............

$20.88 26715................. T.................... ..................... Treat knuckle

0046 31.9719 $1,735.72 $535.76 $347.14 dislocation. 26720................. T.................... ..................... Treat finger fracture, 0043 1.9233 $104.41 ............

$20.88 each. 26725................. T.................... ..................... Treat finger fracture, 0043 1.9233 $104.41 ............

$20.88 each. 26727................. T.................... ..................... Treat finger fracture, 0046 31.9719 $1,735.72 $535.76 $347.14 each. 26735................. T.................... ..................... Treat finger fracture, 0046 31.9719 $1,735.72 $535.76 $347.14 each. 26740................. T.................... ..................... Treat finger fracture, 0043 1.9233 $104.41 ............

$20.88 each. 26742................. T.................... ..................... Treat finger fracture, 0043 1.9233 $104.41 ............

$20.88 each. 26746................. T.................... ..................... Treat finger fracture, 0046 31.9719 $1,735.72 $535.76 $347.14 each. 26750................. T.................... ..................... Treat finger fracture, 0043 1.9233 $104.41 ............

$20.88 each. 26755................. T.................... ..................... Treat finger fracture, 0043 1.9233 $104.41 ............

$20.88 each. 26756................. T.................... ..................... Pin finger fracture, 0046 31.9719 $1,735.72 $535.76 $347.14 each. 26765................. T.................... ..................... Treat finger fracture, 0046 31.9719 $1,735.72 $535.76 $347.14 each. 26770................. T.................... ..................... Treat finger

0043 1.9233 $104.41 ............

$20.88 dislocation. 26775................. T.................... ..................... Treat finger

0045 13.5546 $735.87 $268.47 $147.17 dislocation. 26776................. T.................... ..................... Pin finger dislocation. 0046 31.9719 $1,735.72 $535.76 $347.14 26785................. T.................... ..................... Treat finger

0046 31.9719 $1,735.72 $535.76 $347.14 dislocation. 26820................. T.................... ..................... Thumb fusion with graft 0054 24.2685 $1,317.51 ............ $263.50 26841................. T.................... ..................... Fusion of thumb........ 0054 24.2685 $1,317.51 ............ $263.50 26842................. T.................... ..................... Thumb fusion with graft 0054 24.2685 $1,317.51 ............ $263.50 26843................. T.................... ..................... Fusion of hand joint... 0054 24.2685 $1,317.51 ............ $263.50 26844................. T.................... ..................... Fusion/graft of hand 0054 24.2685 $1,317.51 ............ $263.50 joint. 26850................. T.................... ..................... Fusion of knuckle...... 0054 24.2685 $1,317.51 ............ $263.50 26852................. T.................... ..................... Fusion of knuckle with 0054 24.2685 $1,317.51 ............ $263.50 graft. 26860................. T.................... ..................... Fusion of finger joint. 0054 24.2685 $1,317.51 ............ $263.50 26861................. T.................... ..................... Fusion of finger jnt, 0054 24.2685 $1,317.51 ............ $263.50 add-on. 26862................. T.................... ..................... Fusion/graft of finger 0054 24.2685 $1,317.51 ............ $263.50 joint. 26863................. T.................... ..................... Fuse/graft added joint. 0054 24.2685 $1,317.51 ............ $263.50 26910................. T.................... ..................... Amputate metacarpal 0054 24.2685 $1,317.51 ............ $263.50 bone. 26951................. T.................... ..................... Amputation of finger/ 0053 14.8188 $804.50 $253.49 $160.90 thumb. 26952................. T.................... ..................... Amputation of finger/ 0053 14.8188 $804.50 $253.49 $160.90 thumb. 26989................. T.................... ..................... Hand/finger surgery.... 0043 1.9233 $104.41 ............

$20.88 26990................. T.................... ..................... Drainage of pelvis

0049 19.9376 $1,082.39 ............ $216.48 lesion. 26991................. T.................... ..................... Drainage of pelvis

0049 19.9376 $1,082.39 ............ $216.48 bursa.

[[Page 48054]]

26992................. C.................... ..................... Drainage of bone lesion ..... ......... ........... ............ ............ 27000................. T.................... ..................... Incision of hip tendon. 0049 19.9376 $1,082.39 ............ $216.48 27001................. T.................... ..................... Incision of hip tendon. 0050 25.1166 $1,363.56 ............ $272.71 27003................. T.................... ..................... Incision of hip tendon. 0050 25.1166 $1,363.56 ............ $272.71 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 34.9381 $1,896.75 ............ $379.35 joint. 27035................. T.................... ..................... Denervation of hip

0052 42.6430 $2,315.05 ............ $463.01 joint. 27036................. C.................... ..................... Excision of hip joint/ ..... ......... ........... ............ ............ muscle. 27040................. T.................... ..................... Biopsy of soft tissues. 0021 14.5749 $791.26 $219.48 $158.25 27041................. T.................... ..................... Biopsy of soft tissues. 0022 18.6725 $1,013.71 $354.45 $202.74 27047................. T.................... ..................... Remove hip/pelvis

0022 18.6725 $1,013.71 $354.45 $202.74 lesion. 27048................. T.................... ..................... Remove hip/pelvis

0022 18.6725 $1,013.71 $354.45 $202.74 lesion. 27049................. T.................... ..................... Remove tumor, hip/

0022 18.6725 $1,013.71 $354.45 $202.74 pelvis. 27050................. T.................... ..................... Biopsy of sacroiliac 0049 19.9376 $1,082.39 ............ $216.48 joint. 27052................. T.................... ..................... Biopsy of hip joint.... 0049 19.9376 $1,082.39 ............ $216.48 27054................. C.................... ..................... Removal of hip joint ..... ......... ........... ............ ............ lining. 27060................. T.................... ..................... Removal of ischial

0049 19.9376 $1,082.39 ............ $216.48 bursa. 27062................. T.................... ..................... Remove femur lesion/ 0049 19.9376 $1,082.39 ............ $216.48 bursa. 27065................. T.................... ..................... Removal of hip bone 0049 19.9376 $1,082.39 ............ $216.48 lesion. 27066................. T.................... ..................... Removal of hip bone 0050 25.1166 $1,363.56 ............ $272.71 lesion. 27067................. T.................... ..................... Remove/graft hip bone 0050 25.1166 $1,363.56 ............ $272.71 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 25.1166 $1,363.56 ............ $272.71 27086................. T.................... ..................... Remove hip foreign body 0020 7.3105 $396.88 $113.25

$79.38 27087................. T.................... ..................... Remove hip foreign body 0049 19.9376 $1,082.39 ............ $216.48 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................. E.................... ..................... Inject sacroiliac joint ..... ......... ........... ............ ............ 27097................. T.................... ..................... Revision of hip tendon. 0050 25.1166 $1,363.56 ............ $272.71 27098................. T.................... ..................... Transfer tendon to

0050 25.1166 $1,363.56 ............ $272.71 pelvis. 27100................. T.................... ..................... Transfer of abdominal 0051 34.9381 $1,896.75 ............ $379.35 muscle. 27105................. T.................... ..................... Transfer of spinal

0051 34.9381 $1,896.75 ............ $379.35 muscle. 27110................. T.................... ..................... Transfer of iliopsoas 0051 34.9381 $1,896.75 ............ $379.35 muscle. 27111................. T.................... ..................... Transfer of iliopsoas 0051 34.9381 $1,896.75 ............ $379.35 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... ..... ......... ........... ............ ............ 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 ..... ......... ........... ............ ............

[[Page 48055]]

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 1.9233 $104.41 ............

$20.88 fracture. 27194................. T.................... ..................... Treat pelvic ring

0045 13.5546 $735.87 $268.47 $147.17 fracture. 27200................. T.................... ..................... Treat tail bone

0043 1.9233 $104.41 ............

$20.88 fracture. 27202................. T.................... ..................... Treat tail bone

0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 27215................. C.................... ..................... Treat pelvic

..... ......... ........... ............ ............ fracture(s). 27216................. T.................... ..................... Treat pelvic ring

0050 25.1166 $1,363.56 ............ $272.71 fracture. 27217................. C.................... ..................... Treat pelvic ring

..... ......... ........... ............ ............ fracture. 27218................. C.................... ..................... Treat pelvic ring

..... ......... ........... ............ ............ fracture. 27220................. T.................... ..................... Treat hip socket

0043 1.9233 $104.41 ............

$20.88 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 1.9233 $104.41 ............

$20.88 27232................. C.................... ..................... Treat thigh fracture... ..... ......... ........... ............ ............ 27235................. T.................... ..................... Treat thigh fracture... 0050 25.1166 $1,363.56 ............ $272.71 27236................. C.................... ..................... Treat thigh fracture... ..... ......... ........... ............ ............ 27238................. T.................... ..................... Treat thigh fracture... 0043 1.9233 $104.41 ............

$20.88 27240................. C.................... ..................... Treat thigh fracture... ..... ......... ........... ............ ............ 27244................. C.................... ..................... Treat thigh fracture... ..... ......... ........... ............ ............ 27245................. C.................... ..................... Treat thigh fracture... ..... ......... ........... ............ ............ 27246................. T.................... ..................... Treat thigh fracture... 0043 1.9233 $104.41 ............

$20.88 27248................. C.................... ..................... Treat thigh fracture... ..... ......... ........... ............ ............ 27250................. T.................... ..................... Treat hip dislocation.. 0043 1.9233 $104.41 ............

$20.88 27252................. T.................... ..................... Treat hip dislocation.. 0045 13.5546 $735.87 $268.47 $147.17 27253................. C.................... ..................... Treat hip dislocation.. ..... ......... ........... ............ ............ 27254................. C.................... ..................... Treat hip dislocation.. ..... ......... ........... ............ ............ 27256................. T.................... ..................... Treat hip dislocation.. 0043 1.9233 $104.41 ............

$20.88 27257................. T.................... ..................... Treat hip dislocation.. 0045 13.5546 $735.87 $268.47 $147.17 27258................. C.................... ..................... Treat hip dislocation.. ..... ......... ........... ............ ............ 27259................. C.................... ..................... Treat hip dislocation.. ..... ......... ........... ............ ............ 27265................. T.................... ..................... Treat hip dislocation.. 0043 1.9233 $104.41 ............

$20.88 27266................. T.................... ..................... Treat hip dislocation.. 0045 13.5546 $735.87 $268.47 $147.17 27275................. T.................... ..................... Manipulation of hip 0045 13.5546 $735.87 $268.47 $147.17 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 1.9233 $104.41 ............

$20.88 surgery. 27301................. T.................... ..................... Drain thigh/knee lesion 0008 16.8303 $913.70 ............ $182.74 27303................. C.................... ..................... Drainage of bone lesion ..... ......... ........... ............ ............ 27305................. T.................... ..................... Incise thigh tendon & 0049 19.9376 $1,082.39 ............ $216.48 fascia. 27306................. T.................... ..................... Incision of thigh

0049 19.9376 $1,082.39 ............ $216.48 tendon. 27307................. T.................... ..................... Incision of thigh

0049 19.9376 $1,082.39 ............ $216.48 tendons. 27310................. T.................... ..................... Exploration of knee 0050 25.1166 $1,363.56 ............ $272.71 joint. 27315................. T.................... ..................... Partial removal, thigh 0220 16.5293 $897.36 ............ $179.47 nerve. 27320................. T.................... ..................... Partial removal, thigh 0220 16.5293 $897.36 ............ $179.47 nerve. 27323................. T.................... ..................... Biopsy, thigh soft

0021 14.5749 $791.26 $219.48 $158.25 tissues. 27324................. T.................... ..................... Biopsy, thigh soft

0022 18.6725 $1,013.71 $354.45 $202.74 tissues. 27327................. T.................... ..................... Removal of thigh lesion 0022 18.6725 $1,013.71 $354.45 $202.74 27328................. T.................... ..................... Removal of thigh lesion 0022 18.6725 $1,013.71 $354.45 $202.74 27329................. T.................... ..................... Remove tumor, thigh/ 0022 18.6725 $1,013.71 $354.45 $202.74 knee. 27330................. T.................... ..................... Biopsy, knee joint

0050 25.1166 $1,363.56 ............ $272.71 lining. 27331................. T.................... ..................... Explore/treat knee

0050 25.1166 $1,363.56 ............ $272.71 joint. 27332................. T.................... ..................... Removal of knee

0050 25.1166 $1,363.56 ............ $272.71 cartilage. 27333................. T.................... ..................... Removal of knee

0050 25.1166 $1,363.56 ............ $272.71 cartilage. 27334................. T.................... ..................... Remove knee joint

0050 25.1166 $1,363.56 ............ $272.71 lining. 27335................. T.................... ..................... Remove knee joint

0050 25.1166 $1,363.56 ............ $272.71 lining. 27340................. T.................... ..................... Removal of kneecap

0049 19.9376 $1,082.39 ............ $216.48 bursa. 27345................. T.................... ..................... Removal of knee cyst... 0049 19.9376 $1,082.39 ............ $216.48

[[Page 48056]]

27347................. T.................... ..................... Remove knee cyst....... 0049 19.9376 $1,082.39 ............ $216.48 27350................. T.................... ..................... Removal of kneecap..... 0050 25.1166 $1,363.56 ............ $272.71 27355................. T.................... ..................... Remove femur lesion.... 0050 25.1166 $1,363.56 ............ $272.71 27356................. T.................... ..................... Remove femur lesion/ 0050 25.1166 $1,363.56 ............ $272.71 graft. 27357................. T.................... ..................... Remove femur lesion/ 0050 25.1166 $1,363.56 ............ $272.71 graft. 27358................. T.................... ..................... Remove femur lesion/ 0050 25.1166 $1,363.56 ............ $272.71 fixation. 27360................. T.................... ..................... Partial removal, leg 0050 25.1166 $1,363.56 ............ $272.71 bone(s). 27365................. C.................... ..................... Extensive leg surgery.. ..... ......... ........... ............ ............ 27370................. N.................... ..................... Injection for knee x- ..... ......... ........... ............ ............ ray. 27372................. T.................... ..................... Removal of foreign body 0022 18.6725 $1,013.71 $354.45 $202.74 27380................. T.................... ..................... Repair of kneecap

0049 19.9376 $1,082.39 ............ $216.48 tendon. 27381................. T.................... ..................... Repair/graft kneecap 0049 19.9376 $1,082.39 ............ $216.48 tendon. 27385................. T.................... ..................... Repair of thigh muscle. 0049 19.9376 $1,082.39 ............ $216.48 27386................. T.................... ..................... Repair/graft of thigh 0049 19.9376 $1,082.39 ............ $216.48 muscle. 27390................. T.................... ..................... Incision of thigh

0049 19.9376 $1,082.39 ............ $216.48 tendon. 27391................. T.................... ..................... Incision of thigh

0049 19.9376 $1,082.39 ............ $216.48 tendons. 27392................. T.................... ..................... Incision of thigh

0049 19.9376 $1,082.39 ............ $216.48 tendons. 27393................. T.................... ..................... Lengthening of thigh 0050 25.1166 $1,363.56 ............ $272.71 tendon. 27394................. T.................... ..................... Lengthening of thigh 0050 25.1166 $1,363.56 ............ $272.71 tendons. 27395................. T.................... ..................... Lengthening of thigh 0051 34.9381 $1,896.75 ............ $379.35 tendons. 27396................. T.................... ..................... Transplant of thigh 0050 25.1166 $1,363.56 ............ $272.71 tendon. 27397................. T.................... ..................... Transplants of thigh 0051 34.9381 $1,896.75 ............ $379.35 tendons. 27400................. T.................... ..................... Revise thigh muscles/ 0051 34.9381 $1,896.75 ............ $379.35 tendons. 27403................. T.................... ..................... Repair of knee

0050 25.1166 $1,363.56 ............ $272.71 cartilage. 27405................. T.................... ..................... Repair of knee ligament 0051 34.9381 $1,896.75 ............ $379.35 27407................. T.................... ..................... Repair of knee ligament 0051 34.9381 $1,896.75 ............ $379.35 27409................. T.................... ..................... Repair of knee

0051 34.9381 $1,896.75 ............ $379.35 ligaments. 27418................. T.................... ..................... Repair degenerated

0051 34.9381 $1,896.75 ............ $379.35 kneecap. 27420................. T.................... ..................... Revision of unstable 0051 34.9381 $1,896.75 ............ $379.35 kneecap. 27422................. T.................... ..................... Revision of unstable 0051 34.9381 $1,896.75 ............ $379.35 kneecap. 27424................. T.................... ..................... Revision/removal of 0051 34.9381 $1,896.75 ............ $379.35 kneecap. 27425................. T.................... ..................... Lateral retinacular 0050 25.1166 $1,363.56 ............ $272.71 release. 27427................. T.................... ..................... Reconstruction, knee... 0052 42.6430 $2,315.05 ............ $463.01 27428................. T.................... ..................... Reconstruction, knee... 0052 42.6430 $2,315.05 ............ $463.01 27429................. T.................... ..................... Reconstruction, knee... 0052 42.6430 $2,315.05 ............ $463.01 27430................. T.................... ..................... Revision of thigh

0051 34.9381 $1,896.75 ............ $379.35 muscles. 27435................. T.................... ..................... Incision of knee joint. 0051 34.9381 $1,896.75 ............ $379.35 27437................. T.................... ..................... Revise kneecap......... 0047 30.3786 $1,649.22 $537.03 $329.84 27438................. T.................... ..................... Revise kneecap with 0048 47.4707 $2,577.14 $695.60 $515.43 implant. 27440................. T.................... ..................... Revision of knee joint. 0047 30.3786 $1,649.22 $537.03 $329.84 27441................. T.................... ..................... Revision of knee joint. 0047 30.3786 $1,649.22 $537.03 $329.84 27442................. T.................... ..................... Revision of knee joint. 0047 30.3786 $1,649.22 $537.03 $329.84 27443................. T.................... ..................... Revision of knee joint. 0047 30.3786 $1,649.22 $537.03 $329.84 27445................. C.................... ..................... Revision of knee joint. ..... ......... ........... ............ ............ 27446................. T.................... ..................... Revision of knee joint. 0681 96.7483 $5,252.37 $2,090.21 $1,050.47 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 thigh/ 0049 19.9376 $1,082.39 ............ $216.48 knee. 27497................. T.................... ..................... Decompression of thigh/ 0049 19.9376 $1,082.39 ............ $216.48 knee.

[[Page 48057]]

27498................. T.................... ..................... Decompression of thigh/ 0049 19.9376 $1,082.39 ............ $216.48 knee. 27499................. T.................... ..................... Decompression of thigh/ 0049 19.9376 $1,082.39 ............ $216.48 knee. 27500................. T.................... ..................... Treatment of thigh

0043 1.9233 $104.41 ............

$20.88 fracture. 27501................. T.................... ..................... Treatment of thigh

0043 1.9233 $104.41 ............

$20.88 fracture. 27502................. T.................... ..................... Treatment of thigh

0043 1.9233 $104.41 ............

$20.88 fracture. 27503................. T.................... ..................... Treatment of thigh

0043 1.9233 $104.41 ............

$20.88 fracture. 27506................. C.................... ..................... Treatment of thigh ..... ......... ........... ............ ............ fracture. 27507................. C.................... ..................... Treatment of thigh ..... ......... ........... ............ ............ fracture. 27508................. T.................... ..................... Treatment of thigh

0043 1.9233 $104.41 ............

$20.88 fracture. 27509................. T.................... ..................... Treatment of thigh

0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 27510................. T.................... ..................... Treatment of thigh

0043 1.9233 $104.41 ............

$20.88 fracture. 27511................. C.................... ..................... Treatment of thigh ..... ......... ........... ............ ............ fracture. 27513................. C.................... ..................... Treatment of thigh ..... ......... ........... ............ ............ fracture. 27514................. C.................... ..................... Treatment of thigh ..... ......... ........... ............ ............ fracture. 27516................. T.................... ..................... Treat thigh fx growth 0043 1.9233 $104.41 ............

$20.88 plate. 27517................. T.................... ..................... Treat thigh fx growth 0043 1.9233 $104.41 ............

$20.88 plate. 27519................. C.................... ..................... Treat thigh fx growth ..... ......... ........... ............ ............ plate. 27520................. T.................... ..................... Treat kneecap fracture. 0043 1.9233 $104.41 ............

$20.88 27524................. T.................... ..................... Treat kneecap fracture. 0046 31.9719 $1,735.72 $535.76 $347.14 27530................. T.................... ..................... Treat knee fracture.... 0043 1.9233 $104.41 ............

$20.88 27532................. T.................... ..................... Treat knee fracture.... 0043 1.9233 $104.41 ............

$20.88 27535................. C.................... ..................... Treat knee fracture.... ..... ......... ........... ............ ............ 27536................. C.................... ..................... Treat knee fracture.... ..... ......... ........... ............ ............ 27538................. T.................... ..................... Treat knee fracture(s). 0043 1.9233 $104.41 ............

$20.88 27540................. C.................... ..................... Treat knee fracture.... ..... ......... ........... ............ ............ 27550................. T.................... ..................... Treat knee dislocation. 0043 1.9233 $104.41 ............

$20.88 27552................. T.................... ..................... Treat knee dislocation. 0045 13.5546 $735.87 $268.47 $147.17 27556................. C.................... ..................... Treat knee dislocation. ..... ......... ........... ............ ............ 27557................. C.................... ..................... Treat knee dislocation. ..... ......... ........... ............ ............ 27558................. C.................... ..................... Treat knee dislocation. ..... ......... ........... ............ ............ 27560................. T.................... ..................... Treat kneecap

0043 1.9233 $104.41 ............

$20.88 dislocation. 27562................. T.................... ..................... Treat kneecap

0045 13.5546 $735.87 $268.47 $147.17 dislocation. 27566................. T.................... ..................... Treat kneecap

0046 31.9719 $1,735.72 $535.76 $347.14 dislocation. 27570................. T.................... ..................... Fixation of knee joint. 0045 13.5546 $735.87 $268.47 $147.17 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 19.9376 $1,082.39 ............ $216.48 surgery. 27596................. C.................... ..................... Amputation follow-up ..... ......... ........... ............ ............ surgery. 27598................. C.................... ..................... Amputate lower leg at ..... ......... ........... ............ ............ knee. 27599................. T.................... ..................... Leg surgery procedure.. 0043 1.9233 $104.41 ............

$20.88 27600................. T.................... ..................... Decompression of lower 0049 19.9376 $1,082.39 ............ $216.48 leg. 27601................. T.................... ..................... Decompression of lower 0049 19.9376 $1,082.39 ............ $216.48 leg. 27602................. T.................... ..................... Decompression of lower 0049 19.9376 $1,082.39 ............ $216.48 leg. 27603................. T.................... ..................... Drain lower leg lesion. 0008 16.8303 $913.70 ............ $182.74 27604................. T.................... ..................... Drain lower leg bursa.. 0049 19.9376 $1,082.39 ............ $216.48 27605................. T.................... ..................... Incision of achilles 0055 18.8851 $1,025.25 $355.34 $205.05 tendon. 27606................. T.................... ..................... Incision of achilles 0049 19.9376 $1,082.39 ............ $216.48 tendon. 27607................. T.................... ..................... Treat lower leg bone 0049 19.9376 $1,082.39 ............ $216.48 lesion. 27610................. T.................... ..................... Explore/treat ankle 0050 25.1166 $1,363.56 ............ $272.71 joint. 27612................. T.................... ..................... Exploration of ankle 0050 25.1166 $1,363.56 ............ $272.71 joint. 27613................. T.................... ..................... Biopsy lower leg soft 0020 7.3105 $396.88 $113.25

$79.38 tissue. 27614................. T.................... ..................... Biopsy lower leg soft 0022 18.6725 $1,013.71 $354.45 $202.74 tissue. 27615................. T.................... ..................... Remove tumor, lower leg 0046 31.9719 $1,735.72 $535.76 $347.14 27618................. T.................... ..................... Remove lower leg lesion 0021 14.5749 $791.26 $219.48 $158.25 27619................. T.................... ..................... Remove lower leg lesion 0022 18.6725 $1,013.71 $354.45 $202.74 27620................. T.................... ..................... Explore/treat ankle 0050 25.1166 $1,363.56 ............ $272.71 joint. 27625................. T.................... ..................... Remove ankle joint

0050 25.1166 $1,363.56 ............ $272.71 lining. 27626................. T.................... ..................... Remove ankle joint

0050 25.1166 $1,363.56 ............ $272.71 lining. 27630................. T.................... ..................... Removal of tendon

0049 19.9376 $1,082.39 ............ $216.48 lesion. 27635................. T.................... ..................... Remove lower leg bone 0050 25.1166 $1,363.56 ............ $272.71 lesion. 27637................. T.................... ..................... Remove/graft leg bone 0050 25.1166 $1,363.56 ............ $272.71 lesion. 27638................. T.................... ..................... Remove/graft leg bone 0050 25.1166 $1,363.56 ............ $272.71 lesion. 27640................. T.................... ..................... Partial removal of

0051 34.9381 $1,896.75 ............ $379.35 tibia. 27641................. T.................... ..................... Partial removal of

0050 25.1166 $1,363.56 ............ $272.71 fibula.

[[Page 48058]]

27645................. C.................... ..................... Extensive lower leg ..... ......... ........... ............ ............ surgery. 27646................. C.................... ..................... Extensive lower leg ..... ......... ........... ............ ............ surgery. 27647................. T.................... ..................... Extensive ankle/heel 0051 34.9381 $1,896.75 ............ $379.35 surgery. 27648................. N.................... ..................... Injection for ankle x- ..... ......... ........... ............ ............ ray. 27650................. T.................... ..................... Repair achilles tendon. 0051 34.9381 $1,896.75 ............ $379.35 27652................. T.................... ..................... Repair/graft achilles 0051 34.9381 $1,896.75 ............ $379.35 tendon. 27654................. T.................... ..................... Repair of achilles

0051 34.9381 $1,896.75 ............ $379.35 tendon. 27656................. T.................... ..................... Repair leg fascia

0049 19.9376 $1,082.39 ............ $216.48 defect. 27658................. T.................... ..................... Repair of leg tendon, 0049 19.9376 $1,082.39 ............ $216.48 each. 27659................. T.................... ..................... Repair of leg tendon, 0049 19.9376 $1,082.39 ............ $216.48 each. 27664................. T.................... ..................... Repair of leg tendon, 0049 19.9376 $1,082.39 ............ $216.48 each. 27665................. T.................... ..................... Repair of leg tendon, 0050 25.1166 $1,363.56 ............ $272.71 each. 27675................. T.................... ..................... Repair lower leg

0049 19.9376 $1,082.39 ............ $216.48 tendons. 27676................. T.................... ..................... Repair lower leg

0050 25.1166 $1,363.56 ............ $272.71 tendons. 27680................. T.................... ..................... Release of lower leg 0050 25.1166 $1,363.56 ............ $272.71 tendon. 27681................. T.................... ..................... Release of lower leg 0050 25.1166 $1,363.56 ............ $272.71 tendons. 27685................. T.................... ..................... Revision of lower leg 0050 25.1166 $1,363.56 ............ $272.71 tendon. 27686................. T.................... ..................... Revise lower leg

0050 25.1166 $1,363.56 ............ $272.71 tendons. 27687................. T.................... ..................... Revision of calf tendon 0050 25.1166 $1,363.56 ............ $272.71 27690................. T.................... ..................... Revise lower leg tendon 0051 34.9381 $1,896.75 ............ $379.35 27691................. T.................... ..................... Revise lower leg tendon 0051 34.9381 $1,896.75 ............ $379.35 27692................. T.................... ..................... Revise additional leg 0051 34.9381 $1,896.75 ............ $379.35 tendon. 27695................. T.................... ..................... Repair of ankle

0050 25.1166 $1,363.56 ............ $272.71 ligament. 27696................. T.................... ..................... Repair of ankle

0050 25.1166 $1,363.56 ............ $272.71 ligaments. 27698................. T.................... ..................... Repair of ankle

0050 25.1166 $1,363.56 ............ $272.71 ligament. 27700................. T.................... ..................... Revision of ankle joint 0047 30.3786 $1,649.22 $537.03 $329.84 27702................. C.................... ..................... Reconstruct ankle joint ..... ......... ........... ............ ............ 27703................. C.................... ..................... Reconstruction, ankle ..... ......... ........... ............ ............ joint. 27704................. T.................... ..................... Removal of ankle

0049 19.9376 $1,082.39 ............ $216.48 implant. 27705................. T.................... ..................... Incision of tibia...... 0051 34.9381 $1,896.75 ............ $379.35 27707................. T.................... ..................... Incision of fibula..... 0049 19.9376 $1,082.39 ............ $216.48 27709................. T.................... ..................... Incision of tibia & 0050 25.1166 $1,363.56 ............ $272.71 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 25.1166 $1,363.56 ............ $272.71 epiphysis. 27732................. T.................... ..................... Repair of fibula

0050 25.1166 $1,363.56 ............ $272.71 epiphysis. 27734................. T.................... ..................... Repair lower leg

0050 25.1166 $1,363.56 ............ $272.71 epiphyses. 27740................. T.................... ..................... Repair of leg epiphyses 0050 25.1166 $1,363.56 ............ $272.71 27742................. T.................... ..................... Repair of leg epiphyses 0051 34.9381 $1,896.75 ............ $379.35 27745................. T.................... ..................... Reinforce tibia........ 0051 34.9381 $1,896.75 ............ $379.35 27750................. T.................... ..................... Treatment of tibia

0043 1.9233 $104.41 ............

$20.88 fracture. 27752................. T.................... ..................... Treatment of tibia

0043 1.9233 $104.41 ............

$20.88 fracture. 27756................. T.................... ..................... Treatment of tibia

0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 27758................. T.................... ..................... Treatment of tibia

0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 27759................. T.................... ..................... Treatment of tibia

0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 27760................. T.................... ..................... Treatment of ankle

0043 1.9233 $104.41 ............

$20.88 fracture. 27762................. T.................... ..................... Treatment of ankle

0043 1.9233 $104.41 ............

$20.88 fracture. 27766................. T.................... ..................... Treatment of ankle

0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 27780................. T.................... ..................... Treatment of fibula 0043 1.9233 $104.41 ............

$20.88 fracture. 27781................. T.................... ..................... Treatment of fibula 0043 1.9233 $104.41 ............

$20.88 fracture. 27784................. T.................... ..................... Treatment of fibula 0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 27786................. T.................... ..................... Treatment of ankle

0043 1.9233 $104.41 ............

$20.88 fracture. 27788................. T.................... ..................... Treatment of ankle

0043 1.9233 $104.41 ............

$20.88 fracture. 27792................. T.................... ..................... Treatment of ankle

0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 27808................. T.................... ..................... Treatment of ankle

0043 1.9233 $104.41 ............

$20.88 fracture. 27810................. T.................... ..................... Treatment of ankle

0043 1.9233 $104.41 ............

$20.88 fracture. 27814................. T.................... ..................... Treatment of ankle

0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 27816................. T.................... ..................... Treatment of ankle

0043 1.9233 $104.41 ............

$20.88 fracture. 27818................. T.................... ..................... Treatment of ankle

0043 1.9233 $104.41 ............

$20.88 fracture. 27822................. T.................... ..................... Treatment of ankle

0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 27823................. T.................... ..................... Treatment of ankle

0046 31.9719 $1,735.72 $535.76 $347.14 fracture.

[[Page 48059]]

27824................. T.................... ..................... Treat lower leg

0043 1.9233 $104.41 ............

$20.88 fracture. 27825................. T.................... ..................... Treat lower leg

0043 1.9233 $104.41 ............

$20.88 fracture. 27826................. T.................... ..................... Treat lower leg

0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 27827................. T.................... ..................... Treat lower leg

0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 27828................. T.................... ..................... Treat lower leg

0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 27829................. T.................... ..................... Treat lower leg joint.. 0046 31.9719 $1,735.72 $535.76 $347.14 27830................. T.................... ..................... Treat lower leg

0043 1.9233 $104.41 ............

$20.88 dislocation. 27831................. T.................... ..................... Treat lower leg

0043 1.9233 $104.41 ............

$20.88 dislocation. 27832................. T.................... ..................... Treat lower leg

0046 31.9719 $1,735.72 $535.76 $347.14 dislocation. 27840................. T.................... ..................... Treat ankle dislocation 0043 1.9233 $104.41 ............

$20.88 27842................. T.................... ..................... Treat ankle dislocation 0045 13.5546 $735.87 $268.47 $147.17 27846................. T.................... ..................... Treat ankle dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 27848................. T.................... ..................... Treat ankle dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 27860................. T.................... ..................... Fixation of ankle joint 0045 13.5546 $735.87 $268.47 $147.17 27870................. T.................... ..................... Fusion of ankle joint.. 0051 34.9381 $1,896.75 ............ $379.35 27871................. T.................... ..................... Fusion of tibiofibular 0051 34.9381 $1,896.75 ............ $379.35 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 19.9376 $1,082.39 ............ $216.48 surgery. 27886................. C.................... ..................... Amputation follow-up ..... ......... ........... ............ ............ surgery. 27888................. C.................... ..................... Amputation of foot at ..... ......... ........... ............ ............ ankle. 27889................. T.................... ..................... Amputation of foot at 0050 25.1166 $1,363.56 ............ $272.71 ankle. 27892................. T.................... ..................... Decompression of leg... 0049 19.9376 $1,082.39 ............ $216.48 27893................. T.................... ..................... Decompression of leg... 0049 19.9376 $1,082.39 ............ $216.48 27894................. T.................... ..................... Decompression of leg... 0049 19.9376 $1,082.39 ............ $216.48 27899................. T.................... ..................... Leg/ankle surgery

0043 1.9233 $104.41 ............

$20.88 procedure. 28001................. T.................... ..................... Drainage of bursa of 0008 16.8303 $913.70 ............ $182.74 foot. 28002................. T.................... ..................... Treatment of foot

0049 19.9376 $1,082.39 ............ $216.48 infection. 28003................. T.................... ..................... Treatment of foot

0049 19.9376 $1,082.39 ............ $216.48 infection. 28005................. T.................... ..................... Treat foot bone lesion. 0055 18.8851 $1,025.25 $355.34 $205.05 28008................. T.................... ..................... Incision of foot fascia 0055 18.8851 $1,025.25 $355.34 $205.05 28010................. T.................... ..................... Incision of toe tendon. 0055 18.8851 $1,025.25 $355.34 $205.05 28011................. T.................... ..................... Incision of toe tendons 0055 18.8851 $1,025.25 $355.34 $205.05 28020................. T.................... ..................... Exploration of foot 0055 18.8851 $1,025.25 $355.34 $205.05 joint. 28022................. T.................... ..................... Exploration of foot 0055 18.8851 $1,025.25 $355.34 $205.05 joint. 28024................. T.................... ..................... Exploration of toe

0055 18.8851 $1,025.25 $355.34 $205.05 joint. 28030................. T.................... ..................... Removal of foot nerve.. 0220 16.5293 $897.36 ............ $179.47 28035................. T.................... ..................... Decompression of tibia 0220 16.5293 $897.36 ............ $179.47 nerve. 28043................. T.................... ..................... Excision of foot lesion 0021 14.5749 $791.26 $219.48 $158.25 28045................. T.................... ..................... Excision of foot lesion 0055 18.8851 $1,025.25 $355.34 $205.05 28046................. T.................... ..................... Resection of tumor, 0055 18.8851 $1,025.25 $355.34 $205.05 foot. 28050................. T.................... ..................... Biopsy of foot joint 0055 18.8851 $1,025.25 $355.34 $205.05 lining. 28052................. T.................... ..................... Biopsy of foot joint 0055 18.8851 $1,025.25 $355.34 $205.05 lining. 28054................. T.................... ..................... Biopsy of toe joint 0055 18.8851 $1,025.25 $355.34 $205.05 lining. 28060................. T.................... ..................... Partial removal, foot 0056 25.1591 $1,365.86 $405.81 $273.17 fascia. 28062................. T.................... ..................... Removal of foot fascia. 0056 25.1591 $1,365.86 $405.81 $273.17 28070................. T.................... ..................... Removal of foot joint 0056 25.1591 $1,365.86 $405.81 $273.17 lining. 28072................. T.................... ..................... Removal of foot joint 0056 25.1591 $1,365.86 $405.81 $273.17 lining. 28080................. T.................... ..................... Removal of foot lesion. 0055 18.8851 $1,025.25 $355.34 $205.05 28086................. T.................... ..................... Excise foot tendon

0055 18.8851 $1,025.25 $355.34 $205.05 sheath. 28088................. T.................... ..................... Excise foot tendon

0055 18.8851 $1,025.25 $355.34 $205.05 sheath. 28090................. T.................... ..................... Removal of foot lesion. 0055 18.8851 $1,025.25 $355.34 $205.05 28092................. T.................... ..................... Removal of toe lesions. 0055 18.8851 $1,025.25 $355.34 $205.05 28100................. T.................... ..................... Removal of ankle/heel 0055 18.8851 $1,025.25 $355.34 $205.05 lesion. 28102................. T.................... ..................... Remove/graft foot

0056 25.1591 $1,365.86 $405.81 $273.17 lesion. 28103................. T.................... ..................... Remove/graft foot

0056 25.1591 $1,365.86 $405.81 $273.17 lesion. 28104................. T.................... ..................... Removal of foot lesion. 0055 18.8851 $1,025.25 $355.34 $205.05 28106................. T.................... ..................... Remove/graft foot

0056 25.1591 $1,365.86 $405.81 $273.17 lesion. 28107................. T.................... ..................... Remove/graft foot

0056 25.1591 $1,365.86 $405.81 $273.17 lesion. 28108................. T.................... ..................... Removal of toe lesions. 0055 18.8851 $1,025.25 $355.34 $205.05 28110................. T.................... ..................... Part removal of

0056 25.1591 $1,365.86 $405.81 $273.17 metatarsal. 28111................. T.................... ..................... Part removal of

0055 18.8851 $1,025.25 $355.34 $205.05 metatarsal. 28112................. T.................... ..................... Part removal of

0055 18.8851 $1,025.25 $355.34 $205.05 metatarsal. 28113................. T.................... ..................... Part removal of

0055 18.8851 $1,025.25 $355.34 $205.05 metatarsal. 28114................. T.................... ..................... Removal of metatarsal 0055 18.8851 $1,025.25 $355.34 $205.05 heads.

[[Page 48060]]

28116................. T.................... ..................... Revision of foot....... 0055 18.8851 $1,025.25 $355.34 $205.05 28118................. T.................... ..................... Removal of heel bone... 0055 18.8851 $1,025.25 $355.34 $205.05 28119................. T.................... ..................... Removal of heel spur... 0055 18.8851 $1,025.25 $355.34 $205.05 28120................. T.................... ..................... Part removal of ankle/ 0055 18.8851 $1,025.25 $355.34 $205.05 heel. 28122................. T.................... ..................... Partial removal of foot 0055 18.8851 $1,025.25 $355.34 $205.05 bone. 28124................. T.................... ..................... Partial removal of toe. 0055 18.8851 $1,025.25 $355.34 $205.05 28126................. T.................... ..................... Partial removal of toe. 0055 18.8851 $1,025.25 $355.34 $205.05 28130................. T.................... ..................... Removal of ankle bone.. 0055 18.8851 $1,025.25 $355.34 $205.05 28140................. T.................... ..................... Removal of metatarsal.. 0055 18.8851 $1,025.25 $355.34 $205.05 28150................. T.................... ..................... Removal of toe......... 0055 18.8851 $1,025.25 $355.34 $205.05 28153................. T.................... ..................... Partial removal of toe. 0055 18.8851 $1,025.25 $355.34 $205.05 28160................. T.................... ..................... Partial removal of toe. 0055 18.8851 $1,025.25 $355.34 $205.05 28171................. T.................... ..................... Extensive foot surgery. 0055 18.8851 $1,025.25 $355.34 $205.05 28173................. T.................... ..................... Extensive foot surgery. 0055 18.8851 $1,025.25 $355.34 $205.05 28175................. T.................... ..................... Extensive foot surgery. 0055 18.8851 $1,025.25 $355.34 $205.05 28190................. T.................... ..................... Removal of foot foreign 0019 3.9807 $216.11

$71.87

$43.22 body. 28192................. T.................... ..................... Removal of foot foreign 0021 14.5749 $791.26 $219.48 $158.25 body. 28193................. T.................... ..................... Removal of foot foreign 0021 14.5749 $791.26 $219.48 $158.25 body. 28200................. T.................... ..................... Repair of foot tendon.. 0055 18.8851 $1,025.25 $355.34 $205.05 28202................. T.................... ..................... Repair/graft of foot 0056 25.1591 $1,365.86 $405.81 $273.17 tendon. 28208................. T.................... ..................... Repair of foot tendon.. 0055 18.8851 $1,025.25 $355.34 $205.05 28210................. T.................... ..................... Repair/graft of foot 0055 18.8851 $1,025.25 $355.34 $205.05 tendon. 28220................. T.................... ..................... Release of foot tendon. 0055 18.8851 $1,025.25 $355.34 $205.05 28222................. T.................... ..................... Release of foot tendons 0055 18.8851 $1,025.25 $355.34 $205.05 28225................. T.................... ..................... Release of foot tendon. 0055 18.8851 $1,025.25 $355.34 $205.05 28226................. T.................... ..................... Release of foot tendons 0055 18.8851 $1,025.25 $355.34 $205.05 28230................. T.................... ..................... Incision of foot

0055 18.8851 $1,025.25 $355.34 $205.05 tendon(s). 28232................. T.................... ..................... Incision of toe tendon. 0055 18.8851 $1,025.25 $355.34 $205.05 28234................. T.................... ..................... Incision of foot tendon 0055 18.8851 $1,025.25 $355.34 $205.05 28238................. T.................... ..................... Revision of foot tendon 0056 25.1591 $1,365.86 $405.81 $273.17 28240................. T.................... ..................... Release of big toe..... 0055 18.8851 $1,025.25 $355.34 $205.05 28250................. T.................... ..................... Revision of foot fascia 0056 25.1591 $1,365.86 $405.81 $273.17 28260................. T.................... ..................... Release of midfoot

0056 25.1591 $1,365.86 $405.81 $273.17 joint. 28261................. T.................... ..................... Revision of foot tendon 0056 25.1591 $1,365.86 $405.81 $273.17 28262................. T.................... ..................... Revision of foot and 0056 25.1591 $1,365.86 $405.81 $273.17 ankle. 28264................. T.................... ..................... Release of midfoot

0056 25.1591 $1,365.86 $405.81 $273.17 joint. 28270................. T.................... ..................... Release of foot

0055 18.8851 $1,025.25 $355.34 $205.05 contracture. 28272................. T.................... ..................... Release of toe joint, 0055 18.8851 $1,025.25 $355.34 $205.05 each. 28280................. T.................... ..................... Fusion of toes......... 0055 18.8851 $1,025.25 $355.34 $205.05 28285................. T.................... ..................... Repair of hammertoe.... 0055 18.8851 $1,025.25 $355.34 $205.05 28286................. T.................... ..................... Repair of hammertoe.... 0055 18.8851 $1,025.25 $355.34 $205.05 28288................. T.................... ..................... Partial removal of foot 0056 25.1591 $1,365.86 $405.81 $273.17 bone. 28289................. T.................... ..................... Repair hallux rigidus.. 0056 25.1591 $1,365.86 $405.81 $273.17 28290................. T.................... ..................... Correction of bunion... 0056 25.1591 $1,365.86 $405.81 $273.17 28292................. T.................... ..................... Correction of bunion... 0057 25.4248 $1,380.29 $475.91 $276.06 28293................. T.................... ..................... Correction of bunion... 0057 25.4248 $1,380.29 $475.91 $276.06 28294................. T.................... ..................... Correction of bunion... 0056 25.1591 $1,365.86 $405.81 $273.17 28296................. T.................... ..................... Correction of bunion... 0056 25.1591 $1,365.86 $405.81 $273.17 28297................. T.................... ..................... Correction of bunion... 0057 25.4248 $1,380.29 $475.91 $276.06 28298................. T.................... ..................... Correction of bunion... 0056 25.1591 $1,365.86 $405.81 $273.17 28299................. T.................... ..................... Correction of bunion... 0057 25.4248 $1,380.29 $475.91 $276.06 28300................. T.................... ..................... Incision of heel bone.. 0056 25.1591 $1,365.86 $405.81 $273.17 28302................. T.................... ..................... Incision of ankle bone. 0056 25.1591 $1,365.86 $405.81 $273.17 28304................. T.................... ..................... Incision of midfoot 0056 25.1591 $1,365.86 $405.81 $273.17 bones. 28305................. T.................... ..................... Incise/graft midfoot 0056 25.1591 $1,365.86 $405.81 $273.17 bones. 28306................. T.................... ..................... Incision of metatarsal. 0056 25.1591 $1,365.86 $405.81 $273.17 28307................. T.................... ..................... Incision of metatarsal. 0056 25.1591 $1,365.86 $405.81 $273.17 28308................. T.................... ..................... Incision of metatarsal. 0056 25.1591 $1,365.86 $405.81 $273.17 28309................. T.................... ..................... Incision of metatarsals 0056 25.1591 $1,365.86 $405.81 $273.17 28310................. T.................... ..................... Revision of big toe.... 0055 18.8851 $1,025.25 $355.34 $205.05 28312................. T.................... ..................... Revision of toe........ 0055 18.8851 $1,025.25 $355.34 $205.05 28313................. T.................... ..................... Repair deformity of toe 0055 18.8851 $1,025.25 $355.34 $205.05 28315................. T.................... ..................... Removal of sesamoid 0055 18.8851 $1,025.25 $355.34 $205.05 bone. 28320................. T.................... ..................... Repair of foot bones... 0056 25.1591 $1,365.86 $405.81 $273.17 28322................. T.................... ..................... Repair of metatarsals.. 0056 25.1591 $1,365.86 $405.81 $273.17 28340................. T.................... ..................... Resect enlarged toe 0055 18.8851 $1,025.25 $355.34 $205.05 tissue.

[[Page 48061]]

28341................. T.................... ..................... Resect enlarged toe.... 0055 18.8851 $1,025.25 $355.34 $205.05 28344................. T.................... ..................... Repair extra toe(s).... 0056 25.1591 $1,365.86 $405.81 $273.17 28345................. T.................... ..................... Repair webbed toe(s)... 0056 25.1591 $1,365.86 $405.81 $273.17 28360................. T.................... ..................... Reconstruct cleft foot. 0056 25.1591 $1,365.86 $405.81 $273.17 28400................. T.................... ..................... Treatment of heel

0043 1.9233 $104.41 ............

$20.88 fracture. 28405................. T.................... ..................... Treatment of heel

0043 1.9233 $104.41 ............

$20.88 fracture. 28406................. T.................... ..................... Treatment of heel

0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 28415................. T.................... ..................... Treat heel fracture.... 0046 31.9719 $1,735.72 $535.76 $347.14 28420................. T.................... ..................... Treat/graft heel

0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 28430................. T.................... ..................... Treatment of ankle

0043 1.9233 $104.41 ............

$20.88 fracture. 28435................. T.................... ..................... Treatment of ankle

0043 1.9233 $104.41 ............

$20.88 fracture. 28436................. T.................... ..................... Treatment of ankle

0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 28445................. T.................... ..................... Treat ankle fracture... 0046 31.9719 $1,735.72 $535.76 $347.14 28450................. T.................... ..................... Treat midfoot fracture, 0043 1.9233 $104.41 ............

$20.88 each. 28455................. T.................... ..................... Treat midfoot fracture, 0043 1.9233 $104.41 ............

$20.88 each. 28456................. T.................... ..................... Treat midfoot fracture. 0046 31.9719 $1,735.72 $535.76 $347.14 28465................. T.................... ..................... Treat midfoot fracture, 0046 31.9719 $1,735.72 $535.76 $347.14 each. 28470................. T.................... ..................... Treat metatarsal

0043 1.9233 $104.41 ............

$20.88 fracture. 28475................. T.................... ..................... Treat metatarsal

0043 1.9233 $104.41 ............

$20.88 fracture. 28476................. T.................... ..................... Treat metatarsal

0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 28485................. T.................... ..................... Treat metatarsal

0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 28490................. T.................... ..................... Treat big toe fracture. 0043 1.9233 $104.41 ............

$20.88 28495................. T.................... ..................... Treat big toe fracture. 0043 1.9233 $104.41 ............

$20.88 28496................. T.................... ..................... Treat big toe fracture. 0046 31.9719 $1,735.72 $535.76 $347.14 28505................. T.................... ..................... Treat big toe fracture. 0046 31.9719 $1,735.72 $535.76 $347.14 28510................. T.................... ..................... Treatment of toe

0043 1.9233 $104.41 ............

$20.88 fracture. 28515................. T.................... ..................... Treatment of toe

0043 1.9233 $104.41 ............

$20.88 fracture. 28525................. T.................... ..................... Treat toe fracture..... 0046 31.9719 $1,735.72 $535.76 $347.14 28530................. T.................... ..................... Treat sesamoid bone 0043 1.9233 $104.41 ............

$20.88 fracture. 28531................. T.................... ..................... Treat sesamoid bone 0046 31.9719 $1,735.72 $535.76 $347.14 fracture. 28540................. T.................... ..................... Treat foot dislocation. 0043 1.9233 $104.41 ............

$20.88 28545................. T.................... ..................... Treat foot dislocation. 0045 13.5546 $735.87 $268.47 $147.17 28546................. T.................... ..................... Treat foot dislocation. 0046 31.9719 $1,735.72 $535.76 $347.14 28555................. T.................... ..................... Repair foot dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 28570................. T.................... ..................... Treat foot dislocation. 0043 1.9233 $104.41 ............

$20.88 28575................. T.................... ..................... Treat foot dislocation. 0043 1.9233 $104.41 ............

$20.88 28576................. T.................... ..................... Treat foot dislocation. 0046 31.9719 $1,735.72 $535.76 $347.14 28585................. T.................... ..................... Repair foot dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 28600................. T.................... ..................... Treat foot dislocation. 0043 1.9233 $104.41 ............

$20.88 28605................. T.................... ..................... Treat foot dislocation. 0043 1.9233 $104.41 ............

$20.88 28606................. T.................... ..................... Treat foot dislocation. 0046 31.9719 $1,735.72 $535.76 $347.14 28615................. T.................... ..................... Repair foot dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 28630................. T.................... ..................... Treat toe dislocation.. 0043 1.9233 $104.41 ............

$20.88 28635................. T.................... ..................... Treat toe dislocation.. 0045 13.5546 $735.87 $268.47 $147.17 28636................. T.................... ..................... Treat toe dislocation.. 0046 31.9719 $1,735.72 $535.76 $347.14 28645................. T.................... ..................... Repair toe dislocation. 0046 31.9719 $1,735.72 $535.76 $347.14 28660................. T.................... ..................... Treat toe dislocation.. 0043 1.9233 $104.41 ............

$20.88 28665................. T.................... ..................... Treat toe dislocation.. 0045 13.5546 $735.87 $268.47 $147.17 28666................. T.................... ..................... Treat toe dislocation.. 0046 31.9719 $1,735.72 $535.76 $347.14 28675................. T.................... ..................... Repair of toe

0046 31.9719 $1,735.72 $535.76 $347.14 dislocation. 28705................. T.................... ..................... Fusion of foot bones... 0056 25.1591 $1,365.86 $405.81 $273.17 28715................. T.................... ..................... Fusion of foot bones... 0056 25.1591 $1,365.86 $405.81 $273.17 28725................. T.................... ..................... Fusion of foot bones... 0056 25.1591 $1,365.86 $405.81 $273.17 28730................. T.................... ..................... Fusion of foot bones... 0056 25.1591 $1,365.86 $405.81 $273.17 28735................. T.................... ..................... Fusion of foot bones... 0056 25.1591 $1,365.86 $405.81 $273.17 28737................. T.................... ..................... Revision of foot bones. 0055 18.8851 $1,025.25 $355.34 $205.05 28740................. T.................... ..................... Fusion of foot bones... 0056 25.1591 $1,365.86 $405.81 $273.17 28750................. T.................... ..................... Fusion of big toe joint 0055 18.8851 $1,025.25 $355.34 $205.05 28755................. T.................... ..................... Fusion of big toe joint 0055 18.8851 $1,025.25 $355.34 $205.05 28760................. T.................... ..................... Fusion of big toe joint 0056 25.1591 $1,365.86 $405.81 $273.17 28800................. C.................... ..................... Amputation of midfoot.. ..... ......... ........... ............ ............ 28805................. C.................... ..................... Amputation thru

..... ......... ........... ............ ............ metatarsal. 28810................. T.................... ..................... Amputation toe &

0055 18.8851 $1,025.25 $355.34 $205.05 metatarsal. 28820................. T.................... ..................... Amputation of toe...... 0055 18.8851 $1,025.25 $355.34 $205.05 28825................. T.................... ..................... Partial amputation of 0055 18.8851 $1,025.25 $355.34 $205.05 toe. 28899................. T.................... ..................... Foot/toes surgery

0043 1.9233 $104.41 ............

$20.88 procedure.

[[Page 48062]]

29000................. S.................... ..................... Application of body 0058 1.0785 $58.55 ............

$11.71 cast. 29010................. S.................... ..................... Application of body 0058 1.0785 $58.55 ............

$11.71 cast. 29015................. S.................... ..................... Application of body 0058 1.0785 $58.55 ............

$11.71 cast. 29020................. S.................... ..................... Application of body 0058 1.0785 $58.55 ............

$11.71 cast. 29025................. S.................... ..................... Application of body 0058 1.0785 $58.55 ............

$11.71 cast. 29035................. S.................... ..................... Application of body 0058 1.0785 $58.55 ............

$11.71 cast. 29040................. S.................... ..................... Application of body 0058 1.0785 $58.55 ............

$11.71 cast. 29044................. S.................... ..................... Application of body 0058 1.0785 $58.55 ............

$11.71 cast. 29046................. S.................... ..................... Application of body 0058 1.0785 $58.55 ............

$11.71 cast. 29049................. S.................... ..................... Application of figure 0058 1.0785 $58.55 ............

$11.71 eight. 29055................. S.................... ..................... Application of shoulder 0058 1.0785 $58.55 ............

$11.71 cast. 29058................. S.................... ..................... Application of shoulder 0058 1.0785 $58.55 ............

$11.71 cast. 29065................. S.................... ..................... Application of long arm 0058 1.0785 $58.55 ............

$11.71 cast. 29075................. S.................... ..................... Application of forearm 0058 1.0785 $58.55 ............

$11.71 cast. 29085................. S.................... ..................... Apply hand/wrist cast.. 0058 1.0785 $58.55 ............

$11.71 29086................. S.................... ..................... Apply finger cast...... 0058 1.0785 $58.55 ............

$11.71 29105................. S.................... ..................... Apply long arm splint.. 0058 1.0785 $58.55 ............

$11.71 29125................. S.................... ..................... Apply forearm splint... 0058 1.0785 $58.55 ............

$11.71 29126................. S.................... ..................... Apply forearm splint... 0058 1.0785 $58.55 ............

$11.71 29130................. S.................... ..................... Application of finger 0058 1.0785 $58.55 ............

$11.71 splint. 29131................. S.................... ..................... Application of finger 0058 1.0785 $58.55 ............

$11.71 splint. 29200................. S.................... ..................... Strapping of chest..... 0058 1.0785 $58.55 ............

$11.71 29220................. S.................... ..................... Strapping of low back.. 0058 1.0785 $58.55 ............

$11.71 29240................. S.................... ..................... Strapping of shoulder.. 0058 1.0785 $58.55 ............

$11.71 29260................. S.................... ..................... Strapping of elbow or 0058 1.0785 $58.55 ............

$11.71 wrist. 29280................. S.................... ..................... Strapping of hand or 0058 1.0785 $58.55 ............

$11.71 finger. 29305................. S.................... ..................... Application of hip cast 0058 1.0785 $58.55 ............

$11.71 29325................. S.................... ..................... Application of hip

0058 1.0785 $58.55 ............

$11.71 casts. 29345................. S.................... ..................... Application of long leg 0058 1.0785 $58.55 ............

$11.71 cast. 29355................. S.................... ..................... Application of long leg 0058 1.0785 $58.55 ............

$11.71 cast. 29358................. S.................... ..................... Apply long leg cast 0058 1.0785 $58.55 ............

$11.71 brace. 29365................. S.................... ..................... Application of long leg 0058 1.0785 $58.55 ............

$11.71 cast. 29405................. S.................... ..................... Apply short leg cast... 0058 1.0785 $58.55 ............

$11.71 29425................. S.................... ..................... Apply short leg cast... 0058 1.0785 $58.55 ............

$11.71 29435................. S.................... ..................... Apply short leg cast... 0058 1.0785 $58.55 ............

$11.71 29440................. S.................... ..................... Addition of walker to 0058 1.0785 $58.55 ............

$11.71 cast. 29445................. S.................... ..................... Apply rigid leg cast... 0058 1.0785 $58.55 ............

$11.71 29450................. S.................... ..................... Application of leg cast 0058 1.0785 $58.55 ............

$11.71 29505................. S.................... ..................... Application, long leg 0058 1.0785 $58.55 ............

$11.71 splint. 29515................. S.................... ..................... Application lower leg 0058 1.0785 $58.55 ............

$11.71 splint. 29520................. S.................... ..................... Strapping of hip....... 0058 1.0785 $58.55 ............

$11.71 29530................. S.................... ..................... Strapping of knee...... 0058 1.0785 $58.55 ............

$11.71 29540................. S.................... ..................... Strapping of ankle..... 0058 1.0785 $58.55 ............

$11.71 29550................. S.................... ..................... Strapping of toes...... 0058 1.0785 $58.55 ............

$11.71 29580................. S.................... ..................... Application of paste 0058 1.0785 $58.55 ............

$11.71 boot. 29590................. S.................... ..................... Application of foot 0058 1.0785 $58.55 ............

$11.71 splint. 29700................. S.................... ..................... Removal/revision of 0058 1.0785 $58.55 ............

$11.71 cast. 29705................. S.................... ..................... Removal/revision of 0058 1.0785 $58.55 ............

$11.71 cast. 29710................. S.................... ..................... Removal/revision of 0058 1.0785 $58.55 ............

$11.71 cast. 29715................. S.................... ..................... Removal/revision of 0058 1.0785 $58.55 ............

$11.71 cast. 29720................. S.................... ..................... Repair of body cast.... 0058 1.0785 $58.55 ............

$11.71 29730................. S.................... ..................... Windowing of cast...... 0058 1.0785 $58.55 ............

$11.71 29740................. S.................... ..................... Wedging of cast........ 0058 1.0785 $58.55 ............

$11.71 29750................. S.................... ..................... Wedging of clubfoot 0058 1.0785 $58.55 ............

$11.71 cast. 29799................. S.................... ..................... Casting/strapping

0058 1.0785 $58.55 ............

$11.71 procedure. 29800................. T.................... ..................... Jaw arthroscopy/surgery 0041 27.2538 $1,479.58 ............ $295.92 29804................. T.................... ..................... Jaw arthroscopy/surgery 0041 27.2538 $1,479.58 ............ $295.92 29805................. T.................... ..................... Shoulder arthroscopy, 0041 27.2538 $1,479.58 ............ $295.92 dx. 29806................. T.................... ..................... Shoulder arthroscopy/ 0041 27.2538 $1,479.58 ............ $295.92 surgery. 29807................. T.................... ..................... Shoulder arthroscopy/ 0041 27.2538 $1,479.58 ............ $295.92 surgery. 29819................. T.................... ..................... Shoulder arthroscopy/ 0041 27.2538 $1,479.58 ............ $295.92 surgery. 29820................. T.................... ..................... Shoulder arthroscopy/ 0041 27.2538 $1,479.58 ............ $295.92 surgery. 29821................. T.................... ..................... Shoulder arthroscopy/ 0041 27.2538 $1,479.58 ............ $295.92 surgery. 29822................. T.................... ..................... Shoulder arthroscopy/ 0041 27.2538 $1,479.58 ............ $295.92 surgery. 29823................. T.................... ..................... Shoulder arthroscopy/ 0041 27.2538 $1,479.58 ............ $295.92 surgery. 29824................. T.................... ..................... Shoulder arthroscopy/ 0041 27.2538 $1,479.58 ............ $295.92 surgery.

[[Page 48063]]

29825................. T.................... ..................... Shoulder arthroscopy/ 0041 27.2538 $1,479.58 ............ $295.92 surgery. 29826................. T.................... ..................... Shoulder arthroscopy/ 0042 42.8551 $2,326.56 $804.74 $465.31 surgery. 29827................. T.................... ..................... Arthroscop rotator cuff 0041 27.2538 $1,479.58 ............ $295.92 repr. 29830................. T.................... ..................... Elbow arthroscopy...... 0041 27.2538 $1,479.58 ............ $295.92 29834................. T.................... ..................... Elbow arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29835................. T.................... ..................... Elbow arthroscopy/

0042 42.8551 $2,326.56 $804.74 $465.31 surgery. 29836................. T.................... ..................... Elbow arthroscopy/

0042 42.8551 $2,326.56 $804.74 $465.31 surgery. 29837................. T.................... ..................... Elbow arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29838................. T.................... ..................... Elbow arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29840................. T.................... ..................... Wrist arthroscopy...... 0041 27.2538 $1,479.58 ............ $295.92 29843................. T.................... ..................... Wrist arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29844................. T.................... ..................... Wrist arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29845................. T.................... ..................... Wrist arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29846................. T.................... ..................... Wrist arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29847................. T.................... ..................... Wrist arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29848................. T.................... ..................... Wrist endoscopy/surgery 0041 27.2538 $1,479.58 ............ $295.92 29850................. T.................... ..................... Knee arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29851................. T.................... ..................... Knee arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29855................. T.................... ..................... Tibial arthroscopy/ 0042 42.8551 $2,326.56 $804.74 $465.31 surgery. 29856................. T.................... ..................... Tibial arthroscopy/ 0041 27.2538 $1,479.58 ............ $295.92 surgery. 29860................. T.................... ..................... Hip arthroscopy, dx.... 0041 27.2538 $1,479.58 ............ $295.92 29861................. T.................... ..................... Hip arthroscopy/surgery 0041 27.2538 $1,479.58 ............ $295.92 29862................. T.................... ..................... Hip arthroscopy/surgery 0042 42.8551 $2,326.56 $804.74 $465.31 29863................. T.................... ..................... Hip arthroscopy/surgery 0042 42.8551 $2,326.56 $804.74 $465.31 29870................. T.................... ..................... Knee arthroscopy, dx... 0041 27.2538 $1,479.58 ............ $295.92 29871................. T.................... ..................... Knee arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 drainage. 29873................. T.................... ..................... Knee arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29874................. T.................... ..................... Knee arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29875................. T.................... ..................... Knee arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29876................. T.................... ..................... Knee arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29877................. T.................... ..................... Knee arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29879................. T.................... ..................... Knee arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29880................. T.................... ..................... Knee arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29881................. T.................... ..................... Knee arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29882................. T.................... ..................... Knee arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29883................. T.................... ..................... Knee arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29884................. T.................... ..................... Knee arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29885................. T.................... ..................... Knee arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29886................. T.................... ..................... Knee arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29887................. T.................... ..................... Knee arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29888................. T.................... ..................... Knee arthroscopy/

0042 42.8551 $2,326.56 $804.74 $465.31 surgery. 29889................. T.................... ..................... Knee arthroscopy/

0042 42.8551 $2,326.56 $804.74 $465.31 surgery. 29891................. T.................... ..................... Ankle arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29892................. T.................... ..................... Ankle arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29893................. T.................... ..................... Scope, plantar

0055 18.8851 $1,025.25 $355.34 $205.05 fasciotomy. 29894................. T.................... ..................... Ankle arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29895................. T.................... ..................... Ankle arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29897................. T.................... ..................... Ankle arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29898................. T.................... ..................... Ankle arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29899................. T.................... ..................... Ankle arthroscopy/

0041 27.2538 $1,479.58 ............ $295.92 surgery. 29900................. T.................... ..................... Mcp joint arthroscopy, 0053 14.8188 $804.50 $253.49 $160.90 dx. 29901................. T.................... ..................... Mcp joint arthroscopy, 0053 14.8188 $804.50 $253.49 $160.90 surg. 29902................. T.................... ..................... Mcp joint arthroscopy, 0053 14.8188 $804.50 $253.49 $160.90 surg. 29999................. T.................... ..................... Arthroscopy of joint... 0041 27.2538 $1,479.58 ............ $295.92 30000................. T.................... ..................... Drainage of nose lesion 0251 1.8643 $101.21 ............

$20.24 30020................. T.................... ..................... Drainage of nose lesion 0251 1.8643 $101.21 ............

$20.24 30100................. T.................... ..................... Intranasal biopsy...... 0252 6.5416 $355.14 $113.41

$71.03 30110................. T.................... ..................... Removal of nose

0253 15.1698 $823.55 $282.29 $164.71 polyp(s). 30115................. T.................... ..................... Removal of nose

0253 15.1698 $823.55 $282.29 $164.71 polyp(s). 30117................. T.................... ..................... Removal of intranasal 0253 15.1698 $823.55 $282.29 $164.71 lesion. 30118................. T.................... ..................... Removal of intranasal 0254 21.4368 $1,163.78 $321.35 $232.76 lesion. 30120................. T.................... ..................... Revision of nose....... 0253 15.1698 $823.55 $282.29 $164.71 30124................. T.................... ..................... Removal of nose lesion. 0252 6.5416 $355.14 $113.41

$71.03 30125................. T.................... ..................... Removal of nose lesion. 0256 35.0866 $1,904.82 ............ $380.96 30130................. T.................... ..................... Removal of turbinate 0253 15.1698 $823.55 $282.29 $164.71 bones. 30140................. T.................... ..................... Removal of turbinate 0254 21.4368 $1,163.78 $321.35 $232.76 bones.

[[Continued on page 48065]]

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

[[pp. 48065-48114]] Medicare Program; Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2004 Payment Rates

[[Continued from page 48064]]

[[Page 48064]]

30150................. T.................... ..................... Partial removal of nose 0256 35.0866 $1,904.82 ............ $380.96 30160................. T.................... ..................... Removal of nose........ 0256 35.0866 $1,904.82 ............ $380.96 30200................. T.................... ..................... Injection treatment of 0253 15.1698 $823.55 $282.29 $164.71 nose. 30210................. T.................... ..................... Nasal sinus therapy.... 0252 6.5416 $355.14 $113.41

$71.03 30220................. T.................... ..................... Insert nasal septal 0252 6.5416 $355.14 $113.41

$71.03 button. 30300................. X.................... ..................... Remove nasal foreign 0340 0.6232 $33.83 ............

$6.77 body. 30310................. T.................... ..................... Remove nasal foreign 0253 15.1698 $823.55 $282.29 $164.71 body. 30320................. T.................... ..................... Remove nasal foreign 0253 15.1698 $823.55 $282.29 $164.71 body. 30400................. T.................... ..................... Reconstruction of nose. 0256 35.0866 $1,904.82 ............ $380.96 30410................. T.................... ..................... Reconstruction of nose. 0256 35.0866 $1,904.82 ............ $380.96 30420................. T.................... ..................... Reconstruction of nose. 0256 35.0866 $1,904.82 ............ $380.96 30430................. T.................... ..................... Revision of nose....... 0254 21.4368 $1,163.78 $321.35 $232.76 30435................. T.................... ..................... Revision of nose....... 0256 35.0866 $1,904.82 ............ $380.96 30450................. T.................... ..................... Revision of nose....... 0256 35.0866 $1,904.82 ............ $380.96 30460................. T.................... ..................... Revision of nose....... 0256 35.0866 $1,904.82 ............ $380.96 30462................. T.................... ..................... Revision of nose....... 0256 35.0866 $1,904.82 ............ $380.96 30465................. T.................... ..................... Repair nasal stenosis.. 0256 35.0866 $1,904.82 ............ $380.96 30520................. T.................... ..................... Repair of nasal septum. 0254 21.4368 $1,163.78 $321.35 $232.76 30540................. T.................... ..................... Repair nasal defect.... 0256 35.0866 $1,904.82 ............ $380.96 30545................. T.................... ..................... Repair nasal defect.... 0256 35.0866 $1,904.82 ............ $380.96 30560................. T.................... ..................... Release of nasal

0251 1.8643 $101.21 ............

$20.24 adhesions. 30580................. T.................... ..................... Repair upper jaw

0256 35.0866 $1,904.82 ............ $380.96 fistula. 30600................. T.................... ..................... Repair mouth/nose

0256 35.0866 $1,904.82 ............ $380.96 fistula. 30620................. T.................... ..................... Intranasal

0256 35.0866 $1,904.82 ............ $380.96 reconstruction. 30630................. T.................... ..................... Repair nasal septum 0254 21.4368 $1,163.78 $321.35 $232.76 defect. 30801................. T.................... ..................... Cauterization, inner 0252 6.5416 $355.14 $113.41

$71.03 nose. 30802................. T.................... ..................... Cauterization, inner 0253 15.1698 $823.55 $282.29 $164.71 nose. 30901................. T.................... ..................... Control of nosebleed... 0250 1.5381 $83.50

$29.23

$16.70 30903................. T.................... ..................... Control of nosebleed... 0250 1.5381 $83.50

$29.23

$16.70 30905................. T.................... ..................... Control of nosebleed... 0250 1.5381 $83.50

$29.23

$16.70 30906................. T.................... ..................... Repeat control of

0250 1.5381 $83.50

$29.23

$16.70 nosebleed. 30915................. T.................... ..................... Ligation, nasal sinus 0091 28.5187 $1,548.25 $348.23 $309.65 artery. 30920................. T.................... ..................... Ligation, upper jaw 0092 25.1347 $1,364.54 $505.37 $272.91 artery. 30930................. T.................... ..................... Therapy, fracture of 0253 15.1698 $823.55 $282.29 $164.71 nose. 30999................. T.................... ..................... Nasal surgery procedure 0251 1.8643 $101.21 ............

$20.24 31000................. T.................... ..................... Irrigation, maxillary 0251 1.8643 $101.21 ............

$20.24 sinus. 31002................. T.................... ..................... Irrigation, sphenoid 0252 6.5416 $355.14 $113.41

$71.03 sinus. 31020................. T.................... ..................... Exploration, maxillary 0254 21.4368 $1,163.78 $321.35 $232.76 sinus. 31030................. T.................... ..................... Exploration, maxillary 0256 35.0866 $1,904.82 ............ $380.96 sinus. 31032................. T.................... ..................... Explore sinus, remove 0256 35.0866 $1,904.82 ............ $380.96 polyps. 31040................. T.................... ..................... Exploration behind

0254 21.4368 $1,163.78 $321.35 $232.76 upper jaw. 31050................. T.................... ..................... Exploration, sphenoid 0256 35.0866 $1,904.82 ............ $380.96 sinus. 31051................. T.................... ..................... Sphenoid sinus surgery. 0256 35.0866 $1,904.82 ............ $380.96 31070................. T.................... ..................... Exploration of frontal 0254 21.4368 $1,163.78 $321.35 $232.76 sinus. 31075................. T.................... ..................... Exploration of frontal 0256 35.0866 $1,904.82 ............ $380.96 sinus. 31080................. T.................... ..................... Removal of frontal

0256 35.0866 $1,904.82 ............ $380.96 sinus. 31081................. T.................... ..................... Removal of frontal

0256 35.0866 $1,904.82 ............ $380.96 sinus. 31084................. T.................... ..................... Removal of frontal

0256 35.0866 $1,904.82 ............ $380.96 sinus. 31085................. T.................... ..................... Removal of frontal

0256 35.0866 $1,904.82 ............ $380.96 sinus. 31086................. T.................... ..................... Removal of frontal

0256 35.0866 $1,904.82 ............ $380.96 sinus. 31087................. T.................... ..................... Removal of frontal

0256 35.0866 $1,904.82 ............ $380.96 sinus. 31090................. T.................... ..................... Exploration of sinuses. 0256 35.0866 $1,904.82 ............ $380.96 31200................. T.................... ..................... Removal of ethmoid

0256 35.0866 $1,904.82 ............ $380.96 sinus. 31201................. T.................... ..................... Removal of ethmoid

0256 35.0866 $1,904.82 ............ $380.96 sinus. 31205................. T.................... ..................... Removal of ethmoid

0256 35.0866 $1,904.82 ............ $380.96 sinus. 31225................. C.................... ..................... Removal of upper jaw... ..... ......... ........... ............ ............ 31230................. C.................... ..................... Removal of upper jaw... ..... ......... ........... ............ ............ 31231................. T.................... ..................... Nasal endoscopy, dx.... 0071 0.9012 $48.93

$12.89

$9.79 31233................. T.................... ..................... Nasal/sinus endoscopy, 0073 3.4396 $186.73

$73.38

$37.35 dx. 31235................. T.................... ..................... Nasal/sinus endoscopy, 0074 14.4952 $786.93 $295.70 $157.39 dx. 31237................. T.................... ..................... Nasal/sinus endoscopy, 0075 20.4113 $1,108.11 $445.92 $221.62 surg. 31238................. T.................... ..................... Nasal/sinus endoscopy, 0074 14.4952 $786.93 $295.70 $157.39 surg. 31239................. T.................... ..................... Nasal/sinus endoscopy, 0075 20.4113 $1,108.11 $445.92 $221.62 surg. 31240................. T.................... ..................... Nasal/sinus endoscopy, 0074 14.4952 $786.93 $295.70 $157.39 surg. 31254................. T.................... ..................... Revision of ethmoid 0075 20.4113 $1,108.11 $445.92 $221.62 sinus. 31255................. T.................... ..................... Removal of ethmoid

0075 20.4113 $1,108.11 $445.92 $221.62 sinus.

[[Page 48065]]

31256................. T.................... ..................... Exploration maxillary 0075 20.4113 $1,108.11 $445.92 $221.62 sinus. 31267................. T.................... ..................... Endoscopy, maxillary 0075 20.4113 $1,108.11 $445.92 $221.62 sinus. 31276................. T.................... ..................... Sinus endoscopy,

0075 20.4113 $1,108.11 $445.92 $221.62 surgical. 31287................. T.................... ..................... Nasal/sinus endoscopy, 0075 20.4113 $1,108.11 $445.92 $221.62 surg. 31288................. T.................... ..................... Nasal/sinus endoscopy, 0075 20.4113 $1,108.11 $445.92 $221.62 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 procedure 0252 6.5416 $355.14 $113.41

$71.03 31300................. T.................... ..................... Removal of larynx

0254 21.4368 $1,163.78 $321.35 $232.76 lesion. 31320................. T.................... ..................... Diagnostic incision, 0256 35.0866 $1,904.82 ............ $380.96 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 35.0866 $1,904.82 ............ $380.96 31420................. T.................... ..................... Removal of epiglottis.. 0256 35.0866 $1,904.82 ............ $380.96 31500................. S.................... ..................... Insert emergency airway 0094 2.6412 $143.39

$48.46

$28.68 31502................. T.................... ..................... Change of windpipe

0121 2.2058 $119.75

$43.80

$23.95 airway. 31505................. T.................... ..................... Diagnostic laryngoscopy 0071 0.9012 $48.93

$12.89

$9.79 31510................. T.................... ..................... Laryngoscopy with

0074 14.4952 $786.93 $295.70 $157.39 biopsy. 31511................. T.................... ..................... Remove foreign body, 0072 1.6987 $92.22

$26.68

$18.44 larynx. 31512................. T.................... ..................... Removal of larynx

0074 14.4952 $786.93 $295.70 $157.39 lesion. 31513................. T.................... ..................... Injection into vocal 0072 1.6987 $92.22

$26.68

$18.44 cord. 31515................. T.................... ..................... Laryngoscopy for

0074 14.4952 $786.93 $295.70 $157.39 aspiration. 31520................. T.................... ..................... Diagnostic laryngoscopy 0072 1.6987 $92.22

$26.68

$18.44 31525................. T.................... ..................... Diagnostic laryngoscopy 0074 14.4952 $786.93 $295.70 $157.39 31526................. T.................... ..................... Diagnostic laryngoscopy 0075 20.4113 $1,108.11 $445.92 $221.62 31527................. T.................... ..................... Laryngoscopy for

0075 20.4113 $1,108.11 $445.92 $221.62 treatment. 31528................. T.................... ..................... Laryngoscopy and

0074 14.4952 $786.93 $295.70 $157.39 dilation. 31529................. T.................... ..................... Laryngoscopy and

0074 14.4952 $786.93 $295.70 $157.39 dilation. 31530................. T.................... ..................... Operative laryngoscopy. 0075 20.4113 $1,108.11 $445.92 $221.62 31531................. T.................... ..................... Operative laryngoscopy. 0075 20.4113 $1,108.11 $445.92 $221.62 31535................. T.................... ..................... Operative laryngoscopy. 0075 20.4113 $1,108.11 $445.92 $221.62 31536................. T.................... ..................... Operative laryngoscopy. 0075 20.4113 $1,108.11 $445.92 $221.62 31540................. T.................... ..................... Operative laryngoscopy. 0075 20.4113 $1,108.11 $445.92 $221.62 31541................. T.................... ..................... Operative laryngoscopy. 0075 20.4113 $1,108.11 $445.92 $221.62 31560................. T.................... ..................... Operative laryngoscopy. 0075 20.4113 $1,108.11 $445.92 $221.62 31561................. T.................... ..................... Operative laryngoscopy. 0075 20.4113 $1,108.11 $445.92 $221.62 31570................. T.................... ..................... Laryngoscopy with

0074 14.4952 $786.93 $295.70 $157.39 injection. 31571................. T.................... ..................... Laryngoscopy with

0075 20.4113 $1,108.11 $445.92 $221.62 injection. 31575................. T.................... ..................... Diagnostic laryngoscopy 0072 1.6987 $92.22

$26.68

$18.44 31576................. T.................... ..................... Laryngoscopy with

0075 20.4113 $1,108.11 $445.92 $221.62 biopsy. 31577................. T.................... ..................... Remove foreign body, 0073 3.4396 $186.73

$73.38

$37.35 larynx. 31578................. T.................... ..................... Removal of larynx

0075 20.4113 $1,108.11 $445.92 $221.62 lesion. 31579................. T.................... ..................... Diagnostic laryngoscopy 0073 3.4396 $186.73

$73.38

$37.35 31580................. T.................... ..................... Revision of larynx..... 0256 35.0866 $1,904.82 ............ $380.96 31582................. T.................... ..................... Revision of larynx..... 0256 35.0866 $1,904.82 ............ $380.96 31584................. C.................... ..................... Treat larynx fracture.. ..... ......... ........... ............ ............ 31585................. T.................... ..................... Treat larynx fracture.. 0253 15.1698 $823.55 $282.29 $164.71 31586................. T.................... ..................... Treat larynx fracture.. 0256 35.0866 $1,904.82 ............ $380.96 31587................. C.................... ..................... Revision of larynx..... ..... ......... ........... ............ ............ 31588................. T.................... ..................... Revision of larynx..... 0256 35.0866 $1,904.82 ............ $380.96 31590................. T.................... ..................... Reinnervate larynx..... 0256 35.0866 $1,904.82 ............ $380.96 31595................. T.................... ..................... Larynx nerve surgery... 0256 35.0866 $1,904.82 ............ $380.96 31599................. T.................... ..................... Larynx surgery

0254 21.4368 $1,163.78 $321.35 $232.76 procedure. 31600................. T.................... ..................... Incision of windpipe... 0254 21.4368 $1,163.78 $321.35 $232.76 31601................. T.................... ..................... Incision of windpipe... 0254 21.4368 $1,163.78 $321.35 $232.76

[[Page 48066]]

31603................. T.................... ..................... Incision of windpipe... 0252 6.5416 $355.14 $113.41

$71.03 31605................. T.................... ..................... Incision of windpipe... 0253 15.1698 $823.55 $282.29 $164.71 31610................. T.................... ..................... Incision of windpipe... 0254 21.4368 $1,163.78 $321.35 $232.76 31611................. T.................... ..................... Surgery/speech

0254 21.4368 $1,163.78 $321.35 $232.76 prosthesis. 31612................. T.................... ..................... Puncture/clear windpipe 0254 21.4368 $1,163.78 $321.35 $232.76 31613................. T.................... ..................... Repair windpipe opening 0254 21.4368 $1,163.78 $321.35 $232.76 31614................. T.................... ..................... Repair windpipe opening 0256 35.0866 $1,904.82 ............ $380.96 31615................. T.................... ..................... Visualization of

0076 9.3560 $507.93 $189.82 $101.59 windpipe. 31622................. T.................... ..................... Dx bronchoscope/wash... 0076 9.3560 $507.93 $189.82 $101.59 31623................. T.................... ..................... Dx bronchoscope/brush.. 0076 9.3560 $507.93 $189.82 $101.59 31624................. T.................... ..................... Dx bronchoscope/lavage. 0076 9.3560 $507.93 $189.82 $101.59 31625................. T.................... ..................... Bronchoscopy w/

0076 9.3560 $507.93 $189.82 $101.59 biopsy(s). 31628................. T.................... ..................... Bronchoscopy/lung bx, 0076 9.3560 $507.93 $189.82 $101.59 each. 31629................. T.................... ..................... Bronchoscopy/needle bx, 0076 9.3560 $507.93 $189.82 $101.59 each. 31630................. T.................... ..................... Bronchoscopy dilate/fx 0415 20.9920 $1,139.63 $463.30 $227.93 repr. 31631................. T.................... ..................... Bronchoscopy, dilate w/ 0415 20.9920 $1,139.63 $463.30 $227.93 stent. 31635................. T.................... ..................... Bronchoscopy w/fb

0076 9.3560 $507.93 $189.82 $101.59 removal. 31640................. T.................... ..................... Bronchoscopy w/tumor 0415 20.9920 $1,139.63 $463.30 $227.93 excise. 31641................. T.................... ..................... Bronchoscopy, treat 0415 20.9920 $1,139.63 $463.30 $227.93 blockage. 31643................. T.................... ..................... Diag bronchoscope/

0076 9.3560 $507.93 $189.82 $101.59 catheter. 31645................. T.................... ..................... Bronchoscopy, clear 0076 9.3560 $507.93 $189.82 $101.59 airways. 31646................. T.................... ..................... Bronchoscopy, reclear 0076 9.3560 $507.93 $189.82 $101.59 airway. 31656................. T.................... ..................... Bronchoscopy, inj for x- 0076 9.3560 $507.93 $189.82 $101.59 ray. 31700................. T.................... ..................... Insertion of airway 0072 1.6987 $92.22

$26.68

$18.44 catheter. 31708................. N.................... ..................... Instill airway contrast ..... ......... ........... ............ ............ dye. 31710................. N.................... ..................... Insertion of airway ..... ......... ........... ............ ............ catheter. 31715................. N.................... ..................... Injection for bronchus ..... ......... ........... ............ ............ x-ray. 31717................. T.................... ..................... Bronchial brush biopsy. 0073 3.4396 $186.73

$73.38

$37.35 31720................. T.................... ..................... Clearance of airways... 0072 1.6987 $92.22

$26.68

$18.44 31725................. C.................... ..................... Clearance of airways... ..... ......... ........... ............ ............ 31730................. T.................... ..................... Intro, windpipe wire/ 0073 3.4396 $186.73

$73.38

$37.35 tube. 31750................. T.................... ..................... Repair of windpipe..... 0256 35.0866 $1,904.82 ............ $380.96 31755................. T.................... ..................... Repair of windpipe..... 0256 35.0866 $1,904.82 ............ $380.96 31760................. C.................... ..................... Repair of windpipe..... ..... ......... ........... ............ ............ 31766................. C.................... ..................... Reconstruction of

..... ......... ........... ............ ............ windpipe. 31770................. C.................... ..................... Repair/graft of

..... ......... ........... ............ ............ bronchus. 31775................. C.................... ..................... Reconstruct bronchus... ..... ......... ........... ............ ............ 31780................. C.................... ..................... Reconstruct windpipe... ..... ......... ........... ............ ............ 31781................. C.................... ..................... Reconstruct windpipe... ..... ......... ........... ............ ............ 31785................. T.................... ..................... Remove windpipe lesion. 0254 21.4368 $1,163.78 $321.35 $232.76 31786................. C.................... ..................... Remove windpipe lesion. ..... ......... ........... ............ ............ 31800................. C.................... ..................... Repair of windpipe ..... ......... ........... ............ ............ injury. 31805................. C.................... ..................... Repair of windpipe ..... ......... ........... ............ ............ injury. 31820................. T.................... ..................... Closure of windpipe 0253 15.1698 $823.55 $282.29 $164.71 lesion. 31825................. T.................... ..................... Repair of windpipe

0254 21.4368 $1,163.78 $321.35 $232.76 defect. 31830................. T.................... ..................... Revise windpipe scar... 0254 21.4368 $1,163.78 $321.35 $232.76 31899................. T.................... ..................... Airways surgical

0076 9.3560 $507.93 $189.82 $101.59 procedure. 32000................. T.................... ..................... Drainage of chest...... 0070 3.1393 $170.43 ............

$34.09 32002................. T.................... ..................... Treatment of collapsed 0070 3.1393 $170.43 ............

$34.09 lung. 32005................. T.................... ..................... Treat lung lining

0070 3.1393 $170.43 ............

$34.09 chemically. 32020................. T.................... ..................... Insertion of chest tube 0070 3.1393 $170.43 ............

$34.09 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 3.1393 $170.43 ............

$34.09 lesion. 32215................. C.................... ..................... Treat chest lining..... ..... ......... ........... ............ ............

[[Page 48067]]

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 3.3675 $182.82

$71.59

$36.56 lining. 32402................. C.................... ..................... Open biopsy chest

..... ......... ........... ............ ............ lining. 32405................. T.................... ..................... Biopsy, lung or

0685 4.8912 $265.54 $116.83

$53.11 mediastinum. 32420................. T.................... ..................... Puncture/clear lung.... 0070 3.1393 $170.43 ............

$34.09 32440................. C.................... ..................... Removal of lung........ ..... ......... ........... ............ ............ 32442................. C.................... ..................... Sleeve pneumonectomy... ..... ......... ........... ............ ............ 32445................. C.................... ..................... Removal of lung........ ..... ......... ........... ............ ............ 32480................. C.................... ..................... Partial removal of lung ..... ......... ........... ............ ............ 32482................. C.................... ..................... Bilobectomy............ ..... ......... ........... ............ ............ 32484................. C.................... ..................... Segmentectomy.......... ..... ......... ........... ............ ............ 32486................. C.................... ..................... Sleeve lobectomy....... ..... ......... ........... ............ ............ 32488................. C.................... ..................... Completion

..... ......... ........... ............ ............ pneumonectomy. 32491................. C.................... ..................... Lung volume reduction.. ..... ......... ........... ............ ............ 32500................. C.................... ..................... Partial removal of lung ..... ......... ........... ............ ............ 32501................. C.................... ..................... Repair bronchus add-on. ..... ......... ........... ............ ............ 32520................. C.................... ..................... Remove lung & revise ..... ......... ........... ............ ............ chest. 32522................. C.................... ..................... Remove lung & revise ..... ......... ........... ............ ............ chest. 32525................. C.................... ..................... Remove lung & revise ..... ......... ........... ............ ............ chest. 32540................. C.................... ..................... Removal of lung lesion. ..... ......... ........... ............ ............ 32601................. T.................... ..................... Thoracoscopy,

0069 28.6334 $1,554.48 $591.64 $310.90 diagnostic. 32602................. T.................... ..................... Thoracoscopy,

0069 28.6334 $1,554.48 $591.64 $310.90 diagnostic. 32603................. T.................... ..................... Thoracoscopy,

0069 28.6334 $1,554.48 $591.64 $310.90 diagnostic. 32604................. T.................... ..................... Thoracoscopy,

0069 28.6334 $1,554.48 $591.64 $310.90 diagnostic. 32605................. T.................... ..................... Thoracoscopy,

0069 28.6334 $1,554.48 $591.64 $310.90 diagnostic. 32606................. T.................... ..................... Thoracoscopy,

0069 28.6334 $1,554.48 $591.64 $310.90 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 3.1393 $170.43 ............

$34.09 pneumothorax. 32997................. C.................... ..................... Total lung lavage...... ..... ......... ........... ............ ............ 32999................. T.................... ..................... Chest surgery procedure 0070 3.1393 $170.43 ............

$34.09 33010................. T.................... ..................... Drainage of heart sac.. 0070 3.1393 $170.43 ............

$34.09 33011................. T.................... ..................... Repeat drainage of

0070 3.1393 $170.43 ............

$34.09 heart sac. 33015................. C.................... ..................... Incision of heart sac.. ..... ......... ........... ............ ............ 33020................. C.................... ..................... Incision of heart sac.. ..... ......... ........... ............ ............ 33025................. C.................... ..................... Incision of heart sac.. ..... ......... ........... ............ ............

[[Page 48068]]

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 116.1611 $6,306.27 $1,722.59 $1,261.25 pacemaker. 33207................. T.................... ..................... Insertion of heart

0089 116.1611 $6,306.27 $1,722.59 $1,261.25 pacemaker. 33208................. T.................... ..................... Insertion of heart

0655 142.2244 $7,721.22 ............ $1,544.24 pacemaker. 33210................. T.................... ..................... Insertion of heart

0106 49.9534 $2,711.92 $542.39 $542.38 electrode. 33211................. T.................... ..................... Insertion of heart

0106 49.9534 $2,711.92 $542.39 $542.38 electrode. 33212................. T.................... ..................... Insertion of pulse

0090 87.2850 $4,738.62 $1,705.90 $947.72 generator. 33213................. T.................... ..................... Insertion of pulse

0654 103.8544 $5,638.15 ............ $1,127.63 generator. 33214................. T.................... ..................... Upgrade of pacemaker 0655 142.2244 $7,721.22 ............ $1,544.24 system. 33215................. T.................... ..................... Reposition pacing-defib 0105 18.9084 $1,026.52 $370.40 $205.30 lead. 33216................. T.................... ..................... Revise eltrd pacing- 0106 49.9534 $2,711.92 $542.39 $542.38 defib. 33217................. T.................... ..................... Insert lead pace-defib, 0106 49.9534 $2,711.92 $542.39 $542.38 dual. 33218................. T.................... ..................... Repair lead pace-defib, 0106 49.9534 $2,711.92 $542.39 $542.38 one. 33220................. T.................... ..................... Repair lead pace-defib, 0106 49.9534 $2,711.92 $542.39 $542.38 dual. 33222................. T.................... ..................... Revise pocket,

0027 15.8319 $859.50 $329.72 $171.90 pacemaker. 33223................. T.................... ..................... Revise pocket, pacing- 0027 15.8319 $859.50 $329.72 $171.90 defib. 33224................. T.................... ..................... Insert pacing lead & 1547 ......... $850.00 ............ $170.00 connect. 33225................. T.................... ..................... L ventric pacing lead 1550 ......... $1,150.00 ............ $230.00 add-on. 33226................. T.................... ..................... Reposition l ventric 0105 18.9084 $1,026.52 $370.40 $205.30 lead. 33233................. T.................... ..................... Removal of pacemaker 0105 18.9084 $1,026.52 $370.40 $205.30 system. 33234................. T.................... ..................... Removal of pacemaker 0105 18.9084 $1,026.52 $370.40 $205.30 system. 33235................. T.................... ..................... Removal pacemaker

0105 18.9084 $1,026.52 $370.40 $205.30 electrode. 33236................. C.................... ..................... Remove electrode/

..... ......... ........... ............ ............ thoracotomy. 33237................. C.................... ..................... Remove electrode/

..... ......... ........... ............ ............ thoracotomy. 33238................. C.................... ..................... Remove electrode/

..... ......... ........... ............ ............ thoracotomy. 33240................. T.................... ..................... Insert pulse generator. 0107 290.5429 $15,773.28 $3,429.62 $3,154.66 33241................. T.................... ..................... Remove pulse generator. 0105 18.9084 $1,026.52 $370.40 $205.30 33243................. C.................... ..................... Remove eltrd/

..... ......... ........... ............ ............ thoracotomy. 33244................. T.................... ..................... Remove eltrd, transven. 0105 18.9084 $1,026.52 $370.40 $205.30 33245................. C.................... ..................... Insert epic eltrd pace- ..... ......... ........... ............ ............ defib. 33246................. C.................... ..................... Insert epic eltrd/ ..... ......... ........... ............ ............ generator. 33249................. T.................... ..................... Eltrd/insert pace-defib 0108 489.5275 $26,575.96 ............ $5,315.19 33250................. C.................... ..................... Ablate heart dysrhythm ..... ......... ........... ............ ............ focus. 33251................. C.................... ..................... Ablate heart dysrhythm ..... ......... ........... ............ ............ focus. 33253................. C.................... ..................... Reconstruct atria...... ..... ......... ........... ............ ............ 33261................. C.................... ..................... Ablate heart dysrhythm ..... ......... ........... ............ ............ focus. 33282................. S.................... ..................... Implant pat-active ht 0680 61.4222 $3,334.55 ............ $666.91 record. 33284................. T.................... ..................... Remove pat-active ht 0109 7.7075 $418.43 $131.49

$83.69 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.

[[Page 48069]]

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

[[Page 48070]]

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

[[Page 48071]]

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 3.1393 $170.43 ............

$34.09 procedure. 34001................. C.................... ..................... Removal of artery clot. ..... ......... ........... ............ ............ 34051................. C.................... ..................... Removal of artery clot. ..... ......... ........... ............ ............ 34101................. T.................... ..................... Removal of artery clot. 0088 34.6065 $1,878.75 $655.22 $375.75 34111................. T.................... ..................... Removal of arm artery 0088 34.6065 $1,878.75 $655.22 $375.75 clot. 34151................. C.................... ..................... Removal of artery clot. ..... ......... ........... ............ ............ 34201................. T.................... ..................... Removal of artery clot. 0088 34.6065 $1,878.75 $655.22 $375.75 34203................. T.................... ..................... Removal of leg artery 0088 34.6065 $1,878.75 $655.22 $375.75 clot. 34401................. C.................... ..................... Removal of vein clot... ..... ......... ........... ............ ............ 34421................. T.................... ..................... Removal of vein clot... 0088 34.6065 $1,878.75 $655.22 $375.75 34451................. C.................... ..................... Removal of vein clot... ..... ......... ........... ............ ............ 34471................. T.................... ..................... Removal of vein clot... 0088 34.6065 $1,878.75 $655.22 $375.75 34490................. T.................... ..................... Removal of vein clot... 0088 34.6065 $1,878.75 $655.22 $375.75 34501................. T.................... ..................... Repair valve, femoral 0088 34.6065 $1,878.75 $655.22 $375.75 vein. 34502................. C.................... ..................... Reconstruct vena cava.. ..... ......... ........... ............ ............ 34510................. T.................... ..................... Transposition of vein 0088 34.6065 $1,878.75 $655.22 $375.75 valve. 34520................. T.................... ..................... Cross-over vein graft.. 0088 34.6065 $1,878.75 $655.22 $375.75 34530................. T.................... ..................... Leg vein fusion........ 0088 34.6065 $1,878.75 $655.22 $375.75 34800................. C.................... ..................... Endovasc abdo repair w/ ..... ......... ........... ............ ............ tube. 34802................. C.................... ..................... Endovasc abdo repr w/ ..... ......... ........... ............ ............ device. 34804................. C.................... ..................... Endovasc abdo repr w/ ..... ......... ........... ............ ............ device. 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 ..... ......... ........... ............ ............ 35011................. T.................... ..................... Repair defect of artery 0653 32.4880 $1,763.74 ............ $352.75 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.

[[Page 48072]]

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 20.6662 $1,121.95 $277.34 $224.39 lesion. 35182................. C.................... ..................... Repair blood vessel ..... ......... ........... ............ ............ lesion. 35184................. T.................... ..................... Repair blood vessel 0093 20.6662 $1,121.95 $277.34 $224.39 lesion. 35188................. T.................... ..................... Repair blood vessel 0088 34.6065 $1,878.75 $655.22 $375.75 lesion. 35189................. C.................... ..................... Repair blood vessel ..... ......... ........... ............ ............ lesion. 35190................. T.................... ..................... Repair blood vessel 0093 20.6662 $1,121.95 $277.34 $224.39 lesion. 35201................. T.................... ..................... Repair blood vessel 0093 20.6662 $1,121.95 $277.34 $224.39 lesion. 35206................. T.................... ..................... Repair blood vessel 0093 20.6662 $1,121.95 $277.34 $224.39 lesion. 35207................. T.................... ..................... Repair blood vessel 0088 34.6065 $1,878.75 $655.22 $375.75 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 20.6662 $1,121.95 $277.34 $224.39 lesion. 35231................. T.................... ..................... Repair blood vessel 0093 20.6662 $1,121.95 $277.34 $224.39 lesion. 35236................. T.................... ..................... Repair blood vessel 0093 20.6662 $1,121.95 $277.34 $224.39 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 20.6662 $1,121.95 $277.34 $224.39 lesion. 35261................. T.................... ..................... Repair blood vessel 0653 32.4880 $1,763.74 ............ $352.75 lesion. 35266................. T.................... ..................... Repair blood vessel 0653 32.4880 $1,763.74 ............ $352.75 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 32.4880 $1,763.74 ............ $352.75 lesion. 35301................. C.................... ..................... Rechanneling of artery. ..... ......... ........... ............ ............ 35311................. C.................... ..................... Rechanneling of artery. ..... ......... ........... ............ ............ 35321................. T.................... ..................... Rechanneling of artery. 0093 20.6662 $1,121.95 $277.34 $224.39 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 34.8355 $1,891.18 ............ $378.24 blockage. 35459................. T.................... ..................... Repair arterial

0081 34.8355 $1,891.18 ............ $378.24 blockage. 35460................. T.................... ..................... Repair venous blockage. 0081 34.8355 $1,891.18 ............ $378.24 35470................. T.................... ..................... Repair arterial

0081 34.8355 $1,891.18 ............ $378.24 blockage. 35471................. T.................... ..................... Repair arterial

0081 34.8355 $1,891.18 ............ $378.24 blockage. 35472................. T.................... ..................... Repair arterial

0081 34.8355 $1,891.18 ............ $378.24 blockage. 35473................. T.................... ..................... Repair arterial

0081 34.8355 $1,891.18 ............ $378.24 blockage. 35474................. T.................... ..................... Repair arterial

0081 34.8355 $1,891.18 ............ $378.24 blockage. 35475................. T.................... ..................... Repair arterial

0081 34.8355 $1,891.18 ............ $378.24 blockage. 35476................. T.................... ..................... Repair venous blockage. 0081 34.8355 $1,891.18 ............ $378.24 35480................. C.................... ..................... Atherectomy, open...... ..... ......... ........... ............ ............ 35481................. C.................... ..................... Atherectomy, open...... ..... ......... ........... ............ ............ 35482................. C.................... ..................... Atherectomy, open...... ..... ......... ........... ............ ............ 35483................. C.................... ..................... Atherectomy, open...... ..... ......... ........... ............ ............ 35484................. T.................... ..................... Atherectomy, open...... 0081 34.8355 $1,891.18 ............ $378.24

[[Page 48073]]

35485................. T.................... ..................... Atherectomy, open...... 0081 34.8355 $1,891.18 ............ $378.24 35490................. T.................... ..................... Atherectomy,

0081 34.8355 $1,891.18 ............ $378.24 percutaneous. 35491................. T.................... ..................... Atherectomy,

0081 34.8355 $1,891.18 ............ $378.24 percutaneous. 35492................. T.................... ..................... Atherectomy,

0081 34.8355 $1,891.18 ............ $378.24 percutaneous. 35493................. T.................... ..................... Atherectomy,

0081 34.8355 $1,891.18 ............ $378.24 percutaneous. 35494................. T.................... ..................... Atherectomy,

0081 34.8355 $1,891.18 ............ $378.24 percutaneous. 35495................. T.................... ..................... Atherectomy,

0081 34.8355 $1,891.18 ............ $378.24 percutaneous. 35500................. T.................... ..................... Harvest vein for bypass 0081 34.8355 $1,891.18 ............ $378.24 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.... ..... ......... ........... ............ ............ 35511................. C.................... ..................... Artery bypass graft.... ..... ......... ........... ............ ............ 35515................. C.................... ..................... Artery bypass graft.... ..... ......... ........... ............ ............ 35516................. C.................... ..................... Artery bypass graft.... ..... ......... ........... ............ ............ 35518................. C.................... ..................... Artery bypass graft.... ..... ......... ........... ............ ............ 35521................. C.................... ..................... Artery bypass graft.... ..... ......... ........... ............ ............ 35526................. C.................... ..................... Artery bypass graft.... ..... ......... ........... ............ ............ 35531................. C.................... ..................... Artery bypass graft.... ..... ......... ........... ............ ............ 35533................. C.................... ..................... Artery bypass graft.... ..... ......... ........... ............ ............ 35536................. C.................... ..................... Artery bypass graft.... ..... ......... ........... ............ ............ 35541................. C.................... ..................... Artery bypass graft.... ..... ......... ........... ............ ............ 35546................. C.................... ..................... Artery bypass graft.... ..... ......... ........... ............ ............ 35548................. C.................... ..................... Artery bypass graft.... ..... ......... ........... ............ ............ 35549................. C.................... ..................... Artery bypass graft.... ..... ......... ........... ............ ............ 35551................. C.................... ..................... Artery bypass graft.... ..... ......... ........... ............ ............ 35556................. C.................... ..................... Artery bypass graft.... ..... ......... ........... ............ ............ 35558................. C.................... ..................... Artery bypass graft.... ..... ......... ........... ............ ............ 35560................. C.................... ..................... Artery bypass graft.... ..... ......... ........... ............ ............ 35563................. C.................... ..................... Artery bypass graft.... ..... ......... ........... ............ ............ 35565................. C.................... ..................... Artery bypass graft.... ..... ......... ........... ............ ............ 35566................. C.................... ..................... Artery bypass graft.... ..... ......... ........... ............ ............ 35571................. C.................... ..................... Artery bypass graft.... ..... ......... ........... ............ ............ 35572................. N.................... ..................... Harvest femoropopliteal ..... ......... ........... ............ ............ vein. 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. ..... ......... ........... ............ ............

[[Page 48074]]

35685................. T.................... ..................... Bypass graft patency/ 0093 20.6662 $1,121.95 $277.34 $224.39 patch. 35686................. T.................... ..................... Bypass graft/av fist 0093 20.6662 $1,121.95 $277.34 $224.39 patency. 35691................. C.................... ..................... Arterial transposition. ..... ......... ........... ............ ............ 35693................. C.................... ..................... Arterial transposition. ..... ......... ........... ............ ............ 35694................. C.................... ..................... Arterial transposition. ..... ......... ........... ............ ............ 35695................. C.................... ..................... Arterial transposition. ..... ......... ........... ............ ............ 35700................. C.................... ..................... Reoperation, bypass ..... ......... ........... ............ ............ graft. 35701................. C.................... ..................... Exploration, carotid ..... ......... ........... ............ ............ artery. 35721................. C.................... ..................... Exploration, femoral ..... ......... ........... ............ ............ artery. 35741................. C.................... ..................... Exploration popliteal ..... ......... ........... ............ ............ artery. 35761................. T.................... ..................... Exploration of artery/ 0115 25.6233 $1,391.06 $459.35 $278.21 vein. 35800................. C.................... ..................... Explore neck vessels... ..... ......... ........... ............ ............ 35820................. C.................... ..................... Explore chest vessels.. ..... ......... ........... ............ ............ 35840................. C.................... ..................... Explore abdominal

..... ......... ........... ............ ............ vessels. 35860................. T.................... ..................... Explore limb vessels... 0093 20.6662 $1,121.95 $277.34 $224.39 35870................. C.................... ..................... Repair vessel graft ..... ......... ........... ............ ............ defect. 35875................. T.................... ..................... Removal of clot in

0088 34.6065 $1,878.75 $655.22 $375.75 graft. 35876................. T.................... ..................... Removal of clot in

0088 34.6065 $1,878.75 $655.22 $375.75 graft. 35879................. T.................... ..................... Revise graft w/vein.... 0088 34.6065 $1,878.75 $655.22 $375.75 35881................. T.................... ..................... Revise graft w/vein.... 0088 34.6065 $1,878.75 $655.22 $375.75 35901................. C.................... ..................... Excision, graft, neck.. ..... ......... ........... ............ ............ 35903................. T.................... ..................... Excision, graft,

0115 25.6233 $1,391.06 $459.35 $278.21 extremity. 35905................. C.................... ..................... Excision, graft, thorax ..... ......... ........... ............ ............ 35907................. C.................... ..................... Excision, graft,

..... ......... ........... ............ ............ abdomen. 36000................. N.................... ..................... Place needle in vein... ..... ......... ........... ............ ............ 36002................. S.................... ..................... Pseudoaneurysm

0267 2.4805 $134.66

$65.52

$26.93 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 infusion 0119 129.8988 $7,052.08 ............ $1,410.42 pump. 36261................. T.................... ..................... Revision of infusion 0124 27.4545 $1,490.48 $298.10 $298.10 pump. 36262................. T.................... ..................... Removal of infusion 0109 7.7075 $418.43 $131.49

$83.69 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 1 yr. 36430................. S.................... ..................... Blood transfusion

0110 3.7128 $201.56 ............

$40.31 service. 36440................. S.................... ..................... Bl push transfuse, 2 yr 0110 3.7128 $201.56 ............

$40.31 or 5 yr. 49507................. T.................... ..................... Prp i/hern init

0154 26.8861 $1,459.62 $464.85 $291.92 block5 yr. 49520................. T.................... ..................... Rerepair ing hernia, 0154 26.8861 $1,459.62 $464.85 $291.92 reduce. 49521................. T.................... ..................... Rerepair ing hernia, 0154 26.8861 $1,459.62 $464.85 $291.92 blocked.

[[Page 48089]]

49525................. T.................... ..................... Repair ing hernia,

0154 26.8861 $1,459.62 $464.85 $291.92 sliding. 49540................. T.................... ..................... Repair lumbar hernia... 0154 26.8861 $1,459.62 $464.85 $291.92 49550................. T.................... ..................... Rpr rem hernia, init, 0154 26.8861 $1,459.62 $464.85 $291.92 reduce. 49553................. T.................... ..................... Rpr fem hernia, init 0154 26.8861 $1,459.62 $464.85 $291.92 blocked. 49555................. T.................... ..................... Rerepair fem hernia, 0154 26.8861 $1,459.62 $464.85 $291.92 reduce. 49557................. T.................... ..................... Rerepair fem hernia, 0154 26.8861 $1,459.62 $464.85 $291.92 blocked. 49560................. T.................... ..................... Rpr ventral hern init, 0154 26.8861 $1,459.62 $464.85 $291.92 reduc. 49561................. T.................... ..................... Rpr ventral hern init, 0154 26.8861 $1,459.62 $464.85 $291.92 block. 49565................. T.................... ..................... Rerepair ventrl hern, 0154 26.8861 $1,459.62 $464.85 $291.92 reduce. 49566................. T.................... ..................... Rerepair ventrl hern, 0154 26.8861 $1,459.62 $464.85 $291.92 block. 49568................. T.................... ..................... Hernia repair w/mesh... 0154 26.8861 $1,459.62 $464.85 $291.92 49570................. T.................... ..................... Rpr epigastric hern, 0154 26.8861 $1,459.62 $464.85 $291.92 reduce. 49572................. T.................... ..................... Rpr epigastric hern, 0154 26.8861 $1,459.62 $464.85 $291.92 blocked. 49580................. T.................... ..................... Rpr umbil hern, reduc 5 yr. 49587................. T.................... ..................... Rpr umbil hern, block 0154 26.8861 $1,459.62 $464.85 $291.92 5 yr. 49590................. T.................... ..................... Repair spigilian hernia 0154 26.8861 $1,459.62 $464.85 $291.92 49600................. T.................... ..................... Repair umbilical lesion 0154 26.8861 $1,459.62 $464.85 $291.92 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 40.8955 $2,220.18 $1,001.89 $444.04 initial. 49651................. T.................... ..................... Laparo hernia repair 0131 40.8955 $2,220.18 $1,001.89 $444.04 recur. 49659................. T.................... ..................... Laparo proc, hernia 0131 40.8955 $2,220.18 $1,001.89 $444.04 repair. 49900................. C.................... ..................... Repair of abdominal ..... ......... ........... ............ ............ wall. 49904................. C.................... ..................... Omental flap, extra- ..... ......... ........... ............ ............ abdom. 49905................. C.................... ..................... Omental flap........... ..... ......... ........... ............ ............ 49906................. C.................... ..................... Free omental flap, ..... ......... ........... ............ ............ microvasc. 49999................. T.................... ..................... Abdomen surgery

0153 21.2745 $1,154.97 $410.87 $230.99 procedure. 50010................. C.................... ..................... Exploration of kidney.. ..... ......... ........... ............ ............ 50020................. C.................... ..................... Renal abscess, open ..... ......... ........... ............ ............ drain. 50021................. T.................... ..................... Renal abscess, percut 0005 3.3675 $182.82

$71.59

$36.56 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 stone 0163 33.6435 $1,826.47 ............ $365.29 50081................. T.................... ..................... Removal of kidney stone 0163 33.6435 $1,826.47 ............ $365.29 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 4.8912 $265.54 $116.83

$53.11 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 4.8912 $265.54 $116.83

$53.11 lesion. 50392................. T.................... ..................... Insert kidney drain.... 0161 16.5822 $900.23 $249.36 $180.05

[[Page 48090]]

50393................. T.................... ..................... Insert ureteral tube... 0161 16.5822 $900.23 $249.36 $180.05 50394................. N.................... ..................... Injection for kidney x- ..... ......... ........... ............ ............ ray. 50395................. T.................... ..................... Create passage to

0161 16.5822 $900.23 $249.36 $180.05 kidney. 50396................. T.................... ..................... Measure kidney pressure 0164 1.2115 $65.77

$17.59

$13.15 50398................. T.................... ..................... Change kidney tube..... 0122 8.4398 $458.19

$93.97

$91.64 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 32.5959 $1,769.60 $659.53 $353.92 cyst. 50542................. T.................... ..................... Laparo ablate renal 0131 40.8955 $2,220.18 $1,001.89 $444.04 mass. 50543................. T.................... ..................... Laparo partial

0131 40.8955 $2,220.18 $1,001.89 $444.04 nephrectomy. 50544................. T.................... ..................... Laparoscopy,

0130 32.5959 $1,769.60 $659.53 $353.92 pyeloplasty. 50545................. C.................... ..................... Laparo radical

..... ......... ........... ............ ............ nephrectomy. 50546................. C.................... ..................... Laparoscopic

..... ......... ........... ............ ............ nephrectomy. 50547................. C.................... ..................... Laparo removal donor ..... ......... ........... ............ ............ kidney. 50548................. C.................... ..................... Laparo remove k/ureter. ..... ......... ........... ............ ............ 50549................. T.................... ..................... Laparoscope proc, renal 0130 32.5959 $1,769.60 $659.53 $353.92 50551................. T.................... ..................... Kidney endoscopy....... 0160 6.8152 $369.99 $105.06

$74.00 50553................. T.................... ..................... Kidney endoscopy....... 0161 16.5822 $900.23 $249.36 $180.05 50555................. T.................... ..................... Kidney endoscopy &

0160 6.8152 $369.99 $105.06

$74.00 biopsy. 50557................. T.................... ..................... Kidney endoscopy &

0162 21.8578 $1,186.64 ............ $237.33 treatment. 50559................. T.................... ..................... Renal endoscopy/

0160 6.8152 $369.99 $105.06

$74.00 radiotracer. 50561................. T.................... ..................... Kidney endoscopy &

0161 16.5822 $900.23 $249.36 $180.05 treatment. 50562................. T.................... ..................... Renal scope w/tumor 0160 6.8152 $369.99 $105.06

$74.00 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 kidney 0169 44.5329 $2,417.65 $1,115.69 $483.53 stone. 50600................. C.................... ..................... Exploration of ureter.. ..... ......... ........... ............ ............ 50605................. C.................... ..................... Insert ureteral support ..... ......... ........... ............ ............ 50610................. C.................... ..................... Removal of ureter stone ..... ......... ........... ............ ............ 50620................. C.................... ..................... Removal of ureter stone ..... ......... ........... ............ ............ 50630................. C.................... ..................... Removal of ureter stone ..... ......... ........... ............ ............ 50650................. C.................... ..................... Removal of ureter...... ..... ......... ........... ............ ............ 50660................. C.................... ..................... Removal of ureter...... ..... ......... ........... ............ ............ 50684................. N.................... ..................... Injection for ureter x- ..... ......... ........... ............ ............ ray. 50686................. T.................... ..................... Measure ureter pressure 0164 1.2115 $65.77

$17.59

$13.15 50688................. T.................... ..................... Change of ureter tube.. 0122 8.4398 $458.19

$93.97

$91.64 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 ..... ......... ........... ............ ............

[[Page 48091]]

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 40.8955 $2,220.18 $1,001.89 $444.04 ureterolithotomy. 50947................. T.................... ..................... Laparo new ureter/

0131 40.8955 $2,220.18 $1,001.89 $444.04 bladder. 50948................. T.................... ..................... Laparo new ureter/

0131 40.8955 $2,220.18 $1,001.89 $444.04 bladder. 50949................. T.................... ..................... Laparoscope proc,

0130 32.5959 $1,769.60 $659.53 $353.92 ureter. 50951................. T.................... ..................... Endoscopy of ureter.... 0160 6.8152 $369.99 $105.06

$74.00 50953................. T.................... ..................... Endoscopy of ureter.... 0160 6.8152 $369.99 $105.06

$74.00 50955................. T.................... ..................... Ureter endoscopy &

0161 16.5822 $900.23 $249.36 $180.05 biopsy. 50957................. T.................... ..................... Ureter endoscopy &

0161 16.5822 $900.23 $249.36 $180.05 treatment. 50959................. T.................... ..................... Ureter endoscopy &

0161 16.5822 $900.23 $249.36 $180.05 tracer. 50961................. T.................... ..................... Ureter endoscopy &

0161 16.5822 $900.23 $249.36 $180.05 treatment. 50970................. T.................... ..................... Ureter endoscopy....... 0160 6.8152 $369.99 $105.06

$74.00 50972................. T.................... ..................... Ureter endoscopy &

0160 6.8152 $369.99 $105.06

$74.00 catheter. 50974................. T.................... ..................... Ureter endoscopy &

0161 16.5822 $900.23 $249.36 $180.05 biopsy. 50976................. T.................... ..................... Ureter endoscopy &

0161 16.5822 $900.23 $249.36 $180.05 treatment. 50978................. T.................... ..................... Ureter endoscopy &

0161 16.5822 $900.23 $249.36 $180.05 tracer. 50980................. T.................... ..................... Ureter endoscopy &

0161 16.5822 $900.23 $249.36 $180.05 treatment. 51000................. T.................... ..................... Drainage of bladder.... 0165 14.0780 $764.28 ............ $152.86 51005................. T.................... ..................... Drainage of bladder.... 0164 1.2115 $65.77

$17.59

$13.15 51010................. T.................... ..................... Drainage of bladder.... 0165 14.0780 $764.28 ............ $152.86 51020................. T.................... ..................... Incise & treat bladder. 0162 21.8578 $1,186.64 ............ $237.33 51030................. T.................... ..................... Incise & treat bladder. 0162 21.8578 $1,186.64 ............ $237.33 51040................. T.................... ..................... Incise & drain bladder. 0162 21.8578 $1,186.64 ............ $237.33 51045................. T.................... ..................... Incise bladder/drain 0160 6.8152 $369.99 $105.06

$74.00 ureter. 51050................. T.................... ..................... Removal of bladder

0162 21.8578 $1,186.64 ............ $237.33 stone. 51060................. C.................... ..................... Removal of ureter stone ..... ......... ........... ............ ............ 51065................. T.................... ..................... Remove ureter calculus. 0162 21.8578 $1,186.64 ............ $237.33 51080................. T.................... ..................... Drainage of bladder 0007 11.4943 $624.01 ............ $124.80 abscess. 51500................. T.................... ..................... Removal of bladder cyst 0154 26.8861 $1,459.62 $464.85 $291.92 51520................. T.................... ..................... Removal of bladder

0162 21.8578 $1,186.64 ............ $237.33 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. 51580................. C.................... ..................... Remove bladder/revise ..... ......... ........... ............ ............ tract. 51585................. C.................... ..................... Removal of bladder & ..... ......... ........... ............ ............ nodes. 51590................. C.................... ..................... Remove bladder/revise ..... ......... ........... ............ ............ tract. 51595................. C.................... ..................... Remove bladder/revise ..... ......... ........... ............ ............ tract. 51596................. C.................... ..................... Remove bladder/create ..... ......... ........... ............ ............ pouch. 51597................. C.................... ..................... Removal of pelvic

..... ......... ........... ............ ............ structures. 51600................. N.................... ..................... Injection for bladder x- ..... ......... ........... ............ ............ ray. 51605................. N.................... ..................... Preparation for bladder ..... ......... ........... ............ ............ xray. 51610................. N.................... ..................... Injection for bladder x- ..... ......... ........... ............ ............ ray. 51700................. T.................... ..................... Irrigation of bladder.. 0164 1.2115 $65.77

$17.59

$13.15 51701................. N.................... ..................... Insert bladder catheter ..... ......... ........... ............ ............ 51702................. N.................... ..................... Insert temp bladder ..... ......... ........... ............ ............ cath. 51703................. N.................... ..................... Insert bladder cath, ..... ......... ........... ............ ............ complex. 51705................. T.................... ..................... Change of bladder tube. 0121 2.2058 $119.75

$43.80

$23.95 51710................. T.................... ..................... Change of bladder tube. 0122 8.4398 $458.19

$93.97

$91.64 51715................. T.................... ..................... Endoscopic injection/ 0167 30.1066 $1,634.46 $555.84 $326.89 implant. 51720................. T.................... ..................... Treatment of bladder 0156 3.1438 $170.67

$46.55

$34.13 lesion. 51725................. T.................... ..................... Simple cystometrogram.. 0156 3.1438 $170.67

$46.55

$34.13 51726................. T.................... ..................... Complex cystometrogram. 0156 3.1438 $170.67

$46.55

$34.13 51736................. T.................... ..................... Urine flow measurement. 0164 1.2115 $65.77

$17.59

$13.15 51741................. T.................... ..................... Electro-uroflowmetry, 0164 1.2115 $65.77

$17.59

$13.15 first.

[[Page 48092]]

51772................. T.................... ..................... Urethra pressure

0164 1.2115 $65.77

$17.59

$13.15 profile. 51784................. T.................... ..................... Anal/urinary muscle 0164 1.2115 $65.77

$17.59

$13.15 study. 51785................. T.................... ..................... Anal/urinary muscle 0164 1.2115 $65.77

$17.59

$13.15 study. 51792................. T.................... ..................... Urinary reflex study... 0164 1.2115 $65.77

$17.59

$13.15 51795................. T.................... ..................... Urine voiding pressure 0164 1.2115 $65.77

$17.59

$13.15 study. 51797................. T.................... ..................... Intraabdominal pressure 0164 1.2115 $65.77

$17.59

$13.15 test. 51798................. X.................... ..................... Us urine capacity

0340 0.6232 $33.83 ............

$6.77 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 21.8578 $1,186.64 ............ $237.33 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 40.8955 $2,220.18 $1,001.89 $444.04 suspension. 51992................. T.................... ..................... Laparo sling operation. 0132 56.6318 $3,074.48 $1,239.22 $614.90 52000................. T.................... ..................... Cystoscopy............. 0160 6.8152 $369.99 $105.06

$74.00 52001................. T.................... ..................... Cystoscopy, removal of 0160 6.8152 $369.99 $105.06

$74.00 clots. 52005................. T.................... ..................... Cystoscopy & ureter 0161 16.5822 $900.23 $249.36 $180.05 catheter. 52007................. T.................... ..................... Cystoscopy and biopsy.. 0161 16.5822 $900.23 $249.36 $180.05 52010................. T.................... ..................... Cystoscopy & duct

0160 6.8152 $369.99 $105.06

$74.00 catheter. 52204................. T.................... ..................... Cystoscopy............. 0161 16.5822 $900.23 $249.36 $180.05 52214................. T.................... ..................... Cystoscopy and

0162 21.8578 $1,186.64 ............ $237.33 treatment. 52224................. T.................... ..................... Cystoscopy and

0162 21.8578 $1,186.64 ............ $237.33 treatment. 52234................. T.................... ..................... Cystoscopy and

0162 21.8578 $1,186.64 ............ $237.33 treatment. 52235................. T.................... ..................... Cystoscopy and

0162 21.8578 $1,186.64 ............ $237.33 treatment. 52240................. T.................... ..................... Cystoscopy and

0162 21.8578 $1,186.64 ............ $237.33 treatment. 52250................. T.................... ..................... Cystoscopy and

0162 21.8578 $1,186.64 ............ $237.33 radiotracer. 52260................. T.................... ..................... Cystoscopy and

0161 16.5822 $900.23 $249.36 $180.05 treatment. 52265................. T.................... ..................... Cystoscopy and

0160 6.8152 $369.99 $105.06

$74.00 treatment. 52270................. T.................... ..................... Cystoscopy & revise 0161 16.5822 $900.23 $249.36 $180.05 urethra. 52275................. T.................... ..................... Cystoscopy & revise 0161 16.5822 $900.23 $249.36 $180.05 urethra. 52276................. T.................... ..................... Cystoscopy and

0161 16.5822 $900.23 $249.36 $180.05 treatment. 52277................. T.................... ..................... Cystoscopy and

0162 21.8578 $1,186.64 ............ $237.33 treatment. 52281................. T.................... ..................... Cystoscopy and

0161 16.5822 $900.23 $249.36 $180.05 treatment. 52282................. T.................... ..................... Cystoscopy, implant 0385 66.4829 $3,609.29 ............ $721.86 stent. 52283................. T.................... ..................... Cystoscopy and

0161 16.5822 $900.23 $249.36 $180.05 treatment. 52285................. T.................... ..................... Cystoscopy and

0161 16.5822 $900.23 $249.36 $180.05 treatment. 52290................. T.................... ..................... Cystoscopy and

0161 16.5822 $900.23 $249.36 $180.05 treatment. 52300................. T.................... ..................... Cystoscopy and

0161 16.5822 $900.23 $249.36 $180.05 treatment. 52301................. T.................... ..................... Cystoscopy and

0161 16.5822 $900.23 $249.36 $180.05 treatment. 52305................. T.................... ..................... Cystoscopy and

0161 16.5822 $900.23 $249.36 $180.05 treatment. 52310................. T.................... ..................... Cystoscopy and

0160 6.8152 $369.99 $105.06

$74.00 treatment. 52315................. T.................... ..................... Cystoscopy and

0161 16.5822 $900.23 $249.36 $180.05 treatment. 52317................. T.................... ..................... Remove bladder stone... 0162 21.8578 $1,186.64 ............ $237.33 52318................. T.................... ..................... Remove bladder stone... 0162 21.8578 $1,186.64 ............ $237.33 52320................. T.................... ..................... Cystoscopy and

0162 21.8578 $1,186.64 ............ $237.33 treatment. 52325................. T.................... ..................... Cystoscopy, stone

0162 21.8578 $1,186.64 ............ $237.33 removal. 52327................. T.................... ..................... Cystoscopy, inject

0162 21.8578 $1,186.64 ............ $237.33 material. 52330................. T.................... ..................... Cystoscopy and

0162 21.8578 $1,186.64 ............ $237.33 treatment. 52332................. T.................... ..................... Cystoscopy and

0162 21.8578 $1,186.64 ............ $237.33 treatment. 52334................. T.................... ..................... Create passage to

0162 21.8578 $1,186.64 ............ $237.33 kidney. 52341................. T.................... ..................... Cysto w/ureter

0162 21.8578 $1,186.64 ............ $237.33 stricture tx. 52342................. T.................... ..................... Cysto w/up stricture tx 0162 21.8578 $1,186.64 ............ $237.33 52343................. T.................... ..................... Cysto w/renal stricture 0162 21.8578 $1,186.64 ............ $237.33 tx. 52344................. T.................... ..................... Cysto/uretero, stone 0162 21.8578 $1,186.64 ............ $237.33 remove. 52345................. T.................... ..................... Cysto/uretero w/up

0162 21.8578 $1,186.64 ............ $237.33 stricture. 52346................. T.................... ..................... Cystouretero w/renal 0162 21.8578 $1,186.64 ............ $237.33 strict. 52347................. T.................... ..................... Cystoscopy, resect

0160 6.8152 $369.99 $105.06

$74.00 ducts.

[[Page 48093]]

52351................. T.................... ..................... Cystouretero & or

0160 6.8152 $369.99 $105.06

$74.00 pyeloscope. 52352................. T.................... ..................... Cystouretero w/stone 0162 21.8578 $1,186.64 ............ $237.33 remove. 52353................. T.................... ..................... Cystouretero w/

0163 33.6435 $1,826.47 ............ $365.29 lithotripsy. 52354................. T.................... ..................... Cystouretero w/biopsy.. 0162 21.8578 $1,186.64 ............ $237.33 52355................. T.................... ..................... Cystouretero w/excise 0162 21.8578 $1,186.64 ............ $237.33 tumor. 52400................. T.................... ..................... Cystouretero w/congen 0162 21.8578 $1,186.64 ............ $237.33 repr. 52450................. T.................... ..................... Incision of prostate... 0162 21.8578 $1,186.64 ............ $237.33 52500................. T.................... ..................... Revision of bladder 0162 21.8578 $1,186.64 ............ $237.33 neck. 52510................. T.................... ..................... Dilation prostatic

0161 16.5822 $900.23 $249.36 $180.05 urethra. 52601................. T.................... ..................... Prostatectomy (TURP)... 0163 33.6435 $1,826.47 ............ $365.29 52606................. T.................... ..................... Control postop bleeding 0162 21.8578 $1,186.64 ............ $237.33 52612................. T.................... ..................... Prostatectomy, first 0163 33.6435 $1,826.47 ............ $365.29 stage. 52614................. T.................... ..................... Prostatectomy, second 0163 33.6435 $1,826.47 ............ $365.29 stage. 52620................. T.................... ..................... Remove residual

0163 33.6435 $1,826.47 ............ $365.29 prostate. 52630................. T.................... ..................... Remove prostate

0163 33.6435 $1,826.47 ............ $365.29 regrowth. 52640................. T.................... ..................... Relieve bladder

0162 21.8578 $1,186.64 ............ $237.33 contracture. 52647................. T.................... ..................... Laser surgery of

0163 33.6435 $1,826.47 ............ $365.29 prostate. 52648................. T.................... ..................... Laser surgery of

0163 33.6435 $1,826.47 ............ $365.29 prostate. 52700................. T.................... ..................... Drainage of prostate 0162 21.8578 $1,186.64 ............ $237.33 abscess. 53000................. T.................... ..................... Incision of urethra.... 0166 16.8401 $914.23 $218.73 $182.85 53010................. T.................... ..................... Incision of urethra.... 0166 16.8401 $914.23 $218.73 $182.85 53020................. T.................... ..................... Incision of urethra.... 0166 16.8401 $914.23 $218.73 $182.85 53025................. T.................... ..................... Incision of urethra.... 0166 16.8401 $914.23 $218.73 $182.85 53040................. T.................... ..................... Drainage of urethra 0166 16.8401 $914.23 $218.73 $182.85 abscess. 53060................. T.................... ..................... Drainage of urethra 0166 16.8401 $914.23 $218.73 $182.85 abscess. 53080................. T.................... ..................... Drainage of urinary 0166 16.8401 $914.23 $218.73 $182.85 leakage. 53085................. C.................... ..................... Drainage of urinary ..... ......... ........... ............ ............ leakage. 53200................. T.................... ..................... Biopsy of urethra...... 0166 16.8401 $914.23 $218.73 $182.85 53210................. T.................... ..................... Removal of urethra..... 0168 30.3485 $1,647.59 $405.60 $329.52 53215................. T.................... ..................... Removal of urethra..... 0168 30.3485 $1,647.59 $405.60 $329.52 53220................. T.................... ..................... Treatment of urethra 0168 30.3485 $1,647.59 $405.60 $329.52 lesion. 53230................. T.................... ..................... Removal of urethra

0168 30.3485 $1,647.59 $405.60 $329.52 lesion. 53235................. T.................... ..................... Removal of urethra

0168 30.3485 $1,647.59 $405.60 $329.52 lesion. 53240................. T.................... ..................... Surgery for urethra 0168 30.3485 $1,647.59 $405.60 $329.52 pouch. 53250................. T.................... ..................... Removal of urethra

0166 16.8401 $914.23 $218.73 $182.85 gland. 53260................. T.................... ..................... Treatment of urethra 0166 16.8401 $914.23 $218.73 $182.85 lesion. 53265................. T.................... ..................... Treatment of urethra 0166 16.8401 $914.23 $218.73 $182.85 lesion. 53270................. T.................... ..................... Removal of urethra

0167 30.1066 $1,634.46 $555.84 $326.89 gland. 53275................. T.................... ..................... Repair of urethra

0166 16.8401 $914.23 $218.73 $182.85 defect. 53400................. T.................... ..................... Revise urethra, stage 1 0168 30.3485 $1,647.59 $405.60 $329.52 53405................. T.................... ..................... Revise urethra, stage 2 0168 30.3485 $1,647.59 $405.60 $329.52 53410................. T.................... ..................... Reconstruction of

0168 30.3485 $1,647.59 $405.60 $329.52 urethra. 53415................. C.................... ..................... Reconstruction of

..... ......... ........... ............ ............ urethra. 53420................. T.................... ..................... Reconstruct urethra, 0168 30.3485 $1,647.59 $405.60 $329.52 stage 1. 53425................. T.................... ..................... Reconstruct urethra, 0168 30.3485 $1,647.59 $405.60 $329.52 stage 2. 53430................. T.................... ..................... Reconstruction of

0168 30.3485 $1,647.59 $405.60 $329.52 urethra. 53431................. T.................... ..................... Reconstruct urethra/ 0168 30.3485 $1,647.59 $405.60 $329.52 bladder. 53440................. T.................... ..................... Correct bladder

0385 66.4829 $3,609.29 ............ $721.86 function. 53442................. T.................... ..................... Remove perineal

0166 16.8401 $914.23 $218.73 $182.85 prosthesis. 53444................. T.................... ..................... Insert tandem cuff..... 0385 66.4829 $3,609.29 ............ $721.86 53445................. T.................... ..................... Insert uro/ves nck

0386 118.8122 $6,450.20 ............ $1,290.04 sphincter. 53446................. T.................... ..................... Remove uro sphincter... 0168 30.3485 $1,647.59 $405.60 $329.52 53447................. T.................... ..................... Remove/replace ur

0386 118.8122 $6,450.20 ............ $1,290.014 sphincter. 53448................. C.................... ..................... Remov/replc ur sphinctr ..... ......... ........... ............ ............ comp. 53449................. T.................... ..................... Repair uro sphincter... 0168 30.3485 $1,647.59 $405.60 $329.52 53450................. T.................... ..................... Revision of urethra.... 0168 30.3485 $1,647.59 $405.60 $329.52 53460................. T.................... ..................... Revision of urethra.... 0168 30.3485 $1,647.59 $405.60 $329.52 53502................. T.................... ..................... Repair of urethra

0166 16.8401 $914.23 $218.73 $182.85 injury. 53505................. T.................... ..................... Repair of urethra

0167 30.1066 $1,634.46 $555.84 $326.89 injury. 53510................. T.................... ..................... Repair of urethra

0166 16.8401 $914.23 $218.73 $182.85 injury. 53515................. T.................... ..................... Repair of urethra

0168 30.3485 $1,647.59 $405.60 $329.52 injury. 53520................. T.................... ..................... Repair of urethra

0168 30.3485 $1,647.59 $405.60 $329.52 defect. 53600................. T.................... ..................... Dilate urethra

0156 3.1438 $170.67

$46.55

$34.13 stricture. 53601................. T.................... ..................... Dilate urethra

0164 1.2115 $65.77

$17.59

$13.15 stricture. 53605................. T.................... ..................... Dilate urethra

0161 16.5822 $900.23 $249.36 $180.05 stricture. 53620................. T.................... ..................... Dilate urethra

0165 14.0780 $764.28 ............ $152.86 stricture.

[[Page 48094]]

53621................. T.................... ..................... Dilate urethra

0164 1.2115 $65.77

$17.59

$13.15 stricture. 53660................. T.................... ..................... Dilation of urethra.... 0164 1.2115 $65.77

$17.59

$13.15 53661................. T.................... ..................... Dilation of urethra.... 0164 1.2115 $65.77

$17.59

$13.15 53665................. T.................... ..................... Dilation of urethra.... 0166 16.8401 $914.23 $218.73 $182.85 53850................. T.................... ..................... Prostatic microwave 0675 49.3613 $2,679.78 ............ $535.96 thermotx. 53852................. T.................... ..................... Prostatic rf thermotx.. 0675 49.3613 $2,679.78 ............ $535.96 53853................. T.................... ..................... Prostatic water

1550 ......... $1,150.00 ............ $230.00 thermother. 53899................. T.................... ..................... Urology surgery

0164 1.2115 $65.77

$17.59

$13.15 procedure. 54000................. T.................... ..................... Slitting of prepuce.... 0166 16.8401 $914.23 $218.73 $182.85 54001................. T.................... ..................... Slitting of prepuce.... 0166 16.8401 $914.23 $218.73 $182.85 54015................. T.................... ..................... Drain penis lesion..... 0007 11.4943 $624.01 ............ $124.80 54050................. T.................... ..................... Destruction, penis

0013 1.1420 $62.00

$14.20

$12.40 lesion(s). 54055................. T.................... ..................... Destruction, penis

0017 16.7332 $908.43 $227.84 $181.69 lesion(s). 54056................. T.................... ..................... Cryosurgery, penis

0012 0.8203 $44.53

$11.18

$8.91 lesion(s). 54057................. T.................... ..................... Laser surg, penis

0017 16.7332 $908.43 $227.84 $181.69 lesion(s). 54060................. T.................... ..................... Excision of penis

0017 16.7332 $908.43 $227.84 $181.69 lesion(s). 54065................. T.................... ..................... Destruction, penis

0695 19.1377 $1,038.97 $266.59 $207.79 lesion(s). 54100................. T.................... ..................... Biopsy of penis........ 0021 14.5749 $791.26 $219.48 $158.25 54105................. T.................... ..................... Biopsy of penis........ 0022 18.6725 $1,013.71 $354.45 $202.74 54110................. T.................... ..................... Treatment of penis

0181 29.0094 $1,574.89 $621.82 $314.98 lesion. 54111................. T.................... ..................... Treat penis lesion, 0181 29.0094 $1,574.89 $621.82 $314.98 graft. 54112................. T.................... ..................... Treat penis lesion, 0181 29.0094 $1,574.89 $621.82 $314.98 graft. 54115................. T.................... ..................... Treatment of penis

0008 16.8303 $913.70 ............ $182.74 lesion. 54120................. T.................... ..................... Partial removal of

0181 29.0094 $1,574.89 $621.82 $314.98 penis. 54125................. C.................... ..................... Removal of penis....... ..... ......... ........... ............ ............ 54130................. C.................... ..................... Remove penis & nodes... ..... ......... ........... ............ ............ 54135................. C.................... ..................... Remove penis & nodes... ..... ......... ........... ............ ............ 54150................. T.................... ..................... Circumcision........... 0180 18.4967 $1,004.17 $304.87 $200.83 54152................. T.................... ..................... Circumcision........... 0180 18.4967 $1,004.17 $304.87 $200.83 54160................. T.................... ..................... Circumcision........... 0180 18.4967 $1,004.17 $304.87 $200.83 54161................. T.................... ..................... Circumcision........... 0180 18.4967 $1,004.17 $304.87 $200.83 54162................. T.................... ..................... Lysis penil circumic 0180 18.4967 $1,004.17 $304.87 $200.83 lesion. 54163................. T.................... ..................... Repair of circumcision. 0180 18.4967 $1,004.17 $304.87 $200.83 54164................. T.................... ..................... Frenulotomy of penis... 0180 18.4967 $1,004.17 $304.87 $200.83 54200................. T.................... ..................... Treatment of penis

0156 3.1438 $170.67

$46.55

$34.13 lesion. 54205................. T.................... ..................... Treatment of penis

0181 29.0094 $1,574.89 $621.82 $314.98 lesion. 54220................. T.................... ..................... Treatment of penis

0156 3.1438 $170.67

$46.55

$34.13 lesion. 54230................. N.................... ..................... Prepare penis study.... ..... ......... ........... ............ ............ 54231................. T.................... ..................... Dynamic cavernosometry. 0165 14.0780 $764.28 ............ $152.86 54235................. T.................... ..................... Penile injection....... 0164 1.2115 $65.77

$17.59

$13.15 54240................. T.................... ..................... Penis study............ 0164 1.2115 $65.77

$17.59

$13.15 54250................. T.................... ..................... Penis study............ 0165 14.0780 $764.28 ............ $152.86 54300................. T.................... ..................... Revision of penis...... 0181 29.0094 $1,574.89 $621.82 $314.98 54304................. T.................... ..................... Revision of penis...... 0181 29.0094 $1,574.89 $621.82 $314.98 54308................. T.................... ..................... Reconstruction of

0181 29.0094 $1,574.89 $621.82 $314.98 urethra. 54312................. T.................... ..................... Reconstruction of

0181 29.0094 $1,574.89 $621.82 $314.98 urethra. 54316................. T.................... ..................... Reconstruction of

0181 29.0094 $1,574.89 $621.82 $314.98 urethra. 54318................. T.................... ..................... Reconstruction of

0181 29.0094 $1,574.89 $621.82 $314.98 urethra. 54322................. T.................... ..................... Reconstruction of

0181 29.0094 $1,574.89 $621.82 $314.98 urethra. 54324................. T.................... ..................... Reconstruction of

0181 29.0094 $1,574.89 $621.82 $314.98 urethra. 54326................. T.................... ..................... Reconstruction of

0181 29.0094 $1,574.89 $621.82 $314.98 urethra. 54328................. T.................... ..................... Revise penis/urethra... 0181 29.0094 $1,574.89 $621.82 $314.98 54332................. C.................... ..................... Revise penis/urethra... ..... ......... ........... ............ ............ 54336................. C.................... ..................... Revise penis/urethra... ..... ......... ........... ............ ............ 54340................. T.................... ..................... Secondary urethral

0181 29.0094 $1,574.89 $621.82 $314.98 surgery. 54344................. T.................... ..................... Secondary urethral

0181 29.0094 $1,574.89 $621.82 $314.98 surgery. 54348................. T.................... ..................... Secondary urethral

0181 29.0094 $1,574.89 $621.82 $314.98 surgery. 54352................. T.................... ..................... Reconstruct urethra/ 0181 29.0094 $1,574.89 $621.82 $314.98 penis. 54360................. T.................... ..................... Penis plastic surgery.. 0181 29.0094 $1,574.89 $621.82 $314.98 54380................. T.................... ..................... Repair penis........... 0181 29.0094 $1,574.89 $621.82 $314.98 54385................. T.................... ..................... Repair penis........... 0181 29.0094 $1,574.89 $621.82 $314.98 54390................. C.................... ..................... Repair penis and

..... ......... ........... ............ ............ bladder. 54400................. T.................... ..................... Insert semi-rigid

0385 66.4829 $3,609.29 ............ $721.86 prosthesis. 54401................. T.................... ..................... Insert self-contd

0386 118.8122 $6,450.20 ............ $1,240.04 prosthesis. 54405................. T.................... ..................... Insert multi-comp penis 0386 118.8122 $6,450.20 ............ $1,240.04 pros. 54406................. T.................... ..................... Remove muti-comp penis 0181 29.0094 $1,574.89 $621.82 $314.98 pros.

[[Page 48095]]

54408................. T.................... ..................... Repair multi-comp penis 0181 29.0094 $1,574.89 $621.82 $314.98 pros. 54410................. T.................... ..................... Remove/replace penis 0386 118.8122 $6,450.20 ............ $1,290.04 prosth. 54411................. C.................... ..................... Remov/replc penis pros, ..... ......... ........... ............ ............ comp. 54415................. T.................... ..................... Remove self-contd penis 0181 29.0094 $1,574.89 $621.82 $314.98 pros. 54416................. T.................... ..................... Remv/repl penis contain 0385 66.4829 $3,609.29 ............ $721.86 pros. 54417................. C.................... ..................... Remv/replc penis pros, ..... ......... ........... ............ ............ compl. 54420................. T.................... ..................... Revision of penis...... 0181 29.0094 $1,574.89 $621.82 $314.98 54430................. C.................... ..................... Revision of penis...... ..... ......... ........... ............ ............ 54435................. T.................... ..................... Revision of penis...... 0181 29.0094 $1,574.89 $621.82 $314.98 54440................. T.................... ..................... Repair of penis........ 0181 29.0094 $1,574.89 $621.82 $314.98 54450................. T.................... ..................... Preputial stretching... 0156 3.1438 $170.67

$46.55

$34.13 54500................. T.................... ..................... Biopsy of testis....... 0005 3.3675 $182.82

$71.59

$36.56 54505................. T.................... ..................... Biopsy of testis....... 0183 21.7612 $1,181.39 ............ $236.28 54512................. T.................... ..................... Excise lesion testis... 0183 21.7612 $1,181.39 ............ $236.28 54520................. T.................... ..................... Removal of testis...... 0183 21.7612 $1,181.39 ............ $236.28 54522................. T.................... ..................... Orchiectomy, partial... 0183 21.7612 $1,181.39 ............ $236.28 54530................. T.................... ..................... Removal of testis...... 0154 26.8861 $1,459.62 $464.85 $291.92 54535................. C.................... ..................... Extensive testis

..... ......... ........... ............ ............ surgery. 54550................. T.................... ..................... Exploration for testis. 0154 26.8861 $1,459.62 $464.85 $291.92 54560................. C.................... ..................... Exploration for testis. ..... ......... ........... ............ ............ 54600................. T.................... ..................... Reduce testis torsion.. 0183 21.7612 $1,181.39 ............ $236.28 54620................. T.................... ..................... Suspension of testis... 0183 21.7612 $1,181.39 ............ $236.28 54640................. T.................... ..................... Suspension of testis... 0154 26.8861 $1,459.62 $464.85 $291.92 54650................. C.................... ..................... Orchiopexy (Fowler- ..... ......... ........... ............ ............ Stephens). 54660................. T.................... ..................... Revision of testis..... 0183 21.7612 $1,181.39 ............ $236.28 54670................. T.................... ..................... Repair testis injury... 0183 21.7612 $1,181.39 ............ $236.28 54680................. T.................... ..................... Relocation of

0183 21.7612 $1,181.39 ............ $236.28 testis(es). 54690................. T.................... ..................... Laparoscopy,

0131 40.8955 $2,220.18 $1,001.89 $444.04 orchiectomy. 54692................. T.................... ..................... Laparoscopy, orchiopexy 0132 56.6318 $3,074.48 $1,239.22 $614.90 54699................. T.................... ..................... Laparoscope proc,

0130 32.5959 $1,769.60 $659.53 $353.92 testis. 54700................. T.................... ..................... Drainage of scrotum.... 0183 21.7612 $1,181.39 ............ $236.28 54800................. T.................... ..................... Biopsy of epididymis... 0004 1.5774 $85.64

$22.10

$17.13 54820................. T.................... ..................... Exploration of

0183 21.7612 $1,181.39 ............ $236.28 epididymis. 54830................. T.................... ..................... Remove epididymis

0183 21.7612 $1,181.39 ............ $236.28 lesion. 54840................. T.................... ..................... Remove epididymis

0183 21.7612 $1,181.39 ............ $236.28 lesion. 54860................. T.................... ..................... Removal of epididymis.. 0183 21.7612 $1,181.39 ............ $236.28 54861................. T.................... ..................... Removal of epididymis.. 0183 21.7612 $1,181.39 ............ $236.28 54900................. T.................... ..................... Fusion of spermatic 0183 21.7612 $1,181.39 ............ $236.28 ducts. 54901................. T.................... ..................... Fusion of spermatic 0183 21.7612 $1,181.39 ............ $236.28 ducts. 55000................. T.................... ..................... Drainage of hydrocele.. 0004 1.5774 $85.64

$22.10

$17.13 55040................. T.................... ..................... Removal of hydrocele... 0154 26.8861 $1,459.62 $464.85 $291.92 55041................. T.................... ..................... Removal of hydroceles.. 0154 26.8861 $1,459.62 $464.85 $291.92 55060................. T.................... ..................... Repair of hydrocele.... 0183 21.7612 $1,181.39 ............ $236.28 55100................. T.................... ..................... Drainage of scrotum 0007 11.4943 $624.01 ............ $124.80 abscess. 55110................. T.................... ..................... Explore scrotum........ 0183 21.7612 $1,181.39 ............ $236.28 55120................. T.................... ..................... Removal of scrotum

0183 21.7612 $1,181.39 ............ $236.28 lesion. 55150................. T.................... ..................... Removal of scrotum..... 0183 21.7612 $1,181.39 ............ $236.28 55175................. T.................... ..................... Revision of scrotum.... 0183 21.7612 $1,181.39 ............ $236.28 55180................. T.................... ..................... Revision of scrotum.... 0183 21.7612 $1,181.39 ............ $236.28 55200................. T.................... ..................... Incision of sperm duct. 0183 21.7612 $1,181.39 ............ $236.28 55250................. T.................... ..................... Removal of sperm

0183 21.7612 $1,181.39 ............ $236.28 duct(s). 55300................. N.................... ..................... Prepare, sperm duct x- ..... ......... ........... ............ ............ ray. 55400................. T.................... ..................... Repair of sperm duct... 0183 21.7612 $1,181.39 ............ $236.28 55450................. T.................... ..................... Ligation of sperm duct. 0183 21.7612 $1,181.39 ............ $236.28 55500................. T.................... ..................... Removal of hydrocele... 0183 21.7612 $1,181.39 ............ $236.28 55520................. T.................... ..................... Removal of sperm cord 0183 21.7612 $1,181.39 ............ $236.28 lesion. 55530................. T.................... ..................... Revise spermatic cord 0183 21.7612 $1,181.39 ............ $236.28 veins. 55535................. T.................... ..................... Revise spermatic cord 0154 26.8861 $1,459.62 $464.85 $291.92 veins. 55540................. T.................... ..................... Revise hernia & sperm 0154 26.8861 $1,459.62 $464.85 $291.92 veins. 55550................. T.................... ..................... Laparo ligate spermatic 0131 40.8955 $2,220.18 $1,001.89 $444.04 vein. 55559................. T.................... ..................... Laparo proc, spermatic 0130 32.5959 $1,769.60 $659.53 $353.92 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 21.7612 $1,181.39 ............ $236.28 lesion. 55700................. T.................... ..................... Biopsy of prostate..... 0184 3.8073 $206.69

$96.27

$41.34

[[Page 48096]]

55705................. T.................... ..................... Biopsy of prostate..... 0184 3.8073 $206.69

$96.27

$41.34 55720................. T.................... ..................... Drainage of prostate 0162 21.8578 $1,186.64 ............ $237.33 abscess. 55725................. T.................... ..................... Drainage of prostate 0162 21.8578 $1,186.64 ............ $237.33 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 insert, 0163 33.6435 $1,826.47 ............ $365.29 pros. 55860................. T.................... ..................... Surgical exposure,

0165 14.0780 $764.28 ............ $152.86 prostate. 55862................. C.................... ..................... Extensive prostate ..... ......... ........... ............ ............ surgery. 55865................. C.................... ..................... Extensive prostate ..... ......... ........... ............ ............ surgery. 55866................. C.................... ..................... Laparo radical

..... ......... ........... ............ ............ prostatectomy. 55870................. T.................... ..................... Vag hyst w/enterocele 0197 5.1958 $282.07 ............

$56.41 repair. 55873................. T.................... ..................... Cryoablate prostate.... 0674 101.1198 $5,489.69 ............ $1,097.94 55899................. T.................... ..................... Genital surgery

0164 1.2115 $65.77

$17.59

$13.15 procedure. 55970................. E.................... ..................... Sex transformation, M ..... ......... ........... ............ ............ to F. 55980................. E.................... ..................... Sex transformation, F ..... ......... ........... ............ ............ to M. 56405................. T.................... ..................... I & D of vulva/perineum 0192 2.6966 $146.40

$39.11

$29.28 56420................. T.................... ..................... Drainage of gland

0192 2.6966 $146.40

$39.11

$29.28 abscess. 56440................. T.................... ..................... Surgery for vulva

0194 18.8194 $1,021.69 $397.84 $204.34 lesion. 56441................. T.................... ..................... Lysis of labial

0193 15.7365 $854.32 $171.13 $170.86 lesion(s). 56501................. T.................... ..................... Destroy, vulva lesions, 0017 16.7332 $908.43 $227.84 $181.69 sim. 56515................. T.................... ..................... Destroy vulva lesion/s 0695 19.1377 $1,038.97 $266.59 $207.79 compl. 56605................. T.................... ..................... Biopsy of vulva/

0019 3.9807 $216.11

$71.87

$43.22 perineum. 56606................. T.................... ..................... Biopsy of vulva/

0019 3.9807 $216.11

$71.87

$43.22 perineum. 56620................. T.................... ..................... Partial removal of

0195 25.3207 $1,374.64 $483.80 $274.93 vulva. 56625................. T.................... ..................... Complete removal of 0195 25.3207 $1,374.64 $483.80 $274.93 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 18.8194 $1,021.69 $397.84 $204.34 hymen. 56720................. T.................... ..................... Incision of hymen...... 0193 15.7365 $854.32 $171.13 $170.86 56740................. T.................... ..................... Remove vagina gland 0194 18.8194 $1,021.69 $397.84 $204.34 lesion. 56800................. T.................... ..................... Repair of vagina....... 0194 18.8194 $1,021.69 $397.84 $204.34 56805................. T.................... ..................... Repair clitoris........ 0194 18.8194 $1,021.69 $397.84 $204.34 56810................. T.................... ..................... Repair of perineum..... 0194 18.8194 $1,021.69 $397.84 $204.34 56820................. T.................... ..................... Exam of vulva w/scope.. 0188 1.1079 $60.15 ............

$12.03 56821................. T.................... ..................... Exam/biopsy of vulva w/ 0189 1.3207 $71.70

$16.70

$14.34 scope. 57000................. T.................... ..................... Exploration of vagina.. 0194 18.8194 $1,021.69 $397.84 $204.34 57010................. T.................... ..................... Drainage of pelvic

0194 18.8194 $1,021.69 $397.84 $204.34 abscess. 57020................. T.................... ..................... Drainage of pelvic

0192 2.6966 $146.40

$39.11

$29.28 fluid. 57022................. T.................... ..................... I & d vaginal hematoma, 0007 11.4943 $624.01 ............ $124.80 pp. 57023................. T.................... ..................... I & d vag hematoma, non- 0007 11.4943 $624.01 ............ $124.80 ob. 57061................. T.................... ..................... Destroy vag lesions, 0194 18.8194 $1,021.69 $397.84 $204.34 simple. 57065................. T.................... ..................... Destroy vag lesions, 0194 18.8194 $1,021.69 $397.84 $204.34 complex. 57100................. T.................... ..................... Biopsy of vagina....... 0192 2.6966 $146.40

$39.11

$29.28 57105................. T.................... ..................... Biopsy of vagina....... 0194 18.8194 $1,021.69 $397.84 $204.34 57106................. T.................... ..................... Remove vagina wall, 0194 18.8194 $1,021.69 $397.84 $204.34 partial. 57107................. T.................... ..................... Remove vagina tissue, 0195 25.3207 $1,374.64 $483.80 $274.93 part. 57109................. T.................... ..................... Vaginectomy partial w/ 0195 25.3207 $1,374.64 $483.80 $274.93 nodes. 57110................. C.................... ..................... Remove vagina wall, ..... ......... ........... ............ ............ complete. 57111................. C.................... ..................... Remove vagina tissue, ..... ......... ........... ............ ............ compl. 57112................. C.................... ..................... Vaginectomy w/nodes, ..... ......... ........... ............ ............ compl. 57120................. T.................... ..................... Closure of vagina...... 0194 18.8194 $1,021.69 $397.84 $204.34 57130................. T.................... ..................... Remove vagina lesion... 0194 18.8194 $1,021.69 $397.84 $204.34 57135................. T.................... ..................... Remove vagina lesion... 0194 18.8194 $1,021.69 $397.84 $204.34 57150................. T.................... ..................... Treat vagina infection. 0191 0.1679

$9.12

$2.65

$1.82

[[Page 48097]]

57155................. T.................... ..................... Insert uteri tandems/ 0193 15.7365 $854.32 $171.13 $170.86 ovoids. 57160................. T.................... ..................... Insert pessary/other 0188 1.1079 $60.15 ............

$12.03 device. 57170................. T.................... ..................... Fitting of diaphragm/ 0191 0.1679

$9.12

$2.65

$1.82 cap. 57180................. T.................... ..................... Treat vaginal bleeding. 0192 2.6966 $146.40

$39.11

$29.28 57200................. T.................... ..................... Repair of vagina....... 0194 18.8194 $1,021.69 $397.84 $204.34 57210................. T.................... ..................... Repair vagina/perineum. 0194 18.8194 $1,021.69 $397.84 $204.34 57220................. T.................... ..................... Revision of urethra.... 0195 25.3207 $1,374.64 $483.80 $274.93 57230................. T.................... ..................... Repair of urethral

0194 18.8194 $1,021.69 $397.84 $204.34 lesion. 57240................. T.................... ..................... Repair bladder & vagina 0195 25.3207 $1,374.64 $483.80 $274.93 57250................. T.................... ..................... Repair rectum & vagina. 0195 25.3207 $1,374.64 $483.80 $274.93 57260................. T.................... ..................... Repair of vagina....... 0195 25.3207 $1,374.64 $483.80 $274.93 57265................. T.................... ..................... Extensive repair of 0195 25.3207 $1,374.64 $483.80 $274.93 vagina. 57268................. T.................... ..................... Repair of bowel bulge.. 0195 25.3207 $1,374.64 $483.80 $274.93 57270................. C.................... ..................... Repair of bowel pouch.. ..... ......... ........... ............ ............ 57280................. C.................... ..................... Suspension of vagina... ..... ......... ........... ............ ............ 57282................. C.................... ..................... Repair of vaginal

..... ......... ........... ............ ............ prolapse. 57284................. T.................... ..................... Repair paravaginal

0195 25.3207 $1,374.64 $483.80 $274.93 defect. 57287................. T.................... ..................... Revise/remove sling 0202 38.8053 $2,106.70 $1,032.28 $421.34 repair. 57288................. T.................... ..................... Repair bladder defect.. 0202 38.8053 $2,106.70 $1,032.28 $421.34 57289................. T.................... ..................... Repair bladder & vagina 0195 25.3207 $1,374.64 $483.80 $274.93 57291................. T.................... ..................... Construction of vagina. 0195 25.3207 $1,374.64 $483.80 $274.93 57292................. C.................... ..................... Construct vagina with ..... ......... ........... ............ ............ graft. 57300................. T.................... ..................... Repair rectum-vagina 0195 25.3207 $1,374.64 $483.80 $274.93 fistula. 57305................. C.................... ..................... Repair rectum-vagina ..... ......... ........... ............ ............ fistula. 57307................. C.................... ..................... Fistula repair &

..... ......... ........... ............ ............ colostomy. 57308................. C.................... ..................... Fistula repair,

..... ......... ........... ............ ............ transperine. 57310................. T.................... ..................... Repair urethrovaginal 0195 25.3207 $1,374.64 $483.80 $274.93 lesion. 57311................. C.................... ..................... Repair urethrovaginal ..... ......... ........... ............ ............ lesion. 57320................. T.................... ..................... Repair bladder-vagina 0195 25.3207 $1,374.64 $483.80 $274.93 lesion. 57330................. T.................... ..................... Repair bladder-vagina 0195 25.3207 $1,374.64 $483.80 $274.93 lesion. 57335................. C.................... ..................... Repair vagina.......... ..... ......... ........... ............ ............ 57400................. T.................... ..................... Dilation of vagina..... 0194 18.8194 $1,021.69 $397.84 $204.34 57410................. T.................... ..................... Pelvic examination..... 0194 18.8194 $1,021.69 $397.84 $204.34 57415................. T.................... ..................... Remove vaginal foreign 0194 18.8194 $1,021.69 $397.84 $204.34 body. 57420................. T.................... ..................... Exam of vagina w/scope. 0192 2.6966 $146.40

$39.11

$29.28 57421................. T.................... ..................... Exam/biopsy of vag w/ 0192 2.6966 $146.40

$39.11

$29.28 scope. 57452................. T.................... ..................... Examination of vagina.. 0189 1.3207 $71.70

$16.70

$14.34 57454................. T.................... ..................... Vagina examination & 0192 2.6966 $146.40

$39.11

$29.28 biopsy. 57455................. T.................... ..................... Biopsy of cervix w/ 0192 2.6966 $146.40

$39.11

$29.28 scope. 57456................. T.................... ..................... Endocerv curettage w/ 0192 2.6966 $146.40

$39.11

$29.28 scope. 57460................. T.................... ..................... Cervix excision........ 0193 15.7365 $854.32 $171.13 $170.86 57461................. T.................... ..................... Conz of cervix w/scope, 0194 18.8194 $1,021.69 $397.84 $204.34 leep. 57500................. T.................... ..................... Biopsy of cervix....... 0192 2.6966 $146.40

$39.11

$29.28 57505................. T.................... ..................... Endocervical curettage. 0192 2.6966 $146.40

$39.11

$29.28 57510................. T.................... ..................... Cauterization of cervix 0193 15.7365 $854.32 $171.13 $170.86 57511................. T.................... ..................... Cryocautery of cervix.. 0189 1.3207 $71.70

$16.70

$14.34 57513................. T.................... ..................... Laser surgery of cervix 0193 15.7365 $854.32 $171.13 $170.86 57520................. T.................... ..................... Conization of cervix... 0194 18.8194 $1,021.69 $397.84 $204.34 57522................. T.................... ..................... Conization of cervix... 0195 25.3207 $1,374.64 $483.80 $274.93 57530................. T.................... ..................... Removal of cervix...... 0195 25.3207 $1,374.64 $483.80 $274.93 57531................. C.................... ..................... Removal of cervix, ..... ......... ........... ............ ............ radical. 57540................. C.................... ..................... Removal of residual ..... ......... ........... ............ ............ cervix. 57545................. C.................... ..................... Remove cervix/repair ..... ......... ........... ............ ............ pelvis. 57550................. T.................... ..................... Removal of residual 0195 25.3207 $1,374.64 $483.80 $274.93 cervix. 57555................. T.................... ..................... Remove cervix/repair 0195 25.3207 $1,374.64 $483.80 $274.93 vagina. 57556................. T.................... ..................... Remove cervix, repair 0195 25.3207 $1,374.64 $483.80 $274.93 bowel. 57700................. T.................... ..................... Revision of cervix..... 0194 18.8194 $1,021.69 $397.84 $204.34 57720................. T.................... ..................... Revision of cervix..... 0194 18.8194 $1,021.69 $397.84 $204.34 57800................. T.................... ..................... Dilation of cervical 0193 15.7365 $854.32 $171.13 $170.86 canal. 57820................. T.................... ..................... D & c of residual

0196 16.1823 $878.52 $338.23 $175.70 cervix. 58100................. T.................... ..................... Biopsy of uterus lining 0188 1.1079 $60.15 ............

$12.03 58120................. T.................... ..................... Dilation and curettage. 0196 16.1823 $878.52 $338.23 $175.70 58140................. C.................... ..................... Removal of uterus

..... ......... ........... ............ ............ lesion. 58145................. T.................... ..................... Myomectomy vag method.. 0195 25.3207 $1,374.64 $483.80 $274.93 58146................. C.................... ..................... Myomectomy abdom

..... ......... ........... ............ ............ complex. 58150................. C.................... ..................... Total hysterectomy..... ..... ......... ........... ............ ............

[[Page 48098]]

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 1.3207 $71.70

$16.70

$14.34 device. 58321................. T.................... ..................... Artificial insemination 0197 5.1958 $282.07 ............

$56.41 58322................. T.................... ..................... Artificial insemination 0197 5.1958 $282.07 ............

$56.41 58323................. T.................... ..................... Sperm washing.......... 0197 5.1958 $282.07 ............

$56.41 58340................. N.................... ..................... Catheter for

..... ......... ........... ............ ............ hysterography. 58345................. T.................... ..................... Reopen fallopian tube.. 0194 18.8194 $1,021.69 $397.84 $204.34 58346................. T.................... ..................... Insert heyman uteri 0193 15.7365 $854.32 $171.13 $170.86 capsule. 58350................. T.................... ..................... Reopen fallopian tube.. 0194 18.8194 $1,021.69 $397.84 $204.34 58353................. T.................... ..................... Endometr ablate,

0195 25.3207 $1,374.64 $483.80 $274.93 thermal. 58400................. C.................... ..................... Suspension of uterus... ..... ......... ........... ............ ............ 58410................. C.................... ..................... Suspension of uterus... ..... ......... ........... ............ ............ 58520................. C.................... ..................... Repair of ruptured ..... ......... ........... ............ ............ uterus. 58540................. C.................... ..................... Revision of uterus..... ..... ......... ........... ............ ............ 58545................. T.................... ..................... Laparoscopic myomectomy 0130 32.5959 $1,769.60 $659.53 $353.92 58546................. T.................... ..................... Laparo-myomectomy,

0131 40.8955 $2,220.18 $1,001.89 $444.04 complex. 58550................. T.................... ..................... Laparo-asst vag

0132 56.6318 $3,074.48 $1,239.22 $614.90 hysterectomy. 58552................. T.................... ..................... Laparo-vag hyst incl t/ 0131 40.8955 $2,220.18 $1,001.89 $444.04 o. 58553................. T.................... ..................... Laparo-vag hyst,

0131 40.8955 $2,220.18 $1,001.89 $444.04 complex. 58554................. T.................... ..................... Laparo-vag hyst w/t/o, 0131 40.8955 $2,220.18 $1,001.89 $444.04 compl. 58555................. T.................... ..................... Hysteroscopy, dx, sep 0190 19.8088 $1,075.40 $424.28 $215.08 proc. 58558................. T.................... ..................... Hysteroscopy, biopsy... 0190 19.8088 $1,075.40 $424.28 $215.08 58559................. T.................... ..................... Hysteroscopy, lysis.... 0190 19.8088 $1,075.40 $424.28 $215.08 58560................. T.................... ..................... Hysteroscopy, resect 0387 28.5174 $1,548.18 $660.84 $309.64 septum. 58561................. T.................... ..................... Hysteroscopy, remove 0387 28.5174 $1,548.18 $660.84 $309.64 myoma. 58562................. T.................... ..................... Hysteroscopy, remove fb 0190 19.8088 $1,075.40 $424.28 $215.08 58563................. T.................... ..................... Hysteroscopy, ablation. 0387 28.5174 $1,548.18 $660.84 $309.64 58578................. T.................... ..................... Laparo proc, uterus.... 0130 32.5959 $1,769.60 $659.53 $353.92 58579................. T.................... ..................... Hysteroscope procedure. 0190 19.8088 $1,075.40 $424.28 $215.08 58600................. T.................... ..................... Division of fallopian 0194 18.8194 $1,021.69 $397.84 $204.34 tube. 58605................. C.................... ..................... Division of fallopian ..... ......... ........... ............ ............ tube. 58611................. C.................... ..................... Ligate oviduct(s) add- ..... ......... ........... ............ ............ on. 58615................. T.................... ..................... Occlude fallopian

0194 18.8194 $1,021.69 $397.84 $204.34 tube(s). 58660................. T.................... ..................... Laparoscopy, lysis..... 0131 40.8955 $2,220.18 $1,001.89 $444.04 58661................. T.................... ..................... Laparoscopy, remove 0131 40.8955 $2,220.18 $1,001.89 $444.04 adnexa. 58662................. T.................... ..................... Laparoscopy, excise 0131 40.8955 $2,220.18 $1,001.89 $444.04 lesions. 58670................. T.................... ..................... Laparoscopy, tubal

0131 40.8955 $2,220.18 $1,001.89 $444.04 cautery. 58671................. T.................... ..................... Laparoscopy, tubal

0131 40.8955 $2,220.18 $1,001.89 $444.04 block. 58672................. T.................... ..................... Laparoscopy,

0131 40.8955 $2,220.18 $1,001.89 $444.04 fimbrioplasty. 58673................. T.................... ..................... Laparoscopy,

0131 40.8955 $2,220.18 $1,001.89 $444.04 salpingostomy. 58679................. T.................... ..................... Laparo proc, oviduct- 0130 32.5959 $1,769.60 $659.53 $353.92 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.

[[Page 48099]]

58800................. T.................... ..................... Drainage of ovarian 0195 25.3207 $1,374.64 $483.80 $274.93 cyst(s). 58805................. C.................... ..................... Drainage of ovarian ..... ......... ........... ............ ............ cyst(s). 58820................. T.................... ..................... Drain ovary abscess, 0195 25.3207 $1,374.64 $483.80 $274.93 open. 58822................. C.................... ..................... Drain ovary abscess, ..... ......... ........... ............ ............ percut. 58823................. T.................... ..................... Drain pelvic abscess, 0193 15.7365 $854.32 $171.13 $170.86 percut. 58825................. C.................... ..................... Transposition, ovary(s) ..... ......... ........... ............ ............ 58900................. T.................... ..................... Biopsy of ovary(s)..... 0195 25.3207 $1,374.64 $483.80 $274.93 58920................. T.................... ..................... Partial removal of

0195 25.3207 $1,374.64 $483.80 $274.93 ovary(s). 58925................. T.................... ..................... Removal of ovarian

0195 25.3207 $1,374.64 $483.80 $274.93 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 18.8194 $1,021.69 $397.84 $204.34 58974................. T.................... ..................... Transfer of embryo..... 0197 5.1958 $282.07 ............

$56.41 58976................. T.................... ..................... Transfer of embryo..... 0197 5.1958 $282.07 ............

$56.41 58999................. T.................... ..................... Genital surgery

0191 0.1679

$9.12

$2.65

$1.82 procedure. 59000................. T.................... ..................... Amniocentesis,

0198 1.3718 $74.47

$32.19

$14.89 diagnostic. 59001................. T.................... ..................... Amniocentesis,

0198 1.3718 $74.47

$32.19

$14.89 therapeutic. 59012................. T.................... ..................... Fetal cord

0198 1.3718 $74.47

$32.19

$14.89 puncture,prenatal. 59015................. T.................... ..................... Chorion biopsy......... 0198 1.3718 $74.47

$32.19

$14.89 59020................. T.................... ..................... Fetal contract stress 0198 1.3718 $74.47

$32.19

$14.89 test. 59025................. T.................... ..................... Fetal non-stress test.. 0198 1.3718 $74.47

$32.19

$14.89 59030................. T.................... ..................... Fetal scalp blood

0198 1.3718 $74.47

$32.19

$14.89 sample. 59050................. E.................... ..................... Fetal monitor w/report. ..... ......... ........... ............ ............ 59051................. E.................... ..................... Fetal monitor/interpret ..... ......... ........... ............ ............ only. 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 ..... ......... ........... ............ ............ 59150................. T.................... ..................... Treat ectopic pregnancy 0131 40.8955 $2,220.18 $1,001.89 $444.04 59151................. T.................... ..................... Treat ectopic pregnancy 0131 40.8955 $2,220.18 $1,001.89 $444.04 59160................. T.................... ..................... D & c after delivery... 0196 16.1823 $878.52 $338.23 $175.70 59200................. T.................... ..................... Insert cervical dilator 0189 1.3207 $71.70

$16.70

$14.34 59300................. T.................... ..................... Episiotomy or vaginal 0193 15.7365 $854.32 $171.13 $170.86 repair. 59320................. T.................... ..................... Revision of cervix..... 0194 18.8194 $1,021.69 $397.84 $204.34 59325................. C.................... ..................... Revision of cervix..... ..... ......... ........... ............ ............ 59350................. C.................... ..................... Repair of uterus....... ..... ......... ........... ............ ............ 59400................. E.................... ..................... Obstetrical care....... ..... ......... ........... ............ ............ 59409................. T.................... ..................... Obstetrical care....... 0199 16.8630 $915.48 ............ $183.10 59410................. E.................... ..................... Obstetrical care....... ..... ......... ........... ............ ............ 59412................. T.................... ..................... Antepartum manipulation 0700 2.4359 $132.24

$37.03

$26.45 59414................. T.................... ..................... Deliver placenta....... 0199 16.8630 $915.48 ............ $183.10 59425................. E.................... ..................... Antepartum care only... ..... ......... ........... ............ ............ 59426................. E.................... ..................... Antepartum care only... ..... ......... ........... ............ ............ 59430................. E.................... ..................... 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 16.8630 $915.48 ............ $183.10 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 17.2803 $938.13 $329.65 $187.63 miscarriage. 59820................. T.................... ..................... Care of miscarriage.... 0201 17.2803 $938.13 $329.65 $187.63 59821................. T.................... ..................... Treatment of

0201 17.2803 $938.13 $329.65 $187.63 miscarriage.

[[Page 48100]]

59830................. C.................... ..................... Treat uterus infection. ..... ......... ........... ............ ............ 59840................. T.................... ..................... Abortion............... 0200 18.3633 $996.93 $307.83 $199.39 59841................. T.................... ..................... Abortion............... 0200 18.3633 $996.93 $307.83 $199.39 59850................. C.................... ..................... Abortion............... ..... ......... ........... ............ ............ 59851................. C.................... ..................... Abortion............... ..... ......... ........... ............ ............ 59852................. C.................... ..................... Abortion............... ..... ......... ........... ............ ............ 59855................. C.................... ..................... Abortion............... ..... ......... ........... ............ ............ 59856................. C.................... ..................... Abortion............... ..... ......... ........... ............ ............ 59857................. C.................... ..................... Abortion............... ..... ......... ........... ............ ............ 59866................. T.................... ..................... Abortion (mpr)......... 0198 1.3718 $74.47

$32.19

$14.89 59870................. T.................... ..................... Evacuate mole of uterus 0201 17.2803 $938.13 $329.65 $187.63 59871................. T.................... ..................... Remove cerclage suture. 0194 18.8194 $1,021.69 $397.84 $204.34 59898................. T.................... ..................... Laparo proc, ob care/ 0130 32.5959 $1,769.60 $659.53 $353.92 deliver. 59899................. T.................... ..................... Maternity care

0198 1.3718 $74.47

$32.19

$14.89 procedure. 60000................. T.................... ..................... Drain thyroid/tongue 0252 6.5416 $355.14 $113.41

$71.03 cyst. 60001................. T.................... ..................... Aspirate/inject thyriod 0004 1.5774 $85.64

$22.10

$17.13 cyst. 60100................. T.................... ..................... Biopsy of thyroid...... 0004 1.5774 $85.64

$22.10

$17.13 60200................. T.................... ..................... Remove thyroid lesion.. 0114 37.3583 $2,028.14 $485.91 $405.63 60210................. T.................... ..................... Partial thyroid

0114 37.3583 $2,028.14 $485.91 $405.63 excision. 60212................. T.................... ..................... Partial thyroid

0114 37.3583 $2,028.14 $485.91 $405.63 excision. 60220................. T.................... ..................... Partial removal of

0114 37.3583 $2,028.14 $485.91 $405.63 thyroid. 60225................. T.................... ..................... Partial removal of

0114 37.3583 $2,028.14 $485.91 $405.63 thyroid. 60240................. T.................... ..................... Removal of thyroid..... 0114 37.3583 $2,028.14 $485.91 $405.63 60252................. T.................... ..................... Removal of thyroid..... 0256 35.0866 $1,904.82 ............ $380.96 60254................. C.................... ..................... Extensive thyroid

..... ......... ........... ............ ............ surgery. 60260................. T.................... ..................... Repeat thyroid surgery. 0256 35.0866 $1,904.82 ............ $380.96 60270................. C.................... ..................... Removal of thyroid..... ..... ......... ........... ............ ............ 60271................. C.................... ..................... Removal of thyroid..... ..... ......... ........... ............ ............ 60280................. T.................... ..................... Remove thyroid duct 0114 37.3583 $2,028.14 $485.91 $405.63 lesion. 60281................. T.................... ..................... Remove thyroid duct 0114 37.3583 $2,028.14 $485.91 $405.63 lesion. 60500................. T.................... ..................... Explore parathyroid 0256 35.0866 $1,904.82 ............ $380.96 glands. 60502................. C.................... ..................... Re-explore parathyroids ..... ......... ........... ............ ............ 60505................. C.................... ..................... Explore parathyroid ..... ......... ........... ............ ............ glands. 60512................. T.................... ..................... Autotransplant

0022 18.6725 $1,013.71 $354.45 $202.74 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, endocrine. 0130 32.5959 $1,769.60 $659.53 $353.92 60699................. T.................... ..................... Endocrine surgery

0114 37.3583 $2,028.14 $485.91 $405.63 procedure. 61000................. T.................... ..................... Remove cranial cavity 0212 2.9989 $162.81

$74.92

$32.56 fluid. 61001................. T.................... ..................... Remove cranial cavity 0212 2.9989 $162.81

$74.92

$32.56 fluid. 61020................. T.................... ..................... Remove brain cavity 0212 2.9989 $162.81

$74.92

$32.56 fluid. 61026................. T.................... ..................... Injection into brain 0212 2.9989 $162.81

$74.92

$32.56 canal. 61050................. T.................... ..................... Remove brain canal

0212 2.9989 $162.81

$74.92

$32.56 fluid. 61055................. T.................... ..................... Injection into brain 0212 2.9989 $162.81

$74.92

$32.56 canal. 61070................. T.................... ..................... Brain canal shunt

0212 2.9989 $162.81

$74.92

$32.56 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 34.0161 $1,846.70 $453.41 $369.34 device. 61250................. C.................... ..................... Pierce skull & explore. ..... ......... ........... ............ ............ 61253................. C.................... ..................... Pierce skull & explore. ..... ......... ........... ............ ............ 61304................. C.................... ..................... Open skull for

..... ......... ........... ............ ............ exploration. 61305................. C.................... ..................... Open skull for

..... ......... ........... ............ ............ exploration.

[[Page 48101]]

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................. N.................... ..................... Implt cran bone flap to ..... ......... ........... ............ ............ abdo. 61320................. C.................... ..................... Open skull for drainage ..... ......... ........... ............ ............ 61321................. C.................... ..................... Open skull for drainage ..... ......... ........... ............ ............ 61322................. C.................... ..................... Decompressive

..... ......... ........... ............ ............ craniotomy. 61323................. C.................... ..................... Decompressive lobectomy ..... ......... ........... ............ ............ 61330................. T.................... ..................... Decompress eye socket.. 0256 35.0866 $1,904.82 ............ $380.96 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................. N.................... ..................... 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 ..... ......... ........... ............ ............ 61538................. C.................... ..................... Removal of brain tissue ..... ......... ........... ............ ............ 61539................. 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 ..... ......... ........... ............ ............ 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.

[[Page 48102]]

61582................. C.................... ..................... Craniofacial approach, ..... ......... ........... ............ ............ skull. 61583................. C.................... ..................... Craniofacial approach, ..... ......... ........... ............ ............ skull. 61584................. C.................... ..................... Orbitocranial approach/ ..... ......... ........... ............ ............ skull. 61585................. C.................... ..................... Orbitocranial approach/ ..... ......... ........... ............ ............ skull. 61586................. C.................... ..................... Resect nasopharynx, ..... ......... ........... ............ ............ skull. 61590................. C.................... ..................... Infratemporal approach/ ..... ......... ........... ............ ............ skull. 61591................. C.................... ..................... Infratemporal approach/ ..... ......... ........... ............ ............ skull. 61592................. C.................... ..................... Orbitocranial approach/ ..... ......... ........... ............ ............ skull. 61595................. C.................... ..................... Transtemporal approach/ ..... ......... ........... ............ ............ skull. 61596................. C.................... ..................... Transcochlear approach/ ..... ......... ........... ............ ............ skull. 61597................. C.................... ..................... Transcondylar approach/ ..... ......... ........... ............ ............ skull. 61598................. C.................... ..................... Transpetrosal approach/ ..... ......... ........... ............ ............ skull. 61600................. C.................... ..................... Resect/excise cranial ..... ......... ........... ............ ............ lesion. 61601................. C.................... ..................... Resect/excise cranial ..... ......... ........... ............ ............ lesion. 61605................. C.................... ..................... Resect/excise cranial ..... ......... ........... ............ ............ lesion. 61606................. C.................... ..................... Resect/excise cranial ..... ......... ........... ............ ............ lesion. 61607................. C.................... ..................... Resect/excise cranial ..... ......... ........... ............ ............ lesion. 61608................. C.................... ..................... Resect/excise cranial ..... ......... ........... ............ ............ lesion. 61609................. C.................... ..................... Transect artery, sinus. ..... ......... ........... ............ ............ 61610................. C.................... ..................... Transect artery, sinus. ..... ......... ........... ............ ............ 61611................. C.................... ..................... Transect artery, sinus. ..... ......... ........... ............ ............ 61612................. C.................... ..................... Transect artery, sinus. ..... ......... ........... ............ ............ 61613................. C.................... ..................... Remove aneurysm, sinus. ..... ......... ........... ............ ............ 61615................. C.................... ..................... Resect/excise lesion, ..... ......... ........... ............ ............ skull. 61616................. C.................... ..................... Resect/excise lesion, ..... ......... ........... ............ ............ skull. 61618................. C.................... ..................... Repair dura............ ..... ......... ........... ............ ............ 61619................. C.................... ..................... Repair dura............ ..... ......... ........... ............ ............ 61623................. T.................... ..................... Endovasc tempory vessel 1555 ......... $1,650.00 ............ $330.00 occl. 61624................. C.................... ..................... Occlusion/embolization ..... ......... ........... ............ ............ cath. 61626................. T.................... ..................... Transcath occlusion, 0081 34.8355 $1,891.18 ............ $378.24 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 nerve. 0220 16.5293 $897.36 ............ $179.47 61791................. T.................... ..................... Treat trigeminal tract. 0204 2.2209 $120.57

$40.13

$24.11 61793................. E.................... ..................... Focus radiation beam... ..... ......... ........... ............ ............ 61795................. S.................... ..................... Brain surgery using 0302 6.1992 $336.55 $127.49

$67.31 computer. 61850................. C.................... ..................... Implant neuroelectrodes ..... ......... ........... ............ ............ 61860................. C.................... ..................... Implant neuroelectrodes ..... ......... ........... ............ ............ 61862................. C.................... ..................... Implant neurostimul, ..... ......... ........... ............ ............ subcort. 61870................. C.................... ..................... Implant neuroelectrodes ..... ......... ........... ............ ............ 61875................. C.................... ..................... Implant neuroelectrodes ..... ......... ........... ............ ............ 61880................. T.................... ..................... Revise/remove

0687 19.9913 $1,085.31 $499.24 $217.06 neuroelectrode. 61885................. T.................... ..................... Implant neurostim one 0222 188.7735 $10,248.32 ............ $2,049.66 array. 61886................. T.................... ..................... Implant neurostim

0222 188.7735 $10,248.32 ............ $2,049.66 arrays. 61888................. T.................... ..................... Revise/remove

0688 42.5880 $2,312.06 $1,132.91 $462.41 neuroreceiver. 62000................. C.................... ..................... Treat skull fracture... ..... ......... ........... ............ ............ 62005................. C.................... ..................... Treat skull fracture... ..... ......... ........... ............ ............

[[Page 48103]]

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................. N.................... ..................... Retr bone flap to fix ..... ......... ........... ............ ............ skull. 62160................. N.................... ..................... 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 2.2058 $119.75

$43.80

$23.95 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 8.4398 $458.19

$93.97

$91.64 catheter. 62230................. T.................... ..................... Replace/revise brain 0224 34.0161 $1,846.70 $453.41 $369.34 shunt. 62252................. S.................... ..................... Csf shunt reprogram.... 0691 2.9894 $162.29

$81.14

$32.46 62256................. C.................... ..................... Remove brain cavity ..... ......... ........... ............ ............ shunt. 62258................. C.................... ..................... Replace brain cavity ..... ......... ........... ............ ............ shunt. 62263................. T.................... ..................... Lysis epidural

0203 11.8511 $643.38 $276.76 $128.68 adhesions. 62264................. T.................... ..................... Epidural lysis on

0203 11.8511 $643.38 $276.76 $128.68 single day. 62268................. T.................... ..................... Drain spinal cord cyst. 0212 2.9989 $162.81

$74.92

$32.56 62269................. T.................... ..................... Needle biopsy, spinal 0005 3.3675 $182.82

$71.59

$36.56 cord. 62270................. T.................... ..................... Spinal fluid tap,

0206 5.2584 $285.47

$75.55

$57.09 diagnostic. 62272................. T.................... ..................... Drain cerebro spinal 0206 5.2584 $285.47

$75.55

$57.09 fluid. 62273................. T.................... ..................... Treat epidural spine 0206 5.2584 $285.47

$75.55

$57.09 lesion. 62280................. T.................... ..................... Treat spinal cord

0207 6.5998 $358.30 $123.69

$71.66 lesion. 62281................. T.................... ..................... Treat spinal cord

0207 6.5998 $358.30 $123.69

$71.66 lesion. 62282................. T.................... ..................... Treat spinal canal

0207 6.5998 $358.30 $123.69

$71.66 lesion. 62284................. N.................... ..................... Injection for myelogram ..... ......... ........... ............ ............ 62287................. T.................... ..................... Percutaneous diskectomy 0220 16.5293 $897.36 ............ $179.47 62290................. N.................... ..................... Inject for spine disk x- ..... ......... ........... ............ ............ ray. 62291................. N.................... ..................... Inject for spine disk x- ..... ......... ........... ............ ............ ray. 62292................. T.................... ..................... Injection into disk 0212 2.9989 $162.81

$74.92

$32.56 lesion. 62294................. T.................... ..................... Injection into spinal 0212 2.9989 $162.81

$74.92

$32.56 artery. 62310................. T.................... ..................... Inject spine c/t....... 0206 5.2584 $285.47

$75.55

$57.09 62311................. T.................... ..................... Inject spine l/s (cd).. 0206 5.2584 $285.47

$75.55

$57.09 62318................. T.................... ..................... Inject spine w/cath, c/ 0206 5.2584 $285.47

$75.55

$57.09 t. 62319................. T.................... ..................... Inject spine w/cath l/s 0206 5.2584 $285.47

$75.55

$57.09 (cd). 62350................. T.................... ..................... Implant spinal canal 0223 26.0352 $1,413.42 ............ $282.68 cath. 62351................. T.................... ..................... Implant spinal canal 0208 40.6521 $2,206.96 ............ $441.39 cath. 62355................. T.................... ..................... Remove spinal canal 0203 11.8511 $643.38 $276.76 $128.68 catheter. 62360................. T.................... ..................... Insert spine infusion 0226 159.6795 $8,668.84 ............ $1,733.77 device. 62361................. T.................... ..................... Implant spine infusion 0227 163.6124 $8,882.35 ............ $1,776.47 pump. 62362................. T.................... ..................... Implant spine infusion 0227 163.6124 $8,882.35 ............ $1,776.47 pump. 62365................. T.................... ..................... Remove spine infusion 0203 11.8511 $643.38 $276.76 $128.68 device. 62367................. S.................... ..................... Analyze spine infusion 0691 2.9894 $162.29

$81.14

$32.46 pump. 62368................. S.................... ..................... Analyze spine infusion 0691 2.9894 $162.29

$81.14

$32.46 pump. 63001................. T.................... ..................... Removal of spinal

0208 40.6521 $2,206.96 ............ $441.39 lamina. 63003................. T.................... ..................... Removal of spinal

0208 40.6521 $2,206.96 ............ $441.39 lamina. 63005................. T.................... ..................... Removal of spinal

0208 40.6521 $2,206.96 ............ $441.39 lamina.

[[Page 48104]]

63011................. T.................... ..................... Removal of spinal

0208 40.6521 $2,206.96 ............ $441.39 lamina. 63012................. T.................... ..................... Removal of spinal

0208 40.6521 $2,206.96 ............ $441.39 lamina. 63015................. T.................... ..................... Removal of spinal

0208 40.6521 $2,206.96 ............ $441.39 lamina. 63016................. T.................... ..................... Removal of spinal

0208 40.6521 $2,206.96 ............ $441.39 lamina. 63017................. T.................... ..................... Removal of spinal

0208 40.6521 $2,206.96 ............ $441.39 lamina. 63020................. T.................... ..................... Neck spine disk surgery 0208 40.6521 $2,206.96 ............ $441.39 63030................. T.................... ..................... Low back disk surgery.. 0208 40.6521 $2,206.96 ............ $441.39 63035................. T.................... ..................... Spinal disk surgery add- 0208 40.6521 $2,206.96 ............ $441.39 on. 63040................. T.................... ..................... Laminotomy, single

0208 40.6521 $2,206.96 ............ $441.39 cervical. 63042................. T.................... ..................... Laminotomy, single

0208 40.6521 $2,206.96 ............ $441.39 lumbar. 63043................. C.................... ..................... Laminotomy, addl

..... ......... ........... ............ ............ cervical. 63044................. C.................... ..................... Laminotomy, addl lumbar ..... ......... ........... ............ ............ 63045................. T.................... ..................... Removal of spinal

0208 40.6521 $2,206.96 ............ $441.39 lamina. 63046................. T.................... ..................... Removal of spinal

0208 40.6521 $2,206.96 ............ $441.39 lamina. 63047................. T.................... ..................... Removal of spinal

0208 40.6521 $2,206.96 ............ $441.39 lamina. 63048................. T.................... ..................... Remove spinal lamina 0208 40.6521 $2,206.96 ............ $441.39 add-on. 63055................. T.................... ..................... Decompress spinal cord. 0208 40.6521 $2,206.96 ............ $441.39 63056................. T.................... ..................... Decompress spinal cord. 0208 40.6521 $2,206.96 ............ $441.39 63057................. T.................... ..................... Decompress spine cord 0208 40.6521 $2,206.96 ............ $441.39 add-on. 63064................. T.................... ..................... Decompress spinal cord. 0208 40.6521 $2,206.96 ............ $441.39 63066................. T.................... ..................... Decompress spine cord 0208 40.6521 $2,206.96 ............ $441.39 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. 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.

[[Page 48105]]

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. 63600................. T.................... ..................... Remove spinal cord

0220 16.5293 $897.36 ............ $179.47 lesion. 63610................. T.................... ..................... Stimulation of spinal 0220 16.5293 $897.36 ............ $179.47 cord. 63615................. T.................... ..................... Remove lesion of spinal 0220 16.5293 $897.36 ............ $179.47 cord. 63650................. S.................... ..................... Implant neuroelectrodes 0225 56.0375 $3,042.22 ............ $608.44 63655................. S.................... ..................... Implant neuroelectrodes 0225 56.0375 $3,042.22 ............ $608.44 63660................. T.................... ..................... Revise/remove

0687 19.9913 $1,085.31 $499.24 $217.06 neuroelectrode. 63685................. T.................... ..................... Implant neuroreceiver.. 0222 188.7735 $10,248.32 ............ $2,049.66 63688................. T.................... ..................... Revise/remove

0688 42.5880 $2,312.06 $1,132.91 $462.41 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 51.1329 $2,775.95 $621.80 $555.19 63744................. T.................... ..................... Revision of spinal

0228 51.1329 $2,775.95 $621.80 $555.19 shunt. 63746................. T.................... ..................... Removal of spinal shunt 0109 7.7075 $418.43 $131.49

$83.69 64400................. T.................... ..................... N block inj, trigeminal 0204 2.2209 $120.57

$40.13

$24.11 64402................. T.................... ..................... N block inj, facial.... 0204 2.2209 $120.57

$40.13

$24.11 64405................. T.................... ..................... N block inj, occipital. 0204 2.2209 $120.57

$40.13

$24.11 64408................. T.................... ..................... N block inj, vagus..... 0204 2.2209 $120.57

$40.13

$24.11 64410................. T.................... ..................... N block inj, phrenic... 0204 2.2209 $120.57

$40.13

$24.11 64412................. T.................... ..................... N block inj, spinal 0204 2.2209 $120.57

$40.13

$24.11 accessor. 64413................. T.................... ..................... N block inj, cervical 0204 2.2209 $120.57

$40.13

$24.11 plexus. 64415................. T.................... ..................... Injection for nerve 0204 2.2209 $120.57

$40.13

$24.11 block. 64416................. T.................... ..................... N block cont infuse, b 0204 2.2209 $120.57

$40.13

$24.11 plex. 64417................. T.................... ..................... N block inj, axillary.. 0204 2.2209 $120.57

$40.13

$24.11 64418................. T.................... ..................... N block inj,

0204 2.2209 $120.57

$40.13

$24.11 suprascapular. 64420................. T.................... ..................... N block inj, intercost, 0207 6.5998 $358.30 $123.69

$71.66 sng. 64421................. T.................... ..................... N block inj, intercost, 0207 6.5998 $358.30 $123.69

$71.66 mlt. 64425................. T.................... ..................... N block inj ilio-ing/ 0204 2.2209 $120.57

$40.13

$24.11 hypogi. 64430................. T.................... ..................... N block inj, pudendal.. 0204 2.2209 $120.57

$40.13

$24.11 64435................. T.................... ..................... N block inj,

0204 2.2209 $120.57

$40.13

$24.11 paracervical. 64445................. T.................... ..................... Injection for nerve 0204 2.2209 $120.57

$40.13

$24.11 block. 64446................. T.................... ..................... N blk inj, sciatic, 0204 2.2209 $120.57

$40.13

$24.11 cont inf. 64447................. T.................... ..................... N block inj fem, single 0204 2.2209 $120.57

$40.13

$24.11 64448................. T.................... ..................... N block inj fem, cont 0204 2.2209 $120.57

$40.13

$24.11 inf. 64450................. T.................... ..................... N block, other

0204 2.2209 $120.57

$40.13

$24.11 peripheral. 64470................. T.................... ..................... Inj paravertebral c/t.. 0207 6.5998 $358.30 $123.69

$71.66 64472................. T.................... ..................... Inj paravertebral c/t 0207 6.5998 $358.30 $123.69

$71.66 add-on. 64475................. T.................... ..................... Inj paravertebral l/s.. 0207 6.5998 $358.30 $123.69

$71.66 64476................. T.................... ..................... Inj paravertebral l/s 0207 6.5998 $358.30 $123.69

$71.66 add-on. 64479................. T.................... ..................... Inj foramen epidural c/ 0207 6.5998 $358.30 $123.69

$71.66 t. 64480................. T.................... ..................... Inj foramen epidural 0207 6.5998 $358.30 $123.69

$71.66 add-on. 64483................. T.................... ..................... Inj foramen epidural l/ 0207 6.5998 $358.30 $123.69

$71.66 s. 64484................. T.................... ..................... Inj foramen epidural 0207 6.5998 $358.30 $123.69

$71.66 add-on. 64505................. T.................... ..................... N block, spenopalatine 0204 2.2209 $120.57

$40.13

$24.11 gangl. 64508................. T.................... ..................... N block, carotid sinus 0204 2.2209 $120.57

$40.13

$24.11 s/p. 64510................. T.................... ..................... N block, stellate

0207 6.5998 $358.30 $123.69

$71.66 ganglion. 64520................. T.................... ..................... N block, lumbar/

0207 6.5998 $358.30 $123.69

$71.66 thoracic.

[[Page 48106]]

64530................. T.................... ..................... N block inj, celiac 0207 6.5998 $358.30 $123.69

$71.66 pelus. 64550................. A.................... ..................... Apply neurostimulator.. ..... ......... ........... ............ ............ 64553................. S.................... ..................... Implant neuroelectrodes 0225 56.0375 $3,042.22 ............ $608.44 64555................. S.................... ..................... Implant neuroelectrodes 0225 56.0375 $3,042.22 ............ $608.44 64560................. S.................... ..................... Implant neuroelectrodes 0225 56.0375 $3,042.22 ............ $608.44 64561................. S.................... ..................... Implant neuroelectrodes 0225 56.0375 $3,042.22 ............ $608.44 64565................. S.................... ..................... Implant neuroelectrodes 0225 56.0375 $3,042.22 ............ $608.44 64573................. S.................... ..................... Implant neuroelectrodes 0225 56.0375 $3,042.22 ............ $608.44 64575................. S.................... ..................... Implant neuroelectrodes 0225 56.0375 $3,042.22 ............ $608.44 64577................. S.................... ..................... Implant neuroelectrodes 0225 56.0375 $3,042.22 ............ $608.44 64580................. S.................... ..................... Implant neuroelectrodes 0225 56.0375 $3,042.22 ............ $608.44 64581................. S.................... ..................... Implant neuroelectrodes 0225 56.0375 $3,042.22 ............ $608.44 64585................. T.................... ..................... Revise/remove

0687 19.9913 $1,085.31 $499.24 $217.06 neuroelectrode. 64590................. T.................... ..................... Implant neuroreceiver.. 0222 188.7735 $10,248.32 ............ $2,049.66 64595................. T.................... ..................... Revise/remove

0688 42.5880 $2,312.06 $1,132.91 $462.41 neuroreceiver. 64600................. T.................... ..................... Injection treatment of 0203 11.8511 $643.38 $276.76 $128.68 nerve. 64605................. T.................... ..................... Injection treatment of 0203 11.8511 $643.38 $276.76 $128.68 nerve. 64610................. T.................... ..................... Injection treatment of 0203 11.8511 $643.38 $276.76 $128.68 nerve. 64612................. T.................... ..................... Destroy nerve, face 0204 2.2209 $120.57

$40.13

$24.11 muscle. 64613................. T.................... ..................... Destroy nerve, spine 0204 2.2209 $120.57

$40.13

$24.11 muscle. 64614................. T.................... ..................... Destroy nerve, extrem 0204 2.2209 $120.57

$40.13

$24.11 musc. 64620................. T.................... ..................... Injection treatment of 0203 11.8511 $643.38 $276.76 $128.68 nerve. 64622................. T.................... ..................... Destr paravertebrl

0203 11.8511 $643.38 $276.76 $128.68 nerve l/s. 64623................. T.................... ..................... Destr paravertebral n 0203 11.8511 $643.38 $276.76 $128.68 add-on. 64626................. T.................... ..................... Destr paravertebrl

0203 11.8511 $643.38 $276.76 $128.68 nerve c/t. 64627................. T.................... ..................... Destr paravertebral n 0203 11.8511 $643.38 $276.76 $128.68 add-on. 64630................. T.................... ..................... Injection treatment of 0207 6.5998 $358.30 $123.69

$71.66 nerve. 64640................. T.................... ..................... Injection treatment of 0207 6.5998 $358.30 $123.69

$71.66 nerve. 64680................. T.................... ..................... Injection treatment of 0203 11.8511 $643.38 $276.76 $128.68 nerve. 64702................. T.................... ..................... Revise finger/toe nerve 0220 16.5293 $897.36 ............ $179.47 64704................. T.................... ..................... Revise hand/foot nerve. 0220 16.5293 $897.36 ............ $179.47 64708................. T.................... ..................... Revise arm/leg nerve... 0220 16.5293 $897.36 ............ $179.47 64712................. T.................... ..................... Revision of sciatic 0220 16.5293 $897.36 ............ $179.47 nerve. 64713................. T.................... ..................... Revision of arm

0220 16.5293 $897.36 ............ $179.47 nerve(s). 64714................. T.................... ..................... Revise low back

0220 16.5293 $897.36 ............ $179.47 nerve(s). 64716................. T.................... ..................... Revision of cranial 0220 16.5293 $897.36 ............ $179.47 nerve. 64718................. T.................... ..................... Revise ulnar nerve at 0220 16.5293 $897.36 ............ $179.47 elbow. 64719................. T.................... ..................... Revise ulnar nerve at 0220 16.5293 $897.36 ............ $179.47 wrist. 64721................. T.................... ..................... Carpal tunnel surgery.. 0220 16.5293 $897.36 ............ $179.47 64722................. T.................... ..................... Relieve pressure on 0220 16.5293 $897.36 ............ $179.47 nerve(s). 64726................. T.................... ..................... Release foot/toe nerve. 0220 16.5293 $897.36 ............ $179.47 64727................. T.................... ..................... Internal nerve revision 0220 16.5293 $897.36 ............ $179.47 64732................. T.................... ..................... Incision of brow nerve. 0220 16.5293 $897.36 ............ $179.47 64734................. T.................... ..................... Incision of cheek nerve 0220 16.5293 $897.36 ............ $179.47 64736................. T.................... ..................... Incision of chin nerve. 0220 16.5293 $897.36 ............ $179.47 64738................. T.................... ..................... Incision of jaw nerve.. 0220 16.5293 $897.36 ............ $179.47 64740................. T.................... ..................... Incision of tongue

0220 16.5293 $897.36 ............ $179.47 nerve. 64742................. T.................... ..................... Incision of facial

0220 16.5293 $897.36 ............ $179.47 nerve. 64744................. T.................... ..................... Incise nerve, back of 0220 16.5293 $897.36 ............ $179.47 head. 64746................. T.................... ..................... Incise diaphragm nerve. 0220 16.5293 $897.36 ............ $179.47 64752................. C.................... ..................... Incision of vagus nerve ..... ......... ........... ............ ............ 64755................. C.................... ..................... Incision of stomach ..... ......... ........... ............ ............ nerves. 64760................. C.................... ..................... Incision of vagus nerve ..... ......... ........... ............ ............ 64761................. T.................... ..................... Incision of pelvis

0220 16.5293 $897.36 ............ $179.47 nerve. 64763................. C.................... ..................... Incise hip/thigh nerve. ..... ......... ........... ............ ............ 64766................. C.................... ..................... Incise hip/thigh nerve. ..... ......... ........... ............ ............ 64771................. T.................... ..................... Sever cranial nerve.... 0220 16.5293 $897.36 ............ $179.47 64772................. T.................... ..................... Incision of spinal

0220 16.5293 $897.36 ............ $179.47 nerve. 64774................. T.................... ..................... Remove skin nerve

0220 16.5293 $897.36 ............ $179.47 lesion. 64776................. T.................... ..................... Remove digit nerve

0220 16.5293 $897.36 ............ $179.47 lesion. 64778................. T.................... ..................... Digit nerve surgery add- 0220 16.5293 $897.36 ............ $179.47 on. 64782................. T.................... ..................... Remove limb nerve

0220 16.5293 $897.36 ............ $179.47 lesion. 64783................. T.................... ..................... Limb nerve surgery add- 0220 16.5293 $897.36 ............ $179.47 on. 64784................. T.................... ..................... Remove nerve lesion.... 0220 16.5293 $897.36 ............ $179.47 64786................. T.................... ..................... Remove sciatic nerve 0221 25.8194 $1,401.71 $463.62 $280.34 lesion. 64787................. T.................... ..................... Implant nerve end...... 0220 16.5293 $897.36 ............ $179.47

[[Page 48107]]

64788................. T.................... ..................... Remove skin nerve

0220 16.5293 $897.36 ............ $179.47 lesion. 64790................. T.................... ..................... Removal of nerve lesion 0220 16.5293 $897.36 ............ $179.47 64792................. T.................... ..................... Removal of nerve lesion 0221 25.8194 $1,401.71 $463.62 $280.34 64795................. T.................... ..................... Biopsy of nerve........ 0220 16.5293 $897.36 ............ $179.47 64802................. T.................... ..................... Remove sympathetic

0220 16.5293 $897.36 ............ $179.47 nerves. 64804................. C.................... ..................... Remove sympathetic ..... ......... ........... ............ ............ nerves. 64809................. C.................... ..................... Remove sympathetic ..... ......... ........... ............ ............ nerves. 64818................. C.................... ..................... Remove sympathetic ..... ......... ........... ............ ............ nerves. 64820................. T.................... ..................... Remove sympathetic

0220 16.5293 $897.36 ............ $179.47 nerves. 64821................. T.................... ..................... Remove sympathestic 0054 24.2685 $1,317.51 ............ $263.50 nerves. 64822................. T.................... ..................... Remove sympathetic

0054 24.2685 $1,317.51 ............ $263.50 nerves. 64823................. T.................... ..................... Remove sympathetic

0054 24.2685 $1,317.51 ............ $263.50 nerves. 64831................. T.................... ..................... Repair of digit nerve.. 0221 25.8194 $1,401.71 $463.62 $280.34 64832................. T.................... ..................... Repair nerve add-on.... 0221 25.8194 $1,401.71 $463.62 $280.34 64834................. T.................... ..................... Repair of hand or foot 0221 25.8194 $1,401.71 $463.62 $280.34 nerve. 64835................. T.................... ..................... Repair of hand or foot 0221 25.8194 $1,401.71 $463.62 $280.34 nerve. 64836................. T.................... ..................... Repair of hand or foot 0221 25.8194 $1,401.71 $463.62 $280.34 nerve. 64837................. T.................... ..................... Repair nerve add-on.... 0221 25.8194 $1,401.71 $463.62 $280.34 64840................. T.................... ..................... Repair of leg nerve.... 0221 25.8194 $1,401.71 $463.62 $280.34 64856................. T.................... ..................... Repair/transpose nerve. 0221 25.8194 $1,401.71 $463.62 $280.34 64857................. T.................... ..................... Repair arm/leg nerve... 0221 25.8194 $1,401.71 $463.62 $280.34 64858................. T.................... ..................... Repair sciatic nerve... 0221 25.8194 $1,401.71 $463.62 $280.34 64859................. T.................... ..................... Nerve surgery.......... 0221 25.8194 $1,401.71 $463.62 $280.34 64861................. T.................... ..................... Repair of arm nerves... 0221 25.8194 $1,401.71 $463.62 $280.34 64862................. T.................... ..................... Repair of low back

0221 25.8194 $1,401.71 $463.62 $280.34 nerves. 64864................. T.................... ..................... Repair of facial nerve. 0221 25.8194 $1,401.71 $463.62 $280.34 64865................. T.................... ..................... Repair of facial nerve. 0221 25.8194 $1,401.71 $463.62 $280.34 64866................. C.................... ..................... Fusion of facial/other ..... ......... ........... ............ ............ nerve. 64868................. C.................... ..................... Fusion of facial/other ..... ......... ........... ............ ............ nerve. 64870................. T.................... ..................... Fusion of facial/other 0221 25.8194 $1,401.71 $463.62 $280.34 nerve. 64872................. T.................... ..................... Subsequent repair of 0221 25.8194 $1,401.71 $463.62 $280.34 nerve. 64874................. T.................... ..................... Repair & revise nerve 0221 25.8194 $1,401.71 $463.62 $280.34 add-on. 64876................. T.................... ..................... Repair nerve/shorten 0221 25.8194 $1,401.71 $463.62 $280.34 bone. 64885................. T.................... ..................... Nerve graft, head or 0221 25.8194 $1,401.71 $463.62 $280.34 neck. 64886................. T.................... ..................... Nerve graft, head or 0221 25.8194 $1,401.71 $463.62 $280.34 neck. 64890................. T.................... ..................... Nerve graft, hand or 0221 25.8194 $1,401.71 $463.62 $280.34 foot. 64891................. T.................... ..................... Nerve graft, hand or 0221 25.8194 $1,401.71 $463.62 $280.34 foot. 64892................. T.................... ..................... Nerve graft, arm or leg 0221 25.8194 $1,401.71 $463.62 $280.34 64893................. T.................... ..................... Nerve graft, arm or leg 0221 25.8194 $1,401.71 $463.62 $280.34 64895................. T.................... ..................... Nerve graft, hand or 0221 25.8194 $1,401.71 $463.62 $280.34 foot. 64896................. T.................... ..................... Nerve graft, hand or 0221 25.8194 $1,401.71 $463.62 $280.34 foot. 64897................. T.................... ..................... Nerve graft, arm or leg 0221 25.8194 $1,401.71 $463.62 $280.34 64898................. T.................... ..................... Nerve graft, arm or leg 0221 25.8194 $1,401.71 $463.62 $280.34 64901................. T.................... ..................... Nerve graft add-on..... 0221 25.8194 $1,401.71 $463.62 $280.34 64902................. T.................... ..................... Nerve graft add-on..... 0221 25.8194 $1,401.71 $463.62 $280.34 64905................. T.................... ..................... Nerve pedicle transfer. 0221 25.8194 $1,401.71 $463.62 $280.34 64907................. T.................... ..................... Nerve pedicle transfer. 0221 25.8194 $1,401.71 $463.62 $280.34 64999................. T.................... ..................... Nervous system surgery. 0204 2.2209 $120.57

$40.13

$24.11 65091................. T.................... ..................... Revise eye............. 0242 29.2193 $1,586.29 $597.36 $317.26 65093................. T.................... ..................... Revise eye with implant 0241 21.9830 $1,193.44 $384.47 $238.69 65101................. T.................... ..................... Removal of eye......... 0242 29.2193 $1,586.29 $597.36 $317.26 65103................. T.................... ..................... Remove eye/insert

0242 29.2193 $1,586.29 $597.36 $317.26 implant. 65105................. T.................... ..................... Remove eye/attach

0242 29.2193 $1,586.29 $597.36 $317.26 implant. 65110................. T.................... ..................... Removal of eye......... 0242 29.2193 $1,586.29 $597.36 $317.26 65112................. T.................... ..................... Remove eye/revise

0242 29.2193 $1,586.29 $597.36 $317.26 socket. 65114................. T.................... ..................... Remove eye/revise

0242 29.2193 $1,586.29 $597.36 $317.26 socket. 65125................. T.................... ..................... Revise ocular implant.. 0240 17.3397 $941.35 $315.31 $188.27 65130................. T.................... ..................... Insert ocular implant.. 0241 21.9830 $1,193.44 $384.47 $238.69 65135................. T.................... ..................... Insert ocular implant.. 0241 21.9830 $1,193.44 $384.47 $238.69 65140................. T.................... ..................... Attach ocular implant.. 0242 29.2193 $1,586.29 $597.36 $317.26 65150................. T.................... ..................... Revise ocular implant.. 0241 21.9830 $1,193.44 $384.47 $238.69 65155................. T.................... ..................... Reinsert ocular implant 0242 29.2193 $1,586.29 $597.36 $317.26 65175................. T.................... ..................... Removal of ocular

0240 17.3397 $941.35 $315.31 $188.27 implant. 65205................. S.................... ..................... Remove foreign body 0698 0.9355 $50.79

$18.72

$10.16 from eye. 65210................. S.................... ..................... Remove foreign body 0231 2.0880 $113.36

$50.94

$22.67 from eye. 65220................. S.................... ..................... Remove foreign body 0231 2.0880 $113.36

$50.94

$22.67 from eye.

[[Page 48108]]

65222................. S.................... ..................... Remove foreign body 0231 2.0880 $113.36

$50.94

$22.67 from eye. 65235................. T.................... ..................... Remove foreign body 0233 14.5435 $789.55 $266.33 $157.91 from eye. 65260................. T.................... ..................... Remove foreign body 0236 19.6866 $1,068.77 ............ $213.75 from eye. 65265................. T.................... ..................... Remove foreign body 0236 19.6866 $1,068.77 ............ $213.75 from eye. 65270................. T.................... ..................... Repair of eye wound.... 0240 17.3397 $941.35 $315.31 $188.27 65272................. T.................... ..................... Repair of eye wound.... 0233 14.5435 $789.55 $266.33 $157.91 65273................. C.................... ..................... Repair of eye wound.... ..... ......... ........... ............ ............ 65275................. T.................... ..................... Repair of eye wound.... 0233 14.5435 $789.55 $266.33 $157.91 65280................. T.................... ..................... Repair of eye wound.... 0234 21.5482 $1,169.83 $511.31 $233.97 65285................. T.................... ..................... Repair of eye wound.... 0234 21.5482 $1,169.83 $511.31 $233.97 65286................. T.................... ..................... Repair of eye wound.... 0233 14.5435 $789.55 $266.33 $157.91 65290................. T.................... ..................... Repair of eye socket 0243 21.1035 $1,145.69 $431.39 $229.14 wound. 65400................. T.................... ..................... Removal of eye lesion.. 0233 14.5435 $789.55 $266.33 $157.91 65410................. T.................... ..................... Biopsy of cornea....... 0233 14.5435 $789.55 $266.33 $157.91 65420................. T.................... ..................... Removal of eye lesion.. 0233 14.5435 $789.55 $266.33 $157.91 65426................. T.................... ..................... Removal of eye lesion.. 0234 21.5482 $1,169.83 $511.31 $233.97 65430................. S.................... ..................... Corneal smear.......... 0230 0.7379 $40.06

$14.97

$8.01 65435................. T.................... ..................... Curette/treat cornea... 0239 6.2432 $338.94 $110.62

$67.79 65436................. T.................... ..................... Curette/treat cornea... 0233 14.5435 $789.55 $266.33 $157.91 65450................. S.................... ..................... Treatment of corneal 0231 2.0880 $113.36

$50.94

$22.67 lesion. 65600................. T.................... ..................... Revision of cornea..... 0240 17.3397 $941.35 $315.31 $188.27 65710................. T.................... ..................... Corneal transplant..... 0244 37.4885 $2,035.21 $803.26 $407.04 65730................. T.................... ..................... Corneal transplant..... 0244 37.4885 $2,035.21 $803.26 $407.04 65750................. T.................... ..................... Corneal transplant..... 0244 37.4885 $2,035.21 $803.26 $407.04 65755................. T.................... ..................... Corneal transplant..... 0244 37.4885 $2,035.21 $803.26 $407.04 65760................. E.................... ..................... Revision of cornea..... ..... ......... ........... ............ ............ 65765................. E.................... ..................... Revision of cornea..... ..... ......... ........... ............ ............ 65767................. E.................... ..................... Corneal tissue

..... ......... ........... ............ ............ transplant. 65770................. T.................... ..................... Revise cornea with

0244 37.4885 $2,035.21 $803.26 $407.04 implant. 65771................. E.................... ..................... Radial keratotomy...... ..... ......... ........... ............ ............ 65772................. T.................... ..................... Correction of

0233 14.5435 $789.55 $266.33 $157.91 astigmatism. 65775................. T.................... ..................... Correction of

0233 14.5435 $789.55 $266.33 $157.91 astigmatism. 65800................. T.................... ..................... Drainage of eye........ 0233 14.5435 $789.55 $266.33 $157.91 65805................. T.................... ..................... Drainage of eye........ 0233 14.5435 $789.55 $266.33 $157.91 65810................. T.................... ..................... Drainage of eye........ 0234 21.5482 $1,169.83 $511.31 $233.97 65815................. T.................... ..................... Drainage of eye........ 0234 21.5482 $1,169.83 $511.31 $233.97 65820................. T.................... ..................... Relieve inner eye

0232 4.9739 $270.03 $103.17

$54.01 pressure. 65850................. T.................... ..................... Incision of eye........ 0234 21.5482 $1,169.83 $511.31 $233.97 65855................. T.................... ..................... Laser surgery of eye... 0247 5.0192 $272.49 $104.31

$54.50 65860................. T.................... ..................... Incise inner eye

0247 5.0192 $272.49 $104.31

$54.50 adhesions. 65865................. T.................... ..................... Incise inner eye

0233 14.5435 $789.55 $266.33 $157.91 adhesions. 65870................. T.................... ..................... Incise inner eye

0234 21.5482 $1,169.83 $511.31 $233.97 adhesions. 65875................. T.................... ..................... Incise inner eye

0234 21.5482 $1,169.83 $511.31 $233.97 adhesions. 65880................. T.................... ..................... Incise inner eye

0233 14.5435 $789.55 $266.33 $157.91 adhesions. 65900................. T.................... ..................... Remove eye lesion...... 0233 14.5435 $789.55 $266.33 $157.91 65920................. T.................... ..................... Remove implant of eye.. 0233 14.5435 $789.55 $266.33 $157.91 65930................. T.................... ..................... Remove blood clot from 0234 21.5482 $1,169.83 $511.31 $233.97 eye. 66020................. T.................... ..................... Injection treatment of 0233 14.5435 $789.55 $266.33 $157.91 eye. 66030................. T.................... ..................... Injection treatment of 0233 14.5435 $789.55 $266.33 $157.91 eye. 66130................. T.................... ..................... Remove eye lesion...... 0234 21.5482 $1,169.83 $511.31 $233.97 66150................. T.................... ..................... Glaucoma surgery....... 0233 14.5435 $789.55 $266.33 $157.91 66155................. T.................... ..................... Glaucoma surgery....... 0234 21.5482 $1,169.83 $511.31 $233.97 66160................. T.................... ..................... Glaucoma surgery....... 0234 21.5482 $1,169.83 $511.31 $233.97 66165................. T.................... ..................... Glaucoma surgery....... 0234 21.5482 $1,169.83 $511.31 $233.97 66170................. T.................... ..................... Glaucoma surgery....... 0234 21.5482 $1,169.83 $511.31 $233.97 66172................. T.................... ..................... Incision of eye........ 0673 26.7626 $1,452.91 $649.56 $290.58 66180................. T.................... ..................... Implant eye shunt...... 0673 26.7626 $1,452.91 $649.56 $290.58 66185................. T.................... ..................... Revise eye shunt....... 0673 26.7626 $1,452.91 $649.56 $290.58 66220................. T.................... ..................... Repair eye lesion...... 0236 19.6866 $1,068.77 ............ $213.75 66225................. T.................... ..................... Repair/graft eye lesion 0673 26.7626 $1,452.91 $649.56 $290.58 66250................. T.................... ..................... Follow-up surgery of 0233 14.5435 $789.55 $266.33 $157.91 eye. 66500................. T.................... ..................... Incision of iris....... 0232 4.9739 $270.03 $103.17

$54.01 66505................. T.................... ..................... Incision of iris....... 0232 4.9739 $270.03 $103.17

$54.01 66600................. T.................... ..................... Remove iris and lesion. 0233 14.5435 $789.55 $266.33 $157.91 66605................. T.................... ..................... Removal of iris........ 0234 21.5482 $1,169.83 $511.31 $233.97 66625................. T.................... ..................... Removal of iris........ 0233 14.5435 $789.55 $266.33 $157.91

[[Page 48109]]

66630................. T.................... ..................... Removal of iris........ 0233 14.5435 $789.55 $266.33 $157.91 66635................. T.................... ..................... Removal of iris........ 0234 21.5482 $1,169.83 $511.31 $233.97 66680................. T.................... ..................... Repair iris & ciliary 0234 21.5482 $1,169.83 $511.31 $233.97 body. 66682................. T.................... ..................... Repair iris & ciliary 0234 21.5482 $1,169.83 $511.31 $233.97 body. 66700................. T.................... ..................... Destruction, ciliary 0233 14.5435 $789.55 $266.33 $157.91 body. 66710................. T.................... ..................... Destruction, ciliary 0233 14.5435 $789.55 $266.33 $157.91 body. 66720................. T.................... ..................... Destruction, ciliary 0233 14.5435 $789.55 $266.33 $157.91 body. 66740................. T.................... ..................... Destruction, ciliary 0233 14.5435 $789.55 $266.33 $157.91 body. 66761................. T.................... ..................... Revision of iris....... 0247 5.0192 $272.49 $104.31

$54.50 66762................. T.................... ..................... Revision of iris....... 0247 5.0192 $272.49 $104.31

$54.50 66770................. T.................... ..................... Removal of inner eye 0247 5.0192 $272.49 $104.31

$54.50 lesion. 66820................. T.................... ..................... Incision, secondary 0232 4.9739 $270.03 $103.17

$54.01 cataract. 66821................. T.................... ..................... After cataract laser 0247 5.0192 $272.49 $104.31

$54.50 surgery. 66825................. T.................... ..................... Reposition intraocular 0234 21.5482 $1,169.83 $511.31 $233.97 lens. 66830................. T.................... ..................... Removal of lens lesion. 0232 4.9739 $270.03 $103.17

$54.01 66840................. T.................... ..................... Removal of lens

0245 12.5751 $682.69 $226.11 $136.54 material. 66850................. T.................... ..................... Removal of lens

0249 28.3307 $1,538.05 $524.67 $307.61 material. 66852................. T.................... ..................... Removal of lens

0249 28.3307 $1,538.05 $524.67 $307.61 material. 66920................. T.................... ..................... Extraction of lens..... 0249 28.3307 $1,538.05 $524.67 $307.61 66930................. T.................... ..................... Extraction of lens..... 0249 28.3307 $1,538.05 $524.67 $307.61 66940................. T.................... ..................... Extraction of lens..... 0245 12.5751 $682.69 $226.11 $136.54 66982................. T.................... ..................... Cataract surgery,

0246 22.8428 $1,240.11 $495.96 $248.02 complex. 66983................. T.................... ..................... Cataract surg w/iol, 1 0246 22.8428 $1,240.11 $495.96 $248.02 stage. 66984................. T.................... ..................... Cataract surg w/iol, 1 0246 22.8428 $1,240.11 $495.96 $248.02 stage. 66985................. T.................... ..................... Insert lens prosthesis. 0246 22.8428 $1,240.11 $495.96 $248.02 66986................. T.................... ..................... Exchange lens

0246 22.8428 $1,240.11 $495.96 $248.02 prosthesis. 66990................. N.................... ..................... Ophthalmic endoscope ..... ......... ........... ............ ............ add-on. 66999................. T.................... ..................... Eye surgery procedure.. 0232 4.9739 $270.03 $103.17

$54.01 67005................. T.................... ..................... Partial removal of eye 0237 34.0324 $1,847.58 $818.54 $369.52 fluid. 67010................. T.................... ..................... Partial removal of eye 0237 34.0324 $1,847.58 $818.54 $369.52 fluid. 67015................. T.................... ..................... Release of eye fluid... 0237 34.0324 $1,847.58 $818.54 $369.52 67025................. T.................... ..................... Replace eye fluid...... 0236 19.6866 $1,068.77 ............ $213.75 67027................. T.................... ..................... Implant eye drug system 0237 34.0324 $1,847.58 $818.54 $369.52 67028................. T.................... ..................... Injection eye drug..... 0235 4.9900 $270.90

$72.04

$54.18 67030................. T.................... ..................... Incise inner eye

0236 19.6866 $1,068.77 ............ $213.75 strands. 67031................. T.................... ..................... Laser surgery, eye

0247 5.0192 $272.49 $104.31

$54.50 strands. 67036................. T.................... ..................... Removal of inner eye 0237 34.0324 $1,847.58 $818.54 $369.52 fluid. 67038................. T.................... ..................... Strip retinal membrane. 0237 34.0324 $1,847.58 $818.54 $369.52 67039................. T.................... ..................... Laser treatment of

0237 34.0324 $1,847.58 $818.54 $369.52 retina. 67040................. T.................... ..................... Laser treatment of

0672 39.1363 $2,124.67 $988.43 $424.93 retina. 67101................. T.................... ..................... Repair detached retina. 0235 4.9900 $270.90

$72.04

$54.18 67105................. T.................... ..................... Repair detached retina. 0248 4.7544 $258.11

$95.08

$51.62 67107................. T.................... ..................... Repair detached retina. 0672 39.1363 $2,124.67 $988.43 $424.93 67108................. T.................... ..................... Repair detached retina. 0672 39.1363 $2,124.67 $988.43 $424.93 67110................. T.................... ..................... Repair detached retina. 0236 19.6866 $1,068.77 ............ $213.75 67112................. T.................... ..................... Rerepair detached

0672 39.1363 $2,124.67 $988.43 $424.93 retina. 67115................. T.................... ..................... Release encircling

0236 19.6866 $1,068.77 ............ $213.75 material. 67120................. T.................... ..................... Remove eye implant

0236 19.6866 $1,068.77 ............ $213.75 material. 67121................. T.................... ..................... Remove eye implant

0237 34.0324 $1,847.58 $818.54 $369.52 material. 67141................. T.................... ..................... Treatment of retina.... 0235 4.9900 $270.90

$72.04

$54.18 67145................. T.................... ..................... Treatment of retina.... 0248 4.7544 $258.11

$95.08

$51.62 67208................. T.................... ..................... Treatment of retinal 0235 4.9900 $270.90

$72.04

$54.18 lesion. 67210................. T.................... ..................... Treatment of retinal 0248 4.7544 $258.11

$95.08

$51.62 lesion. 67218................. T.................... ..................... Treatment of retinal 0236 19.6866 $1,068.77 ............ $213.75 lesion. 67220................. T.................... ..................... Treatment of choroid 0235 4.9900 $270.90

$72.04

$54.18 lesion. 67221................. T.................... ..................... Ocular photodynamic 0235 4.9900 $270.90

$72.04

$54.18 ther. 67225................. T.................... ..................... Eye photodynamic ther 0235 4.9900 $270.90

$72.04

$54.18 add-on. 67227................. T.................... ..................... Treatment of retinal 0235 4.9900 $270.90

$72.04

$54.18 lesion. 67228................. T.................... ..................... Treatment of retinal 0248 4.7544 $258.11

$95.08

$51.62 lesion. 67250................. T.................... ..................... Reinforce eye wall..... 0240 17.3397 $941.35 $315.31 $188.27 67255................. T.................... ..................... Reinforce/graft eye 0237 34.0324 $1,847.58 $818.54 $369.52 wall. 67299................. T.................... ..................... Eye surgery procedure.. 0235 4.9900 $270.90

$72.04

$54.18 67311................. T.................... ..................... Revise eye muscle...... 0243 21.1035 $1,145.69 $431.39 $229.14 67312................. T.................... ..................... Revise two eye muscles. 0243 21.1035 $1,145.69 $431.39 $229.14 67314................. T.................... ..................... Revise eye muscle...... 0243 21.1035 $1,145.69 $431.39 $229.14 67316................. T.................... ..................... Revise two eye muscles. 0243 21.1035 $1,145.69 $431.39 $229.14

[[Page 48110]]

67318................. T.................... ..................... Revise eye muscle(s)... 0243 21.1035 $1,145.69 $431.39 $229.14 67320................. T.................... ..................... Revise eye muscle(s) 0243 21.1035 $1,145.69 $431.39 $229.14 add-on. 67331................. T.................... ..................... Eye surgery follow-up 0243 21.1035 $1,145.69 $431.39 $229.14 add-on. 67332................. T.................... ..................... Rerevise eye muscles 0243 21.1035 $1,145.69 $431.39 $229.14 add-on. 67334................. T.................... ..................... Revise eye muscle w/ 0243 21.1035 $1,145.69 $431.39 $229.14 suture. 67335................. T.................... ..................... Eye suture during

0243 21.1035 $1,145.69 $431.39 $229.14 surgery. 67340................. T.................... ..................... Revise eye muscle add- 0243 21.1035 $1,145.69 $431.39 $229.14 on. 67343................. T.................... ..................... Release eye tissue..... 0243 21.1035 $1,145.69 $431.39 $229.14 67345................. T.................... ..................... Destroy nerve of eye 0238 3.2016 $173.81

$58.96

$34.76 muscle. 67350................. T.................... ..................... Biopsy eye muscle...... 0699 2.2211 $120.58

$54.26

$24.12 67399................. T.................... ..................... Eye muscle surgery

0243 21.1035 $1,145.69 $431.39 $229.14 procedure. 67400................. T.................... ..................... Explore/biopsy eye

0241 21.9830 $1,193.44 $384.47 $238.69 socket. 67405................. T.................... ..................... Explore/drain eye

0241 21.9830 $1,193.44 $384.47 $238.69 socket. 67412................. T.................... ..................... Explore/treat eye

0241 21.9830 $1,193.44 $384.47 $238.69 socket. 67413................. T.................... ..................... Explore/treat eye

0241 21.9830 $1,193.44 $384.47 $238.69 socket. 67414................. T.................... ..................... Explr/decompress eye 0242 29.2193 $1,586.29 $597.36 $317.26 socket. 67415................. T.................... ..................... Aspiration, orbital 0239 6.2432 $338.94 $110.62

$67.79 contents. 67420................. T.................... ..................... Explore/treat eye

0242 29.2193 $1,586.29 $597.36 $317.26 socket. 67430................. T.................... ..................... Explore/treat eye

0242 29.2193 $1,586.29 $597.36 $317.26 socket. 67440................. T.................... ..................... Explore/drain eye

0242 29.2193 $1,586.29 $597.36 $317.26 socket. 67445................. T.................... ..................... Explr/decompress eye 0242 29.2193 $1,586.29 $597.36 $317.26 socket. 67450................. T.................... ..................... Explore/biopsy eye

0242 29.2193 $1,586.29 $597.36 $317.26 socket. 67500................. S.................... ..................... Inject/treat eye socket 0231 2.0880 $113.36

$50.94

$22.67 67505................. T.................... ..................... Inject/treat eye socket 0238 3.2016 $173.81

$58.96

$34.76 67515................. T.................... ..................... Inject/treat eye socket 0239 6.2432 $338.94 $110.62

$67.79 67550................. T.................... ..................... Insert eye socket

0242 29.2193 $1,586.29 $597.36 $317.26 implant. 67560................. T.................... ..................... Revise eye socket

0241 21.9830 $1,193.44 $384.47 $238.69 implant. 67570................. T.................... ..................... Decompress optic nerve. 0242 29.2193 $1,586.29 $597.36 $317.26 67599................. T.................... ..................... Orbit surgery procedure 0239 6.2432 $338.94 $110.62

$67.79 67700................. T.................... ..................... Drainage of eyelid

0238 3.2016 $173.81

$58.96

$34.76 abscess. 67710................. T.................... ..................... Incision of eyelid..... 0239 6.2432 $338.94 $110.62

$67.79 67715................. T.................... ..................... Incision of eyelid fold 0240 17.3397 $941.35 $315.31 $188.27 67800................. T.................... ..................... Remove eyelid lesion... 0238 3.2016 $173.81

$58.96

$34.76 67801................. T.................... ..................... Remove eyelid lesions.. 0239 6.2432 $338.94 $110.62

$67.79 67805................. T.................... ..................... Remove eyelid lesions.. 0238 3.2016 $173.81

$58.96

$34.76 67808................. T.................... ..................... Remove eyelid lesion(s) 0240 17.3397 $941.35 $315.31 $188.27 67810................. T.................... ..................... Biopsy of eyelid....... 0238 3.2016 $173.81

$58.96

$34.76 67820................. S.................... ..................... Revise eyelashes....... 0698 0.9355 $50.79

$18.72

$10.16 67825................. T.................... ..................... Revise eyelashes....... 0238 3.2016 $173.81

$58.96

$34.76 67830................. T.................... ..................... Revise eyelashes....... 0239 6.2432 $338.94 $110.62

$67.79 67835................. T.................... ..................... Revise eyelashes....... 0240 17.3397 $941.35 $315.31 $188.27 67840................. T.................... ..................... Remove eyelid lesion... 0239 6.2432 $338.94 $110.62

$67.79 67850................. T.................... ..................... Treat eyelid lesion.... 0239 6.2432 $338.94 $110.62

$67.79 67875................. T.................... ..................... Closure of eyelid by 0239 6.2432 $338.94 $110.62

$67.79 suture. 67880................. T.................... ..................... Revision of eyelid..... 0233 14.5435 $789.55 $266.33 $157.91 67882................. T.................... ..................... Revision of eyelid..... 0240 17.3397 $941.35 $315.31 $188.27 67900................. T.................... ..................... Repair brow defect..... 0240 17.3397 $941.35 $315.31 $188.27 67901................. T.................... ..................... Repair eyelid defect... 0240 17.3397 $941.35 $315.31 $188.27 67902................. T.................... ..................... Repair eyelid defect... 0240 17.3397 $941.35 $315.31 $188.27 67903................. T.................... ..................... Repair eyelid defect... 0240 17.3397 $941.35 $315.31 $188.27 67904................. T.................... ..................... Repair eyelid defect... 0240 17.3397 $941.35 $315.31 $188.27 67906................. T.................... ..................... Repair eyelid defect... 0240 17.3397 $941.35 $315.31 $188.27 67908................. T.................... ..................... Repair eyelid defect... 0240 17.3397 $941.35 $315.31 $188.27 67909................. T.................... ..................... Revise eyelid defect... 0240 17.3397 $941.35 $315.31 $188.27 67911................. T.................... ..................... Revise eyelid defect... 0240 17.3397 $941.35 $315.31 $188.27 67914................. T.................... ..................... Repair eyelid defect... 0240 17.3397 $941.35 $315.31 $188.27 67915................. T.................... ..................... Repair eyelid defect... 0239 6.2432 $338.94 $110.62

$67.79 67916................. T.................... ..................... Repair eyelid defect... 0240 17.3397 $941.35 $315.31 $188.27 67917................. T.................... ..................... Repair eyelid defect... 0240 17.3397 $941.35 $315.31 $188.27 67921................. T.................... ..................... Repair eyelid defect... 0240 17.3397 $941.35 $315.31 $188.27 67922................. T.................... ..................... Repair eyelid defect... 0239 6.2432 $338.94 $110.62

$67.79 67923................. T.................... ..................... Repair eyelid defect... 0240 17.3397 $941.35 $315.31 $188.27 67924................. T.................... ..................... Repair eyelid defect... 0240 17.3397 $941.35 $315.31 $188.27 67930................. T.................... ..................... Repair eyelid wound.... 0240 17.3397 $941.35 $315.31 $188.27 67935................. T.................... ..................... Repair eyelid wound.... 0240 17.3397 $941.35 $315.31 $188.27 67938................. S.................... ..................... Remove eyelid foreign 0698 0.9355 $50.79

$18.72

$10.16 body.

[[Page 48111]]

67950................. T.................... ..................... Revision of eyelid..... 0240 17.3397 $941.35 $315.31 $188.27 67961................. T.................... ..................... Revision of eyelid..... 0240 17.3397 $941.35 $315.31 $188.27 67966................. T.................... ..................... Revision of eyelid..... 0240 17.3397 $941.35 $315.31 $188.27 67971................. T.................... ..................... Reconstruction of

0241 21.9830 $1,193.44 $384.47 $238.69 eyelid. 67973................. T.................... ..................... Reconstruction of

0241 21.9830 $1,193.44 $384.47 $238.69 eyelid. 67974................. T.................... ..................... Reconstruction of

0241 21.9830 $1,193.44 $384.47 $238.69 eyelid. 67975................. T.................... ..................... Reconstruction of

0240 17.3397 $941.35 $315.31 $188.27 eyelid. 67999................. T.................... ..................... Revision of eyelid..... 0240 17.3397 $941.35 $315.31 $188.27 68020................. T.................... ..................... Incise/drain eyelid 0240 17.3397 $941.35 $315.31 $188.27 lining. 68040................. S.................... ..................... Treatment of eyelid 0698 0.9355 $50.79

$18.72

$10.16 lesions. 68100................. T.................... ..................... Biopsy of eyelid lining 0232 4.9739 $270.03 $103.17

$54.01 68110................. T.................... ..................... Remove eyelid lining 0699 2.2211 $120.58

$54.26

$24.12 lesion. 68115................. T.................... ..................... Remove eyelid lining 0239 6.2432 $338.94 $110.62

$67.79 lesion. 68130................. T.................... ..................... Remove eyelid lining 0233 14.5435 $789.55 $266.33 $157.91 lesion. 68135................. T.................... ..................... Remove eyelid lining 0239 6.2432 $338.94 $110.62

$67.79 lesion. 68200................. S.................... ..................... Treat eyelid by

0698 0.9355 $50.79

$18.72

$10.16 injection. 68320................. T.................... ..................... Revise/graft eyelid 0240 17.3397 $941.35 $315.31 $188.27 lining. 68325................. T.................... ..................... Revise/graft eyelid 0242 29.2193 $1,586.29 $597.36 $317.26 lining. 68326................. T.................... ..................... Revise/graft eyelid 0241 21.9830 $1,193.44 $384.47 $238.69 lining. 68328................. T.................... ..................... Revise/graft eyelid 0241 21.9830 $1,193.44 $384.47 $238.69 lining. 68330................. T.................... ..................... Revise eyelid lining... 0233 14.5435 $789.55 $266.33 $157.91 68335................. T.................... ..................... Revise/graft eyelid 0241 21.9830 $1,193.44 $384.47 $238.69 lining. 68340................. T.................... ..................... Separate eyelid

0240 17.3397 $941.35 $315.31 $188.27 adhesions. 68360................. T.................... ..................... Revise eyelid lining... 0234 21.5482 $1,169.83 $511.31 $233.97 68362................. T.................... ..................... Revise eyelid lining... 0234 21.5482 $1,169.83 $511.31 $233.97 68399................. T.................... ..................... Eyelid lining surgery.. 0239 6.2432 $338.94 $110.62

$67.79 68400................. T.................... ..................... Incise/drain tear gland 0238 3.2016 $173.81

$58.96

$34.76 68420................. T.................... ..................... Incise/drain tear sac.. 0240 17.3397 $941.35 $315.31 $188.27 68440................. T.................... ..................... Incise tear duct

0238 3.2016 $173.81

$58.96

$34.76 opening. 68500................. T.................... ..................... Removal of tear gland.. 0241 21.9830 $1,193.44 $384.47 $238.69 68505................. T.................... ..................... Partial removal, tear 0241 21.9830 $1,193.44 $384.47 $238.69 gland. 68510................. T.................... ..................... Biopsy of tear gland... 0240 17.3397 $941.35 $315.31 $188.27 68520................. T.................... ..................... Removal of tear sac.... 0241 21.9830 $1,193.44 $384.47 $238.69 68525................. T.................... ..................... Biopsy of tear sac..... 0240 17.3397 $941.35 $315.31 $188.27 68530................. T.................... ..................... Clearance of tear duct. 0240 17.3397 $941.35 $315.31 $188.27 68540................. T.................... ..................... Remove tear gland

0241 21.9830 $1,193.44 $384.47 $238.69 lesion. 68550................. T.................... ..................... Remove tear gland

0242 29.2193 $1,586.29 $597.36 $317.26 lesion. 68700................. T.................... ..................... Repair tear ducts...... 0241 21.9830 $1,193.44 $384.47 $238.69 68705................. T.................... ..................... Revise tear duct

0238 3.2016 $173.81

$58.96

$34.76 opening. 68720................. T.................... ..................... Create tear sac drain.. 0242 29.2193 $1,586.29 $597.36 $317.26 68745................. T.................... ..................... Create tear duct drain. 0241 21.9830 $1,193.44 $384.47 $238.69 68750................. T.................... ..................... Create tear duct drain. 0242 29.2193 $1,586.29 $597.36 $317.26 68760................. S.................... ..................... Close tear duct opening 0698 0.9355 $50.79

$18.72

$10.16 68761................. S.................... ..................... Close tear duct opening 0231 2.0880 $113.36

$50.94

$22.67 68770................. T.................... ..................... Close tear system

0240 17.3397 $941.35 $315.31 $188.27 fistula. 68801................. S.................... ..................... Dilate tear duct

0231 2.0880 $113.36

$50.94

$22.67 opening. 68810................. T.................... ..................... Probe nasolacrimal duct 0699 2.2211 $120.58

$54.26

$24.12 68811................. T.................... ..................... Probe nasolacrimal duct 0240 17.3397 $941.35 $315.31 $188.27 68815................. T.................... ..................... Probe nasolacrimal duct 0240 17.3397 $941.35 $315.31 $188.27 68840................. T.................... ..................... Explore/irrigate tear 0699 2.2211 $120.58

$54.26

$24.12 ducts. 68850................. N.................... ..................... Injection for tear sac ..... ......... ........... ............ ............ x-ray. 68899................. T.................... ..................... Tear duct system

0699 2.2211 $120.58

$54.26

$24.12 surgery. 69000................. T.................... ..................... Drain external ear

0006 1.7487 $94.94

$24.12

$18.99 lesion. 69005................. T.................... ..................... Drain external ear

0007 11.4943 $624.01 ............ $124.80 lesion. 69020................. T.................... ..................... Drain outer ear canal 0006 1.7487 $94.94

$24.12

$18.99 lesion. 69090................. E.................... ..................... Pierce earlobes........ ..... ......... ........... ............ ............ 69100................. T.................... ..................... Biopsy of external ear. 0019 3.9807 $216.11

$71.87

$43.22 69105................. T.................... ..................... Biopsy of external ear 0253 15.1698 $823.55 $282.29 $164.71 canal. 69110................. T.................... ..................... Remove external ear, 0021 14.5749 $791.26 $219.48 $158.25 partial. 69120................. T.................... ..................... Removal of external ear 0254 21.4368 $1,163.78 $321.35 $232.76 69140................. T.................... ..................... Remove ear canal

0254 21.4368 $1,163.78 $321.35 $232.76 lesion(s). 69145................. T.................... ..................... Remove ear canal

0021 14.5749 $791.26 $219.48 $158.25 lesion(s). 69150................. T.................... ..................... Extensive ear canal 0252 6.5416 $355.14 $113.41

$71.03 surgery. 69155................. C.................... ..................... Extensive ear/neck ..... ......... ........... ............ ............ surgery. 69200................. X.................... ..................... Clear outer ear canal.. 0340 0.6232 $33.83 ............

$6.77 69205................. T.................... ..................... Clear outer ear canal.. 0022 18.6725 $1,013.71 $354.45 $202.74

[[Page 48112]]

69210................. X.................... ..................... Remove impacted ear wax 0340 0.6232 $33.83 ............

$6.77 69220................. T.................... ..................... Clean out mastoid

0012 0.8203 $44.53

$11.18

$8.91 cavity. 69222................. T.................... ..................... Clean out mastoid

0253 15.1698 $823.55 $282.29 $164.71 cavity. 69300................. T.................... ..................... Revise external ear.... 0254 21.4368 $1,163.78 $321.35 $232.76 69310................. T.................... ..................... Rebuild outer ear canal 0256 35.0866 $1,904.82 ............ $380.96 69320................. T.................... ..................... Rebuild outer ear canal 0256 35.0866 $1,904.82 ............ $380.96 69399................. T.................... ..................... Outer ear surgery

0251 1.8643 $101.21 ............

$20.24 procedure. 69400................. T.................... ..................... Inflate middle ear

0251 1.8643 $101.21 ............

$20.24 canal. 69401................. T.................... ..................... Inflate middle ear

0251 1.8643 $101.21 ............

$20.24 canal. 69405................. T.................... ..................... Catheterize middle ear 0252 6.5416 $355.14 $113.41

$71.03 canal. 69410................. T.................... ..................... Inset middle ear

0252 6.5416 $355.14 $113.41

$71.03 (baffle). 69420................. T.................... ..................... Incision of eardrum.... 0252 6.5416 $355.14 $113.41

$71.03 69421................. T.................... ..................... Incision of eardrum.... 0253 15.1698 $823.55 $282.29 $164.71 69424................. T.................... ..................... Remove ventilating tube 0252 6.5416 $355.14 $113.41

$71.03 69433................. T.................... ..................... Create eardrum opening. 0252 6.5416 $355.14 $113.41

$71.03 69436................. T.................... ..................... Create eardrum opening. 0253 15.1698 $823.55 $282.29 $164.71 69440................. T.................... ..................... Exploration of middle 0254 21.4368 $1,163.78 $321.35 $232.76 ear. 69450................. T.................... ..................... Eardrum revision....... 0256 35.0866 $1,904.82 ............ $380.96 69501................. T.................... ..................... Mastoidectomy.......... 0256 35.0866 $1,904.82 ............ $380.96 69502................. T.................... ..................... Mastoidectomy.......... 0254 21.4368 $1,163.78 $321.35 $232.76 69505................. T.................... ..................... Remove mastoid

0256 35.0866 $1,904.82 ............ $380.96 structures. 69511................. T.................... ..................... Extensive mastoid

0256 35.0866 $1,904.82 ............ $380.96 surgery. 69530................. T.................... ..................... Extensive mastoid

0256 35.0866 $1,904.82 ............ $380.96 surgery. 69535................. C.................... ..................... Remove part of temporal ..... ......... ........... ............ ............ bone. 69540................. T.................... ..................... Remove ear lesion...... 0253 15.1698 $823.55 $282.29 $164.71 69550................. T.................... ..................... Remove ear lesion...... 0256 35.0866 $1,904.82 ............ $380.96 69552................. T.................... ..................... Remove ear lesion...... 0256 35.0866 $1,904.82 ............ $380.96 69554................. C.................... ..................... Remove ear lesion...... ..... ......... ........... ............ ............ 69601................. T.................... ..................... Mastoid surgery

0256 35.0866 $1,904.82 ............ $380.96 revision. 69602................. T.................... ..................... Mastoid surgery

0256 35.0866 $1,904.82 ............ $380.96 revision. 69603................. T.................... ..................... Mastoid surgery

0256 35.0866 $1,904.82 ............ $380.96 revision. 69604................. T.................... ..................... Mastoid surgery

0256 35.0866 $1,904.82 ............ $380.96 revision. 69605................. T.................... ..................... Mastoid surgery

0256 35.0866 $1,904.82 ............ $380.96 revision. 69610................. T.................... ..................... Repair of eardrum...... 0254 21.4368 $1,163.78 $321.35 $232.76 69620................. T.................... ..................... Repair of eardrum...... 0254 21.4368 $1,163.78 $321.35 $232.76 69631................. T.................... ..................... Repair eardrum

0256 35.0866 $1,904.82 ............ $380.96 structures. 69632................. T.................... ..................... Rebuild eardrum

0256 35.0866 $1,904.82 ............ $380.96 structures. 69633................. T.................... ..................... Rebuild eardrum

0256 35.0866 $1,904.82 ............ $380.96 structures. 69635................. T.................... ..................... Repair eardrum

0256 35.0866 $1,904.82 ............ $380.96 structures. 69636................. T.................... ..................... Rebuild eardrum

0256 35.0866 $1,904.82 ............ $380.96 structures. 69637................. T.................... ..................... Rebuild eardrum

0256 35.0866 $1,904.82 ............ $380.96 structures. 69641................. T.................... ..................... Revise middle ear & 0256 35.0866 $1,904.82 ............ $380.96 mastoid. 69642................. T.................... ..................... Revise middle ear & 0256 35.0866 $1,904.82 ............ $380.96 mastoid. 69643................. T.................... ..................... Revise middle ear & 0256 35.0866 $1,904.82 ............ $380.96 mastoid. 69644................. T.................... ..................... Revise middle ear & 0256 35.0866 $1,904.82 ............ $380.96 mastoid. 69645................. T.................... ..................... Revise middle ear & 0256 35.0866 $1,904.82 ............ $380.96 mastoid. 69646................. T.................... ..................... Revise middle ear & 0256 35.0866 $1,904.82 ............ $380.96 mastoid. 69650................. T.................... ..................... Release middle ear bone 0254 21.4368 $1,163.78 $321.35 $232.76 69660................. T.................... ..................... Revise middle ear bone. 0256 35.0866 $1,904.82 ............ $380.96 69661................. T.................... ..................... Revise middle ear bone. 0256 35.0866 $1,904.82 ............ $380.96 69662................. T.................... ..................... Revise middle ear bone. 0256 35.0866 $1,904.82 ............ $380.96 69666................. T.................... ..................... Repair middle ear

0256 35.0866 $1,904.82 ............ $380.96 structures. 69667................. T.................... ..................... Repair middle ear

0256 35.0866 $1,904.82 ............ $380.96 structures. 69670................. T.................... ..................... Remove mastoid air

0256 35.0866 $1,904.82 ............ $380.96 cells. 69676................. T.................... ..................... Remove middle ear nerve 0256 35.0866 $1,904.82 ............ $380.96 69700................. T.................... ..................... Close mastoid fistula.. 0256 35.0866 $1,904.82 ............ $380.96 69710................. E.................... ..................... Implant/replace hearing ..... ......... ........... ............ ............ aid. 69711................. T.................... ..................... Remove/repair hearing 0256 35.0866 $1,904.82 ............ $380.96 aid. 69714................. T.................... ..................... Implant temple bone w/ 0256 35.0866 $1,904.82 ............ $380.96 stimul. 69715................. T.................... ..................... Temple bne implnt w/ 0256 35.0866 $1,904.82 ............ $380.96 stimulat. 69717................. T.................... ..................... Temple bone implant 0256 35.0866 $1,904.82 ............ $380.96 revision. 69718................. T.................... ..................... Revise temple bone

0256 35.0866 $1,904.82 ............ $380.96 implant. 69720................. T.................... ..................... Release facial nerve... 0256 35.0866 $1,904.82 ............ $380.96 69725................. T.................... ..................... Release facial nerve... 0256 35.0866 $1,904.82 ............ $380.96 69740................. T.................... ..................... Repair facial nerve.... 0256 35.0866 $1,904.82 ............ $380.96 69745................. T.................... ..................... Repair facial nerve.... 0256 35.0866 $1,904.82 ............ $380.96

[[Page 48113]]

69799................. T.................... ..................... Middle ear surgery

0253 15.1698 $823.55 $282.29 $164.71 procedure. 69801................. T.................... ..................... Incise inner ear....... 0256 35.0866 $1,904.82 ............ $380.96 69802................. T.................... ..................... Incise inner ear....... 0256 35.0866 $1,904.82 ............ $380.96 69805................. T.................... ..................... Explore inner ear...... 0256 35.0866 $1,904.82 ............ $380.96 69806................. T.................... ..................... Explore inner ear...... 0256 35.0866 $1,904.82 ............ $380.96 69820................. T.................... ..................... Establish inner ear 0256 35.0866 $1,904.82 ............ $380.96 window. 69840................. T.................... ..................... Revise inner ear window 0256 35.0866 $1,904.82 ............ $380.96 69905................. T.................... ..................... Remove inner ear....... 0256 35.0866 $1,904.82 ............ $380.96 69910................. T.................... ..................... Remove inner ear &

0256 35.0866 $1,904.82 ............ $380.96 mastoid. 69915................. T.................... ..................... Incise inner ear nerve. 0256 35.0866 $1,904.82 ............ $380.96 69930................. T.................... ..................... Implant cochlear device 0259 389.1764 $21,128.00 $9,394.83 $4,225.60 69949................. T.................... ..................... Inner ear surgery

0253 15.1698 $823.55 $282.29 $164.71 procedure. 69950................. C.................... ..................... Incise inner ear nerve. ..... ......... ........... ............ ............ 69955................. T.................... ..................... Release facial nerve... 0256 35.0866 $1,904.82 ............ $380.96 69960................. T.................... ..................... Release inner ear canal 0256 35.0866 $1,904.82 ............ $380.96 69970................. C.................... ..................... Remove inner ear lesion ..... ......... ........... ............ ............ 69979................. T.................... ..................... Temporal bone surgery.. 0251 1.8643 $101.21 ............

$20.24 69990................. N.................... ..................... Microsurgery add-on.... ..... ......... ........... ............ ............ 70010................. S.................... ..................... Contrast x-ray of brain 0274 3.5837 $194.56

$92.92

$38.91 70015................. S.................... ..................... Contrast x-ray of brain 0274 3.5837 $194.56

$92.92

$38.91 70030................. X.................... ..................... X-ray eye for foreign 0260 0.7845 $42.59

$21.29

$8.52 body. 70100................. X.................... ..................... X-ray exam of jaw...... 0260 0.7845 $42.59

$21.29

$8.52 70110................. X.................... ..................... X-ray exam of jaw...... 0260 0.7845 $42.59

$21.29

$8.52 70120................. X.................... ..................... X-ray exam of mastoids. 0260 0.7845 $42.59

$21.29

$8.52 70130................. X.................... ..................... X-ray exam of mastoids. 0260 0.7845 $42.59

$21.29

$8.52 70134................. X.................... ..................... X-ray exam of middle 0261 1.3238 $71.87 ............

$14.37 ear. 70140................. X.................... ..................... X-ray exam of facial 0260 0.7845 $42.59

$21.29

$8.52 bones. 70150................. X.................... ..................... X-ray exam of facial 0260 0.7845 $42.59

$21.29

$8.52 bones. 70160................. X.................... ..................... X-ray exam of nasal 0260 0.7845 $42.59

$21.29

$8.52 bones. 70170................. X.................... ..................... X-ray exam of tear duct 0263 2.1875 $118.76

$43.58

$23.75 70190................. X.................... ..................... X-ray exam of eye

0260 0.7845 $42.59

$21.29

$8.52 sockets. 70200................. X.................... ..................... X-ray exam of eye

0260 0.7845 $42.59

$21.29

$8.52 sockets. 70210................. X.................... ..................... X-ray exam of sinuses.. 0260 0.7845 $42.59

$21.29

$8.52 70220................. X.................... ..................... X-ray exam of sinuses.. 0260 0.7845 $42.59

$21.29

$8.52 70240................. X.................... ..................... X-ray exam, pituitary 0260 0.7845 $42.59

$21.29

$8.52 saddle. 70250................. X.................... ..................... X-ray exam of skull.... 0260 0.7845 $42.59

$21.29

$8.52 70260................. X.................... ..................... X-ray exam of skull.... 0261 1.3238 $71.87 ............

$14.37 70300................. X.................... ..................... X-ray exam of teeth.... 0262 0.7851 $42.62

$9.82

$8.52 70310................. X.................... ..................... X-ray exam of teeth.... 0262 0.7851 $42.62

$9.82

$8.52 70320................. X.................... ..................... Full mouth x-ray of 0262 0.7851 $42.62

$9.82

$8.52 teeth. 70328................. X.................... ..................... X-ray exam of jaw joint 0260 0.7845 $42.59

$21.29

$8.52 70330................. X.................... ..................... X-ray exam of jaw

0260 0.7845 $42.59

$21.29

$8.52 joints. 70332................. S.................... ..................... X-ray exam of jaw joint 0275 3.2967 $178.97

$69.09

$35.79 70336................. S.................... ..................... Magnetic image, jaw 0335 6.4453 $349.91 $151.46

$69.98 joint. 70350................. X.................... ..................... X-ray head for

0260 0.7845 $42.59

$21.29

$8.52 orthodontia. 70355................. X.................... ..................... Panoramic x-ray of jaws 0260 0.7845 $42.59

$21.29

$8.52 70360................. X.................... ..................... X-ray exam of neck..... 0260 0.7845 $42.59

$21.29

$8.52 70370................. X.................... ..................... Throat x-ray &

0272 1.4086 $76.47

$38.23

$15.29 fluoroscopy. 70371................. X.................... ..................... Speech evaluation,

0272 1.4086 $76.47

$38.23

$15.29 complex. 70373................. X.................... ..................... Contrast x-ray of

0263 2.1875 $118.76

$43.58

$23.75 larynx. 70380................. X.................... ..................... X-ray exam of salivary 0260 0.7845 $42.59

$21.29

$8.52 gland. 70390................. X.................... ..................... X-ray exam of salivary 0264 3.0022 $162.99

$79.41

$32.60 duct. 70450................. S.................... ..................... Ct head/brain w/o dye.. 0332 3.3916 $184.13

$91.27

$36.83 70460................. S.................... ..................... Ct head/brain w/dye.... 0283 4.6121 $250.39 $125.19

$50.08 70470................. S.................... ..................... Ct head/brain w/o&w dye 0333 5.4299 $294.78 $146.98

$58.96 70480................. S.................... ..................... Ct orbit/ear/fossa w/o 0332 3.3916 $184.13

$91.27

$36.83 dye. 70481................. S.................... ..................... Ct orbit/ear/fossa w/ 0283 4.6121 $250.39 $125.19

$50.08 dye. 70482................. S.................... ..................... Ct orbit/ear/fossa w/ 0333 5.4299 $294.78 $146.98

$58.96 o&w dye. 70486................. S.................... ..................... Ct maxillofacial w/o 0332 3.3916 $184.13

$91.27

$36.83 dye. 70487................. S.................... ..................... Ct maxillofacial w/dye. 0283 4.6121 $250.39 $125.19

$50.08 70488................. S.................... ..................... Ct maxillofacial w/o&w 0333 5.4299 $294.78 $146.98

$58.96 dye. 70490................. S.................... ..................... Ct soft tissue neck w/o 0332 3.3916 $184.13

$91.27

$36.83 dye. 70491................. S.................... ..................... Ct soft tissue neck w/ 0283 4.6121 $250.39 $125.19

$50.08 dye. 70492................. S.................... ..................... Ct sft tsue nck w/o & w/ 0333 5.4299 $294.78 $146.98

$58.96 dye. 70496................. S.................... ..................... Ct angiography, head... 0662 5.8751 $318.95 $156.47

$63.79 70498................. S.................... ..................... Ct angiography, neck... 0662 5.8751 $318.95 $156.47

$63.79

[[Continued on page 48115]]

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

[[pp. 48115-48164]] Medicare Program; Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2004 Payment Rates

[[Continued from page 48114]]

[[Page 48114]]

70540................. S.................... ..................... Mri orbit/face/neck w/o 0336 6.4817 $351.89 $175.94

$70.38 dye. 70542................. S.................... ..................... Mri orbit/face/neck w/ 0284 7.0207 $381.15 $190.57

$76.23 dye. 70543................. S.................... ..................... Mri orbt/fac/nck w/o&w 0337 9.3215 $506.05 $240.77 $101.21 dye. 70544................. S.................... ..................... Mr angiography head w/o 0336 6.4817 $351.89 $175.94

$70.38 dye. 70545................. S.................... ..................... Mr angiography head w/ 0284 7.0207 $381.15 $190.57

$76.23 dye. 70546................. S.................... ..................... Mr angiograph head w/ 0337 9.3215 $506.05 $240.77 $101.21 o&w dye. 70547................. S.................... ..................... Mr angiography neck w/o 0336 6.4817 $351.89 $175.94

$70.38 dye. 70548................. S.................... ..................... Mr angiography neck w/ 0284 7.0207 $381.15 $190.57

$76.23 dye. 70549................. S.................... ..................... Mr angiograph neck w/ 0337 9.3215 $506.05 $240.77 $101.21 o&w dye. 70551................. S.................... ..................... Mri brain w/o dye...... 0336 6.4817 $351.89 $175.94

$70.38 70552................. S.................... ..................... Mri brain w/dye........ 0284 7.0207 $381.15 $190.57

$76.23 70553................. S.................... ..................... Mri brain w/o&w dye.... 0337 9.3215 $506.05 $240.77 $101.21 71010................. X.................... ..................... Chest x-ray............ 0260 0.7845 $42.59

$21.29

$8.52 71015................. X.................... ..................... Chest x-ray............ 0260 0.7845 $42.59

$21.29

$8.52 71020................. X.................... ..................... Chest x-ray............ 0260 0.7845 $42.59

$21.29

$8.52 71021................. X.................... ..................... Chest x-ray............ 0260 0.7845 $42.59

$21.29

$8.52 71022................. X.................... ..................... Chest x-ray............ 0260 0.7845 $42.59

$21.29

$8.52 71023................. X.................... ..................... Chest x-ray and

0272 1.4086 $76.47

$38.23

$15.29 fluoroscopy. 71030................. X.................... ..................... Chest x-ray............ 0260 0.7845 $42.59

$21.29

$8.52 71034................. X.................... ..................... Chest x-ray and

0272 1.4086 $76.47

$38.23

$15.29 fluoroscopy. 71035................. X.................... ..................... Chest x-ray............ 0260 0.7845 $42.59

$21.29

$8.52 71040................. X.................... ..................... Contrast x-ray of

0263 2.1875 $118.76

$43.58

$23.75 bronchi. 71060................. X.................... ..................... Contrast x-ray of

0264 3.0022 $162.99

$79.41

$32.60 bronchi. 71090................. X.................... ..................... X-ray & pacemaker

0272 1.4086 $76.47

$38.23

$15.29 insertion. 71100................. X.................... ..................... X-ray exam of ribs..... 0260 0.7845 $42.59

$21.29

$8.52 71101................. X.................... ..................... X-ray exam of ribs/ 0260 0.7845 $42.59

$21.29

$8.52 chest. 71110................. X.................... ..................... X-ray exam of ribs..... 0260 0.7845 $42.59

$21.29

$8.52 71111................. X.................... ..................... X-ray exam of ribs/ 0261 1.3238 $71.87 ............

$14.37 chest. 71120................. X.................... ..................... X-ray exam of

0260 0.7845 $42.59

$21.29

$8.52 breastbone. 71130................. X.................... ..................... X-ray exam of

0260 0.7845 $42.59

$21.29

$8.52 breastbone. 71250................. S.................... ..................... Ct thorax w/o dye...... 0332 3.3916 $184.13

$91.27

$36.83 71260................. S.................... ..................... Ct thorax w/dye........ 0283 4.6121 $250.39 $125.19

$50.08 71270................. S.................... ..................... Ct thorax w/o&w dye.... 0333 5.4299 $294.78 $146.98

$58.96 71275................. S.................... ..................... Ct angiography, chest.. 0662 5.8751 $318.95 $156.47

$63.79 71550................. S.................... ..................... Mri chest w/o dye...... 0336 6.4817 $351.89 $175.94

$70.38 71551................. S.................... ..................... Mri chest w/dye........ 0284 7.0207 $381.15 $190.57

$76.23 71552................. S.................... ..................... Mri chest w/o&w/dye.... 0337 9.3215 $506.05 $240.77 $101.21 71555................. E.................... ..................... Mri angio chest w or w/ ..... ......... ........... ............ ............ o dye. 72010................. X.................... ..................... X-ray exam of spine.... 0261 1.3238 $71.87 ............

$14.37 72020................. X.................... ..................... X-ray exam of spine.... 0260 0.7845 $42.59

$21.29

$8.52 72040................. X.................... ..................... X-ray exam of neck

0260 0.7845 $42.59

$21.29

$8.52 spine. 72050................. X.................... ..................... X-ray exam of neck

0261 1.3238 $71.87 ............

$14.37 spine. 72052................. X.................... ..................... X-ray exam of neck

0261 1.3238 $71.87 ............

$14.37 spine. 72069................. X.................... ..................... X-ray exam of trunk 0260 0.7845 $42.59

$21.29

$8.52 spine. 72070................. X.................... ..................... X-ray exam of thoracic 0260 0.7845 $42.59

$21.29

$8.52 spine. 72072................. X.................... ..................... X-ray exam of thoracic 0260 0.7845 $42.59

$21.29

$8.52 spine. 72074................. X.................... ..................... X-ray exam of thoracic 0260 0.7845 $42.59

$21.29

$8.52 spine. 72080................. X.................... ..................... X-ray exam of trunk 0260 0.7845 $42.59

$21.29

$8.52 spine. 72090................. X.................... ..................... X-ray exam of trunk 0261 1.3238 $71.87 ............

$14.37 spine. 72100................. X.................... ..................... X-ray exam of lower 0260 0.7845 $42.59

$21.29

$8.52 spine. 72110................. X.................... ..................... X-ray exam of lower 0261 1.3238 $71.87 ............

$14.37 spine. 72114................. X.................... ..................... X-ray exam of lower 0261 1.3238 $71.87 ............

$14.37 spine. 72120................. X.................... ..................... X-ray exam of lower 0260 0.7845 $42.59

$21.29

$8.52 spine. 72125................. S.................... ..................... Ct neck spine w/o dye.. 0332 3.3916 $184.13

$91.27

$36.83 72126................. S.................... ..................... Ct neck spine w/dye.... 0283 4.6121 $250.39 $125.19

$50.08 72127................. S.................... ..................... Ct neck spine w/o&w/dye 0333 5.4299 $294.78 $146.98

$58.96 72128................. S.................... ..................... Ct chest spine w/o dye. 0332 3.3916 $184.13

$91.27

$36.83 72129................. S.................... ..................... Ct chest spine w/dye... 0283 4.6121 $250.39 $125.19

$50.08 72130................. S.................... ..................... Ct chest spine w/o&w/ 0333 5.4299 $294.78 $146.98

$58.96 dye. 72131................. S.................... ..................... Ct lumbar spine w/o dye 0332 3.3916 $184.13

$91.27

$36.83 72132................. S.................... ..................... Ct lumbar spine w/dye.. 0283 4.6121 $250.39 $125.19

$50.08 72133................. S.................... ..................... Ct lumbar spine w/o&w/ 0333 5.4299 $294.78 $146.98

$58.96 dye. 72141................. S.................... ..................... Mri neck spine w/o dye. 0336 6.4817 $351.89 $175.94

$70.38 72142................. S.................... ..................... Mri neck spine w/dye... 0284 7.0207 $381.15 $190.57

$76.23 72146................. S.................... ..................... Mri chest spine w/o dye 0336 6.4817 $351.89 $175.94

$70.38 72147................. S.................... ..................... Mri chest spine w/dye.. 0284 7.0207 $381.15 $190.57

$76.23

[[Page 48115]]

72148................. S.................... ..................... Mri lumbar spine w/o 0336 6.4817 $351.89 $175.94

$70.38 dye. 72149................. S.................... ..................... Mri lumbar spine w/dye. 0284 7.0207 $381.15 $190.57

$76.23 72156................. S.................... ..................... Mri neck spine w/o&w/ 0337 9.3215 $506.05 $240.77 $101.21 dye. 72157................. S.................... ..................... Mri chest spine w/o&w/ 0337 9.3215 $506.05 $240.77 $101.21 dye. 72158................. S.................... ..................... Mri lumbar spine w/o&w/ 0337 9.3215 $506.05 $240.77 $101.21 dye. 72159................. E.................... ..................... Mr angio spine w/o&w/ ..... ......... ........... ............ ............ dye. 72170................. X.................... ..................... X-ray exam of pelvis... 0260 0.7845 $42.59

$21.29

$8.52 72190................. X.................... ..................... X-ray exam of pelvis... 0260 0.7845 $42.59

$21.29

$8.52 72191................. S.................... ..................... Ct angiograph pelv w/ 0662 5.8751 $318.95 $156.47

$63.79 o&w/dye. 72192................. S.................... ..................... Ct pelvis w/o dye...... 0332 3.3916 $184.13

$91.27

$36.83 72193................. S.................... ..................... Ct pelvis w/dye........ 0283 4.6121 $250.39 $125.19

$50.08 72194................. S.................... ..................... Ct pelvis w/o&w/dye.... 0333 5.4299 $294.78 $146.98

$58.96 72195................. S.................... ..................... Mri pelvis w/o dye..... 0336 6.4817 $351.89 $175.94

$70.38 72196................. S.................... ..................... Mri pelvis w/dye....... 0284 7.0207 $381.15 $190.57

$76.23 72197................. S.................... ..................... Mri pelvis w/o & w/dye. 0337 9.3215 $506.05 $240.77 $101.21 72198................. E.................... ..................... Mr angio pelvis w/o&w/ ..... ......... ........... ............ ............ dye. 72200................. X.................... ..................... X-ray exam sacroiliac 0260 0.7845 $42.59

$21.29

$8.52 joints. 72202................. X.................... ..................... X-ray exam sacroiliac 0260 0.7845 $42.59

$21.29

$8.52 joints. 72220................. X.................... ..................... X-ray exam of tailbone. 0260 0.7845 $42.59

$21.29

$8.52 72240................. S.................... ..................... Contrast x-ray of neck 0274 3.5837 $194.56

$92.92

$38.91 spine. 72255................. S.................... ..................... Contrast x-ray, thorax 0274 3.5837 $194.56

$92.92

$38.91 spine. 72265................. S.................... ..................... Contrast x-ray, lower 0274 3.5837 $194.56

$92.92

$38.91 spine. 72270................. S.................... ..................... Contrast x-ray of spine 0274 3.5837 $194.56

$92.92

$38.91 72275................. S.................... ..................... Epidurography.......... 0274 3.5837 $194.56

$92.92

$38.91 72285................. S.................... ..................... X-ray c/t spine disk... 0388 11.7450 $637.62 $304.54 $127.52 72295................. S.................... ..................... X-ray of lower spine 0388 11.7450 $637.62 $304.54 $127.52 disk. 73000................. X.................... ..................... X-ray exam of collar 0260 0.7845 $42.59

$21.29

$8.52 bone. 73010................. X.................... ..................... X-ray exam of shoulder 0260 0.7845 $42.59

$21.29

$8.52 blade. 73020................. X.................... ..................... X-ray exam of shoulder. 0260 0.7845 $42.59

$21.29

$8.52 73030................. X.................... ..................... X-ray exam of shoulder. 0260 0.7845 $42.59

$21.29

$8.52 73040................. S.................... ..................... Contrast x-ray of

0275 3.2967 $178.97

$69.09

$35.79 shoulder. 73050................. X.................... ..................... X-ray exam of shoulders 0260 0.7845 $42.59

$21.29

$8.52 73060................. X.................... ..................... X-ray exam of humerus.. 0260 0.7845 $42.59

$21.29

$8.52 73070................. X.................... ..................... X-ray exam of elbow.... 0260 0.7845 $42.59

$21.29

$8.52 73080................. X.................... ..................... X-ray exam of elbow.... 0260 0.7845 $42.59

$21.29

$8.52 73085................. S.................... ..................... Contrast x-ray of elbow 0275 3.2967 $178.97

$69.09

$35.79 73090................. X.................... ..................... X-ray exam of forearm.. 0260 0.7845 $42.59

$21.29

$8.52 73092................. X.................... ..................... X-ray exam of arm,

0260 0.7845 $42.59

$21.29

$8.52 infant. 73100................. X.................... ..................... X-ray exam of wrist.... 0260 0.7845 $42.59

$21.29

$8.52 73110................. X.................... ..................... X-ray exam of wrist.... 0260 0.7845 $42.59

$21.29

$8.52 73115................. S.................... ..................... Contrast x-ray of wrist 0275 3.2967 $178.97

$69.09

$35.79 73120................. X.................... ..................... X-ray exam of hand..... 0260 0.7845 $42.59

$21.29

$8.52 73130................. X.................... ..................... X-ray exam of hand..... 0260 0.7845 $42.59

$21.29

$8.52 73140................. X.................... ..................... X-ray exam of finger(s) 0260 0.7845 $42.59

$21.29

$8.52 73200................. S.................... ..................... Ct upper extremity w/o 0332 3.3916 $184.13

$91.27

$36.83 dye. 73201................. S.................... ..................... Ct upper extremity w/ 0283 4.6121 $250.39 $125.19

$50.08 dye. 73202................. S.................... ..................... Ct uppr extremity w/o&w/ 0333 5.4299 $294.78 $146.98

$58.96 dye. 73206................. S.................... ..................... Ct angio upr extrm w/ 0662 5.8751 $318.95 $156.47

$63.79 o&w/dye. 73218................. S.................... ..................... Mri upper extremity w/o 0336 6.4817 $351.89 $175.94

$70.38 dye. 73219................. S.................... ..................... Mri upper extremity w/ 0284 7.0207 $381.15 $190.57

$76.23 dye. 73220................. S.................... ..................... Mri uppr extremity w/ 0337 9.3215 $506.05 $240.77 $101.21 o&w/dye. 73221................. S.................... ..................... Mri joint upr extrem w/ 0336 6.4817 $351.89 $175.94

$70.38 o dye. 73222................. S.................... ..................... Mri joint upr extrem w/ 0284 7.0207 $381.15 $190.57

$76.23 dye. 73223................. S.................... ..................... Mri joint upr extr w/ 0337 9.3215 $506.05 $240.77 $101.21 o&w/dye. 73225................. E.................... ..................... Mr angio upr extr w/o&w/ ..... ......... ........... ............ ............ dye. 73500................. X.................... ..................... X-ray exam of hip...... 0260 0.7845 $42.59

$21.29

$8.52 73510................. X.................... ..................... X-ray exam of hip...... 0260 0.7845 $42.59

$21.29

$8.52 73520................. X.................... ..................... X-ray exam of hips..... 0260 0.7845 $42.59

$21.29

$8.52 73525................. S.................... ..................... Contrast x-ray of hip.. 0275 3.2967 $178.97

$69.09

$35.79 73530................. X.................... ..................... X-ray exam of hip...... 0261 1.3238 $71.87 ............

$14.37 73540................. X.................... ..................... X-ray exam of pelvis & 0260 0.7845 $42.59

$21.29

$8.52 hips. 73542................. S.................... ..................... X-ray exam, sacroiliac 0275 3.2967 $178.97

$69.09

$35.79 joint. 73550................. X.................... ..................... X-ray exam of thigh.... 0260 0.7845 $42.59

$21.29

$8.52 73560................. X.................... ..................... X-ray exam of knee, 1 0260 0.7845 $42.59

$21.29

$8.52 or 2. 73562................. X.................... ..................... X-ray exam of knee, 3.. 0260 0.7845 $42.59

$21.29

$8.52 73564................. X.................... ..................... X-ray exam, knee, 4 or 0260 0.7845 $42.59

$21.29

$8.52 more.

[[Page 48116]]

73565................. X.................... ..................... X-ray exam of knees.... 0260 0.7845 $42.59

$21.29

$8.52 73580................. S.................... ..................... Contrast x-ray of knee 0275 3.2967 $178.97

$69.09

$35.79 joint. 73590................. X.................... ..................... X-ray exam of lower leg 0260 0.7845 $42.59

$21.29

$8.52 73592................. X.................... ..................... X-ray exam of leg,

0260 0.7845 $42.59

$21.29

$8.52 infant. 73600................. X.................... ..................... X-ray exam of ankle.... 0260 0.7845 $42.59

$21.29

$8.52 73610................. X.................... ..................... X-ray exam of ankle.... 0260 0.7845 $42.59

$21.29

$8.52 73615................. S.................... ..................... Contrast x-ray of ankle 0275 3.2967 $178.97

$69.09

$35.79 73620................. X.................... ..................... X-ray exam of foot..... 0260 0.7845 $42.59

$21.29

$8.52 73630................. X.................... ..................... X-ray exam of foot..... 0260 0.7845 $42.59

$21.29

$8.52 73650................. X.................... ..................... X-ray exam of heel..... 0260 0.7845 $42.59

$21.29

$8.52 73660................. X.................... ..................... X-ray exam of toe(s)... 0260 0.7845 $42.59

$21.29

$8.52 73700................. S.................... ..................... Ct lower extremity w/o 0332 3.3916 $184.13

$91.27

$36.83 dye. 73701................. S.................... ..................... Ct lower extremity w/ 0283 4.6121 $250.39 $125.19

$50.08 dye. 73702................. S.................... ..................... Ct lwr extremity w/o&w/ 0333 5.4299 $294.78 $146.98

$58.96 dye. 73706................. S.................... ..................... Ct angio lwr extr w/o&w/ 0662 5.8751 $318.95 $156.47

$63.79 dye. 73718................. S.................... ..................... Mri lower extremity w/o 0336 6.4817 $351.89 $175.94

$70.38 dye. 73719................. S.................... ..................... Mri lower extremity w/ 0284 7.0207 $381.15 $190.57

$76.23 dye. 73720................. S.................... ..................... Mri lwr extremity w/o&w/ 0337 9.3215 $506.05 $240.77 $101.21 dye. 73721................. S.................... ..................... Mri jnt of lwr extre w/ 0336 6.4817 $351.89 $175.94

$70.38 o dye. 73722................. S.................... ..................... Mri joint of lwr extr w/ 0284 7.0207 $381.15 $190.57

$76.23 dye. 73723................. S.................... ..................... Mri joint lwr extr w/ 0337 9.3215 $506.05 $240.77 $101.21 o&w/dye. 73725................. E.................... ..................... Mr ang lwr ext w or w/o ..... ......... ........... ............ ............ dye. 74000................. X.................... ..................... X-ray exam of abdomen.. 0260 0.7845 $42.59

$21.29

$8.52 74010................. X.................... ..................... X-ray exam of abdomen.. 0260 0.7845 $42.59

$21.29

$8.52 74020................. X.................... ..................... X-ray exam of abdomen.. 0260 0.7845 $42.59

$21.29

$8.52 74022................. X.................... ..................... X-ray exam series,

0261 1.3238 $71.87 ............

$14.37 abdomen. 74150................. S.................... ..................... Ct abdomen w/o dye..... 0332 3.3916 $184.13

$91.27

$36.83 74160................. S.................... ..................... Ct abdomen w/dye....... 0283 4.6121 $250.39 $125.19

$50.08 74170................. S.................... ..................... Ct abdomen w/o&w/dye... 0333 5.4299 $294.78 $146.98

$58.96 74175................. S.................... ..................... Ct angio abdom w/o&w/ 0662 5.8751 $318.95 $156.47

$63.79 dye. 74181................. S.................... ..................... Mri abdomen w/o dye.... 0336 6.4817 $351.89 $175.94

$70.38 74182................. S.................... ..................... Mri abdomen w/dye...... 0284 7.0207 $381.15 $190.57

$76.23 74183................. S.................... ..................... Mri abdomen w/o&w/dye.. 0337 9.3215 $506.05 $240.77 $101.21 74185................. E.................... ..................... Mri angio, abdom w or w/ ..... ......... ........... ............ ............ o dy. 74190................. X.................... ..................... X-ray exam of

0263 2.1875 $118.76

$43.58

$23.75 peritoneum. 74210................. S.................... ..................... Contrst x-ray exam of 0276 1.6025 $87.00

$41.72

$17.40 throat. 74220................. S.................... ..................... Contrast x-ray,

0276 1.6025 $87.00

$41.72

$17.40 esophagus. 74230................. S.................... ..................... Cine/vid x-ray, throat/ 0276 1.6025 $87.00

$41.72

$17.40 esoph. 74235................. S.................... ..................... Remove esophagus

0296 3.1381 $170.36

$69.20

$34.07 obstruction. 74240................. S.................... ..................... X-ray exam, upper gi 0276 1.6025 $87.00

$41.72

$17.40 tract. 74241................. S.................... ..................... X-ray exam, upper gi 0276 1.6025 $87.00

$41.72

$17.40 tract. 74245................. S.................... ..................... X-ray exam, upper gi 0277 2.4462 $132.80

$60.47

$26.56 tract. 74246................. S.................... ..................... Contrst x-ray uppr gi 0276 1.6025 $87.00

$41.72

$17.40 tract. 74247................. S.................... ..................... Contrst x-ray uppr gi 0276 1.6025 $87.00

$41.72

$17.40 tract. 74249................. S.................... ..................... Contrst x-ray uppr gi 0277 2.4462 $132.80

$60.47

$26.56 tract. 74250................. S.................... ..................... X-ray exam of small 0276 1.6025 $87.00

$41.72

$17.40 bowel. 74251................. S.................... ..................... X-ray exam of small 0277 2.4462 $132.80

$60.47

$26.56 bowel. 74260................. S.................... ..................... X-ray exam of small 0277 2.4462 $132.80

$60.47

$26.56 bowel. 74270................. S.................... ..................... Contrast x-ray exam of 0276 1.6025 $87.00

$41.72

$17.40 colon. 74280................. S.................... ..................... Contrast x-ray exam of 0277 2.4462 $132.80

$60.47

$26.56 colon. 74283................. S.................... ..................... Contrast x-ray exam of 0276 1.6025 $87.00

$41.72

$17.40 colon. 74290................. S.................... ..................... Contrast x-ray,

0276 1.6025 $87.00

$41.72

$17.40 gallbladder. 74291................. S.................... ..................... Contrast x-rays,

0276 1.6025 $87.00

$41.72

$17.40 gallbladder. 74300................. X.................... ..................... X-ray bile ducts/

0263 2.1875 $118.76

$43.58

$23.75 pancreas. 74301................. X.................... ..................... X-rays at surgery add- 0263 2.1875 $118.76

$43.58

$23.75 on. 74305................. X.................... ..................... X-ray bile ducts/

0263 2.1875 $118.76

$43.58

$23.75 pancreas. 74320................. X.................... ..................... Contrast x-ray of bile 0264 3.0022 $162.99

$79.41

$32.60 ducts. 74327................. S.................... ..................... X-ray bile stone

0296 3.1381 $170.36

$69.20

$34.07 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 tube 0272 1.4086 $76.47

$38.23

$15.29 74350................. X.................... ..................... X-ray guide, stomach 0263 2.1875 $118.76

$43.58

$23.75 tube. 74355................. X.................... ..................... X-ray guide, intestinal 0263 2.1875 $118.76

$43.58

$23.75 tube. 74360................. S.................... ..................... X-ray guide, GI

0296 3.1381 $170.36

$69.20

$34.07 dilation. 74363................. S.................... ..................... X-ray, bile duct

0297 8.1532 $442.63 $172.51

$88.53 dilation.

[[Page 48117]]

74400................. S.................... ..................... Contrst x-ray, urinary 0278 2.7365 $148.56

$66.07

$29.71 tract. 74410................. S.................... ..................... Contrst x-ray, urinary 0278 2.7365 $148.56

$66.07

$29.71 tract. 74415................. S.................... ..................... Contrst x-ray, urinary 0278 2.7365 $148.56

$66.07

$29.71 tract. 74420................. S.................... ..................... Contrst x-ray, urinary 0278 2.7365 $148.56

$66.07

$29.71 tract. 74425................. S.................... ..................... Contrst x-ray, urinary 0278 2.7365 $148.56

$66.07

$29.71 tract. 74430................. S.................... ..................... Contrast x-ray, bladder 0278 2.7365 $148.56

$66.07

$29.71 74440................. S.................... ..................... X-ray, male genital 0278 2.7365 $148.56

$66.07

$29.71 tract. 74445................. S.................... ..................... X-ray exam of penis.... 0278 2.7365 $148.56

$66.07

$29.71 74450................. S.................... ..................... X-ray, urethra/bladder. 0278 2.7365 $148.56

$66.07

$29.71 74455................. S.................... ..................... X-ray, urethra/bladder. 0278 2.7365 $148.56

$66.07

$29.71 74470................. X.................... ..................... X-ray exam of kidney 0264 3.0022 $162.99

$79.41

$32.60 lesion. 74475................. S.................... ..................... X-ray control, cath 0297 8.1532 $442.63 $172.51

$88.53 insert. 74480................. S.................... ..................... X-ray control, cath 0296 3.1381 $170.36

$69.20

$34.07 insert. 74485................. S.................... ..................... X-ray guide, GU

0296 3.1381 $170.36

$69.20

$34.07 dilation. 74710................. X.................... ..................... X-ray measurement of 0260 0.7845 $42.59

$21.29

$8.52 pelvis. 74740................. X.................... ..................... X-ray, female genital 0264 3.0022 $162.99

$79.41

$32.60 tract. 74742................. X.................... ..................... X-ray, fallopian tube.. 0263 2.1875 $118.76

$43.58

$23.75 74775................. S.................... ..................... X-ray exam of perineum. 0278 2.7365 $148.56

$66.07

$29.71 75552................. S.................... ..................... Heart mri for morph w/o 0336 6.4817 $351.89 $175.94

$70.38 dye. 75553................. S.................... ..................... Heart mri for morph w/ 0284 7.0207 $381.15 $190.57

$76.23 dye. 75554................. S.................... ..................... Cardiac MRI/function... 0335 6.4453 $349.91 $151.46

$69.98 75555................. S.................... ..................... Cardiac MRI/limited 0335 6.4453 $349.91 $151.46

$69.98 study. 75556................. E.................... ..................... Cardiac MRI/flow

..... ......... ........... ............ ............ mapping. 75600................. S.................... ..................... Contrast x-ray exam of 0280 19.0237 $1,032.78 $353.85 $206.56 aorta. 75605................. S.................... ..................... Contrast x-ray exam of 0280 19.0237 $1,032.78 $353.85 $206.56 aorta. 75625................. S.................... ..................... Contrast x-ray exam of 0280 19.0237 $1,032.78 $353.85 $206.56 aorta. 75630................. S.................... ..................... X-ray aorta, leg

0280 19.0237 $1,032.78 $353.85 $206.56 arteries. 75635................. S.................... ..................... Ct angio abdominal

0662 5.8751 $318.95 $156.47

$63.79 arteries. 75650................. S.................... ..................... Artery x-rays, head & 0280 19.0237 $1,032.78 $353.85 $206.56 neck. 75658................. S.................... ..................... Artery x-rays, arm..... 0280 19.0237 $1,032.78 $353.85 $206.56 75660................. S.................... ..................... Artery x-rays, head & 0279 11.0678 $600.86 $174.57 $120.17 neck. 75662................. S.................... ..................... Artery x-rays, head & 0279 11.0678 $600.86 $174.57 $120.17 neck. 75665................. S.................... ..................... Artery x-rays, head & 0280 19.0237 $1,032.78 $353.85 $206.56 neck. 75671................. S.................... ..................... Artery x-rays, head & 0280 19.0237 $1,032.78 $353.85 $206.56 neck. 75676................. S.................... ..................... Artery x-rays, neck.... 0280 19.0237 $1,032.78 $353.85 $206.56 75680................. S.................... ..................... Artery x-rays, neck.... 0280 19.0237 $1,032.78 $353.85 $206.56 75685................. S.................... ..................... Artery x-rays, spine... 0279 11.0678 $600.86 $174.57 $120.17 75705................. S.................... ..................... Artery x-rays, spine... 0279 11.0678 $600.86 $174.57 $120.17 75710................. S.................... ..................... Artery x-rays, arm/leg. 0280 19.0237 $1,032.78 $353.85 $206.56 75716................. S.................... ..................... Artery x-rays, arms/ 0280 19.0237 $1,032.78 $353.85 $206.56 legs. 75722................. S.................... ..................... Artery x-rays, kidney.. 0280 19.0237 $1,032.78 $353.85 $206.56 75724................. S.................... ..................... Artery x-rays, kidneys. 0280 19.0237 $1,032.78 $353.85 $206.56 75726................. S.................... ..................... Artery x-rays, abdomen. 0280 19.0237 $1,032.78 $353.85 $206.56 75731................. S.................... ..................... Artery x-rays, adrenal 0280 19.0237 $1,032.78 $353.85 $206.56 gland. 75733................. S.................... ..................... Artery x-rays, adrenals 0280 19.0237 $1,032.78 $353.85 $206.56 75736................. S.................... ..................... Artery x-rays, pelvis.. 0280 19.0237 $1,032.78 $353.85 $206.56 75741................. S.................... ..................... Artery x-rays, lung.... 0279 11.0678 $600.86 $174.57 $120.17 75743................. S.................... ..................... Artery x-rays, lungs... 0280 19.0237 $1,032.78 $353.85 $206.56 75746................. S.................... ..................... Artery x-rays, lung.... 0279 11.0678 $600.86 $174.57 $120.17 75756................. S.................... ..................... Artery x-rays, chest... 0279 11.0678 $600.86 $174.57 $120.17 75774................. S.................... ..................... Artery x-ray, each

0668 10.4896 $569.47 $237.76 $113.89 vessel. 75790................. S.................... ..................... Visualize A-V shunt.... 0281 6.6888 $363.13 $115.16

$72.63 75801................. X.................... ..................... Lymph vessel x-ray, arm/ 0264 3.0022 $162.99

$79.41

$32.60 leg. 75803................. X.................... ..................... Lymph vessel x-ray,arms/ 0264 3.0022 $162.99

$79.41

$32.60 legs. 75805................. X.................... ..................... Lymph vessel x-ray, 0264 3.0022 $162.99

$79.41

$32.60 trunk. 75807................. X.................... ..................... Lymph vessel x-ray, 0264 3.0022 $162.99

$79.41

$32.60 trunk. 75809................. X.................... ..................... Nonvascular shunt, x- 0263 2.1875 $118.76

$43.58

$23.75 ray. 75810................. S.................... ..................... Vein x-ray, spleen/ 0279 11.0678 $600.86 $174.57 $120.17 liver. 75820................. S.................... ..................... Vein x-ray, arm/leg.... 0281 6.6888 $363.13 $115.16

$72.63 75822................. S.................... ..................... Vein x-ray, arms/legs.. 0281 6.6888 $363.13 $115.16

$72.63 75825................. S.................... ..................... Vein x-ray, trunk...... 0279 11.0678 $600.86 $174.57 $120.17 75827................. S.................... ..................... Vein x-ray, chest...... 0279 11.0678 $600.86 $174.57 $120.17 75831................. S.................... ..................... Vein x-ray, kidney..... 0287 6.2829 $341.09 $107.20

$68.22 75833................. S.................... ..................... Vein x-ray, kidneys.... 0279 11.0678 $600.86 $174.57 $120.17 75840................. S.................... ..................... Vein x-ray, adrenal 0287 6.2829 $341.09 $107.20

$68.22 gland. 75842................. S.................... ..................... Vein x-ray, adrenal 0287 6.2829 $341.09 $107.20

$68.22 glands.

[[Page 48118]]

75860................. S.................... ..................... Vein x-ray, neck....... 0287 6.2829 $341.09 $107.20

$68.22 75870................. S.................... ..................... Vein x-ray, skull...... 0287 6.2829 $341.09 $107.20

$68.22 75872................. S.................... ..................... Vein x-ray, skull...... 0287 6.2829 $341.09 $107.20

$68.22 75880................. S.................... ..................... Vein x-ray, eye socket. 0287 6.2829 $341.09 $107.20

$68.22 75885................. S.................... ..................... Vein x-ray, liver...... 0279 11.0678 $600.86 $174.57 $120.17 75887................. S.................... ..................... Vein x-ray, liver...... 0280 19.0237 $1,032.78 $353.85 $206.56 75889................. S.................... ..................... Vein x-ray, liver...... 0279 11.0678 $600.86 $174.57 $120.17 75891................. S.................... ..................... Vein x-ray, liver...... 0279 11.0678 $600.86 $174.57 $120.17 75893................. N.................... ..................... Venous sampling by ..... ......... ........... ............ ............ catheter. 75894................. S.................... ..................... X-rays, transcath

0297 8.1532 $442.63 $172.51

$88.53 therapy. 75896................. S.................... ..................... X-rays, transcath

0297 8.1532 $442.63 $172.51

$88.53 therapy. 75898................. X.................... ..................... Follow-up angiography.. 0264 3.0022 $162.99

$79.41

$32.60 75900................. C.................... ..................... Arterial catheter

..... ......... ........... ............ ............ exchange. 75901................. X.................... ..................... Remove cva device

0264 3.0022 $162.99

$79.41

$32.60 obstruct. 75902................. X.................... ..................... Remove cva lumen

0263 2.1875 $118.76

$43.58

$23.75 obstruct. 75940................. X.................... ..................... X-ray placement, vein 0187 4.4274 $240.36

$90.71

$48.07 filter. 75945................. S.................... ..................... Intravascular us....... 0267 2.4805 $134.66

$65.52

$26.93 75946................. S.................... ..................... Intravascular us add-on 0267 2.4805 $134.66

$65.52

$26.93 75952................. C.................... ..................... Endovasc repair abdom ..... ......... ........... ............ ............ aorta. 75953................. C.................... ..................... Abdom aneurysm endovas ..... ......... ........... ............ ............ rpr. 75954................. C.................... ..................... Iliac aneurysm endovas ..... ......... ........... ............ ............ rpr. 75960................. S.................... ..................... Transcatheter intro, 0280 19.0237 $1,032.78 $353.85 $206.56 stent. 75961................. S.................... ..................... Retrieval, broken

0280 19.0237 $1,032.78 $353.85 $206.56 catheter. 75962................. S.................... ..................... Repair arterial

0280 19.0237 $1,032.78 $353.85 $206.56 blockage. 75964................. S.................... ..................... Repair artery blockage, 0280 19.0237 $1,032.78 $353.85 $206.56 each. 75966................. S.................... ..................... Repair arterial

0280 19.0237 $1,032.78 $353.85 $206.56 blockage. 75968................. S.................... ..................... Repair artery blockage, 0280 19.0237 $1,032.78 $353.85 $206.56 each. 75970................. S.................... ..................... Vascular biopsy........ 0280 19.0237 $1,032.78 $353.85 $206.56 75978................. S.................... ..................... Repair venous blockage. 0668 10.4896 $569.47 $237.76 $113.89 75980................. S.................... ..................... Contrast xray exam bile 0296 3.1381 $170.36

$69.20

$34.07 duct. 75982................. S.................... ..................... Contrast xray exam bile 0297 8.1532 $442.63 $172.51

$88.53 duct. 75984................. X.................... ..................... Xray control catheter 0264 3.0022 $162.99

$79.41

$32.60 change. 75989................. N.................... ..................... Abscess drainage under ..... ......... ........... ............ ............ x-ray. 75992................. S.................... ..................... Atherectomy, x-ray exam 0280 19.0237 $1,032.78 $353.85 $206.56 75993................. S.................... ..................... Atherectomy, x-ray exam 0280 19.0237 $1,032.78 $353.85 $206.56 75994................. S.................... ..................... Atherectomy, x-ray exam 0280 19.0237 $1,032.78 $353.85 $206.56 75995................. S.................... ..................... Atherectomy, x-ray exam 0280 19.0237 $1,032.78 $353.85 $206.56 75996................. S.................... ..................... Atherectomy, x-ray exam 0280 19.0237 $1,032.78 $353.85 $206.56 76000................. X.................... ..................... Fluoroscope examination 0272 1.4086 $76.47

$38.23

$15.29 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 0.7845 $42.59

$21.29

$8.52 76010................. X.................... ..................... X-ray, nose to rectum.. 0260 0.7845 $42.59

$21.29

$8.52 76012................. S.................... ..................... Percut vertebroplasty 0274 3.5837 $194.56

$92.92

$38.91 fluor. 76013................. S.................... ..................... Percut vertebroplasty, 0274 3.5837 $194.56

$92.92

$38.91 ct. 76020................. X.................... ..................... X-rays for bone age.... 0260 0.7845 $42.59

$21.29

$8.52 76040................. X.................... ..................... X-rays, bone evaluation 0260 0.7845 $42.59

$21.29

$8.52 76061................. X.................... ..................... X-rays, bone survey.... 0261 1.3238 $71.87 ............

$14.37 76062................. X.................... ..................... X-rays, bone survey.... 0261 1.3238 $71.87 ............

$14.37 76065................. X.................... ..................... X-rays, bone evaluation 0261 1.3238 $71.87 ............

$14.37 76066................. X.................... ..................... Joint survey, single 0260 0.7845 $42.59

$21.29

$8.52 view. 76070................. S.................... ..................... CT scan, bone density 0288 1.2854 $69.78 ............

$13.96 study. 76071................. S.................... ..................... Ct bone density,

0282 1.6813 $91.28

$44.51

$18.26 peripheral. 76075................. S.................... ..................... Dexa, axial skeleton 0288 1.2854 $69.78 ............

$13.96 study. 76076................. S.................... ..................... Dexa, peripheral study. 0665 0.7225 $39.22 ............

$7.84 76078................. X.................... ..................... Radiographic

0261 1.3238 $71.87 ............

$14.37 absorptiometry. 76080................. X.................... ..................... X-ray exam of fistula.. 0263 2.1875 $118.76

$43.58

$23.75 76085................. A.................... ..................... Computer mammogram add- ..... ......... ........... ............ ............ on. 76086................. X.................... ..................... X-ray of mammary duct.. 0263 2.1875 $118.76

$43.58

$23.75 76088................. X.................... ..................... X-ray of mammary ducts. 0263 2.1875 $118.76

$43.58

$23.75 76090................. S.................... ..................... Mammogram, one breast.. 0271 0.6548 $35.55

$16.80

$7.11 76091................. S.................... ..................... Mammogram, both breasts 0271 0.6548 $35.55

$16.80

$7.11 76092................. A.................... ..................... Mammogram, screening... ..... ......... ........... ............ ............ 76093................. E.................... ..................... Magnetic image, breast. ..... ......... ........... ............ ............ 76094................. E.................... ..................... Magnetic image, both ..... ......... ........... ............ ............ breasts.

[[Page 48119]]

76095................. X.................... ..................... Stereotactic breast 0187 4.4274 $240.36

$90.71

$48.07 biopsy. 76096................. X.................... ..................... X-ray of needle wire, 0289 3.6386 $197.54

$44.80

$39.51 breast. 76098................. X.................... ..................... X-ray exam, breast

0260 0.7845 $42.59

$21.29

$8.52 specimen. 76100................. X.................... ..................... X-ray exam of body

0261 1.3238 $71.87 ............

$14.37 section. 76101................. X.................... ..................... Complex body section x- 0264 3.0022 $162.99

$79.41

$32.60 ray. 76102................. X.................... ..................... Complex body section x- 0264 3.0022 $162.99

$79.41

$32.60 rays. 76120................. X.................... ..................... Cine/video x-rays...... 0272 1.4086 $76.47

$38.23

$15.29 76125................. X.................... ..................... Cine/video x-rays add- 0260 0.7845 $42.59

$21.29

$8.52 on. 76140................. E.................... ..................... X-ray consultation..... ..... ......... ........... ............ ............ 76150................. X.................... ..................... X-ray exam, dry process 0260 0.7845 $42.59

$21.29

$8.52 76350................. N.................... ..................... Special x-ray contrast ..... ......... ........... ............ ............ study. 76355................. S.................... ..................... CAT scan for

0283 4.6121 $250.39 $125.19

$50.08 localization. 76360................. S.................... ..................... CAT scan for needle 0283 4.6121 $250.39 $125.19

$50.08 biopsy. 76362................. S.................... ..................... Cat scan for tissue 0332 3.3916 $184.13

$91.27

$36.83 ablation. 76370................. S.................... ..................... CAT scan for therapy 0282 1.6813 $91.28

$44.51

$18.26 guide. 76375................. S.................... ..................... 3d/holograph reconstr 0282 1.6813 $91.28

$44.51

$18.26 add-on. 76380................. S.................... ..................... CAT scan follow-up

0282 1.6813 $91.28

$44.51

$18.26 study. 76390................. E.................... ..................... Mr spectroscopy........ ..... ......... ........... ............ ............ 76393................. S.................... ..................... Mr guidance for needle 0335 6.4453 $349.91 $151.46

$69.98 place. 76394................. S.................... ..................... Mri for tissue ablation 0335 6.4453 $349.91 $151.46

$69.98 76400................. S.................... ..................... Magnetic image, bone 0335 6.4453 $349.91 $151.46

$69.98 marrow. 76490................. S.................... ..................... Us for tissue ablation. 0268 1.2640 $68.62 ............

$13.72 76496................. X.................... ..................... Fluoroscopic procedure. 0272 1.4086 $76.47

$38.23

$15.29 76497................. S.................... ..................... Ct procedure........... 0282 1.6813 $91.28

$44.51

$18.26 76498................. S.................... ..................... Mri procedure.......... 0335 6.4453 $349.91 $151.46

$69.98 76499................. X.................... ..................... Radiographic procedure. 0260 0.7845 $42.59

$21.29

$8.52 76506................. S.................... ..................... Echo exam of head...... 0266 1.6234 $88.13

$44.06

$17.63 76511................. S.................... ..................... Echo exam of eye....... 0266 1.6234 $88.13

$44.06

$17.63 76512................. S.................... ..................... Echo exam of eye....... 0266 1.6234 $88.13

$44.06

$17.63 76513................. S.................... ..................... Echo exam of eye, water 0265 1.0245 $55.62

$27.81

$11.12 bath. 76516................. S.................... ..................... Echo exam of eye....... 0266 1.6234 $88.13

$44.06

$17.63 76519................. S.................... ..................... Echo exam of eye....... 0266 1.6234 $88.13

$44.06

$17.63 76529................. S.................... ..................... Echo exam of eye....... 0265 1.0245 $55.62

$27.81

$11.12 76536................. S.................... ..................... Us exam of head and 0266 1.6234 $88.13

$44.06

$17.63 neck. 76604................. S.................... ..................... Us exam, chest, b-scan. 0266 1.6234 $88.13

$44.06

$17.63 76645................. S.................... ..................... Us exam, breast(s)..... 0265 1.0245 $55.62

$27.81

$11.12 76700................. S.................... ..................... Us exam, abdom,

0266 1.6234 $88.13

$44.06

$17.63 complete. 76705................. S.................... ..................... Echo exam of abdomen... 0266 1.6234 $88.13

$44.06

$17.63 76770................. S.................... ..................... Us exam abdo back wall, 0266 1.6234 $88.13

$44.06

$17.63 comp. 76775................. S.................... ..................... Us eam abdo back wall, 0266 1.6234 $88.13

$44.06

$17.63 lim. 76778................. S.................... ..................... Us exam kidney

0266 1.6234 $88.13

$44.06

$17.63 transplant. 76800................. S.................... ..................... Us exam, spinal canal.. 0266 1.6234 $88.13

$44.06

$17.63 76801................. S.................... ..................... Ob us ..... ......... ........... ............ ............ 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 vaccine, 0356 0.4353 $23.63 ............

$4.73 im. 90725................. N.................... ..................... Cholera vaccine,

..... ......... ........... ............ ............ injectable. 90727................. N.................... ..................... Plague vaccine, im..... ..... ......... ........... ............ ............ 90732................. L.................... ..................... Pneumococcal vaccine... ..... ......... ........... ............ ............ 90733................. N.................... ..................... Meningococcal vaccine, ..... ......... ........... ............ ............ sc. 90735................. N.................... ..................... Encephalitis vaccine, ..... ......... ........... ............ ............ sc. 90740................. K.................... ..................... Hepb vacc, ill pat 3 0356 0.4353 $23.63 ............

$4.73 dose im. 90743................. K.................... ..................... Hep b vacc, adol, 2 0356 0.4353 $23.63 ............

$4.73 dose, im. 90744................. K.................... ..................... Hepb vacc ped/adol 3 0356 0.4353 $23.63 ............

$4.73 dose im. 90746................. K.................... ..................... Hep b vaccine, adult, 0356 0.4353 $23.63 ............

$4.73 im. 90747................. K.................... ..................... Hepb vacc, ill pat 4 0356 0.4353 $23.63 ............

$4.73 dose im. 90748................. K.................... ..................... Hep b/hib vaccine, im.. 0356 0.4353 $23.63 ............

$4.73 90749................. N.................... ..................... Vaccine toxoid......... ..... ......... ........... ............ ............ 90780................. E.................... ..................... IV infusion therapy, 1 ..... ......... ........... ............ ............ hour. 90781................. E.................... ..................... IV infusion, additional ..... ......... ........... ............ ............ hour. 90782................. X.................... ..................... Injection, sc/im....... 0353 0.4106 $22.29 ............

$4.46 90783................. X.................... ..................... Injection, ia.......... 0359 0.8794 $47.74 ............

$9.55 90784................. X.................... ..................... Injection, iv.......... 0359 0.8794 $47.74 ............

$9.55 90788................. X.................... ..................... Injection of antibiotic 0359 0.8794 $47.74 ............

$9.55 90799................. X.................... ..................... Ther/prophylactic/dx 0352 0.1076

$5.84 ............

$1.17 inject. 90801................. S.................... ..................... Psy dx interview....... 0323 1.7955 $97.48

$21.26

$19.50 90802................. S.................... ..................... Intac psy dx interview. 0323 1.7955 $97.48

$21.26

$19.50 90804................. S.................... ..................... Psytx, office, 20-30 0322 1.3091 $71.07 ............

$14.21 min. 90805................. S.................... ..................... Psytx, off, 20-30 min w/ 0322 1.3091 $71.07 ............

$14.21 e&m. 90806................. S.................... ..................... Psytx, off, 45-50 min.. 0323 1.7955 $97.48

$21.26

$19.50 90807................. S.................... ..................... Psytx, off, 45-50 min w/ 0323 1.7955 $97.48

$21.26

$19.50 e&m. 90808................. S.................... ..................... Psytx, office, 75-80 0323 1.7955 $97.48

$21.26

$19.50 min. 90809................. S.................... ..................... Psytx, off, 75-80, w/ 0323 1.7955 $97.48

$21.26

$19.50 e&m. 90810................. S.................... ..................... Intac psytx, off, 20-30 0322 1.3091 $71.07 ............

$14.21 min. 90811................. S.................... ..................... Intac psytx, 20-30, w/ 0322 1.3091 $71.07 ............

$14.21 e&m. 90812................. S.................... ..................... Intac psytx, off, 45-50 0323 1.7955 $97.48

$21.26

$19.50 min. 90813................. S.................... ..................... Intac psytx, 45-50 min 0323 1.7955 $97.48

$21.26

$19.50 w/e&m. 90814................. S.................... ..................... Intac psytx, off, 75-80 0323 1.7955 $97.48

$21.26

$19.50 min. 90815................. S.................... ..................... Intac psytx, 75-80 w/ 0323 1.7955 $97.48

$21.26

$19.50 e&m. 90816................. S.................... ..................... Psytx, hosp, 20-30 min. 0322 1.3091 $71.07 ............

$14.21 90817................. S.................... ..................... Psytx, hosp, 20-30 min 0322 1.3091 $71.07 ............

$14.21 w/e&m. 90818................. S.................... ..................... Psytx, hosp, 45-50 min. 0323 1.7955 $97.48

$21.26

$19.50 90819................. S.................... ..................... Psytx, hosp, 45-50 min 0323 1.7955 $97.48

$21.26

$19.50 w/e&m. 90821................. S.................... ..................... Psytx, hosp, 75-80 min. 0323 1.7955 $97.48

$21.26

$19.50 90822................. S.................... ..................... Psytx, hosp, 75-80 min 0323 1.7955 $97.48

$21.26

$19.50 w/e&m. 90823................. S.................... ..................... Intac psytx, hosp, 20- 0322 1.3091 $71.07 ............

$14.21 30 min. 90824................. S.................... ..................... Intac psytx, hsp 20-30 0322 1.3091 $71.07 ............

$14.21 w/e&m. 90826................. S.................... ..................... Intac psytx, hosp, 45- 0323 1.7955 $97.48

$21.26

$19.50 50 min. 90827................. S.................... ..................... Intac psytx, hsp 45-50 0323 1.7955 $97.48

$21.26

$19.50 w/e&m. 90828................. S.................... ..................... Intac psytx, hosp, 75- 0323 1.7955 $97.48

$21.26

$19.50 80 min. 90829................. S.................... ..................... Intac psytx, hsp 75-80 0323 1.7955 $97.48

$21.26

$19.50 w/e&m. 90845................. S.................... ..................... Psychoanalysis......... 0323 1.7955 $97.48

$21.26

$19.50 90846................. S.................... ..................... Family psytx w/o

0324 2.8219 $153.20 ............

$30.64 patient. 90847................. S.................... ..................... Family psytx w/patient. 0324 2.8219 $153.20 ............

$30.64 90849................. S.................... ..................... Multiple family group 0325 1.5820 $85.89

$18.27

$17.18 psytx. 90853................. S.................... ..................... Group psychotherapy.... 0325 1.5820 $85.89

$18.27

$17.18 90857................. S.................... ..................... Intac group psytx...... 0325 1.5820 $85.89

$18.27

$17.18 90862................. X.................... ..................... Medication management.. 0374 1.1062 $60.05 ............

$12.01 90865................. S.................... ..................... Narcosynthesis......... 0323 1.7955 $97.48

$21.26

$19.50 90870................. S.................... ..................... Electroconvulsive

0320 5.4480 $295.77

$80.06

$59.15 therapy. 90871................. E.................... ..................... Electroconvulsive

..... ......... ........... ............ ............ therapy.

[[Page 48143]]

90875................. E.................... ..................... Psychophysiological ..... ......... ........... ............ ............ therapy. 90876................. E.................... ..................... Psychophysiological ..... ......... ........... ............ ............ therapy. 90880................. S.................... ..................... Hypnotherapy........... 0323 1.7955 $97.48

$21.26

$19.50 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 1.3091 $71.07 ............

$14.21 therapy. 90901................. S.................... ..................... Biofeedback train, any 0321 1.2462 $67.65

$21.78

$13.53 meth. 90911................. S.................... ..................... Biofeedback peri/uro/ 0321 1.2462 $67.65

$21.78

$13.53 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 5.9427 $322.62 ............

$64.52 evaluation. 90937................. E.................... ..................... Hemodialysis, repeated ..... ......... ........... ............ ............ eval. 90939................. N.................... ..................... Hemodialysis study, ..... ......... ........... ............ ............ transcut. 90940................. N.................... ..................... Hemodialysis access ..... ......... ........... ............ ............ study. 90945................. S.................... ..................... Dialysis, one

0170 5.9427 $322.62 ............

$64.52 evaluation. 90947................. E.................... ..................... Dialysis, repeated eval ..... ......... ........... ............ ............ 90989................. E.................... ..................... Dialysis training, ..... ......... ........... ............ ............ complete. 90993................. E.................... ..................... Dialysis training, ..... ......... ........... ............ ............ incompl. 90997................. E.................... ..................... Hemoperfusion.......... ..... ......... ........... ............ ............ 90999................. E.................... ..................... Dialysis procedure..... ..... ......... ........... ............ ............ 91000................. X.................... ..................... Esophageal intubation.. 0361 3.5574 $193.13

$83.23

$38.63 91010................. X.................... ..................... Esophagus motility

0361 3.5574 $193.13

$83.23

$38.63 study. 91011................. X.................... ..................... Esophagus motility

0361 3.5574 $193.13

$83.23

$38.63 study. 91012................. X.................... ..................... Esophagus motility

0361 3.5574 $193.13

$83.23

$38.63 study. 91020................. X.................... ..................... Gastric motility....... 0361 3.5574 $193.13

$83.23

$38.63 91030................. X.................... ..................... Acid perfusion of

0361 3.5574 $193.13

$83.23

$38.63 esophagus. 91032................. X.................... ..................... Esophagus, acid reflux 0361 3.5574 $193.13

$83.23

$38.63 test. 91033................. X.................... ..................... Prolonged acid reflux 0361 3.5574 $193.13

$83.23

$38.63 test. 91052................. X.................... ..................... Gastric analysis test.. 0361 3.5574 $193.13

$83.23

$38.63 91055................. X.................... ..................... Gastric intubation for 0360 1.7088 $92.77

$42.45

$18.55 smear. 91060................. X.................... ..................... Gastric saline load 0360 1.7088 $92.77

$42.45

$18.55 test. 91065................. X.................... ..................... Breath hydrogen test... 0360 1.7088 $92.77

$42.45

$18.55 91100................. X.................... ..................... Pass intestine bleeding 0360 1.7088 $92.77

$42.45

$18.55 tube. 91105................. X.................... ..................... Gastric intubation

0360 1.7088 $92.77

$42.45

$18.55 treatment. 91122................. T.................... ..................... Anal pressure record... 0156 3.1438 $170.67

$46.55

$34.13 91123................. N.................... ..................... Irrigate fecal

..... ......... ........... ............ ............ impaction. 91132................. X.................... ..................... Electrogastrography.... 0360 1.7088 $92.77

$42.45

$18.55 91133................. X.................... ..................... Electrogastrography w/ 0360 1.7088 $92.77

$42.45

$18.55 test. 91299................. X.................... ..................... Gastroenterology

0360 1.7088 $92.77

$42.45

$18.55 procedure. 92002................. V.................... ..................... Eye exam, new patient.. 0601 1.0031 $54.46 ............

$10.89 92004................. V.................... ..................... Eye exam, new patient.. 0602 1.5603 $84.71 ............

$16.94 92012................. V.................... ..................... Eye exam established 0600 0.9376 $50.90 ............

$10.18 pat. 92014................. V.................... ..................... Eye exam & treatment... 0602 1.5603 $84.71 ............

$16.94 92015................. E.................... ..................... Refraction............. ..... ......... ........... ............ ............ 92018................. T.................... ..................... New eye exam &

0699 2.2211 $120.58

$54.26

$24.12 treatment. 92019................. S.................... ..................... Eye exam & treatment... 0698 0.9355 $50.79

$18.72

$10.16 92020................. S.................... ..................... Special eye evaluation. 0230 0.7379 $40.06

$14.97

$8.01 92060................. S.................... ..................... Special eye evaluation. 0230 0.7379 $40.06

$14.97

$8.01 92065................. S.................... ..................... Orthoptic/pleoptic

0230 0.7379 $40.06

$14.97

$8.01 training. 92070................. N.................... ..................... Fitting of contact lens ..... ......... ........... ............ ............ 92081................. S.................... ..................... Visual field

0230 0.7379 $40.06

$14.97

$8.01 examination(s). 92082................. S.................... ..................... Visual field

0698 0.9355 $50.79

$18.72

$10.16 examination(s). 92083................. S.................... ..................... Visual field

0698 0.9355 $50.79

$18.72

$10.16 examination(s). 92100................. N.................... ..................... Serial tonometry

..... ......... ........... ............ ............ exam(s). 92120................. S.................... ..................... Tonography & eye

0230 0.7379 $40.06

$14.97

$8.01 evaluation. 92130................. S.................... ..................... Water provocation

0698 0.9355 $50.79

$18.72

$10.16 tonography. 92135................. S.................... ..................... Opthalmic dx imaging... 0230 0.7379 $40.06

$14.97

$8.01 92136................. S.................... ..................... Ophthalmic biometry.... 0230 0.7379 $40.06

$14.97

$8.01

[[Page 48144]]

92140................. S.................... ..................... Glaucoma provocative 0698 0.9355 $50.79

$18.72

$10.16 tests. 92225................. S.................... ..................... Special eye exam,

0698 0.9355 $50.79

$18.72

$10.16 initial. 92226................. S.................... ..................... Special eye exam,

0698 0.9355 $50.79

$18.72

$10.16 subsequent. 92230................. T.................... ..................... Eye exam with photos... 0699 2.2211 $120.58

$54.26

$24.12 92235................. T.................... ..................... Eye exam with photos... 0699 2.2211 $120.58

$54.26

$24.12 92240................. S.................... ..................... Icg angiography........ 0231 2.0880 $113.36

$50.94

$22.67 92250................. S.................... ..................... Eye exam with photos... 0230 0.7379 $40.06

$14.97

$8.01 92260................. S.................... ..................... Ophthalmoscopy/

0230 0.7379 $40.06

$14.97

$8.01 dynamometry. 92265................. S.................... ..................... Eye muscle evaluation.. 0231 2.0880 $113.36

$50.94

$22.67 92270................. S.................... ..................... Electro-oculography.... 0698 0.9355 $50.79

$18.72

$10.16 92275................. S.................... ..................... Electroretinography.... 0231 2.0880 $113.36

$50.94

$22.67 92283................. S.................... ..................... Color vision

0230 0.7379 $40.06

$14.97

$8.01 examination. 92284................. S.................... ..................... Dark adaptation eye 0698 0.9355 $50.79

$18.72

$10.16 exam. 92285................. S.................... ..................... Eye photography........ 0230 0.7379 $40.06

$14.97

$8.01 92286................. S.................... ..................... Internal eye

0698 0.9355 $50.79

$18.72

$10.16 photography. 92287................. S.................... ..................... Internal eye

0231 2.0880 $113.36

$50.94

$22.67 photography. 92310................. E.................... ..................... Contact lens fitting... ..... ......... ........... ............ ............ 92311................. X.................... ..................... Contact lens fitting... 0362 2.5384 $137.81 ............

$27.56 92312................. X.................... ..................... Contact lens fitting... 0362 2.5384 $137.81 ............

$27.56 92313................. X.................... ..................... Contact lens fitting... 0362 2.5384 $137.81 ............

$27.56 92314................. E.................... ..................... Prescription of contact ..... ......... ........... ............ ............ lens. 92315................. X.................... ..................... Prescription of contact 0362 2.5384 $137.81 ............

$27.56 lens. 92316................. X.................... ..................... Prescription of contact 0362 2.5384 $137.81 ............

$27.56 lens. 92317................. X.................... ..................... Prescription of contact 0362 2.5384 $137.81 ............

$27.56 lens. 92325................. X.................... ..................... Modification of contact 0362 2.5384 $137.81 ............

$27.56 lens. 92326................. X.................... ..................... Replacement of contact 0362 2.5384 $137.81 ............

$27.56 lens. 92330................. S.................... ..................... Fitting of artificial 0230 0.7379 $40.06

$14.97

$8.01 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 2.5384 $137.81 ............

$27.56 fitting. 92353................. X.................... ..................... Special spectacles

0362 2.5384 $137.81 ............

$27.56 fitting. 92354................. X.................... ..................... Special spectacles

0362 2.5384 $137.81 ............

$27.56 fitting. 92355................. X.................... ..................... Special spectacles

0362 2.5384 $137.81 ............

$27.56 fitting. 92358................. X.................... ..................... Eye prosthesis service. 0362 2.5384 $137.81 ............

$27.56 92370................. E.................... ..................... Repair & adjust

..... ......... ........... ............ ............ spectacles. 92371................. X.................... ..................... Repair & adjust

0362 2.5384 $137.81 ............

$27.56 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 0.7379 $40.06

$14.97

$8.01 procedure. 92502................. T.................... ..................... Ear and throat

0251 1.8643 $101.21 ............

$20.24 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 0.9012 $48.93

$12.89

$9.79 92512................. X.................... ..................... Nasal function studies. 0363 0.8536 $46.34

$17.15

$9.27 92516................. X.................... ..................... Facial nerve function 0660 1.7330 $94.08

$30.66

$18.82 test. 92520................. X.................... ..................... Laryngeal function

0660 1.7330 $94.08

$30.66

$18.82 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 nystagmus 0363 0.8536 $46.34

$17.15

$9.27 test. 92542................. X.................... ..................... Positional nystagmus 0363 0.8536 $46.34

$17.15

$9.27 test. 92543................. X.................... ..................... Caloric vestibular test 0363 0.8536 $46.34

$17.15

$9.27 92544................. X.................... ..................... Optokinetic nystagmus 0363 0.8536 $46.34

$17.15

$9.27 test. 92545................. X.................... ..................... Oscillating tracking 0363 0.8536 $46.34

$17.15

$9.27 test. 92546................. X.................... ..................... Sinusoidal rotational 0660 1.7330 $94.08

$30.66

$18.82 test.

[[Page 48145]]

92547................. X.................... ..................... Supplemental electrical 0363 0.8536 $46.34

$17.15

$9.27 test. 92548................. X.................... ..................... Posturography.......... 0660 1.7330 $94.08

$30.66

$18.82 92551................. E.................... ..................... Pure tone hearing test, ..... ......... ........... ............ ............ air. 92552................. X.................... ..................... Pure tone audiometry, 0364 0.4415 $23.97

$9.06

$4.79 air. 92553................. X.................... ..................... Audiometry, air & bone. 0365 1.1915 $64.69

$18.95

$12.94 92555................. X.................... ..................... Speech threshold

0364 0.4415 $23.97

$9.06

$4.79 audiometry. 92556................. X.................... ..................... Speech audiometry,

0364 0.4415 $23.97

$9.06

$4.79 complete. 92557................. X.................... ..................... Comprehensive hearing 0365 1.1915 $64.69

$18.95

$12.94 test. 92559................. E.................... ..................... Group audiometric

..... ......... ........... ............ ............ testing. 92560................. E.................... ..................... Bekesy audiometry, ..... ......... ........... ............ ............ screen. 92561................. X.................... ..................... Bekesy audiometry,

0365 1.1915 $64.69

$18.95

$12.94 diagnosis. 92562................. X.................... ..................... Loudness balance test.. 0364 0.4415 $23.97

$9.06

$4.79 92563................. X.................... ..................... Tone decay hearing test 0364 0.4415 $23.97

$9.06

$4.79 92564................. X.................... ..................... Sisi hearing test...... 0364 0.4415 $23.97

$9.06

$4.79 92565................. X.................... ..................... Stenger test, pure tone 0364 0.4415 $23.97

$9.06

$4.79 92567................. X.................... ..................... Tympanometry........... 0364 0.4415 $23.97

$9.06

$4.79 92568................. X.................... ..................... Acoustic reflex testing 0364 0.4415 $23.97

$9.06

$4.79 92569................. X.................... ..................... Acoustic reflex decay 0364 0.4415 $23.97

$9.06

$4.79 test. 92571................. X.................... ..................... Filtered speech hearing 0364 0.4415 $23.97

$9.06

$4.79 test. 92572................. X.................... ..................... Staggered spondaic word 0364 0.4415 $23.97

$9.06

$4.79 test. 92573................. X.................... ..................... Lombard test........... 0364 0.4415 $23.97

$9.06

$4.79 92575................. X.................... ..................... Sensorineural acuity 0365 1.1915 $64.69

$18.95

$12.94 test. 92576................. X.................... ..................... Synthetic sentence test 0364 0.4415 $23.97

$9.06

$4.79 92577................. X.................... ..................... Stenger test, speech... 0365 1.1915 $64.69

$18.95

$12.94 92579................. X.................... ..................... Visual audiometry (vra) 0365 1.1915 $64.69

$18.95

$12.94 92582................. X.................... ..................... Conditioning play

0365 1.1915 $64.69

$18.95

$12.94 audiometry. 92583................. X.................... ..................... Select picture

0364 0.4415 $23.97

$9.06

$4.79 audiometry. 92584................. X.................... ..................... Electrocochleography... 0660 1.7330 $94.08

$30.66

$18.82 92585................. S.................... ..................... Auditor evoke potent, 0216 2.8332 $153.81

$67.98

$30.76 compre. 92586................. S.................... ..................... Auditor evoke potent, 0218 1.1296 $61.32 ............

$12.26 limit. 92587................. X.................... ..................... Evoked auditory test... 0363 0.8536 $46.34

$17.15

$9.27 92588................. X.................... ..................... Evoked auditory test... 0363 0.8536 $46.34

$17.15

$9.27 92589................. X.................... ..................... Auditory function

0364 0.4415 $23.97

$9.06

$4.79 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 1.1915 $64.69

$18.95

$12.94 evaluation. 92597................. E.................... ..................... Voice Prosthetic

..... ......... ........... ............ ............ Evaluation. 92601................. A.................... ..................... Cochlear implt f/up ..... ......... ........... ............ ............ exam . 92604................. A.................... ..................... Reprogram cochlear ..... ......... ........... ............ ............ 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/service.. 0364 0.4415 $23.97

$9.06

$4.79 92950................. S.................... ..................... Heart/lung

0094 2.6412 $143.39

$48.46

$28.68 resuscitation cpr. 92953................. S.................... ..................... Temporary external

0094 2.6412 $143.39

$48.46

$28.68 pacing. 92960................. S.................... ..................... Cardioversion electric, 0679 5.4862 $297.84

$95.30

$59.57 ext. 92961................. S.................... ..................... Cardioversion,

0679 5.4862 $297.84

$95.30

$59.57 electric, int. 92970................. C.................... ..................... Cardioassist, internal. ..... ......... ........... ............ ............ 92971................. C.................... ..................... Cardioassist, external. ..... ......... ........... ............ ............ 92973................. T.................... ..................... Percut coronary

1541 ......... $250.00 ............

$50.00 thrombectomy.

[[Page 48146]]

92974................. T.................... ..................... Cath place, cardio

1559 ......... $2,250.00 ............ $450.00 brachytx. 92975................. C.................... ..................... Dissolve clot, heart ..... ......... ........... ............ ............ vessel. 92977................. T.................... ..................... Dissolve clot, heart 0676 3.7505 $203.61

$55.06

$40.72 vessel. 92978................. S.................... ..................... Intravasc us, heart add- 0670 26.5472 $1,441.22 $521.95 $288.24 on. 92979................. S.................... ..................... Intravasc us, heart add- 0670 26.5472 $1,441.22 $521.95 $288.24 on. 92980................. T.................... ..................... Insert intracoronary 0104 80.8877 $4,391.31 ............ $878.26 stent. 92981................. T.................... ..................... Insert intracoronary 0104 80.8877 $4,391.31 ............ $878.26 stent. 92982................. T.................... ..................... Coronary artery

0083 59.3417 $3,221.60 ............ $644.32 dilation. 92984................. T.................... ..................... Coronary artery

0083 59.3417 $3,221.60 ............ $644.32 dilation. 92986................. T.................... ..................... Revision of aortic

0083 59.3417 $3,221.60 ............ $644.32 valve. 92987................. T.................... ..................... Revision of mitral

0083 59.3417 $3,221.60 ............ $644.32 valve. 92990................. T.................... ..................... Revision of pulmonary 0083 59.3417 $3,221.60 ............ $644.32 valve. 92992................. C.................... ..................... Revision of heart

..... ......... ........... ............ ............ chamber. 92993................. C.................... ..................... Revision of heart

..... ......... ........... ............ ............ chamber. 92995................. T.................... ..................... Coronary atherectomy... 0082 100.3996 $5,450.59 $1,293.59 $1,090.12 92996................. T.................... ..................... Coronary atherectomy 0082 100.3996 $5,450.59 $1,293.59 $1,090.12 add-on. 92997................. T.................... ..................... Pul art balloon repr, 0081 34.8355 $1,891.18 ............ $378.24 percut. 92998................. T.................... ..................... Pul art balloon repr, 0081 34.8355 $1,891.18 ............ $378.24 percut. 93000................. E.................... ..................... Electrocardiogram, ..... ......... ........... ............ ............ complete. 93005................. S.................... ..................... Electrocardiogram,

0099 0.3708 $20.13 ............

$4.03 tracing. 93010................. A.................... ..................... Electrocardiogram

..... ......... ........... ............ ............ report. 93012................. N.................... ..................... Transmission of ecg.... ..... ......... ........... ............ ............ 93014................. E.................... ..................... Report on transmitted ..... ......... ........... ............ ............ ecg. 93015................. E.................... ..................... Cardiovascular stress ..... ......... ........... ............ ............ test. 93016................. E.................... ..................... Cardiovascular stress ..... ......... ........... ............ ............ test. 93017................. X.................... ..................... Cardiovascular stress 0100 1.6726 $90.80

$41.44

$18.16 test. 93018................. E.................... ..................... Cardiovascular stress ..... ......... ........... ............ ............ test. 93024................. X.................... ..................... Cardiac drug stress 0100 1.6726 $90.80

$41.44

$18.16 test. 93025................. X.................... ..................... Microvolt t-wave assess 0100 1.6726 $90.80

$41.44

$18.16 93040................. E.................... ..................... Rhythm ECG with report. ..... ......... ........... ............ ............ 93041................. S.................... ..................... Rhythm ECG, tracing.... 0099 0.3708 $20.13 ............

$4.03 93042................. E.................... ..................... Rhythm ECG, report..... ..... ......... ........... ............ ............ 93224................. E.................... ..................... ECG monitor/report, 24 ..... ......... ........... ............ ............ hrs. 93225................. X.................... ..................... ECG monitor/record, 24 0097 1.0565 $57.36

$23.80

$11.47 hrs. 93226................. X.................... ..................... ECG monitor/report, 24 0097 1.0565 $57.36

$23.80

$11.47 hrs. 93227................. E.................... ..................... ECG monitor/review, 24 ..... ......... ........... ............ ............ hrs. 93230................. E.................... ..................... ECG monitor/report, 24 ..... ......... ........... ............ ............ hrs. 93231................. X.................... ..................... Ecg monitor/record, 24 0097 1.0565 $57.36

$23.80

$11.47 hrs. 93232................. X.................... ..................... ECG monitor/report, 24 0097 1.0565 $57.36

$23.80

$11.47 hrs. 93233................. E.................... ..................... ECG monitor/review, 24 ..... ......... ........... ............ ............ hrs. 93235................. E.................... ..................... ECG monitor/report, 24 ..... ......... ........... ............ ............ hrs. 93236................. X.................... ..................... ECG monitor/report, 24 0097 1.0565 $57.36

$23.80

$11.47 hrs. 93237................. E.................... ..................... ECG monitor/review, 24 ..... ......... ........... ............ ............ hrs. 93268................. E.................... ..................... ECG record/review...... ..... ......... ........... ............ ............ 93270................. X.................... ..................... ECG recording.......... 0097 1.0565 $57.36

$23.80

$11.47 93271................. X.................... ..................... Ecg/monitoring and

0097 1.0565 $57.36

$23.80

$11.47 analysis. 93272................. E.................... ..................... Ecg/review, interpret ..... ......... ........... ............ ............ only. 93278................. S.................... ..................... ECG/signal-averaged.... 0099 0.3708 $20.13 ............

$4.03 93303................. S.................... ..................... Echo transthoracic..... 0269 3.2517 $176.53

$87.24

$35.31 93304................. S.................... ..................... Echo transthoracic..... 0697 1.4621 $79.38

$39.69

$15.88 93307................. S.................... ..................... Echo exam of heart..... 0269 3.2517 $176.53

$87.24

$35.31 93308................. S.................... ..................... Echo exam of heart..... 0697 1.4621 $79.38

$39.69

$15.88 93312................. S.................... ..................... Echo transesophageal... 0270 5.9057 $320.61 $146.79

$64.12 93313................. S.................... ..................... Echo transesophageal... 0270 5.9057 $320.61 $146.79

$64.12 93314................. N.................... ..................... Echo transesophageal... ..... ......... ........... ............ ............ 93315................. S.................... ..................... Echo transesophageal... 0270 5.9057 $320.61 $146.79

$64.12 93316................. S.................... ..................... Echo transesophageal... 0270 5.9057 $320.61 $146.79

$64.12 93317................. N.................... ..................... Echo transesophageal... ..... ......... ........... ............ ............ 93318................. S.................... ..................... Echo transesophageal 0270 5.9057 $320.61 $146.79

$64.12 intraop. 93320................. S.................... ..................... Doppler echo exam,

0671 1.6392 $88.99

$44.49

$17.80 heart. 93321................. S.................... ..................... Doppler echo exam,

0697 1.4621 $79.38

$39.69

$15.88 heart. 93325................. S.................... ..................... Doppler color flow add- 0697 1.4621 $79.38

$39.69

$15.88 on. 93350................. S.................... ..................... Echo transthoracic..... 0269 3.2517 $176.53

$87.24

$35.31 93501................. T.................... ..................... Right heart

0080 36.0982 $1,959.74 $838.92 $391.95 catheterization. 93503................. T.................... ..................... Insert/place heart

0103 12.1256 $658.29 $223.63 $131.66 catheter. 93505................. T.................... ..................... Biopsy of heart lining. 0103 12.1256 $658.29 $223.63 $131.66

[[Page 48147]]

93508................. T.................... ..................... Cath placement,

0080 36.0982 $1,959.74 $838.92 $391.95 angiography. 93510................. T.................... ..................... Left heart

0080 36.0982 $1,959.74 $838.92 $391.95 catheterization. 93511................. T.................... ..................... Left heart

0080 36.0982 $1,959.74 $838.92 $391.95 catheterization. 93514................. T.................... ..................... Left heart

0080 36.0982 $1,959.74 $838.92 $391.95 catheterization. 93524................. T.................... ..................... Left heart

0080 36.0982 $1,959.74 $838.92 $391.95 catheterization. 93526................. T.................... ..................... Rt & Lt heart catheters 0080 36.0982 $1,959.74 $838.92 $391.95 93527................. T.................... ..................... Rt & Lt heart catheters 0080 36.0982 $1,959.74 $838.92 $391.95 93528................. T.................... ..................... Rt & Lt heart catheters 0080 36.0982 $1,959.74 $838.92 $391.95 93529................. T.................... ..................... Rt, lt heart

0080 36.0982 $1,959.74 $838.92 $391.95 catheterization. 93530................. T.................... ..................... Rt heart cath,

0080 36.0982 $1,959.74 $838.92 $391.95 congenital. 93531................. T.................... ..................... R & l heart cath,

0080 36.0982 $1,959.74 $838.92 $391.95 congenital. 93532................. T.................... ..................... R & l heart cath,

0080 36.0982 $1,959.74 $838.92 $391.95 congenital. 93533................. T.................... ..................... R & l heart cath,

0080 36.0982 $1,959.74 $838.92 $391.95 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. 93600................. T.................... ..................... Bundle of His recording 0087 40.4579 $2,196.42 ............ $439.28 93602................. T.................... ..................... Intra-atrial recording. 0087 40.4579 $2,196.42 ............ $439.28 93603................. T.................... ..................... Right ventricular

0087 40.4579 $2,196.42 ............ $439.28 recording. 93609................. T.................... ..................... Map tachycardia, add-on 0087 40.4579 $2,196.42 ............ $439.28 93610................. T.................... ..................... Intra-atrial pacing.... 0087 40.4579 $2,196.42 ............ $439.28 93612................. T.................... ..................... Intraventricular pacing 0087 40.4579 $2,196.42 ............ $439.28 93613................. T.................... ..................... Electrophys map 3d, add- 0087 40.4579 $2,196.42 ............ $439.28 on. 93615................. T.................... ..................... Esophageal recording... 0087 40.4579 $2,196.42 ............ $439.28 93616................. T.................... ..................... Esophageal recording... 0087 40.4579 $2,196.42 ............ $439.28 93618................. T.................... ..................... Heart rhythm pacing.... 0087 40.4579 $2,196.42 ............ $439.28 93619................. T.................... ..................... Electrophysiology

0085 36.3284 $1,972.23 $435.09 $394.45 evaluation. 93620................. T.................... ..................... Electrophysiology

0085 36.3284 $1,972.23 $435.09 $394.45 evaluation. 93621................. T.................... ..................... Electrophysiology

0085 36.3284 $1,972.23 $435.09 $394.45 evaluation. 93622................. T.................... ..................... Electrophysiology

0085 36.3284 $1,972.23 $435.09 $394.45 evaluation. 93623................. T.................... ..................... Stimulation, pacing 0087 40.4579 $2,196.42 ............ $439.28 heart. 93624................. S.................... ..................... Electrophysiologic

0084 10.3392 $561.30 ............ $112.26 study. 93631................. T.................... ..................... Heart pacing, mapping.. 0087 40.4579 $2,196.42 ............ $439.28 93640................. S.................... ..................... Evaluation heart device 0084 10.3392 $561.30 ............ $112.26 93641................. S.................... ..................... Electrophysiology

0084 10.3392 $561.30 ............ $112.26 evaluation. 93642................. S.................... ..................... Electrophysiology

0084 10.3392 $561.30 ............ $112.26 evaluation. 93650................. T.................... ..................... Ablate heart dysrhythm 0086 44.5652 $2,419.40 $822.28 $483.88 focus. 93651................. T.................... ..................... Ablate heart dysrhythm 0086 44.5652 $2,419.40 $822.28 $483.88 focus. 93652................. T.................... ..................... Ablate heart dysrhythm 0086 44.5652 $2,419.40 $822.28 $483.88 focus. 93660................. S.................... ..................... Tilt table evaluation.. 0101 4.3675 $237.11 $105.27

$47.42 93662................. S.................... ..................... Intracardiac ecg (ice). 0670 26.5472 $1,441.22 $521.95 $288.24 93668................. E.................... ..................... Peripheral vascular ..... ......... ........... ............ ............ rehab. 93701................. S.................... ..................... Bioimpedance, thoracic. 0099 0.3708 $20.13 ............

$4.03 93720................. E.................... ..................... Total body

..... ......... ........... ............ ............ plethysmography. 93721................. X.................... ..................... Plethysmography tracing 0368 0.9321 $50.60

$25.30

$10.12 93722................. E.................... ..................... Plethysmography report. ..... ......... ........... ............ ............ 93724................. S.................... ..................... Analyze pacemaker

0690 0.3986 $21.64

$10.35

$4.33 system. 93727................. S.................... ..................... Analyze ilr system..... 0690 0.3986 $21.64

$10.35

$4.33 93731................. S.................... ..................... Analyze pacemaker

0690 0.3986 $21.64

$10.35

$4.33 system. 93732................. S.................... ..................... Analyze pacemaker

0690 0.3986 $21.64

$10.35

$4.33 system. 93733................. S.................... ..................... Telephone analy,

0690 0.3986 $21.64

$10.35

$4.33 pacemaker. 93734................. S.................... ..................... Analyze pacemaker

0690 0.3986 $21.64

$10.35

$4.33 system. 93735................. S.................... ..................... Analyze pacemaker

0690 0.3986 $21.64

$10.35

$4.33 system. 93736................. S.................... ..................... Telephone analy,

0690 0.3986 $21.64

$10.35

$4.33 pacemaker.

[[Page 48148]]

93740................. X.................... ..................... Temperature gradient 0367 0.5828 $31.64

$15.16

$6.33 studies. 93741................. S.................... ..................... Analyze ht pace device 0689 0.5427 $29.46 ............

$5.89 sngl. 93742................. S.................... ..................... Analyze ht pace device 0689 0.5427 $29.46 ............

$5.89 sngl. 93743................. S.................... ..................... Analyze ht pace device 0689 0.5427 $29.46 ............

$5.89 dual. 93744................. S.................... ..................... Analyze ht pace device 0689 0.5427 $29.46 ............

$5.89 dual. 93760................. E.................... ..................... Cephalic thermogram.... ..... ......... ........... ............ ............ 93762................. E.................... ..................... Peripheral thermogram.. ..... ......... ........... ............ ............ 93770................. N.................... ..................... Measure venous pressure ..... ......... ........... ............ ............ 93784................. E.................... ..................... Ambulatory BP

..... ......... ........... ............ ............ monitoring. 93786................. X.................... ..................... Ambulatory BP recording 0097 1.0565 $57.36

$23.80

$11.47 93788................. E.................... ..................... Ambulatory BP analysis. ..... ......... ........... ............ ............ 93790................. E.................... ..................... Review/report BP

..... ......... ........... ............ ............ recording. 93797................. S.................... ..................... Cardiac rehab.......... 0095 0.5984 $32.49

$16.24

$6.50 93798................. S.................... ..................... Cardiac rehab/monitor.. 0095 0.5984 $32.49

$16.24

$6.50 93799................. S.................... ..................... Cardiovascular

0096 1.7332 $94.09

$47.04

$18.82 procedure. 93875................. S.................... ..................... Extracranial study..... 0096 1.7332 $94.09

$47.04

$18.82 93880................. S.................... ..................... Extracranial study..... 0267 2.4805 $134.66

$65.52

$26.93 93882................. S.................... ..................... Extracranial study..... 0267 2.4805 $134.66

$65.52

$26.93 93886................. S.................... ..................... Intracranial study..... 0267 2.4805 $134.66

$65.52

$26.93 93888................. S.................... ..................... Intracranial study..... 0266 1.6234 $88.13

$44.06

$17.63 93922................. S.................... ..................... Extremity study........ 0096 1.7332 $94.09

$47.04

$18.82 93923................. S.................... ..................... Extremity study........ 0096 1.7332 $94.09

$47.04

$18.82 93924................. S.................... ..................... Extremity study........ 0096 1.7332 $94.09

$47.04

$18.82 93925................. S.................... ..................... Lower extremity study.. 0267 2.4805 $134.66

$65.52

$26.93 93926................. S.................... ..................... Lower extremity study.. 0267 2.4805 $134.66

$65.52

$26.93 93930................. S.................... ..................... Upper extremity study.. 0267 2.4805 $134.66

$65.52

$26.93 93931................. S.................... ..................... Upper extremity study.. 0266 1.6234 $88.13

$44.06

$17.63 93965................. S.................... ..................... Extremity study........ 0096 1.7332 $94.09

$47.04

$18.82 93970................. S.................... ..................... Extremity study........ 0267 2.4805 $134.66

$65.52

$26.93 93971................. S.................... ..................... Extremity study........ 0267 2.4805 $134.66

$65.52

$26.93 93975................. S.................... ..................... Vascular study......... 0267 2.4805 $134.66

$65.52

$26.93 93976................. S.................... ..................... Vascular study......... 0267 2.4805 $134.66

$65.52

$26.93 93978................. S.................... ..................... Vascular study......... 0267 2.4805 $134.66

$65.52

$26.93 93979................. S.................... ..................... Vascular study......... 0267 2.4805 $134.66

$65.52

$26.93 93980................. S.................... ..................... Penile vascular study.. 0267 2.4805 $134.66

$65.52

$26.93 93981................. S.................... ..................... Penile vascular study.. 0267 2.4805 $134.66

$65.52

$26.93 93990................. S.................... ..................... Doppler flow testing... 0267 2.4805 $134.66

$65.52

$26.93 94010................. X.................... ..................... Breathing capacity test 0368 0.9321 $50.60

$25.30

$10.12 94014................. X.................... ..................... Patient recorded

0367 0.5828 $31.64

$15.16

$6.33 spirometry. 94015................. X.................... ..................... Patient recorded

0367 0.5828 $31.64

$15.16

$6.33 spirometry. 94016................. A.................... ..................... Review patient

..... ......... ........... ............ ............ spirometry. 94060................. X.................... ..................... Evaluation of wheezing. 0368 0.9321 $50.60

$25.30

$10.12 94070................. X.................... ..................... Evaluation of wheezing. 0369 2.5282 $137.25

$44.18

$27.45 94150................. X.................... ..................... Vital capacity test.... 0367 0.5828 $31.64

$15.16

$6.33 94200................. X.................... ..................... Lung function test (MBC/ 0367 0.5828 $31.64

$15.16

$6.33 MVV). 94240................. X.................... ..................... Residual lung capacity. 0368 0.9321 $50.60

$25.30

$10.12 94250................. X.................... ..................... Expired gas collection. 0367 0.5828 $31.64

$15.16

$6.33 94260................. X.................... ..................... Thoracic gas volume.... 0368 0.9321 $50.60

$25.30

$10.12 94350................. X.................... ..................... Lung nitrogen washout 0368 0.9321 $50.60

$25.30

$10.12 curve. 94360................. X.................... ..................... Measure airflow

0367 0.5828 $31.64

$15.16

$6.33 resistance. 94370................. X.................... ..................... Breath airway closing 0367 0.5828 $31.64

$15.16

$6.33 volume. 94375................. X.................... ..................... Respiratory flow volume 0367 0.5828 $31.64

$15.16

$6.33 loop. 94400................. X.................... ..................... CO2 breathing response 0367 0.5828 $31.64

$15.16

$6.33 curve. 94450................. X.................... ..................... Hypoxia response curve. 0367 0.5828 $31.64

$15.16

$6.33 94620................. X.................... ..................... Pulmonary stress test/ 0368 0.9321 $50.60

$25.30

$10.12 simple. 94621................. X.................... ..................... Pulm stress test/

0369 2.5282 $137.25

$44.18

$27.45 complex. 94640................. S.................... ..................... Airway inhalation

0077 0.2772 $15.05

$7.52

$3.01 treatment. 94642................. S.................... ..................... Aerosol inhalation

0078 0.7731 $41.97

$14.55

$8.39 treatment. 94656................. S.................... ..................... Initial ventilator mgmt 0079 2.2837 $123.98 ............

$24.80 94657................. S.................... ..................... Continued ventilator 0079 2.2837 $123.98 ............

$24.80 mgmt. 94660................. S.................... ..................... Pos airway pressure, 0068 1.1234 $60.99

$30.49

$12.20 CPAP. 94662................. S.................... ..................... Neg press ventilation, 0079 2.2837 $123.98 ............

$24.80 cnp. 94664................. S.................... ..................... Aerosol or vapor

0077 0.2772 $15.05

$7.52

$3.01 inhalations. 94667................. S.................... ..................... Chest wall manipulation 0077 0.2772 $15.05

$7.52

$3.01 94668................. S.................... ..................... Chest wall manipulation 0077 0.2772 $15.05

$7.52

$3.01 94680................. X.................... ..................... Exhaled air analysis, 0367 0.5828 $31.64

$15.16

$6.33 o2.

[[Page 48149]]

94681................. X.................... ..................... Exhaled air analysis, 0368 0.9321 $50.60

$25.30

$10.12 o2/co2. 94690................. X.................... ..................... Exhaled air analysis... 0367 0.5828 $31.64

$15.16

$6.33 94720................. X.................... ..................... Monoxide diffusing

0368 0.9321 $50.60

$25.30

$10.12 capacity. 94725................. X.................... ..................... Membrane diffusion

0368 0.9321 $50.60

$25.30

$10.12 capacity. 94750................. X.................... ..................... Pulmonary compliance 0367 0.5828 $31.64

$15.16

$6.33 study. 94760................. N.................... ..................... Measure blood oxygen ..... ......... ........... ............ ............ level. 94761................. N.................... ..................... Measure blood oxygen ..... ......... ........... ............ ............ level. 94762................. N.................... ..................... Measure blood oxygen ..... ......... ........... ............ ............ level. 94770................. X.................... ..................... Exhaled carbon dioxide 0367 0.5828 $31.64

$15.16

$6.33 test. 94772................. X.................... ..................... Breath recording,

0369 2.5282 $137.25

$44.18

$27.45 infant. 94799................. X.................... ..................... Pulmonary service/

0367 0.5828 $31.64

$15.16

$6.33 procedure. 95004................. X.................... ..................... Percut allergy skin 0370 0.8858 $48.09

$11.58

$9.62 tests. 95010................. X.................... ..................... Percut allergy titrate 0370 0.8858 $48.09

$11.58

$9.62 test. 95015................. X.................... ..................... Id allergy titrate-drug/ 0370 0.8858 $48.09

$11.58

$9.62 bug. 95024................. X.................... ..................... Id allergy test, drug/ 0370 0.8858 $48.09

$11.58

$9.62 bug. 95027................. X.................... ..................... Skin end point

0370 0.8858 $48.09

$11.58

$9.62 titration. 95028................. X.................... ..................... Id allergy test-delayed 0370 0.8858 $48.09

$11.58

$9.62 type. 95044................. X.................... ..................... Allergy patch tests.... 0370 0.8858 $48.09

$11.58

$9.62 95052................. X.................... ..................... Photo patch test....... 0370 0.8858 $48.09

$11.58

$9.62 95056................. X.................... ..................... Photosensitivity tests. 0370 0.8858 $48.09

$11.58

$9.62 95060................. X.................... ..................... Eye allergy tests...... 0370 0.8858 $48.09

$11.58

$9.62 95065................. X.................... ..................... Nose allergy test...... 0370 0.8858 $48.09

$11.58

$9.62 95070................. X.................... ..................... Bronchial allergy tests 0369 2.5282 $137.25

$44.18

$27.45 95071................. X.................... ..................... Bronchial allergy tests 0369 2.5282 $137.25

$44.18

$27.45 95075................. X.................... ..................... Ingestion challenge 0361 3.5574 $193.13

$83.23

$38.63 test. 95078................. X.................... ..................... Provocative testing.... 0370 0.8858 $48.09

$11.58

$9.62 95115................. X.................... ..................... Immunotherapy, one

0352 0.1076

$5.84 ............

$1.17 injection. 95117................. X.................... ..................... Immunotherapy

0353 0.4106 $22.29 ............

$4.46 injections. 95120................. E.................... ..................... Immunotherapy, one ..... ......... ........... ............ ............ injection. 95125................. E.................... ..................... Immunotherapy, many ..... ......... ........... ............ ............ antigens. 95130................. E.................... ..................... Immunotherapy, insect ..... ......... ........... ............ ............ venom. 95131................. E.................... ..................... Immunotherapy, insect ..... ......... ........... ............ ............ venoms. 95132................. E.................... ..................... Immunotherapy, insect ..... ......... ........... ............ ............ venoms. 95133................. E.................... ..................... Immunotherapy, insect ..... ......... ........... ............ ............ venoms. 95134................. E.................... ..................... Immunotherapy, insect ..... ......... ........... ............ ............ venoms. 95144................. X.................... ..................... Antigen therapy

0371 0.4084 $22.17

$4.44

$4.43 services. 95145................. X.................... ..................... Antigen therapy

0371 0.4084 $22.17

$4.44

$4.43 services. 95146................. X.................... ..................... Antigen therapy

0371 0.4084 $22.17

$4.44

$4.43 services. 95147................. X.................... ..................... Antigen therapy

0371 0.4084 $22.17

$4.44

$4.43 services. 95148................. X.................... ..................... Antigen therapy

0371 0.4084 $22.17

$4.44

$4.43 services. 95149................. X.................... ..................... Antigen therapy

0371 0.4084 $22.17

$4.44

$4.43 services. 95165................. X.................... ..................... Antigen therapy

0371 0.4084 $22.17

$4.44

$4.43 services. 95170................. X.................... ..................... Antigen therapy

0371 0.4084 $22.17

$4.44

$4.43 services. 95180................. X.................... ..................... Rapid desensitization.. 0370 0.8858 $48.09

$11.58

$9.62 95199................. X.................... ..................... Allergy immunology

0370 0.8858 $48.09

$11.58

$9.62 services. 95250................. T.................... ..................... Glucose monitoring, 1540 ......... $150.00 ............

$30.00 cont. 95805................. S.................... ..................... Multiple sleep latency 0209 11.5352 $626.23 $280.58 $125.25 test. 95806................. S.................... ..................... Sleep study, unattended 0213 3.2422 $176.02

$70.41

$35.20 95807................. S.................... ..................... Sleep study, attended.. 0209 11.5352 $626.23 $280.58 $125.25 95808................. S.................... ..................... Polysomnography, 1-3... 0209 11.5352 $626.23 $280.58 $125.25 95810................. S.................... ..................... Polysomnography, 4 or 0209 11.5352 $626.23 $280.58 $125.25 more. 95811................. S.................... ..................... Polysomnography w/cpap. 0209 11.5352 $626.23 $280.58 $125.25 95812................. S.................... ..................... Electroencephalogram 0213 3.2422 $176.02

$70.41

$35.20 (EEG). 95813................. S.................... ..................... Eeg, over 1 hour....... 0213 3.2422 $176.02

$70.41

$35.20 95816................. S.................... ..................... Electroencephalogram 0214 2.2459 $121.93

$58.12

$24.39 (EEG). 95819................. S.................... ..................... Electroencephalogram 0214 2.2459 $121.93

$58.12

$24.39 (EEG). 95822................. S.................... ..................... Sleep

0214 2.2459 $121.93

$58.12

$24.39 electroencephalogram. 95824................. S.................... ..................... Eeg, cerebral death 0214 2.2459 $121.93

$58.12

$24.39 only. 95827................. S.................... ..................... Night

0209 11.5352 $626.23 $280.58 $125.25 electroencephalogram. 95829................. S.................... ..................... Surgery

0214 2.2459 $121.93

$58.12

$24.39 electrocorticogram. 95830................. E.................... ..................... Insert electrodes for ..... ......... ........... ............ ............ EEG. 95831................. N.................... ..................... Limb muscle testing, ..... ......... ........... ............ ............ manual. 95832................. N.................... ..................... Hand muscle testing, ..... ......... ........... ............ ............ manual. 95833................. N.................... ..................... Body muscle testing, ..... ......... ........... ............ ............ manual. 95834................. N.................... ..................... Body muscle testing, ..... ......... ........... ............ ............ manual. 95851................. N.................... ..................... Range of motion

..... ......... ........... ............ ............ measurements.

[[Page 48150]]

95852................. N.................... ..................... Range of motion

..... ......... ........... ............ ............ measurements. 95857................. S.................... ..................... Tensilon test.......... 0218 1.1296 $61.32 ............

$12.26 95858................. S.................... ..................... Tensilon test & myogram 0215 0.6390 $34.69

$15.76

$6.94 95860................. S.................... ..................... Muscle test, one limb.. 0218 1.1296 $61.32 ............

$12.26 95861................. S.................... ..................... Muscle test, 2 limbs... 0218 1.1296 $61.32 ............

$12.26 95863................. S.................... ..................... Muscle test, 3 limbs... 0218 1.1296 $61.32 ............

$12.26 95864................. S.................... ..................... Muscle test, 4 limbs... 0218 1.1296 $61.32 ............

$12.26 95867................. S.................... ..................... Muscle test, head or 0218 1.1296 $61.32 ............

$12.26 neck. 95868................. S.................... ..................... Muscle test cran nerve 0218 1.1296 $61.32 ............

$12.26 bilat. 95869................. S.................... ..................... Muscle test, thor

0215 0.6390 $34.69

$15.76

$6.94 paraspinal. 95870................. S.................... ..................... Muscle test,

0215 0.6390 $34.69

$15.76

$6.94 nonparaspinal. 95872................. S.................... ..................... Muscle test, one fiber. 0218 1.1296 $61.32 ............

$12.26 95875................. S.................... ..................... Limb exercise test..... 0215 0.6390 $34.69

$15.76

$6.94 95900................. S.................... ..................... Motor nerve conduction 0215 0.6390 $34.69

$15.76

$6.94 test. 95903................. S.................... ..................... Motor nerve conduction 0215 0.6390 $34.69

$15.76

$6.94 test. 95904................. S.................... ..................... Sense nerve conduction 0215 0.6390 $34.69

$15.76

$6.94 test. 95920................. S.................... ..................... Intraop nerve test add- 0216 2.8332 $153.81

$67.98

$30.76 on. 95921................. S.................... ..................... Autonomic nerv function 0218 1.1296 $61.32 ............

$12.26 test. 95922................. S.................... ..................... Autonomic nerv function 0218 1.1296 $61.32 ............

$12.26 test. 95923................. S.................... ..................... Autonomic nerv function 0215 0.6390 $34.69

$15.76

$6.94 test. 95925................. S.................... ..................... Somatosensory testing.. 0216 2.8332 $153.81

$67.98

$30.76 95926................. S.................... ..................... Somatosensory testing.. 0216 2.8332 $153.81

$67.98

$30.76 95927................. S.................... ..................... Somatosensory testing.. 0216 2.8332 $153.81

$67.98

$30.76 95930................. S.................... ..................... Visual evoked potential 0218 1.1296 $61.32 ............

$12.26 test. 95933................. S.................... ..................... Blink reflex test...... 0215 0.6390 $34.69

$15.76

$6.94 95934................. S.................... ..................... H-reflex test.......... 0215 0.6390 $34.69

$15.76

$6.94 95936................. S.................... ..................... H-reflex test.......... 0215 0.6390 $34.69

$15.76

$6.94 95937................. S.................... ..................... Neuromuscular junction 0218 1.1296 $61.32 ............

$12.26 test. 95950................. S.................... ..................... Ambulatory eeg

0213 3.2422 $176.02

$70.41

$35.20 monitoring. 95951................. S.................... ..................... EEG monitoring/

0209 11.5352 $626.23 $280.58 $125.25 videorecord. 95953................. S.................... ..................... EEG monitoring/computer 0209 11.5352 $626.23 $280.58 $125.25 95954................. S.................... ..................... EEG monitoring/giving 0214 2.2459 $121.93

$58.12

$24.39 drugs. 95955................. S.................... ..................... EEG during surgery..... 0213 3.2422 $176.02

$70.41

$35.20 95956................. S.................... ..................... Eeg monitoring, cable/ 0214 2.2459 $121.93

$58.12

$24.39 radio. 95957................. S.................... ..................... EEG digital analysis... 0214 2.2459 $121.93

$58.12

$24.39 95958................. S.................... ..................... EEG monitoring/function 0213 3.2422 $176.02

$70.41

$35.20 test. 95961................. S.................... ..................... Electrode stimulation, 0216 2.8332 $153.81

$67.98

$30.76 brain. 95962................. S.................... ..................... Electrode stim, brain 0216 2.8332 $153.81

$67.98

$30.76 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 addl. 1511 ......... $950.00 ............ $190.00 95970................. S.................... ..................... Analyze neurostim, no 0692 0.9625 $52.25

$26.12

$10.45 prog. 95971................. S.................... ..................... Analyze neurostim,

0692 0.9625 $52.25

$26.12

$10.45 simple. 95972................. S.................... ..................... Analyze neurostim,

0692 0.9625 $52.25

$26.12

$10.45 complex. 95973................. S.................... ..................... Analyze neurostim,

0692 0.9625 $52.25

$26.12

$10.45 complex. 95974................. S.................... ..................... Cranial neurostim,

0692 0.9625 $52.25

$26.12

$10.45 complex. 95975................. S.................... ..................... Cranial neurostim,

0692 0.9625 $52.25

$26.12

$10.45 complex. 95990................. T.................... ..................... Spin/brain pump refil & 0125 2.5105 $136.29 ............

$27.26 main. 95999................. S.................... ..................... Neurological procedure. 0215 0.6390 $34.69

$15.76

$6.94 96000................. S.................... ..................... Motion analysis, video/ 1503 ......... $150.00 ............

$30.00 3d. 96001................. S.................... ..................... Motion test w/ft press 1503 ......... $150.00 ............

$30.00 meas. 96002................. S.................... ..................... Dynamic surface emg.... 1503 ......... $150.00 ............

$30.00 96003................. S.................... ..................... Dynamic fine wire emg.. 1503 ......... $150.00 ............

$30.00 96004................. E.................... ..................... Phys review of motion ..... ......... ........... ............ ............ tests. 96100................. X.................... ..................... Psychological testing.. 0373 2.1165 $114.90

$22.98

$22.98 96105................. X.................... ..................... Assessment of aphasia.. 0373 2.1165 $114.90

$22.98

$22.98 96110................. X.................... ..................... Developmental test, lim 0373 2.1165 $114.90

$22.98

$22.98 96111................. X.................... ..................... Developmental test, 0373 2.1165 $114.90

$22.98

$22.98 extend. 96115................. X.................... ..................... Neurobehavior status 0373 2.1165 $114.90

$22.98

$22.98 exam. 96117................. X.................... ..................... Neuropsych test battery 0373 2.1165 $114.90

$22.98

$22.98 96150................. S.................... ..................... Assess lth/behave, init 0322 1.3091 $71.07 ............

$14.21 96151................. S.................... ..................... Assess hlth/behave, 0322 1.3091 $71.07 ............

$14.21 subseq. 96152................. S.................... ..................... Intervene hlth/behave, 0322 1.3091 $71.07 ............

$14.21 indiv. 96153................. S.................... ..................... Intervene hlth/behave, 0322 1.3091 $71.07 ............

$14.21 group. 96154................. S.................... ..................... Interv hlth/behav, fam 0322 1.3091 $71.07 ............

$14.21 w/pt. 96155................. S.................... ..................... Interv hlth/behav fam 0322 1.3091 $71.07 ............

$14.21 no pt.

[[Page 48151]]

96400................. E.................... ..................... Chemotherapy, sc/im.... ..... ......... ........... ............ ............ 96405................. E.................... ..................... Intralesional chemo ..... ......... ........... ............ ............ admin. 96406................. E.................... ..................... Intralesional chemo ..... ......... ........... ............ ............ admin. 96408................. E.................... ..................... Chemotherapy, push ..... ......... ........... ............ ............ technique. 96410................. E.................... ..................... Chemotherapy, infusion ..... ......... ........... ............ ............ method. 96412................. E.................... ..................... Chemo, infuse method ..... ......... ........... ............ ............ add-on. 96414................. E.................... ..................... Chemo, infuse method ..... ......... ........... ............ ............ add-on. 96420................. E.................... ..................... Chemotherapy, push ..... ......... ........... ............ ............ technique. 96422................. E.................... ..................... Chemotherapy,infusion ..... ......... ........... ............ ............ method. 96423................. E.................... ..................... Chemo, infuse method ..... ......... ........... ............ ............ add-on. 96425................. E.................... ..................... Chemotherapy, infusion ..... ......... ........... ............ ............ method. 96440................. E.................... ..................... Chemotherapy,

..... ......... ........... ............ ............ intracavitary. 96445................. E.................... ..................... Chemotherapy,

..... ......... ........... ............ ............ intracavitary. 96450................. E.................... ..................... Chemotherapy, into CNS. ..... ......... ........... ............ ............ 96520................. T.................... ..................... Port pump refill & main 0125 2.5105 $136.29 ............

$27.26 96530................. T.................... ..................... Pump refilling,

0125 2.5105 $136.29 ............

$27.26 maintenance. 96542................. E.................... ..................... Chemotherapy injection. ..... ......... ........... ............ ............ 96545................. E.................... ..................... Provide chemotherapy ..... ......... ........... ............ ............ agent. 96549................. E.................... ..................... Chemotherapy,

..... ......... ........... ............ ............ unspecified. 96567................. T.................... ..................... Photodynamic tx, skin.. 1540 ......... $150.00 ............

$30.00 96570................. T.................... ..................... Photodynamic tx, 30 min 1541 ......... $250.00 ............

$50.00 96571................. T.................... ..................... Photodynamic tx, addl 1541 ......... $250.00 ............

$50.00 15 min. 96900................. S.................... ..................... Ultraviolet light

0001 0.3940 $21.39

$7.09

$4.28 therapy. 96902................. N.................... ..................... Trichogram............. ..... ......... ........... ............ ............ 96910................. S.................... ..................... Photochemotherapy with 0001 0.3940 $21.39

$7.09

$4.28 UV-B. 96912................. S.................... ..................... Photochemotherapy with 0001 0.3940 $21.39

$7.09

$4.28 UV-A. 96913................. S.................... ..................... Photochemotherapy, UV-A 0683 1.7915 $97.26

$35.01

$19.45 or B. 96920................. T.................... ..................... Laser tx, skin 500 sq cm. 96999................. T.................... ..................... Dermatological

0010 0.6806 $36.95

$10.08

$7.39 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.... ..... ......... ........... ............ ............ 97530................. A.................... ..................... Therapeutic activities. ..... ......... ........... ............ ............ 97532................. A.................... ..................... Cognitive skills

..... ......... ........... ............ ............ development. 97533................. A.................... ..................... Sensory integration.... ..... ......... ........... ............ ............

[[Page 48152]]

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. 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 0.3151 $17.11

$3.43

$3.42 manipulation. 98926................. S.................... ..................... Osteopathic

0060 0.3151 $17.11

$3.43

$3.42 manipulation. 98927................. S.................... ..................... Osteopathic

0060 0.3151 $17.11

$3.43

$3.42 manipulation. 98928................. S.................... ..................... Osteopathic

0060 0.3151 $17.11

$3.43

$3.42 manipulation. 98929................. S.................... ..................... Osteopathic

0060 0.3151 $17.11

$3.43

$3.42 manipulation. 98940................. S.................... ..................... Chiropractic

0060 0.3151 $17.11

$3.43

$3.42 manipulation. 98941................. S.................... ..................... Chiropractic

0060 0.3151 $17.11

$3.43

$3.42 manipulation. 98942................. S.................... ..................... Chiropractic

0060 0.3151 $17.11

$3.43

$3.42 manipulation. 98943................. E.................... ..................... Chiropractic

..... ......... ........... ............ ............ manipulation. 99000................. E.................... ..................... Specimen handling...... ..... ......... ........... ............ ............ 99001................. E.................... ..................... Specimen handling...... ..... ......... ........... ............ ............ 99002................. E.................... ..................... Device handling........ ..... ......... ........... ............ ............ 99024................. E.................... ..................... Postop follow-up visit. ..... ......... ........... ............ ............ 99025................. E.................... ..................... Initial surgical

..... ......... ........... ............ ............ evaluation. 99026................. E.................... ..................... In-hospital on call ..... ......... ........... ............ ............ service. 99027................. E.................... ..................... Out-of-hosp on call ..... ......... ........... ............ ............ service. 99050................. E.................... ..................... Medical services after ..... ......... ........... ............ ............ hrs. 99052................. E.................... ..................... Medical services at ..... ......... ........... ............ ............ night. 99054................. E.................... ..................... Medical servcs, unusual ..... ......... ........... ............ ............ hrs. 99056................. E.................... ..................... Non-office medical ..... ......... ........... ............ ............ services. 99058................. E.................... ..................... Office emergency care.. ..... ......... ........... ............ ............ 99070................. E.................... ..................... Special supplies....... ..... ......... ........... ............ ............ 99071................. E.................... ..................... Patient education

..... ......... ........... ............ ............ materials. 99075................. E.................... ..................... Medical testimony...... ..... ......... ........... ............ ............ 99078................. N.................... ..................... Group health education. ..... ......... ........... ............ ............ 99080................. E.................... ..................... Special reports or ..... ......... ........... ............ ............ forms. 99082................. E.................... ..................... Unusual physician

..... ......... ........... ............ ............ travel. 99090................. E.................... ..................... Computer data analysis. ..... ......... ........... ............ ............ 99091................. E.................... ..................... Collect/review data ..... ......... ........... ............ ............ from pt. 99100................. E.................... ..................... Special anesthesia ..... ......... ........... ............ ............ service. 99116................. E.................... ..................... Anesthesia with

..... ......... ........... ............ ............ hypothermia. 99135................. E.................... ..................... Special anesthesia ..... ......... ........... ............ ............ procedure. 99140................. E.................... ..................... Emergency anesthesia... ..... ......... ........... ............ ............ 99141................. N.................... ..................... Sedation, iv/im or ..... ......... ........... ............ ............ inhalant. 99142................. N.................... ..................... Sedation, oral/rectal/ ..... ......... ........... ............ ............ nasal. 99170................. T.................... ..................... Anogenital exam, child. 0191 0.1679

$9.12

$2.65

$1.82 99172................. E.................... ..................... Ocular function screen. ..... ......... ........... ............ ............ 99173................. E.................... ..................... Visual acuity screen... ..... ......... ........... ............ ............ 99175................. N.................... ..................... Induction of vomiting.. ..... ......... ........... ............ ............ 99183................. E.................... ..................... 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 0.5529 $30.02

$10.09

$6.00 99199................. E.................... ..................... Special service/proc/ ..... ......... ........... ............ ............ report. 99201................. V.................... ..................... Office/outpatient

0600 0.9376 $50.90 ............

$10.18 visit, new. 99202................. V.................... ..................... Office/outpatient

0600 0.9376 $50.90 ............

$10.18 visit, new. 99203................. V.................... ..................... Office/outpatient

0601 1.0031 $54.46 ............

$10.89 visit, new. 99204................. V.................... ..................... Office/outpatient

0602 1.5603 $84.71 ............

$16.94 visit, new.

[[Page 48153]]

99205................. V.................... ..................... Office/outpatient

0602 1.5603 $84.71 ............

$16.94 visit, new. 99211................. V.................... ..................... Office/outpatient

0600 0.9376 $50.90 ............

$10.18 visit, est. 99212................. V.................... ..................... Office/outpatient

0600 0.9376 $50.90 ............

$10.18 visit, est. 99213................. V.................... ..................... Office/outpatient

0601 1.0031 $54.46 ............

$10.89 visit, est. 99214................. V.................... ..................... Office/outpatient

0602 1.5603 $84.71 ............

$16.94 visit, est. 99215................. V.................... ..................... Office/outpatient

0602 1.5603 $84.71 ............

$16.94 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 0.9376 $50.90 ............

$10.18 99242................. V.................... ..................... Office consultation.... 0600 0.9376 $50.90 ............

$10.18 99243................. V.................... ..................... Office consultation.... 0601 1.0031 $54.46 ............

$10.89 99244................. V.................... ..................... Office consultation.... 0602 1.5603 $84.71 ............

$16.94 99245................. V.................... ..................... Office consultation.... 0602 1.5603 $84.71 ............

$16.94 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 0.9376 $50.90 ............

$10.18 consultation. 99272................. V.................... ..................... Confirmatory

0600 0.9376 $50.90 ............

$10.18 consultation. 99273................. V.................... ..................... Confirmatory

0601 1.0031 $54.46 ............

$10.89 consultation. 99274................. V.................... ..................... Confirmatory

0602 1.5603 $84.71 ............

$16.94 consultation. 99275................. V.................... ..................... Confirmatory

0602 1.5603 $84.71 ............

$16.94 consultation. 99281................. V.................... ..................... Emergency dept visit... 0610 1.4146 $76.80

$19.57

$15.36 99282................. V.................... ..................... Emergency dept visit... 0610 1.4146 $76.80

$19.57

$15.36 99283................. V.................... ..................... Emergency dept visit... 0611 2.4881 $135.08

$36.47

$27.02 99284................. V.................... ..................... Emergency dept visit... 0612 4.3235 $234.72

$54.14

$46.94 99285................. V.................... ..................... Emergency dept visit... 0612 4.3235 $234.72

$54.14

$46.94 99288................. E.................... ..................... Direct advanced life ..... ......... ........... ............ ............ support. 99289................. N.................... ..................... Pt transport, 30-74 min ..... ......... ........... ............ ............ 99290................. N.................... ..................... Pt transport, addl 30 ..... ......... ........... ............ ............ min. 99291................. S.................... ..................... Critical care, first 0620 9.2657 $503.03 $145.78 $100.61 hour. 99292................. N.................... ..................... Critical care, addl 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................. E.................... ..................... Nursing facility care.. ..... ......... ........... ............ ............ 99302................. E.................... ..................... Nursing facility care.. ..... ......... ........... ............ ............ 99303................. E.................... ..................... Nursing facility care.. ..... ......... ........... ............ ............ 99311................. E.................... ..................... Nursing fac care,

..... ......... ........... ............ ............ subseq. 99312................. E.................... ..................... Nursing fac care,

..... ......... ........... ............ ............ subseq. 99313................. E.................... ..................... Nursing fac care,

..... ......... ........... ............ ............ subseq. 99315................. E.................... ..................... Nursing fac discharge ..... ......... ........... ............ ............ day. 99316................. E.................... ..................... Nursing fac discharge ..... ......... ........... ............ ............ day. 99321................. E.................... ..................... Rest home visit, new ..... ......... ........... ............ ............ patient. 99322................. E.................... ..................... Rest home visit, new ..... ......... ........... ............ ............ patient. 99323................. E.................... ..................... Rest home visit, new ..... ......... ........... ............ ............ patient.

[[Page 48154]]

99331................. E.................... ..................... Rest home visit, est ..... ......... ........... ............ ............ pat. 99332................. E.................... ..................... Rest home visit, est ..... ......... ........... ............ ............ pat. 99333................. E.................... ..................... Rest home visit, est ..... ......... ........... ............ ............ pat. 99341................. E.................... ..................... Home visit, new patient ..... ......... ........... ............ ............ 99342................. E.................... ..................... Home visit, new patient ..... ......... ........... ............ ............ 99343................. E.................... ..................... Home visit, new patient ..... ......... ........... ............ ............ 99344................. E.................... ..................... Home visit, new patient ..... ......... ........... ............ ............ 99345................. E.................... ..................... Home visit, new patient ..... ......... ........... ............ ............ 99347................. E.................... ..................... Home visit, est patient ..... ......... ........... ............ ............ 99348................. E.................... ..................... Home visit, est patient ..... ......... ........... ............ ............ 99349................. E.................... ..................... Home visit, est patient ..... ......... ........... ............ ............ 99350................. E.................... ..................... Home visit, est patient ..... ......... ........... ............ ............ 99354................. N.................... ..................... Prolonged service, ..... ......... ........... ............ ............ office. 99355................. N.................... ..................... Prolonged service, ..... ......... ........... ............ ............ office. 99356................. C.................... ..................... Prolonged service, ..... ......... ........... ............ ............ inpatient. 99357................. C.................... ..................... Prolonged service, ..... ......... ........... ............ ............ inpatient. 99358................. N.................... ..................... Prolonged serv, w/o ..... ......... ........... ............ ............ contact. 99359................. N.................... ..................... Prolonged serv, w/o ..... ......... ........... ............ ............ contact. 99360................. E.................... ..................... Physician standby

..... ......... ........... ............ ............ services. 99361................. E.................... ..................... Physician/team

..... ......... ........... ............ ............ conference. 99362................. E.................... ..................... Physician/team

..... ......... ........... ............ ............ conference. 99371................. E.................... ..................... Physician phone

..... ......... ........... ............ ............ consultation. 99372................. E.................... ..................... Physician phone

..... ......... ........... ............ ............ consultation. 99373................. E.................... ..................... Physician phone

..... ......... ........... ............ ............ consultation. 99374................. E.................... ..................... Home health care

..... ......... ........... ............ ............ supervision. 99377................. E.................... ..................... Hospice care

..... ......... ........... ............ ............ supervision. 99379................. E.................... ..................... Nursing fac care

..... ......... ........... ............ ............ supervision. 99380................. E.................... ..................... 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 0.9376 $50.90 ............

$10.18 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 resuscitation.. 0094 2.6412 $143.39

$48.46

$28.68 99450................. E.................... ..................... Life/disability

..... ......... ........... ............ ............ evaluation. 99455................. E.................... ..................... Disability examination. ..... ......... ........... ............ ............ 99456................. E.................... ..................... Disability examination. ..... ......... ........... ............ ............ 99499................. E.................... ..................... 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. ..... ......... ........... ............ ............

[[Page 48155]]

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,

..... ......... ........... ............ ............ hemodialysis. 99551................. E.................... ..................... Home infus, pain mgmt, ..... ......... ........... ............ ............ iv/sc. 99552................. E.................... ..................... Hm infus pain mgmt, ..... ......... ........... ............ ............ epid/ith. 99553................. E.................... ..................... Home infuse, tocolytic ..... ......... ........... ............ ............ tx. 99554................. E.................... ..................... Home infus, hormone/ ..... ......... ........... ............ ............ platelet. 99555................. E.................... ..................... Home infuse,

..... ......... ........... ............ ............ chemotheraphy. 99556................. E.................... ..................... Home infus, antibio/ ..... ......... ........... ............ ............ fung/vir. 99557................. E.................... ..................... Home infuse,

..... ......... ........... ............ ............ anticoagulant. 99558................. E.................... ..................... Home infuse,

..... ......... ........... ............ ............ immunotherapy. 99559................. E.................... ..................... Home infus, periton ..... ......... ........... ............ ............ dialysis. 99560................. E.................... ..................... Home infus, entero ..... ......... ........... ............ ............ nutrition. 99561................. E.................... ..................... Home infuse, hydration ..... ......... ........... ............ ............ tx. 99562................. E.................... ..................... Home infus, parent ..... ......... ........... ............ ............ nutrition. 99563................. E.................... ..................... Home admin, pentamidine ..... ......... ........... ............ ............ 99564................. E.................... ..................... Hme infus, antihemophil ..... ......... ........... ............ ............ agnt. 99565................. E.................... ..................... Home infus, proteinase ..... ......... ........... ............ ............ inhib. 99566................. E.................... ..................... Home infuse, iv therapy ..... ......... ........... ............ ............ 99567................. E.................... ..................... Home infuse, sympath ..... ......... ........... ............ ............ agent. 99568................. E.................... ..................... Home infus, misc drug, ..... ......... ........... ............ ............ daily. 99569................. E.................... ..................... Home infuse, each addl ..... ......... ........... ............ ............ tx. 99600................. E.................... ..................... Home visit nos......... ..... ......... ........... ............ ............ 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 ..... ......... ........... ............ ............ A0888................. E.................... ..................... Noncovered ambulance ..... ......... ........... ............ ............ mileage. A0999................. A.................... ..................... Unlisted ambulance ..... ......... ........... ............ ............ service.

[[Page 48156]]

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................. E.................... ..................... Supp for self-adm

..... ......... ........... ............ ............ injections. A4212................. E.................... ..................... Non coring needle or ..... ......... ........... ............ ............ stylet. A4213................. E.................... ..................... 20+ CC syringe only.... ..... ......... ........... ............ ............ A4214................. A.................... ..................... 30 CC sterile water/ ..... ......... ........... ............ ............ saline. A4215................. E.................... ..................... Sterile needle......... ..... ......... ........... ............ ............ A4220................. A.................... ..................... 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. 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. 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''. A4409................. A.................... ..................... Ost skn barr w flng 4sq''. A4413................. A.................... ..................... 2 pc drainable ost ..... ......... ........... ............ ............ pouch.

[[Page 48158]]

A4414................. A.................... ..................... Ostomy sknbarr w flng ..... ......... ........... ............ ............ 4sq''. A4421................. A.................... ..................... Ostomy supply misc..... ..... ......... ........... ............ ............ A4422................. A.................... ..................... Ost pouch absorbent ..... ......... ........... ............ ............ material. 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. 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.................... ..................... Diaper sv ea reusable ..... ......... ........... ............ ............ diaper. A4550................. E.................... ..................... 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................. N.................... ..................... Splint................. ..... ......... ........... ............ ............ A4575................. E.................... ..................... Hyperbaric o2 chamber ..... ......... ........... ............ ............ disps. A4580................. N.................... ..................... Cast supplies (plaster) ..... ......... ........... ............ ............ A4590................. N.................... ..................... 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.................... ..................... Tracheotomy mask or ..... ......... ........... ............ ............ collar. A4622................. A.................... ..................... Tracheostomy or

..... ......... ........... ............ ............ larngectomy. A4623................. A.................... ..................... Tracheostomy inner ..... ......... ........... ............ ............ cannula.

[[Page 48159]]

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.................... ..................... 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. A4639................. A.................... ..................... Infrared ht sys

..... ......... ........... ............ ............ replcmnt pad. A4640................. A.................... ..................... Alternating pressure ..... ......... ........... ............ ............ pad. A4641................. N.................... ..................... Diagnostic imaging ..... ......... ........... ............ ............ agent. A4642................. K.................... ..................... Satumomab pendetide per 0704 2.9212 $158.59 ............

$31.72 dose. A4643................. N.................... ..................... High dose contrast MRI. ..... ......... ........... ............ ............ A4644................. N.................... ..................... Contrast 100-199 MGs ..... ......... ........... ............ ............ iodine. A4645................. N.................... ..................... Contrast 200-299 MGs ..... ......... ........... ............ ............ iodine. A4646................. N.................... ..................... 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. 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.................... ..................... Sterile water inj per ..... ......... ........... ............ ............ 10 ml. A4714................. A.................... ..................... Treated water per

..... ......... ........... ............ ............ gallon. A4719................. A.................... ..................... ``Y set'' 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 999cc. A4726................. A.................... ..................... Dialys sol fld vol 5999cc. 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.

[[Page 48160]]

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. 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 1648 ..... ......... ........... ............ ............ sq in w/o brdr. A6212................. A.................... ..................... Foam drg 1648 ..... ......... ........... ............ ............ sq in w/border. A6215................. A.................... ..................... Foam dressing wound ..... ......... ........... ............ ............ filler. A6216................. A.................... ..................... Non-sterile gauze1648 sq in. A6219................. A.................... ..................... Gauze 16 ..... ......... ........... ............ ............ 48 sq ..... ......... ........... ............ ............ in w/border. A6222................. A.................... ..................... Gauze 1648 in ..... ......... ........... ............ ............ no w/sal w/o b. A6228................. A.................... ..................... Gauze 1648 sq ..... ......... ........... ............ ............ in water/salne. A6231................. A.................... ..................... Hydrogel dsg1648 sq in. A6234................. A.................... ..................... Hydrocolld drg 1648 in w/o b. A6237................. A.................... ..................... Hydrocolld drg 1648 in w/bdr. A6240................. A.................... ..................... Hydrocolld drg filler ..... ......... ........... ............ ............ paste. A6241................. A.................... ..................... Hydrocolloid drg filler ..... ......... ........... ............ ............ dry. A6242................. A.................... ..................... Hydrogel drg 1648 in w/o bdr. A6245................. A.................... ..................... Hydrogel drg 1648 sq in w/b. A6248................. A.................... ..................... Hydrogel drsg gel

..... ......... ........... ............ ............ filler. A6250................. A.................... ..................... Skin seal protect

..... ......... ........... ............ ............ moisturizr. A6251................. A.................... ..................... Absorpt drg 16 ..... ......... ........... ............ ............ 48 sq in w/o b. A6254................. A.................... ..................... Absorpt drg 16..... ......... ........... ............ ............ 48 sq in w/bdr. A6257................. A.................... ..................... Transparent film 1648 sq in. A6260................. A.................... ..................... Wound cleanser any type/ ..... ......... ........... ............ ............ size. A6261................. A.................... ..................... Wound filler gel/paste / ..... ......... ........... ............ ............ oz. A6262................. A.................... ..................... Wound filler dry form / ..... ......... ........... ............ ............ gram. A6266................. A.................... ..................... Impreg gauze no h20/sal/ ..... ......... ........... ............ ............ yard. A6402................. A.................... ..................... Sterile gauze 16 48 sq in. A6410................. A.................... ..................... Sterile eye pad........ ..... ......... ........... ............ ............ A6411................. A.................... ..................... Non-sterile eye pad.... ..... ......... ........... ............ ............ A6412................. E.................... ..................... Occlusive eye patch.... ..... ......... ........... ............ ............ A6421................. A.................... ..................... Pad bandage =3 =3=5``w /roll. A6426................. A.................... ..................... Conf bandage s =3=5`` w /roll. A6430................. A.................... ..................... Lt compres bdg =3=5``w /roll. A6434................. A.................... ..................... Mo compres bdg =3=3=3=3. 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.

[[Continued on page 48165]]

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

[[pp. 48165-48214]] Medicare Program; Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2004 Payment Rates

[[Continued from page 48164]]

[[Page 48164]]

B9999................. A.................... ..................... Parenteral supp not ..... ......... ........... ............ ............ othrws c. C1010................. K.................... ..................... Blood, L/R, CMV-NEG.... 1010 2.1361 $115.97 ............

$23.19 C1011................. K.................... ..................... Platelets, HLA-m, L/R, 1011 8.2851 $449.79 ............

$89.96 unit. C1015................. K.................... ..................... Plt, pher,L/R,CMV,

1020 9.6266 $522.62 ............ $104.52 irrad. C1016................. K.................... ..................... BLOOD,L/R,FROZ/DEGLY/ 1016 5.0012 $271.51 ............

$54.30 Washed. C1017................. K.................... ..................... Plt, APH/PHER,L/R,CMV- 1017 6.5175 $353.83 ............

$70.77 NEG. C1018................. K.................... ..................... Blood, L/R, IRRADIATED. 1018 2.1950 $119.16 ............

$23.83 C1020................. K.................... ..................... RBC, frz/deg/wsh, L/R, 1021 6.5287 $354.44 ............

$70.89 irrad. C1021................. K.................... ..................... RBC, L/R, CMV neg,

1022 3.9139 $212.48 ............

$42.50 irrad. C1022................. K.................... ..................... Plasma, frz within 24 0955 1.5750 $85.51 ............

$17.10 hour. C1079................. N.................... ..................... CO 57/58 per 0.5 uCi... ..... ......... ........... ............ ............ C1088................. T.................... ..................... LASER OPTIC TR Sys..... 1557 ......... $1,850.00 ............ $370.00 C1091................. K.................... ..................... IN111

1091 4.0535 $220.06 ............

$44.01 oxyquinoline,per0.5mCi. C1092................. K.................... ..................... IN 111 pentetate per 1092 4.0824 $221.63 ............

$44.33 0.5 mCi. C1122................. K.................... ..................... Tc 99M ARCITUMOMAB PER 1122 9.6556 $524.19 ............ $104.84 VIAL. C1166................. N.................... ..................... CYTARABINE LIPOSOMAL, ..... ......... ........... ............ ............ 10 mg. C1167................. K.................... ..................... EPIRUBICIN HCL, 2 mg... 1167 0.3597 $19.53 ............

$3.91 C1178................. K.................... ..................... BUSULFAN IV, 6 Mg...... 1178 6.0245 $327.06 ............

$65.41 C1200................. N.................... ..................... TC 99M Sodium

..... ......... ........... ............ ............ Glucoheptonat. C1201................. N.................... ..................... TC 99M SUCCIMER, PER ..... ......... ........... ............ ............ Vial. C1300................. S.................... ..................... HYPERBARIC Oxygen...... 0659 3.2220 $174.92 ............

$34.98 C1305................. K.................... ..................... Apligraf............... 1305 11.2075 $608.44 ............ $121.69 C1716................. K.................... ..................... Brachytx source, Gold 1716 1.3399 $72.74 ............

$14.55 198. C1718................. K.................... ..................... Brachytx source, Iodine 1718 0.6695 $36.35 ............

$7.27 125. C1719................. K.................... ..................... Brachytx sour,Non-HDR 1719 0.3053 $16.57 ............

$3.31 Ir-192. C1720................. K.................... ..................... Brachytx sour,

1720 0.8104 $44.00 ............

$8.80 Palladium 103. C1765................. N.................... ..................... Adhesion barrier....... ..... ......... ........... ............ ............ C1774................. K.................... ..................... Darbepoetin alfa, 1 mcg 0734 0.0463

$2.51 ............

$.50 C1775................. K.................... ..................... FDG, per dose (4-40 mCi/ 1775 5.8606 $318.17 ............

$63.63 ml). C1783................. H.................... ..................... Ocular imp, aqueous 1783 ......... ........... ............ ............ drain dev. C1814................. H.................... ..................... Retinal tamp, silicone 1814 ......... ........... ............ ............ oil. C1818................. H.................... ..................... Integrated

1818 ......... ........... ............ ............ keratoprosthesis. C1900................. H.................... ..................... Lead coronary venous... 1900 ......... ........... ............ ............ C2614................. H.................... ..................... Probe, perc lumb disc.. 2614 ......... ........... ............ ............ C2616................. K.................... ..................... Brachytx source,

2616 163.4011 $8,870.88 ............ $1,774.18 Yttrium-90. C2618................. N.................... ..................... Probe, cryoablation.... ..... ......... ........... ............ ............ C2632................. H.................... ..................... Brachytx sol, I-125, 2632 ......... ........... ............ ............ per mCi. C8900................. S.................... ..................... MRA w/cont, abd........ 0284 7.0207 $381.15 $190.57

$76.23 C8901................. S.................... ..................... MRA w/o cont, abd...... 0336 6.4817 $351.89 $175.94

$70.38 C8902................. S.................... ..................... MRA w/o fol w/cont, abd 0337 9.3215 $506.05 $240.77 $101.21 C8903................. S.................... ..................... MRI w/cont, breast, uni 0284 7.0207 $381.15 $190.57

$76.23 C8904................. S.................... ..................... MRI w/o cont, breast, 0336 6.4817 $351.89 $175.94

$70.38 uni. C8905................. S.................... ..................... MRI w/o fol w/cont, 0337 9.3215 $506.05 $240.77 $101.21 brst, un. C8906................. S.................... ..................... MRI w/cont, breast, bi. 0284 7.0207 $381.15 $190.57

$76.23 C8907................. S.................... ..................... MRI w/o cont, breast, 0336 6.4817 $351.89 $175.94

$70.38 bi. C8908................. S.................... ..................... MRI w/o fol w/cont, 0337 9.3215 $506.05 $240.77 $101.21 breast,. C8909................. S.................... ..................... MRA w/cont, chest...... 0284 7.0207 $381.15 $190.57

$76.23 C8910................. S.................... ..................... MRA w/o cont, chest.... 0336 6.4817 $351.89 $175.94

$70.38 C8911................. S.................... ..................... MRA w/o fol w/cont, 0337 9.3215 $506.05 $240.77 $101.21 chest. C8912................. S.................... ..................... MRA w/cont, lwr ext.... 0284 7.0207 $381.15 $190.57

$76.23 C8913................. S.................... ..................... MRA w/o cont, lwr ext.. 0336 6.4817 $351.89 $175.94

$70.38 C8914................. S.................... ..................... MRA w/o fol w/cont, lwr 0337 9.3215 $506.05 $240.77 $101.21 ext. C8918................. S.................... ..................... MRA w/cont, pelvis..... 0284 7.0207 $381.15 $190.57

$76.23 C8919................. S.................... ..................... MRA w/o cont, pelvis... 0336 6.4817 $351.89 $175.94

$70.38 C8920................. S.................... ..................... MRA w/o fol w/cont, 0337 9.3215 $506.05 $240.77 $101.21 pelvis. C9000................. K.................... ..................... Na chromateCr51, per 9000 1.2631 $68.57 ............

$13.71 0.25mCi. C9003................. K.................... ..................... Palivizumab, per 50 mg. 9003 6.3850 $346.64 ............

$69.33 C9007................. N.................... ..................... Baclofen Intrathecal ..... ......... ........... ............ ............ kit-1am. C9008................. N.................... ..................... Baclofen Refill Kit- ..... ......... ........... ............ ............ 500mcg. C9009................. K.................... ..................... Baclofen Refill Kit- 9009 0.7478 $40.60 ............

$8.12 2000mcg. C9010................. K.................... ..................... Baclofen Refill Kit-- 9010 0.7340 $39.85 ............

$7.97 4000mcg. C9013................. N.................... ..................... Co 57 cobaltous

..... ......... ........... ............ ............ chloride. C9102................. N.................... ..................... 51 Na Chromate, 50mCi.. ..... ......... ........... ............ ............ C9103................. N.................... ..................... Na Iothalamate I-125, ..... ......... ........... ............ ............ 10 uCi. C9105................. K.................... ..................... Hep B imm glob, per 1 9105 1.5621 $84.80 ............

$16.96 ml. C9109................. K.................... ..................... Tirofiban hcl, 6.25 mg. 9109 2.2328 $121.22 ............

$24.24

[[Page 48165]]

C9111................. G.................... ..................... Inj, bivalirudin, 250mg 9111 ......... $397.81 ............

$59.46 vial. C9112................. G.................... ..................... Perflutren lipid micro, 9112 ......... $148.20 ............

$22.15 2ml. C9113................. G.................... ..................... Inj pantoprazole

9113 ......... $22.80 ............

$3.41 sodium, via. C9116................. G.................... ..................... Ertapenem sodium, per 1 9116 ......... $45.31 ............

$6.77 gm. C9120................. G.................... ..................... Injection, fulvestrant. 9120 ......... $175.16 ............

$26.18 C9121................. G.................... ..................... Injection, argatroban.. 9121 ......... $14.25 ............

$2.13 C9200................. G.................... ..................... Orcel, per 36 cm2...... 9200 ......... $1,135.25 ............ $169.69 C9201................. K.................... ..................... Dermagraft, per 37.5 sq 9201 7.9288 $430.45 ............

$86.09 cm. C9202................. K.................... ..................... Octafluoropropane...... 9202 2.1253 $115.38 ............

$23.08 C9203................. G.................... ..................... Perflexane lipid micro. 9203 ......... $142.50 ............

$21.30 C9204................. G.................... ..................... Ziprasidone mesylate... 9204 ......... $41.56 ............

$6.21 C9205................. G.................... ..................... Oxaliplatin............ 9205 ......... $94.46 ............

$14.12 C9503................. K.................... ..................... Fresh frozen plasma, ea 9503 1.1560 $62.76 ............

$12.55 unit. C9701................. T.................... ..................... Stretta System......... 1557 ......... $1,850.00 ............ $370.00 C9703................. T.................... ..................... Bard Endoscopic

1555 ......... $1,650.00 ............ $330.00 Suturing Sys. C9711................. T.................... ..................... 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 0.5609 $30.45

$6.09

$6.09 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 film 0330 0.5609 $30.45

$6.09

$6.09 D0250................. S.................... ..................... Extraoral first film... 0330 0.5609 $30.45

$6.09

$6.09 D0260................. S.................... ..................... Extraoral ea additional 0330 0.5609 $30.45

$6.09

$6.09 film. D0270................. S.................... ..................... Dental bitewing single 0330 0.5609 $30.45

$6.09

$6.09 film. D0272................. S.................... ..................... Dental bitewings two 0330 0.5609 $30.45

$6.09

$6.09 films. D0274................. S.................... ..................... Dental bitewings four 0330 0.5609 $30.45

$6.09

$6.09 films. D0277................. S.................... ..................... Vert bitewings-sev to 0330 0.5609 $30.45

$6.09

$6.09 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 0.5609 $30.45

$6.09

$6.09 D0470................. E.................... ..................... Diagnostic casts....... ..... ......... ........... ............ ............ D0472................. S.................... ..................... Gross exam, prep &

0330 0.5609 $30.45

$6.09

$6.09 report. D0473................. S.................... ..................... Micro exam, prep &

0330 0.5609 $30.45

$6.09

$6.09 report. D0474................. S.................... ..................... Micro w exam of surg 0330 0.5609 $30.45

$6.09

$6.09 margins. D0480................. S.................... ..................... Cytopath smear prep & 0330 0.5609 $30.45

$6.09

$6.09 report. D0502................. S.................... ..................... Other oral pathology 0330 0.5609 $30.45

$6.09

$6.09 procedu. D0999................. S.................... ..................... Unspecified diagnostic 0330 0.5609 $30.45

$6.09

$6.09 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 0.5609 $30.45

$6.09

$6.09 unilat. D1515................. S.................... ..................... Fixed bilat space

0330 0.5609 $30.45

$6.09

$6.09 maintainer. D1520................. S.................... ..................... Remove unilat space 0330 0.5609 $30.45

$6.09

$6.09 maintain. D1525................. S.................... ..................... Remove bilat space

0330 0.5609 $30.45

$6.09

$6.09 maintain. D1550................. S.................... ..................... Recement space

0330 0.5609 $30.45

$6.09

$6.09 maintainer. D2140................. E.................... ..................... Amalgam one surface ..... ......... ........... ............ ............ permanen.

[[Page 48166]]

D2150................. E.................... ..................... Amalgam two surfaces ..... ......... ........... ............ ............ permane. D2160................. E.................... ..................... Amalgam three surfaces ..... ......... ........... ............ ............ perma. D2161................. E.................... ..................... Amalgam 4 or surfaces perm. D2330................. E.................... ..................... Resin one surface- ..... ......... ........... ............ ............ anterior. D2331................. E.................... ..................... Resin two surfaces- ..... ......... ........... ............ ............ anterior. D2332................. E.................... ..................... Resin three surfaces- ..... ......... ........... ............ ............ anterio. D2335................. E.................... ..................... Resin 4/..... ......... ........... ............ ............ surf or w incis an. D2390................. E.................... ..................... Ant resin-based cmpst ..... ......... ........... ............ ............ crown. D2391................. E.................... ..................... Post 1 srfc resinbased ..... ......... ........... ............ ............ cmpst. D2392................. E.................... ..................... Post 2 srfc resinbased ..... ......... ........... ............ ............ cmpst. D2393................. E.................... ..................... Post 3 srfc resinbased ..... ......... ........... ............ ............ cmpst. D2394................. E.................... ..................... Post =4srfc ..... ......... ........... ............ ............ resinbase cmpst. D2410................. E.................... ..................... Dental gold foil one ..... ......... ........... ............ ............ surface. D2420................. E.................... ..................... Dental gold foil two ..... ......... ........... ............ ............ surface. D2430................. E.................... ..................... Dental gold foil three ..... ......... ........... ............ ............ surfa. D2510................. E.................... ..................... Dental inlay metalic 1 ..... ......... ........... ............ ............ surf. D2520................. E.................... ..................... Dental inlay metallic 2 ..... ......... ........... ............ ............ surf. D2530................. E.................... ..................... Dental inlay metl 3/ ..... ......... ........... ............ ............ more sur. D2542................. E.................... ..................... Dental onlay metallic 2 ..... ......... ........... ............ ............ surf. D2543................. E.................... ..................... Dental onlay metallic 3 ..... ......... ........... ............ ............ surf. D2544................. E.................... ..................... Dental onlay metl 4/ ..... ......... ........... ............ ............ more sur. D2610................. E.................... ..................... Inlay porcelain/ceramic ..... ......... ........... ............ ............ 1 su. D2620................. E.................... ..................... Inlay porcelain/ceramic ..... ......... ........... ............ ............ 2 su. D2630................. E.................... ..................... Dental onlay porc 3/ ..... ......... ........... ............ ............ more sur. D2642................. E.................... ..................... Dental onlay porcelin 2 ..... ......... ........... ............ ............ surf. D2643................. E.................... ..................... Dental onlay porcelin 3 ..... ......... ........... ............ ............ surf. D2644................. E.................... ..................... Dental onlay porc 4/ ..... ......... ........... ............ ............ more sur. D2650................. E.................... ..................... Inlay composite/resin ..... ......... ........... ............ ............ one su. D2651................. E.................... ..................... Inlay composite/resin ..... ......... ........... ............ ............ two su. D2652................. E.................... ..................... Dental inlay resin 3/ ..... ......... ........... ............ ............ mre sur. D2662................. E.................... ..................... Dental onlay resin 2 ..... ......... ........... ............ ............ surface. D2663................. E.................... ..................... Dental onlay resin 3 ..... ......... ........... ............ ............ surface. D2664................. E.................... ..................... Dental onlay resin 4/ ..... ......... ........... ............ ............ mre sur. D2710................. E.................... ..................... Crown resin laboratory. ..... ......... ........... ............ ............ 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.

[[Page 48167]]

D2970................. S.................... ..................... Temporary- fractured 0330 0.5609 $30.45

$6.09

$6.09 tooth. D2980................. E.................... ..................... Crown repair........... ..... ......... ........... ............ ............ D2999................. S.................... ..................... Dental unspec

0330 0.5609 $30.45

$6.09

$6.09 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 endosseous 0330 0.5609 $30.45

$6.09

$6.09 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 0.5609 $30.45

$6.09

$6.09 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 0.5609 $30.45

$6.09

$6.09 quadrant. D4261................. E.................... ..................... Osseous surgl-

..... ......... ........... ............ ............ 3teethperquad. D4263................. S.................... ..................... Bone replce graft first 0330 0.5609 $30.45

$6.09

$6.09 site. D4264................. S.................... ..................... Bone replce graft each 0330 0.5609 $30.45

$6.09

$6.09 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 0.5609 $30.45

$6.09

$6.09 procedure. D4270................. S.................... ..................... Pedicle soft tissue 0330 0.5609 $30.45

$6.09

$6.09 graft pr. D4271................. S.................... ..................... Free soft tissue graft 0330 0.5609 $30.45

$6.09

$6.09 proc. D4273................. S.................... ..................... Subepithelial tissue 0330 0.5609 $30.45

$6.09

$6.09 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 debridement. 0330 0.5609 $30.45

$6.09

$6.09 D4381................. S.................... ..................... Localized chemo

0330 0.5609 $30.45

$6.09

$6.09 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.

[[Page 48168]]

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 ..... ......... ........... ............ ............ D5899................. E.................... ..................... Removable prosthodontic ..... ......... ........... ............ ............ proc. D5911................. S.................... ..................... Facial moulage

0330 0.5609 $30.45

$6.09

$6.09 sectional. D5912................. S.................... ..................... Facial moulage complete 0330 0.5609 $30.45

$6.09

$6.09 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............ ..... ......... ........... ............ ............

[[Page 48169]]

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 0.5609 $30.45

$6.09

$6.09 D5984................. S.................... ..................... Radiation shield....... 0330 0.5609 $30.45

$6.09

$6.09 D5985................. S.................... ..................... Radiation cone locator. 0330 0.5609 $30.45

$6.09

$6.09 D5986................. E.................... ..................... Fluoride applicator.... ..... ......... ........... ............ ............ D5987................. S.................... ..................... Commissure splint...... 0330 0.5609 $30.45

$6.09

$6.09 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...... ..... ......... ........... ............ ............ 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.

[[Page 48170]]

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 0.5609 $30.45

$6.09

$6.09 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 0.5609 $30.45

$6.09

$6.09 deciduous t. D7140................. S.................... ..................... Extraction erupted

0330 0.5609 $30.45

$6.09

$6.09 tooth/exr. D7210................. S.................... ..................... Rem imp tooth w mucoper 0330 0.5609 $30.45

$6.09

$6.09 flp. D7220................. S.................... ..................... Impact tooth remov soft 0330 0.5609 $30.45

$6.09

$6.09 tiss. D7230................. S.................... ..................... Impact tooth remov part 0330 0.5609 $30.45

$6.09

$6.09 bony. D7240................. S.................... ..................... Impact tooth remov comp 0330 0.5609 $30.45

$6.09

$6.09 bony. D7241................. S.................... ..................... Impact tooth rem bony w/ 0330 0.5609 $30.45

$6.09

$6.09 comp. D7250................. S.................... ..................... Tooth root removal..... 0330 0.5609 $30.45

$6.09

$6.09 D7260................. S.................... ..................... Oral antral fistula 0330 0.5609 $30.45

$6.09

$6.09 closure. D7261................. S.................... ..................... Primary closure sinus 0330 0.5609 $30.45

$6.09

$6.09 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. D7287................. E.................... ..................... Cytology sample

..... ......... ........... ............ ............ collection. D7290................. E.................... ..................... Repositioning of teeth. ..... ......... ........... ............ ............ D7291................. S.................... ..................... Transseptal fiberotomy. 0330 0.5609 $30.45

$6.09

$6.09 D7310................. E.................... ..................... Alveoplasty w/

..... ......... ........... ............ ............ extraction. D7320................. E.................... ..................... Alveoplasty w/o

..... ......... ........... ............ ............ extraction. D7340................. E.................... ..................... Vestibuloplasty ridge ..... ......... ........... ............ ............ extens.

[[Page 48171]]

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

..... ......... ........... ............ ............ lesion1.25c m. 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.

[[Page 48172]]

D7912................. E.................... ..................... Suture complicate wnd ..... ......... ........... ............ ............ 5 cm. D7920................. E.................... ..................... Dental skin graft...... ..... ......... ........... ............ ............ D7940................. S.................... ..................... Reshaping bone

0330 0.5609 $30.45

$6.09

$6.09 orthognathic. 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/medicaments 0330 0.5609 $30.45

$6.09

$6.09 D9910................. E.................... ..................... Dent appl desensitizing ..... ......... ........... ............ ............ med. D9911................. E.................... ..................... Appl desensitizing ..... ......... ........... ............ ............ resin.

[[Page 48173]]

D9920................. E.................... ..................... Behavior management.... ..... ......... ........... ............ ............ D9930................. S.................... ..................... Treatment of

0330 0.5609 $30.45

$6.09

$6.09 complications. D9940................. S.................... ..................... Dental occlusal guard.. 0330 0.5609 $30.45

$6.09

$6.09 D9941................. E.................... ..................... Fabrication athletic ..... ......... ........... ............ ............ guard. D9950................. S.................... ..................... Occlusion analysis..... 0330 0.5609 $30.45

$6.09

$6.09 D9951................. S.................... ..................... Limited occlusal

0330 0.5609 $30.45

$6.09

$6.09 adjustment. D9952................. S.................... ..................... Complete occlusal

0330 0.5609 $30.45

$6.09

$6.09 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. 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. E0130................. A.................... ..................... Walker rigid adjust/ ..... ......... ........... ............ ............ fixed ht. E0135................. A.................... ..................... Walker folding adjust/ ..... ......... ........... ............ ............ fixed. E0141................. A.................... ..................... Rigid walker wheeled wo ..... ......... ........... ............ ............ seat. E0142................. A.................... ..................... Walker rigid wheeled ..... ......... ........... ............ ............ with se. E0143................. A.................... ..................... Walker folding wheeled ..... ......... ........... ............ ............ w/o s. E0144................. A.................... ..................... Enclosed walker w rear ..... ......... ........... ............ ............ seat. E0145................. A.................... ..................... Walker whled seat/ ..... ......... ........... ............ ............ crutch att. E0146................. A.................... ..................... 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.................... ..................... 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 ..... ......... ........... ............ ............ E0191................. A.................... ..................... Protector heel or elbow ..... ......... ........... ............ ............ E0192................. A.................... ..................... Pad wheelchr low press/ ..... ......... ........... ............ ............ posit.

[[Page 48174]]

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

[[Page 48175]]

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............ ..... ......... ........... ............ ............ 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. 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. 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. E0650................. A.................... ..................... Pneuma compresor non- ..... ......... ........... ............ ............ segment. E0651................. A.................... ..................... Pneum compressor

..... ......... ........... ............ ............ segmental.

[[Page 48176]]

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. 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......... ..... ......... ........... ............ ............ 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 ..... ......... ........... ............ ............ 10 CC inj. J1563................. K.................... ..................... Immune globulin, 1 g... 0905 0.8103 $43.99 ............

$8.80 J1564................. K.................... ..................... Immune globulin 10 mg.. 9021 0.0080

$.43 ............

$.09 J1565................. K.................... ..................... RSV-ivig............... 0906 6.0142 $326.50 ............

$65.30 J1570................. N.................... ..................... Ganciclovir sodium ..... ......... ........... ............ ............ injection. J1580................. N.................... ..................... Garamycin gentamicin ..... ......... ........... ............ ............ inj. J1590................. N.................... ..................... Gatifloxacin injection. ..... ......... ........... ............ ............ J1600................. N.................... ..................... Gold sodium thiomaleate ..... ......... ........... ............ ............ inj. J1610................. N.................... ..................... Glucagon hydrochloride/ ..... ......... ........... ............ ............ 1 MG. J1620................. N.................... ..................... Gonadorelin hydroch/ ..... ......... ........... ............ ............ 100 mcg. J1626................. N.................... ..................... Granisetron HCl

..... ......... ........... ............ ............ 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 0.6841 $37.14 ............

$7.43 J1750................. N.................... ..................... Iron dextran........... ..... ......... ........... ............ ............ J1756................. N.................... ..................... Iron sucrose injection. ..... ......... ........... ............ ............ J1785................. K.................... ..................... Injection imiglucerase / 0916 0.0531

$2.88 ............

$.58 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 2.8010 $152.06 ............

$30.41 J1830................. K.................... ..................... Interferon beta-1b / 0910 1.9843 $107.73 ............

$21.55 .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.................... ..................... Kutapressin injection.. ..... ......... ........... ............ ............ J1940................. N.................... ..................... Furosemide injection... ..... ......... ........... ............ ............ J1950................. K.................... ..................... Leuprolide acetate / 0800 3.3020 $179.26 ............

$35.85 3.75 MG.

[[Page 48186]]

J1955................. E.................... ..................... Inj levocarnitine per 1 ..... ......... ........... ............ ............ gm. J1956................. N.................... ..................... Levofloxacin injection. ..... ......... ........... ............ ............ J1960................. N.................... ..................... Levorphanol tartrate ..... ......... ........... ............ ............ inj. J1980................. N.................... ..................... Hyoscyamine sulfate inj ..... ......... ........... ............ ............ J1990................. N.................... ..................... Chlordiazepoxide

..... ......... ........... ............ ............ injection. J2000................. N.................... ..................... Lidocaine injection.... ..... ......... ........... ............ ............ J2010................. N.................... ..................... Lincomycin injection... ..... ......... ........... ............ ............ J2020................. N.................... ..................... Linezolid injection.... ..... ......... ........... ............ ............ J2060................. N.................... ..................... Lorazepam injection.... ..... ......... ........... ............ ............ J2150................. N.................... ..................... Mannitol injection..... ..... ......... ........... ............ ............ J2175................. N.................... ..................... Meperidine hydrochl / ..... ......... ........... ............ ............ 100 MG. J2180................. N.................... ..................... Meperidine/promethazine ..... ......... ........... ............ ............ inj. J2210................. N.................... ..................... Methylergonovin maleate ..... ......... ........... ............ ............ inj. J2250................. N.................... ..................... Inj midazolam

..... ......... ........... ............ ............ hydrochloride. J2260................. N.................... ..................... Inj milrinone lactate, ..... ......... ........... ............ ............ per 5 mg. J2270................. N.................... ..................... Morphine sulfate

..... ......... ........... ............ ............ injection. J2271................. N.................... ..................... Morphine so4 injection ..... ......... ........... ............ ............ 100mg. J2275................. N.................... ..................... Morphine sulfate

..... ......... ........... ............ ............ injection. 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 mg 9114 ......... $144.40 ............

$21.58 vial. J2352................. K.................... ..................... Octreotide acetate

7031 1.0339 $56.13 ............

$11.23 injection. J2355................. K.................... ..................... Oprelvekin injection... 7011 2.7246 $147.92 ............

$29.58 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 2.0537 $111.49 ............

$22.30 30 MG. J2440................. N.................... ..................... Papaverin hcl injection ..... ......... ........... ............ ............ J2460................. N.................... ..................... Oxytetracycline

..... ......... ........... ............ ............ injection. J2501................. N.................... ..................... Paricalcitol........... ..... ......... ........... ............ ............ J2510................. N.................... ..................... Penicillin g procaine ..... ......... ........... ............ ............ inj. J2515................. N.................... ..................... Pentobarbital sodium ..... ......... ........... ............ ............ inj. J2540................. N.................... ..................... Penicillin g potassium ..... ......... ........... ............ ............ inj. J2543................. N.................... ..................... Piperacillin/tazobactam ..... ......... ........... ............ ............ J2545................. A.................... ..................... 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. J2788................. K.................... ..................... Rho d immune globulin 9023 0.0523

$2.84 ............

$.57 50 mcg. J2790................. K.................... ..................... Rho d immune globulin 0884 0.2312 $12.55 ............

$2.51 inj. J2792................. K.................... ..................... Rho(D) immune globulin 1609 0.1863 $10.11 ............

$2.02 h, sd. J2795................. N.................... ..................... Ropivacaine HCl

..... ......... ........... ............ ............ injection. J2800................. N.................... ..................... Methocarbamol injection ..... ......... ........... ............ ............ J2810................. N.................... ..................... Inj theophylline per 40 ..... ......... ........... ............ ............ MG. J2820................. N.................... ..................... Sargramostim injection. ..... ......... ........... ............ ............ J2910................. N.................... ..................... Aurothioglucose

..... ......... ........... ............ ............ injeciton.

[[Page 48187]]

J2912................. N.................... ..................... Sodium chloride

..... ......... ........... ............ ............ injection. J2916................. N.................... ..................... Na ferric gluconate ..... ......... ........... ............ ............ complex. J2920................. N.................... ..................... Methylprednisolone ..... ......... ........... ............ ............ injection. J2930................. N.................... ..................... Methylprednisolone ..... ......... ........... ............ ............ injection. J2940................. N.................... ..................... Somatrem injection..... ..... ......... ........... ............ ............ J2941................. K.................... ..................... Somatropin injection... 7034 0.9206 $49.98 ............

$10.00 J2950................. N.................... ..................... Promazine hcl injection ..... ......... ........... ............ ............ J2993................. K.................... ..................... Reteplase injection.... 9005 10.1332 $550.12 ............ $110.02 J2995................. K.................... ..................... Inj streptokinase / 0911 1.6055 $87.16 ............

$17.43 250000 IU. J2997................. N.................... ..................... Alteplase recombinant.. ..... ......... ........... ............ ............ J3000................. N.................... ..................... Streptomycin injection. ..... ......... ........... ............ ............ J3010................. N.................... ..................... Fentanyl citrate

..... ......... ........... ............ ............ injeciton. J3030................. N.................... ..................... Sumatriptan succinate / ..... ......... ........... ............ ............ 6 MG. J3070................. N.................... ..................... Pentazocine hcl

..... ......... ........... ............ ............ injection. J3100................. K.................... ..................... Tenecteplase injection. 9002 23.2303 $1,261.15 ............ $252.23 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 injection.. 9108 6.6059 $358.63 ............

$71.73 J3245................. K.................... ..................... Tirofiban hydrochloride 7041 4.2976 $233.31 ............

$46.66 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 1.2099 $65.68 ............

$13.14 glucoronate. J3310................. N.................... ..................... Perphenazine injeciton. ..... ......... ........... ............ ............ J3315................. G.................... ..................... Triptorelin pamoate.... 9122 ......... $415.24 ............

$62.07 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 5.1032 $277.05 ............

$55.41 inj. J3370................. N.................... ..................... Vancomycin hcl

..... ......... ........... ............ ............ injection. J3395................. K.................... ..................... Verteporfin injection.. 1203 16.1946 $879.19 ............ $175.84 J3400................. N.................... ..................... Triflupromazine hcl inj ..... ......... ........... ............ ............ J3410................. N.................... ..................... Hydroxyzine hcl

..... ......... ........... ............ ............ injection. J3420................. N.................... ..................... Vitamin b12 injection.. ..... ......... ........... ............ ............ J3430................. N.................... ..................... Vitamin k phytonadione ..... ......... ........... ............ ............ inj. J3470................. N.................... ..................... Hyaluronidase injection ..... ......... ........... ............ ............ J3475................. N.................... ..................... Inj magnesium sulfate.. ..... ......... ........... ............ ............ J3480................. N.................... ..................... Inj potassium chloride. ..... ......... ........... ............ ............ J3485................. N.................... ..................... Zidovudine............. ..... ......... ........... ............ ............ J3487................. G.................... ..................... Zoledronic acid........ 9115 ......... $203.40 ............

$30.40 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.

[[Page 48188]]

J7190................. K.................... ..................... Factor viii............ 0925 0.0085

$.46 ............

$.09 J7191................. K.................... ..................... Factor VIII (porcine).. 0926 0.0253

$1.37 ............

$.27 J7192................. K.................... ..................... Factor viii recombinant 0927 0.0168

$.91 ............

$.18 J7193................. K.................... ..................... Factor IX non-

0931 0.0104

$.56 ............

$.11 recombinant. J7194................. K.................... ..................... Factor ix complex...... 0928 0.0085

$.46 ............

$.09 J7195................. K.................... ..................... Factor IX recombinant.. 0932 0.0168

$.91 ............

$.18 J7197................. K.................... ..................... Antithrombin iii

0930 0.0117

$.64 ............

$.13 injection. J7198................. K.................... ..................... Anti-inhibitor......... 0929 0.0168

$.91 ............

$.18 J7199................. E.................... ..................... Hemophilia clot factor ..... ......... ........... ............ ............ noc. J7300................. E.................... ..................... Intraut copper

..... ......... ........... ............ ............ contraceptive. J7302................. E.................... ..................... Levonorgestrel iu

..... ......... ........... ............ ............ contracept. J7308................. N.................... ..................... Aminolevulinic acid hcl ..... ......... ........... ............ ............ top. J7310................. N.................... ..................... Ganciclovir long act ..... ......... ........... ............ ............ implant. J7317................. N.................... ..................... Sodium hyaluronate ..... ......... ........... ............ ............ injection. J7320................. K.................... ..................... Hylan G-F 20 injection. 1611 2.1566 $117.08 ............

$23.42 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 100 0888 0.0482

$2.62 ............

$.52 mg. J7504................. K.................... ..................... Lymphocyte immune

0890 2.1958 $119.21 ............

$23.84 globulin. J7505................. K.................... ..................... Monoclonal antibodies.. 7038 5.8452 $317.33 ............

$63.47 J7506................. N.................... ..................... Prednisone oral........ ..... ......... ........... ............ ............ J7507................. K.................... ..................... Tacrolimus oral per 1 0891 0.0236

$1.28 ............

$.26 MG. J7508................. E.................... ..................... Tacrolimus oral per 5 ..... ......... ........... ............ ............ MG. J7509................. N.................... ..................... Methylprednisolone oral ..... ......... ........... ............ ............ J7510................. N.................... ..................... Prednisolone oral per 5 ..... ......... ........... ............ ............ mg. J7511................. K.................... ..................... Antithymocyte globuln 9104 2.9801 $161.79 ............

$32.36 rabbit. J7513................. K.................... ..................... Daclizumab, parenteral. 1612 3.7304 $202.52 ............

$40.50 J7515................. N.................... ..................... Cyclosporine oral 25 mg ..... ......... ........... ............ ............ J7516................. N.................... ..................... Cyclosporin parenteral ..... ......... ........... ............ ............ 250mg. J7517................. K.................... ..................... Mycophenolate mofetil 9015 0.0373

$2.02 ............

$.40 oral. J7520................. K.................... ..................... Sirolimus, oral........ 9020 0.0520

$2.82 ............

$.56 J7525................. N.................... ..................... Tacrolimus injection... ..... ......... ........... ............ ............ J7599................. E.................... ..................... Immunosuppressive drug ..... ......... ........... ............ ............ noc. J7608................. A.................... ..................... Acetylcysteine inh sol ..... ......... ........... ............ ............ u d. J7618................. A.................... ..................... Albuterol inh sol con.. ..... ......... ........... ............ ............ J7619................. A.................... ..................... Albuterol inh sol u d.. ..... ......... ........... ............ ............ J7622................. A.................... ..................... Beclomethasone inhalatn ..... ......... ........... ............ ............ sol. J7624................. A.................... ..................... Betamethasone

..... ......... ........... ............ ............ inhalation sol. J7626................. A.................... ..................... Budesonide inhalation ..... ......... ........... ............ ............ sol. J7628................. A.................... ..................... Bitolterol mes inhal ..... ......... ........... ............ ............ sol con. J7629................. A.................... ..................... Bitolterol mes inh sol ..... ......... ........... ............ ............ u d. J7631................. A.................... ..................... Cromolyn sodium inh sol ..... ......... ........... ............ ............ u d. J7633................. N.................... ..................... Budesonide concentrated ..... ......... ........... ............ ............ sol. J7635................. A.................... ..................... Atropine inhal sol con. ..... ......... ........... ............ ............ J7636................. A.................... ..................... Atropine inhal sol unit ..... ......... ........... ............ ............ dose. J7637................. A.................... ..................... Dexamethasone inhal sol ..... ......... ........... ............ ............ con. J7638................. A.................... ..................... Dexamethasone inhal sol ..... ......... ........... ............ ............ u d. J7639................. A.................... ..................... Dornase alpha inhal sol ..... ......... ........... ............ ............ u d. J7641................. A.................... ..................... Flunisolide, inhalation ..... ......... ........... ............ ............ sol. J7642................. A.................... ..................... Glycopyrrolate inhal ..... ......... ........... ............ ............ sol con. J7643................. A.................... ..................... Glycopyrrolate inhal ..... ......... ........... ............ ............ sol u d. J7644................. A.................... ..................... Ipratropium brom inh ..... ......... ........... ............ ............ sol u d. J7648................. A.................... ..................... Isoetharine hcl inh sol ..... ......... ........... ............ ............ con. J7649................. A.................... ..................... Isoetharine hcl inh sol ..... ......... ........... ............ ............ u d. J7658................. A.................... ..................... Isoproterenolhcl inh ..... ......... ........... ............ ............ sol con. J7659................. A.................... ..................... Isoproterenol hcl inh ..... ......... ........... ............ ............ sol ud. J7668................. A.................... ..................... Metaproterenol inh sol ..... ......... ........... ............ ............ con. J7669................. A.................... ..................... Metaproterenol inh sol ..... ......... ........... ............ ............ u d. J7680................. A.................... ..................... Terbutaline so4 inh sol ..... ......... ........... ............ ............ con. J7681................. A.................... ..................... Terbutaline so4 inh sol ..... ......... ........... ............ ............ u d. J7682................. A.................... ..................... Tobramycin inhalation ..... ......... ........... ............ ............ sol. J7683................. A.................... ..................... Triamcinolone inh sol ..... ......... ........... ............ ............ con.

[[Page 48189]]

J7684................. A.................... ..................... Triamcinolone inh sol u ..... ......... ........... ............ ............ d. J7699................. A.................... ..................... Inhalation solution for ..... ......... ........... ............ ............ DME. J7799................. A.................... ..................... Non-inhalation drug for ..... ......... ........... ............ ............ DME. J8499................. E.................... ..................... Oral prescrip drug non ..... ......... ........... ............ ............ chemo. J8510................. K.................... ..................... Oral busulfan.......... 7015 0.0263

$1.43 ............

$.29 J8520................. K.................... ..................... Capecitabine, oral, 150 7042 0.0290

$1.57 ............

$.31 mg. J8521................. E.................... ..................... Capecitabine, oral, 500 ..... ......... ........... ............ ............ mg. J8530................. N.................... ..................... Cyclophosphamide oral ..... ......... ........... ............ ............ 25 MG. J8560................. K.................... ..................... Etoposide oral 50 MG... 0802 0.4830 $26.22 ............

$5.24 J8600................. N.................... ..................... Melphalan oral 2 MG.... ..... ......... ........... ............ ............ J8610................. N.................... ..................... Methotrexate oral 2.5 ..... ......... ........... ............ ............ MG. J8700................. K.................... ..................... Temozolmide............ 1086 0.0643

$3.49 ............

$.70 J8999................. E.................... ..................... Oral prescription drug ..... ......... ........... ............ ............ chemo. J9000................. N.................... ..................... Doxorubic hcl 10 MG vl ..... ......... ........... ............ ............ chemo. J9001................. K.................... ..................... Doxorubicin hcl

7046 4.6362 $251.69 ............

$50.34 liposome inj. J9010................. K.................... ..................... Alemtuzumab injection.. 9110 7.6422 $414.89 ............

$82.98 J9015................. K.................... ..................... Aldesleukin/single use 0807 7.0936 $385.10 ............

$77.02 vial. J9017................. K.................... ..................... Arsenic trioxide....... 9012 0.4837 $26.26 ............

$5.25 J9020................. N.................... ..................... Asparaginase injection. ..... ......... ........... ............ ............ J9031................. N.................... ..................... Bcg live intravesical ..... ......... ........... ............ ............ vac. J9040................. K.................... ..................... Bleomycin sulfate

0857 2.2352 $121.35 ............

$24.27 injection. J9045................. K.................... ..................... Carboplatin injection.. 0811 1.5475 $84.01 ............

$16.80 J9050................. K.................... ..................... Carmus bischl nitro inj 0812 0.9972 $54.14 ............

$10.83 J9060................. K.................... ..................... Cisplatin 10 MG

0813 0.3594 $19.51 ............

$3.90 injection. J9062................. E.................... ..................... Cisplatin 50 MG

..... ......... ........... ............ ............ injection. J9065................. K.................... ..................... Inj cladribine per 1 MG 0858 0.7031 $38.17 ............

$7.63 J9070................. N.................... ..................... Cyclophosphamide 100 MG ..... ......... ........... ............ ............ inj. J9080................. E.................... ..................... Cyclophosphamide 200 MG ..... ......... ........... ............ ............ inj. J9090................. E.................... ..................... Cyclophosphamide 500 MG ..... ......... ........... ............ ............ inj. J9091................. E.................... ..................... Cyclophosphamide 1.0 ..... ......... ........... ............ ............ grm inj. J9092................. E.................... ..................... Cyclophosphamide 2.0 ..... ......... ........... ............ ............ grm inj. J9093................. N.................... ..................... Cyclophosphamide

..... ......... ........... ............ ............ lyophilized. J9094................. E.................... ..................... Cyclophosphamide

..... ......... ........... ............ ............ lyophilized. J9095................. E.................... ..................... Cyclophosphamide

..... ......... ........... ............ ............ lyophilized. J9096................. E.................... ..................... Cyclophosphamide

..... ......... ........... ............ ............ lyophilized. J9097................. E.................... ..................... Cyclophosphamide

..... ......... ........... ............ ............ lyophilized. J9100................. N.................... ..................... Cytarabine hcl 100 MG ..... ......... ........... ............ ............ inj. J9110................. E.................... ..................... Cytarabine hcl 500 MG ..... ......... ........... ............ ............ inj. J9120................. N.................... ..................... Dactinomycin

..... ......... ........... ............ ............ actinomycin d. J9130................. N.................... ..................... Dacarbazine 10 MG inj.. ..... ......... ........... ............ ............ J9140................. E.................... ..................... Dacarbazine 200 MG inj. ..... ......... ........... ............ ............ J9150................. K.................... ..................... Daunorubicin........... 0820 .6052 $32.86 ............

$6.57 J9151................. K.................... ..................... Daunorubicin citrate 0821 2.9697 $161.22 ............

$32.24 liposom. J9160................. K.................... ..................... Denileukin diftitox, 1084 15.0913 $819.29 ............ $163.86 300 mcg. J9165................. K.................... ..................... Diethylstilbestrol

0822 1.3274 $72.06 ............

$14.41 injection. J9170................. K.................... ..................... Docetaxel.............. 0823 4.0041 $217.38 ............

$43.48 J9180................. E.................... ..................... Epirubicin HCl

..... ......... ........... ............ ............ injection. J9181................. N.................... ..................... Etoposide 10 MG inj.... ..... ......... ........... ............ ............ J9182................. E.................... ..................... Etoposide 100 MG inj... ..... ......... ........... ............ ............ J9185................. K.................... ..................... Fludarabine phosphate 0842 3.6854 $200.08 ............

$40.02 inj. J9190................. N.................... ..................... Fluorouracil injection. ..... ......... ........... ............ ............ J9200................. K.................... ..................... Floxuridine injection.. 0827 2.1836 $118.55 ............

$23.71 J9201................. K.................... ..................... Gemcitabine HCl........ 0828 1.4523 $78.84 ............

$15.77 J9202................. K.................... ..................... Goserelin acetate

0810 4.9549 $269.00 ............

$53.80 implant. J9206................. K.................... ..................... Irinotecan injection... 0830 1.8626 $101.12 ............

$20.22 J9208................. K.................... ..................... Ifosfomide injection... 0831 1.1616 $63.06 ............

$12.61 J9209................. K.................... ..................... Mesna injection........ 0732 0.4908 $26.65 ............

$5.33 J9211................. K.................... ..................... Idarubicin hcl

0832 3.2438 $176.10 ............

$35.22 injection. J9212................. N.................... ..................... Interferon alfacon-1... ..... ......... ........... ............ ............ J9213................. N.................... ..................... Interferon alfa-2a inj. ..... ......... ........... ............ ............ J9214................. K.................... ..................... Interferon alfa-2b inj. 0836 0.2000 $10.86 ............

$2.17 J9215................. K.................... ..................... Interferon alfa-n3 inj. 0865 1.5823 $85.90 ............

$17.18 J9216................. K.................... ..................... Interferon gamma 1-b 0838 2.4742 $134.32 ............

$26.86 inj. J9217................. K.................... ..................... Leuprolide acetate

9217 5.5128 $299.28 ............

$59.86 suspnsion. J9218................. K.................... ..................... Leuprolide acetate

0861 0.8223 $44.64 ............

$8.93 injeciton. J9219................. K.................... ..................... Leuprolide acetate

7051 68.9392 $3,742.64 ............ $748.53 implant.

[[Page 48190]]

J9230................. N.................... ..................... Mechlorethamine hcl inj ..... ......... ........... ............ ............ J9245................. K.................... ..................... Inj melphalan hydrochl 0840 4.4072 $239.26 ............

$47.85 50 MG. J9250................. N.................... ..................... Methotrexate sodium inj ..... ......... ........... ............ ............ J9260................. E.................... ..................... Methotrexate sodium inj ..... ......... ........... ............ ............ J9265................. K.................... ..................... Paclitaxel injection... 0863 1.2674 $68.81 ............

$13.76 J9266................. K.................... ..................... Pegaspargase/singl dose 0843 5.7621 $312.82 ............

$62.56 vial. J9268................. K.................... ..................... Pentostatin injection.. 0844 17.4201 $945.72 ............ $189.14 J9270................. N.................... ..................... Plicamycin

..... ......... ........... ............ ............ (mithramycin) inj. J9280................. K.................... ..................... Mitomycin 5 MG inj..... 0862 0.9557 $51.88 ............

$10.38 J9290................. E.................... ..................... Mitomycin 20 MG inj.... ..... ......... ........... ............ ............ J9291................. E.................... ..................... Mitomycin 40 MG inj.... ..... ......... ........... ............ ............ J9293................. K.................... ..................... Mitoxantrone hydrochl / 0864 3.1513 $171.08 ............

$34.22 5 MG. J9300................. K.................... ..................... Gemtuzumab ozogamicin.. 9004 17.5020 $950.17 ............ $190.03 J9310................. K.................... ..................... Rituximab cancer

0849 5.5636 $302.04 ............

$60.41 treatment. J9320................. K.................... ..................... Streptozocin injection. 0850 1.3942 $75.69 ............

$15.14 J9340................. N.................... ..................... Thiotepa injection..... ..... ......... ........... ............ ............ J9350................. K.................... ..................... Topotecan.............. 0852 7.9075 $429.29 ............

$85.86 J9355................. K.................... ..................... Trastuzumab............ 1613 0.7384 $40.09 ............

$8.02 J9357................. K.................... ..................... Valrubicin, 200 mg..... 1614 9.6183 $522.17 ............ $104.43 J9360................. N.................... ..................... Vinblastine sulfate inj ..... ......... ........... ............ ............ J9370................. N.................... ..................... Vincristine sulfate 1 ..... ......... ........... ............ ............ MG inj. J9375................. E.................... ..................... Vincristine sulfate 2 ..... ......... ........... ............ ............ MG inj. J9380................. E.................... ..................... Vincristine sulfate 5 ..... ......... ........... ............ ............ MG inj. J9390................. K.................... ..................... Vinorelbine tartrate/10 0855 1.1683 $63.43 ............

$12.69 mg. J9600................. K.................... ..................... Porfimer sodium........ 0856 25.3788 $1,377.79 ............ $275.56 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.................... ..................... 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.................... ..................... Reinforced back

..... ......... ........... ............ ............ upholstery. K0023................. A.................... ..................... Planr back insrt foam w/ ..... ......... ........... ............ ............ strp. K0024................. A.................... ..................... Plnr back insrt foam w/ ..... ......... ........... ............ ............ hrdwr. K0025................. A.................... ..................... Hook-on headrest

..... ......... ........... ............ ............ extension. K0026................. A.................... ..................... Back upholst lgtwt ..... ......... ........... ............ ............ whlchr. K0027................. A.................... ..................... Back upholst other ..... ......... ........... ............ ............ whlchr. K0028................. A.................... ..................... Manual fully reclining ..... ......... ........... ............ ............ back. K0029................. A.................... ..................... Reinforced seat

..... ......... ........... ............ ............ upholstery. K0030................. A.................... ..................... Solid plnr seat sngl ..... ......... ........... ............ ............ dnsfoam. K0031................. A.................... ..................... Safety belt/pelvic ..... ......... ........... ............ ............ strap. K0032................. A.................... ..................... Seat uphols lgtwt

..... ......... ........... ............ ............ whlchr. K0033................. A.................... ..................... Seat upholstery other ..... ......... ........... ............ ............ whlchr. K0035................. A.................... ..................... Heel loop with ankle ..... ......... ........... ............ ............ strap. K0036................. A.................... ..................... 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.

[[Page 48191]]

K0045................. A.................... ..................... Footrest complete

..... ......... ........... ............ ............ assembly. K0046................. A.................... ..................... Elevat legrst low

..... ......... ........... ............ ............ extension. K0047................. A.................... ..................... Elevat legrst up hangr ..... ......... ........... ............ ............ brack. K0048................. A.................... ..................... Elevate legrest

..... ......... ........... ............ ............ complete. K0049................. A.................... ..................... 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.................... ..................... Seat wdth 10-12/15/17/ ..... ......... ........... ............ ............ 20 wc. K0055................. A.................... ..................... Seat dpth 15/17/18 ltwt ..... ......... ........... ............ ............ wc. K0056................. A.................... ..................... Seat ht 17 ..... ......... ........... ............ ............ or 8 min. K0543................. A.................... ..................... SGD msg formed by

..... ......... ........... ............ ............ spelling. K0544................. A.................... ..................... SGD w multi methods msg/ ..... ......... ........... ............ ............ accs. K0545................. A.................... ..................... SGD sftwre prgrm for PC/ ..... ......... ........... ............ ............ PDA. K0546................. A.................... ..................... SGD accessory,mounting ..... ......... ........... ............ ............ systm. K0547................. A.................... ..................... SGD accessory NOC...... ..... ......... ........... ............ ............ K0548................. A.................... ..................... Insulin lispro......... ..... ......... ........... ............ ............ K0549................. A.................... ..................... Hosp bed hvy dty xtra ..... ......... ........... ............ ............ wide. K0550................. A.................... ..................... Hosp bed xtra hvy dty x ..... ......... ........... ............ ............ wide. K0556................. A.................... ..................... Socket insert w lock ..... ......... ........... ............ ............ mech. K0557................. A.................... ..................... Socket insert w/o lock ..... ......... ........... ............ ............ mech. K0558................. A.................... ..................... Intl custm cong/atyp ..... ......... ........... ............ ............ insert. K0559................. A.................... ..................... Initial custom socket ..... ......... ........... ............ ............ insert. K0560................. N.................... ..................... Mcp joint 2-piece for ..... ......... ........... ............ ............ implant. K0581................. A.................... ..................... Ost pch clsd w barrier/ ..... ......... ........... ............ ............ filtr. K0582................. A.................... ..................... Ost pch w bar/bltinconv/ ..... ......... ........... ............ ............ fltr. K0583................. A.................... ..................... Ost pch clsd w/o bar w ..... ......... ........... ............ ............ filtr. K0584................. A.................... ..................... Ost pch for bar w

..... ......... ........... ............ ............ flange/flt. K0585................. A.................... ..................... Ost pch clsd for bar w ..... ......... ........... ............ ............ lk fl. K0586................. A.................... ..................... Ost pch for bar w lk fl/ ..... ......... ........... ............ ............ fltr. K0587................. A.................... ..................... Ost pch drain w bar & ..... ......... ........... ............ ............ filter. K0588................. A.................... ..................... Ost pch drain for

..... ......... ........... ............ ............ barrier fl. K0589................. A.................... ..................... Ost pch drain 2 piece ..... ......... ........... ............ ............ system. K0590................. A.................... ..................... Ost pch drain/barr lk ..... ......... ........... ............ ............ flng/f. K0591................. A.................... ..................... Urine ost pouch w

..... ......... ........... ............ ............ faucet/tap. K0592................. A.................... ..................... Urine ost pouch w

..... ......... ........... ............ ............ bltinconv. K0593................. A.................... ..................... Ost urine pch w b/bltin ..... ......... ........... ............ ............ conv. K0594................. A.................... ..................... Ost pch urine w barrier/ ..... ......... ........... ............ ............ tapv. K0595................. A.................... ..................... Os pch urine w bar/ ..... ......... ........... ............ ............ fange/tap. K0596................. A.................... ..................... Urine ost pch bar w ..... ......... ........... ............ ............ lock fln. K0597................. A.................... ..................... Ost pch urine w lock ..... ......... ........... ............ ............ flng/ft. K0600................. A.................... ..................... Functional

..... ......... ........... ............ ............ neuromuscular stim. K0601................. A.................... ..................... Repl batt silver oxide ..... ......... ........... ............ ............ 1.5 v. K0602................. A.................... ..................... Repl batt silver oxide ..... ......... ........... ............ ............ 3 v. K0603................. A.................... ..................... Repl batt alkaline 1.5 ..... ......... ........... ............ ............ v. K0604................. A.................... ..................... Repl batt lithium 3.6 v ..... ......... ........... ............ ............ K0605................. A.................... ..................... Repl batt lithium 4.5 v ..... ......... ........... ............ ............ K0606................. A.................... ..................... AED garment w/elec ..... ......... ........... ............ ............ analysis. K0607................. A.................... ..................... Repl batt for AED

..... ......... ........... ............ ............ device. K0608................. A.................... ..................... Repl garment for AED... ..... ......... ........... ............ ............ K0609................. A.................... ..................... Repl electrode for AED. ..... ......... ........... ............ ............ K0610................. A.................... ..................... Peritoneal dialysis ..... ......... ........... ............ ............ clamp. K0611................. A.................... ..................... Disposable cycler set.. ..... ......... ........... ............ ............ K0612................. A.................... ..................... Drainage ext line, ..... ......... ........... ............ ............ dialysis. K0613................. A.................... ..................... Ext line w/easy lock ..... ......... ........... ............ ............ connect. K0614................. A.................... ..................... Chem/antiseptic

..... ......... ........... ............ ............ solution, 8oz. K0615................. A.................... ..................... 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.................... ..................... Gauze, non-impreg pack ..... ......... ........... ............ ............ strip. L0100................. A.................... ..................... Cranial orthosis/helmet ..... ......... ........... ............ ............ mold. L0110................. A.................... ..................... Cranial orthosis/helmet ..... ......... ........... ............ ............ nonm. 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. 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. 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........ ..... ......... ........... ............ ............

[[Page 48194]]

L0978................. A.................... ..................... Axillary crutch

..... ......... ........... ............ ............ extension. L0980................. A.................... ..................... Peroneal straps pair... ..... ......... ........... ............ ............ L0982................. A.................... ..................... Stocking supp grips set ..... ......... ........... ............ ............ of f. L0984................. A.................... ..................... Protective body sock ..... ......... ........... ............ ............ each. L0999................. A.................... ..................... Add to spinal orthosis ..... ......... ........... ............ ............ NOS. L1000................. A.................... ..................... Ctlso milwauke initial ..... ......... ........... ............ ............ model. L1005................. A.................... ..................... Tension based scoliosis ..... ......... ........... ............ ............ orth. L1010................. A.................... ..................... Ctlso axilla sling..... ..... ......... ........... ............ ............ L1020................. A.................... ..................... Kyphosis pad........... ..... ......... ........... ............ ............ L1025................. A.................... ..................... Kyphosis pad floating.. ..... ......... ........... ............ ............ L1030................. A.................... ..................... Lumbar bolster pad..... ..... ......... ........... ............ ............ L1040................. A.................... ..................... Lumbar or lumbar rib ..... ......... ........... ............ ............ pad. L1050................. A.................... ..................... Sternal pad............ ..... ......... ........... ............ ............ L1060................. A.................... ..................... Thoracic pad........... ..... ......... ........... ............ ............ L1070................. A.................... ..................... Trapezius sling........ ..... ......... ........... ............ ............ L1080................. A.................... ..................... Outrigger.............. ..... ......... ........... ............ ............ L1085................. A.................... ..................... Outrigger bil w/ vert ..... ......... ........... ............ ............ extens. L1090................. A.................... ..................... Lumbar sling........... ..... ......... ........... ............ ............ L1100................. A.................... ..................... Ring flange plastic/ ..... ......... ........... ............ ............ leather. L1110................. A.................... ..................... Ring flange plas/

..... ......... ........... ............ ............ leather mol. L1120................. A.................... ..................... Covers for upright each ..... ......... ........... ............ ............ L1200................. A.................... ..................... Furnsh initial orthosis ..... ......... ........... ............ ............ only. L1210................. A.................... ..................... Lateral thoracic

..... ......... ........... ............ ............ extension. L1220................. A.................... ..................... Anterior thoracic

..... ......... ........... ............ ............ extension. L1230................. A.................... ..................... Milwaukee type

..... ......... ........... ............ ............ superstructur. L1240................. A.................... ..................... Lumbar derotation pad.. ..... ......... ........... ............ ............ L1250................. A.................... ..................... Anterior asis pad...... ..... ......... ........... ............ ............ L1260................. A.................... ..................... Anterior thoracic

..... ......... ........... ............ ............ derotation. L1270................. A.................... ..................... Abdominal pad.......... ..... ......... ........... ............ ............ L1280................. A.................... ..................... Rib gusset (elastic) ..... ......... ........... ............ ............ each. L1290................. A.................... ..................... Lateral trochanteric ..... ......... ........... ............ ............ pad. L1300................. A.................... ..................... Body jacket mold to ..... ......... ........... ............ ............ patient. L1310................. A.................... ..................... Post-operative body ..... ......... ........... ............ ............ jacket. L1499................. A.................... ..................... Spinal orthosis NOS.... ..... ......... ........... ............ ............ L1500................. A.................... ..................... Thkao mobility frame... ..... ......... ........... ............ ............ L1510................. A.................... ..................... Thkao standing frame... ..... ......... ........... ............ ............ L1520................. A.................... ..................... Thkao swivel walker.... ..... ......... ........... ............ ............ L1600................. A.................... ..................... Abduct hip flex frejka ..... ......... ........... ............ ............ w cvr. L1610................. A.................... ..................... Abduct hip flex frejka ..... ......... ........... ............ ............ covr. L1620................. A.................... ..................... Abduct hip flex pavlik ..... ......... ........... ............ ............ harne. L1630................. A.................... ..................... Abduct control hip semi- ..... ......... ........... ............ ............ flex. L1640................. A.................... ..................... Pelv band/spread bar ..... ......... ........... ............ ............ thigh c. L1650................. A.................... ..................... HO abduction hip

..... ......... ........... ............ ............ adjustable. L1652................. A.................... ..................... HO bi thighcuffs w ..... ......... ........... ............ ............ sprdr bar. L1660................. A.................... ..................... HO abduction static ..... ......... ........... ............ ............ plastic. L1680................. A.................... ..................... Pelvic & hip control ..... ......... ........... ............ ............ thigh c. L1685................. A.................... ..................... Post-op hip abduct ..... ......... ........... ............ ............ custom fa. L1686................. A.................... ..................... HO post-op hip

..... ......... ........... ............ ............ abduction. L1690................. A.................... ..................... Combination bilateral ..... ......... ........... ............ ............ HO. L1700................. A.................... ..................... Leg perthes orth

..... ......... ........... ............ ............ toronto typ. L1710................. A.................... ..................... Legg perthes orth

..... ......... ........... ............ ............ newington. L1720................. A.................... ..................... Legg perthes orthosis ..... ......... ........... ............ ............ trilat. L1730................. A.................... ..................... Legg perthes orth

..... ......... ........... ............ ............ scottish r. L1750................. A.................... ..................... Legg perthes sling..... ..... ......... ........... ............ ............ L1755................. A.................... ..................... Legg perthes patten ..... ......... ........... ............ ............ bottom t. L1800................. A.................... ..................... Knee orthoses elas w ..... ......... ........... ............ ............ stays. L1810................. A.................... ..................... Ko elastic with joints. ..... ......... ........... ............ ............ 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. 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.

[[Page 48195]]

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.................... ..................... 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. 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. L1960................. A.................... ..................... Afo pos solid ank

..... ......... ........... ............ ............ plastic mo. L1970................. A.................... ..................... Afo plastic molded w/ ..... ......... ........... ............ ............ ankle j. 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.................... ..................... Afo tibial fx cast ..... ......... ........... ............ ............ plstr mol. L2104................. E.................... ..................... 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.................... ..................... Kafo fem fx cast

..... ......... ........... ............ ............ plaster mol. L2124................. E.................... ..................... 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. 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.

[[Page 48196]]

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. L2840................. A.................... ..................... Tibial length sock fx ..... ......... ........... ............ ............ or equ. L2850................. A.................... ..................... Femoral lgth sock fx or ..... ......... ........... ............ ............ equa. L2860................. A.................... ..................... Torsion mechanism knee/ ..... ......... ........... ............ ............ ankle.

[[Page 48197]]

L2999................. A.................... ..................... Lower extremity

..... ......... ........... ............ ............ orthosis NOS. L3000................. E.................... ..................... Ft insert ucb berkeley ..... ......... ........... ............ ............ shell. L3001................. E.................... ..................... Foot insert remov

..... ......... ........... ............ ............ molded spe. L3002................. E.................... ..................... Foot insert plastazote ..... ......... ........... ............ ............ or eq. L3003................. E.................... ..................... Foot insert silicone ..... ......... ........... ............ ............ gel eac. L3010................. E.................... ..................... Foot longitudinal arch ..... ......... ........... ............ ............ suppo. L3020................. E.................... ..................... Foot longitud/

..... ......... ........... ............ ............ metatarsal sup. L3030................. E.................... ..................... Foot arch support remov ..... ......... ........... ............ ............ prem. L3040................. E.................... ..................... Ft arch suprt premold ..... ......... ........... ............ ............ longit. L3050................. E.................... ..................... Foot arch supp premold ..... ......... ........... ............ ............ metat. L3060................. E.................... ..................... Foot arch supp longitud/ ..... ......... ........... ............ ............ meta. L3070................. E.................... ..................... Arch suprt att to sho ..... ......... ........... ............ ............ longit. L3080................. E.................... ..................... Arch supp att to shoe ..... ......... ........... ............ ............ metata. L3090................. E.................... ..................... Arch supp att to shoe ..... ......... ........... ............ ............ long/m. L3100................. E.................... ..................... Hallus-valgus nght ..... ......... ........... ............ ............ dynamic s. L3140................. E.................... ..................... Abduction rotation bar ..... ......... ........... ............ ............ shoe. L3150................. E.................... ..................... Abduct rotation bar w/o ..... ......... ........... ............ ............ shoe. L3160................. E.................... ..................... Shoe styled positioning ..... ......... ........... ............ ............ dev. L3170................. E.................... ..................... Foot plastic heel

..... ......... ........... ............ ............ stabilizer. L3201................. E.................... ..................... Oxford w supinat/pronat ..... ......... ........... ............ ............ inf. L3202................. E.................... ..................... Oxford w/ supinat/ ..... ......... ........... ............ ............ pronator c. L3203................. E.................... ..................... Oxford w/ supinator/ ..... ......... ........... ............ ............ pronator. L3204................. E.................... ..................... Hightop w/ supp/

..... ......... ........... ............ ............ pronator inf. L3206................. E.................... ..................... Hightop w/ supp/

..... ......... ........... ............ ............ pronator chi. L3207................. E.................... ..................... Hightop w/ supp/

..... ......... ........... ............ ............ pronator jun. L3208................. E.................... ..................... Surgical boot each ..... ......... ........... ............ ............ infant. L3209................. E.................... ..................... Surgical boot each ..... ......... ........... ............ ............ child. L3211................. E.................... ..................... Surgical boot each ..... ......... ........... ............ ............ junior. L3212................. E.................... ..................... Benesch boot pair

..... ......... ........... ............ ............ infant. L3213................. E.................... ..................... Benesch boot pair child ..... ......... ........... ............ ............ L3214................. E.................... ..................... Benesch boot pair

..... ......... ........... ............ ............ junior. L3215................. E.................... ..................... Orthopedic ftwear

..... ......... ........... ............ ............ ladies oxf. L3216................. E.................... ..................... Orthoped ladies shoes ..... ......... ........... ............ ............ dpth i. L3217................. E.................... ..................... Ladies shoes hightop ..... ......... ........... ............ ............ depth i. L3219................. E.................... ..................... Orthopedic mens shoes ..... ......... ........... ............ ............ oxford. L3221................. E.................... ..................... Orthopedic mens shoes ..... ......... ........... ............ ............ dpth i. L3222................. E.................... ..................... Mens shoes hightop ..... ......... ........... ............ ............ depth inl. L3224................. A.................... ..................... Woman's shoe oxford ..... ......... ........... ............ ............ brace. L3225................. A.................... ..................... Man's shoe oxford brace ..... ......... ........... ............ ............ L3230................. E.................... ..................... Custom shoes depth ..... ......... ........... ............ ............ inlay. L3250................. E.................... ..................... Custom mold shoe remov ..... ......... ........... ............ ............ prost. L3251................. E.................... ..................... Shoe molded to pt

..... ......... ........... ............ ............ silicone s. L3252................. E.................... ..................... Shoe molded plastazote ..... ......... ........... ............ ............ cust. L3253................. E.................... ..................... Shoe molded plastazote ..... ......... ........... ............ ............ cust. L3254................. E.................... ..................... Orth foot non-stndard ..... ......... ........... ............ ............ size/w. L3255................. E.................... ..................... Orth foot non-standard ..... ......... ........... ............ ............ size/. L3257................. E.................... ..................... Orth foot add charge ..... ......... ........... ............ ............ split s. L3260................. E.................... ..................... Ambulatory surgical ..... ......... ........... ............ ............ boot eac. L3265................. E.................... ..................... Plastazote sandal each. ..... ......... ........... ............ ............ L3300................. E.................... ..................... Sho lift taper to

..... ......... ........... ............ ............ metatarsal. L3310................. E.................... ..................... Shoe lift elev heel/ ..... ......... ........... ............ ............ sole neo. L3320................. E.................... ..................... Shoe lift elev heel/ ..... ......... ........... ............ ............ sole cor. L3330................. E.................... ..................... Lifts elevation metal ..... ......... ........... ............ ............ extens. L3332................. E.................... ..................... Shoe lifts tapered to ..... ......... ........... ............ ............ one-ha. L3334................. E.................... ..................... Shoe lifts elevation ..... ......... ........... ............ ............ heel /i. L3340................. E.................... ..................... Shoe wedge sach........ ..... ......... ........... ............ ............ L3350................. E.................... ..................... Shoe heel wedge........ ..... ......... ........... ............ ............ L3360................. E.................... ..................... Shoe sole wedge outside ..... ......... ........... ............ ............ sole. L3370................. E.................... ..................... Shoe sole wedge between ..... ......... ........... ............ ............ sole. L3380................. E.................... ..................... Shoe clubfoot wedge.... ..... ......... ........... ............ ............ L3390................. E.................... ..................... Shoe outflare wedge.... ..... ......... ........... ............ ............ L3400................. E.................... ..................... Shoe metatarsal bar ..... ......... ........... ............ ............ wedge ro. L3410................. E.................... ..................... Shoe metatarsal bar ..... ......... ........... ............ ............ between. L3420................. E.................... ..................... Full sole/heel wedge ..... ......... ........... ............ ............ btween. L3430................. E.................... ..................... Sho heel count plast ..... ......... ........... ............ ............ reinfor. L3440................. E.................... ..................... Heel leather reinforced ..... ......... ........... ............ ............

[[Page 48198]]

L3450................. E.................... ..................... Shoe heel sach cushion ..... ......... ........... ............ ............ type. L3455................. E.................... ..................... Shoe heel new leather ..... ......... ........... ............ ............ standa. L3460................. E.................... ..................... Shoe heel new rubber ..... ......... ........... ............ ............ standar. L3465................. E.................... ..................... Shoe heel thomas with ..... ......... ........... ............ ............ wedge. L3470................. E.................... ..................... Shoe heel thomas extend ..... ......... ........... ............ ............ to b. L3480................. E.................... ..................... Shoe heel pad & depress ..... ......... ........... ............ ............ for. L3485................. E.................... ..................... Shoe heel pad removable ..... ......... ........... ............ ............ for. L3500................. E.................... ..................... Ortho shoe add leather ..... ......... ........... ............ ............ insol. L3510................. E.................... ..................... Orthopedic shoe add rub ..... ......... ........... ............ ............ insl. L3520................. E.................... ..................... O shoe add felt w leath ..... ......... ........... ............ ............ insl. L3530................. E.................... ..................... Ortho shoe add half ..... ......... ........... ............ ............ sole. L3540................. E.................... ..................... Ortho shoe add full ..... ......... ........... ............ ............ sole. L3550................. E.................... ..................... O shoe add standard toe ..... ......... ........... ............ ............ tap. L3560................. E.................... ..................... O shoe add horseshoe ..... ......... ........... ............ ............ toe tap. L3570................. E.................... ..................... O shoe add instep

..... ......... ........... ............ ............ extension. L3580................. E.................... ..................... O shoe add instep

..... ......... ........... ............ ............ velcro clo. L3590................. E.................... ..................... O shoe convert to sof ..... ......... ........... ............ ............ counte. L3595................. E.................... ..................... Ortho shoe add march ..... ......... ........... ............ ............ bar. L3600................. E.................... ..................... Trans shoe calip plate ..... ......... ........... ............ ............ exist. L3610................. E.................... ..................... Trans shoe caliper ..... ......... ........... ............ ............ plate new. L3620................. E.................... ..................... Trans shoe solid

..... ......... ........... ............ ............ stirrup exi. L3630................. E.................... ..................... Trans shoe solid

..... ......... ........... ............ ............ stirrup new. L3640................. E.................... ..................... Shoe dennis browne ..... ......... ........... ............ ............ splint bo. L3649................. E.................... ..................... 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................. E.................... ..................... 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.

[[Page 48199]]

L3916................. A.................... ..................... Whfo wrist extens w/ ..... ......... ........... ............ ............ outrigg. L3918................. A.................... ..................... HFO knuckle bender..... ..... ......... ........... ............ ............ L3920................. A.................... ..................... Knuckle bender with ..... ......... ........... ............ ............ outrigge. L3922................. A.................... ..................... Knuckle bend 2 seg to ..... ......... ........... ............ ............ flex j. L3923................. A.................... ..................... HFO, no joint,

..... ......... ........... ............ ............ prefabricated. L3924................. A.................... ..................... Oppenheimer............ ..... ......... ........... ............ ............ L3926................. A.................... ..................... Thomas suspension...... ..... ......... ........... ............ ............ L3928................. A.................... ..................... Finger extension w/ ..... ......... ........... ............ ............ clock sp. L3930................. A.................... ..................... Finger extension with ..... ......... ........... ............ ............ wrist. L3932................. A.................... ..................... Safety pin spring wire. ..... ......... ........... ............ ............ L3934................. A.................... ..................... Safety pin modified.... ..... ......... ........... ............ ............ L3936................. A.................... ..................... Palmer................. ..... ......... ........... ............ ............ L3938................. A.................... ..................... Dorsal wrist........... ..... ......... ........... ............ ............ L3940................. A.................... ..................... Dorsal wrist w/

..... ......... ........... ............ ............ outrigger at. L3942................. A.................... ..................... Reverse knuckle bender. ..... ......... ........... ............ ............ L3944................. A.................... ..................... Reverse knuckle bend w/ ..... ......... ........... ............ ............ outr. L3946................. A.................... ..................... HFO composite elastic.. ..... ......... ........... ............ ............ L3948................. A.................... ..................... Finger knuckle bender.. ..... ......... ........... ............ ............ L3950................. A.................... ..................... Oppenheimer w/ knuckle ..... ......... ........... ............ ............ bend. L3952................. A.................... ..................... Oppenheimer w/ rev ..... ......... ........... ............ ............ knuckle 2. L3954................. A.................... ..................... Spreading hand......... ..... ......... ........... ............ ............ L3956................. A.................... ..................... Add joint upper ext ..... ......... ........... ............ ............ orthosis. L3960................. A.................... ..................... Sewho airplan desig ..... ......... ........... ............ ............ abdu pos. L3962................. A.................... ..................... Sewho erbs palsey

..... ......... ........... ............ ............ design abd. L3963................. A.................... ..................... Molded w/ articulating ..... ......... ........... ............ ............ elbow. L3964................. 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.

[[Page 48200]]

L5000................. A.................... ..................... Sho insert w arch toe ..... ......... ........... ............ ............ filler. L5010................. A.................... ..................... Mold socket ank hgt w/ ..... ......... ........... ............ ............ toe f. L5020................. A.................... ..................... Tibial tubercle hgt w/ ..... ......... ........... ............ ............ toe f. L5050................. A.................... ..................... Ank symes mold sckt ..... ......... ........... ............ ............ sach ft. L5060................. A.................... ..................... Symes met fr leath ..... ......... ........... ............ ............ socket ar. L5100................. A.................... ..................... Molded socket shin sach ..... ......... ........... ............ ............ foot. L5105................. A.................... ..................... Plast socket jts/thgh ..... ......... ........... ............ ............ lacer. L5150................. A.................... ..................... Mold sckt ext knee shin ..... ......... ........... ............ ............ sach. L5160................. A.................... ..................... Mold socket bent knee ..... ......... ........... ............ ............ shin s. L5200................. A.................... ..................... Kne sing axis fric shin ..... ......... ........... ............ ............ sach. L5210................. A.................... ..................... No knee/ankle joints w/ ..... ......... ........... ............ ............ ft b. L5220................. A.................... ..................... No knee joint with ..... ......... ........... ............ ............ artic ali. L5230................. A.................... ..................... Fem focal defic

..... ......... ........... ............ ............ constant fri. L5250................. A.................... ..................... Hip canad sing axi cons ..... ......... ........... ............ ............ fric. L5270................. A.................... ..................... Tilt table locking hip ..... ......... ........... ............ ............ sing. L5280................. A.................... ..................... Hemipelvect canad sing ..... ......... ........... ............ ............ axis. L5301................. A.................... ..................... BK mold socket SACH ft ..... ......... ........... ............ ............ endo. L5311................. A.................... ..................... Knee disart, SACH ft, ..... ......... ........... ............ ............ endo. L5321................. A.................... ..................... AK open end SACH....... ..... ......... ........... ............ ............ L5331................. A.................... ..................... Hip disart canadian ..... ......... ........... ............ ............ SACH ft. L5341................. A.................... ..................... Hemipelvectomy canadian ..... ......... ........... ............ ............ SACH. L5400................. A.................... ..................... Postop dress & 1 cast ..... ......... ........... ............ ............ chg bk. L5410................. A.................... ..................... Postop dsg bk ea add ..... ......... ........... ............ ............ cast ch. L5420................. A.................... ..................... Postop dsg & 1 cast chg ..... ......... ........... ............ ............ ak/d. L5430................. A.................... ..................... Postop dsg ak ea add ..... ......... ........... ............ ............ cast ch. L5450................. A.................... ..................... Postop app non-wgt bear ..... ......... ........... ............ ............ dsg. L5460................. A.................... ..................... Postop app non-wgt bear ..... ......... ........... ............ ............ dsg. L5500................. A.................... ..................... Init bk ptb plaster ..... ......... ........... ............ ............ direct. L5505................. A.................... ..................... Init ak ischal plstr ..... ......... ........... ............ ............ direct. L5510................. A.................... ..................... Prep BK ptb plaster ..... ......... ........... ............ ............ molded. L5520................. A.................... ..................... Perp BK ptb thermopls ..... ......... ........... ............ ............ direct. L5530................. A.................... ..................... Prep BK ptb thermopls ..... ......... ........... ............ ............ molded. L5535................. A.................... ..................... Prep BK ptb open end ..... ......... ........... ............ ............ socket. L5540................. A.................... ..................... Prep BK ptb laminated ..... ......... ........... ............ ............ socket. L5560................. A.................... ..................... Prep AK ischial plast ..... ......... ........... ............ ............ molded. L5570................. A.................... ..................... Prep AK ischial direct ..... ......... ........... ............ ............ form. L5580................. A.................... ..................... Prep AK ischial thermo ..... ......... ........... ............ ............ mold. L5585................. A.................... ..................... Prep AK ischial open ..... ......... ........... ............ ............ end. L5590................. A.................... ..................... Prep AK ischial

..... ......... ........... ............ ............ laminated. L5595................. A.................... ..................... Hip disartic sach

..... ......... ........... ............ ............ thermopls. L5600................. A.................... ..................... Hip disart sach laminat ..... ......... ........... ............ ............ mold. L5610................. A.................... ..................... Above knee hydracadence ..... ......... ........... ............ ............ L5611................. A.................... ..................... Ak 4 bar link w/fric ..... ......... ........... ............ ............ swing. L5613................. A.................... ..................... Ak 4 bar ling w/hydraul ..... ......... ........... ............ ............ swig. L5614................. A.................... ..................... 4-bar link above knee w/ ..... ......... ........... ............ ............ swng. L5616................. A.................... ..................... Ak univ multiplex sys ..... ......... ........... ............ ............ frict. L5617................. A.................... ..................... AK/BK self-aligning ..... ......... ........... ............ ............ unit ea. L5618................. A.................... ..................... Test socket symes...... ..... ......... ........... ............ ............ L5620................. A.................... ..................... Test socket below knee. ..... ......... ........... ............ ............ L5622................. A.................... ..................... Test socket knee

..... ......... ........... ............ ............ disarticula. L5624................. A.................... ..................... Test socket above knee. ..... ......... ........... ............ ............ L5626................. A.................... ..................... Test socket hip

..... ......... ........... ............ ............ disarticulat. L5628................. A.................... ..................... Test socket

..... ......... ........... ............ ............ hemipelvectomy. 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. ..... ......... ........... ............ ............

[[Page 48201]]

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. 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... ..... ......... ........... ............ ............ L5680................. A.................... ..................... Bk thigh lacer non- ..... ......... ........... ............ ............ molded. L5682................. A.................... ..................... Bk thigh lacer glut/ ..... ......... ........... ............ ............ ischia m. 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.

[[Page 48202]]

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. 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.

[[Page 48203]]

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-friction wrist ..... ......... ........... ............ ............ unit. L6623................. A.................... ..................... Spring-ass rot wrst w/ ..... ......... ........... ............ ............ latch. L6625................. A.................... ..................... Rotation wrst w/ cable ..... ......... ........... ............ ............ lock. L6628................. A.................... ..................... Quick disconn hook ..... ......... ........... ............ ............ adapter o. L6629................. A.................... ..................... Lamination collar w/ ..... ......... ........... ............ ............ couplin. L6630................. A.................... ..................... Stainless steel any ..... ......... ........... ............ ............ wrist. L6632................. A.................... ..................... Latex suspension sleeve ..... ......... ........... ............ ............ each. L6635................. A.................... ..................... Lift assist for elbow.. ..... ......... ........... ............ ............ L6637................. A.................... ..................... Nudge control elbow ..... ......... ........... ............ ............ lock. L6638................. A.................... ..................... Elec lock on manual pw ..... ......... ........... ............ ............ elbow. L6640................. A.................... ..................... Shoulder abduction ..... ......... ........... ............ ............ joint pai. L6641................. A.................... ..................... Excursion amplifier ..... ......... ........... ............ ............ pulley t. L6642................. A.................... ..................... Excursion amplifier ..... ......... ........... ............ ............ lever ty. L6645................. A.................... ..................... Shoulder flexion-

..... ......... ........... ............ ............ abduction j. L6646................. A.................... ..................... Multipo locking

..... ......... ........... ............ ............ shoulder jnt. L6647................. A.................... ..................... Shoulder lock actuator. ..... ......... ........... ............ ............ L6648................. A.................... ..................... Ext pwrd shlder lock/ ..... ......... ........... ............ ............ unlock. L6650................. A.................... ..................... Shoulder universal ..... ......... ........... ............ ............ joint. L6655................. A.................... ..................... Standard control cable ..... ......... ........... ............ ............ extra. L6660................. A.................... ..................... Heavy duty control ..... ......... ........... ............ ............ cable. L6665................. A.................... ..................... Teflon or equal cable ..... ......... ........... ............ ............ lining. L6670................. A.................... ..................... Hook to hand cable ..... ......... ........... ............ ............ adapter. L6672................. A.................... ..................... Harness chest/shlder ..... ......... ........... ............ ............ saddle. L6675................. A.................... ..................... Harness figure of 8 ..... ......... ........... ............ ............ sing con. L6676................. A.................... ..................... Harness figure of 8 ..... ......... ........... ............ ............ dual con. L6680................. A.................... ..................... Test sock wrist disart/ ..... ......... ........... ............ ............ bel e. L6682................. A.................... ..................... Test sock elbw disart/ ..... ......... ........... ............ ............ above. L6684................. A.................... ..................... Test socket shldr

..... ......... ........... ............ ............ disart/tho. L6686................. A.................... ..................... Suction socket......... ..... ......... ........... ............ ............ L6687................. A.................... ..................... Frame typ socket bel ..... ......... ........... ............ ............ elbow/w. L6688................. A.................... ..................... Frame typ sock above ..... ......... ........... ............ ............ elb/dis. L6689................. A.................... ..................... Frame typ socket

..... ......... ........... ............ ............ shoulder di. L6690................. A.................... ..................... Frame typ sock

..... ......... ........... ............ ............ interscap-tho. L6691................. A.................... ..................... Removable insert each.. ..... ......... ........... ............ ............ 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.

[[Page 48204]]

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... ..... ......... ........... ............ ............ L6845................. A.................... ..................... Hand becker lock grip.. ..... ......... ........... ............ ............ L6850................. A.................... ..................... Term dvc-hand becker ..... ......... ........... ............ ............ plylite. L6855................. A.................... ..................... Hand robin-aids vo..... ..... ......... ........... ............ ............ L6860................. A.................... ..................... Hand robin-aids vo soft ..... ......... ........... ............ ............ L6865................. A.................... ..................... Hand passive hand...... ..... ......... ........... ............ ............ L6867................. A.................... ..................... Hand detroit infant ..... ......... ........... ............ ............ hand. L6868................. A.................... ..................... Passive inf hand

..... ......... ........... ............ ............ steeper/hos. L6870................. A.................... ..................... Hand child mitt........ ..... ......... ........... ............ ............ L6872................. A.................... ..................... Hand nyu child hand.... ..... ......... ........... ............ ............ L6873................. A.................... ..................... Hand mech inf steeper ..... ......... ........... ............ ............ or equ. L6875................. A.................... ..................... Hand bock vc........... ..... ......... ........... ............ ............ L6880................. A.................... ..................... Hand bock vo........... ..... ......... ........... ............ ............ L6881................. A.................... ..................... Autograsp feature ul ..... ......... ........... ............ ............ term dv. L6882................. A.................... ..................... Microprocessor control ..... ......... ........... ............ ............ uplmb. L6890................. A.................... ..................... Production glove....... ..... ......... ........... ............ ............ L6895................. A.................... ..................... Custom glove........... ..... ......... ........... ............ ............ L6900................. A.................... ..................... Hand restorat thumb/1 ..... ......... ........... ............ ............ finger. L6905................. A.................... ..................... Hand restoration

..... ......... ........... ............ ............ multiple fi. L6910................. A.................... ..................... Hand restoration no ..... ......... ........... ............ ............ fingers. L6915................. A.................... ..................... Hand restoration

..... ......... ........... ............ ............ replacmnt g. L6920................. A.................... ..................... Wrist disarticul switch ..... ......... ........... ............ ............ ctrl. L6925................. A.................... ..................... Wrist disart

..... ......... ........... ............ ............ myoelectronic c. L6930................. A.................... ..................... Below elbow switch ..... ......... ........... ............ ............ control. L6935................. A.................... ..................... Below elbow

..... ......... ........... ............ ............ myoelectronic ct. L6940................. A.................... ..................... Elbow disarticulation ..... ......... ........... ............ ............ switch. L6945................. A.................... ..................... Elbow disart

..... ......... ........... ............ ............ myoelectronic c. L6950................. A.................... ..................... Above elbow switch ..... ......... ........... ............ ............ control. L6955................. A.................... ..................... Above elbow

..... ......... ........... ............ ............ myoelectronic ct. L6960................. A.................... ..................... Shldr disartic switch ..... ......... ........... ............ ............ contro. L6965................. A.................... ..................... Shldr disartic

..... ......... ........... ............ ............ myoelectronic. L6970................. A.................... ..................... Interscapular-thor ..... ......... ........... ............ ............ switch ct. L6975................. A.................... ..................... Interscap-thor

..... ......... ........... ............ ............ myoelectronic. L7010................. A.................... ..................... Hand otto back steeper/ ..... ......... ........... ............ ............ eq sw. L7015................. A.................... ..................... Hand sys teknik village ..... ......... ........... ............ ............ swit. L7020................. A.................... ..................... Electronic greifer ..... ......... ........... ............ ............ switch ct. L7025................. A.................... ..................... Electron hand

..... ......... ........... ............ ............ myoelectronic. L7030................. A.................... ..................... Hand sys teknik vill ..... ......... ........... ............ ............ myoelec. L7035................. A.................... ..................... Electron greifer

..... ......... ........... ............ ............ myoelectro. L7040................. A.................... ..................... Prehensile actuator ..... ......... ........... ............ ............ hosmer s. L7045................. A.................... ..................... Electron hook child ..... ......... ........... ............ ............ michigan. L7170................. A.................... ..................... Electronic elbow hosmer ..... ......... ........... ............ ............ swit. L7180................. A.................... ..................... Electronic elbow utah ..... ......... ........... ............ ............ myoele. L7185................. A.................... ..................... Electron elbow

..... ......... ........... ............ ............ adolescent sw. L7186................. A.................... ..................... Electron elbow child ..... ......... ........... ............ ............ switch. L7190................. A.................... ..................... Elbow adolescent

..... ......... ........... ............ ............ myoelectron. L7191................. A.................... ..................... Elbow child

..... ......... ........... ............ ............ myoelectronic ct. L7260................. A.................... ..................... Electron wrist rotator ..... ......... ........... ............ ............ otto. L7261................. A.................... ..................... Electron wrist rotator ..... ......... ........... ............ ............ utah. L7266................. A.................... ..................... Servo control steeper ..... ......... ........... ............ ............ or equ. L7272................. A.................... ..................... Analogue control unb or ..... ......... ........... ............ ............ equa.

[[Page 48205]]

L7274................. A.................... ..................... Proportional ctl 12 ..... ......... ........... ............ ............ volt uta. L7360................. A.................... ..................... Six volt bat otto bock/ ..... ......... ........... ............ ............ eq ea. L7362................. A.................... ..................... Battery chrgr six volt ..... ......... ........... ............ ............ otto. L7364................. A.................... ..................... Twelve volt battery ..... ......... ........... ............ ............ utah/equ. L7366................. A.................... ..................... Battery chrgr 12 volt ..... ......... ........... ............ ............ utah/e. L7367................. A.................... ..................... Replacemnt lithium ..... ......... ........... ............ ............ ionbatter. L7368................. A.................... ..................... Lithium ion battery ..... ......... ........... ............ ............ charger. L7499................. A.................... ..................... Upper extremity

..... ......... ........... ............ ............ prosthes NOS. L7500................. A.................... ..................... Prosthetic dvc repair ..... ......... ........... ............ ............ hourly. L7510................. A.................... ..................... Prosthetic device

..... ......... ........... ............ ............ repair rep. L7520................. A.................... ..................... Repair prosthesis per ..... ......... ........... ............ ............ 15 min. L7900................. A.................... ..................... Vacuum erection system. ..... ......... ........... ............ ............ L8000................. A.................... ..................... Mastectomy bra......... ..... ......... ........... ............ ............ L8001................. A.................... ..................... Breast prosthesis bra & ..... ......... ........... ............ ............ form. L8002................. A.................... ..................... Brst prsth bra & bilat ..... ......... ........... ............ ............ form. L8010................. A.................... ..................... Mastectomy sleeve...... ..... ......... ........... ............ ............ L8015................. A.................... ..................... Ext breastprosthesis ..... ......... ........... ............ ............ garment. L8020................. A.................... ..................... Mastectomy form........ ..... ......... ........... ............ ............ L8030................. A.................... ..................... Breast prosthesis

..... ......... ........... ............ ............ silicone/e. L8035................. A.................... ..................... Custom breast

..... ......... ........... ............ ............ prosthesis. L8039................. A.................... ..................... Breast prosthesis NOS.. ..... ......... ........... ............ ............ L8040................. A.................... ..................... Nasal prosthesis....... ..... ......... ........... ............ ............ L8041................. A.................... ..................... Midfacial prosthesis... ..... ......... ........... ............ ............ L8042................. A.................... ..................... Orbital prosthesis..... ..... ......... ........... ............ ............ L8043................. A.................... ..................... Upper facial prosthesis ..... ......... ........... ............ ............ L8044................. A.................... ..................... Hemi-facial prosthesis. ..... ......... ........... ............ ............ L8045................. A.................... ..................... Auricular prosthesis... ..... ......... ........... ............ ............ L8046................. A.................... ..................... Partial facial

..... ......... ........... ............ ............ prosthesis. L8047................. A.................... ..................... Nasal septal prosthesis ..... ......... ........... ............ ............ L8048................. A.................... ..................... Unspec maxillofacial ..... ......... ........... ............ ............ prosth. L8049................. A.................... ..................... Repair maxillofacial ..... ......... ........... ............ ............ prosth. L8100................. E.................... ..................... Compression stocking ..... ......... ........... ............ ............ BK18-30. L8110................. E.................... ..................... Compression stocking ..... ......... ........... ............ ............ BK30-40. L8120................. E.................... ..................... Compression stocking ..... ......... ........... ............ ............ BK40-50. L8130................. E.................... ..................... Gc stocking thighlngth ..... ......... ........... ............ ............ 18-30. L8140................. E.................... ..................... Gc stocking thighlngth ..... ......... ........... ............ ............ 30-40. L8150................. E.................... ..................... Gc stocking thighlngth ..... ......... ........... ............ ............ 40-50. L8160................. E.................... ..................... Gc stocking full lngth ..... ......... ........... ............ ............ 18-30. L8170................. E.................... ..................... Gc stocking full lngth ..... ......... ........... ............ ............ 30-40. L8180................. E.................... ..................... Gc stocking full lngth ..... ......... ........... ............ ............ 40-50. L8190................. E.................... ..................... Gc stocking waistlngth ..... ......... ........... ............ ............ 18-30. L8195................. E.................... ..................... Gc stocking waistlngth ..... ......... ........... ............ ............ 30-40. L8200................. E.................... ..................... Gc stocking waistlngth ..... ......... ........... ............ ............ 40-50. L8210................. E.................... ..................... Gc stocking custom made ..... ......... ........... ............ ............ L8220................. E.................... ..................... Gc stocking lymphedema. ..... ......... ........... ............ ............ L8230................. E.................... ..................... Gc stocking garter belt ..... ......... ........... ............ ............ L8239................. E.................... ..................... G compression stocking ..... ......... ........... ............ ............ NOS. L8300................. A.................... ..................... Truss single w/

..... ......... ........... ............ ............ standard pad. L8310................. A.................... ..................... Truss double w/

..... ......... ........... ............ ............ standard pad. L8320................. A.................... ..................... Truss addition to std ..... ......... ........... ............ ............ pad wa. L8330................. A.................... ..................... Truss add to std pad ..... ......... ........... ............ ............ scrotal. L8400................. A.................... ..................... Sheath below knee...... ..... ......... ........... ............ ............ L8410................. A.................... ..................... Sheath above knee...... ..... ......... ........... ............ ............ L8415................. A.................... ..................... Sheath upper limb...... ..... ......... ........... ............ ............ L8417................. A.................... ..................... Pros sheath/sock w gel ..... ......... ........... ............ ............ cushn. L8420................. A.................... ..................... Prosthetic sock multi ..... ......... ........... ............ ............ ply BK. L8430................. A.................... ..................... Prosthetic sock multi ..... ......... ........... ............ ............ ply AK. L8435................. A.................... ..................... Pros sock multi ply ..... ......... ........... ............ ............ upper lm. L8440................. A.................... ..................... Shrinker below knee.... ..... ......... ........... ............ ............ L8460................. A.................... ..................... Shrinker above knee.... ..... ......... ........... ............ ............ L8465................. A.................... ..................... Shrinker upper limb.... ..... ......... ........... ............ ............ L8470................. A.................... ..................... Pros sock single ply BK ..... ......... ........... ............ ............ L8480................. A.................... ..................... Pros sock single ply AK ..... ......... ........... ............ ............ L8485................. A.................... ..................... Pros sock single ply ..... ......... ........... ............ ............ upper l. L8490................. A.................... ..................... Air seal suction reten ..... ......... ........... ............ ............ systm. L8499................. A.................... ..................... Unlisted misc

..... ......... ........... ............ ............ prosthetic ser.

[[Page 48206]]

L8500................. A.................... ..................... Artificial larynx...... ..... ......... ........... ............ ............ L8501................. A.................... ..................... Tracheostomy speaking ..... ......... ........... ............ ............ valve. L8505................. A.................... ..................... Artificial larynx, ..... ......... ........... ............ ............ accessory. L8507................. A.................... ..................... Trach-esoph voice pros ..... ......... ........... ............ ............ pt in. L8509................. A.................... ..................... Trach-esoph voice pros ..... ......... ........... ............ ............ md in. L8510................. A.................... ..................... Voice amplifier........ ..... ......... ........... ............ ............ L8600................. N.................... ..................... Implant breast silicone/ ..... ......... ........... ............ ............ eq. L8603................. N.................... ..................... Collagen imp urinary ..... ......... ........... ............ ............ 2.5 ml. L8606................. N.................... ..................... Synthetic implnt

..... ......... ........... ............ ............ urinary 1ml. L8610................. N.................... ..................... Ocular implant......... ..... ......... ........... ............ ............ L8612................. N.................... ..................... Aqueous shunt

..... ......... ........... ............ ............ prosthesis. L8613................. N.................... ..................... Ossicular implant...... ..... ......... ........... ............ ............ L8614................. E.................... ..................... Cochlear device/system. ..... ......... ........... ............ ............ L8619................. A.................... ..................... Replace cochlear

..... ......... ........... ............ ............ processor. L8630................. N.................... ..................... Metacarpophalangeal ..... ......... ........... ............ ............ implant. L8641................. N.................... ..................... Metatarsal joint

..... ......... ........... ............ ............ implant. L8642................. N.................... ..................... Hallux implant......... ..... ......... ........... ............ ............ L8658................. N.................... ..................... Interphalangeal joint ..... ......... ........... ............ ............ implnt. L8670................. N.................... ..................... Vascular graft,

..... ......... ........... ............ ............ synthetic. L8699................. N.................... ..................... Prosthetic implant NOS. ..... ......... ........... ............ ............ L9900................. A.................... ..................... O&P supply/accessory/ ..... ......... ........... ............ ............ service. M0064................. X.................... ..................... Visit for drug

0374 1.1062 $60.05 ............

$12.01 monitoring. M0075................. E.................... ..................... Cellular therapy....... ..... ......... ........... ............ ............ M0076................. E.................... ..................... Prolotherapy........... ..... ......... ........... ............ ............ M0100................. E.................... ..................... Intragastric

..... ......... ........... ............ ............ hypothermia. M0300................. E.................... ..................... IV chelationtherapy.... ..... ......... ........... ............ ............ M0301................. E.................... ..................... Fabric wrapping of ..... ......... ........... ............ ............ aneurysm. P2028................. A.................... ..................... Cephalin floculation ..... ......... ........... ............ ............ test. P2029................. A.................... ..................... Congo red blood test... ..... ......... ........... ............ ............ P2031................. E.................... ..................... Hair analysis.......... ..... ......... ........... ............ ............ P2033................. A.................... ..................... Blood thymol turbidity. ..... ......... ........... ............ ............ P2038................. A.................... ..................... Blood mucoprotein...... ..... ......... ........... ............ ............ P3000................. A.................... ..................... Screen pap by tech w md ..... ......... ........... ............ ............ supv. P3001................. E.................... ..................... Screening pap smear by ..... ......... ........... ............ ............ phys. P7001................. E.................... ..................... Culture bacterial urine ..... ......... ........... ............ ............ P9010................. K.................... ..................... Whole blood for

0950 1.4575 $79.13 ............

$15.83 transfusion. P9011................. K.................... ..................... Blood split unit....... 0957 0.6870 $37.30 ............

$7.46 P9012................. K.................... ..................... Cryoprecipitate each 0952 0.4860 $26.38 ............

$5.28 unit. P9016................. K.................... ..................... RBC leukocytes reduced. 0954 1.9770 $107.33 ............

$21.47 P9017................. K.................... ..................... One donor fresh frozn 0955 1.5750 $85.51 ............

$17.10 plasma. P9019................. K.................... ..................... Platelets, each unit... 0957 0.6870 $37.30 ............

$7.46 P9020................. K.................... ..................... Plaelet rich plasma 0958 1.1296 $61.32 ............

$12.26 unit. P9021................. K.................... ..................... Red blood cells unit... 0959 1.4326 $77.77 ............

$15.55 P9022................. K.................... ..................... Washed red blood cells 0960 2.6638 $144.62 ............

$28.92 unit. P9023................. K.................... ..................... Frozen plasma, pooled, 0949 2.0608 $111.88 ............

$22.38 sd. P9031................. K.................... ..................... Platelets leukocytes 1013 0.9101 $49.41 ............

$9.88 reduced. P9032................. K.................... ..................... Platelets, irradiated.. 9500 1.2398 $67.31 ............

$13.46 P9033................. K.................... ..................... Platelets leukoreduced 0954 1.9770 $107.33 ............

$21.47 irrad. P9034................. K.................... ..................... Platelets, pheresis.... 9501 6.7772 $367.93 ............

$73.59 P9035................. K.................... ..................... Platelet pheres

9501 6.7772 $367.93 ............

$73.59 leukoreduced. P9036................. K.................... ..................... Platelet pheresis

9502 7.3552 $399.31 ............

$79.86 irradiated. P9037................. K.................... ..................... Plate pheres leukoredu 1019 6.7353 $365.65 ............

$73.13 irrad. P9038................. K.................... ..................... RBC irradiated......... 9505 1.8011 $97.78 ............

$19.56 P9039................. K.................... ..................... RBC deglycerolized..... 9504 3.9764 $215.87 ............

$43.17 P9040................. K.................... ..................... RBC leukoreduced

9504 3.9764 $215.87 ............

$43.17 irradiated. P9041................. K.................... ..................... Albumin (human),5%, 0961 0.7319 $39.73 ............

$7.95 50ml. P9043................. K.................... ..................... Plasma protein

0956 1.5414 $83.68 ............

$16.74 fract,5%,50ml. P9044................. K.................... ..................... Cryoprecipitatereducedp 1009 0.9447 $51.29 ............

$10.26 lasma. P9045................. K.................... ..................... Albumin (human), 5%, 0963 3.4713 $188.45 ............

$37.69 250 ml. P9046................. K.................... ..................... Albumin (human), 25%, 0964 0.7911 $42.95 ............

$8.59 20 ml. P9047................. K.................... ..................... Albumin (human), 25%, 0965 1.9432 $105.49 ............

$21.10 50ml. P9048................. K.................... ..................... Plasmaprotein

0966 7.7071 $418.41 ............

$83.68 fract,5%,250ml. P9050................. K.................... ..................... Granulocytes, pheresis 9506 20.7004 $1,123.80 ............ $224.76 unit. P9603................. A.................... ..................... One-way allow prorated ..... ......... ........... ............ ............ miles. P9604................. A.................... ..................... One-way allow prorated ..... ......... ........... ............ ............ trip. P9612................. N.................... ..................... Catheterize for urine ..... ......... ........... ............ ............ spec.

[[Page 48207]]

P9615................. N.................... ..................... Urine specimen collect ..... ......... ........... ............ ............ mult. Q0035................. X.................... ..................... Cardiokymography....... 0100 1.6726 $90.80

$41.44

$18.16 Q0081................. E.................... ..................... Infusion ther other ..... ......... ........... ............ ............ than che. Q0083................. E.................... ..................... Chemo by other than ..... ......... ........... ............ ............ infusion. Q0084................. E.................... ..................... Chemotherapy by

..... ......... ........... ............ ............ infusion. Q0085................. E.................... ..................... Chemo by both infusion ..... ......... ........... ............ ............ and o. Q0086................. A.................... ..................... Physical therapy

..... ......... ........... ............ ............ evaluation/. Q0091................. T.................... ..................... Obtaining screen pap 0191 0.1679

$9.12

$2.65

$1.82 smear. Q0092................. N.................... ..................... Set up port xray

..... ......... ........... ............ ............ equipment. Q0111................. A.................... ..................... Wet mounts/ w

..... ......... ........... ............ ............ preparations. Q0112................. A.................... ..................... Potassium hydroxide ..... ......... ........... ............ ............ preps. Q0113................. A.................... ..................... Pinworm examinations... ..... ......... ........... ............ ............ Q0114................. A.................... ..................... Fern test.............. ..... ......... ........... ............ ............ Q0115................. A.................... ..................... Post-coital mucous exam ..... ......... ........... ............ ............ Q0136................. K.................... ..................... Non esrd epoetin alpha 0733 0.1782

$9.67 ............

$1.93 inj. Q0144................. E.................... ..................... Azithromycin dihydrate, ..... ......... ........... ............ ............ oral. Q0163................. N.................... ..................... Diphenhydramine HCl ..... ......... ........... ............ ............ 50mg. Q0164................. N.................... ..................... Prochlorperazine

..... ......... ........... ............ ............ maleate 5mg. Q0165................. E.................... ..................... Prochlorperazine

..... ......... ........... ............ ............ maleate10mg. Q0166................. N.................... ..................... Granisetron HCl 1 mg ..... ......... ........... ............ ............ oral. Q0167................. N.................... ..................... Dronabinol 2.5mg oral.. ..... ......... ........... ............ ............ Q0168................. E.................... ..................... Dronabinol 5mg oral.... ..... ......... ........... ............ ............ Q0169................. N.................... ..................... Promethazine HCl 12.5mg ..... ......... ........... ............ ............ oral. Q0170................. E.................... ..................... Promethazine HCl 25 mg ..... ......... ........... ............ ............ oral. Q0171................. N.................... ..................... Chlorpromazine HCl 10mg ..... ......... ........... ............ ............ oral. Q0172................. E.................... ..................... Chlorpromazine HCl 25mg ..... ......... ........... ............ ............ oral. Q0173................. N.................... ..................... Trimethobenzamide HCl ..... ......... ........... ............ ............ 250mg. Q0174................. N.................... ..................... Thiethylperazine

..... ......... ........... ............ ............ maleate10mg. Q0175................. N.................... ..................... Perphenazine 4mg oral.. ..... ......... ........... ............ ............ Q0176................. E.................... ..................... Perphenazine 8mg oral.. ..... ......... ........... ............ ............ Q0177................. N.................... ..................... Hydroxyzine pamoate ..... ......... ........... ............ ............ 25mg. Q0178................. E.................... ..................... Hydroxyzine pamoate ..... ......... ........... ............ ............ 50mg. Q0179................. N.................... ..................... Ondansetron HCl 8mg ..... ......... ........... ............ ............ oral. Q0180................. N.................... ..................... Dolasetron mesylate ..... ......... ........... ............ ............ oral. Q0181................. E.................... ..................... Unspecified oral anti- ..... ......... ........... ............ ............ emetic. Q0183................. N.................... ..................... Nonmetabolic active ..... ......... ........... ............ ............ tissue. Q0187................. K.................... ..................... Factor viia recombinant 1409 17.9693 $975.54 ............ $195.11 Q1001................. N.................... ..................... Ntiol category 1....... ..... ......... ........... ............ ............ Q1002................. N.................... ..................... Ntiol category 2....... ..... ......... ........... ............ ............ Q1003................. N.................... ..................... Ntiol category 3....... ..... ......... ........... ............ ............ Q1004................. N.................... ..................... Ntiol category 4....... ..... ......... ........... ............ ............ Q1005................. N.................... ..................... Ntiol category 5....... ..... ......... ........... ............ ............ Q2001................. N.................... ..................... Oral cabergoline 0.5 mg ..... ......... ........... ............ ............ Q2002................. N.................... ..................... Elliotts b solution per ..... ......... ........... ............ ............ ml. Q2003................. N.................... ..................... Aprotinin, 10,000 kiu.. ..... ......... ........... ............ ............ Q2004................. N.................... ..................... Bladder calculi irrig ..... ......... ........... ............ ............ sol. Q2005................. K.................... ..................... Corticorelin ovine

7024 3.4880 $189.36 ............

$37.87 triflutat. Q2006................. K.................... ..................... Digoxin immune fab

7025 4.4789 $243.16 ............

$48.63 (ovine). Q2007................. N.................... ..................... Ethanolamine oleate 100 ..... ......... ........... ............ ............ mg. Q2008................. K.................... ..................... Fomepizole, 15 mg...... 7027 0.2215 $12.03 ............

$2.41 Q2009................. N.................... ..................... Fosphenytoin, 50 mg.... ..... ......... ........... ............ ............ Q2010................. N.................... ..................... Glatiramer acetate, per ..... ......... ........... ............ ............ dose. Q2011................. K.................... ..................... Hemin, per 1 mg........ 7030 0.0119

$.65 ............

$.13 Q2012................. N.................... ..................... Pegademase bovine, 25 ..... ......... ........... ............ ............ iu. Q2013................. N.................... ..................... Pentastarch 10%

..... ......... ........... ............ ............ solution. Q2014................. N.................... ..................... Sermorelin acetate, 0.5 ..... ......... ........... ............ ............ mg. Q2017................. K.................... ..................... Teniposide, 50 mg...... 7035 1.5530 $84.31 ............

$16.86 Q2018................. K.................... ..................... Urofollitropin, 75 iu.. 7037 1.1321 $61.46 ............

$12.29 Q2019................. K.................... ..................... Basiliximab............ 1615 11.2007 $608.07 ............ $121.61 Q2020................. E.................... ..................... Histrelin acetate...... ..... ......... ........... ............ ............ Q2021................. N.................... ..................... Lepirudin.............. ..... ......... ........... ............ ............ Q2022................. K.................... ..................... VonWillebrandFactrCmplx 1618 0.0168

$.91 ............

$.18 perIU. Q3000................. K.................... ..................... Rubidium-Rb-82......... 9025 2.5939 $140.82 ............

$28.16 Q3001................. N.................... ..................... Brachytherapy

..... ......... ........... ............ ............ Radioelements. Q3002................. N.................... ..................... Gallium ga 67.......... ..... ......... ........... ............ ............ Q3003................. K.................... ..................... Technetium tc99m

1620 3.3106 $179.73 ............

$35.95 bicisate.

[[Page 48208]]

Q3004................. N.................... ..................... Xenon xe 133........... ..... ......... ........... ............ ............ Q3005................. N.................... ..................... Technetium tc99m

..... ......... ........... ............ ............ mertiatide. Q3006................. N.................... ..................... Technetium tc99m

..... ......... ........... ............ ............ glucepatate. Q3007................. N.................... ..................... Sodium phosphate p32... ..... ......... ........... ............ ............ Q3008................. K.................... ..................... Indium 111-in

1625 6.8170 $370.09 ............

$74.02 pentetreotide. Q3009................. N.................... ..................... Technetium tc99m

..... ......... ........... ............ ............ oxidronate. Q3010................. N.................... ..................... Technetium

..... ......... ........... ............ ............ tc99mlabeledrbcs. Q3011................. K.................... ..................... Chromic phosphate p32.. 1628 2.0103 $109.14 ............

$21.83 Q3012................. N.................... ..................... Cyanocobalamin cobalt ..... ......... ........... ............ ............ co57. Q3014................. A.................... ..................... Telehealth facility fee ..... ......... ........... ............ ............ Q3019................. A.................... ..................... ALS emer trans no ALS ..... ......... ........... ............ ............ serv. Q3020................. A.................... ..................... ALS nonemer trans no ..... ......... ........... ............ ............ ALS se. Q3021................. E.................... ..................... Ped hepatitis b vaccine ..... ......... ........... ............ ............ inj. Q3022................. E.................... ..................... Hepatitis b vaccine ..... ......... ........... ............ ............ adult ds. Q3023................. E.................... ..................... Injection hepatitis ..... ......... ........... ............ ............ Bvaccine. Q3025................. K.................... ..................... IM inj interferon beta 9022 0.9417 $51.12 ............

$10.22 1-a. Q3026................. N.................... ..................... Subc inj interferon ..... ......... ........... ............ ............ beta-1a. Q4001................. A.................... ..................... Cast sup body cast ..... ......... ........... ............ ............ plaster. Q4002................. A.................... ..................... Cast sup body cast ..... ......... ........... ............ ............ fiberglas. Q4003................. A.................... ..................... Cast sup shoulder cast ..... ......... ........... ............ ............ plstr. Q4004................. A.................... ..................... Cast sup shoulder cast ..... ......... ........... ............ ............ fbrgl. Q4005................. A.................... ..................... Cast sup long arm adult ..... ......... ........... ............ ............ plst. Q4006................. A.................... ..................... Cast sup long arm adult ..... ......... ........... ............ ............ fbrg. Q4007................. A.................... ..................... Cast sup long arm ped ..... ......... ........... ............ ............ plster. Q4008................. A.................... ..................... Cast sup long arm ped ..... ......... ........... ............ ............ fbrgls. Q4009................. A.................... ..................... Cast sup sht arm adult ..... ......... ........... ............ ............ plstr. Q4010................. A.................... ..................... Cast sup sht arm adult ..... ......... ........... ............ ............ fbrgl. Q4011................. A.................... ..................... Cast sup sht arm ped ..... ......... ........... ............ ............ plaster. Q4012................. A.................... ..................... Cast sup sht arm ped ..... ......... ........... ............ ............ fbrglas. Q4013................. A.................... ..................... Cast sup gauntlet

..... ......... ........... ............ ............ plaster. Q4014................. A.................... ..................... Cast sup gauntlet

..... ......... ........... ............ ............ fiberglass. Q4015................. A.................... ..................... Cast sup gauntlet ped ..... ......... ........... ............ ............ plster. Q4016................. A.................... ..................... Cast sup gauntlet ped ..... ......... ........... ............ ............ fbrgls. Q4017................. A.................... ..................... Cast sup lng arm splint ..... ......... ........... ............ ............ plst. Q4018................. A.................... ..................... Cast sup lng arm splint ..... ......... ........... ............ ............ fbrg. Q4019................. A.................... ..................... Cast sup lng arm splnt ..... ......... ........... ............ ............ ped p. Q4020................. A.................... ..................... Cast sup lng arm splnt ..... ......... ........... ............ ............ ped f. Q4021................. A.................... ..................... Cast sup sht arm splint ..... ......... ........... ............ ............ plst. Q4022................. A.................... ..................... Cast sup sht arm splint ..... ......... ........... ............ ............ fbrg. Q4023................. A.................... ..................... Cast sup sht arm splnt ..... ......... ........... ............ ............ ped p. Q4024................. A.................... ..................... Cast sup sht arm splnt ..... ......... ........... ............ ............ ped f. Q4025................. A.................... ..................... Cast sup hip spica ..... ......... ........... ............ ............ plaster. Q4026................. A.................... ..................... Cast sup hip spica ..... ......... ........... ............ ............ fiberglas. Q4027................. A.................... ..................... Cast sup hip spica ped ..... ......... ........... ............ ............ plstr. Q4028................. A.................... ..................... Cast sup hip spica ped ..... ......... ........... ............ ............ fbrgl. Q4029................. A.................... ..................... Cast sup long leg

..... ......... ........... ............ ............ plaster. Q4030................. A.................... ..................... Cast sup long leg

..... ......... ........... ............ ............ fiberglass. Q4031................. A.................... ..................... Cast sup lng leg ped ..... ......... ........... ............ ............ plaster. Q4032................. A.................... ..................... Cast sup lng leg ped ..... ......... ........... ............ ............ fbrgls. Q4033................. A.................... ..................... Cast sup lng leg

..... ......... ........... ............ ............ cylinder pl. Q4034................. A.................... ..................... Cast sup lng leg

..... ......... ........... ............ ............ cylinder fb. Q4035................. A.................... ..................... Cast sup lngleg cylndr ..... ......... ........... ............ ............ ped p. Q4036................. A.................... ..................... Cast sup lngleg cylndr ..... ......... ........... ............ ............ ped f. Q4037................. A.................... ..................... Cast sup shrt leg

..... ......... ........... ............ ............ plaster. Q4038................. A.................... ..................... Cast sup shrt leg

..... ......... ........... ............ ............ fiberglass. Q4039................. A.................... ..................... Cast sup shrt leg ped ..... ......... ........... ............ ............ plster. Q4040................. A.................... ..................... Cast sup shrt leg ped ..... ......... ........... ............ ............ fbrgls. Q4041................. A.................... ..................... Cast sup lng leg splnt ..... ......... ........... ............ ............ plstr. Q4042................. A.................... ..................... Cast sup lng leg splnt ..... ......... ........... ............ ............ fbrgl. Q4043................. A.................... ..................... Cast sup lng leg splnt ..... ......... ........... ............ ............ ped p. Q4044................. A.................... ..................... Cast sup lng leg splnt ..... ......... ........... ............ ............ ped f. Q4045................. A.................... ..................... Cast sup sht leg splnt ..... ......... ........... ............ ............ plstr. Q4046................. A.................... ..................... Cast sup sht leg splnt ..... ......... ........... ............ ............ fbrgl. Q4047................. A.................... ..................... Cast sup sht leg splnt ..... ......... ........... ............ ............ ped p. Q4048................. A.................... ..................... Cast sup sht leg splnt ..... ......... ........... ............ ............ ped f. Q4049................. A.................... ..................... Finger splint, static.. ..... ......... ........... ............ ............

[[Page 48209]]

Q4050................. A.................... ..................... Cast supplies unlisted. ..... ......... ........... ............ ............ Q4051................. A.................... ..................... Splint supplies misc... ..... ......... ........... ............ ............ Q4052................. K.................... ..................... Octreotide injection, 1207 1.1849 $64.33 ............

$12.87 depot. Q4053................. G.................... ..................... Pegfilgrastim, per 1 mg 9119 ......... $467.09 ............

$69.82 Q9920................. A.................... ..................... Epoetin with hct = 40. R0070................. N.................... ..................... Transport portable x- ..... ......... ........... ............ ............ ray. R0075................. N.................... ..................... Transport port x-ray ..... ......... ........... ............ ............ multipl. R0076................. N.................... ..................... Transport portable EKG. ..... ......... ........... ............ ............ T1015................. E.................... ..................... Clinic service......... ..... ......... ........... ............ ............ T1016................. E.................... ..................... Case management........ ..... ......... ........... ............ ............ T1017................. E.................... ..................... Targeted case

..... ......... ........... ............ ............ management. T1018................. E.................... ..................... School-based IEP ser ..... ......... ........... ............ ............ bundled. T1019................. E.................... ..................... Personal care ser per ..... ......... ........... ............ ............ 15 min. T1020................. E.................... ..................... Personal care ser per ..... ......... ........... ............ ............ diem. T1021................. E.................... ..................... HH Aide or cn aide per ..... ......... ........... ............ ............ visit. T1022................. E.................... ..................... Contracted services per ..... ......... ........... ............ ............ day. T1023................. E.................... ..................... Program intake

..... ......... ........... ............ ............ assessment. T1024................. E.................... ..................... Team evaluation &

..... ......... ........... ............ ............ management. T1025................. E.................... ..................... Ped compr care pkg, per ..... ......... ........... ............ ............ diem. T1026................. E.................... ..................... Ped compr care pkg, per ..... ......... ........... ............ ............ hour. T1027................. E.................... ..................... Family training &

..... ......... ........... ............ ............ counseling. T1028................. E.................... ..................... Home environment

..... ......... ........... ............ ............ assessment. T1029................. E.................... ..................... Dwelling lead

..... ......... ........... ............ ............ investigation. T1030................. E.................... ..................... RN home care per diem.. ..... ......... ........... ............ ............ T1031................. E.................... ..................... LPN home care per diem. ..... ......... ........... ............ ............ T1500................. E.................... ..................... Reusable diaper/pant... ..... ......... ........... ............ ............ T1502................. E.................... ..................... Medication admin visit. ..... ......... ........... ............ ............ T1999................. E.................... ..................... NOC retail items

..... ......... ........... ............ ............ andsupplies. T2001................. E.................... ..................... N-et; patient attend/ ..... ......... ........... ............ ............ escort. T2002................. E.................... ..................... N-et; per diem......... ..... ......... ........... ............ ............ T2003................. E.................... ..................... N-et; encounter/trip... ..... ......... ........... ............ ............ T2004................. E.................... ..................... N-et; commerc carrier ..... ......... ........... ............ ............ pass. T2005................. E.................... ..................... N-et; stretcher van.... ..... ......... ........... ............ ............ T2006................. E.................... ..................... Amb response & trt, no ..... ......... ........... ............ ............ trans. T2007................. E.................... ..................... Non-emer transport wait ..... ......... ........... ............ ............ time. 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.

[[Page 48210]]

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.................... ..................... Nonaspheric lens

..... ......... ........... ............ ............ bifocal. V2117................. A.................... ..................... Aspheric lens bifocal.. ..... ......... ........... ............ ............ V2118................. A.................... ..................... Lens aniseikonic 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.................... ..................... Lens lenticular

..... ......... ........... ............ ............ nonaspheric. V2217................. A.................... ..................... Lens lenticular

..... ......... ........... ............ ............ aspheric bif. V2218................. A.................... ..................... Lens aniseikonic

..... ......... ........... ............ ............ bifocal. V2219................. A.................... ..................... Lens bifocal seg width ..... ......... ........... ............ ............ over. V2220................. A.................... ..................... Lens bifocal add over ..... ......... ........... ............ ............ 3.25d. V2299................. A.................... ..................... Lens bifocal speciality ..... ......... ........... ............ ............ V2300................. A.................... ..................... Lens sphere trifocal ..... ......... ........... ............ ............ 4.00d. V2301................. A.................... ..................... Lens sphere trifocal ..... ......... ........... ............ ............ 4.12-7.. V2302................. A.................... ..................... Lens sphere trifocal ..... ......... ........... ............ ............ 7.12-20. V2303................. A.................... ..................... Lens sphcy trifocal 4.0/ ..... ......... ........... ............ ............ .12-. V2304................. A.................... ..................... Lens sphcy trifocal 4.0/ ..... ......... ........... ............ ............ 2.25. V2305................. A.................... ..................... Lens sphcy trifocal 4.0/ ..... ......... ........... ............ ............ 4.25. V2306................. A.................... ..................... Lens sphcyl trifocal ..... ......... ........... ............ ............ 4.00/6. V2307................. A.................... ..................... Lens sphcy trifocal ..... ......... ........... ............ ............ 4.25-7/.. V2308................. A.................... ..................... Lens sphc trifocal 4.25- ..... ......... ........... ............ ............ 7/2.. V2309................. A.................... ..................... Lens sphc trifocal 4.25- ..... ......... ........... ............ ............ 7/4.. V2310................. A.................... ..................... Lens sphc trifocal 4.25- ..... ......... ........... ............ ............ 7/6. V2311................. A.................... ..................... Lens sphc trifo 7.25-12/ ..... ......... ........... ............ ............ .25-. V2312................. A.................... ..................... Lens sphc trifo 7.25-12/ ..... ......... ........... ............ ............ 2.25. V2313................. A.................... ..................... Lens sphc trifo 7.25-12/ ..... ......... ........... ............ ............ 4.25. V2314................. A.................... ..................... Lens sphcyl trifocal ..... ......... ........... ............ ............ over 12. V2315................. A.................... ..................... Lens lenticular

..... ......... ........... ............ ............ trifocal. V2316................. A.................... ..................... Lens lenticular

..... ......... ........... ............ ............ nonaspheric. V2317................. A.................... ..................... Lens lenticular

..... ......... ........... ............ ............ aspheric tri. V2318................. A.................... ..................... Lens aniseikonic

..... ......... ........... ............ ............ trifocal. V2319................. A.................... ..................... Lens trifocal seg width ..... ......... ........... ............ ............ 28. V2320................. A.................... ..................... Lens trifocal add over ..... ......... ........... ............ ............ 3.25d. 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.

[[Page 48211]]

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.................... ..................... Rose tint plastic...... ..... ......... ........... ............ ............ V2741................. A.................... ..................... Non-rose tint plastic.. ..... ......... ........... ............ ............ V2742................. A.................... ..................... Rose tint glass........ ..... ......... ........... ............ ............ V2743................. A.................... ..................... Non-rose tint glass.... ..... ......... ........... ............ ............ V2744................. A.................... ..................... Tint photochromatic ..... ......... ........... ............ ............ lens/es. V2750................. A.................... ..................... Anti-reflective coating ..... ......... ........... ............ ............ V2755................. A.................... ..................... UV lens/es............. ..... ......... ........... ............ ............ V2760................. A.................... ..................... Scratch resistant

..... ......... ........... ............ ............ coating. V2770................. A.................... ..................... Occluder lens/es....... ..... ......... ........... ............ ............ V2780................. A.................... ..................... Oversize lens/es....... ..... ......... ........... ............ ............ V2781................. E.................... ..................... Progressive lens per ..... ......... ........... ............ ............ lens. V2785................. F.................... ..................... Corneal tissue

..... ......... ........... ............ ............ processing. V2790................. N.................... ..................... Amniotic membrane...... ..... ......... ........... ............ ............ 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.

[[Page 48212]]

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................. E.................... ..................... Hearing service........ ..... ......... ........... ............ ............ V5336................. E.................... ..................... Repair communication ..... ......... ........... ............ ............ device. V5362................. A.................... ..................... Speech screening....... ..... ......... ........... ............ ............ V5363................. A.................... ..................... Language screening..... ..... ......... ........... ............ ............ V5364................. A.................... ..................... Dysphagia screening.... ..... ......... ........... ............ ............

CPT codes and escriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All right reserved.

[[Page 48212]]

Addendum D.--Payment Status Indicators for the Hospital Outpatient Prospective Payment System

Indicator

Service

Status

A................. Services Paid under a Fee Paid under a Payment Schedule Other than

System other than OPPS. OPPS, e.g., Clinical Diagnostic Laboratory Services; Physical, Occupational and Speech Therapy; and Screening Mammography. C................. Inpatient Procedures..... Not Paid under OPPS; Admit Patient; Bill as Inpatient. D................. Deleted Code............. Not Paid under Medicare. E................. Non-Covered Items and Not Covered under Services; Codes not

Medicare, or not an Payable in Hospital

Allowed Code when Outpatient Setting;

Performed in a Hospital Codes Not Recognized by Outpatient Setting. OPPS but for Which an Alternate Code may be Applicable.. F................. Corneal Tissue

Paid at Reasonable Cost. Acquisition. 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 Drug/ Paid under OPPS; Separate Biological,

APC. Radiopharmaceutical Agent, Certain Brachytherapy Sources. L................. Influenza Vaccine;

Paid at Reasonable Cost; Pneumococcal Pneumonia Not Subject to Vaccine.

Deductible or Coinsurance.

[[Continued on page 48215]]

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

[[pp. 48215-48248]] Medicare Program; Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2004 Payment Rates

[[Continued from page 48214]]

[[Page 48213]]

N................. Items and Services

Paid under OPPS; Payment Packaged into APC Rate. is Packaged into Payment for Other Services. P................. Partial Hospitalization.. Paid under OPPS; Per Diem APC. S................. Significant Procedure, Paid under OPPS; Separate Not Discounted when

APC. Multiple. T................. Significant Procedure, Paid under OPPS; Separate Multiple Procedure

APC. Reduction Applies. V................. Clinic or Emergency

Paid under OPPS; Separate Department Visit.

APC. X................. Ancillary Service........ Paid under OPPS; Separate APC.

[[Page 48214]]

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 48214]]

Addendum E.--CPT Codes Which Would Be Paid Only as Inpatient Procedures [Calendar Year 2004]

CPT/HCPCS

Status indicator

Description

0001T................................. C........................... Endovas repr abdo ao aneurys 0002T................................. C........................... Endovas repr abdo ao aneurys 0005T................................. C........................... Perc cath stent/brain cv art 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) 00524................................. C........................... Anesth, chest drainage 00540................................. C........................... Anesth, chest surgery 00542................................. C........................... Anesth, release of lung 00544................................. C........................... Anesth, chest lining removal 00546................................. C........................... Anesth, lung,chest wall surg 00560................................. C........................... Anesth, open heart surgery 00562................................. C........................... Anesth, open heart surgery 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

[[Page 48215]]

01272................................. C........................... Anesth, femoral artery surg 01274................................. C........................... Anesth, femoral embolectomy 01402................................. C........................... Anesth, knee arthroplasty 01404................................. C........................... Anesth, amputation at knee 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 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 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

[[Page 48216]]

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 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 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

[[Page 48217]]

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 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

[[Page 48218]]

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 22326................................. C........................... Treat neck spine fracture 22327................................. C........................... Treat thorax spine fracture 22328................................. C........................... Treat each add spine fx 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

[[Page 48219]]

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 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

[[Page 48220]]

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 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

[[Page 48221]]

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 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

[[Page 48222]]

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 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

[[Page 48223]]

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 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

[[Page 48224]]

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 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 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

[[Page 48225]]

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 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 35511................................. C........................... Artery bypass graft 35515................................. C........................... Artery bypass graft 35516................................. C........................... Artery bypass graft 35518................................. C........................... Artery bypass graft 35521................................. 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

[[Page 48226]]

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 35691................................. C........................... Arterial transposition 35693................................. C........................... Arterial transposition 35694................................. C........................... Arterial transposition 35695................................. C........................... Arterial transposition 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

[[Page 48227]]

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 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

[[Page 48228]]

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 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

[[Page 48229]]

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 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

[[Page 48230]]

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 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 47134................................. C........................... Partial removal, donor liver 47135................................. C........................... Transplantation of liver 47136................................. C........................... Transplantation of liver 47300................................. C........................... Surgery for liver lesion 47350................................. C........................... Repair liver wound 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

[[Page 48231]]

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 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

[[Page 48232]]

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 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

[[Page 48233]]

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 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

[[Page 48234]]

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 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

[[Page 48235]]

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 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 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

[[Page 48236]]

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 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 61538................................. C........................... Removal of brain tissue 61539................................. 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 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

[[Page 48237]]

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 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 61862................................. C........................... Implant neurostimul, subcort 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 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

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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 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 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

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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 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 escriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/ DFARS Apply. Copyright American Dental Association. All right reserved.

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Addendum H.--Wage Index for Urban Areas

Wage Urban area (constituent counties)

index

0040 Abilene, TX.............................................. 0.7678 Taylor, TX 0060 Aguadilla, PR............................................ 0.4335 Aguada, PR Aguadilla, PR Moca, PR 0080 Akron, OH................................................ 0.9445 Portage, OH Summit, OH 0120 Albany, GA............................................... 1.0838 Dougherty, GA Lee, GA 0160 Albany-Schenectady-Troy, NY.............................. 0.8693 Albany, NY Montgomery, NY Rensselaer, NY Saratoga, NY Schenectady, NY Schoharie, NY 0200 Albuquerque, NM.......................................... 0.9431 Bernalillo, NM Sandoval, NM Valencia, NM

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0220 Alexandria, LA........................................... 0.8087 Rapides, LA 0240 Allentown-Bethlehem-Easton, PA........................... 0.9576 Carbon, PA Lehigh, PA Northampton, PA 0280 Altoona, PA.............................................. 0.8886 Blair, PA 0320 Amarillo, TX............................................. 0.8968 Potter, TX Randall, TX 0380 Anchorage, AK............................................ 1.2433 Anchorage, AK 0440 Ann Arbor, MI............................................ 1.1069 Lenawee, MI Livingston, MI Washtenaw, MI 0450 Anniston, AL............................................. 0.8140 Calhoun, AL 0460 Appleton-Oshkosh-Neenah, WI \2\.......................... 0.9130 Calumet, WI Outagamie, WI Winnebago, WI 0470 Arecibo, PR.............................................. 0.4130 Arecibo, PR Camuy, PR Hatillo, PR 0480 Asheville, NC............................................ 0.9697 Buncombe, NC Madison, NC 0500 Athens, GA............................................... 0.9664 Clarke, GA Madison, GA Oconee, GA 0520 Atlanta, GA \1\.......................................... 1.0027 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.................................... 1.0862 Atlantic, NJ Cape May, NJ 0580 Auburn-Opelika, AL....................................... 0.8540 Lee, AL 0600 Augusta-Aiken, GA-SC..................................... 0.9725 Columbia, GA McDuffie, GA Richmond, GA Aiken, SC Edgefield, SC 0640 Austin-San Marcos, TX \1\................................ 0.9551 Bastrop, TX Caldwell, TX Hays, TX Travis, TX Williamson, TX 0680 Bakersfield, CA \2\...................................... 0.9907 Kern, CA 0720 Baltimore, MD \1\........................................ 0.9951 Anne Arundel, MD Baltimore, MD Baltimore City, MD Carroll, MD Harford, MD Howard, MD Queen Anne's, MD 0733 Bangor, ME............................................... 0.9750 Penobscot, ME 0743 Barnstable-Yarmouth, MA.................................. 1.2893 Barnstable, MA 0760 Baton Rouge, LA.......................................... 0.8271 Ascension, LA East Baton Rouge, LA Livingston, LA West Baton Rouge, LA 0840 Beaumont-Port Arthur, TX................................. 0.8503 Hardin, TX Jefferson, TX Orange, TX 0860 Bellingham, WA........................................... 1.1834 Whatcom, WA 0870 Benton Harbor, MI........................................ 0.8949 Berrien, MI 0875 Bergen-Passaic, NJ \1\................................... 1.1655 Bergen, NJ Passaic, NJ 0880 Billings, MT............................................. 0.8889 Yellowstone, MT 0920 Biloxi-Gulfport-Pascagoula, MS........................... 0.9089 Hancock, MS Harrison, MS Jackson, MS 0960 Binghamton, NY \2\....................................... 0.8530 Broome, NY Tioga, NY 1000 Birmingham, AL........................................... 0.9251 Blount, AL Jefferson, AL St. Clair, AL Shelby, AL 1010 Bismarck, ND............................................. 0.8101 Burleigh, ND Morton, ND 1020 Bloomington, IN.......................................... 0.8968 Monroe, IN 1040 Bloomington-Normal, IL................................... 0.8954 McLean, IL 1080 Boise City, ID........................................... 0.9295 Ada, ID Canyon, ID 1123 Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH \1\..... 1.1269 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..................................... 1.0119 Boulder, CO 1145 Brazoria, TX............................................. 0.8324 Brazoria, TX 1150 Bremerton, WA............................................ 1.0601 Kitsap, WA 1240 Brownsville-Harlingen-San Benito, TX..................... 21.0231 Cameron, TX 1260 Bryan-College Station, TX................................ Brazos, TX 0.9044...................................................... 1280 Buffalo-Niagara Falls, NY \1\............................ 0.9600 Erie, NY Niagara, NY 1303 Burlington, VT........................................... 0.9768 Chittenden, VT Franklin, VT Grand Isle, VT 1310 Caguas, PR............................................... 0.4229 Caguas, PR Cayey, PR Cidra, PR Gurabo, PR San Lorenzo, PR 1320 Canton-Massillon, OH..................................... 0.9128 Carroll, OH Stark, OH 1350 Casper, WY............................................... 0.9239 Natrona, WY 1360 Cedar Rapids, IA......................................... 0.8933 Linn, IA 1400 Champaign-Urbana, IL..................................... 0.9907 Champaign, IL 1440 Charleston-North Charleston, SC.......................... 0.9307 Berkeley, SC Charleston, SC Dorchester, SC 1480 Charleston, WV........................................... 0.8753 Kanawha, WV Putnam, WV 1520 Charlotte-Gastonia-Rock Hill, NC-SC \1\.................. 0.9766 Cabarrus, NC Gaston, NC Lincoln, NC Mecklenburg, NC Rowan, NC Stanly, NC Union, NC York, SC 1540 Charlottesville, VA...................................... 1.0092 Albemarle, VA Charlottesville City, VA Fluvanna, VA Greene, VA 1560 Chattanooga, TN-GA....................................... 0.8985 Catoosa, GA Dade, GA Walker, GA Hamilton, TN Marion, TN 1580 Cheyenne, WY \2\......................................... 0.9137 Laramie, WY 1600 Chicago, IL \1\.......................................... 1.1012 Cook, IL DeKalb, IL

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DuPage, IL Grundy, IL Kane, IL Kendall, IL Lake, IL McHenry, IL Will, IL 1620 Chico-Paradise, CA....................................... 1.0147 Butte, CA 1640 Cincinnati, OH-KY-IN \1\................................. 0.9452 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.......................... 0.8410 Christian, KY Montgomery, TN 1680 Cleveland-Lorain-Elyria, OH \1\.......................... 0.9686 Ashtabula, OH Cuyahoga, OH Geauga, OH Lake, OH Lorain, OH Medina, OH 1720 Colorado Springs, CO \2\................................. 0.8897 El Paso, CO 1740 Columbia, MO............................................. 0.8745 Boone, MO 1760 Columbia, SC............................................. 0.8958 Lexington, SC Richland, SC 1800 Columbus, GA-AL.......................................... 0.8700 Russell, AL Chattahoochee, GA Harris, GA Muscogee, GA 1840 Columbus, OH \1\......................................... 0.9649 Delaware, OH Fairfield, OH Franklin, OH Licking, OH Madison, OH Pickaway, OH 1880 Corpus Christi, TX....................................... 0.8565 Nueces, TX San Patricio, TX 1890 Corvallis, OR............................................ 1.1593 Benton, OR 1900 Cumberland, MD-WV \2\ (MD Hospitals)..................... 0.9175 Allegany, MD Mineral, WV 1900 Cumberland, MD-WV (WV Hospitals)......................... 0.8224 Allegany, MD Mineral, WV 1920 Dallas, TX \1\........................................... 0.9733 Collin, TX Dallas, TX Denton, TX Ellis, TX Henderson, TX Hunt, TX Kaufman, TX Rockwall, TX 1950 Danville, VA............................................. 0.9095 Danville City, VA Pittsylvania, VA 1960 Davenport-Moline-Rock Island, IA-IL...................... 0.8727 Scott, IA Henry, IL Rock Island, IL 2000 Dayton-Springfield, OH................................... 0.9432 Clark, OH Greene, OH Miami, OH Montgomery, OH 2020 Daytona Beach, FL........................................ 0.9208 Flagler, FL Volusia, FL 2030 Decatur, AL.............................................. 0.8882 Lawrence, AL Morgan, AL 2040 Decatur, IL \2\.......................................... 0.8282 Macon, IL 2080 Denver, CO \1\........................................... 1.0776 Adams, CO Arapahoe, CO Broomfield, CO Denver, CO Douglas, CO Jefferson, CO 2120 Des Moines, IA........................................... 0.9053 Dallas, IA Polk, IA Warren, IA 2160 Detroit, MI \1\.......................................... 1.0097 Lapeer, MI Macomb, MI Monroe, MI Oakland, MI St. Clair, MI Wayne, MI 2180 Dothan, AL............................................... 0.7931 Dale, AL Houston, AL 2190 Dover, DE................................................ 0.9870 Kent, DE 2200 Dubuque, IA.............................................. 0.8946 Dubuque, IA 2240 Duluth-Superior, MN-WI................................... 1.0133 St. Louis, MN Douglas, WI 2281 Dutchess County, NY...................................... 1.0966 Dutchess, NY 2290 Eau Claire, WI........................................... 0.9141 Chippewa, WI Eau Claire, WI 2320 El Paso, TX.............................................. 0.9267 El Paso, TX 2330 Elkhart-Goshen, IN....................................... 0.9848 Elkhart, IN 2335 Elmira, NY \2\........................................... 0.8530 Chemung, NY 2340 Enid, OK................................................. 0.8616 Garfield, OK 2360 Erie, PA................................................. 0.8636 Erie, PA 2400 Eugene-Springfield, OR................................... 1.1212 Lane, OR 2440 Evansville-Henderson, IN-KY \2\ (IN Hospitals)........... 0.8770 Posey, IN Vanderburgh, IN Warrick, IN Henderson, KY 2440 Evansville-Henderson, IN-KY (KY Hospitals)............... 0.8442 Posey, IN Vanderburgh, IN Warrick, IN Henderson, KY 2520 Fargo-Moorhead, ND-MN.................................... 0.9650 Clay, MN Cass, ND 2560 Fayetteville, NC......................................... 0.8957 Cumberland, NC 2580 Fayetteville-Springdale-Rogers, AR....................... 0.8038 Benton, AR Washington, AR 2620 Flagstaff, AZ-UT......................................... 1.1283 Coconino, AZ Kane, UT 2640 Flint, MI................................................ 1.0929 Genesee, MI 2650 Florence, AL............................................. 0.7824 Colbert, AL Lauderdale, AL 2655 Florence, SC............................................. 0.8763 Florence, SC 2670 Fort Collins-Loveland, CO................................ 1.0201 Larimer, CO 2680 Ft. Lauderdale, FL \1\................................... 1.0534 Broward, FL 2700 Fort Myers-Cape Coral, FL................................ 0.9877 Lee, FL 2710 Fort Pierce-Port St. Lucie, FL........................... 1.0227 Martin, FL St. Lucie, FL 2720 Fort Smith, AR-OK \2\ (AR Hospitals)..................... 0.7746 Crawford, AR Sebastian, AR Sequoyah, OK 2720 Fort Smith, AR-OK (OK Hospitals)......................... 0.7740 Crawford, AR Sebastian, AR Sequoyah, OK 2750 Fort Walton Beach, FL.................................... 0.8929 Okaloosa, FL 2760 Fort Wayne, IN........................................... 0.9674 Adams, IN Allen, IN De Kalb, IN Huntington, IN Wells, IN Whitley, IN 2800 Forth Worth-Arlington, TX \1\............................ 0.9268 Hood, TX Johnson, TX Parker, TX Tarrant, TX 2840 Fresno, CA............................................... 1.0157 Fresno, CA Madera, CA 2880 Gadsden, AL.............................................. 0.8295

[[Page 48242]]

Etowah, AL 2900 Gainesville, FL \2\...................................... 0.8782 Alachua, FL 2920 Galveston-Texas City, TX................................. 0.9360 Galveston, TX 2960 Gary, IN................................................. 0.9462 Lake, IN Porter, IN 2975 Glens Falls, NY \2\...................................... 0.8530 Warren, NY Washington, NY 2980 Goldsboro, NC............................................ 0.8679 Wayne, NC 2985 Grand Forks, ND-MN (ND Hospitals)........................ 0.9031 Polk, MN Grand Forks, ND 2985 Grand Forks, ND-MN \2\ (MN Hospitals).................... 0.9243 Polk, MN Grand Forks, ND 2995 Grand Junction, CO....................................... 0.9940 Mesa, CO 3000 Grand Rapids-Muskegon-Holland, MI \1\.................... 0.9406 Allegan, MI Kent, MI Muskegon, MI Ottawa, MI 3040 Great Falls, MT.......................................... 0.8977 Cascade, MT 3060 Greeley, CO.............................................. 0.9516 Weld, CO 3080 Green Bay, WI............................................ 0.9524 Brown, WI 3120 Greensboro-Winston-Salem-High Point, NC \1\.............. 0.8533 Alamance, NC Davidson, NC Davie, NC Forsyth, NC Guilford, NC Randolph, NC Stokes, NC Yadkin, NC 3150 Greenville, NC........................................... 0.9621 Pitt, NC 3160 Greenville-Spartanburg-Anderson, SC...................... 0.9289 Anderson, SC Cherokee, SC Greenville, SC Pickens, SC Spartanburg, SC 3180 Hagerstown, MD........................................... 0.9233 Washington, MD 3200 Hamilton-Middletown, OH.................................. 0.9236 Butler, OH 3240 Harrisburg-Lebanon-Carlisle, PA.......................... 0.9178 Cumberland, PA Dauphin, PA Lebanon, PA Perry, PA 3283 Hartford, CT 1,2........................................ 1.2199 Hartford, CT Litchfield, CT Middlesex, CT Tolland, CT 3285 Hattiesburg, MS \2\...................................... 0.7810 Forrest, MS Lamar, MS 3290 Hickory-Morganton-Lenoir, NC............................. 0.9090 Alexander, NC Burke, NC Caldwell, NC Catawba, NC 3320 Honolulu, HI............................................. 1.1176 Honolulu, HI 3350 Houma, LA................................................ 0.7763 Lafourche, LA Terrebonne, LA 3360 Houston, TX \1\.......................................... 0.9591 Chambers, TX Fort Bend, TX Harris, TX Liberty, TX Montgomery, TX Waller, TX 3400 Huntington-Ashland, WV-KY-OH............................. 0.9620 Boyd, KY Carter, KY Greenup, KY Lawrence, OH Cabell, WV Wayne, WV 3440 Huntsville, AL........................................... 0.9238 Limestone, AL Madison, AL 3480 Indianapolis, IN \1\..................................... 0.9934 Boone, IN Hamilton, IN Hancock, IN Hendricks, IN Johnson, IN Madison, IN Marion, IN Morgan, IN Shelby, IN 3500 Iowa City, IA............................................ 0.9605 Johnson, IA 3520 Jackson, MI.............................................. 0.9043 Jackson, MI 3560 Jackson, MS.............................................. 0.8459 Hinds, MS Madison, MS Rankin, MS 3580 Jackson, TN.............................................. 0.8602 Madison, TN Chester, TN 3600 Jacksonville, FL \1\..................................... 0.9426 Clay, FL Duval, FL Nassau, FL St. Johns, FL 3605 Jacksonville, NC......................................... 0.8589 Onslow, NC 3610 Jamestown, NY \2\........................................ 0.8530 Chautauqua, NY 3620 Janesville-Beloit, WI.................................... 0.9344 Rock, WI 3640 Jersey City, NJ.......................................... 1.1203 Hudson, NJ 3660 Johnson City-Kingsport-Bristol, TN-VA (TN Hospitals)..... 0.8371 Carter, TN Hawkins, TN Sullivan, TN Unicoi, TN Washington, TN Bristol City, VA Scott, VA Washington, VA 3660 Johnson City-Kingsport-Bristol, TN-VA \2\ (VA Hospitals). 0.8542 Carter, TN Hawkins, TN Sullivan, TN Unicoi, TN Washington, TN Bristol City, VA Scott, VA Washington, VA 3680 Johnstown, PA \2\........................................ 0.8429 Cambria, PA Somerset, PA 3700 Jonesboro, AR \2\........................................ 0.7755 Craighead, AR 3710 Joplin, MO............................................... 0.8739 Jasper, MO Newton, MO 3720 Kalamazoo-Battlecreek, MI................................ 1.0554 Calhoun, MI Kalamazoo, MI Van Buren, MI 3740 Kankakee, IL............................................. 1.1074 Kankakee, IL 3760 Kansas City, KS-MO \1\................................... 0.9551 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.............................................. 0.9826 Kenosha, WI 3810 Killeen-Temple, TX....................................... 0.9221 Bell, TX Coryell, TX 3840 Knoxville, TN............................................ 0.8987 Anderson, TN Blount, TN Knox, TN Loudon, TN Sevier, TN Union, TN 3850 Kokomo, IN............................................... 0.8963 Howard, IN Tipton, IN 3870 La Crosse, WI-MN......................................... 0.9259 Houston, MN La Crosse, WI 3880 Lafayette, LA............................................ 0.8271 Acadia, LA Lafayette, LA St. Landry, LA St. Martin, LA 3920 Lafayette, IN............................................ 0.9052 Clinton, IN Tippecanoe, IN 3960 Lake Charles, LA......................................... 0.8460 Calcasieu, LA

[[Page 48243]]

3980 Lakeland-Winter Haven, FL \2\............................ 0.8782 Polk, FL 4000 Lancaster, PA............................................ 0.9325 Lancaster, PA 4040 Lansing-East Lansing, MI................................. 0.9270 Clinton, MI Eaton, MI Ingham, MI 4080 Laredo, TX............................................... 0.8145 Webb, TX 4100 Las Cruces, NM........................................... 0.8532 Dona Ana, NM 4120 Las Vegas, NV-AZ \1\..................................... 1.1457 Mohave, AZ Clark, NV Nye, NV 4150 Lawrence, KS \2\......................................... 0.7860 Douglas, KS 4200 Lawton, OK............................................... 0.8322 Comanche, OK 4243 Lewiston-Auburn, ME...................................... 0.9389 Androscoggin, ME 4280 Lexington, KY............................................ 0.8622 Bourbon, KY Clark, KY Fayette, KY Jessamine, KY Madison, KY Scott, KY Woodford, KY 4320 Lima, OH................................................. 0.9457 Allen, OH Auglaize, OH 4360 Lincoln, NE.............................................. 1.0101 Lancaster, NE 4400 Little Rock-North Little Rock, AR........................ 0.8905 Faulkner, AR Lonoke, AR Pulaski, AR Saline, AR 4420 Longview-Marshall, TX.................................... 0.9141 Gregg, TX Harrison, TX Upshur, TX 4480 Los Angeles-Long Beach, CA \1\........................... 1.1656 Los Angeles, CA 4520 Louisville, KY-IN \1\.................................... 0.9174 Clark, IN Floyd, IN Harrison, IN Scott, IN Bullitt, KY Jefferson, KY Oldham, KY 4600 Lubbock, TX.............................................. 0.8330 Lubbock, TX 4640 Lynchburg, VA............................................ 0.9202 Amherst, VA Bedford, VA Bedford City, VA Campbell, VA Lynchburg City, VA 4680 Macon, GA................................................ 0.9011 Bibb, GA Houston, GA Jones, GA Peach, GA Twiggs, GA 4720 Madison, WI.............................................. 1.0235 Dane, WI 4800 Mansfield, OH............................................ 0.9059 Crawford, OH Richland, OH 4840 Mayaguez, PR............................................. 0.4780 Anasco, PR Cabo Rojo, PR Hormigueros, PR Mayaguez, PR Sabana Grande, PR San German, PR 4880 McAllen-Edinburg-Mission, TX............................. 0.9084 Hidalgo, TX 4890 Medford-Ashland, OR...................................... 1.0844 Jackson, OR 4900 Melbourne-Titusville-Palm Bay, FL........................ 0.9837 Brevard, Fl 4920 Memphis, TN-AR-MS \1\.................................... 0.9325 Crittenden, AR DeSoto, MS Fayette, TN Shelby, TN Tipton, TN 4940 Merced, CA \2\........................................... 0.9907 Merced, CA 5000 Miami, FL \1\............................................ 0.9888 Dade, FL 5015 Middlesex-Somerset-Hunterdon, NJ \1\..................... 1.1437 Hunterdon, NJ Middlesex, NJ Somerset, NJ 5080 Milwaukee-Waukesha, WI \1\............................... 0.9888 Milwaukee, WI Ozaukee, WI Washington, WI Waukesha, WI 5120 Minneapolis-St. Paul, MN-WI \1\.......................... 1.1064 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............................................. 0.8943 Missoula, MT 5160 Mobile, AL............................................... 0.7948 Baldwin, AL Mobile, AL 5170 Modesto, CA.............................................. 1.1344 Stanislaus, CA 5190 Monmouth-Ocean, NJ \1\................................... 1.1094 Monmouth, NJ Ocean, NJ 5200 Monroe, LA............................................... 0.7978 Ouachita, LA 5240 Montgomery, AL........................................... 0.7856 Autauga, AL Elmore, AL Montgomery, AL 5280 Muncie, IN \2\........................................... 0.8770 Delaware, IN 5330 Myrtle Beach, SC......................................... 0.8950 Horry, SC 5345 Naples, FL............................................... 0.9866 Collier, FL 5360 Nashville, TN \1\........................................ 0.9836 Cheatham, TN Davidson, TN Dickson, TN Robertson, TN Rutherford TN Sumner, TN Williamson, TN Wilson, TN 5380 Nassau-Suffolk, NY \1\................................... 1.3011 Nassau, NY Suffolk, NY 5483 New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT \1\.. 1.2525 Fairfield, CT New Haven, CT 5523 New London-Norwich, CT \2\............................... 1.2199 New London, CT 5560 New Orleans, LA \1\...................................... 0.9167 Jefferson, LA Orleans, LA Plaquemines, LA St. Bernard, LA St. Charles, LA St. James, LA St. John The Baptist, LA St. Tammany, LA 5600 New York, NY \1\......................................... 1.3867 Bronx, NY Kings, NY New York, NY Putnam, NY Queens, NY Richmond, NY Rockland, NY Westchester, NY 5640 Newark, NJ \1\........................................... 1.1417 Essex, NJ Morris, NJ Sussex, NJ Union, NJ Warren, NJ 5660 Newburgh, NY-PA.......................................... 1.1377 Orange, NY Pike, PA 5720 Norfolk-Virginia Beach-Newport News, VA-NC \1\........... 0.8659 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

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York, VA 5775 Oakland, CA \1\.......................................... 1.5204 Alameda, CA Contra Costa, CA 5790 Ocala, FL................................................ 0.9788 Marion, FL 5800 Odessa-Midland, TX....................................... 0.9447 Ector, TX Midland, TX 5880 Oklahoma City, OK \1\.................................... 0.9027 Canadian, OK Cleveland, OK Logan, OK McClain, OK Oklahoma, OK Pottawatomie, OK 5910 Olympia, WA.............................................. 1.1030 Thurston, WA 5920 Omaha, NE-IA............................................. 0.9744 Pottawattamie, IA Cass, NE Douglas, NE Sarpy, NE Washington, NE 5945 Orange County, CA \1\.................................... 1.1235 Orange, CA 5960 Orlando, FL \1\.......................................... 0.9612 Lake, FL Orange, FL Osceola, FL Seminole, FL 5990 Owensboro, KY............................................ 0.8429 Daviess, KY 6015 Panama City, FL \2\...................................... 0.8782 Bay, FL 6020 Parkersburg-Marietta, WV-OH (WV Hospitals)............... 0.8093 Washington, OH Wood, WV 6020 Parkersburg-Marietta, WV-OH \2\ (OH Hospitals)........... 0.8756 Washington, OH Wood, WV 6080 Pensacola, FL \2\........................................ 0.8782 Escambia, FL Santa Rosa, FL 6120 Peoria-Pekin, IL......................................... 0.8811 Peoria, IL Tazewell, IL Woodford, IL 6160 Philadelphia, PA-NJ \1\.................................. 1.0947 Burlington, NJ Camden, NJ Gloucester, NJ Salem, NJ Bucks, PA Chester, PA Delaware, PA Montgomery, PA Philadelphia, PA 6200 Phoenix-Mesa, AZ \1\..................................... 1.0213 Maricopa, AZ Pinal, AZ 6240 Pine Bluff, AR........................................... 0.7753 Jefferson, AR 6280 Pittsburgh, PA \1\....................................... 0.8788 Allegheny, PA Beaver, PA Butler, PA Fayette, PA Washington, PA Westmoreland, PA 6323 Pittsfield, MA \2\....................................... 1.1234 Berkshire, MA 6340 Pocatello, ID............................................ 0.9103 Bannock, ID 6360 Ponce, PR................................................ 0.4762 Guayanilla, PR Juana Diaz, PR Penuelas, PR Ponce, PR Villalba, PR Yauco, PR 6403 Portland, ME............................................. 0.9985 Cumberland, ME Sagadahoc, ME York, ME 6440 Portland-Vancouver, OR-WA \1\............................ 1.1193 Clackamas, OR Columbia, OR Multnomah, OR Washington, OR Yamhill, OR Clark, WA 6483 Providence-Warwick-Pawtucket, RI \1\..................... 1.1025 Bristol, RI Kent, RI Newport, RI Providence, RI Washington, RI 6520 Provo-Orem, UT........................................... 1.0043 Utah, UT 6560 Pueblo, CO \2\........................................... 0.8897 Pueblo, CO 6580 Punta Gorda, FL.......................................... 0.9518 Charlotte, FL 6600 Racine, WI \2\........................................... 0.9130 Racine, WI 6640 Raleigh-Durham-Chapel Hill, NC \1\....................... 1.0084 Chatham, NC Durham, NC Franklin, NC Johnston, NC Orange, NC Wake, NC 6660 Rapid City, SD........................................... 0.8865 Pennington, SD 6680 Reading, PA.............................................. 0.9042 Berks, PA 6690 Redding, CA.............................................. 1.1357 Shasta, CA 6720 Reno, NV................................................. 1.0758 Washoe, NV 6740 Richland-Kennewick-Pasco, WA............................. 1.0639 Benton, WA Franklin, WA 6760 Richmond-Petersburg, VA.................................. 0.9402 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 Riverside-San Bernardino, CA \1\......................... 1.1318 Riverside, CA San Bernardino, CA 6800 Roanoke, VA.............................................. 0.8759 Botetourt, VA Roanoke, VA Roanoke City, VA Salem City, VA 6820 Rochester, MN............................................ 1.1802 Olmsted, MN 6840 Rochester, NY \1\........................................ 0.9556 Genesee, NY Livingston, NY Monroe, NY Ontario, NY Orleans, NY Wayne, NY 6880 Rockford, IL............................................. 0.9730 Boone, IL Ogle, IL Winnebago, IL 6895 Rocky Mount, NC.......................................... 0.9058 Edgecombe, NC Nash, NC 6920 Sacramento, CA \1\....................................... 1.1911 El Dorado, CA Placer, CA Sacramento, CA 6960 Saginaw-Bay City-Midland, MI............................. 0.9620 Bay, MI Midland, MI Saginaw, MI 6980 St. Cloud, MN............................................ 0.9723 Benton, MN Stearns, MN 7000 St. Joseph, MO \2\....................................... 0.7793 Andrew, MO Buchanan, MO 7040 St. Louis, MO-IL \1\..................................... 0.9049 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................................................ 1.0594 Marion, OR Polk, OR 7120 Salinas, CA.............................................. 1.4435 Monterey, CA 7160 Salt Lake City-Ogden, UT \1\............................. 0.9899 Davis, UT Salt Lake, UT Weber, UT 7200 San Angelo, TX........................................... 0.8288 Tom Green, TX 7240 San Antonio, TX \1\...................................... 0.8876 Bexar, TX

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Comal, TX Guadalupe, TX Wilson, TX 7320 San Diego, CA \1\........................................ 1.1206 San Diego, CA 7360 San Francisco, CA \1\.................................... 1.4349 Marin, CA San Francisco, CA San Mateo, CA 7400 San Jose, CA \1\......................................... 1.4642 Santa Clara, CA 7440 San Juan-Bayamon, PR \1\................................. 0.4904 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 Trujillo Alto, PR Vega Alta, PR Vega Baja, PR Yabucoa, PR 7460 San Luis Obispo-Atascadero-Paso Robles, CA............... 1.1484 San Luis Obispo, CA 7480 Santa Barbara-Santa Maria-Lompoc, CA..................... 1.0511 Santa Barbara, CA 7485 Santa Cruz-Watsonville, CA............................... 1.3012 Santa Cruz, CA 7490 Santa Fe, NM............................................. 1.0639 Los Alamos, NM Santa Fe, NM 7500 Santa Rosa, CA........................................... 1.2836 Sonoma, CA 7510 Sarasota-Bradenton, FL................................... 0.9834 Manatee, FL Sarasota, FL 7520 Savannah, GA............................................. 0.9556 Bryan, GA Chatham, GA Effingham, GA 7560 Scranton--Wilkes-Barre--Hazleton, PA \2\................. 0.8429 Columbia, PA Lackawanna, PA Luzerne, PA Wyoming, PA 7600 Seattle-Bellevue-Everett, WA \1\......................... 1.1557 Island, WA King, WA Snohomish, WA 7610 Sharon, PA \2\........................................... 0.8429 Mercer, PA 7620 Sheboygan, WI \2\........................................ 0.9130 Sheboygan, WI 7640 Sherman-Denison, TX...................................... 0.9508 Grayson, TX 7680 Shreveport-Bossier City, LA.............................. 0.9127 Bossier, LA Caddo, LA Webster, LA 7720 Sioux City, IA-NE........................................ 0.9052 Woodbury, IA Dakota, NE 7760 Sioux Falls, SD.......................................... 0.9371 Lincoln, SD Minnehaha, SD 7800 South Bend, IN........................................... 0.9887 St. Joseph, IN 7840 Spokane, WA.............................................. 1.0954 Spokane, WA 7880 Springfield, IL.......................................... 0.9004 Menard, IL Sangamon, IL 7920 Springfield, MO.......................................... 0.8470 Christian, MO Greene, MO Webster, MO 8003 Springfield, MA \2\...................................... 1.1234 Hampden, MA Hampshire, MA 8050 State College, PA........................................ 0.8798 Centre, PA 8080 Steubenville-Weirton, OH-WV.............................. 0.8454 Jefferson, OH Brooke, WV Hancock, WV 8120 Stockton-Lodi, CA........................................ 1.1168 San Joaquin, CA 8140 Sumter, SC \2\........................................... 0.8489 Sumter, SC 8160 Syracuse, NY............................................. 0.9482 Cayuga, NY Madison, NY Onondaga, NY Oswego, NY 8200 Tacoma, WA \2\........................................... 1.0242 Pierce, WA 8240 Tallahassee, FL \2\...................................... 0.8782 Gadsden, FL Leon, FL 8280 Tampa-St. Petersburg-Clearwater, FL \1\.................. 0.9111 Hernando, FL Hillsborough, FL Pasco, FL Pinellas, FL 8320 Terre Haute, IN \2\...................................... 0.8770 Clay, IN Vermillion, IN Vigo, IN 8360 Texarkana, AR-Texarkana, TX.............................. 0.8198 Miller, AR Bowie, TX 8400 Toledo, OH............................................... 0.9551 Fulton, OH Lucas, OH Wood, OH 8440 Topeka, KS............................................... 0.9021 Shawnee, KS 8480 Trenton, NJ.............................................. 1.0556 Mercer, NJ 8520 Tucson, AZ............................................... 0.8958 Pima, AZ 8560 Tulsa, OK................................................ 0.9093 Creek, OK Osage, OK Rogers, OK Tulsa, OK Wagoner, OK 8600 Tuscaloosa, AL........................................... 0.8239 Tuscaloosa, AL 8640 Tyler, TX................................................ 0.8789 Smith, TX 8680 Utica-Rome, NY \2\....................................... 0.8530 Herkimer, NY Oneida, NY 8720 Vallejo-Fairfield-Napa, CA............................... 1.3500 Napa, CA Solano, CA 8735 Ventura, CA.............................................. 1.0472 Ventura, CA 8750 Victoria, TX............................................. 0.8105 Victoria, TX 8760 Vineland-Millville-Bridgeton, NJ......................... 1.0475 Cumberland, NJ 8780 Visalia-Tulare-Porterville, CA \2\....................... 0.9907 Tulare, CA 8800 Waco, TX................................................. 0.8449 McLennan, TX 8840 Washington, DC-MD-VA-WV \1\.............................. 1.0707 District of Columbia, DC Calvert, MD Charles, MD Frederick, MD Montgomery, MD Prince Georges, MD Alexandria City, VA Arlington, VA Clarke, VA Culpepper, 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 Waterloo-Cedar Falls, IA................................. 0.8422 Black Hawk, IA 8940 Wausau, WI............................................... 0.9806 Marathon, WI 8960 West Palm Beach-Boca Raton, FL \1\....................... 0.9784 Palm Beach, FL

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9000 Wheeling, WV-OH \2\ (WV Hospitals)....................... 0.8008 Belmont, OH Marshall, WV Ohio, WV 9000 Wheeling, WV-OH \2\ (OH Hospitals)....................... 0.8756 Belmont, OH Marshall, WV Ohio, WV 9040 Wichita, KS.............................................. 0.9300 Butler, KS Harvey, KS Sedgwick, KS 9080 Wichita Falls, TX........................................ 0.8407 Archer, TX Wichita, TX 9140 Williamsport, PA \2\..................................... 0.8429 Lycoming, PA 9160 Wilmington-Newark, DE-MD................................. 1.0955 New Castle, DE Cecil, MD 9200 Wilmington, NC........................................... 0.9604 New Hanover, NC Brunswick, NC 9260 Yakima, WA............................................... 1.0320 Yakima, WA 9270Yolo, CA \2\.............................................. 0.9907 Yolo, CA 9280 York, PA................................................. 0.9154 York, PA 9320 Youngstown-Warren, OH.................................... 0.9273 Columbiana, OH Mahoning, OH Trumbull, OH 9340 Yuba City, CA............................................ 1.0264 Sutter, CA Yuba, CA 9360 Yuma, AZ................................................. 0.8954 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

Alaska........................................................ 1.1958 Arizona....................................................... 0.8906 Arkansas...................................................... 0.7746 California.................................................... 0.9907 Colorado...................................................... 0.8897 Connecticut................................................... 1.2199 Delaware...................................................... 0.9669 Florida....................................................... 0.8782 Georgia....................................................... 0.8365 Hawaii........................................................ 0.9896 Idaho......................................................... 0.8907 Illinois...................................................... 0.8282 Indiana....................................................... 0.8770 Iowa.......................................................... 0.8278 Kansas........................................................ 0.7860 Kentucky...................................................... 0.7924 Louisiana..................................................... 0.7565 Maine......................................................... 0.8995 Maryland...................................................... 0.9175 Massachusetts................................................. 1.1234 Michigan...................................................... 0.8807 Minnesota..................................................... 0.9243 Mississippi................................................... 0.7810 Missouri...................................................... 0.7793 Montana....................................................... 0.8530 Nebraska...................................................... 0.8326 Nevada........................................................ 0.9758 New Hampshire................................................. 0.9944 New Jersey\1\................................................. ........ New Mexico.................................................... 0.8314 New York...................................................... 0.8530 North Carolina................................................ 0.8355 North Dakota.................................................. 0.7536 Ohio.......................................................... 0.8756 Oklahoma...................................................... 0.7577 Oregon........................................................ 0.9939 Pennsylvania.................................................. 0.8429 Puerto Rico................................................... 0.4037 Rhode Island\1\............................................... ........ South Carolina................................................ 0.8489 South Dakota.................................................. 0.8093 Tennessee..................................................... 0.7945 Texas......................................................... 0.7673 Utah.......................................................... 0.9034 Vermont....................................................... 0.9401 Virginia...................................................... 0.8542 Washington.................................................... 1.0242 West Virginia................................................. 0.8008 Wisconsin..................................................... 0.9130 Wyoming....................................................... 0.9137

\1\All counties within the State are classified as urban.

Addendum J.--Wage Index for Hospitals That are Reclassified

Wage Area

index

Akron, OH..................................................... 0.9445 Albany, GA.................................................... 1.0643 Albuquerque, NM............................................... 0.9431 Alexandria, LA................................................ 0.8087 Altoona, PA................................................... 0.8886 Amarillo, TX.................................................. 0.8814 Anchorage, AK................................................. 1.2433 Ann Arbor, MI................................................. 1.0859 Anniston, AL.................................................. 0.8025 Asheville, NC................................................. 0.9503 Athens, GA.................................................... 0.9437 Atlanta, GA................................................... 0.9912 Atlantic-Cape May, NJ......................................... 1.0597 Augusta-Aiken, GA-SC.......................................... 0.9491 Austin-San Marcos, TX......................................... 0.9551 Bangor, ME.................................................... 0.9750 Barnstable-Yarmouth, MA....................................... 1.2703 Baton Rouge, LA............................................... 0.8271 Bellingham, WA................................................ 1.1834 Benton Harbor, MI............................................. 0.8949 Bergen-Passaic, NJ............................................ 1.1655 Billings, MT.................................................. 0.8889 Biloxi-Gulfport-Pascagoula, MS................................ 0.8449 Binghamton, NY................................................ 0.8433 Birmingham, AL................................................ 0.9251 Bismarck, ND.................................................. 0.8101 Bloomington-Normal, IL........................................ 0.8954 Boise City, ID................................................ 0.9295 Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH.............. 1.1269 Burlington, VT................................................ 0.9442 Caguas, PR.................................................... 0.4229 Casper, WY.................................................... 0.9239 Champaign-Urbana, IL.......................................... 0.9385 Charleston-North Charleston, SC............................... 0.9307 Charleston, WV (WV Hospitals)................................. 0.8510 Charleston, WV (OH Hospitals)................................. 0.8756 Charlotte-Gastonia-Rock Hill, NC-SC........................... 0.9636 Charlottesville, VA........................................... 0.9946 Chattanooga, TN-GA............................................ 0.8985 Chicago, IL................................................... 1.0863 Cincinnati, OH-KY-IN.......................................... 0.9452 Clarksville-Hopkinsville, TN-KY............................... 0.8410 Cleveland-Lorain-Elyria, OH................................... 0.9686 Columbia, MO.................................................. 0.8607 Columbia, SC.................................................. 0.8958 Columbus, GA-AL............................................... 0.8505 Columbus, OH.................................................. 0.9649 Corpus Christi, TX............................................ 0.8565 Corvallis, OR................................................. 1.1316 Dallas, TX.................................................... 0.9733 Davenport-Moline-Rock Island, IA-IL........................... 0.8727 Dayton-Springfield, OH........................................ 0.9432 Decatur, AL................................................... 0.8633 Denver, CO.................................................... 1.0581 Des Moines, IA................................................ 0.9053 Detroit, MI................................................... 1.0097 Dothan, AL.................................................... 0.7931 Dover, DE..................................................... 0.9669 Duluth-Superior, MN-WI........................................ 1.0133 Dutchess County, NY........................................... 1.0769 Eau Claire, WI................................................ 0.9141 Elkhart-Goshen, IN............................................ 0.9613 Erie, PA...................................................... 0.8530 Eugene-Springfield, OR........................................ 1.0889 Fargo-Moorhead, ND-MN......................................... 0.9444 Fayetteville, NC.............................................. 0.8957 Flagstaff, AZ-UT.............................................. 1.1086 Flint, MI..................................................... 1.0929 Florence, AL.................................................. 0.7824 Florence, SC.................................................. 0.8763 Fort Collins-Loveland, CO..................................... 1.0201 Ft. Lauderdale, FL............................................ 1.0534 Fort Pierce-Port St. Lucie, FL................................ 1.0227 Fort Smith, AR-OK............................................. 0.7577 Fort Walton Beach, FL......................................... 0.8700 Forth Worth-Arlington, TX..................................... 0.9268 Gadsden, AL................................................... 0.8295 Grand Forks, ND-MN (ND Hospitals)............................. 0.9031 Grand Forks, ND-MN (MN Hospitals)............................. 0.9243 Grand Junction, CO............................................ 0.9940 Grand Rapids-Muskegon-Holland, MI............................. 0.9406 Great Falls, MT............................................... 0.8977 Greeley, CO................................................... 0.9516 Green Bay, WI................................................. 0.9201 Greensboro-Winston-Salem-High Point, NC (NC Hospitals)........ 0.8533 Greensboro-Winston-Salem-High Point, NC (VA Hospitals)........ 0.8542 Greenville, NC................................................ 0.9621 Hamilton-Middletown, OH....................................... 0.9236 Harrisburg-Lebanon-Carlisle, PA............................... 0.9178

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Hartford, CT (MA Hospitals)................................... 1.1234 Hartford, CT (NY Hospitals)................................... 1.1211 Hattiesburg, MS............................................... 0.7810 Hickory-Morganton-Lenoir, NC.................................. 0.8987 Honolulu, HI.................................................. 1.1176 Houston, TX................................................... 0.9591 Huntington-Ashland, WV-KY-OH.................................. 0.9080 Huntsville, AL................................................ 0.8954 Indianapolis, IN.............................................. 0.9934 Iowa City, IA................................................. 0.9460 Jackson, MS................................................... 0.8459 Jackson, TN................................................... 0.8602 Jacksonville, FL.............................................. 0.9426 Johnson City-Kingsport-Bristol, TN-VA (VA Hospitals).......... 0.8542 Johnson City-Kingsport-Bristol, TN-VA (KY Hospitals).......... 0.8371 Jonesboro, AR (AR Hospitals).................................. 0.7755 Jonesboro, AR (MO Hospitals).................................. 0.7793 Joplin, MO.................................................... 0.8621 Kalamazoo-Battlecreek, MI..................................... 1.0554 Kansas City, KS-MO............................................ 0.9551 Knoxville, TN................................................. 0.8987 Kokomo, IN.................................................... 0.8963 Lafayette, LA................................................. 0.8271 Lakeland-Winter Haven, FL..................................... 0.8782 Las Vegas, NV-AZ.............................................. 1.1341 Lawton, OK.................................................... 0.8194 Lexington, KY................................................. 0.8424 Lima, OH...................................................... 0.9457 Lincoln, NE................................................... 0.9613 Little Rock-North Little Rock, AR............................. 0.8905 Longview-Marshall, TX......................................... 0.8969 Los Angeles-Long Beach, CA.................................... 1.1656 Louisville, KY-IN............................................. 0.9056 Lubbock, TX................................................... 0.8330 Lynchburg, VA................................................. 0.9004 Macon, GA..................................................... 0.9011 Madison, WI................................................... 1.0108 Medford-Ashland, OR........................................... 1.0494 Melbourne-Titusville-Palm Bay, FL............................. 0.9837 Memphis, TN-AR-MS............................................. 0.9010 Miami, FL..................................................... 0.9888 Milwaukee-Waukesha, WI........................................ 0.9760 Minneapolis-St. Paul, MN-WI................................... 1.1064 Missoula, MT.................................................. 0.8943 Mobile, AL.................................................... 0.7948 Modesto, CA................................................... 1.1183 Monmouth-Ocean, NJ............................................ 1.1094 Monroe, LA.................................................... 0.7978 Montgomery, AL................................................ 0.7856 Nashville, TN................................................. 0.9582 New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT........... 1.2525 New Orleans, LA............................................... 0.9167 New York, NY.................................................. 1.3867 Newark, NJ.................................................... 1.1417 Newburgh, NY-PA............................................... 1.1377 Norfolk-Virginia Beach-Newport News, VA-NC.................... 0.8659 Oakland, CA................................................... 1.5204 Ocala, FL..................................................... 0.9646 Odessa-Midland, TX............................................ 0.9156 Oklahoma City, OK............................................. 0.9027 Olympia, WA................................................... 1.1030 Omaha, NE-IA.................................................. 0.9744 Orange County, CA............................................. 1.1235 Orlando, FL................................................... 0.9612 Peoria-Pekin, IL.............................................. 0.8811 Philadelphia, PA-NJ........................................... 1.0947 Phoenix-Mesa, AZ.............................................. 1.0213 Pine Bluff, AR................................................ 0.7810 Pittsburgh, PA................................................ 0.8788 Pittsfield, MA................................................ 0.9861 Pocatello, ID (ID Hospitals).................................. 0.9103 Pocatello, ID (WY Hospitals).................................. 0.9137 Portland, ME.................................................. 0.9784 Portland-Vancouver, OR-WA..................................... 1.1193 Provo-Orem, UT................................................ 0.9912 Raleigh-Durham-Chapel Hill, NC................................ 0.9756 Rapid City, SD................................................ 0.8865 Reading, PA................................................... 0.8910 Redding, CA................................................... 1.1357 Reno, NV...................................................... 1.0758 Richland-Kennewick-Pasco, WA.................................. 1.0639 Richmond-Petersburg, VA....................................... 0.9402 Roanoke, VA................................................... 0.8759 Rochester, MN................................................. 1.1802 Rockford, IL.................................................. 0.9500 Sacramento, CA................................................ 1.1911 Saginaw-Bay City-Midland, MI.................................. 0.9470 St. Cloud, MN................................................. 0.9723 St. Joseph, MO................................................ 0.9694 St. Louis, MO-IL.............................................. 0.9049 Salinas, CA................................................... 1.4435 Salt Lake City-Ogden, UT...................................... 0.9899 San Antonio, TX............................................... 0.8876 Santa Fe, NM.................................................. 0.9543 Santa Rosa, CA................................................ 1.2836 Sarasota-Bradenton, FL........................................ 0.9834 Savannah, GA.................................................. 0.9556 Seattle-Bellevue-Everett, WA.................................. 1.1557 Sherman-Denison, TX........................................... 0.9084 Shreveport-Bossier City, LA................................... 0.9127 Sioux City, IA-NE............................................. 0.8806 Sioux Falls, SD............................................... 0.9246 South Bend, IN................................................ 0.9780 Spokane, WA................................................... 1.0770 Springfield, IL............................................... 0.9004 Springfield, MO............................................... 0.8269 Stockton-Lodi, CA............................................. 1.1168 Syracuse, NY.................................................. 0.9381 Tampa-St. Petersburg-Clearwater, FL........................... 0.9111 Texarkana, AR-Texarkana, TX................................... 0.8018 Toledo, OH.................................................... 0.9551 Topeka, KS.................................................... 0.8791 Tucson, AZ.................................................... 0.8958 Tulsa, OK..................................................... 0.8876 Tuscaloosa, AL................................................ 0.8134 Tyler, TX..................................................... 0.8789 Vallejo-Fairfield-Napa, CA.................................... 1.3500 Victoria, TX.................................................. 0.8105 Waco, TX...................................................... 0.8449 Washington, DC-MD-VA-WV....................................... 1.0707 Waterloo-Cedar Falls, IA...................................... 0.8422 Wausau, WI.................................................... 0.9806 West Palm Beach-Boca Raton, FL................................ 0.9784 Wichita, KS................................................... 0.9053 Wichita Falls, TX............................................. 0.8407 Wilmington-Newark, DE-MD...................................... 1.0782 Wilmington, NC................................................ 0.9402 York, PA...................................................... 0.9154 Youngstown-Warren, OH......................................... 0.9273 Rural Alabama................................................. 0.7517 Rural Florida................................................. 0.8782 Rural Illinois................................................ 0.8282 Rural Kentucky................................................ 0.7924 Rural Louisiana............................................... 0.7565 Rural Michigan................................................ 0.8807 Rural Minnesota............................................... 0.9243 Rural Mississippi............................................. 0.7810 Rural Missouri................................................ 0.7793 Rural Nebraska................................................ 0.8326 Rural New Hampshire........................................... 0.9944 Rural Texas................................................... 0.7673 Rural Washington.............................................. 1.0242 Rural Wyoming................................................. 0.9020

Addendum L.--Packaged Nonchemotherapy Infusion Drugs Calendar Year 2004

HCPCS

Descriptor

J0706............................. Caffeine citrate injection J1260............................. Dolasetron mesylate J1325............................. Epoprostenol injection J1436............................. Etidronate disodium inj J1570............................. Ganciclovir sodium injection J1626............................. Granisetron HCl injection J2020............................. Linezolid injection J2260............................. Inj milrinone lactate, per 5 J2275............................. Morphine sulfate injection J2405............................. Ondansetron hcl injection J2765............................. Metoclopramide hcl injection J2770............................. Quinupristin/dalfopristin J2820............................. Sargramostim injection J2997............................. Alteplase recombinant J3010............................. Fentanyl citrate injeciton J7501............................. Azathioprine parenteral J7516............................. Cyclosporin parenteral 250mg J7525............................. Tacrolimus injection Q2003............................. Aprotinin, 10,000 kiu Q2007............................. Ethanolamine oleate 100 mg Q2009............................. Fosphenytoin, 50 mg Q2013............................. Pentastarch 10% solution Q2021............................. Lepirudin

Addendum M.--Separately Paid Nonchemotology Infusion Drugs Calendar Year 2004

HCPCS

Descriptor

C1178............................. BUSULFAN IV, 6 Mg C9019............................. Caspofungin acetate, 5 mg C9109............................. Tirofiban hcl, 6.25 mg J0130............................. Abciximab injection J0151............................. Adenosine injection J0286............................. Amphotericin B lipid complex J0350............................. Injection anistreplase 30 u J0850............................. Cytomegalovirus imm IV /vial J1327............................. Eptifibatide injection J1440............................. Filgrastim 300 mcg injection J1441............................. Filgrastim 480 mcg injection J1561............................. Immune globulin 500 mg J1563............................. Immune globulin, 1 g J1564............................. Immune globulin 10 mg J1565............................. RSV-ivig J1745............................. Infliximab injection J2792............................. Rho(D) immune globulin h, sd J2993............................. Reteplase injection J2995............................. Inj streptokinase /250000 IU

[[Page 48248]]

J3245............................. Tirofiban hydrochloride J3305............................. Inj trimetrexate glucoronate J3365............................. Urokinase 250,000 IU inj J3395............................. Verteporfin injection J7197............................. Antithrombin iii injection J7504............................. Lymphocyte immune globulin J7511............................. Antithymocyte globuln rabbit J9200............................. Floxuridine injection J9600............................. Porfimer sodium P9041............................. Albumin (human),5%, 50ml P9045............................. Albumin (human), 5%, 250 ml P9046............................. Albumin (human), 25%, 20 ml P9047............................. Albumin (human), 25%, 50ml Q2006............................. Digoxin immune fab (ovine) Q2008............................. Fomepizole, 15 mg Q2011............................. Hemin, per 1 mg

Addendum N.--Packaged Chemotherapy Drug Other Than Infusion Calendar Year 2004

HCPCS

Short descriptor

J9000............................ Doxorubic hcl 10 MG vl chemo J9190............................ Fluorouracil injection J9212............................ Interferon alfacon-1 J9213............................ Interferon alfa-2a inj J9230............................ Mechlorethamine hcl inj J9250............................ Methotrexate sodium inj J9360............................ Vinblastine sulfate inj J9370............................ Vincristine sulfate 1 MG inj

Addendum O.--Separately Paid Chemotherapy Drugs Other than Infusion Calendar Year 2004

HCPCS

Short descriptor

J2352............................ Octreotide acetate injection J9202............................ Goserelin acetate implant J9214............................ Interferon alfa-2b inj J9217............................ Leuprolide acetate suspnsion J9218............................ Leuprolide acetate inj J9219............................ Leuprolide acetate implant

Addendum P.--Packaged Chemotherapy Drugs Infusion Only Calendar Year 2004

HCPCS

Short descriptor

C1166............................. CYTARABINE LIPOSOMAL, 10 mg J1620............................. Gonadorelin hydroch/100 mcg J9020............................. Asparaginase injection J9031............................. Bcg live intravesical vac J9070............................. Cyclophosphamide 100 MG inj J9093............................. Cyclophosphamide lyophilized J9100............................. Cytarabine hcl 100 MG inj J9120............................. Dactinomycin actinomycin d J9130............................. Dacarbazine 10 MG inj J9181............................. Etoposide 10 MG inj J9270............................. Plicamycin (mithramycin) inj J9340............................. Thiotepa injection

Addendum Q.--Separately Paid Chemotherapy Drugs Infusion Only Calendar Year 2004

HCPCS

Short descriptor

C1167............................. EPIRUBICIN HCL, 2 mg C1207............................. OCTREOTIDE ACETATE DEPOT 1mg C9110............................. Alemtuzumab, per 10mg/ml J0207............................. Amifostine J1190............................. Dexrazoxane HCl injection J1950............................. Leuprolide acetate /3.75 MG J2355............................. Oprelvekin injection J2430............................. Pamidronate disodium /30 MG J9001............................. Doxorubicin hcl liposome inj J9015............................. Aldesleukin/single use vial J9017............................. Arsenic trioxide J9040............................. Bleomycin sulfate injection J9045............................. Carboplatin injection J9050............................. Carmus bischl nitro inj J9060............................. Cisplatin 10 MG injection J9065............................. Inj cladribine per 1 MG J9150............................. Daunorubicin J9151............................. Daunorubicin citrate liposom J9160............................. Denileukin diftitox, 300 mcg J9165............................. Diethylstilbestrol injection J9170............................. Docetaxel J9185............................. Fludarabine phosphate inj J9201............................. Gemcitabine HCl J9206............................. Irinotecan injection J9208............................. Ifosfomide injection J9209............................. Mesna injection J9211............................. Idarubicin hcl injection J9245............................. Inj melphalan hydrochl 50 MG J9265............................. Paclitaxel injection J9266............................. Pegaspargase/singl dose vial J9268............................. Pentostatin injection J9280............................. Mitomycin 5 MG inj J9293............................. Mitoxantrone hydrochl/5 MG J9300............................. Gemtuzumab ozogamicin J9310............................. Rituximab cancer treatment J9320............................. Streptozocin injection J9350............................. Topotecan J9355............................. Trastuzumab J9357............................. Valrubicin, 200 mg J9390............................. Vinorelbine tartrate/10 mg Q2017............................. Teniposide, 50 mg

[FR Doc. 03-20280 Filed 8-6-03; 8:45 am]

BILLING CODE 4120-01-P

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