RBRVS Fee Schedule 7-1-12

2012 Physician Fee Schedule RVU File Effective March 1, 2012
CPT codes & descriptions only are copyright 2011AMA. Applicable FARS/DFARS Apply. All Other Conversion Factor $ 34.80
$ 35.15
Dental codes (D codes) are copyright 2011/2012 ADA. All Rights Reserved.
The absence or presence of a CPT code in this table does not
indicate PEIA coverage. Also, the presence of a fee
allowance does not indicate coverage.
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
Facility Non-Facility PEIA
Outpatient Outpatient Fee
STATUS PCTC GLOB MULT BILAT ASST CO- TEAM ENDO RVU RVU Allowance
HCPCS MOD DESCRIPTION CODE IND DAYS PROC SURG SURG SURG SURG BASE Payment Payment
000F Heart failure composite X 9 XXX $ - $ -

0005F Osteoarthritis composite X 9 XXX $ - $ -
00100 Anesth salivary gland X 9 XXX $ - $ -
00102 Anesth repair of cleft lip X 9 XXX $ - $ -
00103 Anesth blepharoplasty X 9 XXX $ - $ -
00104 Anesth electroshock X 9 XXX $ - $ -
00120 Anesth ear surgery X 9 XXX $ - $ -
00124 Anesth ear exam X 9 XXX $ - $ -
00126 Anesth tympanotomy X 9 XXX $ - $ -
0012F Cap bacterial assess X 9 XXX $ - $ -
00140 Anesth procedures on eye X 9 XXX $ - $ -
00142 Anesth lens surgery X 9 XXX $ - $ -
00144 Anesth corneal transplant X 9 XXX $ - $ -
00145 Anesth vitreoretinal surg X 9 XXX $ - $ -
00147 Anesth iridectomy X 9 XXX $ - $ -
00148 Anesth eye exam X 9 XXX $ - $ -
0014F Comp preop assess cat surg X 9 XXX $ - $ -
0015F Melan follow-up complete X 9 XXX $ - $ -
00160 Anesth nose/sinus surgery X 9 XXX $ - $ -
00162 Anesth nose/sinus surgery X 9 XXX $ - $ -
00164 Anesth biopsy of nose X 9 XXX $ - $ -
00170 Anesth procedure on mouth X 9 XXX $ - $ -
00172 Anesth cleft palate repair X 9 XXX $ - $ -
00174 Anesth pharyngeal surgery X 9 XXX $ - $ -
00176 Anesth pharyngeal surgery X 9 XXX $ - $ -
00190 Anesth face/skull bone surg X 9 XXX $ - $ -
00192 Anesth facial bone surgery X 9 XXX $ - $ -
0019T Extracorp shock wv tx ms nos N 0 XXX $ - $ -
Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
00210 Anesth cranial surg nos X 9 XXX $ - $ -

00211 Anesth cran surg hemotoma X 9 XXX $ - $ -
00212 Anesth skull drainage X 9 XXX $ - $ -
00214 Anesth skull drainage X 9 XXX $ - $ -
00215 Anesth skull repair/fract X 9 XXX $ - $ -
00216 Anesth head vessel surgery X 9 XXX $ - $ -
00218 Anesth special head surgery X 9 XXX $ - $ -
00220 Anesth intrcrn nerve X 9 XXX $ - $ -
00222 Anesth head nerve surgery X 9 XXX $ - $ -
00300 Anesth head/neck/ptrunk X 9 XXX $ - $ -
0030T Antiprothrombin antibody X 0 XXX $ - $ -
00320 Anesth neck organ 1yr/> X 9 XXX $ - $ -
00322 Anesth biopsy of thyroid X 9 XXX $ - $ -
00326 Anesth larynx/trach < 1 yr X 9 XXX $ - $ -
00350 Anesth neck vessel surgery X 9 XXX $ - $ -
00352 Anesth neck vessel surgery X 9 XXX $ - $ -
00400 Anesth skin ext/per/atrunk X 9 XXX $ - $ -
00402 Anesth surgery of breast X 9 XXX $ - $ -
00410 Anesth correct heart rhythm X 9 XXX $ - $ -
0042T Ct perfusion w/contrast cbf N 0 XXX $ - $ -
00450 Anesth surgery of shoulder X 9 XXX $ - $ -
00454 Anesth collar bone biopsy X 9 XXX $ - $ -
00470 Anesth removal of rib X 9 XXX $ - $ -
00472 Anesth chest wall repair X 9 XXX $ - $ -
00474 Anesth surgery of rib X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
0048T Implant ventricular device C 0 XXX $ - $ -

00500 Anesth esophageal surgery X 9 XXX $ - $ -
0050T Removal circulation assist C 0 XXX $ - $ -
0051T Implant total heart system C 0 XXX $ - $ -
00520 Anesth chest procedure X 9 XXX $ - $ -
00522 Anesth chest lining biopsy X 9 XXX $ - $ -
00524 Anesth chest drainage X 9 XXX $ - $ -
00528 Anes mediascpy & dx thorscpy X 9 XXX $ - $ -
00529 Anes medscpy&thorscpy 1 lung X 9 XXX $ - $ -
0052T Replace component heart syst C 0 XXX $ - $ -
00530 Anesth pacemaker insertion X 9 XXX $ - $ -
00532 Anesth vascular access X 9 XXX $ - $ -
00534 Anesth cardioverter/defib X 9 XXX $ - $ -
00537 Anesth cardiac electrophys X 9 XXX $ - $ -
00539 Anesth trach-bronch reconst X 9 XXX $ - $ -
0053T Replace component heart syst C 0 XXX $ - $ -
00540 Anesth chest surgery X 9 XXX $ - $ -
00541 Anesth one lung ventilation X 9 XXX $ - $ -
00542 Anesth remvl pleura X 9 XXX $ - $ -
00546 Anesth lung chest wall surg X 9 XXX $ - $ -
00548 Anesth trachea bronchi surg X 9 XXX $ - $ -
0054T Bone surgery using computer C 0 XXX $ - $ -
00550 Anesth sternal debridement X 9 XXX $ - $ -
0055T Bone surgery using computer C 0 XXX $ - $ -
00560 Anesth heart surg w/o pump X 9 XXX $ - $ -
00561 Anesth heart surg < 1 yr X 9 XXX $ - $ -
00562 Anesth hrt surg w/pmp age 1+ X 9 XXX $ - $ -
00563 Anesth heart surg w/arrest X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
00566 Anesth cabg w/o pump X 9 XXX $ - $ -

00567 Anesth cabg w/pump X 9 XXX $ - $ -
00580 Anesth heart/lung transplnt X 9 XXX $ - $ -
0058T Cryopreservation ovary tiss C 0 XXX $ - $ -
0059T Cryopreservation oocyte C 0 XXX $ - $ -
00600 Anesth spine cord surgery X 9 XXX $ - $ -
00604 Anesth sitting procedure X 9 XXX $ - $ -
00622 Anesth removal of nerves X 9 XXX $ - $ -
00625 Anes spine tranthor w/o vent X 9 XXX $ - $ -
00626 Anes spine transthor w/vent X 9 XXX $ - $ -
00632 Anesth removal of nerves X 9 XXX $ - $ -
00634 Anesth for chemonucleolysis X 9 XXX $ - $ -
00635 Anesth lumbar puncture X 9 XXX $ - $ -
00640 Anesth spine manipulation X 9 XXX $ - $ -
00700 Anesth abdominal wall surg X 9 XXX $ - $ -
00702 Anesth for liver biopsy X 9 XXX $ - $ -
0071T U/s leiomyomata ablate <200 C 0 XXX $ - $ -
0072T U/s leiomyomata ablate >200 C 0 XXX $ - $ -
0073T Delivery comp imrt A 3 XXX $ - $ 403.68
00740 Anesth upper gi visualize X 9 XXX $ - $ -
00750 Anesth repair of hernia X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
0075T Perq stent/chest vert art C 1 XXX $ - $ -

0075T 26 Perq stent/chest vert art C 1 XXX $ - $ -
0075T TC Perq stent/chest vert art C 1 XXX $ - $ -
0076T S&i stent/chest vert art C 1 XXX $ - $ -
0076T 26 S&i stent/chest vert art C 1 XXX $ - $ -
0076T TC S&i stent/chest vert art C 1 XXX $ - $ -
00770 Anesth blood vessel repair X 9 XXX $ - $ -
0078T Endovasc aort repr w/device C 0 XXX $ - $ -
00790 Anesth surg upper abdomen X 9 XXX $ - $ -
00792 Anesth hemorr/excise liver X 9 XXX $ - $ -
00794 Anesth pancreas removal X 9 XXX $ - $ -
00796 Anesth for liver transplant X 9 XXX $ - $ -
00797 Anesth surgery for obesity X 9 XXX $ - $ -
0079T Endovasc visc extnsn repr C 0 XXX $ - $ -
00802 Anesth fat layer removal X 9 XXX $ - $ -
0080T Endovasc aort repr rad s&i C 0 XXX $ - $ -
00810 Anesth low intestine scope X 9 XXX $ - $ -
0081T Endovasc visc extnsn s&i C 0 XXX $ - $ -
00834 Anesth hernia repair < 1 yr X 9 XXX $ - $ -
00836 Anesth hernia repair preemie X 9 XXX $ - $ -
00840 Anesth surg lower abdomen X 9 XXX $ - $ -
00842 Anesth amniocentesis X 9 XXX $ - $ -
00844 Anesth pelvis surgery X 9 XXX $ - $ -
00846 Anesth hysterectomy X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
00848 Anesth pelvic organ surg X 9 XXX $ - $ -

00851 Anesth tubal ligation X 9 XXX $ - $ -
0085T Breath test heart reject N 9 XXX $ - $ -
00860 Anesth surgery of abdomen X 9 XXX $ - $ -
00862 Anesth kidney/ureter surg X 9 XXX $ - $ -
00864 Anesth removal of bladder X 9 XXX $ - $ -
00865 Anesth removal of prostate X 9 XXX $ - $ -
00866 Anesth removal of adrenal X 9 XXX $ - $ -
00868 Anesth kidney transplant X 9 XXX $ - $ -
00870 Anesth bladder stone surg X 9 XXX $ - $ -
00872 Anesth kidney stone destruct X 9 XXX $ - $ -
00873 Anesth kidney stone destruct X 9 XXX $ - $ -
00880 Anesth abdomen vessel surg X 9 XXX $ - $ -
00882 Anesth major vein ligation X 9 XXX $ - $ -
00902 Anesth anorectal surgery X 9 XXX $ - $ -
00904 Anesth perineal surgery X 9 XXX $ - $ -
00906 Anesth removal of vulva X 9 XXX $ - $ -
00910 Anesth bladder surgery X 9 XXX $ - $ -
00912 Anesth bladder tumor surg X 9 XXX $ - $ -
00916 Anesth bleeding control X 9 XXX $ - $ -
00918 Anesth stone removal X 9 XXX $ - $ -
00920 Anesth genitalia surgery X 9 XXX $ - $ -
00921 Anesth vasectomy X 9 XXX $ - $ -
00922 Anesth sperm duct surgery X 9 XXX $ - $ -
00924 Anesth testis exploration X 9 XXX $ - $ -
00926 Anesth removal of testis X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
00928 Anesth removal of testis X 9 XXX $ - $ -

0092T Artific disc addl C 0 XXX $ - $ -
00930 Anesth testis suspension X 9 XXX $ - $ -
00932 Anesth amputation of penis X 9 XXX $ - $ -
00934 Anesth penis nodes removal X 9 XXX $ - $ -
00936 Anesth penis nodes removal X 9 XXX $ - $ -
00938 Anesth insert penis device X 9 XXX $ - $ -
00940 Anesth vaginal procedures X 9 XXX $ - $ -
00942 Anesth surg on vag/urethral X 9 XXX $ - $ -
00944 Anesth vaginal hysterectomy X 9 XXX $ - $ -
00948 Anesth repair of cervix X 9 XXX $ - $ -
00950 Anesth vaginal endoscopy X 9 XXX $ - $ -
00952 Anesth hysteroscope/graph X 9 XXX $ - $ -
0095T Artific diskectomy addl C 0 XXX $ - $ -
0098T Rev artific disc addl C 0 XXX $ - $ -
0099T Implant corneal ring C 0 XXX $ - $ -
0100T Prosth retina receive&gen C 0 XXX $ - $ -
0101T Extracorp shockwv tx hi enrg C 0 XXX $ - $ -
0102T Extracorp shockwv tx anesth C 0 XXX $ - $ -
0103T Holotranscobalamin C 0 XXX $ - $ -
0106T Touch quant sensory test C 0 XXX $ - $ -
0107T Vibrate quant sensory test C 0 XXX $ - $ -
0108T Cool quant sensory test C 0 XXX $ - $ -
0109T Heat quant sensory test C 0 XXX $ - $ -
0110T Nos quant sensory test C 0 XXX $ - $ -
01112 Anesth bone aspirate/bx X 9 XXX $ - $ -
0111T Rbc membranes fatty acids C 0 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
01130 Anesth body cast procedure X 9 XXX $ - $ -

01140 Anesth amputation at pelvis X 9 XXX $ - $ -
01150 Anesth pelvic tumor surgery X 9 XXX $ - $ -
01160 Anesth pelvis procedure X 9 XXX $ - $ -
01173 Anesth fx repair pelvis X 9 XXX $ - $ -
01180 Anesth pelvis nerve removal X 9 XXX $ - $ -
01190 Anesth pelvis nerve removal X 9 XXX $ - $ -
01200 Anesth hip joint procedure X 9 XXX $ - $ -
01202 Anesth arthroscopy of hip X 9 XXX $ - $ -
01210 Anesth hip joint surgery X 9 XXX $ - $ -
01212 Anesth hip disarticulation X 9 XXX $ - $ -
01214 Anesth hip arthroplasty X 9 XXX $ - $ -
01215 Anesth revise hip repair X 9 XXX $ - $ -
01220 Anesth procedure on femur X 9 XXX $ - $ -
01230 Anesth surgery of femur X 9 XXX $ - $ -
01232 Anesth amputation of femur X 9 XXX $ - $ -
01234 Anesth radical femur surg X 9 XXX $ - $ -
0123T Scleral fistulization C 0 XXX $ - $ -
0124T Conjunctival drug placement C 0 XXX $ - $ -
01250 Anesth upper leg surgery X 9 XXX $ - $ -
01260 Anesth upper leg veins surg X 9 XXX $ - $ -
0126T Chd risk imt study C 0 XXX $ - $ -
01270 Anesth thigh arteries surg X 9 XXX $ - $ -
01272 Anesth femoral artery surg X 9 XXX $ - $ -
01274 Anesth femoral embolectomy X 9 XXX $ - $ -
01320 Anesth knee area surgery X 9 XXX $ - $ -
01340 Anesth knee area procedure X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

01380 Anesth knee joint procedure X 9 XXX $ - $ -
01382 Anesth dx knee arthroscopy X 9 XXX $ - $ -
01390 Anesth knee area procedure X 9 XXX $ - $ -
01400 Anesth knee joint surgery X 9 XXX $ - $ -
01402 Anesth knee arthroplasty X 9 XXX $ - $ -
01404 Anesth amputation at knee X 9 XXX $ - $ -
01420 Anesth knee joint casting X 9 XXX $ - $ -
01430 Anesth knee veins surgery X 9 XXX $ - $ -
01432 Anesth knee vessel surg X 9 XXX $ - $ -
01440 Anesth knee arteries surg X 9 XXX $ - $ -
01442 Anesth knee artery surg X 9 XXX $ - $ -
01444 Anesth knee artery repair X 9 XXX $ - $ -
01462 Anesth lower leg procedure X 9 XXX $ - $ -
01464 Anesth ankle/ft arthroscopy X 9 XXX $ - $ -
01470 Anesth lower leg surgery X 9 XXX $ - $ -
01472 Anesth achilles tendon surg X 9 XXX $ - $ -
01474 Anesth lower leg surgery X 9 XXX $ - $ -
01480 Anesth lower leg bone surg X 9 XXX $ - $ -
01482 Anesth radical leg surgery X 9 XXX $ - $ -
01484 Anesth lower leg revision X 9 XXX $ - $ -
01486 Anesth ankle replacement X 9 XXX $ - $ -
01490 Anesth lower leg casting X 9 XXX $ - $ -
01500 Anesth leg arteries surg X 9 XXX $ - $ -
01502 Anesth lwr leg embolectomy X 9 XXX $ - $ -
01520 Anesth lower leg vein surg X 9 XXX $ - $ -
01522 Anesth lower leg vein surg X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
0159T Cad breast mri N 1 ZZZ $ - $ -

0159T 26 Cad breast mri N 1 ZZZ $ - $ -
0159T TC Cad breast mri N 1 ZZZ $ - $ -
01620 Anesth shoulder procedure X 9 XXX $ - $ -
01622 Anes dx shoulder arthroscopy X 9 XXX $ - $ -
01634 Anesth shoulder joint amput X 9 XXX $ - $ -
01636 Anesth forequarter amput X 9 XXX $ - $ -
01638 Anesth shoulder replacement X 9 XXX $ - $ -
0163T Lumb artif diskectomy addl C 0 YYY $ - $ -
0164T Remove lumb artif disc addl C 0 YYY $ - $ -
01650 Anesth shoulder artery surg X 9 XXX $ - $ -
01652 Anesth shoulder vessel surg X 9 XXX $ - $ -
01654 Anesth shoulder vessel surg X 9 XXX $ - $ -
01656 Anesth arm-leg vessel surg X 9 XXX $ - $ -
0165T Revise lumb artif disc addl C 0 YYY $ - $ -
01670 Anesth shoulder vein surg X 9 XXX $ - $ -
01680 Anesth shoulder casting X 9 XXX $ - $ -
01682 Anesth airplane cast X 9 XXX $ - $ -
0169T Place stereo cath brain C 0 XXX $ - $ -
01710 Anesth elbow area surgery X 9 XXX $ - $ -
01712 Anesth uppr arm tendon surg X 9 XXX $ - $ -
01714 Anesth uppr arm tendon surg X 9 XXX $ - $ -
01716 Anesth biceps tendon repair X 9 XXX $ - $ -
0171T Lumbar spine proces distract C 0 XXX $ - $ -
0172T Lumbar spine process addl C 0 XXX $ - $ -
01730 Anesth uppr arm procedure X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
01732 Anesth dx elbow arthroscopy X 9 XXX $ - $ -

0173T Iop monit io pressure C 0 XXX $ - $ -
01740 Anesth upper arm surgery X 9 XXX $ - $ -
01742 Anesth humerus surgery X 9 XXX $ - $ -
01744 Anesth humerus repair X 9 XXX $ - $ -
0174T Cad cxr with interp C 0 XXX $ - $ -
01756 Anesth radical humerus surg X 9 XXX $ - $ -
01758 Anesth humeral lesion surg X 9 XXX $ - $ -
0175T Cad cxr remote C 0 XXX $ - $ -
01760 Anesth elbow replacement X 9 XXX $ - $ -
01770 Anesth uppr arm artery surg X 9 XXX $ - $ -
01772 Anesth uppr arm embolectomy X 9 XXX $ - $ -
01780 Anesth upper arm vein surg X 9 XXX $ - $ -
01782 Anesth uppr arm vein repair X 9 XXX $ - $ -
0178T 64 lead ecg w/i&r C 4 XXX $ - $ -
0179T 64 lead ecg w/tracing C 3 XXX $ - $ -
0180T 64 lead ecg w/i&r only C 2 XXX $ - $ -
01810 Anesth lower arm surgery X 9 XXX $ - $ -
0181T Corneal hysteresis C 0 XXX $ - $ -
01820 Anesth lower arm procedure X 9 XXX $ - $ -
01829 Anesth dx wrist arthroscopy X 9 XXX $ - $ -
0182T Hdr elect brachytherapy C 1 XXX $ - $ -
0182T 26 Hdr elect brachytherapy C 1 XXX $ - $ -
0182T TC Hdr elect brachytherapy C 1 XXX $ - $ -
01830 Anesth lower arm surgery X 9 XXX $ - $ -
01832 Anesth wrist replacement X 9 XXX $ - $ -
0183T Wound ultrasound N 0 XXX $ - $ -
01840 Anesth lwr arm artery surg X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
01842 Anesth lwr arm embolectomy X 9 XXX $ - $ -

01844 Anesth vascular shunt surg X 9 XXX $ - $ -
0184T Exc rectal tumor endoscopic N 0 XXX $ - $ -
01850 Anesth lower arm vein surg X 9 XXX $ - $ -
01852 Anesth lwr arm vein repair X 9 XXX $ - $ -
0185T Comptr probability analysis C 0 XXX $ - $ -
01860 Anesth lower arm casting X 9 XXX $ - $ -
0186T Suprachoroidal drug delivery C 0 XXX $ - $ -
0188T Videoconf crit care 74 min N 9 XXX $ - $ -
0189T Videoconf crit care addl 30 N 9 XXX $ - $ -
0190T Place intraoc radiation src C 0 XXX $ - $ -
01916 Anesth dx arteriography X 9 XXX $ - $ -
0191T Insert ant segment drain int C 0 XXX $ - $ -
01920 Anesth catheterize heart X 9 XXX $ - $ -
01922 Anesth cat or mri scan X 9 XXX $ - $ -
01924 Anes ther interven rad art X 9 XXX $ - $ -
01925 Anes ther interven rad car X 9 XXX $ - $ -
01926 Anes tx interv rad hrt/cran X 9 XXX $ - $ -
0192T Insert ant segment drain ext C 0 XXX $ - $ -
01930 Anes ther interven rad vei X 9 XXX $ - $ -
01931 Anes ther interven rad tip X 9 XXX $ - $ -
01932 Anes tx interv rad th vein X 9 XXX $ - $ -
01933 Anes tx interv rad cran vein X 9 XXX $ - $ -
01935 Anesth perc img dx sp proc X 9 XXX $ - $ -
01936 Anesth perc img tx sp proc X 9 XXX $ - $ -
01951 Anesth burn less 4 percent X 9 XXX $ - $ -
01952 Anesth burn 4-9 percent X 9 XXX $ - $ -
01953 Anesth burn each 9 percent X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
01958 Anesth antepartum manipul X 9 XXX $ - $ -

0195T Arthrod presac interbody C 0 XXX $ - $ -
01960 Anesth vaginal delivery X 9 XXX $ - $ -
01961 Anesth cs delivery X 9 XXX $ - $ -
01962 Anesth emer hysterectomy X 9 XXX $ - $ -
01963 Anesth cs hysterectomy X 9 XXX $ - $ -
01965 Anesth inc/missed ab proc X 9 XXX $ - $ -
01966 Anesth induced ab procedure X 9 XXX $ - $ -
01967 Anesth/analg vag delivery X 9 XXX $ - $ -
01968 Anes/analg cs deliver add-on X 9 XXX $ - $ -
01969 Anesth/analg cs hyst add-on X 9 XXX $ - $ -
0196T Arthrod presac interbody eac C 0 XXX $ - $ -
0197T Intrafraction track motion C 0 XXX $ - $ -
0198T Ocular blood flow measure C 0 XXX $ - $ -
01990 Support for organ donor X 9 XXX $ - $ -
01991 Anesth nerve block/inj X 9 XXX $ - $ -
01992 Anesth n block/inj prone X 9 XXX $ - $ -
01996 Hosp manage cont drug admin X 9 XXX $ - $ -
01999 Unlisted anesth procedure X 9 XXX $ - $ -
0199T Physiologic tremor record C 0 XXX $ - $ -
0200T Perq sacral augmt unilat inj C 0 XXX Y $ - $ -
0201T Perq sacral augmt bilat inj C 0 XXX $ - $ -
0202T Post vert arthrplst 1 lumbar C 0 XXX $ - $ -
0205T Inirs each vessel add-on C 0 ZZZ $ - $ -
0206T Remote algorithm analys ecg C 3 XXX $ - $ -
0207T Clear eyelid gland w/heat C 0 XXX $ - $ -
0208T Audiometry air only C 3 XXX $ - $ -
0209T Audiometry air & bone C 3 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
0210T Speech audiometry threshold C 3 XXX $ - $ -

0211T Speech audiom thresh & recog C 3 XXX $ - $ -
0212T Compre audiometry evaluation C 3 XXX $ - $ -
0213T Njx paravert w/us cer/thor C 0 XXX Y $ - $ -
0214T Njx paravert w/us cer/thor C 0 ZZZ Y $ - $ -
0215T Njx paravert w/us cer/thor C 0 ZZZ Y $ - $ -
0216T Njx paravert w/us lumb/sac C 0 XXX Y $ - $ -
0217T Njx paravert w/us lumb/sac C 0 ZZZ Y $ - $ -
0218T Njx paravert w/us lumb/sac C 0 ZZZ Y $ - $ -
0219T Plmt post facet implt cerv C 0 XXX $ - $ -
0220T Plmt post facet implt thor C 0 XXX $ - $ -
0221T Plmt post facet implt lumb C 0 XXX $ - $ -
0222T Plmt post facet implt addl C 0 ZZZ $ - $ -
0223T Acoustic ecg w/i&r C 0 XXX $ - $ -
0224T Acoustic ecg 1+ analysis C 0 XXX $ - $ -
0225T Acoustic ecg analy & reprog C 0 XXX $ - $ -
0226T Anoscopy hra w/spec collect C 0 XXX $ - $ -
0227T Anoscopy hra w/biopsy C 0 XXX $ - $ -
0228T Njx tfrml eprl w/us cer/thor C 0 XXX Y $ - $ -
0229T Njx tfrml eprl w/us cer/thor C 0 XXX Y $ - $ -
0230T Njx tfrml eprl w/us lumb/sac C 0 XXX Y $ - $ -
0231T Njx tfrml eprl w/us lumb/sac C 0 XXX Y $ - $ -
0232T Njx platelet plasma C 0 XXX $ - $ -
0233T Skin glycation spectroscopy C 0 XXX $ - $ -
0234T Trluml perip athrc renal art C 0 YYY $ - $ -
0235T Trluml perip athrc visceral C 0 YYY $ - $ -
0236T Trluml perip athrc abd aorta C 0 YYY $ - $ -
0237T Trluml perip athrc brchiocph C 0 YYY $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
0238T Trluml perip athrc iliac art C 0 YYY $ - $ -

0239T Bioimpedance spectroscopy C 0 YYY $ - $ -
0240T Esoph motility 3d topography C 1 YYY $ - $ -
0240T 26 Esoph motility 3d topography C 1 YYY $ - $ -
0240T TC Esoph motility 3d topography C 1 YYY $ - $ -
0241T Esoph motility w/stim/perf C 1 YYY $ - $ -
0241T 26 Esoph motility w/stim/perf C 1 YYY $ - $ -
0241T TC Esoph motility w/stim/perf C 1 YYY $ - $ -
0242T Gi tract transit & pres meas C 1 YYY $ - $ -
0242T 26 Gi tract transit & pres meas C 1 YYY $ - $ -
0242T TC Gi tract transit & pres meas C 1 YYY $ - $ -
0243T Intm msr bronchodil wheeze C 1 YYY $ - $ -
0243T 26 Intm msr bronchodil wheeze C 1 YYY $ - $ -
0243T TC Intm msr bronchodil wheeze C 1 YYY $ - $ -
0244T Cont msr bronchodil wheeze C 1 YYY $ - $ -
0244T 26 Cont msr bronchodil wheeze C 1 YYY $ - $ -
0244T TC Cont msr bronchodil wheeze C 1 YYY $ - $ -
0245T Open tx rib fx 1-2 ribs C 0 YYY Y $ - $ -
0246T Opn tx rib fx 3-4 ribs C 0 YYY Y $ - $ -
0247T Opn tx rib fx 5-6 ribs C 0 YYY Y $ - $ -
0248T Open tx rib fx 7/> ribs C 0 YYY Y $ - $ -
0249T Ligation hemorrhoid w/us C 0 YYY $ - $ -
0250T Insert bronchial valve C 0 YYY $ - $ -
0251T Remov bronchial valve C 0 YYY $ - $ -
0252T Remov bronch valve addl C 0 YYY $ - $ -
0253T Insert aqueous drain device C 0 YYY $ - $ -
0254T Evasc rpr iliac art bifur C 0 YYY $ - $ -
0255T Evasc rpr iliac art bifr s&i C 1 YYY $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
0255T 26 Evasc rpr iliac art bifr s&i C 1 YYY $ - $ -

0255T TC Evasc rpr iliac art bifr s&i C 1 YYY $ - $ -
0256T Evasc aortic hrt valve C 0 YYY Y $ - $ -
0257T Opn tthrc aortic hrt valve C 0 YYY Y $ - $ -
0258T Aortic hrt valv w/o card byp C 0 YYY Y $ - $ -
0259T Aortic hrt valve w/card byp C 0 YYY Y $ - $ -
0260T Hypthrm bdy neonate 28d/< C 0 YYY $ - $ -
0261T Hypthrm head neonate 28d/< C 0 YYY $ - $ -
0262T Impltj pulm vlv evasc appr C 0 YYY $ - $ -
0263T Im B1 mrw cel ther cmpl C 0 XXX $ - $ -
0264T Im B1 mrw cel ther xcl hrvst C 0 XXX $ - $ -
0265T Im B1 mrw cel ther hrvst onl C 0 XXX $ - $ -
0266T Implt/rpl crtd sns dev total C 0 YYY $ - $ -
0267T Implt/rpl crtd sns dev lead C 0 YYY $ - $ -
0268T Implt/rpl crtd sns dev gen C 0 YYY $ - $ -
0269T Rev/remvl crtd sns dev total C 0 XXX $ - $ -
0270T Rev/remvl crtd sns dev lead C 0 XXX $ - $ -
0271T Rev/remvl crtd sns dev gen C 0 XXX $ - $ -
0272T Interrogate crtd sns dev C 0 XXX $ - $ -
0273T Interrogate crtd sns w/pgrmg C 0 XXX $ - $ -
0274T Perq lamot/lam crv/thrc C 0 YYY $ - $ -
0275T Perq lamot/lam lumbar C 0 YYY $ - $ -
0276T Bronch thermoplasty 1 lobe C 0 XXX $ - $ -
0277T Bronch thermoplasty lobes C 0 XXX $ - $ -
0278T Tempr C 0 XXX $ - $ -
0279T Ctc test C 0 XXX $ - $ -
0280T Ctc test w/i & r C 0 XXX $ - $ -
0281T Laa closure w/implant C 0 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
0282T Periph field stimul trial C 0 XXX Y $ - $ -

0283T Periph field stimul perm C 0 XXX Y $ - $ -
0284T Periph field stimul revise C 0 XXX $ - $ -
0285T Periph field stimul analys C 0 XXX $ - $ -
0286T Near ifr spectrsc of wounds C 0 XXX $ - $ -
0287T Near ifr guide of vasc site C 0 XXX $ - $ -
0288T Anoscopy w/rf delivery C 0 XXX $ - $ -
0289T Laser inc for pkp/lkp donor C 0 ZZZ $ - $ -
0290T Laser inc for pkp/lkp recip C 0 ZZZ $ - $ -
0291T Iv oct for proc init vessel C 0 ZZZ $ - $ -
0292T Iv oct for proc addl vessel C 0 ZZZ $ - $ -
0293T Ins lt atrl press monitor C 0 XXX $ - $ -
0294T Ins lt atrl press mont addon C 0 ZZZ $ - $ -
0295T Ext ecg complete C 0 XXX $ - $ -
0296T Ext ecg recording C 0 XXX $ - $ -
0297T Ext ecg scan w/report C 0 XXX $ - $ -
0298T Ext ecg review and interp C 0 XXX $ - $ -
0299T Esw wound healing init wound C 0 XXX $ - $ -
0300T Esw wound healing addl wound C 0 ZZZ $ - $ -
0301T Mw therapy for breast tumor C 0 XXX $ - $ -
0500F Initial prenatal care visit M 9 XXX $ - $ -
0501F Prenatal flow sheet X 9 XXX $ - $ -
0502F Subsequent prenatal care X 9 XXX $ - $ -
0503F Postpartum care visit X 9 XXX $ - $ -
0505F Hemodialysis plan docd X 9 XXX $ - $ -
0507F Periton dialysis plan docd X 9 XXX $ - $ -
0509F Urine incon plan docd M 9 XXX $ - $ -
0513F Elev bp plan of care docd M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
0514F Care plan hgb docd esa pt X 9 XXX $ - $ -

0516F Anemia plan of care docd X 9 XXX $ - $ -
0517F Glaucoma plan of care docd M 9 XXX $ - $ -
0518F Fall plan of care docd M 9 XXX $ - $ -
0519F Pland chemo docd b/4 txmnt X 9 XXX $ - $ -
0520F Rad dos limts b/4 3d rad M 9 XXX $ - $ -
0521F Plan of care 4 pain docd M 9 XXX $ - $ -
0525F Initial visit for episode X 9 XXX $ - $ -
0526F Subs visit for episode M 9 XXX $ - $ -
0528F Rcmnd flw-up 10 yrs docd X 9 XXX $ - $ -
0529F Intrvl 3+yrs pts clnscp docd M 9 XXX $ - $ -
0535F Dyspnea mngmnt plan docd X 9 XXX $ - $ -
0540F Gluco mngmnt plan docd M 9 XXX $ - $ -
0545F Follow up care plan mdd docd X 9 XXX $ - $ -
0550F Cytopath report nongyn spcmn X 9 XXX $ - $ -
0551F Cytopath report non routine X 9 XXX $ - $ -
0555F Symptom mgmnt plan care docd X 9 XXX $ - $ -
0556F Plan care lipid control docd M 9 XXX $ - $ -
0557F Plan caremng angnl symptdocd M 9 XXX $ - $ -
0575F HIV rna plan care docd M 9 XXX $ - $ -
1000F Tobacco use assessed I 9 XXX $ - $ -
10021 Fna w/o image A 0 XXX $ 84.56 $ 148.94
10022 Fna w/image A 0 XXX $ 72.73 $ 133.98
1002F Assess anginal symptom/level M 9 XXX $ - $ -
1003F Level of activity assess X 9 XXX $ - $ -
10040 Acne surgery A 0 010 Y $ 96.40 $ 107.88
1004F Clin symp vol ovrld assess X 9 XXX $ - $ -
1005F Asthma symptoms evaluate X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
10060 Drainage of skin abscess A 0 010 Y $ 96.05 $ 111.71

10061 Drainage of skin abscess A 0 010 Y $ 184.09 $ 204.97
1006F Osteoarthritis assess M 9 XXX $ - $ -
1007F Anti-inflm/anlgsc otc assess M 9 XXX $ - $ -
10080 Drainage of pilonidal cyst A 0 010 Y $ 108.58 $ 170.52
10081 Drainage of pilonidal cyst A 0 010 Y $ 195.23 $ 277.36
1008F Gi/renal risk assess X 9 XXX $ - $ -
1010F Severity angina by actvty M 9 XXX $ - $ -
1011F Angina present M 9 XXX $ - $ -
10120 Remove foreign body A 0 010 Y $ 98.14 $ 137.81
10121 Remove foreign body A 0 010 Y $ 205.32 $ 277.36
1012F Angina absent M 9 XXX $ - $ -
10140 Drainage of hematoma/fluid A 0 010 Y $ 124.24 $ 159.73
1015F Copd symptoms assess X 9 XXX $ - $ -
10160 Puncture drainage of lesion A 0 010 Y $ 100.57 $ 128.06
10180 Complex drainage wound A 0 010 Y $ 203.23 $ 258.56
1018F Assess dyspnea not present X 9 XXX $ - $ -
1019F Assess dyspnea present X 9 XXX $ - $ -
1022F Pneumo imm status assess X 9 XXX $ - $ -
1026F Co-morbid condition assess X 9 XXX $ - $ -
1030F Influenza imm status assess X 9 XXX $ - $ -
1031F Smoking & 2nd hand assessed M 9 XXX $ - $ -
1032F Smoker/exposed 2nd hnd smoke M 9 XXX $ - $ -
1033F Tobacco nonsmoker nor 2ndhnd M 9 XXX $ - $ -
1034F Current tobacco smoker X 9 XXX $ - $ -
1035F Smokeless tobacco user X 9 XXX $ - $ -
1036F Tobacco non-user M 9 XXX $ - $ -
1038F Persistent asthma M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
1039F Intermittent asthma M 9 XXX $ - $ -

1040F Dsm-iv info mdd docd M 9 XXX $ - $ -
1050F History of mole changes X 9 XXX $ - $ -
1052F Type location activity asses M 9 XXX $ - $ -
1055F Visual funct status assess X 9 XXX $ - $ -
1060F Doc perm/cont/parox atr fib X 9 XXX $ - $ -
1061F Doc lack perm+cont+parox fib X 9 XXX $ - $ -
1065F Ischm stroke symp lt3 hrsb/4 X 9 XXX $ - $ -
1066F Ischm stroke symp ge3 hrsb/4 X 9 XXX $ - $ -
1070F Alarm symp assessed-absent X 9 XXX $ - $ -
1071F Alarm symp assessed-1+ prsnt x 9 XXX $ - $ -
1090F Pres/absn urine incon assess M 9 XXX $ - $ -
1091F Urine incon characterized M 9 XXX $ - $ -
11000 Debride infected skin A 0 000 Y $ 31.67 $ 52.20
11001 Debride infected skin add-on A 0 ZZZ $ 16.01 $ 21.92
11004 Debride genitalia & perineum A 0 000 Y $ 707.14 $ -
11005 Debride abdom wall A 0 000 $ 987.62 $ -
11006 Debride genit/per/abdom wall A 0 000 Y $ 864.08 $ -
11008 Remove mesh from abd wall A 0 ZZZ $ 347.30 $ -
1100F Ptfalls assess-docd ge2+/yr M 9 XXX $ - $ -
11010 Debride skin at fx site A 0 010 Y $ 324.34 $ 501.82
11011 Debride skin musc at fx site A 0 000 Y $ 363.31 $ 562.72
11012 Deb skin bone at fx site A 0 000 Y $ 508.08 $ 747.85
1101F Pt falls assess-docd le1/yr M 9 XXX $ - $ -
11042 Deb subq tissue 20 sq cm/< A 0 000 Y $ 66.47 $ 107.53
11043 Deb musc/fascia 20 sq cm/< A 0 000 Y $ 185.83 $ 247.78
11044 Deb bone 20 sq cm/< A 0 000 Y $ 281.88 $ 352.87
11045 Deb subq tissue add-on A 0 ZZZ $ 34.80 $ 46.63

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
11046 Deb musc/fascia add-on A 0 ZZZ $ 67.16 $ 81.08

11047 Deb bone add-on A 0 ZZZ $ 119.71 $ 139.55
11055 Trim skin lesion A 0 000 Y $ 21.58 $ 46.63
11056 Trim skin lesions 2 to 4 A 0 000 Y $ 24.71 $ 52.20
11057 Trim skin lesions over 4 A 0 000 Y $ 38.98 $ 67.16
11100 Biopsy skin lesion A 0 000 Y $ 54.98 $ 101.27
11101 Biopsy skin add-on A 0 ZZZ $ 27.14 $ 33.76
1110F Pt lft inpt fac w/in 60 days M 9 XXX $ - $ -
1111F Dschrg med/current med merge M 9 XXX $ - $ -
1116F Auric/peri pain assessed M 9 XXX $ - $ -
1118F GERD symps assessed 12 month M 9 XXX $ - $ -
1119F Init eval for condition M 9 XXX $ - $ -
11200 Removal of skin tags A 0 010 Y $ 74.47 $ 86.30
11201 Remove skin tags add-on A 0 ZZZ $ 18.79 $ 20.53
1121F Subs eval for condition M 9 XXX $ - $ -
1123F Acp discuss/dscn mkr docd M 9 XXX $ - $ -
1124F Acp discuss-no dscnmkr docd M 9 XXX $ - $ -
1125F Amnt pain noted pain prsnt M 9 XXX $ - $ -
1126F Amnt pain noted none prsnt M 9 XXX $ - $ -
1127F New episode for condition M 9 XXX $ - $ -
1128F Subs episode for condition M 9 XXX $ - $ -
11300 Shave skin lesion A 0 000 Y $ 33.76 $ 67.51

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

1130F Bk pain + fxn assessed M 9 XXX $ - $ -
1134F Epsd bk pain for =< 6 wks M 9 XXX $ - $ -
1135F Epsd bk pain for > 6 wks M 9 XXX $ - $ -
1136F Epsd bk pain for <= 12 wks M 9 XXX $ - $ -
1137F Epsd bk pain for > 12 wks M 9 XXX $ - $ -
11400 Exc tr-ext b9+marg 0.5 < cm A 0 010 Y $ 81.43 $ 117.62
11401 Exc tr-ext b9+marg 0.6-1 cm A 0 010 Y $ 111.01 $ 148.25
11406 Exc tr-ext b9+marg > 4.0 cm A 0 010 Y $ 280.14 $ 334.08
11420 Exc h-f-nk-sp b9+marg 0.5 < A 0 010 Y $ 84.22 $ 117.62
11421 Exc h-f-nk-sp b9+marg 0.6-1 A 0 010 Y $ 119.71 $ 157.99
11426 Exc h-f-nk-sp b9+marg > 4 cm A 0 010 Y $ 311.11 $ 359.14
11440 Exc face-mm b9+marg 0.5 < cm A 0 010 Y $ 105.44 $ 131.54
11441 Exc face-mm b9+marg 0.6-1 cm A 0 010 Y $ 139.20 $ 169.13
11446 Exc face-mm b9+marg > 4 cm A 0 010 Y $ 365.75 $ 417.60

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
11450 Removal sweat gland lesion A 0 090 Y $ 280.84 $ 386.28

1150F Doc pt rsk death w/in 1yr M 9 XXX $ - $ -
1151F Doc no pt rsk death w/in 1yr M 9 XXX $ - $ -
1152F Doc advncd dis comfort 1st M 9 XXX $ - $ -
1153F Doc advncd dis cmfrt not 1st M 9 XXX $ - $ -
1157F Advnc care plan in rcrd M 9 XXX $ - $ -
1158F Advnc care plan tlk docd M 9 XXX $ - $ -
1159F Med list docd in rcrd M 9 XXX $ - $ -
11600 Exc tr-ext mal+marg 0.5 < cm A 0 010 Y $ 130.50 $ 190.01
11601 Exc tr-ext mal+marg 0.6-1 cm A 0 010 Y $ 162.86 $ 228.64
11606 Exc tr-ext mal+marg > 4 cm A 0 010 Y $ 368.53 $ 475.72
1160F Rvw meds by rx/dr in rcrd M 9 XXX $ - $ -
11620 Exc h-f-nk-sp mal+marg 0.5 < A 0 010 Y $ 131.89 $ 192.79
11621 Exc s/n/h/f/g mal+mrg 0.6-1 A 0 010 Y $ 163.91 $ 230.38
11626 Exc s/n/h/f/g mal+mrg > 4 cm A 0 010 Y $ 341.74 $ 436.04
11640 Exc f/e/e/n/l mal+mrg 0.5cm< A 0 010 Y $ 136.42 $ 198.71
11641 Exc f/e/e/n/l mal+mrg 0.6-1 A 0 010 Y $ 172.61 $ 240.12

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

11646 Exc f/e/e/n/l mal+mrg > 4 cm A 0 010 Y $ 459.01 $ 556.80
1170F Fxnl status assessed M 9 XXX $ - $ -
11719 Trim nail(s) A 0 000 Y $ 8.35 $ 20.53
11720 Debride nail 1-5 A 0 000 $ 16.70 $ 30.62
11721 Debride nail 6 or more A 0 000 $ 27.49 $ 42.80
11730 Removal of nail plate A 0 000 Y $ 55.33 $ 93.26
11732 Remove nail plate add-on A 0 ZZZ $ 22.27 $ 34.80
11740 Drain blood from under nail A 0 000 Y $ 31.32 $ 44.54
11750 Removal of nail bed A 0 010 Y $ 176.78 $ 215.06
11752 Remove nail bed/finger tip A 0 010 Y $ 271.09 $ 317.03
11755 Biopsy nail unit A 0 000 Y $ 82.82 $ 128.06
1175F Function stat assessed rvwd M 9 XXX $ - $ -
11760 Repair of nail bed A 0 010 Y $ 143.72 $ 222.37
11762 Reconstruction of nail bed A 0 010 Y $ 198.36 $ 273.18
11765 Excision of nail fold toe A 0 010 Y $ 89.09 $ 147.55
11770 Removal of pilonidal lesion A 0 010 Y $ 211.58 $ 287.10
1180F Thromboemb risk assessed X 9 XXX $ - $ -
1181F Neuropsychia sympts assessed M 9 XXX $ - $ -
1182F Neuropsychi sympt 1+present X 9 XXX $ - $ -
1183F Neuropsychiatric symp absent X 9 XXX $ - $ -
11900 Injection into skin lesions A 0 000 Y $ 35.15 $ 55.68
11901 Added skin lesions injection A 0 000 Y $ 54.64 $ 72.73
11920 Correct skin color defects R 0 000 Y $ 133.98 $ 184.09

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
11921 Correct skin color defects R 0 000 Y $ 157.64 $ 213.32

11922 Correct skin color defects R 0 ZZZ $ 34.45 $ 61.60
11950 Therapy for contour defects R 0 000 Y $ 53.94 $ 72.73
11960 Insert tissue expander(s) A 0 090 Y $ 980.32 $ -
11970 Replace tissue expander A 0 090 Y Y $ 698.09 $ -
11971 Remove tissue expander(s) A 0 090 Y Y $ 342.78 $ 473.28
11976 Removal of contraceptive cap A 0 000 Y $ 116.23 $ 157.64
11980 Implant hormone pellet(s) A 0 000 Y $ 95.35 $ 114.84
11981 Insert drug implant device A 0 XXX Y $ 97.09 $ 142.33
11982 Remove drug implant device A 0 XXX Y $ 111.71 $ 157.99
11983 Remove/insert drug implant A 0 XXX Y $ 191.05 $ 228.64
12001 Repair superficial wound(s) A 0 000 Y $ 58.12 $ 95.35
1200F Seizure type& frequ docd M 9 XXX $ - $ -
12017 Repair superficial wound(s) A 0 000 Y $ 201.49 $ -
12018 Repair superficial wound(s) A 0 000 Y Y $ 232.46 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
12020 Closure of split wound A 0 010 Y $ 207.06 $ 280.84

12021 Closure of split wound A 0 010 Y $ 154.86 $ 175.74
12031 Intmd wnd repair s/a/t/ext A 0 010 Y $ 166.69 $ 236.29
12034 Intmd wnd repair s/tr/ext A 0 010 Y $ 231.77 $ 318.77
12037 Intmd wnd repair s/tr/ext A 0 010 Y $ 384.54 $ 505.64
12041 Intmd wnd repair n-hf/genit A 0 010 Y $ 170.52 $ 240.82
12047 Intmd wnd repair n-hf/genit A 0 010 Y Y $ 393.94 $ 542.53
12051 Intmd wnd repair face/mm A 0 010 Y $ 188.96 $ 261.70
12057 Intmd wnd repair face/mm A 0 010 Y Y $ 434.65 $ 617.35
1205F EPI etiol synd rvwd and docd M 9 XXX $ - $ -
1220F Pt screened for depression M 9 XXX $ - $ -
13100 Repair of wound or lesion A 0 010 Y $ 257.17 $ 323.29
13102 Repair wound/lesion add-on A 0 ZZZ $ 89.78 $ 117.97

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

13160 Late closure of wound A 0 090 Y $ 936.12 $ -
14000 Skin tissue rearrangement A 0 090 Y $ 559.93 $ 658.76
1400F Prkns diag rviewed M 9 XXX $ - $ -
14061 Skin tissue rearrangement A 0 090 Y $ 920.46 $ 1,066.97
14301 Skin tissue rearrangement A 0 090 Y Y $ 1,012.33 $ 1,173.46
14302 Skin tissue rearrange add-on A 0 ZZZ Y $ 263.78 $ 263.78
14350 Skin tissue rearrangement A 0 090 Y $ 798.31 $ -
1450F Symptoms improved/consist M 9 XXX $ - $ -
1451F Sympt show clin import drop M 9 XXX $ - $ -
1460F Qual card diag prior 12 mons M 9 XXX $ - $ -
1461F No qual card diag prior12mon M 9 XXX $ - $ -
1490F Dem severity classified mild M 9 XXX $ - $ -
1491F Dem severity classified mod M 9 XXX $ - $ -
1493F Dem severity class severe M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
1494F Cognit assessed and reviewed M 9 XXX $ - $ -

15002 Wound prep trk/arm/leg A 0 000 $ 266.57 $ 364.36
15003 Wound prep addl 100 cm A 0 ZZZ $ 56.38 $ 81.43
15004 Wound prep f/n/hf/g A 0 000 $ 309.72 $ 415.51
15005 Wnd prep f/n/hf/g addl cm A 0 ZZZ $ 112.06 $ 139.55
15040 Harvest cultured skin graft A 0 000 $ 149.64 $ 258.56
15050 Skin pinch graft A 0 090 Y $ 485.81 $ 587.42
15100 Skin splt grft trnk/arm/leg A 0 090 Y $ 829.98 $ 950.39
15101 Skin splt grft t/a/l add-on A 0 ZZZ $ 131.89 $ 196.62
15110 Epidrm autogrft trnk/arm/leg A 0 090 Y $ 876.61 $ 970.57
15111 Epidrm autogrft t/a/l add-on A 0 ZZZ $ 128.41 $ 138.50
15115 Epidrm a-grft face/nck/hf/g A 0 090 Y $ 860.60 $ 950.04
15116 Epidrm a-grft f/n/hf/g addl A 0 ZZZ $ 185.83 $ 199.06
15120 Skn splt a-grft fac/nck/hf/g A 0 090 Y $ 807.71 $ 935.77
15121 Skn splt a-grft f/n/hf/g add A 0 ZZZ $ 156.60 $ 225.16
15130 Derm autograft trnk/arm/leg A 0 090 Y $ 647.28 $ 738.80
15131 Derm autograft t/a/l add-on A 0 ZZZ $ 112.75 $ 120.41
15135 Derm autograft face/nck/hf/g A 0 090 Y $ 868.61 $ 956.30
15136 Derm autograft f/n/hf/g add A 0 ZZZ $ 83.87 $ 88.74
15150 Cult skin grft t/arm/leg A 0 090 Y $ 752.72 $ 803.53
15151 Cult skin grft t/a/l addl A 0 ZZZ $ 139.90 $ 148.25
15152 Cult skin graft t/a/l +% A 0 ZZZ $ 186.88 $ 195.23
15155 Cult skin graft f/n/hf/g A 0 090 Y $ 646.24 $ 696.70
15156 Cult skin grft f/n/hfg add A 0 ZZZ $ 208.10 $ 215.76
15157 Cult epiderm grft f/n/hfg +% A 0 ZZZ $ 175.39 $ 186.88
15200 Skin full graft trunk A 0 090 Y $ 757.60 $ 888.10
15201 Skin full graft trunk add-on A 0 ZZZ $ 97.44 $ 156.25
15220 Skin full graft sclp/arm/leg A 0 090 Y $ 688.00 $ 816.06

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
15221 Skin full graft add-on A 0 ZZZ $ 87.35 $ 143.03

15240 Skin full grft face/genit/hf A 0 090 Y $ 883.57 $ 990.41
15260 Skin full graft een & lips A 0 090 Y $ 946.56 $ 1,068.01
15271 Skin sub graft trnk/arm/leg A 0 000 Y $ 103.01 $ 151.03
15272 Skin sub graft t/a/l add-on A 0 ZZZ $ 19.84 $ 28.19
15273 Skin sub grft t/arm/lg child A 0 000 Y $ 247.43 $ 321.20
15274 Skn sub grft t/a/l child add A 0 ZZZ $ 49.76 $ 71.34
15275 Skin sub graft face/nk/hf/g A 0 000 Y $ 121.45 $ 166.69
15276 Skin sub graft f/n/hf/g addl A 0 ZZZ $ 28.54 $ 36.19
15277 Skn sub grft f/n/hf/g child A 0 000 Y $ 253.00 $ 322.25
15278 Skn sub grft f/n/hf/g ch add A 0 ZZZ $ 62.29 $ 85.61
15570 Form skin pedicle flap A 0 090 Y $ 853.99 $ 1,000.85
15572 Form skin pedicle flap A 0 090 Y $ 839.03 $ 954.56
15600 Skin graft A 0 090 Y $ 220.98 $ 322.94
15610 Skin graft A 0 090 Y $ 258.22 $ 351.13
15620 Skin graft A 0 090 Y $ 348.70 $ 445.79
15630 Skin graft A 0 090 Y $ 374.10 $ 469.80
15650 Transfer skin pedicle flap A 0 090 Y $ 421.43 $ 525.83
15731 Forehead flap w/vasc pedicle A 0 090 Y $ 1,152.23 $ 1,249.67
15732 Muscle-skin graft head/neck A 0 090 Y $ 1,308.83 $ 1,445.59
15734 Muscle-skin graft trunk A 0 090 Y Y $ 1,584.10 $ 1,734.43
15736 Muscle-skin graft arm A 0 090 Y $ 1,363.12 $ 1,512.41
15738 Muscle-skin graft leg A 0 090 Y Y $ 1,492.22 $ 1,634.21
15740 Island pedicle flap graft A 0 090 Y $ 944.82 $ 1,075.67

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
15750 Neurovascular pedicle graft A 0 090 Y Y $ 1,042.26 $ -

15756 Free myo/skin flap microvasc A 0 090 Y Y Y $ 2,749.20 $ -
15757 Free skin flap microvasc A 0 090 Y Y Y $ 2,675.77 $ -
15758 Free fascial flap microvasc A 0 090 Y Y Y $ 2,678.56 $ -
15760 Composite skin graft A 0 090 Y $ 793.09 $ 912.11
15770 Derma-fat-fascia graft A 0 090 Y Y $ 758.64 $ -
15775 Hair transplant punch grafts N 0 000 Y $ 224.11 $ 289.88
15776 Hair transplant punch grafts N 0 000 Y $ 308.33 $ 398.46
15777 Acellular derm matrix implt A 0 ZZZ $ 265.18 $ 265.18
15780 Abrasion treatment of skin A 0 090 Y $ 682.78 $ 850.86
15786 Abrasion lesion single A 0 010 Y $ 155.90 $ 246.04
15787 Abrasion lesions add-on A 0 ZZZ $ 19.84 $ 46.63
15788 Chemical peel face epiderm R 0 090 Y $ 252.65 $ 429.08
15789 Chemical peel face dermal R 0 090 Y $ 442.31 $ 555.06
15792 Chemical peel nonfacial R 0 090 Y $ 259.96 $ 405.42
15793 Chemical peel nonfacial A 0 090 Y $ 377.93 $ 481.98
15819 Plastic surgery neck A 0 090 Y $ 876.96 $ -
15820 Revision of lower eyelid A 0 090 Y Y $ 574.55 $ 619.44
15821 Revision of lower eyelid A 0 090 Y Y $ 612.83 $ 663.29
15822 Revision of upper eyelid A 0 090 Y Y $ 424.56 $ 468.76
15823 Revision of upper eyelid A 0 090 Y Y $ 613.87 $ 664.33
15824 Removal of forehead wrinkles N 0 000 Y Y $ - $ -
15825 Removal of neck wrinkles N 0 000 Y Y $ - $ -
15826 Removal of brow wrinkles N 0 000 Y Y $ - $ -
15828 Removal of face wrinkles N 0 000 Y Y $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
15829 Removal of skin wrinkles N 0 000 Y Y $ - $ -

15830 Exc skin abd N 0 090 Y Y $ 1,372.16 $ -
15832 Excise excessive skin tissue A 0 090 Y Y $ 1,055.83 $ -
15833 Excise excessive skin tissue A 0 090 Y $ 1,006.42 $ -
15836 Excise excessive skin tissue A 0 090 Y $ 871.39 $ -
15837 Excise excessive skin tissue A 0 090 Y $ 823.02 $ 948.65
15838 Excise excessive skin tissue A 0 090 Y $ 621.88 $ -
15839 Excise excessive skin tissue A 0 090 Y $ 841.81 $ 960.48
15840 Graft for face nerve palsy A 0 090 Y $ 1,152.23 $ -
15841 Graft for face nerve palsy A 0 090 Y Y $ 1,798.81 $ -
15842 Flap for face nerve palsy A 0 090 Y Y $ 2,774.26 $ -
15845 Skin and muscle repair face A 0 090 Y Y $ 1,066.27 $ -
15847 Exc skin abd add-on C 0 YYY Y $ - $ -
15850 Removal of sutures B 9 XXX $ 41.06 $ 80.74
15851 Removal of sutures A 0 000 Y $ 53.59 $ 96.74
15852 Dressing change not for burn A 0 000 Y $ 56.03 $ -
15860 Test for blood flow in graft A 0 000 Y $ 136.42 $ -
15876 Suction assisted lipectomy R 0 000 Y $ - $ -
15877 Suction assisted lipectomy R 0 000 Y $ - $ -
15878 Suction assisted lipectomy R 0 000 Y Y $ - $ -
15879 Suction assisted lipectomy R 0 000 Y Y $ - $ -
15920 Removal of tail bone ulcer A 0 090 Y $ 705.74 $ -
15922 Removal of tail bone ulcer A 0 090 Y Y $ 892.62 $ -
15931 Remove sacrum pressure sore A 0 090 Y $ 801.79 $ -
15933 Remove sacrum pressure sore A 0 090 Y $ 977.53 $ -
15934 Remove sacrum pressure sore A 0 090 Y $ 1,089.59 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
15935 Remove sacrum pressure sore A 0 090 Y Y $ 1,293.17 $ -

15940 Remove hip pressure sore A 0 090 Y $ 816.76 $ -
15941 Remove hip pressure sore A 0 090 Y $ 1,038.78 $ -
15950 Remove thigh pressure sore A 0 090 Y $ 669.90 $ -
15951 Remove thigh pressure sore A 0 090 Y $ 997.02 $ -
15952 Remove thigh pressure sore A 0 090 Y Y $ 1,062.79 $ -
15953 Remove thigh pressure sore A 0 090 Y $ 1,145.96 $ -
15999 Removal of pressure sore C 0 YYY Y Y $ - $ -
16000 Initial treatment of burn(s) A 0 000 Y $ 53.59 $ 72.73
16020 Dress/debrid p-thick burn s A 0 000 Y $ 57.42 $ 80.39
16025 Dress/debrid p-thick burn m A 0 000 Y $ 128.06 $ 157.30
16030 Dress/debrid p-thick burn l A 0 000 Y $ 154.16 $ 194.88
16035 Incision of burn scab initi A 0 000 Y $ 242.21 $ -
16036 Escharotomy addl incision A 0 ZZZ $ 101.27 $ -
17000 Destruct premalg lesion A 0 010 Y $ 57.42 $ 78.65
17003 Destruct premalg les 2-14 A 0 ZZZ $ 4.87 $ 7.31
17004 Destroy premal lesions 15/> A 0 010 $ 144.42 $ 177.48
17106 Destruction of skin lesions A 0 090 Y $ 297.19 $ 352.87
17110 Destruct b9 lesion 1-14 A 0 010 Y $ 69.25 $ 104.05

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
17111 Destruct lesion 15 or more A 0 010 Y $ 87.70 $ 126.32

17250 Chemical cautery tissue A 0 000 Y $ 39.32 $ 74.47
17311 Mohs 1 stage h/n/hf/g A 0 000 Y $ 428.39 $ 666.42
17312 Mohs addl stage A 0 ZZZ $ 226.55 $ 390.11
17313 Mohs 1 stage t/a/l A 0 000 Y $ 384.19 $ 606.56
17314 Mohs addl stage t/a/l A 0 ZZZ $ 210.54 $ 361.92
17315 Mohs surg addl block A 0 ZZZ $ 58.81 $ 80.74
17340 Cryotherapy of skin A 0 010 Y $ 52.90 $ 54.98
17360 Skin peel therapy A 0 010 Y $ 109.97 $ 135.72
17380 Hair removal by electrolysis R 0 000 Y $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
17999 Skin tissue procedure C 0 YYY Y Y $ - $ -

19000 Drainage of breast lesion A 0 000 Y $ 50.46 $ 106.49
19001 Drain breast lesion add-on A 0 ZZZ $ 24.36 $ 28.54
19020 Incision of breast lesion A 0 090 Y Y $ 340.69 $ 479.20
19030 Injection for breast x-ray A 0 000 Y Y $ 84.22 $ 155.21
19100 Bx breast percut w/o image A 0 000 Y Y $ 87.00 $ 153.82
19101 Biopsy of breast open A 0 010 Y Y $ 259.26 $ 359.14
19102 Bx breast percut w/image A 0 000 Y Y $ 114.49 $ 208.10
19103 Bx breast percut w/device A 0 000 Y Y $ 219.59 $ 523.04
19105 Cryosurg ablate fa each A 0 000 Y Y $ 218.20 $ 2,429.04
19110 Nipple exploration A 0 090 Y Y $ 386.28 $ 506.69
19112 Excise breast duct fistula A 0 090 Y Y $ 347.30 $ 470.84
19120 Removal of breast lesion A 0 090 Y Y $ 480.24 $ 545.66
19125 Excision breast lesion A 0 090 Y Y $ 536.62 $ 608.65
19126 Excision addl breast lesion A 0 ZZZ $ 203.93 $ -
19260 Removal of chest wall lesion A 0 090 Y Y $ 1,448.72 $ -
19271 Revision of chest wall A 0 090 Y Y $ 1,935.58 $ -
19272 Extensive chest wall surgery A 0 090 Y Y $ 2,171.17 $ -
19290 Place needle wire breast A 0 000 Y Y $ 70.30 $ 151.38
19291 Place needle wire breast A 0 ZZZ $ 33.76 $ 64.73
19295 Place breast clip percut A 0 ZZZ $ - $ 77.95
19296 Place po breast cath for rad A 0 000 Y Y $ 256.82 $ 3,556.21
19297 Place breast cath for rad A 0 ZZZ $ 117.62 $ -
19298 Place breast rad tube/caths A 0 000 Y Y $ 364.36 $ 1,074.97
19300 Removal of breast tissue A 0 090 Y Y $ 464.93 $ 559.58
19301 Partical mastectomy A 0 090 Y Y $ 776.04 $ -
19302 P-mastectomy w/ln removal A 0 090 Y Y Y $ 1,073.58 $ -
19303 Mast simple complete A 0 090 Y Y Y $ 1,206.86 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
19304 Mast subq A 0 090 Y Y Y $ 661.55 $ -

19305 Mast radical A 0 090 Y Y Y $ 1,351.28 $ -
19306 Mast rad urban type A 0 090 Y Y Y $ 1,421.58 $ -
19307 Mast mod rad A 0 090 Y Y Y $ 1,418.80 $ -
19316 Suspension of breast A 0 090 Y Y Y $ 904.45 $ -
19318 Reduction of large breast A 0 090 Y Y Y $ 1,306.74 $ -
19324 Enlarge breast A 0 090 Y Y $ 570.72 $ -
19325 Enlarge breast with implant A 0 090 Y Y $ 743.68 $ -
19328 Removal of breast implant A 0 090 Y Y $ 567.24 $ -
19330 Removal of implant material A 0 090 Y Y $ 727.67 $ -
19340 Immediate breast prosthesis A 0 090 Y Y $ 1,113.60 $ -
19342 Delayed breast prosthesis A 0 090 Y Y $ 1,067.32 $ -
19350 Breast reconstruction A 0 090 Y Y $ 778.13 $ 910.72
19355 Correct inverted nipple(s) A 0 090 Y Y $ 678.60 $ 793.44
19357 Breast reconstruction A 0 090 Y Y Y $ 1,691.28 $ -
19361 Breast reconstr w/lat flap A 0 090 Y Y Y $ 1,889.64 $ -
19370 Surgery of breast capsule A 0 090 Y Y $ 789.96 $ -
19371 Removal of breast capsule A 0 090 Y Y $ 905.84 $ -
19380 Revise breast reconstruction A 0 090 Y Y $ 891.23 $ -
19396 Design custom breast implant A 0 000 Y Y $ 173.65 $ 287.10
19499 Breast surgery procedure C 0 YYY Y Y Y $ - $ -
20005 I&d abscess subfascial A 0 010 Y $ 263.44 $ 322.25
2000F Blood pressure measure M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
2001F Weight record M 9 XXX $ - $ -

2002F Clin sign vol ovrld assess M 9 XXX $ - $ -
2004F Initial exam involved joints M 9 XXX $ - $ -
20100 Explore wound neck A 0 010 Y Y Y $ 726.97 $ -
20101 Explore wound chest A 0 010 Y $ 250.21 $ 449.27
20102 Explore wound abdomen A 0 010 Y $ 301.02 $ 490.68
20103 Explore wound extremity A 0 010 Y $ 409.25 $ 605.17
2010F Vital signs recorded M 9 XXX $ - $ -
2014F Mental status assess M 9 XXX $ - $ -
20150 Excise epiphyseal bar A 0 090 Y Y Y $ 1,167.54 $ -
2015F Asthma impairment assessed M 9 XXX $ - $ -
2016F Asthma risk assessed M 9 XXX $ - $ -
2018F Hydration status assess M 9 XXX $ - $ -
2019F Dilated macul exam done M 9 XXX $ - $ -
20200 Muscle biopsy A 0 000 Y $ 115.88 $ 209.84
20205 Deep muscle biopsy A 0 000 Y $ 188.96 $ 296.15
20206 Needle biopsy muscle A 0 000 Y $ 63.34 $ 222.37
2020F Dilated fundus eval done M 9 XXX $ - $ -
2021F Dilat macul+ exam done M 9 XXX $ - $ -
20220 Bone biopsy trocar/needle A 0 000 Y $ 77.26 $ 156.25
20225 Bone biopsy trocar/needle A 0 000 Y $ 122.84 $ 524.78
2022F Dil retina exam interp rev M 9 XXX $ - $ -
20240 Bone biopsy excisional A 0 010 Y $ 248.47 $ -
20245 Bone biopsy excisional A 0 010 Y $ 717.23 $ -
2024F 7 field photo interp doc rev M 9 XXX $ - $ -
20250 Open bone biopsy A 0 010 Y $ 454.14 $ -
20251 Open bone biopsy A 0 010 Y Y $ 492.77 $ -
2026F Eye image valid to dx rev M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
2027F Optic nerve head eval done M 9 XXX $ - $ -

2028F Foot exam performed M 9 XXX $ - $ -
2029F Complete phys skin exam done M 9 XXX $ - $ -
2030F H2o stat docd normal M 9 XXX $ - $ -
2031F H2o stat docd dehydrated M 9 XXX $ - $ -
2035F Tymp memb motion examd M 9 XXX $ - $ -
2040F Bk pn xm on init visit date M 9 XXX $ - $ -
2044F Doc mntl tst b/4 bk trxmnt M 9 XXX $ - $ -
20500 Injection of sinus tract A 0 010 Y $ 90.48 $ 107.88
20501 Inject sinus tract for x-ray A 0 000 Y $ 41.76 $ 112.75
2050F Wound char size etc docd M 9 XXX $ - $ -
20520 Removal of foreign body A 0 010 Y $ 158.69 $ 204.28
20525 Removal of foreign body A 0 010 Y $ 283.97 $ 480.94
20526 Ther injection carp tunnel A 0 000 Y Y $ 64.38 $ 80.04
20527 Inj dupuytren cord w/enzyme A 0 000 Y Y $ 68.21 $ 81.78
20550 Inj tendon sheath/ligament A 0 000 Y Y $ 44.89 $ 58.81
20551 Inj tendon origin/insertion A 0 000 Y $ 46.28 $ 59.86
20552 Inj trigger point 1/2 muscl A 0 000 Y $ 40.72 $ 54.64
20553 Inject trigger points =/> 3 A 0 000 Y $ 44.89 $ 61.60
20555 Place ndl musc/tis for rt A 0 000 Y $ 381.76 $ -
20600 Drain/inject joint/bursa A 0 000 Y Y $ 41.76 $ 54.98
2060F Pt talk eval hlthwkr re mdd M 9 XXX $ - $ -
20612 Aspirate/inj ganglion cyst A 0 000 Y $ 45.24 $ 60.20
20615 Treatment of bone cyst A 0 010 Y $ 170.87 $ 232.46
20650 Insert and remove bone pin A 0 010 Y $ 164.60 $ 204.28
20660 Apply rem fixation device A 0 000 Y $ 320.51 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
20661 Application of head brace A 0 090 Y $ 592.99 $ -

20662 Application of pelvis brace A 0 090 Y $ 451.01 $ -
20663 Application of thigh brace A 0 090 Y $ 470.84 $ -
20664 Application of halo A 0 090 Y $ 1,089.94 $ -
20665 Removal of fixation device A 0 010 Y $ 91.52 $ 104.40
20670 Removal of support implant A 0 010 Y $ 160.08 $ 362.96
20680 Removal of support implant A 0 090 Y $ 479.89 $ 642.41
20690 Apply bone fixation device A 0 090 Y $ 673.03 $ -
20692 Apply bone fixation device A 0 090 Y Y $ 1,249.32 $ -
20693 Adjust bone fixation device A 0 090 Y $ 506.69 $ -
20694 Remove bone fixation device A 0 090 Y $ 371.32 $ 445.09
20696 Comp multiplane ext fixation A 0 090 Y Y $ 1,123.34 $ -
20697 Comp ext fixate strut change A 0 000 Y $ - $ 1,649.17
20802 Replantation arm complete A 0 090 Y Y Y $ 2,408.16 $ -
20805 Replant forearm complete A 0 090 Y Y Y $ 3,562.82 $ -
20808 Replantation hand complete A 0 090 Y Y Y $ 4,771.08 $ -
20816 Replantation digit complete A 0 090 Y Y $ 2,295.41 $ -
20822 Replantation digit complete A 0 090 Y Y $ 2,116.19 $ -
20824 Replantation thumb complete A 0 090 Y Y Y $ 2,560.58 $ -
20827 Replantation thumb complete A 0 090 Y Y Y $ 2,183.35 $ -
20838 Replantation foot complete A 0 090 Y Y Y $ 2,636.45 $ -
20900 Removal of bone for graft A 0 000 Y Y $ 249.86 $ 419.34
20902 Removal of bone for graft A 0 000 Y Y $ 365.05 $ -
20910 Remove cartilage for graft A 0 090 Y $ 470.15 $ -
20912 Remove cartilage for graft A 0 090 Y $ 531.05 $ -
20920 Removal of fascia for graft A 0 090 Y $ 427.00 $ -
20922 Removal of fascia for graft A 0 090 Y Y $ 563.76 $ 655.28
20924 Removal of tendon for graft A 0 090 Y Y $ 564.46 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
20926 Removal of tissue for graft A 0 090 Y $ 499.73 $ -

20930 Sp bone algrft morsel add-on B 9 XXX $ - $ -
20931 Sp bone algrft struct add-on A 0 ZZZ $ 153.12 $ -
20936 Sp bone agrft local add-on B 9 XXX $ - $ -
20937 Sp bone agrft morsel add-on A 0 ZZZ Y $ 215.41 $ -
20938 Sp bone agrft struct add-on A 0 ZZZ Y $ 243.60 $ -
20950 Fluid pressure muscle A 0 000 Y $ 102.66 $ 238.73
20955 Fibula bone graft microvasc A 0 090 Y Y $ 2,929.81 $ -
20956 Iliac bone graft microvasc A 0 090 Y Y $ 3,140.70 $ -
20957 Mt bone graft microvasc A 0 090 Y Y $ 3,212.39 $ -
20962 Other bone graft microvasc A 0 090 Y Y $ 2,779.48 $ -
20969 Bone/skin graft microvasc A 0 090 Y Y $ 3,186.64 $ -
20970 Bone/skin graft iliac crest A 0 090 Y Y $ 3,348.46 $ -
20972 Bone/skin graft metatarsal A 0 090 Y Y $ 2,398.07 $ -
20973 Bone/skin graft great toe A 0 090 Y Y $ 2,844.55 $ -
20974 Electrical bone stimulation A 0 000 $ 54.98 $ 75.52
20975 Electrical bone stimulation A 0 000 Y $ 213.32 $ -
20979 Us bone stimulation A 0 000 $ 37.93 $ 54.64
20982 Ablate bone tumor(s) perq A 0 000 Y Y $ 426.30 $ 3,307.04
20985 Cptr-asst dir ms px A 0 ZZZ $ 179.57 $ -
20999 Musculoskeletal surgery C 0 YYY Y Y $ - $ -
21010 Incision of jaw joint A 0 090 Y Y $ 800.05 $ -
21011 Exc face les sc < 2 cm A 0 090 Y Y $ 275.62 $ 352.87
21012 Exc face les sbq 2 cm/> A 0 090 Y Y $ 371.66 $ -
21013 Exc face tum deep < 2 cm A 0 090 Y Y $ 443.35 $ 546.01
21014 Exc face tum deep 2 cm/> A 0 090 Y Y $ 580.81 $ -
21015 Resect face tum < 2 cm A 0 090 Y $ 793.09 $ -
21016 Resect face tum 2 cm/> A 0 090 Y Y $ 1,214.87 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
21025 Excision of bone lower jaw A 0 090 Y $ 806.66 $ 924.29

21026 Excision of facial bone(s) A 0 090 Y $ 520.96 $ 619.79
21029 Contour of face bone lesion A 0 090 Y $ 734.63 $ 843.90
21030 Excise max/zygoma b9 tumor A 0 090 Y $ 440.92 $ 525.13
21031 Remove exostosis mandible A 0 090 Y $ 296.84 $ 378.97
21032 Remove exostosis maxilla A 0 090 Y $ 295.45 $ 385.24
21034 Excise max/zygoma mal tumor A 0 090 Y Y $ 1,292.12 $ 1,428.54
21040 Excise mandible lesion A 0 090 Y $ 439.87 $ 526.18
21044 Removal of jaw bone lesion A 0 090 Y Y $ 969.18 $ -
21045 Extensive jaw surgery A 0 090 Y Y $ 1,357.55 $ -
21046 Remove mandible cyst complex A 0 090 Y $ 1,156.75 $ -
21047 Excise lwr jaw cyst w/repair A 0 090 Y Y $ 1,424.71 $ -
21048 Remove maxilla cyst complex A 0 090 Y $ 1,187.38 $ -
21049 Excis uppr jaw cyst w/repair A 0 090 Y Y $ 1,357.90 $ -
21050 Removal of jaw joint A 0 090 Y Y $ 1,002.24 $ -
21060 Remove jaw joint cartilage A 0 090 Y Y Y $ 960.48 $ -
21070 Remove coronoid process A 0 090 Y Y $ 667.12 $ -
21073 Mnpj of tmj w/anesth A 0 090 Y Y $ 291.62 $ 403.68
21076 Prepare face/oral prosthesis A 0 010 Y $ 907.93 $ 1,039.13
21077 Prepare face/oral prosthesis A 0 090 Y Y $ 2,295.06 $ 2,600.60
21079 Prepare face/oral prosthesis A 0 090 Y $ 1,524.94 $ 1,755.66
21085 Prepare face/oral prosthesis A 0 010 Y $ 870.35 $ 1,018.60
21086 Prepare face/oral prosthesis A 0 090 Y Y $ 1,689.19 $ 1,924.44

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

21088 Prepare face/oral prosthesis C 0 090 $ - $ -
21089 Prepare face/oral prosthesis C 0 YYY Y $ - $ -
21100 Maxillofacial fixation A 0 090 Y $ 407.16 $ 689.39
21110 Interdental fixation A 0 090 Y $ 654.94 $ 762.12
21116 Injection jaw joint x-ray A 0 000 Y $ 43.50 $ 135.02
21120 Reconstruction of chin A 0 090 Y $ 575.24 $ 695.30
21121 Reconstruction of chin A 0 090 Y Y $ 619.79 $ 727.67
21122 Reconstruction of chin A 0 090 Y Y $ 642.06 $ -
21123 Reconstruction of chin A 0 090 Y Y $ 837.64 $ -
21125 Augmentation lower jaw bone A 0 090 Y Y $ 909.32 $ 2,834.46
21127 Augmentation lower jaw bone A 0 090 Y Y $ 922.20 $ 3,680.80
21137 Reduction of forehead A 0 090 Y Y $ 868.61 $ -
21138 Reduction of forehead A 0 090 Y Y $ 976.49 $ -
21139 Reduction of forehead A 0 090 Y Y $ 1,066.97 $ -
21141 Reconstruct midface lefort A 0 090 Y Y $ 1,609.15 $ -
21172 Reconstruct orbit/forehead A 0 090 Y Y $ 1,987.08 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
21175 Reconstruct orbit/forehead A 0 090 Y Y $ 3,150.10 $ -

21179 Reconstruct entire forehead A 0 090 Y Y $ 1,726.43 $ -
21180 Reconstruct entire forehead A 0 090 Y Y $ 1,741.39 $ -
21181 Contour cranial bone lesion A 0 090 Y $ 765.60 $ -
21182 Reconstruct cranial bone A 0 090 Y Y $ 2,181.26 $ -
21188 Reconstruction of midface A 0 090 Y Y $ 1,732.34 $ -
21193 Reconst lwr jaw w/o graft A 0 090 Y Y $ 1,558.69 $ -
21194 Reconst lwr jaw w/graft A 0 090 Y Y $ 1,526.68 $ -
21195 Reconst lwr jaw w/o fixation A 0 090 Y Y $ 1,452.20 $ -
21196 Reconst lwr jaw w/fixation A 0 090 Y Y $ 1,588.27 $ -
21198 Reconstr lwr jaw segment A 0 090 Y Y $ 1,253.50 $ -
21199 Reconstr lwr jaw w/advance A 0 090 Y Y $ 1,132.39 $ -
21206 Reconstruct upper jaw bone A 0 090 Y Y $ 1,361.38 $ -
21208 Augmentation of facial bones A 0 090 Y $ 973.01 $ 1,873.28
21209 Reduction of facial bones A 0 090 Y Y $ 731.84 $ 883.22
21210 Face bone graft A 0 090 Y $ 904.80 $ 2,082.43
21215 Lower jaw bone graft A 0 090 Y $ 1,035.65 $ 3,658.52
21230 Rib cartilage graft A 0 090 Y $ 905.50 $ -
21235 Ear cartilage graft A 0 090 Y $ 620.83 $ 758.29
21240 Reconstruction of jaw joint A 0 090 Y Y Y $ 1,182.85 $ -
21244 Reconstruction of lower jaw A 0 090 Y Y $ 1,140.40 $ -
21245 Reconstruction of jaw A 0 090 Y Y $ 975.79 $ 1,172.06
21246 Reconstruction of jaw A 0 090 Y Y $ 913.50 $ -
21247 Reconstruct lower jaw bone A 0 090 Y Y $ 1,963.42 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
21248 Reconstruction of jaw A 0 090 Y $ 954.56 $ 1,125.08

21249 Reconstruction of jaw A 0 090 Y $ 1,338.41 $ 1,561.82
21255 Reconstruct lower jaw bone A 0 090 Y Y $ 1,480.04 $ -
21256 Reconstruction of orbit A 0 090 Y Y $ 1,296.30 $ -
21260 Revise eye sockets A 0 090 Y Y $ 1,240.62 $ -
21270 Augmentation cheek bone A 0 090 Y Y $ 805.62 $ 1,002.94
21275 Revision orbitofacial bones A 0 090 Y Y $ 976.84 $ -
21280 Revision of eyelid A 0 090 Y Y $ 644.50 $ -
21282 Revision of eyelid A 0 090 Y Y $ 410.64 $ -
21295 Revision of jaw muscle/bone A 0 090 Y $ 198.01 $ -
21296 Revision of jaw muscle/bone A 0 090 Y $ 440.92 $ -
21299 Cranio/maxillofacial surgery C 0 YYY Y Y $ - $ -
21310 Treatment of nose fracture A 0 000 Y $ 35.15 $ 117.28
21325 Treatment of nose fracture A 0 090 Y $ 484.42 $ -
21336 Treat nasal septal fracture A 0 090 Y $ 669.55 $ -
21337 Treat nasal septal fracture A 0 090 Y $ 314.94 $ 409.60
21338 Treat nasoethmoid fracture A 0 090 Y $ 801.44 $ -
21339 Treat nasoethmoid fracture A 0 090 Y Y $ 866.52 $ -
21343 Treatment of sinus fracture A 0 090 Y Y $ 1,359.98 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
21344 Treatment of sinus fracture A 0 090 Y Y Y $ 2,128.37 $ -

21345 Treat nose/jaw fracture A 0 090 Y $ 690.43 $ 824.41
21346 Treat nose/jaw fracture A 0 090 Y $ 974.40 $ -
21347 Treat nose/jaw fracture A 0 090 Y Y $ 1,167.19 $ -
21348 Treat nose/jaw fracture A 0 090 Y Y Y $ 1,218.70 $ -
21355 Treat cheek bone fracture A 0 010 Y $ 347.30 $ 443.70
21356 Treat cheek bone fracture A 0 010 Y $ 407.51 $ 512.26
21360 Treat cheek bone fracture A 0 090 Y Y $ 567.59 $ -
21365 Treat cheek bone fracture A 0 090 Y Y $ 1,275.77 $ -
21366 Treat cheek bone fracture A 0 090 Y Y Y $ 1,435.15 $ -
21385 Treat eye socket fracture A 0 090 Y Y $ 744.02 $ -
21395 Treat eye socket fracture A 0 090 Y Y $ 1,072.54 $ -
21400 Treat eye socket fracture A 0 090 Y $ 162.52 $ 192.44
21401 Treat eye socket fracture A 0 090 Y Y $ 340.34 $ 495.90
21408 Treat eye socket fracture A 0 090 Y Y Y $ 1,056.88 $ -
21421 Treat mouth roof fracture A 0 090 Y $ 692.87 $ 804.92
21422 Treat mouth roof fracture A 0 090 Y Y $ 708.53 $ -
21423 Treat mouth roof fracture A 0 090 Y Y Y $ 921.50 $ -
21431 Treat craniofacial fracture A 0 090 Y Y $ 752.38 $ -
21432 Treat craniofacial fracture A 0 090 Y Y $ 802.49 $ -
21433 Treat craniofacial fracture A 0 090 Y Y $ 1,991.26 $ -
21435 Treat craniofacial fracture A 0 090 Y Y $ 1,493.27 $ -
21436 Treat craniofacial fracture A 0 090 Y Y Y $ 2,426.95 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
21440 Treat dental ridge fracture A 0 090 Y $ 471.19 $ 559.93

21445 Treat dental ridge fracture A 0 090 Y Y $ 625.01 $ 745.42
21450 Treat lower jaw fracture A 0 090 Y $ 489.64 $ 586.38
21454 Treat lower jaw fracture A 0 090 Y $ 615.26 $ -
21461 Treat lower jaw fracture A 0 090 Y $ 971.62 $ 1,972.12
21462 Treat lower jaw fracture A 0 090 Y Y $ 1,054.79 $ 2,069.21
21465 Treat lower jaw fracture A 0 090 Y Y $ 1,097.24 $ -
21470 Treat lower jaw fracture A 0 090 Y Y $ 1,363.46 $ -
21480 Reset dislocated jaw A 0 000 Y Y $ 38.98 $ 93.96
21485 Reset dislocated jaw A 0 090 Y Y $ 565.50 $ 659.46
21490 Repair dislocated jaw A 0 090 Y Y Y $ 1,073.58 $ -
21495 Treat hyoid bone fracture A 0 090 Y Y $ 718.97 $ -
21497 Interdental wiring A 0 090 Y $ 618.05 $ 720.01
21499 Head surgery procedure C 0 YYY Y Y $ - $ -
21501 Drain neck/chest lesion A 0 090 Y $ 357.40 $ 469.10
21502 Drain chest lesion A 0 090 Y Y $ 627.10 $ -
21510 Drainage of bone lesion A 0 090 Y $ 595.43 $ -
21550 Biopsy of neck/chest A 0 010 Y $ 170.17 $ 257.52
21552 Exc neck les sc 3 cm/> A 0 090 Y Y $ 521.65 $ -
21554 Exc neck tum deep 5 cm/> A 0 090 Y Y $ 854.69 $ -
21555 Exc neck les sc < 3 cm A 0 090 Y $ 349.04 $ 440.22
21556 Exc neck tum deep < 5 cm A 0 090 Y $ 608.65 $ -
21557 Resect neck tum < 5 cm A 0 090 Y Y $ 1,100.72 $ -
21558 Resect neck tum 5 cm/> A 0 090 Y Y $ 1,605.32 $ -
21600 Partial removal of rib A 0 090 Y Y $ 656.68 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
21610 Partial removal of rib A 0 090 Y Y $ 1,577.48 $ -

21615 Removal of rib A 0 090 Y Y Y $ 818.84 $ -
21616 Removal of rib and nerves A 0 090 Y Y Y $ 1,045.04 $ -
21620 Partial removal of sternum A 0 090 Y Y $ 617.35 $ -
21627 Sternal debridement A 0 090 Y Y $ 648.67 $ -
21630 Extensive sternum surgery A 0 090 Y Y $ 1,511.71 $ -
21632 Extensive sternum surgery A 0 090 Y Y $ 1,575.40 $ -
21685 Hyoid myotomy & suspension A 0 090 Y Y $ 1,098.29 $ -
21700 Revision of neck muscle A 0 090 Y Y $ 493.12 $ -
21705 Revision of neck muscle/rib A 0 090 Y Y $ 782.30 $ -
21740 Reconstruction of sternum A 0 090 Y Y $ 1,403.14 $ -
21742 Repair stern/nuss w/o scope C 0 090 Y Y $ - $ -
21743 Repair sternum/nuss w/scope C 0 090 Y Y $ - $ -
21750 Repair of sternum separation A 0 090 Y Y $ 887.40 $ -
21800 Treatment of rib fracture A 0 090 Y $ 114.84 $ 112.40
21805 Treatment of rib fracture A 0 090 Y $ 298.93 $ -
21810 Treatment of rib fracture(s) A 0 090 Y Y $ 612.48 $ -
21820 Treat sternum fracture A 0 090 Y $ 149.29 $ 146.86
21825 Treat sternum fracture A 0 090 Y Y $ 668.51 $ -
21899 Neck/chest surgery procedure C 0 YYY Y Y $ - $ -
21920 Biopsy soft tissue of back A 0 010 Y $ 177.48 $ 260.30
21925 Biopsy soft tissue of back A 0 090 Y $ 399.16 $ 475.72
21930 Exc back les sc < 3 cm A 0 090 Y $ 421.78 $ 511.56
21931 Exc back les sc 3 cm/> A 0 090 Y Y $ 555.76 $ -
21932 Exc back tum deep < 5 cm A 0 090 Y Y $ 788.92 $ -
21933 Exc back tum deep 5 cm/> A 0 090 Y Y $ 885.66 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
21935 Resect back tum < 5 cm A 0 090 Y $ 1,226.70 $ -

21936 Resect back tum 5 cm/> A 0 090 Y Y $ 1,701.37 $ -
22010 I&d p-spine c/t/cerv-thor A 0 090 Y $ 1,144.22 $ -
22015 I&d p-spine l/s/ls A 0 090 Y $ 1,111.51 $ -
22100 Remove part of neck vertebra A 0 090 Y Y $ 1,170.67 $ -
22101 Remove part thorax vertebra A 0 090 Y Y $ 1,175.89 $ -
22102 Remove part lumbar vertebra A 0 090 Y Y $ 976.49 $ -
22103 Remove extra spine segment A 0 ZZZ Y $ 187.92 $ -
22110 Remove part of neck vertebra A 0 090 Y Y $ 1,419.84 $ -
22112 Remove part thorax vertebra A 0 090 Y Y $ 1,404.88 $ -
22114 Remove part lumbar vertebra A 0 090 Y Y $ 1,150.49 $ -
22116 Remove extra spine segment A 0 ZZZ Y $ 182.70 $ -
22206 Cut spine 3 col thor A 0 090 Y Y $ 2,805.92 $ -
22207 Cut spine 3 col lumb A 0 090 Y Y $ 2,998.37 $ -
22208 Cut spine 3 col addl seg A 0 ZZZ Y $ 771.17 $ -
22210 Revision of neck spine A 0 090 Y Y $ 2,206.32 $ -
22212 Revision of thorax spine A 0 090 Y Y $ 1,775.50 $ -
22214 Revision of lumbar spine A 0 090 Y Y $ 1,798.12 $ -
22216 Revise extra spine segment A 0 ZZZ Y $ 470.50 $ -
22220 Revision of neck spine A 0 090 Y Y $ 2,037.54 $ -
22222 Revision of thorax spine A 0 090 Y Y $ 1,795.68 $ -
22224 Revision of lumbar spine A 0 090 Y Y $ 1,915.04 $ -
22226 Revise extra spine segment A 0 ZZZ Y $ 477.46 $ -
22305 Treat spine process fracture A 0 090 Y $ 191.40 $ 205.67
22310 Treat spine fracture A 0 090 Y $ 322.25 $ 342.08
22315 Treat spine fracture A 0 090 Y $ 921.85 $ 1,013.72
22318 Treat odontoid fx w/o graft A 0 090 Y Y Y $ 2,160.73 $ -
22319 Treat odontoid fx w/graft A 0 090 Y Y Y $ 2,458.27 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
22325 Treat spine fracture A 0 090 Y Y $ 1,806.12 $ -

22326 Treat neck spine fracture A 0 090 Y Y $ 1,906.00 $ -
22327 Treat thorax spine fracture A 0 090 Y Y $ 1,840.57 $ -
22328 Treat each add spine fx A 0 ZZZ Y $ 381.76 $ -
22505 Manipulation of spine A 0 010 Y $ 134.68 $ -
22520 Percut vertebroplasty thor A 0 010 Y $ 568.98 $ 2,041.37
22521 Percut vertebroplasty lumb A 0 010 Y $ 541.14 $ 2,026.06
22522 Percut vertebroplasty addl A 0 ZZZ $ 258.91 $ -
22523 Percut kyphoplasty thor A 0 010 Y $ 680.34 $ 6,679.86
22524 Percut kyphoplasty lumbar A 0 010 Y $ 645.19 $ 6,617.92
22525 Percut kyphoplasty add-on A 0 ZZZ $ 323.64 $ 4,125.89
22526 Idet single level N 9 010 $ 356.00 $ 1,989.52
22527 Idet 1 or more levels N 9 ZZZ $ 161.12 $ 1,598.36
22532 Lat thorax spine fusion A 0 090 Y Y Y $ 2,293.32 $ -
22533 Lat lumbar spine fusion A 0 090 Y Y Y $ 2,096.70 $ -
22534 Lat thor/lumb addl seg A 0 ZZZ Y Y $ 476.41 $ -
22548 Neck spine fusion A 0 090 Y Y Y $ 2,633.66 $ -
22551 Neck spine fuse&remov bel c2 A 0 090 Y Y Y $ 2,242.51 $ -
22552 Addl neck spine fusion A 0 ZZZ Y Y $ 521.30 $ -
22556 Thorax spine fusion A 0 090 Y Y Y $ 2,106.10 $ -
22558 Lumbar spine fusion A 0 090 Y Y Y $ 1,911.22 $ -
22585 Additional spinal fusion A 0 ZZZ Y Y $ 451.70 $ -
22590 Spine & skull spinal fusion A 0 090 Y Y Y $ 2,055.29 $ -
22595 Neck spinal fusion A 0 090 Y Y Y $ 1,944.28 $ -
22610 Thorax spine fusion A 0 090 Y Y Y $ 1,571.22 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
22614 Spine fusion extra segment A 0 ZZZ Y Y $ 518.87 $ -

22633 Lumbar spine fusion combined A 0 090 Y Y Y $ 2,345.17 $ -
22800 Fusion of spine A 0 090 Y Y $ 1,667.27 $ -
22818 Kyphectomy 1-2 segments A 0 090 Y Y Y Y $ 2,590.51 $ -
22819 Kyphectomy 3 or more A 0 090 Y Y Y Y $ 3,742.74 $ -
22830 Exploration of spinal fusion A 0 090 Y Y $ 992.84 $ -
22840 Insert spine fixation device A 0 ZZZ Y $ 1,014.07 $ -
22841 Insert spine fixation device B 9 XXX $ - $ -
22842 Insert spine fixation device A 0 ZZZ Y Y $ 1,011.64 $ -
22848 Insert pelv fixation device A 0 ZZZ Y Y $ 455.53 $ -
22849 Reinsert spinal fixation A 0 090 Y Y $ 1,643.26 $ -
22850 Remove spine fixation device A 0 090 Y Y $ 885.66 $ -
22851 Apply spine prosth device A 0 ZZZ Y Y $ 545.32 $ -
22852 Remove spine fixation device A 0 090 Y Y $ 839.38 $ -
22855 Remove spine fixation device A 0 090 Y Y $ 1,439.33 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
22856 Cerv artific diskectomy A 0 090 Y Y Y $ 2,160.73 $ -

22857 Lumbar artif diskectomy R 0 090 Y Y Y $ 2,037.54 $ -
22861 Revise cerv artific disc A 0 090 Y Y Y $ 2,647.93 $ -
22862 Revise lumbar artif disc R 0 090 Y Y Y Y $ 2,490.98 $ -
22864 Remove cerv artif disc A 0 090 Y Y Y $ 2,469.06 $ -
22865 Remove lumb artif disc R 0 090 Y Y Y Y $ 2,438.78 $ -
22899 Spine surgery procedure C 0 YYY Y Y Y $ - $ -
22900 Exc abdl tum deep < 5 cm A 0 090 Y Y $ 651.11 $ -
22901 Exc abdl tum deep 5 cm/> A 0 090 Y Y $ 795.88 $ -
22902 Exc abd les sc < 3 cm A 0 090 Y Y $ 358.79 $ 451.36
22903 Exc abd les sc 3 cm/> A 0 090 Y Y $ 505.30 $ -
22904 Resect abd tum < 5 cm A 0 090 Y Y Y $ 1,281.68 $ -
22905 Resect abd tum 5 cm/> A 0 090 Y Y Y $ 1,636.64 $ -
22999 Abdomen surgery procedure C 0 YYY Y Y $ - $ -
23000 Removal of calcium deposits A 0 090 Y Y $ 405.07 $ 576.98
23020 Release shoulder joint A 0 090 Y Y Y $ 783.00 $ -
23030 Drain shoulder lesion A 0 010 Y $ 290.93 $ 444.05
23031 Drain shoulder bursa A 0 010 Y Y $ 241.86 $ 409.25
23035 Drain shoulder bone lesion A 0 090 Y Y Y $ 775.34 $ -
23040 Exploratory shoulder surgery A 0 090 Y Y Y $ 819.19 $ -
23044 Exploratory shoulder surgery A 0 090 Y Y $ 650.41 $ -
23065 Biopsy shoulder tissues A 0 010 Y Y $ 188.27 $ 229.68
23066 Biopsy shoulder tissues A 0 090 Y Y $ 387.67 $ 548.10
23071 Exc shoulder les sc 3 cm/> A 0 090 Y Y Y $ 488.59 $ -
23073 Exc shoulder tum deep 5 cm/> A 0 090 Y Y Y $ 813.62 $ -
23075 Exc shoulder les sc < 3 cm A 0 090 Y Y $ 356.70 $ 466.32
23076 Exc shoulder tum deep < 5 cm A 0 090 Y Y $ 623.96 $ -
23077 Resect shoulder tum < 5 cm A 0 090 Y Y Y $ 1,371.47 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
23078 Resect shoulder tum 5 cm/> A 0 090 Y Y Y $ 1,733.04 $ -

23100 Biopsy of shoulder joint A 0 090 Y Y Y $ 554.36 $ -
23101 Shoulder joint surgery A 0 090 Y Y $ 507.73 $ -
23105 Remove shoulder joint lining A 0 090 Y Y Y $ 722.10 $ -
23106 Incision of collarbone joint A 0 090 Y Y $ 548.45 $ -
23107 Explore treat shoulder joint A 0 090 Y Y Y $ 747.50 $ -
23120 Partial removal collar bone A 0 090 Y Y $ 654.94 $ -
23125 Removal of collar bone A 0 090 Y Y Y $ 805.27 $ -
23130 Remove shoulder bone part A 0 090 Y Y $ 681.38 $ -
23140 Removal of bone lesion A 0 090 Y Y $ 603.08 $ -
23145 Removal of bone lesion A 0 090 Y Y Y $ 789.61 $ -
23146 Removal of bone lesion A 0 090 Y Y $ 694.96 $ -
23150 Removal of humerus lesion A 0 090 Y Y Y $ 746.11 $ -
23170 Remove collar bone lesion A 0 090 Y Y $ 623.27 $ -
23172 Remove shoulder blade lesion A 0 090 Y Y Y $ 635.10 $ -
23174 Remove humerus lesion A 0 090 Y Y Y $ 856.43 $ -
23180 Remove collar bone lesion A 0 090 Y Y $ 769.08 $ -
23182 Remove shoulder blade lesion A 0 090 Y Y Y $ 742.98 $ -
23184 Remove humerus lesion A 0 090 Y Y Y $ 834.85 $ -
23190 Partial removal of scapula A 0 090 Y Y Y $ 641.36 $ -
23195 Removal of head of humerus A 0 090 Y Y Y $ 860.95 $ -
23200 Resect clavicle tumor A 0 090 Y Y Y $ 1,733.39 $ -
23210 Resect scapula tumor A 0 090 Y Y Y $ 2,044.15 $ -
23220 Resect prox humerus tumor A 0 090 Y Y Y $ 2,250.17 $ -
23330 Remove shoulder foreign body A 0 010 Y Y $ 167.74 $ 240.82
23331 Remove shoulder foreign body A 0 090 Y Y $ 665.72 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
23332 Remove shoulder foreign body A 0 090 Y Y Y $ 1,012.68 $ -

23350 Injection for shoulder x-ray A 0 000 Y Y $ 56.38 $ 137.81
23395 Muscle transfer shoulder/arm A 0 090 Y Y $ 1,488.40 $ -
23397 Muscle transfers A 0 090 Y Y $ 1,331.10 $ -
23400 Fixation of shoulder blade A 0 090 Y Y Y $ 1,123.69 $ -
23405 Incision of tendon & muscle A 0 090 Y Y $ 715.49 $ -
23406 Incise tendon(s) & muscle(s) A 0 090 Y Y $ 897.14 $ -
23410 Repair rotator cuff acute A 0 090 Y Y Y $ 942.04 $ -
23412 Repair rotator cuff chronic A 0 090 Y Y Y $ 979.62 $ -
23415 Release of shoulder ligament A 0 090 Y Y $ 773.95 $ -
23420 Repair of shoulder A 0 090 Y Y Y $ 1,114.64 $ -
23430 Repair biceps tendon A 0 090 Y Y Y $ 850.16 $ -
23440 Remove/transplant tendon A 0 090 Y Y Y $ 869.65 $ -
23450 Repair shoulder capsule A 0 090 Y Y Y $ 1,100.72 $ -
23470 Reconstruct shoulder joint A 0 090 Y Y Y $ 1,412.88 $ -
23472 Reconstruct shoulder joint A 0 090 Y Y Y $ 1,758.44 $ -
23480 Revision of collar bone A 0 090 Y Y $ 942.73 $ -
23485 Revision of collar bone A 0 090 Y Y Y $ 1,113.95 $ -
23490 Reinforce clavicle A 0 090 Y Y Y $ 1,015.81 $ -
23491 Reinforce shoulder bones A 0 090 Y Y Y $ 1,174.50 $ -
23500 Treat clavicle fracture A 0 090 Y Y $ 231.07 $ 228.98
23505 Treat clavicle fracture A 0 090 Y Y $ 356.00 $ 372.36
23515 Treat clavicle fracture A 0 090 Y Y Y $ 817.10 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
23520 Treat clavicle dislocation A 0 090 Y Y $ 242.90 $ 240.12

23530 Treat clavicle dislocation A 0 090 Y Y Y $ 639.28 $ -
23570 Treat shoulder blade fx A 0 090 Y Y $ 248.12 $ 242.90
23575 Treat shoulder blade fx A 0 090 Y Y $ 404.03 $ 424.91
23585 Treat scapula fracture A 0 090 Y Y Y $ 1,135.18 $ -
23600 Treat humerus fracture A 0 090 Y Y $ 320.16 $ 338.26
23615 Treat humerus fracture A 0 090 Y Y Y $ 1,013.72 $ -
23616 Treat humerus fracture A 0 090 Y Y Y Y $ 1,454.64 $ -
23630 Treat humerus fracture A 0 090 Y Y Y $ 887.40 $ -
23650 Treat shoulder dislocation A 0 090 Y Y $ 305.89 $ 327.47
23655 Treat shoulder dislocation A 0 090 Y Y $ 430.48 $ -
23660 Treat shoulder dislocation A 0 090 Y Y Y $ 658.42 $ -
23665 Treat dislocation/fracture A 0 090 Y Y $ 429.08 $ 452.75
23670 Treat dislocation/fracture A 0 090 Y Y Y $ 1,000.85 $ -
23675 Treat dislocation/fracture A 0 090 Y Y $ 553.32 $ 592.64
23680 Treat dislocation/fracture A 0 090 Y Y Y $ 1,068.01 $ -
23700 Fixation of shoulder A 0 010 Y Y $ 219.24 $ -
23800 Fusion of shoulder joint A 0 090 Y Y Y $ 1,190.51 $ -
23802 Fusion of shoulder joint A 0 090 Y Y $ 1,479.00 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
23900 Amputation of arm & girdle A 0 090 Y Y $ 1,613.33 $ -

23920 Amputation at shoulder joint A 0 090 Y Y $ 1,296.65 $ -
23921 Amputation follow-up surgery A 0 090 Y $ 504.60 $ -
23929 Shoulder surgery procedure C 0 YYY Y Y Y $ - $ -
23930 Drainage of arm lesion A 0 010 Y Y $ 249.52 $ 366.44
23931 Drainage of arm bursa A 0 010 Y Y $ 172.96 $ 279.44
23935 Drain arm/elbow bone lesion A 0 090 Y Y $ 563.41 $ -
24000 Exploratory elbow surgery A 0 090 Y Y $ 532.09 $ -
24006 Release elbow joint A 0 090 Y Y Y Y $ 805.62 $ -
24065 Biopsy arm/elbow soft tissue A 0 010 Y Y $ 182.70 $ 257.52
24066 Biopsy arm/elbow soft tissue A 0 090 Y Y $ 464.58 $ 636.49
24071 Exc arm/elbow les sc 3 cm/> A 0 090 Y Y Y $ 473.28 $ -
24073 Ex arm/elbow tum deep 5 cm/> A 0 090 Y Y Y $ 811.54 $ -
24075 Exc arm/elbow les sc < 3 cm A 0 090 Y Y $ 370.62 $ 508.78
24076 Ex arm/elbow tum deep < 5 cm A 0 090 Y Y $ 618.74 $ -
24077 Resect arm/elbow tum < 5 cm A 0 090 Y Y $ 1,220.09 $ -
24079 Resect arm/elbow tum 5 cm/> A 0 090 Y Y Y $ 1,609.15 $ -
24100 Biopsy elbow joint lining A 0 090 Y Y Y $ 460.75 $ -
24101 Explore/treat elbow joint A 0 090 Y Y Y $ 555.41 $ -
24102 Remove elbow joint lining A 0 090 Y Y Y $ 692.52 $ -
24105 Removal of elbow bursa A 0 090 Y Y $ 373.06 $ -
24110 Remove humerus lesion A 0 090 Y Y $ 659.81 $ -
24115 Remove/graft bone lesion A 0 090 Y Y Y $ 840.42 $ -
24120 Remove elbow lesion A 0 090 Y Y $ 589.16 $ -
24130 Removal of head of radius A 0 090 Y Y $ 562.37 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
24134 Removal of arm bone lesion A 0 090 Y Y Y $ 852.60 $ -

24136 Remove radius bone lesion A 0 090 Y Y $ 706.44 $ -
24138 Remove elbow bone lesion A 0 090 Y Y Y $ 750.64 $ -
24140 Partial removal of arm bone A 0 090 Y Y Y $ 796.22 $ -
24145 Partial removal of radius A 0 090 Y Y $ 671.64 $ -
24147 Partial removal of elbow A 0 090 Y Y $ 694.96 $ -
24149 Radical resection of elbow A 0 090 Y Y Y $ 1,325.53 $ -
24150 Resect distal humerus tumor A 0 090 Y Y Y $ 1,791.16 $ -
24152 Resect radius tumor A 0 090 Y Y Y $ 1,535.03 $ -
24155 Removal of elbow joint A 0 090 Y Y Y $ 982.40 $ -
24160 Remove elbow joint implant A 0 090 Y Y $ 678.60 $ -
24164 Remove radius head implant A 0 090 Y Y $ 559.24 $ -
24200 Removal of arm foreign body A 0 010 Y Y $ 152.77 $ 207.76
24201 Removal of arm foreign body A 0 090 Y Y $ 410.99 $ 571.07
24220 Injection for elbow x-ray A 0 000 Y Y $ 73.78 $ 152.77
24300 Manipulate elbow w/anesth A 0 090 Y Y $ 425.60 $ -
24301 Muscle/tendon transfer A 0 090 Y Y $ 861.30 $ -
24305 Arm tendon lengthening A 0 090 Y $ 642.76 $ -
24310 Revision of arm tendon A 0 090 Y $ 533.48 $ -
24320 Repair of arm tendon A 0 090 Y Y $ 894.01 $ -
24330 Revision of arm muscles A 0 090 Y Y Y $ 817.10 $ -
24331 Revision of arm muscles A 0 090 Y Y Y $ 861.30 $ -
24332 Tenolysis triceps A 0 090 Y Y $ 686.26 $ -
24340 Repair of biceps tendon A 0 090 Y Y Y $ 693.91 $ -
24341 Repair arm tendon/muscle A 0 090 Y Y Y $ 835.20 $ -
24342 Repair of ruptured tendon A 0 090 Y Y Y $ 888.79 $ -
24343 Repr elbow lat ligmnt w/tiss A 0 090 Y Y Y $ 783.00 $ -
24344 Reconstruct elbow lat ligmnt A 0 090 Y Y Y $ 1,263.59 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
24345 Repr elbw med ligmnt w/tissu A 0 090 Y Y Y $ 779.52 $ -

24346 Reconstruct elbow med ligmnt A 0 090 Y Y Y $ 1,259.41 $ -
24357 Repair elbow perc A 0 090 Y Y $ 489.29 $ -
24358 Repair elbow w/deb open A 0 090 Y Y $ 581.51 $ -
24359 Repair elbow deb/attch open A 0 090 Y Y $ 742.98 $ -
24360 Reconstruct elbow joint A 0 090 Y Y Y $ 1,033.56 $ -
24363 Replace elbow joint A 0 090 Y Y Y $ 1,739.30 $ -
24365 Reconstruct head of radius A 0 090 Y Y Y $ 725.93 $ -
24366 Reconstruct head of radius A 0 090 Y Y Y $ 773.26 $ -
24400 Revision of humerus A 0 090 Y Y Y $ 937.51 $ -
24410 Revision of humerus A 0 090 Y Y Y $ 1,137.61 $ -
24420 Revision of humerus A 0 090 Y Y Y $ 1,136.22 $ -
24430 Repair of humerus A 0 090 Y Y Y $ 1,222.87 $ -
24435 Repair humerus with graft A 0 090 Y Y Y $ 1,236.10 $ -
24470 Revision of elbow joint A 0 090 Y Y Y $ 753.07 $ -
24495 Decompression of forearm A 0 090 Y Y $ 752.03 $ -
24498 Reinforce humerus A 0 090 Y Y Y $ 999.80 $ -
24516 Treat humerus fracture A 0 090 Y Y Y Y $ 991.80 $ -
24538 Treat humerus fracture A 0 090 Y Y $ 839.72 $ -
24546 Treat humerus fracture A 0 090 Y Y Y Y $ 1,203.73 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

24586 Treat elbow fracture A 0 090 Y Y Y $ 1,259.06 $ -
24587 Treat elbow fracture A 0 090 Y Y Y $ 1,244.10 $ -
24600 Treat elbow dislocation A 0 090 Y Y $ 365.05 $ 391.15
24605 Treat elbow dislocation A 0 090 Y Y $ 514.69 $ -
24615 Treat elbow dislocation A 0 090 Y Y Y $ 805.97 $ -
24620 Treat elbow fracture A 0 090 Y Y $ 616.31 $ -
24635 Treat elbow fracture A 0 090 Y Y Y $ 767.69 $ -
24640 Treat elbow dislocation A 0 010 Y Y $ 103.70 $ 139.55
24650 Treat radius fracture A 0 090 Y Y $ 247.08 $ 265.52
24655 Treat radius fracture A 0 090 Y Y $ 432.91 $ 465.28
24665 Treat radius fracture A 0 090 Y Y Y $ 726.62 $ -
24666 Treat radius fracture A 0 090 Y Y Y $ 826.50 $ -
24670 Treat ulnar fracture A 0 090 Y Y $ 274.92 $ 299.28
24675 Treat ulnar fracture A 0 090 Y Y $ 454.49 $ 487.55
24685 Treat ulnar fracture A 0 090 Y Y Y $ 731.50 $ -
24800 Fusion of elbow joint A 0 090 Y Y Y $ 942.04 $ -
24802 Fusion/graft of elbow joint A 0 090 Y Y Y $ 1,157.80 $ -
24900 Amputation of upper arm A 0 090 Y Y Y $ 835.90 $ -
24920 Amputation of upper arm A 0 090 Y Y Y $ 792.05 $ -
24925 Amputation follow-up surgery A 0 090 Y Y Y $ 634.40 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

24931 Amputate upper arm & implant A 0 090 Y Y Y $ 793.09 $ -
24935 Revision of amputation A 0 090 Y Y $ 1,214.17 $ -
24940 Revision of upper arm C 0 090 Y Y Y $ - $ -
24999 Upper arm/elbow surgery C 0 YYY Y Y Y $ - $ -
25000 Incision of tendon sheath A 0 090 Y Y $ 359.48 $ -
25001 Incise flexor carpi radialis A 0 090 Y Y $ 364.01 $ -
25020 Decompress forearm 1 space A 0 090 Y Y $ 610.39 $ -
25023 Decompress forearm 1 space A 0 090 Y Y $ 1,239.92 $ -
25024 Decompress forearm 2 spaces A 0 090 Y Y $ 896.45 $ -
25025 Decompress forearm 2 spaces A 0 090 Y Y $ 1,420.88 $ -
25028 Drainage of forearm lesion A 0 090 Y Y $ 556.10 $ -
25031 Drainage of forearm bursa A 0 090 Y Y $ 401.94 $ -
25035 Treat forearm bone lesion A 0 090 Y Y $ 671.29 $ -
25040 Explore/treat wrist joint A 0 090 Y Y $ 631.27 $ -
25065 Biopsy forearm soft tissues A 0 010 Y Y $ 178.52 $ 254.74
25066 Biopsy forearm soft tissues A 0 090 Y Y $ 396.72 $ -
25071 Exc forearm les sc 3 cm/> A 0 090 Y Y Y $ 492.07 $ -
25073 Exc forearm tum deep 3 cm/> A 0 090 Y Y Y $ 605.17 $ -
25075 Exc forearm les sc < 3 cm A 0 090 Y Y $ 357.05 $ 495.90
25076 Exc forearm tum deep < 3 cm A 0 090 Y Y $ 581.16 $ -
25077 Resect forearm/wrist tum<3cm A 0 090 Y Y $ 1,034.26 $ -
25078 Resect forarm/wrist tum 3cm> A 0 090 Y Y Y $ 1,410.44 $ -
25085 Incision of wrist capsule A 0 090 Y Y Y $ 505.64 $ -
25100 Biopsy of wrist joint A 0 090 Y Y $ 377.93 $ -
25101 Explore/treat wrist joint A 0 090 Y Y $ 441.96 $ -
25105 Remove wrist joint lining A 0 090 Y Y $ 533.14 $ -
25107 Remove wrist joint cartilage A 0 090 Y Y Y $ 675.82 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
25109 Excise tendon forearm/wrist A 0 090 Y Y $ 591.60 $ -

25110 Remove wrist tendon lesion A 0 090 Y Y $ 376.19 $ -
25111 Remove wrist tendon lesion A 0 090 Y Y $ 344.52 $ -
25112 Reremove wrist tendon lesion A 0 090 Y Y $ 424.21 $ -
25115 Remove wrist/forearm lesion A 0 090 Y Y $ 857.82 $ -
25116 Remove wrist/forearm lesion A 0 090 Y Y $ 670.60 $ -
25118 Excise wrist tendon sheath A 0 090 Y Y $ 413.77 $ -
25119 Partial removal of ulna A 0 090 Y Y Y $ 560.28 $ -
25120 Removal of forearm lesion A 0 090 Y Y $ 564.11 $ -
25125 Remove/graft forearm lesion A 0 090 Y Y $ 690.08 $ -
25126 Remove/graft forearm lesion A 0 090 Y Y Y $ 683.12 $ -
25130 Removal of wrist lesion A 0 090 Y Y $ 490.33 $ -
25135 Remove & graft wrist lesion A 0 090 Y Y Y $ 634.75 $ -
25136 Remove & graft wrist lesion A 0 090 Y Y Y $ 549.84 $ -
25145 Remove forearm bone lesion A 0 090 Y Y Y $ 589.16 $ -
25150 Partial removal of ulna A 0 090 Y Y $ 633.36 $ -
25151 Partial removal of radius A 0 090 Y Y Y $ 674.77 $ -
25170 Resect radius/ulnar tumor A 0 090 Y Y Y $ 1,705.55 $ -
25210 Removal of wrist bone A 0 090 Y $ 536.96 $ -
25215 Removal of wrist bones A 0 090 Y Y $ 683.82 $ -
25230 Partial removal of radius A 0 090 Y Y $ 468.41 $ -
25240 Partial removal of ulna A 0 090 Y Y $ 468.76 $ -
25246 Injection for wrist x-ray A 0 000 Y Y $ 81.78 $ 158.34
25248 Remove forearm foreign body A 0 090 Y Y $ 474.67 $ -
25250 Removal of wrist prosthesis A 0 090 Y Y Y $ 591.60 $ -
25251 Removal of wrist prosthesis A 0 090 Y Y $ 819.54 $ -
25259 Manipulate wrist w/anesthes A 0 090 Y Y $ 428.04 $ -
25260 Repair forearm tendon/muscle A 0 090 Y $ 712.01 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
25263 Repair forearm tendon/muscle A 0 090 Y Y $ 715.49 $ -

25265 Repair forearm tendon/muscle A 0 090 Y Y $ 862.00 $ -
25275 Repair forearm tendon sheath A 0 090 Y Y $ 769.08 $ -
25280 Revise wrist/forearm tendon A 0 090 Y $ 635.10 $ -
25290 Incise wrist/forearm tendon A 0 090 Y $ 499.73 $ -
25295 Release wrist/forearm tendon A 0 090 Y $ 588.47 $ -
25300 Fusion of tendons at wrist A 0 090 Y Y Y $ 787.87 $ -
25301 Fusion of tendons at wrist A 0 090 Y Y Y $ 722.10 $ -
25310 Transplant forearm tendon A 0 090 Y Y $ 693.91 $ -
25312 Transplant forearm tendon A 0 090 Y Y $ 821.98 $ -
25315 Revise palsy hand tendon(s) A 0 090 Y Y Y $ 896.10 $ -
25316 Revise palsy hand tendon(s) A 0 090 Y Y Y $ 956.30 $ -
25320 Repair/revise wrist joint A 0 090 Y Y Y $ 1,091.33 $ -
25332 Revise wrist joint A 0 090 Y Y Y $ 960.48 $ -
25335 Realignment of hand A 0 090 Y Y Y $ 896.45 $ -
25337 Reconstruct ulna/radioulnar A 0 090 Y Y $ 982.06 $ -
25350 Revision of radius A 0 090 Y Y Y $ 765.60 $ -
25355 Revision of radius A 0 090 Y Y Y $ 888.44 $ -
25360 Revision of ulna A 0 090 Y Y Y $ 750.98 $ -
25365 Revise radius & ulna A 0 090 Y Y Y $ 1,065.58 $ -
25370 Revise radius or ulna A 0 090 Y Y Y $ 1,088.20 $ -
25375 Revise radius & ulna A 0 090 Y Y Y $ 818.15 $ -
25390 Shorten radius or ulna A 0 090 Y Y Y $ 876.96 $ -
25391 Lengthen radius or ulna A 0 090 Y Y Y $ 1,166.84 $ -
25392 Shorten radius & ulna A 0 090 Y Y Y $ 1,190.16 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
25393 Lengthen radius & ulna A 0 090 Y Y Y $ 1,331.80 $ -

25394 Repair carpal bone shorten A 0 090 Y Y Y $ 896.80 $ -
25400 Repair radius or ulna A 0 090 Y Y Y $ 927.07 $ -
25405 Repair/graft radius or ulna A 0 090 Y Y Y $ 1,198.16 $ -
25415 Repair radius & ulna A 0 090 Y Y Y $ 1,133.44 $ -
25420 Repair/graft radius & ulna A 0 090 Y Y Y $ 1,375.30 $ -
25425 Repair/graft radius or ulna A 0 090 Y Y Y $ 1,136.22 $ -
25426 Repair/graft radius & ulna A 0 090 Y Y Y $ 1,306.04 $ -
25430 Vasc graft into carpal bone A 0 090 Y Y $ 744.37 $ -
25431 Repair nonunion carpal bone A 0 090 Y Y Y $ 901.32 $ -
25440 Repair/graft wrist bone A 0 090 Y Y Y $ 866.17 $ -
25441 Reconstruct wrist joint A 0 090 Y Y Y $ 969.18 $ -
25445 Reconstruct wrist joint A 0 090 Y Y $ 811.54 $ -
25446 Wrist replacement A 0 090 Y Y Y $ 1,328.32 $ -
25447 Repair wrist joints A 0 090 Y Y Y $ 920.46 $ -
25449 Remove wrist joint implant A 0 090 Y Y Y $ 1,208.26 $ -
25450 Revision of wrist joint A 0 090 Y Y $ 691.82 $ -
25455 Revision of wrist joint A 0 090 Y Y $ 676.86 $ -
25490 Reinforce radius A 0 090 Y Y Y $ 727.67 $ -
25491 Reinforce ulna A 0 090 Y Y Y $ 857.47 $ -
25492 Reinforce radius and ulna A 0 090 Y Y Y $ 1,049.22 $ -
25500 Treat fracture of radius A 0 090 Y Y $ 258.22 $ 277.36
25515 Treat fracture of radius A 0 090 Y Y Y $ 750.29 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
25525 Treat fracture of radius A 0 090 Y Y Y Y $ 888.79 $ -

25526 Treat fracture of radius A 0 090 Y Y Y Y $ 1,100.03 $ -
25530 Treat fracture of ulna A 0 090 Y Y $ 242.90 $ 264.13
25535 Treat fracture of ulna A 0 090 Y Y $ 494.86 $ 524.44
25545 Treat fracture of ulna A 0 090 Y Y Y $ 694.26 $ -
25560 Treat fracture radius & ulna A 0 090 Y Y $ 260.30 $ 282.92
25565 Treat fracture radius & ulna A 0 090 Y Y $ 520.61 $ 560.98
25574 Treat fracture radius & ulna A 0 090 Y Y Y Y $ 754.46 $ -
25575 Treat fracture radius/ulna A 0 090 Y Y Y $ 1,019.64 $ -
25600 Treat fracture radius/ulna A 0 090 Y Y $ 308.68 $ 325.73
25605 Treat fracture radius/ulna A 0 090 Y Y $ 573.50 $ 601.00
25606 Treat fx distal radial A 0 090 Y Y $ 738.46 $ -
25607 Treat fx rad extra-articul A 0 090 Y Y Y $ 820.58 $ -
25608 Treat fx rad intra-articul A 0 090 Y Y Y $ 924.64 $ -
25609 Treat fx radial 3+ frag A 0 090 Y Y Y $ 1,182.85 $ -
25622 Treat wrist bone fracture A 0 090 Y Y $ 288.84 $ 312.50
25628 Treat wrist bone fracture A 0 090 Y Y Y $ 804.23 $ -
25645 Treat wrist bone fracture A 0 090 Y Y Y $ 641.02 $ -
25651 Pin ulnar styloid fracture A 0 090 Y Y $ 531.40 $ -
25652 Treat fracture ulnar styloid A 0 090 Y Y $ 689.74 $ -
25660 Treat wrist dislocation A 0 090 Y Y $ 444.05 $ -
25670 Treat wrist dislocation A 0 090 Y Y Y $ 677.90 $ -
25671 Pin radioulnar dislocation A 0 090 Y Y $ 585.68 $ -
25675 Treat wrist dislocation A 0 090 Y Y $ 434.30 $ 465.62

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

25680 Treat wrist fracture A 0 090 Y Y $ 520.61 $ -
25685 Treat wrist fracture A 0 090 Y Y Y $ 836.94 $ -
25690 Treat wrist dislocation A 0 090 Y Y $ 527.22 $ -
25800 Fusion of wrist joint A 0 090 Y Y Y $ 824.41 $ -
25805 Fusion/graft of wrist joint A 0 090 Y Y Y $ 969.88 $ -
25810 Fusion/graft of wrist joint A 0 090 Y Y Y $ 975.10 $ -
25820 Fusion of hand bones A 0 090 Y Y Y $ 675.12 $ -
25825 Fuse hand bones with graft A 0 090 Y Y Y $ 832.42 $ -
25830 Fusion radioulnar jnt/ulna A 0 090 Y Y Y $ 1,043.30 $ -
25900 Amputation of forearm A 0 090 Y Y $ 813.62 $ -
25905 Amputation of forearm A 0 090 Y Y Y $ 809.45 $ -
25915 Amputation of forearm A 0 090 Y Y Y $ 1,247.58 $ -
25920 Amputate hand at wrist A 0 090 Y Y $ 782.65 $ -
25922 Amputate hand at wrist A 0 090 Y Y Y $ 563.41 $ -
25927 Amputation of hand A 0 090 Y Y $ 878.70 $ -
25931 Amputation follow-up surgery A 0 090 Y Y $ 766.99 $ -
25999 Forearm or wrist surgery C 0 YYY Y Y Y $ - $ -
26010 Drainage of finger abscess A 0 010 Y $ 146.51 $ 250.91
26011 Drainage of finger abscess A 0 010 Y $ 200.45 $ 374.80
26020 Drain hand tendon sheath A 0 090 Y $ 470.15 $ -
26025 Drainage of palm bursa A 0 090 Y $ 457.97 $ -
26030 Drainage of palm bursas A 0 090 Y $ 547.06 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
26034 Treat hand bone lesion A 0 090 Y $ 590.56 $ -

26035 Decompress fingers/hand A 0 090 Y $ 964.31 $ -
26037 Decompress fingers/hand A 0 090 Y $ 643.45 $ -
26040 Release palm contracture A 0 090 Y Y $ 326.42 $ -
26055 Incise finger tendon sheath A 0 090 Y $ 322.60 $ 540.10
26060 Incision of finger tendon A 0 090 Y $ 285.36 $ -
26070 Explore/treat hand joint A 0 090 Y Y $ 336.52 $ -
26075 Explore/treat finger joint A 0 090 Y Y $ 350.09 $ -
26080 Explore/treat finger joint A 0 090 Y $ 415.86 $ -
26100 Biopsy hand joint lining A 0 090 Y Y $ 359.83 $ -
26105 Biopsy finger joint lining A 0 090 Y Y $ 365.75 $ -
26110 Biopsy finger joint lining A 0 090 Y $ 342.78 $ -
26111 Exc hand les sc 1.5 cm/> A 0 090 Y Y $ 468.41 $ -
26113 Exc hand tum deep 1.5 cm/> A 0 090 Y Y $ 610.39 $ -
26115 Exc hand les sc < 1.5 cm A 0 090 Y $ 366.10 $ 530.70
26116 Exc hand tum deep < 1.5 cm A 0 090 Y $ 580.12 $ -
26117 Exc hand tum ra < 3 cm A 0 090 Y $ 834.50 $ -
26118 Exc hand tum ra 3 cm/> A 0 090 Y Y $ 1,232.27 $ -
26125 Release palm contracture A 0 ZZZ $ 326.77 $ -
26130 Remove wrist joint lining A 0 090 Y Y $ 506.69 $ -
26135 Revise finger joint each A 0 090 Y $ 608.65 $ -
26140 Revise finger joint each A 0 090 Y $ 554.71 $ -
26145 Tendon excision palm/finger A 0 090 Y $ 565.15 $ -
26160 Remove tendon sheath lesion A 0 090 Y $ 353.57 $ 559.93
26170 Removal of palm tendon each A 0 090 Y $ 440.22 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
26180 Removal of finger tendon A 0 090 Y $ 477.11 $ -

26185 Remove finger bone A 0 090 Y Y Y $ 609.70 $ -
26200 Remove hand bone lesion A 0 090 Y $ 496.60 $ -
26205 Remove/graft bone lesion A 0 090 Y $ 680.34 $ -
26210 Removal of finger lesion A 0 090 Y $ 479.89 $ -
26215 Remove/graft finger lesion A 0 090 Y $ 631.62 $ -
26230 Partial removal of hand bone A 0 090 Y $ 549.49 $ -
26235 Partial removal finger bone A 0 090 Y $ 541.49 $ -
26236 Partial removal finger bone A 0 090 Y $ 482.68 $ -
26250 Extensive hand surgery A 0 090 Y $ 1,201.99 $ -
26260 Resect prox finger tumor A 0 090 Y Y $ 902.02 $ -
26262 Resect distal finger tumor A 0 090 Y Y $ 710.62 $ -
26320 Removal of implant from hand A 0 090 Y $ 373.06 $ -
26340 Manipulate finger w/anesth A 0 090 Y Y $ 337.56 $ -
26341 Manipulat palm cord post inj A 0 010 Y Y $ 79.34 $ 99.88
26350 Repair finger/hand tendon A 0 090 Y $ 726.97 $ -
26352 Repair/graft hand tendon A 0 090 Y Y $ 854.69 $ -
26356 Repair finger/hand tendon A 0 090 Y $ 1,136.57 $ -
26357 Repair finger/hand tendon A 0 090 Y Y $ 917.68 $ -
26373 Repair finger/hand tendon A 0 090 Y Y $ 894.01 $ -
26390 Revise hand/finger tendon A 0 090 Y Y $ 904.45 $ -
26392 Repair/graft hand tendon A 0 090 Y Y $ 1,054.09 $ -
26410 Repair hand tendon A 0 090 Y $ 573.85 $ -
26412 Repair/graft hand tendon A 0 090 Y $ 706.44 $ -
26415 Excision hand/finger tendon A 0 090 Y $ 715.49 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
26416 Graft hand or finger tendon A 0 090 Y $ 929.16 $ -

26418 Repair finger tendon A 0 090 Y $ 578.38 $ -
26420 Repair/graft finger tendon A 0 090 Y Y $ 753.42 $ -
26428 Repair/graft finger tendon A 0 090 Y $ 795.53 $ -
26434 Repair/graft finger tendon A 0 090 Y Y $ 677.21 $ -
26437 Realignment of tendons A 0 090 Y $ 639.62 $ -
26440 Release palm/finger tendon A 0 090 Y $ 626.05 $ -
26442 Release palm & finger tendon A 0 090 Y $ 1,008.16 $ -
26445 Release hand/finger tendon A 0 090 Y $ 575.59 $ -
26449 Release forearm/hand tendon A 0 090 Y $ 775.00 $ -
26450 Incision of palm tendon A 0 090 Y $ 416.21 $ -
26455 Incision of finger tendon A 0 090 Y $ 416.56 $ -
26460 Incise hand/finger tendon A 0 090 Y $ 401.24 $ -
26471 Fusion of finger tendons A 0 090 Y $ 633.36 $ -
26474 Fusion of finger tendons A 0 090 Y Y $ 521.30 $ -
26476 Tendon lengthening A 0 090 Y $ 609.70 $ -
26477 Tendon shortening A 0 090 Y $ 604.82 $ -
26478 Lengthening of hand tendon A 0 090 Y $ 646.93 $ -
26479 Shortening of hand tendon A 0 090 Y Y $ 652.50 $ -
26480 Transplant hand tendon A 0 090 Y $ 771.52 $ -
26483 Transplant/graft hand tendon A 0 090 Y Y $ 889.49 $ -
26485 Transplant palm tendon A 0 090 Y Y $ 839.72 $ -
26489 Transplant/graft palm tendon A 0 090 Y $ 986.23 $ -
26490 Revise thumb tendon A 0 090 Y $ 851.56 $ -
26492 Tendon transfer with graft A 0 090 Y Y $ 950.74 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
26494 Hand tendon/muscle transfer A 0 090 Y Y $ 855.38 $ -

26496 Revise thumb tendon A 0 090 Y $ 909.32 $ -
26497 Finger tendon transfer A 0 090 Y Y $ 936.12 $ -
26498 Finger tendon transfer A 0 090 Y Y $ 1,267.07 $ -
26499 Revision of finger A 0 090 Y Y $ 893.66 $ -
26500 Hand tendon reconstruction A 0 090 Y $ 655.98 $ -
26502 Hand tendon reconstruction A 0 090 Y Y $ 754.46 $ -
26508 Release thumb contracture A 0 090 Y $ 646.93 $ -
26510 Thumb tendon transfer A 0 090 Y $ 612.83 $ -
26516 Fusion of knuckle joint A 0 090 Y $ 736.72 $ -
26517 Fusion of knuckle joints A 0 090 Y Y $ 898.88 $ -
26518 Fusion of knuckle joints A 0 090 Y Y $ 900.62 $ -
26520 Release knuckle contracture A 0 090 Y $ 660.50 $ -
26525 Release finger contracture A 0 090 Y $ 658.07 $ -
26530 Revise knuckle joint A 0 090 Y Y $ 590.56 $ -
26531 Revise knuckle with implant A 0 090 Y Y $ 684.52 $ -
26535 Revise finger joint A 0 090 Y $ 444.05 $ -
26536 Revise/implant finger joint A 0 090 Y $ 718.97 $ -
26540 Repair hand joint A 0 090 Y $ 686.95 $ -
26541 Repair hand joint with graft A 0 090 Y Y $ 845.64 $ -
26542 Repair hand joint with graft A 0 090 Y $ 712.70 $ -
26545 Reconstruct finger joint A 0 090 Y $ 727.67 $ -
26546 Repair nonunion hand A 0 090 Y Y Y $ 1,044.35 $ -
26548 Reconstruct finger joint A 0 090 Y $ 810.49 $ -
26550 Construct thumb replacement A 0 090 Y Y $ 1,820.39 $ -
26551 Great toe-hand transfer A 0 090 Y Y $ 3,564.56 $ -
26553 Single transfer toe-hand A 0 090 Y Y $ 2,790.26 $ -
26554 Double transfer toe-hand A 0 090 Y Y $ 3,317.48 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
26555 Positional change of finger A 0 090 Y Y $ 1,523.54 $ -

26556 Toe joint transfer A 0 090 Y Y $ 3,003.59 $ -
26560 Repair of web finger A 0 090 Y Y $ 610.74 $ -
26561 Repair of web finger A 0 090 Y Y $ 1,054.09 $ -
26562 Repair of web finger A 0 090 Y Y $ 1,264.28 $ -
26565 Correct metacarpal flaw A 0 090 Y Y $ 723.49 $ -
26567 Correct finger deformity A 0 090 Y $ 711.66 $ -
26568 Lengthen metacarpal/finger A 0 090 Y Y $ 954.56 $ -
26580 Repair hand deformity A 0 090 Y Y $ 1,705.55 $ -
26587 Reconstruct extra finger A 0 090 Y Y $ 1,119.52 $ -
26590 Repair finger deformity A 0 090 Y Y $ 1,479.00 $ -
26591 Repair muscles of hand A 0 090 Y $ 438.13 $ -
26593 Release muscles of hand A 0 090 Y $ 610.04 $ -
26596 Excision constricting tissue A 0 090 Y Y $ 832.42 $ -
26600 Treat metacarpal fracture A 0 090 Y $ 282.58 $ 298.24
26605 Treat metacarpal fracture A 0 090 Y $ 308.33 $ 332.34
26607 Treat metacarpal fracture A 0 090 Y $ 500.77 $ -
26641 Treat thumb dislocation A 0 090 Y $ 359.83 $ 385.93
26645 Treat thumb fracture A 0 090 Y $ 422.82 $ 452.05
26650 Treat thumb fracture A 0 090 Y $ 516.78 $ -
26665 Treat thumb fracture A 0 090 Y $ 692.17 $ -
26670 Treat hand dislocation A 0 090 Y $ 327.82 $ 353.22
26675 Treat hand dislocation A 0 090 Y $ 452.05 $ 482.33
26676 Pin hand dislocation A 0 090 Y $ 541.49 $ -
26685 Treat hand dislocation A 0 090 Y $ 638.93 $ -
26686 Treat hand dislocation A 0 090 Y Y $ 702.26 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
26700 Treat knuckle dislocation A 0 090 Y $ 324.68 $ 341.74

26705 Treat knuckle dislocation A 0 090 Y $ 406.81 $ 436.39
26706 Pin knuckle dislocation A 0 090 Y $ 478.15 $ -
26715 Treat knuckle dislocation A 0 090 Y $ 628.49 $ -
26720 Treat finger fracture each A 0 090 Y $ 190.01 $ 202.19
26727 Treat finger fracture each A 0 090 Y $ 507.04 $ -
26756 Pin finger fracture each A 0 090 Y $ 446.14 $ -
26770 Treat finger dislocation A 0 090 Y $ 272.48 $ 290.23
26775 Treat finger dislocation A 0 090 Y $ 368.18 $ 399.85
26776 Pin finger dislocation A 0 090 Y $ 475.02 $ -
26785 Treat finger dislocation A 0 090 Y $ 591.25 $ -
26820 Thumb fusion with graft A 0 090 Y Y $ 842.16 $ -
26841 Fusion of thumb A 0 090 Y $ 766.30 $ -
26842 Thumb fusion with graft A 0 090 Y Y $ 846.34 $ -
26843 Fusion of hand joint A 0 090 Y Y $ 787.18 $ -
26844 Fusion/graft of hand joint A 0 090 Y Y $ 891.23 $ -
26850 Fusion of knuckle A 0 090 Y $ 722.45 $ -
26852 Fusion of knuckle with graft A 0 090 Y Y $ 834.85 $ -
26860 Fusion of finger joint A 0 090 Y $ 568.98 $ -
26861 Fusion of finger jnt add-on A 0 ZZZ $ 123.19 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
26862 Fusion/graft of finger joint A 0 090 Y Y $ 759.34 $ -

26863 Fuse/graft added joint A 0 ZZZ Y $ 278.75 $ -
26910 Amputate metacarpal bone A 0 090 Y $ 771.17 $ -
26951 Amputation of finger/thumb A 0 090 Y $ 671.64 $ -
26952 Amputation of finger/thumb A 0 090 Y $ 679.99 $ -
26989 Hand/finger surgery C 0 YYY Y Y $ - $ -
26990 Drainage of pelvis lesion A 0 090 Y $ 700.87 $ -
26991 Drainage of pelvis bursa A 0 090 Y $ 597.17 $ 751.68
26992 Drainage of bone lesion A 0 090 Y $ 1,104.55 $ -
27000 Incision of hip tendon A 0 090 Y Y $ 489.29 $ -
27001 Incision of hip tendon A 0 090 Y Y Y $ 612.13 $ -
27006 Incision of hip tendons A 0 090 Y Y Y $ 840.42 $ -
27025 Incision of hip/thigh fascia A 0 090 Y Y $ 1,060.70 $ -
27027 Buttock fasciotomy A 0 090 Y Y $ 849.12 $ -
27030 Drainage of hip joint A 0 090 Y Y Y $ 1,086.46 $ -
27033 Exploration of hip joint A 0 090 Y Y Y $ 1,132.04 $ -
27035 Denervation of hip joint A 0 090 Y Y Y $ 1,250.02 $ -
27036 Excision of hip joint/muscle A 0 090 Y Y Y $ 1,162.67 $ -
27040 Biopsy of soft tissues A 0 010 Y Y $ 224.81 $ 344.17
27041 Biopsy of soft tissues A 0 090 Y Y $ 778.48 $ -
27043 Exc hip pelvis les sc 3 cm/> A 0 090 Y Y $ 555.76 $ -
27045 Exc hip/pelv tum deep 5 cm/> A 0 090 Y Y Y $ 886.01 $ -
27047 Exc hip/pelvis les sc < 3 cm A 0 090 Y Y $ 428.39 $ 517.82
27048 Exc hip/pelv tum deep < 5 cm A 0 090 Y Y Y $ 708.18 $ -
27049 Resect hip/pelv tum < 5 cm A 0 090 Y Y Y $ 1,613.68 $ -
27050 Biopsy of sacroiliac joint A 0 090 Y Y $ 431.87 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
27052 Biopsy of hip joint A 0 090 Y Y Y $ 647.63 $ -

27054 Removal of hip joint lining A 0 090 Y Y Y $ 777.43 $ -
27057 Buttock fasciotomy w/dbrdmt A 0 090 Y Y $ 958.04 $ -
27059 Resect hip/pelv tum 5 cm/> A 0 090 Y Y Y $ 2,169.43 $ -
27060 Removal of ischial bursa A 0 090 Y Y $ 515.04 $ -
27062 Remove femur lesion/bursa A 0 090 Y Y $ 509.12 $ -
27065 Remove hip bone les super A 0 090 Y Y Y $ 571.76 $ -
27066 Remove hip bone les deep A 0 090 Y Y Y $ 929.16 $ -
27067 Remove/graft hip bone lesion A 0 090 Y Y Y $ 1,195.38 $ -
27070 Part remove hip bone super A 0 090 Y Y Y $ 971.96 $ -
27071 Part removal hip bone deep A 0 090 Y Y Y $ 1,044.00 $ -
27075 Resect hip tumor A 0 090 Y Y $ 2,495.51 $ -
27076 Resect hip tum incl acetabul A 0 090 Y Y $ 2,972.27 $ -
27077 Resect hip tum w/innom bone A 0 090 Y Y $ 3,375.60 $ -
27078 Rsect hip tum incl femur A 0 090 Y Y $ 2,389.37 $ -
27080 Removal of tail bone A 0 090 Y Y $ 582.90 $ -
27086 Remove hip foreign body A 0 010 Y Y $ 161.82 $ 249.17
27087 Remove hip foreign body A 0 090 Y Y Y $ 723.14 $ -
27090 Removal of hip prosthesis A 0 090 Y Y Y $ 955.61 $ -
27091 Removal of hip prosthesis A 0 090 Y Y Y $ 1,886.16 $ -
27093 Injection for hip x-ray A 0 000 Y Y $ 77.60 $ 183.40
27095 Injection for hip x-ray A 0 000 Y Y $ 91.87 $ 226.90
27096 Inject sacroiliac joint A 0 000 Y Y $ 87.70 $ 163.56
27097 Revision of hip tendon A 0 090 Y Y Y $ 772.56 $ -
27098 Transfer tendon to pelvis A 0 090 Y Y Y $ 777.08 $ -
27100 Transfer of abdominal muscle A 0 090 Y Y Y $ 942.38 $ -
27105 Transfer of spinal muscle A 0 090 Y Y Y $ 991.10 $ -
27110 Transfer of iliopsoas muscle A 0 090 Y Y Y $ 1,116.38 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
27111 Transfer of iliopsoas muscle A 0 090 Y Y Y $ 971.27 $ -

27120 Reconstruction of hip socket A 0 090 Y Y Y $ 1,513.45 $ -
27122 Reconstruction of hip socket A 0 090 Y Y Y $ 1,282.73 $ -
27125 Partial hip replacement A 0 090 Y Y Y $ 1,321.70 $ -
27130 Total hip arthroplasty A 0 090 Y Y Y $ 1,697.89 $ -
27132 Total hip arthroplasty A 0 090 Y Y Y $ 1,984.64 $ -
27134 Revise hip joint replacement A 0 090 Y Y Y $ 2,292.97 $ -
27140 Transplant femur ridge A 0 090 Y Y Y $ 1,036.34 $ -
27146 Incision of hip bone A 0 090 Y Y Y $ 1,496.75 $ -
27147 Revision of hip bone A 0 090 Y Y Y $ 1,723.99 $ -
27151 Incision of hip bones A 0 090 Y Y Y $ 1,859.71 $ -
27156 Revision of hip bones A 0 090 Y Y Y $ 2,021.88 $ -
27158 Revision of pelvis A 0 090 Y Y $ 1,640.82 $ -
27161 Incision of neck of femur A 0 090 Y Y Y $ 1,418.45 $ -
27165 Incision/fixation of femur A 0 090 Y Y Y $ 1,604.98 $ -
27170 Repair/graft femur head/neck A 0 090 Y Y Y $ 1,381.21 $ -
27175 Treat slipped epiphysis A 0 090 Y Y $ 766.99 $ -
27176 Treat slipped epiphysis A 0 090 Y Y Y $ 1,057.22 $ -
27179 Revise head/neck of femur A 0 090 Y Y Y $ 1,128.22 $ -
27185 Revision of femur epiphysis A 0 090 Y Y $ 665.72 $ -
27187 Reinforce hip bones A 0 090 Y Y Y $ 1,149.44 $ -
27193 Treat pelvic ring fracture A 0 090 Y $ 534.18 $ 529.31
27194 Treat pelvic ring fracture A 0 090 Y Y $ 780.56 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
27200 Treat tail bone fracture A 0 090 Y $ 194.88 $ 189.31

27202 Treat tail bone fracture A 0 090 Y Y $ 634.06 $ -
27215 Treat pelvic fracture(s) A 9 090 $ 631.27 $ -
27216 Treat pelvic ring fracture A 9 090 $ 939.95 $ -
27217 Treat pelvic ring fracture A 9 090 $ 883.22 $ -
27218 Treat pelvic ring fracture A 9 090 $ 1,221.48 $ -
27220 Treat hip socket fracture A 0 090 Y Y $ 589.51 $ 593.69
27222 Treat hip socket fracture A 0 090 Y Y $ 1,133.09 $ -
27226 Treat hip wall fracture A 0 090 Y Y Y Y $ 1,232.62 $ -
27227 Treat hip fracture(s) A 0 090 Y Y Y Y $ 1,963.07 $ -
27228 Treat hip fracture(s) A 0 090 Y Y Y Y $ 2,248.08 $ -
27230 Treat thigh fracture A 0 090 Y Y $ 522.35 $ 525.48
27232 Treat thigh fracture A 0 090 Y Y $ 897.14 $ -
27235 Treat thigh fracture A 0 090 Y Y $ 1,052.70 $ -
27236 Treat thigh fracture A 0 090 Y Y Y $ 1,397.22 $ -
27238 Treat thigh fracture A 0 090 Y Y $ 511.56 $ -
27240 Treat thigh fracture A 0 090 Y Y $ 1,109.42 $ -
27244 Treat thigh fracture A 0 090 Y Y Y $ 1,436.89 $ -
27245 Treat thigh fracture A 0 090 Y Y Y Y $ 1,443.16 $ -
27246 Treat thigh fracture A 0 090 Y Y $ 428.39 $ 427.00
27248 Treat thigh fracture A 0 090 Y Y Y $ 865.48 $ -
27250 Treat hip dislocation A 0 000 Y Y $ 239.77 $ -
27253 Treat hip dislocation A 0 090 Y Y Y $ 1,092.72 $ -
27256 Treat hip dislocation A 0 010 Y Y $ 285.01 $ 338.26

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

27267 Cltx thigh fx A 0 090 Y Y Y $ 485.11 $ -
27268 Cltx thigh fx w/mnpj A 0 090 Y Y Y $ 603.43 $ -
27269 Optx thigh fx A 0 090 Y Y Y $ 1,455.34 $ -
27275 Manipulation of hip joint A 0 010 Y $ 196.27 $ -
27280 Fusion of sacroiliac joint A 0 090 Y Y Y $ 1,206.86 $ -
27282 Fusion of pubic bones A 0 090 Y Y $ 967.79 $ -
27284 Fusion of hip joint A 0 090 Y Y Y $ 1,902.86 $ -
27286 Fusion of hip joint A 0 090 Y Y Y $ 1,951.24 $ -
27290 Amputation of leg at hip A 0 090 Y Y $ 1,901.47 $ -
27295 Amputation of leg at hip A 0 090 Y Y $ 1,508.23 $ -
27299 Pelvis/hip joint surgery C 0 YYY Y Y Y Y $ - $ -
27301 Drain thigh/knee lesion A 0 090 Y Y $ 573.85 $ 717.23
27303 Drainage of bone lesion A 0 090 Y Y Y $ 726.62 $ -
27305 Incise thigh tendon & fascia A 0 090 Y Y Y $ 538.01 $ -
27306 Incision of thigh tendon A 0 090 Y Y Y $ 404.03 $ -
27307 Incision of thigh tendons A 0 090 Y Y $ 534.18 $ -
27310 Exploration of knee joint A 0 090 Y Y Y $ 834.50 $ -
27323 Biopsy thigh soft tissues A 0 010 Y Y $ 198.36 $ 276.31
27324 Biopsy thigh soft tissues A 0 090 Y Y $ 444.74 $ -
27325 Neurectomy hamstring A 0 090 Y Y Y $ 588.47 $ -
27326 Neurectomy popliteal A 0 090 Y Y Y $ 567.94 $ -
27327 Exc thigh/knee les sc < 3 cm A 0 090 Y Y $ 354.96 $ 470.15
27328 Exc thigh/knee tum deep <5cm A 0 090 Y Y $ 712.70 $ -
27329 Resect thigh/knee tum < 5 cm A 0 090 Y Y Y $ 1,230.53 $ -
27330 Biopsy knee joint lining A 0 090 Y Y $ 451.36 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
27331 Explore/treat knee joint A 0 090 Y Y Y $ 531.74 $ -

27332 Removal of knee cartilage A 0 090 Y Y Y $ 723.14 $ -
27333 Removal of knee cartilage A 0 090 Y Y Y $ 658.42 $ -
27334 Remove knee joint lining A 0 090 Y Y Y $ 777.08 $ -
27335 Remove knee joint lining A 0 090 Y Y Y $ 875.22 $ -
27337 Exc thigh/knee les sc 3 cm/> A 0 090 Y Y Y $ 490.33 $ -
27339 Exc thigh/knee tum dep 5cm/> A 0 090 Y Y Y $ 886.36 $ -
27340 Removal of kneecap bursa A 0 090 Y Y $ 405.07 $ -
27345 Removal of knee cyst A 0 090 Y Y Y $ 539.05 $ -
27347 Remove knee cyst A 0 090 Y Y Y $ 590.90 $ -
27350 Removal of kneecap A 0 090 Y Y Y $ 737.41 $ -
27355 Remove femur lesion A 0 090 Y Y Y $ 683.82 $ -
27356 Remove femur lesion/graft A 0 090 Y Y Y $ 840.77 $ -
27357 Remove femur lesion/graft A 0 090 Y Y Y $ 930.20 $ -
27358 Remove femur lesion/fixation A 0 ZZZ Y $ 338.95 $ -
27360 Partial removal leg bone(s) A 0 090 Y Y Y $ 971.27 $ -
27364 Resect thigh/knee tum 5 cm/> A 0 090 Y Y Y $ 1,873.63 $ -
27365 Resect femur/knee tumor A 0 090 Y Y Y $ 2,404.68 $ -
27370 Injection for knee x-ray A 0 000 Y Y $ 59.16 $ 160.08
27372 Removal of foreign body A 0 090 Y Y $ 455.18 $ 624.66
27380 Repair of kneecap tendon A 0 090 Y Y Y $ 664.33 $ -
27381 Repair/graft kneecap tendon A 0 090 Y Y Y $ 910.37 $ -
27385 Repair of thigh muscle A 0 090 Y Y Y $ 638.58 $ -
27386 Repair/graft of thigh muscle A 0 090 Y Y Y $ 944.82 $ -
27390 Incision of thigh tendon A 0 090 Y Y $ 496.60 $ -
27391 Incision of thigh tendons A 0 090 Y $ 648.67 $ -
27392 Incision of thigh tendons A 0 090 Y Y $ 807.36 $ -
27393 Lengthening of thigh tendon A 0 090 Y Y $ 572.11 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
27394 Lengthening of thigh tendons A 0 090 Y Y $ 738.46 $ -

27395 Lengthening of thigh tendons A 0 090 Y Y $ 1,007.81 $ -
27396 Transplant of thigh tendon A 0 090 Y Y $ 696.70 $ -
27397 Transplants of thigh tendons A 0 090 Y Y $ 1,046.09 $ -
27400 Revise thigh muscles/tendons A 0 090 Y Y Y $ 787.87 $ -
27403 Repair of knee cartilage A 0 090 Y Y Y $ 726.62 $ -
27405 Repair of knee ligament A 0 090 Y Y Y $ 770.82 $ -
27407 Repair of knee ligament A 0 090 Y Y Y $ 900.62 $ -
27409 Repair of knee ligaments A 0 090 Y Y Y $ 1,114.30 $ -
27412 Autochondrocyte implant knee A 0 090 Y Y Y $ 1,939.40 $ -
27415 Osteochondral knee allograft A 0 090 Y Y Y $ 1,595.23 $ -
27416 Osteochondral knee autograft A 0 090 Y Y $ 1,133.44 $ -
27418 Repair degenerated kneecap A 0 090 Y Y Y $ 955.26 $ -
27420 Revision of unstable kneecap A 0 090 Y Y Y $ 849.82 $ -
27422 Revision of unstable kneecap A 0 090 Y Y Y $ 848.77 $ -
27424 Revision/removal of kneecap A 0 090 Y Y Y $ 851.90 $ -
27425 Lat retinacular release open A 0 090 Y Y $ 493.46 $ -
27427 Reconstruction knee A 0 090 Y Y Y $ 820.24 $ -
27428 Reconstruction knee A 0 090 Y Y Y $ 1,283.08 $ -
27429 Reconstruction knee A 0 090 Y Y Y $ 1,440.37 $ -
27430 Revision of thigh muscles A 0 090 Y Y Y $ 845.99 $ -
27435 Incision of knee joint A 0 090 Y Y Y $ 920.11 $ -
27437 Revise kneecap A 0 090 Y Y $ 753.07 $ -
27438 Revise kneecap with implant A 0 090 Y Y Y $ 969.53 $ -
27440 Revision of knee joint A 0 090 Y Y Y $ 908.28 $ -
27442 Revision of knee joint A 0 090 Y Y Y $ 1,003.28 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

27447 Total knee arthroplasty A 0 090 Y Y Y $ 1,812.73 $ -
27448 Incision of thigh A 0 090 Y Y Y $ 946.21 $ -
27450 Incision of thigh A 0 090 Y Y Y $ 1,181.11 $ -
27454 Realignment of thigh bone A 0 090 Y Y Y $ 1,514.15 $ -
27455 Realignment of knee A 0 090 Y Y Y $ 1,086.80 $ -
27457 Realignment of knee A 0 090 Y Y Y $ 1,119.52 $ -
27465 Shortening of thigh bone A 0 090 Y Y Y $ 1,461.60 $ -
27466 Lengthening of thigh bone A 0 090 Y Y Y $ 1,378.08 $ -
27468 Shorten/lengthen thighs A 0 090 Y Y Y $ 1,568.78 $ -
27470 Repair of thigh A 0 090 Y Y Y $ 1,373.90 $ -
27472 Repair/graft of thigh A 0 090 Y Y Y $ 1,483.52 $ -
27475 Surgery to stop leg growth A 0 090 Y Y $ 753.07 $ -
27479 Surgery to stop leg growth A 0 090 Y Y Y $ 872.44 $ -
27486 Revise/replace knee joint A 0 090 Y Y Y $ 1,654.39 $ -
27487 Revise/replace knee joint A 0 090 Y Y Y $ 2,086.96 $ -
27488 Removal of knee prosthesis A 0 090 Y Y Y $ 1,402.44 $ -
27495 Reinforce thigh A 0 090 Y Y Y $ 1,316.14 $ -
27496 Decompression of thigh/knee A 0 090 Y Y $ 598.21 $ -
27497 Decompression of thigh/knee A 0 090 Y Y Y $ 653.89 $ -
27498 Decompression of thigh/knee A 0 090 Y Y Y Y $ 726.97 $ -
27499 Decompression of thigh/knee A 0 090 Y Y Y Y $ 747.85 $ -
27500 Treatment of thigh fracture A 0 090 Y Y $ 538.01 $ 570.72
27502 Treatment of thigh fracture A 0 090 Y Y $ 901.67 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

27506 Treatment of thigh fracture A 0 090 Y Y Y $ 1,562.17 $ -
27507 Treatment of thigh fracture A 0 090 Y Y Y Y $ 1,142.83 $ -
27514 Treatment of thigh fracture A 0 090 Y Y Y $ 1,147.01 $ -
27516 Treat thigh fx growth plate A 0 090 Y Y $ 520.26 $ 546.01
27517 Treat thigh fx growth plate A 0 090 Y Y $ 776.39 $ -
27519 Treat thigh fx growth plate A 0 090 Y Y Y $ 1,049.22 $ -
27520 Treat kneecap fracture A 0 090 Y Y $ 312.16 $ 336.52
27524 Treat kneecap fracture A 0 090 Y Y Y $ 861.65 $ -
27530 Treat knee fracture A 0 090 Y Y $ 297.19 $ 316.68
27532 Treat knee fracture A 0 090 Y Y $ 651.11 $ 682.78
27535 Treat knee fracture A 0 090 Y Y Y Y $ 1,055.14 $ -
27536 Treat knee fracture A 0 090 Y Y Y $ 1,388.17 $ -
27538 Treat knee fracture(s) A 0 090 Y Y $ 481.98 $ 507.73
27540 Treat knee fracture A 0 090 Y Y Y $ 936.12 $ -
27550 Treat knee dislocation A 0 090 Y Y $ 510.17 $ 540.79
27552 Treat knee dislocation A 0 090 Y Y $ 706.09 $ -
27556 Treat knee dislocation A 0 090 Y Y Y $ 1,032.52 $ -
27557 Treat knee dislocation A 0 090 Y Y Y $ 1,241.66 $ -
27558 Treat knee dislocation A 0 090 Y Y Y Y $ 1,417.40 $ -
27560 Treat kneecap dislocation A 0 090 Y Y $ 377.58 $ 401.94
27562 Treat kneecap dislocation A 0 090 Y Y $ 533.48 $ -
27566 Treat kneecap dislocation A 0 090 Y Y Y $ 1,031.12 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
27570 Fixation of knee joint A 0 010 Y $ 164.26 $ -

27580 Fusion of knee A 0 090 Y Y Y $ 1,679.80 $ -
27590 Amputate leg at thigh A 0 090 Y Y Y $ 1,022.08 $ -
27591 Amputate leg at thigh A 0 090 Y Y Y $ 1,065.58 $ -
27592 Amputate leg at thigh A 0 090 Y Y Y $ 850.16 $ -
27598 Amputate lower leg at knee A 0 090 Y Y Y $ 890.18 $ -
27599 Leg surgery procedure C 0 YYY Y Y Y Y $ - $ -
27600 Decompression of lower leg A 0 090 Y Y $ 496.60 $ -
27601 Decompression of lower leg A 0 090 Y Y $ 512.26 $ -
27602 Decompression of lower leg A 0 090 Y Y Y $ 621.53 $ -
27603 Drain lower leg lesion A 0 090 Y Y $ 445.44 $ 567.24
27604 Drain lower leg bursa A 0 090 Y Y $ 374.80 $ 490.68
27605 Incision of achilles tendon A 0 010 Y Y $ 201.84 $ 337.21
27606 Incision of achilles tendon A 0 010 Y Y $ 325.73 $ -
27607 Treat lower leg bone lesion A 0 090 Y Y $ 697.74 $ -
27610 Explore/treat ankle joint A 0 090 Y Y $ 737.06 $ -
27612 Exploration of ankle joint A 0 090 Y Y Y $ 611.78 $ -
27613 Biopsy lower leg soft tissue A 0 010 Y Y $ 177.48 $ 253.00
27614 Biopsy lower leg soft tissue A 0 090 Y Y $ 463.54 $ 606.22
27615 Resect leg/ankle tum < 5 cm A 0 090 Y Y $ 1,214.52 $ -
27616 Resect leg/ankle tum 5 cm/> A 0 090 Y Y $ 1,514.15 $ -
27618 Exc leg/ankle tum < 3 cm A 0 090 Y Y $ 345.22 $ 457.27
27619 Exc leg/ankle tum deep <5 cm A 0 090 Y Y $ 551.23 $ -
27620 Explore/treat ankle joint A 0 090 Y Y Y $ 506.69 $ -
27625 Remove ankle joint lining A 0 090 Y Y Y $ 636.14 $ -
27626 Remove ankle joint lining A 0 090 Y Y Y $ 712.01 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
27630 Removal of tendon lesion A 0 090 Y Y $ 403.33 $ 565.15

27632 Exc leg/ankle les sc 3 cm/> A 0 090 Y Y Y $ 481.98 $ -
27634 Exc leg/ankle tum dep 5 cm/> A 0 090 Y Y Y $ 789.96 $ -
27635 Remove lower leg bone lesion A 0 090 Y Y $ 669.20 $ -
27637 Remove/graft leg bone lesion A 0 090 Y Y Y $ 865.82 $ -
27638 Remove/graft leg bone lesion A 0 090 Y Y Y $ 894.36 $ -
27640 Partial removal of tibia A 0 090 Y Y $ 961.52 $ -
27641 Partial removal of fibula A 0 090 Y Y $ 761.42 $ -
27645 Resect tibia tumor A 0 090 Y Y Y $ 2,055.98 $ -
27646 Resect fibula tumor A 0 090 Y Y Y $ 1,772.02 $ -
27647 Resect talus/calcaneus tum A 0 090 Y Y Y $ 1,151.18 $ -
27648 Injection for ankle x-ray A 0 000 Y Y $ 58.81 $ 153.82
27650 Repair achilles tendon A 0 090 Y Y Y $ 739.85 $ -
27652 Repair/graft achilles tendon A 0 090 Y Y $ 773.26 $ -
27654 Repair of achilles tendon A 0 090 Y Y Y $ 781.26 $ -
27656 Repair leg fascia defect A 0 090 Y Y Y $ 427.34 $ 620.48
27658 Repair of leg tendon each A 0 090 Y Y $ 409.25 $ -
27664 Repair of leg tendon each A 0 090 Y $ 395.33 $ -
27675 Repair lower leg tendons A 0 090 Y Y Y $ 538.36 $ -
27676 Repair lower leg tendons A 0 090 Y Y Y $ 712.70 $ -
27680 Release of lower leg tendon A 0 090 Y $ 478.85 $ -
27681 Release of lower leg tendons A 0 090 Y $ 610.04 $ -
27685 Revision of lower leg tendon A 0 090 Y Y Y $ 504.25 $ 663.98
27686 Revise lower leg tendons A 0 090 Y Y $ 620.83 $ -
27687 Revision of calf tendon A 0 090 Y Y Y $ 503.56 $ -
27690 Revise lower leg tendon A 0 090 Y Y Y $ 693.56 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
27691 Revise lower leg tendon A 0 090 Y Y Y $ 844.25 $ -

27692 Revise additional leg tendon A 0 ZZZ Y $ 129.46 $ -
27695 Repair of ankle ligament A 0 090 Y Y $ 535.22 $ -
27696 Repair of ankle ligaments A 0 090 Y Y $ 618.74 $ -
27698 Repair of ankle ligament A 0 090 Y Y Y $ 722.45 $ -
27700 Revision of ankle joint A 0 090 Y Y Y $ 652.85 $ -
27702 Reconstruct ankle joint A 0 090 Y Y Y $ 1,124.74 $ -
27703 Reconstruction ankle joint A 0 090 Y Y Y $ 1,320.66 $ -
27704 Removal of ankle implant A 0 090 Y Y $ 648.32 $ -
27705 Incision of tibia A 0 090 Y Y Y $ 872.09 $ -
27707 Incision of fibula A 0 090 Y Y $ 441.26 $ -
27709 Incision of tibia & fibula A 0 090 Y Y Y $ 1,367.29 $ -
27712 Realignment of lower leg A 0 090 Y Y Y $ 1,280.99 $ -
27715 Revision of lower leg A 0 090 Y Y Y $ 1,240.62 $ -
27720 Repair of tibia A 0 090 Y Y Y $ 1,009.90 $ -
27722 Repair/graft of tibia A 0 090 Y Y Y $ 1,019.99 $ -
27724 Repair/graft of tibia A 0 090 Y Y Y $ 1,498.84 $ -
27725 Repair of lower leg A 0 090 Y Y Y $ 1,410.10 $ -
27726 Repair fibula nonunion A 0 090 Y Y $ 1,123.69 $ -
27727 Repair of lower leg A 0 090 Y Y Y $ 1,188.42 $ -
27730 Repair of tibia epiphysis A 0 090 Y Y $ 661.20 $ -
27732 Repair of fibula epiphysis A 0 090 Y Y $ 444.05 $ -
27734 Repair lower leg epiphyses A 0 090 Y Y $ 606.56 $ -
27740 Repair of leg epiphyses A 0 090 Y Y Y $ 736.72 $ -
27742 Repair of leg epiphyses A 0 090 Y Y Y $ 870.70 $ -
27745 Reinforce tibia A 0 090 Y Y Y $ 866.87 $ -
27750 Treatment of tibia fracture A 0 090 Y Y $ 337.21 $ 361.57
27752 Treatment of tibia fracture A 0 090 Y Y $ 554.02 $ 588.12

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
27756 Treatment of tibia fracture A 0 090 Y Y Y $ 648.67 $ -

27758 Treatment of tibia fracture A 0 090 Y Y Y $ 1,025.56 $ -
27759 Treatment of tibia fracture A 0 090 Y Y Y Y $ 1,161.28 $ -
27760 Cltx medial ankle fx A 0 090 Y Y $ 321.90 $ 347.30
27762 Cltx med ankle fx w/mnpj A 0 090 Y Y $ 484.76 $ 518.87
27766 Optx medial ankle fx A 0 090 Y Y $ 683.82 $ -
27767 Cltx post ankle fx A 0 090 Y Y $ 291.97 $ 290.93
27768 Cltx post ankle fx w/mnpj A 0 090 Y Y $ 477.46 $ -
27769 Optx post ankle fx A 0 090 Y Y $ 834.85 $ -
27780 Treatment of fibula fracture A 0 090 Y Y $ 291.62 $ 315.29
27781 Treatment of fibula fracture A 0 090 Y Y $ 429.43 $ 455.18
27784 Treatment of fibula fracture A 0 090 Y Y $ 813.62 $ -
27786 Treatment of ankle fracture A 0 090 Y Y $ 300.67 $ 326.77
27792 Treatment of ankle fracture A 0 090 Y Y $ 740.89 $ -
27814 Treatment of ankle fracture A 0 090 Y Y Y $ 882.18 $ -
27822 Treatment of ankle fracture A 0 090 Y Y Y $ 956.30 $ -
27823 Treatment of ankle fracture A 0 090 Y Y Y $ 1,095.16 $ -
27824 Treat lower leg fracture A 0 090 Y Y $ 322.94 $ 331.30
27825 Treat lower leg fracture A 0 090 Y Y $ 561.67 $ 603.78
27826 Treat lower leg fracture A 0 090 Y Y Y Y $ 943.08 $ -
27827 Treat lower leg fracture A 0 090 Y Y Y Y $ 1,241.32 $ -
27828 Treat lower leg fracture A 0 090 Y Y Y Y $ 1,498.84 $ -
27829 Treat lower leg joint A 0 090 Y Y Y Y $ 766.30 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
27830 Treat lower leg dislocation A 0 090 Y Y $ 377.93 $ 399.85

27831 Treat lower leg dislocation A 0 090 Y Y $ 433.96 $ -
27832 Treat lower leg dislocation A 0 090 Y Y Y $ 851.56 $ -
27840 Treat ankle dislocation A 0 090 Y Y $ 402.29 $ -
27842 Treat ankle dislocation A 0 090 Y Y $ 551.93 $ -
27846 Treat ankle dislocation A 0 090 Y Y Y $ 840.42 $ -
27848 Treat ankle dislocation A 0 090 Y Y Y $ 944.12 $ -
27860 Fixation of ankle joint A 0 010 Y $ 194.88 $ -
27870 Fusion of ankle joint open A 0 090 Y Y Y $ 1,197.47 $ -
27871 Fusion of tibiofibular joint A 0 090 Y Y Y $ 793.09 $ -
27880 Amputation of lower leg A 0 090 Y Y Y $ 1,154.66 $ -
27881 Amputation of lower leg A 0 090 Y Y Y $ 1,060.36 $ -
27882 Amputation of lower leg A 0 090 Y Y $ 761.08 $ -
27888 Amputation of foot at ankle A 0 090 Y Y Y $ 801.10 $ -
27889 Amputation of foot at ankle A 0 090 Y Y $ 835.55 $ -
27892 Decompression of leg A 0 090 Y Y $ 653.89 $ -
27893 Decompression of leg A 0 090 Y Y $ 689.74 $ -
27894 Decompression of leg A 0 090 Y Y Y $ 1,027.64 $ -
27899 Leg/ankle surgery procedure C 0 YYY Y Y Y $ - $ -
28001 Drainage of bursa of foot A 0 010 Y $ 176.44 $ 262.74
28002 Treatment of foot infection A 0 010 Y $ 356.70 $ 459.71
28003 Treatment of foot infection A 0 090 Y $ 613.18 $ 728.71
28005 Treat foot bone lesion A 0 090 Y $ 630.23 $ -
28008 Incision of foot fascia A 0 090 Y Y $ 306.59 $ 420.04
28010 Incision of toe tendon A 0 090 Y $ 215.41 $ 233.51
28011 Incision of toe tendons A 0 090 Y $ 312.85 $ 341.04

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
28020 Exploration of foot joint A 0 090 Y $ 383.84 $ 525.83

28022 Exploration of foot joint A 0 090 Y $ 338.26 $ 469.10
28024 Exploration of toe joint A 0 090 Y $ 313.90 $ 438.48
28035 Decompression of tibia nerve A 0 090 Y $ 383.50 $ 523.39
28039 Exc foot/toe tum sc 1.5 cm/> A 0 090 Y Y Y $ 376.88 $ 522.00
28041 Exc foot/toe tum dep 1.5cm/> A 0 090 Y Y $ 497.64 $ -
28043 Exc foot/toe tum sc < 1.5 cm A 0 090 Y Y $ 277.01 $ 381.06
28045 Exc foot/toe tum deep <1.5cm A 0 090 Y Y $ 372.36 $ 498.68
28046 Resect foot/toe tumor < 3 cm A 0 090 Y Y $ 831.02 $ -
28047 Resect foot/toe tumor 3 cm/> A 0 090 Y Y Y $ 1,073.58 $ -
28050 Biopsy of foot joint lining A 0 090 Y Y $ 312.16 $ 444.74
28052 Biopsy of foot joint lining A 0 090 Y Y $ 298.93 $ 425.60
28054 Biopsy of toe joint lining A 0 090 Y Y $ 242.90 $ 358.79
28055 Neurectomy foot A 0 090 Y $ 394.98 $ -
28060 Partial removal foot fascia A 0 090 Y Y $ 372.01 $ 502.51
28062 Removal of foot fascia A 0 090 Y $ 428.39 $ 575.59
28070 Removal of foot joint lining A 0 090 Y $ 372.71 $ 515.74
28072 Removal of foot joint lining A 0 090 Y $ 366.10 $ 512.26
28080 Removal of foot lesion A 0 090 Y $ 371.66 $ 499.38
28086 Excise foot tendon sheath A 0 090 Y Y Y $ 389.76 $ 542.88
28088 Excise foot tendon sheath A 0 090 Y Y $ 318.07 $ 461.80
28090 Removal of foot lesion A 0 090 Y Y $ 323.99 $ 456.23
28092 Removal of toe lesions A 0 090 Y $ 280.49 $ 407.51
28100 Removal of ankle/heel lesion A 0 090 Y Y Y $ 437.44 $ 596.12
28102 Remove/graft foot lesion A 0 090 Y Y Y $ 491.03 $ -
28103 Remove/graft foot lesion A 0 090 Y Y Y $ 413.42 $ -
28104 Removal of foot lesion A 0 090 Y Y $ 365.05 $ 503.56
28106 Remove/graft foot lesion A 0 090 Y Y $ 450.66 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
28107 Remove/graft foot lesion A 0 090 Y Y $ 363.31 $ 503.90

28108 Removal of toe lesions A 0 090 Y $ 295.10 $ 417.25
28110 Part removal of metatarsal A 0 090 Y Y $ 300.32 $ 443.35
28114 Removal of metatarsal heads A 0 090 Y Y Y $ 909.32 $ 1,105.60
28116 Revision of foot A 0 090 Y Y $ 610.39 $ 763.16
28118 Removal of heel bone A 0 090 Y Y Y $ 443.00 $ 590.21
28119 Removal of heel spur A 0 090 Y Y $ 377.93 $ 513.30
28120 Part removal of ankle/heel A 0 090 Y Y $ 536.96 $ 687.30
28122 Partial removal of foot bone A 0 090 Y Y Y $ 473.28 $ 605.17
28124 Partial removal of toe A 0 090 Y Y $ 339.30 $ 459.01
28126 Partial removal of toe A 0 090 Y $ 258.22 $ 378.28
28130 Removal of ankle bone A 0 090 Y Y Y $ 766.64 $ -
28140 Removal of metatarsal A 0 090 Y $ 490.68 $ 624.66
28150 Removal of toe A 0 090 Y $ 297.19 $ 418.99
28171 Resect tarsal tumor A 0 090 Y Y $ 897.84 $ -
28173 Resect metatarsal tumor A 0 090 Y $ 850.16 $ -
28175 Resect phalanx of toe tumor A 0 090 Y $ 517.13 $ -
28190 Removal of foot foreign body A 0 010 Y Y $ 140.24 $ 240.82
28200 Repair of foot tendon A 0 090 Y $ 329.21 $ 463.88
28202 Repair/graft of foot tendon A 0 090 Y Y $ 447.88 $ 587.08
28208 Repair of foot tendon A 0 090 Y $ 323.99 $ 454.14

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
28210 Repair/graft of foot tendon A 0 090 Y Y $ 431.17 $ 565.50

28220 Release of foot tendon A 0 090 Y $ 313.55 $ 433.96
28222 Release of foot tendons A 0 090 Y $ 368.88 $ 497.29
28225 Release of foot tendon A 0 090 Y $ 266.92 $ 389.41
28226 Release of foot tendons A 0 090 Y $ 315.64 $ 448.22
28230 Incision of foot tendon(s) A 0 090 Y $ 294.76 $ 416.56
28232 Incision of toe tendon A 0 090 Y $ 256.13 $ 375.49
28234 Incision of foot tendon A 0 090 Y $ 272.83 $ 392.89
28238 Revision of foot tendon A 0 090 Y Y Y $ 530.35 $ 684.52
28240 Release of big toe A 0 090 Y Y $ 306.24 $ 428.74
28250 Revision of foot fascia A 0 090 Y Y Y $ 433.26 $ 573.16
28260 Release of midfoot joint A 0 090 Y Y Y $ 568.63 $ 715.49
28261 Revision of foot tendon A 0 090 Y Y $ 825.80 $ 990.76
28262 Revision of foot and ankle A 0 090 Y Y Y $ 1,325.88 $ 1,556.95
28264 Release of midfoot joint A 0 090 Y Y Y $ 725.93 $ 914.20
28270 Release of foot contracture A 0 090 Y Y $ 350.44 $ 479.20
28272 Release of toe joint each A 0 090 Y Y $ 260.65 $ 374.80
28280 Fusion of toes A 0 090 Y Y $ 381.06 $ 522.00
28285 Repair of hammertoe A 0 090 Y Y $ 385.93 $ 513.65
28286 Repair of hammertoe A 0 090 Y $ 311.11 $ 437.09
28288 Partial removal of foot bone A 0 090 Y $ 452.75 $ 596.12
28289 Repair hallux rigidus A 0 090 Y Y Y $ 592.99 $ 746.81
28290 Correction of bunion A 0 090 Y Y $ 424.21 $ 582.20
28292 Correction of bunion A 0 090 Y Y Y $ 626.40 $ 780.91
28293 Correction of bunion A 0 090 Y Y Y $ 736.02 $ 1,011.29

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

28300 Incision of heel bone A 0 090 Y Y Y $ 744.37 $ -
28302 Incision of ankle bone A 0 090 Y Y Y $ 809.10 $ -
28304 Incision of midfoot bones A 0 090 Y Y Y $ 653.54 $ 828.94
28305 Incise/graft midfoot bones A 0 090 Y Y Y $ 668.16 $ -
28306 Incision of metatarsal A 0 090 Y Y Y $ 445.09 $ 619.44
28307 Incision of metatarsal A 0 090 Y Y $ 535.22 $ 733.93
28308 Incision of metatarsal A 0 090 Y Y Y $ 395.68 $ 549.84
28309 Incision of metatarsals A 0 090 Y Y $ 1,000.15 $ -
28310 Revision of big toe A 0 090 Y $ 372.36 $ 525.48
28312 Revision of toe A 0 090 Y $ 336.17 $ 491.72
28313 Repair deformity of toe A 0 090 Y $ 388.37 $ 522.70
28315 Removal of sesamoid bone A 0 090 Y Y $ 340.69 $ 468.06
28320 Repair of foot bones A 0 090 Y Y $ 687.65 $ -
28322 Repair of metatarsals A 0 090 Y Y $ 644.15 $ 817.45
28340 Resect enlarged toe tissue A 0 090 Y $ 433.61 $ 571.42
28341 Resect enlarged toe A 0 090 Y $ 518.52 $ 667.12
28344 Repair extra toe(s) A 0 090 Y $ 316.33 $ 459.71
28345 Repair webbed toe(s) A 0 090 Y $ 382.45 $ 514.00
28360 Reconstruct cleft foot A 0 090 Y Y $ 1,251.41 $ -
28400 Treatment of heel fracture A 0 090 Y Y $ 234.20 $ 251.95
28405 Treatment of heel fracture A 0 090 Y Y $ 374.10 $ 402.29
28406 Treatment of heel fracture A 0 090 Y Y $ 581.16 $ -
28415 Treat heel fracture A 0 090 Y Y Y $ 1,268.46 $ -
28420 Treat/graft heel fracture A 0 090 Y Y Y $ 1,434.80 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
28436 Treatment of ankle fracture A 0 090 Y Y $ 484.42 $ -

28445 Treat ankle fracture A 0 090 Y Y Y $ 1,223.57 $ -
28446 Osteochondral talus autogrft A 0 090 Y Y Y $ 1,417.06 $ -
28450 Treat midfoot fracture each A 0 090 Y $ 197.66 $ 217.85
28455 Treat midfoot fracture each A 0 090 Y $ 274.22 $ 297.19
28456 Treat midfoot fracture A 0 090 Y $ 324.34 $ -
28465 Treat midfoot fracture each A 0 090 Y $ 675.47 $ -
28470 Treat metatarsal fracture A 0 090 Y $ 199.06 $ 217.15
28475 Treat metatarsal fracture A 0 090 Y $ 242.21 $ 265.18
28476 Treat metatarsal fracture A 0 090 Y $ 357.05 $ -
28485 Treat metatarsal fracture A 0 090 Y $ 564.11 $ -
28490 Treat big toe fracture A 0 090 Y $ 123.89 $ 140.59
28510 Treatment of toe fracture A 0 090 Y $ 117.62 $ 120.06
28515 Treatment of toe fracture A 0 090 Y $ 142.33 $ 156.95
28525 Treat toe fracture A 0 090 Y $ 427.00 $ 571.76
28530 Treat sesamoid bone fracture A 0 090 Y $ 100.22 $ 110.66
28531 Treat sesamoid bone fracture A 0 090 Y Y $ 218.54 $ 358.09
28540 Treat foot dislocation A 0 090 Y $ 184.44 $ 200.10
28555 Repair foot dislocation A 0 090 Y Y $ 755.51 $ 935.77
28576 Treat foot dislocation A 0 090 Y $ 426.65 $ -
28585 Repair foot dislocation A 0 090 Y Y $ 789.96 $ 945.86

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

28606 Treat foot dislocation A 0 090 Y $ 429.43 $ -
28615 Repair foot dislocation A 0 090 Y Y $ 876.26 $ -
28630 Treat toe dislocation A 0 010 Y $ 120.76 $ 157.99
28636 Treat toe dislocation A 0 010 Y Y $ 213.67 $ 300.32
28645 Repair toe dislocation A 0 090 Y $ 511.21 $ 651.80
28666 Treat toe dislocation A 0 010 Y Y $ 219.24 $ -
28675 Repair of toe dislocation A 0 090 Y $ 439.52 $ 586.38
28705 Fusion of foot bones A 0 090 Y Y $ 1,487.00 $ -
28715 Fusion of foot bones A 0 090 Y Y $ 1,055.83 $ -
28725 Fusion of foot bones A 0 090 Y Y $ 827.89 $ -
28737 Revision of foot bones A 0 090 Y Y $ 741.59 $ -
28740 Fusion of foot bones A 0 090 Y Y $ 694.96 $ 884.62
28750 Fusion of big toe joint A 0 090 Y Y $ 662.94 $ 854.69
28755 Fusion of big toe joint A 0 090 Y Y $ 347.65 $ 494.16
28760 Fusion of big toe joint A 0 090 Y Y Y $ 622.92 $ 797.27
28800 Amputation of midfoot A 0 090 Y Y Y $ 626.40 $ -
28805 Amputation thru metatarsal A 0 090 Y Y $ 886.36 $ -
28810 Amputation toe & metatarsal A 0 090 Y $ 510.52 $ -
28820 Amputation of toe A 0 090 Y $ 438.48 $ 585.68
28825 Partial amputation of toe A 0 090 Y $ 410.64 $ 556.45
28890 High energy eswt plantar f A 0 090 Y Y $ 237.68 $ 331.64

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
28899 Foot/toes surgery procedure C 0 YYY Y Y $ - $ -

29000 Application of body cast A 0 000 Y $ 173.65 $ 295.10
29049 Application of figure eight A 0 000 Y $ 77.26 $ 100.92
29055 Application of shoulder cast A 0 000 Y $ 155.21 $ 223.07
29058 Application of shoulder cast A 0 000 Y $ 92.92 $ 108.58
29065 Application of long arm cast A 0 000 Y Y $ 75.86 $ 98.83
29075 Application of forearm cast A 0 000 Y Y $ 68.56 $ 91.52
29085 Apply hand/wrist cast A 0 000 Y Y $ 72.73 $ 96.05
29086 Apply finger cast A 0 000 Y Y $ 52.90 $ 74.82
29105 Apply long arm splint A 0 000 Y Y $ 66.47 $ 89.78
29125 Apply forearm splint A 0 000 Y Y $ 42.46 $ 63.34
29126 Apply forearm splint A 0 000 Y Y $ 52.90 $ 76.56
29130 Application of finger splint A 0 000 Y Y $ 32.36 $ 42.46
29131 Application of finger splint A 0 000 Y Y $ 37.93 $ 53.24
29200 Strapping of chest A 0 000 Y $ 40.37 $ 51.50
29240 Strapping of shoulder A 0 000 Y $ 43.85 $ 55.33
29260 Strapping of elbow or wrist A 0 000 Y Y $ 38.28 $ 50.46
29280 Strapping of hand or finger A 0 000 Y Y $ 36.19 $ 48.02
29305 Application of hip cast A 0 000 Y $ 177.48 $ 248.82
29325 Application of hip casts A 0 000 Y $ 200.80 $ 277.70

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
29345 Application of long leg cast A 0 000 Y Y $ 115.88 $ 144.77

29358 Apply long leg cast brace A 0 000 Y Y $ 119.71 $ 165.65
29405 Apply short leg cast A 0 000 Y Y $ 64.03 $ 82.82
29440 Addition of walker to cast A 0 000 Y Y $ 40.02 $ 57.42
29445 Apply rigid leg cast A 0 000 Y Y $ 119.36 $ 145.12
29450 Application of leg cast A 0 000 Y Y $ 125.98 $ 151.03
29505 Application long leg splint A 0 000 Y Y $ 53.94 $ 80.39
29515 Application lower leg splint A 0 000 Y Y $ 53.94 $ 71.69
29520 Strapping of hip A 0 000 Y $ 36.19 $ 47.33
29530 Strapping of knee A 0 000 Y $ 38.63 $ 50.46
29540 Strapping of ankle and/or ft A 0 000 Y $ 26.45 $ 35.15
29550 Strapping of toes A 0 000 Y $ 18.79 $ 27.84
29580 Application of paste boot A 0 000 Y Y $ 38.98 $ 52.90
29581 Apply multlay comprs lwr leg A 0 000 Y Y $ 12.88 $ 53.94
29582 Apply multlay comprs upr leg A 0 000 Y Y $ 15.31 $ 61.60
29583 Apply multlay comprs upr arm A 0 000 Y Y $ 11.48 $ 38.63
29584 Appl multlay comprs arm/hand A 0 000 Y Y $ 15.31 $ 61.60
29590 Application of foot splint A 0 000 Y $ 40.02 $ 52.20
29700 Removal/revision of cast A 0 000 Y $ 40.37 $ 66.82
29705 Removal/revision of cast A 0 000 Y Y $ 53.59 $ 69.95
29710 Removal/revision of cast A 0 000 Y Y $ 96.40 $ 121.45
29715 Removal/revision of cast A 0 000 Y $ 61.25 $ 88.39
29720 Repair of body cast A 0 000 Y $ 50.46 $ 83.17
29730 Windowing of cast A 0 000 Y $ 51.16 $ 67.86

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
29740 Wedging of cast A 0 000 Y $ 75.86 $ 97.79

29750 Wedging of clubfoot cast A 0 000 Y Y $ 93.96 $ 115.54
29799 Casting/strapping procedure C 0 YYY Y Y $ - $ -
29800 Jaw arthroscopy/surgery A 0 090 Y Y $ 584.64 $ -
29804 Jaw arthroscopy/surgery A 0 090 Y Y Y $ 742.28 $ -
29805 Shoulder arthroscopy dx A 0 090 Y Y $ 529.31 $ -
29806 Shoulder arthroscopy/surgery A 0 090 Y Y 29805 $ 1,229.83 $ -
29807 Shoulder arthroscopy/surgery A 0 090 Y Y 29805 $ 1,194.34 $ -
29819 Shoulder arthroscopy/surgery A 0 090 Y Y 29805 $ 664.68 $ -
29820 Shoulder arthroscopy/surgery A 0 090 Y Y Y 29805 $ 612.48 $ -
29826 Shoulder arthroscopy/surgery A 0 ZZZ Y Y $ 216.11 $ -
29827 Arthroscop rotator cuff repr A 0 090 Y Y Y 29805 $ 1,254.54 $ -
29828 Arthroscopy biceps tenodesis A 0 090 Y Y Y 29805 $ 1,068.01 $ -
29830 Elbow arthroscopy A 0 090 Y Y $ 512.95 $ -
29834 Elbow arthroscopy/surgery A 0 090 Y Y Y 29830 $ 552.97 $ -
29838 Elbow arthroscopy/surgery A 0 090 Y Y 29830 $ 667.81 $ -
29840 Wrist arthroscopy A 0 090 Y Y $ 509.12 $ -
29843 Wrist arthroscopy/surgery A 0 090 Y Y Y 29840 $ 542.18 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
29846 Wrist arthroscopy/surgery A 0 090 Y Y 29840 $ 580.12 $ -

29848 Wrist endoscopy/surgery A 0 090 Y Y $ 562.72 $ -
29850 Knee arthroscopy/surgery A 0 090 Y Y Y $ 651.46 $ -
29851 Knee arthroscopy/surgery A 0 090 Y Y Y Y $ 1,077.06 $ -
29855 Tibial arthroscopy/surgery A 0 090 Y Y Y Y $ 900.28 $ -
29856 Tibial arthroscopy/surgery A 0 090 Y Y Y Y $ 1,156.75 $ -
29860 Hip arthroscopy dx A 0 090 Y Y Y $ 758.29 $ -
29861 Hip arthro w/fb removal A 0 090 Y Y Y 29860 $ 832.42 $ -
29862 Hip arthr0 w/debridement A 0 090 Y Y Y 29860 $ 934.38 $ -
29863 Hip arthr0 w/synovectomy A 0 090 Y Y Y 29860 $ 935.42 $ -
29866 Autgrft implnt knee w/scope A 0 090 Y Y $ 1,208.95 $ -
29867 Allgrft implnt knee w/scope A 0 090 Y Y $ 1,480.39 $ -
29868 Meniscal trnspl knee w/scpe A 0 090 Y Y $ 1,964.46 $ -
29870 Knee arthroscopy dx A 0 090 Y Y $ 461.10 $ 613.18
29871 Knee arthroscopy/drainage A 0 090 Y Y 29870 $ 579.42 $ -
29873 Knee arthroscopy/surgery A 0 090 Y Y 29870 $ 576.98 $ -
29884 Knee arthroscopy/surgery A 0 090 Y Y Y 29870 $ 705.05 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

29888 Knee arthroscopy/surgery A 0 090 Y Y Y $ 1,149.10 $ -
29889 Knee arthroscopy/surgery A 0 090 Y Y Y $ 1,404.88 $ -
29891 Ankle arthroscopy/surgery A 0 090 Y Y Y $ 771.17 $ -
29893 Scope plantar fasciotomy A 0 090 Y Y $ 433.61 $ 584.64
29899 Ankle arthroscopy/surgery A 0 090 Y Y Y $ 1,204.78 $ -
29900 Mcp joint arthroscopy dx A 0 090 Y Y $ 460.06 $ -
29901 Mcp joint arthroscopy surg A 0 090 Y Y $ 595.78 $ -
29902 Mcp joint arthroscopy surg A 0 090 Y Y $ 762.82 $ -
29904 Subtalar arthro w/fb rmvl A 0 090 Y Y Y $ 723.49 $ -
29905 Subtalar arthro w/exc A 0 090 Y Y Y $ 780.22 $ -
29906 Subtalar arthro w/deb A 0 090 Y Y Y $ 819.89 $ -
29907 Subtalar arthro w/fusion A 0 090 Y Y Y $ 1,003.28 $ -
29914 Hip arthro w/femoroplasty A 0 090 Y Y Y 29860 $ 1,187.72 $ -
29915 Hip arthro acetabuloplasty A 0 090 Y Y Y 29860 $ 1,208.26 $ -
29916 Hip arthro w/labral repair A 0 090 Y Y Y 29860 $ 1,208.26 $ -
29999 Arthroscopy of joint C 0 YYY Y Y Y $ - $ -
30000 Drainage of nose lesion A 0 010 Y $ 128.76 $ 226.90
30020 Drainage of nose lesion A 0 010 Y $ 127.02 $ 224.81
3006F Cxr doc rev M 9 XXX $ - $ -
3008F Body mass index docd M 9 XXX $ - $ -
30100 Intranasal biopsy A 0 000 Y $ 73.43 $ 136.76

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
30110 Removal of nose polyp(s) A 0 010 Y Y $ 140.24 $ 226.90

30115 Removal of nose polyp(s) A 0 090 Y Y $ 440.92 $ -
30117 Removal of intranasal lesion A 0 090 Y $ 341.74 $ 807.01
30118 Removal of intranasal lesion A 0 090 Y $ 819.54 $ -
3011F Lipid panel doc rev M 9 XXX $ - $ -
30120 Revision of nose A 0 090 Y $ 476.06 $ 543.92
30124 Removal of nose lesion A 0 090 Y $ 294.06 $ -
30125 Removal of nose lesion A 0 090 Y Y $ 639.62 $ -
30130 Excise inferior turbinate A 0 090 Y Y $ 382.10 $ -
30140 Resect inferior turbinate A 0 090 Y Y $ 435.70 $ -
3014F Screen mammo doc rev M 9 XXX $ - $ -
30150 Partial removal of nose A 0 090 Y $ 833.11 $ -
3015F Cerv cancer screen docd M 9 XXX $ - $ -
30160 Removal of nose A 0 090 Y Y $ 826.15 $ -
3016F Pt scrnd unhlthy OH use M 9 XXX $ - $ -
3017F Colorectal ca screen doc rev M 9 XXX $ - $ -
3018F Pre-prxd rsk et al docd M 9 XXX $ - $ -
3019F Lvef assess planpost dschrge M 9 XXX $ - $ -
30200 Injection treatment of nose A 0 000 Y $ 64.03 $ 111.01
3020F Lvf assess M 9 XXX $ - $ -
30210 Nasal sinus therapy A 0 010 Y $ 103.36 $ 147.20
3021F Lvef mod/sever deprs syst M 9 XXX $ - $ -
30220 Insert nasal septal button A 0 010 Y $ 135.02 $ 288.49
3022F Lvef >=40% systolic M 9 XXX $ - $ -
3023F Spirom doc rev M 9 XXX $ - $ -
3025F Spirom fev/fvc<70% w/copd M 9 XXX $ - $ -
3027F Spirom fev/fvc>=70%/w/o copd M 9 XXX $ - $ -
3028F O2 saturation doc rev M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
30300 Remove nasal foreign body A 0 010 Y $ 125.98 $ 217.50

30310 Remove nasal foreign body A 0 010 Y $ 210.19 $ -
30320 Remove nasal foreign body A 0 090 Y $ 463.88 $ -
3035F O2 saturation<=88% /pao<=55 M 9 XXX $ - $ -
3037F O2 saturation> 88% /pao>55 M 9 XXX $ - $ -
3038F Pulm fx w/in 12 mon b/4 surg M 9 XXX $ - $ -
30400 Reconstruction of nose R 0 090 Y $ 1,047.83 $ -
3040F Fev<40% predicted value M 9 XXX $ - $ -
30410 Reconstruction of nose R 0 090 Y Y $ 1,326.58 $ -
30420 Reconstruction of nose R 0 090 Y $ 1,466.82 $ -
3042F Fev>=40% predicted value M 9 XXX $ - $ -
30430 Revision of nose R 0 090 Y Y $ 983.45 $ -
30435 Revision of nose R 0 090 Y Y $ 1,176.59 $ -
3044F Hg a1c level lt 7.0% M 9 XXX $ - $ -
30450 Revision of nose R 0 090 Y Y $ 1,611.94 $ -
3045F Hg a1c level 7.0-9.0% M 9 XXX $ - $ -
30460 Revision of nose A 0 090 Y Y Y $ 873.13 $ -
30462 Revision of nose A 0 090 Y Y Y $ 1,789.42 $ -
30465 Repair nasal stenosis A 0 090 Y $ 1,053.40 $ -
3046F Hemoglobin a1c level > 9.0% M 9 XXX $ - $ -
3048F Ldl-c <100 mg/dl M 9 XXX $ - $ -
3049F Ldl-c 100-129 mg/dl M 9 XXX $ - $ -
3050F Ldl-c >= 130 mg/dl M 9 XXX $ - $ -
30520 Repair of nasal septum A 0 090 Y $ 645.89 $ -
30540 Repair nasal defect A 0 090 Y Y $ 714.44 $ -
30545 Repair nasal defect A 0 090 Y Y $ 917.33 $ -
3055F Lvef less than/equal to 35% M 9 XXX $ - $ -
30560 Release of nasal adhesions A 0 010 Y $ 141.98 $ 257.87

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
3056F Lvef greater than 35% M 9 XXX $ - $ -

30580 Repair upper jaw fistula A 0 090 Y $ 532.44 $ 649.72
30600 Repair mouth/nose fistula A 0 090 Y $ 465.97 $ 590.56
3060F Pos microalbuminuria rev M 9 XXX $ - $ -
3061F Neg microalbuminuria rev M 9 XXX $ - $ -
30620 Intranasal reconstruction A 0 090 Y $ 642.41 $ -
3062F Pos macroalbuminuria rev M 9 XXX $ - $ -
30630 Repair nasal septum defect A 0 090 Y $ 658.07 $ -
3066F Nephropathy doc tx M 9 XXX $ - $ -
3072F Low risk for retinopathy M 9 XXX $ - $ -
3073F Pre-surg eye measures docd M 9 XXX $ - $ -
3074F Syst bp lt 130 mm hg M 9 XXX $ - $ -
3075F Syst bp ge 130 - 139mm hg M 9 XXX $ - $ -
3077F Syst bp >= 140 mm hg M 9 XXX $ - $ -
3078F Diast bp < 80 mm hg M 9 XXX $ - $ -
3079F Diast bp 80-89 mm hg M 9 XXX $ - $ -
30801 Ablate inf turbinate superf A 0 010 Y $ 135.37 $ 216.11
30802 Ablate inf turbinate submuc A 0 010 Y $ 196.97 $ 285.36
3080F Diast bp >= 90 mm hg M 9 XXX $ - $ -
3082F Kt/v <1.2 M 9 XXX $ - $ -
3083F Kt/v > 1.2 <1.7 M 9 XXX $ - $ -
3084F Kt/v ge 1.7 M 9 XXX $ - $ -
3085F Suicide risk assessed M 9 XXX $ - $ -
3088F Mdd mild M 9 XXX $ - $ -
3089F Mdd moderate M 9 XXX $ - $ -
30901 Control of nosebleed A 0 000 Y Y $ 67.51 $ 101.62
30903 Control of nosebleed A 0 000 Y Y $ 95.70 $ 201.84
30905 Control of nosebleed A 0 000 Y $ 122.15 $ 252.30

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
30906 Repeat control of nosebleed A 0 000 Y $ 153.47 $ 281.88

3090F Mdd severe w/o psych I 9 XXX $ - $ -
30915 Ligation nasal sinus artery A 0 090 Y $ 617.00 $ -
3091F Mdd severe w/psych M 9 XXX $ - $ -
30920 Ligation upper jaw artery A 0 090 Y $ 895.06 $ -
3092F Mdd in remission M 9 XXX $ - $ -
30930 Ther fx nasal inf turbinate A 0 010 Y Y $ 128.41 $ -
3093F Doc new diag 1st/addl mdd M 9 XXX $ - $ -
3095F Central dexa results docd M 9 XXX $ - $ -
3096F Central dexa ordered M 9 XXX $ - $ -
30999 Nasal surgery procedure C 0 YYY Y Y $ - $ -
31000 Irrigation maxillary sinus A 0 010 Y Y $ 107.53 $ 173.30
31002 Irrigation sphenoid sinus A 0 010 Y Y $ 204.28 $ -
3100F Image test ref carot diam M 9 XXX $ - $ -
31020 Exploration maxillary sinus A 0 090 Y Y $ 356.70 $ 467.02
31030 Exploration maxillary sinus A 0 090 Y Y $ 540.10 $ 684.52
31032 Explore sinus remove polyps A 0 090 Y Y $ 597.86 $ -
31040 Exploration behind upper jaw A 0 090 Y $ 818.15 $ -
31050 Exploration sphenoid sinus A 0 090 Y Y $ 502.51 $ -
31051 Sphenoid sinus surgery A 0 090 Y Y $ 667.81 $ -
31070 Exploration of frontal sinus A 0 090 Y Y $ 449.96 $ -
31075 Exploration of frontal sinus A 0 090 Y Y Y $ 823.02 $ -
31080 Removal of frontal sinus A 0 090 Y Y Y $ 1,082.28 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
31090 Exploration of sinuses A 0 090 Y Y $ 1,056.53 $ -

3110F Pres/absn hmrhg/lesion docd M 9 XXX $ - $ -
3111F Ct/mri brain done w/in 24hrs M 9 XXX $ - $ -
3112F Ct/mri brain done >24 hrs M 9 XXX $ - $ -
3115F Quant results activity +symp M 9 XXX $ - $ -
3117F Hf assessment tool completed M 9 XXX $ - $ -
3118F Ny heart assoc class docd M 9 XXX $ - $ -
3119F No eval activity clin symp M 9 XXX $ - $ -
31200 Removal of ethmoid sinus A 0 090 Y Y $ 564.11 $ -
31205 Removal of ethmoid sinus A 0 090 Y Y Y $ 947.95 $ -
3120F 12-lead ecg performed M 9 XXX $ - $ -
31225 Removal of upper jaw A 0 090 Y Y Y $ 2,028.49 $ -
31230 Removal of upper jaw A 0 090 Y Y Y $ 2,264.78 $ -
31231 Nasal endoscopy dx A 0 000 Y $ 81.43 $ 182.35
31233 Nasal/sinus endoscopy dx A 0 000 Y Y $ 153.82 $ 266.22
31235 Nasal/sinus endoscopy dx A 0 000 Y Y $ 180.26 $ 301.37
31237 Nasal/sinus endoscopy surg A 0 000 Y Y $ 203.23 $ 328.86
31238 Nasal/sinus endoscopy surg A 0 000 Y Y $ 220.28 $ 340.00
31239 Nasal/sinus endoscopy surg A 0 010 Y Y $ 733.24 $ -
31254 Revision of ethmoid sinus A 0 000 Y Y $ 309.37 $ -
31256 Exploration maxillary sinus A 0 000 Y Y $ 221.68 $ -
3125F Esoph bx rprt w/dyspl info M 9 XXX $ - $ -
31267 Endoscopy maxillary sinus A 0 000 Y Y $ 359.14 $ -
31276 Sinus endoscopy surgical A 0 000 Y Y $ 575.94 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

31290 Nasal/sinus endoscopy surg A 0 010 Y Y $ 1,313.35 $ -
31295 Sinus endo w/balloon dil A 0 000 Y Y Y $ 188.62 $ 1,873.28
31296 Sinus endo w/balloon dil A 0 000 Y Y Y $ 225.16 $ 1,906.69
31297 Sinus endo w/balloon dil A 0 000 Y Y $ 184.44 $ 1,865.98
31299 Sinus surgery procedure C 0 YYY Y Y $ - $ -
31300 Removal of larynx lesion A 0 090 Y Y $ 1,337.36 $ -
3130F Upper gi endoscopy performed M 9 XXX $ - $ -
31320 Diagnostic incision larynx A 0 090 Y $ 657.37 $ -
3132F Doc ref upper gi endoscopy M 9 XXX $ - $ -
31360 Removal of larynx A 0 090 Y Y $ 2,258.52 $ -
31365 Removal of larynx A 0 090 Y Y $ 2,820.89 $ -
31367 Partial removal of larynx A 0 090 Y Y $ 2,378.58 $ -
31390 Removal of larynx & pharynx A 0 090 Y Y $ 3,157.40 $ -
31395 Reconstruct larynx & pharynx A 0 090 Y Y $ 3,269.11 $ -
31400 Revision of larynx A 0 090 Y Y $ 1,047.83 $ -
3140F Upper gi endo shows barrtts M 9 XXX $ - $ -
3141F Upper gi endo not barrtts M 9 XXX $ - $ -
31420 Removal of epiglottis A 0 090 Y Y $ 900.28 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
3142F Barium swallow test ordered M 9 XXX $ - $ -

31500 Insert emergency airway A 0 000 $ 131.20 $ -
31502 Change of windpipe airway A 0 000 Y $ 38.63 $ -
31505 Diagnostic laryngoscopy A 0 000 Y $ 51.16 $ 81.08
3150F Forceps esoph biopsy done M 9 XXX $ - $ -
31510 Laryngoscopy with biopsy A 0 000 Y 31505 $ 136.07 $ 215.06
31511 Remove foreign body larynx A 0 000 Y 31505 $ 148.60 $ 220.28
31512 Removal of larynx lesion A 0 000 Y 31505 $ 146.16 $ 213.67
31513 Injection into vocal cord A 0 000 Y 31505 $ 147.55 $ -
31515 Laryngoscopy for aspiration A 0 000 Y $ 124.24 $ 210.19
31520 Dx laryngoscopy newborn A 0 000 Y $ 176.09 $ -
31525 Dx laryngoscopy excl nb A 0 000 Y $ 179.92 $ 260.30
31526 Dx laryngoscopy w/oper scope A 0 000 Y $ 177.13 $ -
31527 Laryngoscopy for treatment A 0 000 Y 31525 $ 219.59 $ -
31528 Laryngoscopy and dilation A 0 000 Y 31525 $ 163.56 $ -
31529 Laryngoscopy and dilation A 0 000 Y 31525 $ 182.35 $ -
31530 Laryngoscopy w/fb removal A 0 000 Y 31525 $ 225.85 $ -
31531 Laryngoscopy w/fb & op scope A 0 000 Y 31526 $ 240.12 $ -
31535 Laryngoscopy w/biopsy A 0 000 Y 31525 $ 215.06 $ -
31536 Laryngoscopy w/bx & op scope A 0 000 Y 31526 $ 239.08 $ -
31540 Laryngoscopy w/exc of tumor A 0 000 Y 31525 $ 275.62 $ -
31541 Larynscop w/tumr exc + scope A 0 000 Y 31526 $ 302.41 $ -
31545 Remove vc lesion w/scope A 0 000 Y Y 31526 $ 413.42 $ -
31546 Remove vc lesion scope/graft A 0 000 Y Y 31526 $ 631.27 $ -
3155F Cytogen test marrow b/4 tx M 9 XXX $ - $ -
31560 Laryngoscop w/arytenoidectom A 0 000 Y 31525 $ 357.74 $ -
31561 Larynscop remve cart + scop A 0 000 Y 31526 $ 391.50 $ -
31570 Laryngoscope w/vc inj A 0 000 Y 31525 $ 262.39 $ 359.48

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
31571 Laryngoscop w/vc inj + scope A 0 000 Y 31526 $ 283.62 $ -

31575 Diagnostic laryngoscopy A 0 000 Y $ 81.43 $ 114.84
31576 Laryngoscopy with biopsy A 0 000 Y 31575 $ 136.76 $ 225.16
31577 Remove foreign body larynx A 0 000 Y 31575 $ 168.43 $ 249.17
31578 Removal of larynx lesion A 0 000 Y 31575 $ 191.75 $ 287.10
31579 Diagnostic laryngoscopy A 0 000 Y 31575 $ 158.69 $ 221.33
31582 Revision of larynx A 0 090 Y $ 2,008.31 $ -
31584 Treat larynx fracture A 0 090 Y Y $ 1,624.46 $ -
31590 Reinnervate larynx A 0 090 Y Y $ 899.93 $ -
31595 Larynx nerve surgery A 0 090 Y Y $ 801.44 $ -
31599 Larynx surgery procedure C 0 YYY Y Y $ - $ -
31600 Incision of windpipe A 0 000 Y $ 484.07 $ -
31601 Incision of windpipe A 0 000 Y Y $ 293.71 $ -
3160F Doc fe+ stores b/4 epo thx M 9 XXX $ - $ -
31611 Surgery/speech prosthesis A 0 090 Y Y $ 560.98 $ -
31612 Puncture/clear windpipe A 0 000 Y $ 54.29 $ 84.22
31613 Repair windpipe opening A 0 090 Y $ 475.37 $ -
31614 Repair windpipe opening A 0 090 Y $ 792.74 $ -
31615 Visualization of windpipe A 0 000 Y $ 142.68 $ 189.66
31620 Endobronchial us add-on A 0 ZZZ $ 74.47 $ 256.82
31622 Dx bronchoscope/wash A 0 000 Y $ 167.74 $ 312.85
31623 Dx bronchoscope/brush A 0 000 Y 31622 $ 160.78 $ 322.60

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
31624 Dx bronchoscope/lavage A 0 000 Y 31622 $ 161.47 $ 305.54

31625 Bronchoscopy w/biopsy(s) A 0 000 Y 31622 $ 187.92 $ 331.99
31626 Bronchoscopy w/markers A 0 000 Y $ 221.68 $ 428.74
31627 Navigational bronchoscopy A 0 ZZZ $ 102.31 $ 1,135.52
31628 Bronchoscopy/lung bx each A 0 000 Y 31622 $ 204.97 $ 375.84
31629 Bronchoscopy/needle bx each A 0 000 Y 31622 $ 222.02 $ 574.55
31630 Bronchoscopy dilate/fx repr A 0 000 Y 31622 $ 233.86 $ -
31631 Bronchoscopy dilate w/stent A 0 000 Y 31622 $ 269.35 $ -
31632 Bronchoscopy/lung bx addl A 0 ZZZ $ 52.55 $ 72.04
31633 Bronchoscopy/needle bx addl A 0 ZZZ $ 68.56 $ 89.44
31634 Bronch w/balloon occlusion A 0 000 Y Y 31622 $ 229.68 $ 1,917.48
31635 Bronchoscopy w/fb removal A 0 000 Y 31622 $ 212.28 $ 351.13
31636 Bronchoscopy bronch stents A 0 000 Y 31622 $ 260.30 $ -
31637 Bronchoscopy stent add-on A 0 ZZZ $ 81.78 $ -
31638 Bronchoscopy revise stent A 0 000 Y 31622 $ 299.63 $ -
31640 Bronchoscopy w/tumor excise A 0 000 Y 31622 $ 299.63 $ -
31641 Bronchoscopy treat blockage A 0 000 Y 31622 $ 295.45 $ -
31643 Diag bronchoscope/catheter A 0 000 Y $ 191.75 $ -
31645 Bronchoscopy clear airways A 0 000 Y 31622 $ 176.78 $ 309.72
31646 Bronchoscopy reclear airway A 0 000 Y $ 154.16 $ 279.44
31656 Bronchoscopy inj for x-ray A 0 000 Y $ 117.28 $ 285.71
3170F Flow cyto done b/4 tx M 9 XXX $ - $ -
31715 Injection for bronchus x-ray A 0 000 Y Y $ 56.72 $ -
31717 Bronchial brush biopsy A 0 000 Y $ 116.93 $ 259.26
31720 Clearance of airways A 0 000 Y $ 55.33 $ -
31725 Clearance of airways A 0 000 Y $ 106.49 $ -
31730 Intro windpipe wire/tube A 0 000 Y $ 177.83 $ 1,007.11
31750 Repair of windpipe A 0 090 Y Y $ 1,445.59 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

31766 Reconstruction of windpipe A 0 090 Y Y $ 2,393.20 $ -
31770 Repair/graft of bronchus A 0 090 Y Y $ 1,743.13 $ -
31775 Reconstruct bronchus A 0 090 Y Y $ 1,822.13 $ -
31780 Reconstruct windpipe A 0 090 Y Y $ 1,397.22 $ -
31781 Reconstruct windpipe A 0 090 Y Y $ 1,831.87 $ -
31785 Remove windpipe lesion A 0 090 Y Y $ 1,237.49 $ -
31786 Remove windpipe lesion A 0 090 Y Y $ 1,896.25 $ -
31800 Repair of windpipe injury A 0 090 Y $ 743.68 $ -
31805 Repair of windpipe injury A 0 090 Y Y $ 1,046.09 $ -
31820 Closure of windpipe lesion A 0 090 Y $ 364.01 $ 456.92
31825 Repair of windpipe defect A 0 090 Y $ 534.88 $ 640.67
31830 Revise windpipe scar A 0 090 Y $ 378.28 $ 463.88
31899 Airways surgical procedure C 0 YYY Y Y $ - $ -
3200F Barium swallow test not req M 9 XXX $ - $ -
32035 Thoracostomy w/rib resection A 0 090 Y Y $ 898.54 $ -
32036 Thoracostomy w/flap drainage A 0 090 Y Y $ 983.45 $ -
32096 Open wedge/bx lung infiltr A 0 090 Y Y $ 1,042.26 $ -
32097 Open wedge/bx lung nodule A 0 090 Y Y $ 1,042.26 $ -
32098 Open biopsy of lung pleura A 0 090 Y Y $ 978.23 $ -
32100 Exploration of chest A 0 090 Y Y $ 1,081.93 $ -
3210F Grp a strep test performed M 9 XXX $ - $ -
32110 Explore/repair chest A 0 090 Y Y $ 1,883.03 $ -
32120 Re-exploration of chest A 0 090 Y Y $ 1,121.26 $ -
32124 Explore chest free adhesions A 0 090 Y Y $ 1,198.16 $ -
32140 Removal of lung lesion(s) A 0 090 Y Y $ 1,277.16 $ -
32141 Remove/treat lung lesions A 0 090 Y Y $ 2,006.57 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
32150 Removal of lung lesion(s) A 0 090 Y Y $ 1,290.04 $ -

32151 Remove lung foreign body A 0 090 Y Y $ 1,299.78 $ -
3215F Pt immunity to hep a docd M 9 XXX $ - $ -
32160 Open chest heart massage A 0 090 Y Y $ 996.67 $ -
3216F Pt immunity to hep b docd M 9 XXX $ - $ -
3218F Rna tstng hep c docd done M 9 XXX $ - $ -
32200 Drain open lung lesion A 0 090 Y Y $ 1,445.24 $ -
32201 Drain percut lung lesion A 0 000 Y $ 220.28 $ 838.33
3220F Hep c quant rna tstng docd M 9 XXX $ - $ -
32215 Treat chest lining A 0 090 Y Y $ 1,018.94 $ -
32220 Release of lung A 0 090 Y Y $ 2,052.16 $ -
32225 Partial release of lung A 0 090 Y Y $ 1,283.77 $ -
3230F Note hring tst w/in 6 mon M 9 XXX $ - $ -
32310 Removal of chest lining A 0 090 Y Y $ 1,185.29 $ -
32320 Free/remove chest lining A 0 090 Y Y $ 2,063.29 $ -
32400 Needle biopsy chest lining A 0 000 Y $ 98.14 $ 149.99
32405 Percut bx lung/mediastinum A 0 000 Y $ 111.01 $ 221.33
32420 Puncture/clear lung A 0 000 Y $ 124.24 $ -
32421 Thoracentesis for aspiration A 0 000 Y Y $ 83.87 $ 149.29
32422 Thoracentesis w/tube insert A 0 000 Y Y $ 133.28 $ 193.84
32440 Remove lung pneumonectomy A 0 090 Y Y $ 2,043.11 $ -
32442 Sleeve pneumonectomy A 0 090 Y Y $ 4,058.03 $ -
32445 Removal of lung extrapleural A 0 090 Y Y $ 4,643.36 $ -
32480 Partial removal of lung A 0 090 Y Y $ 1,935.92 $ -
32482 Bilobectomy A 0 090 Y Y $ 2,065.03 $ -
32484 Segmentectomy A 0 090 Y Y $ 1,881.98 $ -
32486 Sleeve lobectomy A 0 090 Y Y $ 3,126.78 $ -
32488 Completion pneumonectomy A 0 090 Y Y $ 3,149.40 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
32491 Lung volume reduction R 0 090 Y Y Y $ 1,911.22 $ -

32501 Repair bronchus add-on A 0 ZZZ Y $ 330.25 $ -
32503 Resect apical lung tumor A 0 090 Y Y $ 2,383.10 $ -
32504 Resect apical lung tum/chest A 0 090 Y Y $ 2,695.26 $ -
32505 Wedge resect of lung initial A 0 090 Y Y $ 1,192.94 $ -
32506 Wedge resect of lung add-on A 0 ZZZ Y $ 211.58 $ -
32507 Wedge resect of lung diag A 0 ZZZ Y $ 211.58 $ -
3250F Nonprim loc anat bx site tum M 9 XXX $ - $ -
32540 Removal of lung lesion A 0 090 Y Y $ 2,250.86 $ -
32550 Insert pleural cath A 0 000 $ 271.79 $ 760.38
32551 Insertion of chest tube A 0 000 Y Y $ 206.36 $ -
32552 Remove lung catheter A 0 010 Y $ 206.36 $ 227.94
32553 Ins mark thor for rt perq A 0 000 Y Y $ 271.09 $ 593.69
32560 Treat pleurodesis w/agent A 0 000 Y $ 100.22 $ 248.12
32561 Lyse chest fibrin init day A 0 000 Y Y $ 87.70 $ 107.53
32562 Lyse chest fibrin subq day A 0 000 Y Y $ 80.04 $ 98.14
32601 Thoracoscopy diagnostic A 0 000 Y $ 406.12 $ -
32604 Thoracoscopy wbx sac A 0 000 Y $ 637.88 $ -
32606 Thoracoscopy w/bx med space A 0 000 Y $ 609.00 $ -
32607 Thoracoscopy w/bx infiltrate A 0 000 Y $ 404.38 $ -
32608 Thoracoscopy w/bx nodule A 0 000 Y $ 499.73 $ -
32609 Thoracoscopy w/bx pleura A 0 000 Y $ 345.22 $ -
3260F Pt cat/pn cat/hist grd docd M 9 XXX $ - $ -
32650 Thoracoscopy w/pleurodesis A 0 090 Y Y $ 845.99 $ -
32651 Thoracoscopy remove cortex A 0 090 Y Y $ 1,406.27 $ -
32652 Thoracoscopy rem totl cortex A 0 090 Y Y $ 2,153.08 $ -
32653 Thoracoscopy remov fb/fibrin A 0 090 Y Y $ 1,355.11 $ -
32654 Thoracoscopy contrl bleeding A 0 090 Y Y $ 1,517.28 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
32655 Thoracoscopy resect bullae A 0 090 Y Y $ 1,231.57 $ -

32656 Thoracoscopy w/pleurectomy A 0 090 Y Y $ 1,016.86 $ -
32658 Thoracoscopy w/sac fb remove A 0 090 Y Y $ 915.94 $ -
32659 Thoracoscopy w/sac drainage A 0 090 Y Y $ 936.47 $ -
3265F Rna tstng hepc vir ord/docd M 9 XXX $ - $ -
32661 Thoracoscopy w/pericard exc A 0 090 Y Y $ 1,029.73 $ -
32662 Thoracoscopy w/mediast exc A 0 090 Y Y $ 1,151.88 $ -
32663 Thoracoscopy w/lobectomy A 0 090 Y Y $ 1,831.52 $ -
32664 Thoracoscopy w/ th nrv exc A 0 090 Y Y Y $ 1,096.20 $ -
32665 Thoracoscop w/esoph musc exc A 0 090 Y Y $ 1,555.91 $ -
32666 Thoracoscopy w/wedge resect A 0 090 Y Y $ 1,116.04 $ -
32667 Thoracoscopy w/w resect addl A 0 ZZZ Y $ 211.58 $ -
32668 Thoracoscopy w/w resect diag A 0 ZZZ Y $ 214.37 $ -
32669 Thoracoscopy remove segment A 0 090 Y Y $ 1,746.61 $ -
3266F Hepc gn tstng docd b/4txmnt M 9 XXX $ - $ -
32670 Thoracoscopy bilobectomy A 0 090 Y Y $ 2,089.74 $ -
32671 Thoracoscopy pneumonectomy A 0 090 Y Y $ 2,342.04 $ -
32672 Thoracoscopy for lvrs A 0 090 Y Y $ 1,994.04 $ -
32673 Thoracoscopy w/thymus resect A 0 090 Y Y $ 1,527.02 $ -
32674 Thoracoscopy lymph node exc A 0 ZZZ Y $ 288.84 $ -
3267F path rprt w/ pt pn cat et al M 9 XXX $ - $ -
3268F Psa/t/glsc docd b/4 txmnt M 9 XXX $ - $ -
3269F Bone scn b/4 txmnt/aftr Dx M 9 XXX $ - $ -
3270F No bone scn b/4 txmnt/aftrDx M 9 XXX $ - $ -
3271F Low risk prostate cancer M 9 XXX $ - $ -
3272F Med risk prostate cancer M 9 XXX $ - $ -
3273F High risk prostate cancer M 9 XXX $ - $ -
3274F Prost Cncr rsk not lw/md/hgh M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
3278F Serum lvls CA/iPTH/lpd ord M 9 XXX $ - $ -

3279F Hgb lvl >/= 13 g/dl M 9 XXX $ - $ -
32800 Repair lung hernia A 0 090 Y Y $ 1,211.04 $ -
3280F Hgb lvl 11-12.9 g/dL M 9 XXX $ - $ -
32810 Close chest after drainage A 0 090 Y Y $ 1,157.80 $ -
32815 Close bronchial fistula A 0 090 Y Y $ 3,686.36 $ -
3281F Hgb lvl < 11 g/dl M 9 XXX $ - $ -
32820 Reconstruct injured chest A 0 090 Y Y $ 1,723.99 $ -
3284F Iop down >15% of pre-svc lvl M 9 XXX $ - $ -
32850 Donor pneumonectomy A 9 XXX $ - $ -
32851 Lung transplant single A 0 090 Y Y Y $ 4,365.66 $ -
32852 Lung transplant with bypass A 0 090 Y Y Y $ 4,781.52 $ -
32853 Lung transplant double A 0 090 Y Y Y $ 6,093.83 $ -
32854 Lung transplant with bypass A 0 090 Y Y Y $ 6,482.89 $ -
32855 Prepare donor lung single C 0 XXX Y Y $ - $ -
32856 Prepare donor lung double C 0 XXX Y Y $ - $ -
3285F IOP down <15% of pre-svc lvl M 9 XXX $ - $ -
3288F Fall risk assessment docd M 9 XXX $ - $ -
32900 Removal of rib(s) A 0 090 Y Y $ 1,791.16 $ -
32905 Revise & repair chest wall A 0 090 Y Y $ 1,742.44 $ -
32906 Revise & repair chest wall A 0 090 Y Y $ 2,169.08 $ -
3290F Pt=D(Rh)- and unsensitized M 9 XXX $ - $ -
3291F Pt=d(rh)+ or sensitized M 9 XXX $ - $ -
3292F Hiv tstng asked/docd/revwd M 9 XXX $ - $ -
3293F Abo rh blood typing docd M 9 XXX $ - $ -
32940 Revision of lung A 0 090 Y Y $ 1,605.32 $ -
3294F Grp b strep screening docd M 9 XXX $ - $ -
32960 Therapeutic pneumothorax A 0 000 Y $ 133.63 $ 163.91

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
32997 Total lung lavage A 0 000 Y $ 415.51 $ -

32998 Perq rf ablate tx pul tumor A 0 000 Y Y $ 325.38 $ 2,568.59
32999 Chest surgery procedure C 0 YYY Y Y $ - $ -
3300F AJCC stage docd b/4 thxpy M 9 XXX $ - $ -
33010 Drainage of heart sac A 0 000 Y $ 153.12 $ -
33011 Repeat drainage of heart sac A 0 000 Y $ 157.30 $ -
33015 Incision of heart sac A 0 090 Y $ 627.10 $ -
3301F Cancer stage docd metast M 9 XXX $ - $ -
33020 Incision of heart sac A 0 090 Y Y $ 1,137.26 $ -
33025 Incision of heart sac A 0 090 Y Y $ 1,043.30 $ -
33030 Partial removal of heart sac A 0 090 Y Y $ 2,623.92 $ -
33031 Partial removal of heart sac A 0 090 Y Y $ 3,257.98 $ -
33050 Resect heart sac lesion A 0 090 Y Y $ 1,298.04 $ -
33120 Removal of heart lesion A 0 090 Y Y $ 2,792.00 $ -
33140 Heart revascularize (tmr) A 0 090 Y Y $ 2,132.20 $ -
33141 Heart tmr w/other procedure A 0 ZZZ Y $ 182.70 $ -
3315F Er+ or pr+ breast cancer M 9 XXX $ - $ -
3316F ER- or PR- breast cancer M 9 XXX $ - $ -
3317F Path rpt malig cancer docd M 9 XXX $ - $ -
3318F Path rpt malig cancer docd M 9 XXX $ - $ -
3319F X-ray/ct/ultrsnd et al ord M 9 XXX $ - $ -
33202 Insert epicard eltrd open A 0 090 Y $ 1,013.03 $ -
33203 Insert epicard eltrd endo A 0 090 Y $ 1,053.40 $ -
33206 Insert heart pm atrial A 0 090 Y Y $ 571.07 $ -
33207 Insert heart pm ventricular A 0 090 Y Y $ 611.78 $ -
33208 Insrt heart pm atrial & vent A 0 090 Y Y $ 661.55 $ -
3320F No xray/ct/ et al ordd M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
33210 Insert electrd/pm cath sngl A 0 000 Y $ 232.46 $ -

33211 Insert card electrodes dual A 0 000 Y $ 239.42 $ -
33212 Insert pulse gen sngl lead A 0 090 Y $ 411.68 $ -
33213 Insert pulse gen dual leads A 0 090 Y $ 434.65 $ -
33214 Upgrade of pacemaker system A 0 090 Y Y $ 601.34 $ -
33215 Reposition pacing-defib lead A 0 090 Y $ 380.36 $ -
33216 Insert 1 electrode pm-defib A 0 090 Y $ 463.54 $ -
33217 Insert 2 electrode pm-defib A 0 090 Y $ 461.80 $ -
33218 Repair lead pace-defib one A 0 090 Y $ 482.68 $ -
3321F AJCC cncr 0/IA melan docd M 9 XXX $ - $ -
33220 Repair lead pace-defib dual A 0 090 Y $ 486.85 $ -
33221 Insert pulse gen mult leads A 0 090 Y $ 442.31 $ -
33222 Revise pocket pacemaker A 0 090 Y $ 422.47 $ -
33223 Revise pocket for defib A 0 090 Y $ 515.74 $ -
33224 Insert pacing lead & connect A 0 000 Y $ 653.89 $ -
33225 L ventric pacing lead add-on A 0 ZZZ $ 591.25 $ -
33226 Reposition l ventric lead A 0 000 Y $ 628.84 $ -
33227 Remove&replace pm gen singl A 0 090 Y $ 421.78 $ -
33228 Remv&replc pm gen dual lead A 0 090 Y $ 440.57 $ -
33229 Remv&replc pm gen mult leads A 0 090 Y $ 459.36 $ -
3322F Melanoma>ajcc stage 0 or ia M 9 XXX $ - $ -
33230 Insrt pulse gen w/dual leads A 0 090 Y $ 478.15 $ -
33231 Insrt pulse gen w/mult leads A 0 090 Y $ 496.94 $ -
33233 Removal of pm generator A 0 090 Y $ 285.36 $ -
33234 Removal of pacemaker system A 0 090 Y $ 609.00 $ -
33235 Removal pacemaker electrode A 0 090 Y $ 792.74 $ -
33236 Remove electrode/thoracotomy A 0 090 Y Y $ 1,025.56 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

3323F Clin node stgng docdb/4 surg M 9 XXX $ - $ -
33240 Insrt pulse gen w/singl lead A 0 090 Y $ 478.85 $ -
33241 Remove pulse generator A 0 090 Y $ 270.40 $ -
33243 Remove eltrd/thoracotomy A 0 090 Y Y $ 1,786.98 $ -
33244 Remove eltrd transven A 0 090 Y $ 1,072.88 $ -
33249 Nsert pace-defib w/lead A 0 090 Y $ 1,142.48 $ -
3324F Mri ct scan ord rvwd rqstd M 9 XXX $ - $ -
33250 Ablate heart dysrhythm focus A 0 090 Y Y $ 1,963.76 $ -
33254 Ablate atria lmtd A 0 090 Y Y $ 1,823.52 $ -
33255 Ablate atria w/o bypass ext A 0 090 Y Y $ 2,208.06 $ -
33256 Ablate atria w/bypass exten A 0 090 Y Y $ 2,644.45 $ -
33257 Ablate atria lmtd add-on A 0 ZZZ Y $ 757.25 $ -
33258 Ablate atria x10sv add-on A 0 ZZZ Y $ 853.99 $ -
33259 Ablate atria w/bypass add-on A 0 ZZZ Y $ 1,106.64 $ -
3325F Preop asses 4 cataract surg M 9 XXX $ - $ -
33262 Remv&replc cvd gen sing lead A 0 090 Y $ 459.71 $ -
33263 Remv&replc cvd gen dual lead A 0 090 Y $ 478.85 $ -
33264 Remv&replc cvd gen mult lead A 0 090 Y $ 497.64 $ -
33265 Ablate atria lmtd endo A 0 090 Y Y $ 1,786.98 $ -
33266 Ablate atria x10sv endo A 0 090 Y Y $ 2,465.93 $ -
33282 Implant pat-active ht record A 0 090 Y $ 392.20 $ -
33284 Remove pat-active ht record A 0 090 Y $ 273.88 $ -
3328F Prfrmnc docd 2 wks b/4 surg M 9 XXX $ - $ -
33300 Repair of heart wound A 0 090 Y Y $ 3,269.81 $ -
33305 Repair of heart wound A 0 090 Y Y $ 5,529.02 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
3330F Imaging study ordered (bkp) M 9 XXX $ - $ -

33310 Exploratory heart surgery A 0 090 Y Y $ 1,502.32 $ -
33315 Exploratory heart surgery A 0 090 Y Y $ 2,556.06 $ -
3331F Bk imaging tst not ordered M 9 XXX $ - $ -
33320 Repair major blood vessel(s) A 0 090 Y Y $ 1,390.61 $ -
33321 Repair major vessel A 0 090 Y Y $ 1,563.56 $ -
33322 Repair major blood vessel(s) A 0 090 Y Y $ 1,840.57 $ -
33330 Insert major vessel graft A 0 090 Y Y $ 1,915.74 $ -
33400 Repair of aortic valve A 0 090 Y Y $ 3,049.87 $ -
33401 Valvuloplasty open A 0 090 Y Y $ 1,819.69 $ -
33403 Valvuloplasty w/cp bypass A 0 090 Y Y $ 1,988.47 $ -
33404 Prepare heart-aorta conduit A 0 090 Y Y $ 2,324.64 $ -
33405 Replacement of aortic valve A 0 090 Y Y $ 3,062.75 $ -
3340F Mammo assess inc xray docd M 9 XXX $ - $ -
33415 Revision subvalvular tissue A 0 090 Y Y $ 2,710.92 $ -
33416 Revise ventricle muscle A 0 090 Y Y $ 2,716.84 $ -
3341F Mammo assess negative docd M 9 XXX $ - $ -
33420 Revision of mitral valve A 0 090 Y $ 1,691.98 $ -
33422 Revision of mitral valve A 0 090 Y Y $ 2,262.00 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
33425 Repair of mitral valve A 0 090 Y Y $ 3,659.57 $ -

3342F Mammo assess bengn docd M 9 XXX $ - $ -
33430 Replacement of mitral valve A 0 090 Y Y $ 3,764.32 $ -
3343F Mammo probably bengn docd M 9 XXX $ - $ -
3344F Mammo assess susp docd M 9 XXX $ - $ -
3345F Mammo assess hghlymalig doc M 9 XXX $ - $ -
33460 Revision of tricuspid valve A 0 090 Y Y $ 3,304.61 $ -
33463 Valvuloplasty tricuspid A 0 090 Y Y $ 4,163.47 $ -
33464 Valvuloplasty tricuspid A 0 090 Y Y $ 3,281.29 $ -
33465 Replace tricuspid valve A 0 090 Y Y $ 3,716.64 $ -
33468 Revision of tricuspid valve A 0 090 Y Y $ 3,335.23 $ -
33470 Revision of pulmonary valve A 0 090 Y Y $ 1,618.20 $ -
33471 Valvotomy pulmonary valve A 0 090 Y Y $ 1,770.97 $ -
33475 Replacement pulmonary valve A 0 090 Y Y $ 3,170.28 $ -
33476 Revision of heart chamber A 0 090 Y Y $ 2,033.02 $ -
33496 Repair prosth valve clot A 0 090 Y Y $ 2,209.10 $ -
33500 Repair heart vessel fistula A 0 090 Y Y $ 2,121.41 $ -
33501 Repair heart vessel fistula A 0 090 Y Y Y $ 1,503.36 $ -
33502 Coronary artery correction A 0 090 Y Y $ 1,695.46 $ -
33503 Coronary artery graft A 0 090 Y $ 1,676.66 $ -
33504 Coronary artery graft A 0 090 Y Y $ 1,959.24 $ -
33505 Repair artery w/tunnel A 0 090 Y Y $ 2,824.37 $ -
33506 Repair artery translocation A 0 090 Y Y $ 2,741.20 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
33507 Repair art intramural A 0 090 Y Y $ 2,290.54 $ -

33508 Endoscopic vein harvest A 0 ZZZ Y $ 21.58 $ -
3350F Mammo bx proven malig docd M 9 XXX $ - $ -
33510 Cabg vein single A 0 090 Y Y $ 2,598.86 $ -
33511 Cabg vein two A 0 090 Y Y $ 2,854.64 $ -
33512 Cabg vein three A 0 090 Y Y $ 3,250.32 $ -
33513 Cabg vein four A 0 090 Y Y $ 3,346.02 $ -
33514 Cabg vein five A 0 090 Y Y $ 3,532.90 $ -
33516 Cabg vein six or more A 0 090 Y Y $ 3,715.94 $ -
33517 Cabg artery-vein single A 0 ZZZ Y $ 255.78 $ -
33518 Cabg artery-vein two A 0 ZZZ Y $ 563.76 $ -
33519 Cabg artery-vein three A 0 ZZZ Y $ 745.76 $ -
3351F Neg scrn dep symp by deptool M 9 XXX $ - $ -
33521 Cabg artery-vein four A 0 ZZZ Y $ 898.19 $ -
33522 Cabg artery-vein five A 0 ZZZ Y $ 1,010.24 $ -
33523 Cabg art-vein six or more A 0 ZZZ Y $ 1,145.27 $ -
3352F No sig dep symp by dep tool M 9 XXX $ - $ -
33530 Coronary artery bypass/reop A 0 ZZZ Y $ 717.58 $ -
33533 Cabg arterial single A 0 090 Y Y $ 2,514.30 $ -
33534 Cabg arterial two A 0 090 Y Y $ 2,955.22 $ -
33535 Cabg arterial three A 0 090 Y Y $ 3,300.78 $ -
33536 Cabg arterial four or more A 0 090 Y Y $ 3,567.70 $ -
3353F Mild-mod dep symp by deptool M 9 XXX $ - $ -
33545 Repair of heart damage A 0 090 Y Y $ 4,160.34 $ -
33548 Restore/remodel ventricle A 0 090 Y Y $ 4,004.09 $ -
3354F Clin sig dep sym by dep tool M 9 XXX $ - $ -
33572 Open coronary endarterectomy A 0 ZZZ Y $ 317.72 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
33600 Closure of valve A 0 090 Y Y $ 2,253.30 $ -

33602 Closure of valve A 0 090 Y Y $ 2,110.97 $ -
33606 Anastomosis/artery-aorta A 0 090 Y Y $ 2,323.25 $ -
33608 Repair anomaly w/conduit A 0 090 Y Y $ 2,368.84 $ -
33610 Repair by enlargement A 0 090 Y Y $ 2,334.04 $ -
33611 Repair double ventricle A 0 090 Y Y $ 2,707.79 $ -
33612 Repair double ventricle A 0 090 Y Y $ 2,592.95 $ -
33615 Repair modified fontan A 0 090 Y Y $ 2,646.89 $ -
33617 Repair single ventricle A 0 090 Y Y $ 2,862.30 $ -
33619 Repair single ventricle A 0 090 Y Y $ 3,576.40 $ -
33620 Apply r&l pulm art bands A 0 090 Y Y $ 2,232.42 $ -
33621 Transthor cath for stent A 0 090 Y Y $ 1,176.24 $ -
33622 Redo compl cardiac anomaly A 0 090 Y Y $ 4,632.58 $ -
33641 Repair heart septum defect A 0 090 Y Y $ 2,188.92 $ -
33645 Revision of heart veins A 0 090 Y Y $ 2,343.43 $ -
33647 Repair heart septum defects A 0 090 Y Y $ 2,475.32 $ -
33660 Repair of heart defects A 0 090 Y Y $ 2,385.19 $ -
33670 Repair of heart chambers A 0 090 Y Y $ 2,708.48 $ -
33675 Close mult vsd A 0 090 Y Y $ 2,682.73 $ -
33676 Close mult vsd w/resection A 0 090 Y Y $ 2,826.80 $ -
33677 Cl mult vsd w/rem pul band A 0 090 Y Y $ 2,939.90 $ -
33690 Reinforce pulmonary artery A 0 090 Y Y $ 1,550.34 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

3370F AJCC brst cncr stage 0 docd M 9 XXX $ - $ -
33720 Repair of heart defect A 0 090 Y Y $ 2,033.36 $ -
33722 Repair of heart defect A 0 090 Y Y $ 2,234.16 $ -
33724 Repair venous anomaly A 0 090 Y Y $ 2,039.63 $ -
33726 Repair pul venous stenosis A 0 090 Y Y $ 2,777.74 $ -
3372F Ajcc brst cncr stage 1 docd M 9 XXX $ - $ -
33730 Repair heart-vein defect(s) A 0 090 Y Y $ 2,777.74 $ -
33732 Repair heart-vein defect A 0 090 Y Y $ 2,216.06 $ -
3374F Ajcc brst cncr stage 1 docd M 9 XXX $ - $ -
33750 Major vessel shunt A 0 090 Y Y $ 1,997.52 $ -
33764 Major vessel shunt & graft A 0 090 Y Y $ 1,652.65 $ -
33768 Cavopulmonary shunting A 0 ZZZ Y Y $ 591.95 $ -
3376F AJCC brstcncr stage 2 docd M 9 XXX $ - $ -
33770 Repair great vessels defect A 0 090 Y Y $ 2,883.53 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

33782 Nikaidoh proc A 0 090 Y Y $ 4,292.93 $ -
33783 Nikaidoh proc w/ostia implt A 0 090 Y Y $ 4,648.93 $ -
33786 Repair arterial trunk A 0 090 Y Y $ 3,125.74 $ -
33788 Revision of pulmonary artery A 0 090 Y Y $ 2,076.86 $ -
33800 Aortic suspension A 0 090 Y Y Y $ 1,272.64 $ -
33802 Repair vessel defect A 0 090 Y Y $ 1,435.15 $ -
33803 Repair vessel defect A 0 090 Y Y $ 1,580.62 $ -
33813 Repair septal defect A 0 090 Y Y $ 1,630.38 $ -
33820 Revise major vessel A 0 090 Y Y $ 1,295.60 $ -
3382F AJCC cln cncr stage 0 docd M 9 XXX $ - $ -
33840 Remove aorta constriction A 0 090 Y Y $ 1,667.62 $ -
33860 Ascending aortic graft A 0 090 Y Y $ 4,324.94 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

33870 Transverse aortic arch graft A 0 090 Y Y $ 3,383.60 $ -
33875 Thoracic aortic graft A 0 090 Y Y $ 3,687.06 $ -
33877 Thoracoabdominal graft A 0 090 Y Y $ 4,913.06 $ -
33880 Endovasc taa repr incl subcl A 0 090 Y Y Y $ 2,429.39 $ -
33881 Endovasc taa repr w/o subcl A 0 090 Y Y Y $ 2,086.61 $ -
33883 Insert endovasc prosth taa A 0 090 Y Y Y $ 1,503.36 $ -
33884 Endovasc prosth taa add-on A 0 ZZZ Y Y $ 561.32 $ -
33886 Endovasc prosth delayed A 0 090 Y Y Y $ 1,323.10 $ -
33889 Artery transpose/endovas taa A 0 000 Y Y Y Y $ 1,111.51 $ -
33891 Car-car bp grft/endovas taa A 0 000 Y Y Y Y $ 1,378.43 $ -
33910 Remove lung artery emboli A 0 090 Y Y $ 3,540.55 $ -
33915 Remove lung artery emboli A 0 090 Y Y $ 1,786.63 $ -
33916 Surgery of great vessel A 0 090 Y Y $ 5,628.90 $ -
33917 Repair pulmonary artery A 0 090 Y Y $ 1,913.30 $ -
33920 Repair pulmonary atresia A 0 090 Y Y $ 2,456.88 $ -
33922 Transect pulmonary artery A 0 090 Y Y $ 1,909.82 $ -
33924 Remove pulmonary shunt A 0 ZZZ Y $ 385.93 $ -
33925 Rpr pul art unifocal w/o cpb A 0 090 Y Y $ 2,287.06 $ -
33926 Repr pul art unifocal w/cpb A 0 090 Y Y $ 3,300.08 $ -
33930 Removal of donor heart/lung C 9 XXX $ - $ -
33933 Prepare donor heart/lung C 0 XXX Y Y $ - $ -
33935 Transplantation heart/lung A 0 090 Y Y Y $ 6,728.23 $ -
33940 Removal of donor heart X 9 XXX $ - $ -
33944 Prepare donor heart C 0 XXX Y Y $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
33945 Transplantation of heart A 0 090 Y Y Y $ 6,505.16 $ -

3394F Quant her2 ihc eval brst cx M 9 XXX $ - $ -
3395F Quant nonher2 ihc brst cx M 9 XXX $ - $ -
33960 External circulation assist A 0 000 Y $ 1,286.90 $ -
33961 External circulation assist A 0 ZZZ $ 671.29 $ -
33967 Insert ia percut device A 0 000 Y $ 345.22 $ -
33968 Remove aortic assist device A 0 000 $ 44.89 $ -
33970 Aortic circulation assist A 0 000 Y Y $ 480.59 $ -
33971 Aortic circulation assist A 0 090 Y $ 923.24 $ -
33973 Insert balloon device A 0 000 Y Y $ 695.65 $ -
33974 Remove intra-aortic balloon A 0 090 Y $ 1,176.94 $ -
33975 Implant ventricular device A 0 XXX Y Y $ 1,775.15 $ -
33976 Implant ventricular device A 0 XXX Y Y $ 2,208.06 $ -
33977 Remove ventricular device A 0 XXX Y Y $ 1,540.25 $ -
33978 Remove ventricular device A 0 XXX Y Y $ 1,859.71 $ -
33979 Insert intracorporeal device A 0 XXX Y Y $ 2,693.17 $ -
33980 Remove intracorporeal device A 0 XXX Y Y $ 2,547.71 $ -
33981 Replace vad pump ext A 0 XXX Y Y $ 1,155.71 $ -
33982 Replace vad intra w/o bp A 0 XXX Y Y $ 2,675.77 $ -
33983 Replace vad intra w/bp A 0 XXX Y Y $ 3,143.83 $ -
33999 Cardiac surgery procedure C 0 YYY Y Y Y $ - $ -
34001 Removal of artery clot A 0 090 Y Y Y $ 1,301.52 $ -
34101 Removal of artery clot A 0 090 Y Y Y $ 805.97 $ -
34111 Removal of arm artery clot A 0 090 Y Y Y $ 804.92 $ -
34203 Removal of leg artery clot A 0 090 Y Y Y $ 1,301.52 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
34401 Removal of vein clot A 0 090 Y Y Y $ 1,895.21 $ -

34421 Removal of vein clot A 0 090 Y Y Y $ 976.14 $ -
34451 Removal of vein clot A 0 090 Y Y Y $ 2,027.80 $ -
34471 Removal of vein clot A 0 090 Y Y $ 1,545.12 $ -
34490 Removal of vein clot A 0 090 Y Y $ 812.58 $ -
34501 Repair valve femoral vein A 0 090 Y Y Y $ 1,239.92 $ -
34502 Reconstruct vena cava A 0 090 Y Y $ 1,990.91 $ -
3450F Dyspnea scrnd no-mild dysp M 9 XXX $ - $ -
34510 Transposition of vein valve A 0 090 Y Y Y $ 1,470.30 $ -
3451F Dyspnea scrnd mod-high dysp M 9 XXX $ - $ -
34520 Cross-over vein graft A 0 090 Y Y Y $ 1,383.30 $ -
3452F Dyspnea not screened M 9 XXX $ - $ -
34530 Leg vein fusion A 0 090 Y Y Y $ 1,256.98 $ -
3455F TB scrng done-interpd 6mon M 9 XXX $ - $ -
3470F Ra disease activity low M 9 XXX $ - $ -
3471F Ra disease activity mod M 9 XXX $ - $ -
3472F Ra disease activity high M 9 XXX $ - $ -
3475F Disease progn RA poor docd M 9 XXX $ - $ -
3476F Disease progn RA good docd M 9 XXX $ - $ -
34800 Endovas aaa repr w/sm tube A 0 090 Y Y Y $ 1,503.01 $ -
34802 Endovas aaa repr w/2-p part A 0 090 Y Y Y $ 1,664.48 $ -
34805 Endovas aaa repr w/long tube A 0 090 Y Y Y $ 1,606.02 $ -
34806 Aneurysm press sensor add-on A 0 ZZZ Y Y $ 139.90 $ -
34808 Endovas iliac a device addon A 0 ZZZ Y Y $ 280.14 $ -
34812 Xpose for endoprosth femorl A 0 000 Y Y Y Y $ 466.32 $ -
34813 Femoral endovas graft add-on A 0 ZZZ Y Y $ 329.21 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
34820 Xpose for endoprosth iliac A 0 000 Y Y Y Y $ 666.77 $ -

34825 Endovasc extend prosth init A 0 090 Y Y Y $ 921.85 $ -
34826 Endovasc exten prosth addl A 0 ZZZ Y Y $ 278.40 $ -
34830 Open aortic tube prosth repr A 0 090 Y Y Y $ 2,489.24 $ -
34831 Open aortoiliac prosth repr A 0 090 Y Y Y $ 2,672.99 $ -
34832 Open aortofemor prosth repr A 0 090 Y Y Y $ 2,679.60 $ -
34833 Xpose for endoprosth iliac A 0 000 Y Y Y Y $ 841.12 $ -
34834 Xpose endoprosth brachial A 0 000 Y Y Y Y $ 377.58 $ -
34900 Endovasc iliac repr w/graft A 0 090 Y Y Y Y $ 1,185.64 $ -
3490F History aids-defining cond M 9 XXX $ - $ -
3491F HIV unsure baby of HIV+moms M 9 XXX $ - $ -
3492F History cd4+ cell count <350 M 9 XXX $ - $ -
3493F No hist cd4+ cell count<350 M 9 XXX $ - $ -
3494F CD4+cell count <200cells/mm3 M 9 XXX $ - $ -
3495F Cd4+cell cnt 200-499 cells M 9 XXX $ - $ -
3496F Cd4+ cell count + 500 cells M 9 XXX $ - $ -
3497F CD4+ cell percentage <15% M 9 XXX $ - $ -
3498F Cd4+ cell >=15% (hiv) M 9 XXX $ - $ -
35001 Repair defect of artery A 0 090 Y Y Y $ 1,530.16 $ -
35002 Repair artery rupture neck A 0 090 Y Y Y $ 1,638.38 $ -
3500F Cd4+cell cnt/% docd as done M 9 XXX $ - $ -
35013 Repair artery rupture arm A 0 090 Y Y Y $ 1,674.58 $ -
35022 Repair artery rupture chest A 0 090 Y Y Y $ 1,900.43 $ -
3502F HIV rna vrl ld <lmts quantif M 9 XXX $ - $ -
3503F HIV rna vrl ldnot<lmts quntf M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
35045 Repair defect of arm artery A 0 090 Y Y Y $ 1,305.35 $ -

35081 Repair defect of artery A 0 090 Y Y $ 2,401.20 $ -
35082 Repair artery rupture aorta A 0 090 Y Y $ 2,994.19 $ -
35092 Repair artery rupture aorta A 0 090 Y Y Y $ 3,594.14 $ -
35103 Repair artery rupture groin A 0 090 Y Y Y $ 3,078.76 $ -
3510F Doc tb scrng-rslts interpd M 9 XXX $ - $ -
35112 Repair artery rupture spleen A 0 090 Y Y Y $ 2,352.83 $ -
3511F Chlmyd/gonrh tsts docd done M 9 XXX $ - $ -
35122 Repair artery rupture belly A 0 090 Y Y Y $ 2,724.14 $ -
3512F Syph scrng docd as done M 9 XXX $ - $ -
35132 Repair artery rupture groin A 0 090 Y Y Y $ 2,325.68 $ -
3513F Hep B scrng docd as done M 9 XXX $ - $ -
35142 Repair artery rupture thigh A 0 090 Y Y Y $ 1,811.69 $ -
3514F Hep C scrng docd as done M 9 XXX $ - $ -
35152 Repair artery rupture knee A 0 090 Y Y Y $ 1,969.68 $ -
3515F Pt has docd immun to hep C M 9 XXX $ - $ -
3517F Hbv assess&results intrp 1yr M 9 XXX $ - $ -
35180 Repair blood vessel lesion A 0 090 Y Y $ 1,180.07 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

35201 Repair blood vessel lesion A 0 090 Y Y Y $ 1,238.53 $ -
35207 Repair blood vessel lesion A 0 090 Y Y $ 859.21 $ -
3520F Cdifficile testing performe M 9 XXX $ - $ -
35301 Rechanneling of artery A 0 090 Y Y Y $ 1,428.89 $ -
35306 Rechanneling of artery A 0 ZZZ Y $ 635.45 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

35390 Reoperation carotid add-on A 0 ZZZ Y $ 220.63 $ -
35400 Angioscopy A 0 ZZZ $ 206.36 $ -
35450 Repair arterial blockage A 0 000 Y Y Y $ 700.18 $ -
35460 Repair venous blockage A 0 000 Y Y $ 421.78 $ -
35471 Repair arterial blockage A 0 000 Y Y $ 686.60 $ 2,591.56
35472 Repair arterial blockage A 0 000 Y Y $ 477.80 $ 1,920.61
35475 Repair arterial blockage R 0 000 Y Y $ 601.00 $ 2,162.12
35476 Repair venous blockage A 0 000 Y Y $ 369.58 $ 1,603.24
35500 Harvest vein for bypass A 0 ZZZ Y $ 446.83 $ -
35501 Artery bypass graft A 0 090 Y Y Y $ 2,083.82 $ -
3550F Low rsk thromboembolism M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

3551F Intrmed rsk thromboembolism M 9 XXX $ - $ -
3552F Hgh risk for thromboembolism M 9 XXX $ - $ -
35537 Artery bypass graft A 0 090 Y Y $ 2,950.00 $ -
3555F Pt inr measurement performed M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
35572 Harvest femoropopliteal vein A 0 ZZZ Y $ 478.85 $ -

35583 Vein bypass graft A 0 090 Y Y Y $ 1,977.34 $ -
35600 Harvest art for cabg add-on A 0 ZZZ Y $ 353.92 $ -
35623 Bypass graft not vein A 0 090 Y Y Y $ 1,845.79 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

35681 Composite bypass graft A 0 ZZZ Y $ 111.01 $ -
35682 Composite bypass graft A 0 ZZZ $ 495.90 $ -
35683 Composite bypass graft A 0 ZZZ $ 583.25 $ -
35685 Bypass graft patency/patch A 0 ZZZ Y $ 278.05 $ -
35686 Bypass graft/av fist patency A 0 ZZZ Y $ 228.98 $ -
35691 Arterial transposition A 0 090 Y Y Y $ 1,325.18 $ -
35697 Reimplant artery each A 0 ZZZ Y Y $ 206.71 $ -
35700 Reoperation bypass graft A 0 ZZZ Y $ 213.32 $ -
35701 Exploration carotid artery A 0 090 Y Y Y $ 697.39 $ -
3570F Rprt bone scint xref w xray M 9 XXX $ - $ -
35721 Exploration femoral artery A 0 090 Y Y Y $ 592.64 $ -
3572F Pt consid poss risk fx M 9 XXX $ - $ -
3573F Pt not consid poss risk fx M 9 XXX $ - $ -
35741 Exploration popliteal artery A 0 090 Y Y Y $ 664.33 $ -
35761 Exploration of artery/vein A 0 090 Y Y Y $ 481.98 $ -
35800 Explore neck vessels A 0 090 Y Y $ 886.36 $ -
35820 Explore chest vessels A 0 090 Y Y $ 2,689.69 $ -
35840 Explore abdominal vessels A 0 090 Y Y $ 1,478.30 $ -
35860 Explore limb vessels A 0 090 Y Y $ 1,102.12 $ -
35870 Repair vessel graft defect A 0 090 Y Y $ 1,748.00 $ -
35875 Removal of clot in graft A 0 090 Y $ 797.62 $ -
35876 Removal of clot in graft A 0 090 Y Y $ 1,289.69 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
35879 Revise graft w/vein A 0 090 Y Y Y $ 1,263.94 $ -

35883 Revise graft w/nonauto graft A 0 090 Y Y Y $ 1,655.09 $ -
35901 Excision graft neck A 0 090 Y Y $ 652.85 $ -
35903 Excision graft extremity A 0 090 Y Y $ 739.15 $ -
35905 Excision graft thorax A 0 090 Y Y $ 2,372.32 $ -
35907 Excision graft abdomen A 0 090 Y Y $ 2,637.14 $ -
36000 Place needle in vein B 9 XXX $ 11.83 $ 25.40
36002 Pseudoaneurysm injection trt A 0 000 Y Y $ 128.06 $ 175.39
36005 Injection ext venography A 0 000 Y Y $ 58.46 $ 313.90
36010 Place catheter in vein A 0 XXX Y Y $ 146.86 $ 506.69
36013 Place catheter in artery A 0 XXX Y $ 163.56 $ 768.73
36014 Place catheter in artery A 0 XXX Y Y $ 172.26 $ 774.30
36015 Place catheter in artery A 0 XXX Y Y $ 198.01 $ 841.46
36100 Establish access to artery A 0 XXX Y Y $ 212.63 $ 530.70
36120 Establish access to artery A 0 XXX Y $ 125.28 $ 427.00
36140 Establish access to artery A 0 XXX Y $ 133.28 $ 447.53
36147 Access av dial grft for eval A 0 XXX Y Y $ 220.63 $ 803.18
36148 Access av dial grft for proc A 0 ZZZ Y $ 57.07 $ 243.60
36160 Establish access to aorta A 0 XXX Y $ 156.25 $ 501.12
36200 Place catheter in aorta A 0 000 Y Y $ 200.80 $ 641.02
36215 Place catheter in artery A 0 XXX Y $ 304.15 $ 1,087.85
36218 Place catheter in artery A 0 ZZZ $ 64.03 $ 186.53

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
36245 Ins cath abd/l-ext art 1st A 0 XXX Y Y $ 310.76 $ 1,053.74

36246 Ins cath abd/l-ext art 2nd A 0 000 Y Y $ 345.91 $ 989.36
36247 Ins cath abd/l-ext art 3rd A 0 000 Y Y $ 413.42 $ 1,616.81
36248 Ins cath abd/l-ext art addl A 0 ZZZ $ 62.99 $ 154.16
36251 Ins cath ren art 1st unilat A 0 000 Y $ 350.78 $ 1,356.50
36252 Ins cath ren art 1st bilat A 0 000 Y $ 456.92 $ 1,511.71
36253 Ins cath ren art 2nd+ unilat A 0 000 Y $ 490.33 $ 2,061.90
36254 Ins cath ren art 2nd+ bilat A 0 000 Y $ 528.96 $ 2,151.34
36260 Insertion of infusion pump A 0 090 Y $ 773.60 $ -
36261 Revision of infusion pump A 0 090 Y Y $ 481.63 $ -
36262 Removal of infusion pump A 0 090 Y $ 353.57 $ -
36299 Vessel injection procedure C 0 YYY Y Y $ - $ -
36400 Bl draw < 3 yrs fem/jugular A 0 XXX Y $ 22.62 $ 29.93
36405 Bl draw < 3 yrs scalp vein A 0 XXX Y $ 19.84 $ 27.84
36406 Bl draw < 3 yrs other vein A 0 XXX Y $ 10.79 $ 18.10
36410 Non-routine bl draw > 3 yrs A 0 XXX Y $ 11.48 $ 18.44
36415 Routine venipuncture A 9 XXX $ - $ - $ 3.00
36416 Capillary blood draw B 9 XXX $ - $ -
36420 Vein access cutdown < 1 yr A 0 XXX Y $ 58.81 $ -
36425 Vein access cutdown > 1 yr A 0 XXX Y $ 46.98 $ -
36430 Blood transfusion service A 5 XXX $ - $ 29.93
36440 Bl push transfuse 2 yr or < A 0 XXX Y $ 73.78 $ -
36450 Bl exchange/transfuse nb A 0 XXX Y $ 112.06 $ -
36455 Bl exchange/transfuse non-nb A 0 XXX Y $ 122.84 $ -
36460 Transfusion service fetal A 0 XXX Y Y $ 456.92 $ -
36468 Injection(s) spider veins R 0 000 Y $ - $ -
36469 Injection(s) spider veins R 0 000 Y $ - $ -
36470 Injection therapy of vein A 0 010 Y Y $ 94.66 $ 153.12

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
36471 Injection therapy of veins A 0 010 Y Y $ 123.54 $ 187.57

36475 Endovenous rf 1st vein A 0 000 Y Y $ 462.49 $ 1,704.50
36476 Endovenous rf vein add-on A 0 ZZZ Y $ 229.68 $ 422.47
36478 Endovenous laser 1st vein A 0 000 Y Y $ 452.75 $ 1,372.51
36479 Endovenous laser vein addon A 0 ZZZ Y $ 223.42 $ 430.13
36481 Insertion of catheter vein A 0 000 Y $ 416.21 $ 1,572.96
36500 Insertion of catheter vein A 0 000 Y $ 217.85 $ -
3650F Eeg ordered rvwd reqstd M 9 XXX $ - $ -
36510 Insertion of catheter vein A 0 000 Y $ 77.95 $ 112.06
36511 Apheresis wbc A 0 000 Y $ 112.40 $ -
36512 Apheresis rbc A 0 000 Y $ 100.22 $ -
36513 Apheresis platelets A 0 000 Y $ 122.84 $ -
36514 Apheresis plasma A 0 000 Y $ 110.66 $ 475.72
36515 Apheresis adsorp/reinfuse A 0 000 Y $ 108.58 $ 1,884.07
36516 Apheresis selective A 0 000 Y $ 96.05 $ 1,820.74
36522 Photopheresis A 0 000 Y $ 108.23 $ 1,199.56
36555 Insert non-tunnel cv cath A 0 000 $ 135.37 $ 264.83
36556 Insert non-tunnel cv cath A 0 000 $ 142.33 $ 240.47
36557 Insert tunneled cv cath A 0 010 Y Y $ 397.42 $ 971.96
36558 Insert tunneled cv cath A 0 010 Y Y $ 325.73 $ 766.30
36560 Insert tunneled cv cath A 0 010 Y Y $ 391.15 $ 1,219.04
36563 Insert tunneled cv cath A 0 010 Y $ 467.71 $ 1,282.03
36568 Insert picc cath A 0 000 $ 106.14 $ 273.88
36569 Insert picc cath A 0 000 $ 102.31 $ 236.64
36570 Insert picvad cath A 0 010 Y Y $ 331.99 $ 1,081.93

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
36571 Insert picvad cath A 0 010 Y Y $ 390.11 $ 1,230.53

36575 Repair tunneled cv cath A 0 000 Y $ 42.46 $ 153.12
36576 Repair tunneled cv cath A 0 010 Y $ 231.42 $ 388.37
36578 Replace tunneled cv cath A 0 010 Y $ 249.17 $ 507.04
36580 Replace cvad cath A 0 000 $ 76.91 $ 206.02
36581 Replace tunneled cv cath A 0 010 Y $ 224.81 $ 709.92
36582 Replace tunneled cv cath A 0 010 Y $ 365.75 $ 1,057.92
36583 Replace tunneled cv cath A 0 010 Y $ 401.59 $ 1,140.05
36584 Replace picc cath A 0 000 $ 71.69 $ 191.40
36585 Replace picvad cath A 0 010 Y $ 322.25 $ 1,048.18
36589 Removal tunneled cv cath A 0 010 Y $ 163.21 $ 185.83
36590 Removal tunneled cv cath A 0 010 Y $ 246.73 $ 320.16
36591 Draw blood off venous device B 0 XXX $ - $ 20.53
36592 Collect blood from picc B 0 XXX $ - $ 22.97
36593 Declot vascular device A 0 XXX $ - $ 26.10
36595 Mech remov tunneled cv cath A 0 000 Y $ 209.84 $ 541.49
36596 Mech remov tunneled cv cath A 0 000 Y $ 51.16 $ 127.37
36597 Reposition venous catheter A 0 000 Y $ 67.51 $ 121.10
36598 Inj w/fluor eval cv device B 9 000 Y Y $ 45.94 $ 105.10
36600 Withdrawal of arterial blood A 0 XXX Y $ 17.05 $ 30.28
36620 Insertion catheter artery A 0 000 $ 57.42 $ -
36625 Insertion catheter artery A 0 000 $ 138.50 $ -
36640 Insertion catheter artery A 0 000 Y $ 157.30 $ -
36660 Insertion catheter artery A 0 000 Y $ 101.27 $ -
36680 Insert needle bone cavity A 0 000 Y $ 75.86 $ -
36800 Insertion of cannula A 0 000 Y $ 188.27 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
36818 Av fuse uppr arm cephalic A 0 090 Y Y $ 878.35 $ -

36819 Av fuse uppr arm basilic A 0 090 Y Y $ 975.79 $ -
36820 Av fusion/forearm vein A 0 090 Y Y Y $ 1,060.36 $ -
36821 Av fusion direct any site A 0 090 Y Y $ 902.36 $ -
36822 Insertion of cannula(s) A 0 090 Y $ 474.67 $ -
36823 Insertion of cannula(s) A 0 090 Y $ 1,689.19 $ -
36825 Artery-vein autograft A 0 090 Y Y $ 1,033.56 $ -
36830 Artery-vein nonautograft A 0 090 Y Y $ 873.13 $ -
36831 Open thrombect av fistula A 0 090 Y Y $ 598.21 $ -
36832 Av fistula revision open A 0 090 Y Y $ 765.60 $ -
36833 Av fistula revision A 0 090 Y Y $ 869.30 $ -
36835 Artery to vein shunt A 0 090 Y $ 621.88 $ -
36838 Dist revas ligation hemo A 0 090 Y Y Y $ 1,553.82 $ -
36860 External cannula declotting A 0 000 Y $ 125.28 $ 208.45
36861 Cannula declotting A 0 000 Y $ 187.22 $ -
36870 Percut thrombect av fistula A 0 090 Y Y Y $ 344.87 $ 1,726.78
3700F Psych disorders assessed M 9 XXX $ - $ -
37140 Revision of circulation A 0 090 Y $ 2,839.68 $ -
37145 Revision of circulation A 0 090 Y Y $ 2,666.03 $ -
37181 Splice spleen/kidney veins A 0 090 Y Y $ 2,845.94 $ -
37182 Insert hepatic shunt (tips) A 0 000 Y $ 943.08 $ -
37183 Remove hepatic shunt (tips) A 0 000 Y $ 442.31 $ 4,964.57
37184 Prim art mech thrombectomy A 0 000 Y Y Y $ 566.54 $ 2,192.75
37185 Prim art m-thrombect add-on A 0 ZZZ Y $ 214.37 $ 728.36
37186 Sec art m-thrombect add-on A 0 ZZZ Y $ 327.82 $ 1,403.83
37187 Venous mech thrombectomy A 0 000 Y Y Y $ 491.38 $ 2,053.55

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
37188 Venous m-thrombectomy add-on A 0 000 Y Y Y $ 340.00 $ 1,702.42

37191 Ins endovas vena cava filtr A 0 000 Y $ 285.71 $ 2,344.13
37192 Redo endovas vena cava filtr A 0 000 Y $ 444.05 $ 1,645.69
37193 Rem endovas vena cava filter A 0 000 Y $ 443.70 $ 1,576.44
37195 Thrombolytic therapy stroke C 5 XXX $ - $ -
37200 Transcatheter biopsy A 0 000 Y $ 249.52 $ -
37201 Transcatheter therapy infuse A 0 000 Y $ 327.82 $ -
37202 Transcatheter therapy infuse A 0 000 Y $ 416.56 $ -
37203 Transcatheter retrieval A 0 000 Y $ 307.98 $ 1,227.74
37204 Transcatheter occlusion A 0 000 Y $ 1,051.31 $ -
37205 Transcath iv stent percut A 0 000 Y $ 549.14 $ 3,853.75
37206 Transcath iv stent/perc addl A 0 ZZZ $ 275.62 $ 2,289.84
37207 Transcath iv stent open A 0 000 Y Y Y Y $ 577.68 $ -
37208 Transcath iv stent/open addl A 0 ZZZ Y Y $ 282.23 $ -
37209 Change iv cath at thromb tx A 0 000 Y $ 136.76 $ -
3720F Cognit impairment assessed M 9 XXX $ - $ -
37210 Embolization uterine fibroid A 0 000 Y $ 591.60 $ 3,238.14
37215 Transcath stent cca w/eps R 0 090 Y $ 1,411.84 $ -
37216 Transcath stent cca w/o eps N 9 090 $ 1,068.01 $ -
37220 Iliac revasc A 0 000 Y Y $ 545.32 $ 2,976.44
37221 Iliac revasc w/stent A 0 000 Y Y $ 651.80 $ 4,382.36
37222 Iliac revasc add-on A 0 ZZZ Y $ 247.78 $ 884.62
37223 Iliac revasc w/stent add-on A 0 ZZZ Y $ 279.10 $ 2,378.93
37224 Fem/popl revas w/tla A 0 000 Y Y $ 597.86 $ 3,559.00
37225 Fem/popl revas w/ather A 0 000 Y Y $ 813.62 $ 9,815.69
37226 Fem/popl revasc w/stent A 0 000 Y Y $ 603.78 $ 8,209.67
37227 Fem/popl revasc stnt & ather A 0 000 Y Y $ 983.10 $ 13,237.22
37228 Tib/per revasc w/tla A 0 000 Y Y $ 735.32 $ 5,048.78

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
37229 Tib/per revasc w/ather A 0 000 Y Y $ 954.56 $ 9,760.01

37230 Tib/per revasc w/stent A 0 000 Y Y $ 898.88 $ 7,765.62
37231 Tib/per revasc stent & ather A 0 000 Y Y $ 977.18 $ 12,333.47
37232 Tib/per revasc add-on A 0 ZZZ Y $ 266.22 $ 1,163.36
37233 Tibper revasc w/ather add-on A 0 ZZZ Y $ 439.52 $ 1,452.55
37234 Revsc opn/prq tib/pero stent A 0 ZZZ Y $ 361.92 $ 3,559.00
37235 Tib/per revasc stnt & ather A 0 ZZZ Y $ 513.65 $ 3,839.14
37250 Iv us first vessel add-on A 0 ZZZ $ 143.72 $ -
37251 Iv us each add vessel add-on A 0 ZZZ $ 108.92 $ -
3725F Screen depression performed M 9 XXX $ - $ -
37500 Endoscopy ligate perf veins A 0 090 Y Y $ 894.01 $ -
37501 Vascular endoscopy procedure C 0 YYY Y Y Y $ - $ -
3750F Ptnotrcvngsteroid>/=10mg/day M 9 XXX $ - $ -
37565 Ligation of neck vein A 0 090 Y $ 913.15 $ -
37600 Ligation of neck artery A 0 090 Y Y $ 899.58 $ -
37605 Ligation of neck artery A 0 090 Y Y $ 1,072.19 $ -
37607 Ligation of a-v fistula A 0 090 Y $ 481.63 $ -
37609 Temporal artery procedure A 0 010 Y Y $ 249.86 $ 338.95
37616 Ligation of chest artery A 0 090 Y Y $ 1,392.00 $ -
37617 Ligation of abdomen artery A 0 090 Y Y $ 1,695.80 $ -
37618 Ligation of extremity artery A 0 090 Y Y $ 480.59 $ -
37619 Ligation of inf vena cava A 0 090 Y Y $ 2,143.68 $ -
37650 Revision of major vein A 0 090 Y Y $ 674.08 $ -
37660 Revision of major vein A 0 090 Y Y $ 1,622.03 $ -
37700 Revise leg vein A 0 090 Y Y $ 314.24 $ -
37718 Ligate/strip short leg vein A 0 090 Y Y $ 556.10 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
37722 Ligate/strip long leg vein A 0 090 Y Y $ 622.92 $ -

37735 Removal of leg veins/lesion A 0 090 Y Y $ 814.67 $ -
37760 Ligate leg veins radical A 0 090 Y Y $ 801.79 $ -
37761 Ligate leg veins open A 0 090 Y Y Y $ 699.13 $ -
37765 Stab phleb veins xtr 10-20 A 0 090 Y Y $ 572.11 $ 752.72
37766 Phleb veins - extrem 20+ A 0 090 Y Y $ 707.83 $ 905.84
37780 Revision of leg vein A 0 090 Y Y $ 320.86 $ -
37785 Ligate/divide/excise vein A 0 090 Y Y $ 323.99 $ 406.12
37788 Revascularization penis A 0 090 Y Y $ 1,726.78 $ -
37790 Penile venous occlusion A 0 090 Y $ 522.00 $ -
37799 Vascular surgery procedure C 0 YYY Y Y $ - $ -
38100 Removal of spleen total A 0 090 Y Y $ 1,412.53 $ -
38101 Removal of spleen partial A 0 090 Y Y $ 1,428.19 $ -
38102 Removal of spleen total A 0 ZZZ Y $ 329.21 $ -
38115 Repair of ruptured spleen A 0 090 Y Y $ 1,541.29 $ -
38120 Laparoscopy splenectomy A 0 090 Y Y $ 1,279.25 $ -
38129 Laparoscope proc spleen C 0 YYY Y Y Y $ - $ -
38200 Injection for spleen x-ray A 0 000 Y $ 190.70 $ -
38204 Bl donor search management B 9 XXX $ 106.84 $ -
38205 Harvest allogenic stem cells A 0 000 Y $ 80.39 $ -
38206 Harvest auto stem cells A 0 000 Y $ 84.56 $ -
38207 Cryopreserve stem cells A 9 XXX $ 47.33 $ -
38208 Thaw preserved stem cells A 9 XXX $ 30.97 $ -
38209 Wash harvest stem cells A 9 XXX $ 12.53 $ -
38210 T-cell depletion of harvest A 9 XXX $ 84.91 $ -
38211 Tumor cell deplete of harvst A 9 XXX $ 77.95 $ -
38212 Rbc depletion of harvest A 9 XXX $ 49.76 $ -
38213 Platelet deplete of harvest A 9 XXX $ 12.53 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
38214 Volume deplete of harvest A 9 XXX $ 43.50 $ -

38215 Harvest stem cell concentrte A 9 XXX $ 49.76 $ -
38220 Bone marrow aspiration A 0 XXX Y Y $ 65.77 $ 149.64
38221 Bone marrow biopsy A 0 XXX Y Y $ 76.56 $ 153.82
38230 Bone marrow harvest allogen A 0 000 Y $ 232.12 $ -
38232 Bone marrow harvest autolog A 0 000 Y $ 232.12 $ -
38240 Bn marrow/stm transplt allo A 0 XXX Y $ 129.11 $ -
38241 Bn marrow/stm transplt auto A 0 XXX Y $ 127.37 $ -
38242 Lymphocyte infuse transplant A 0 000 Y $ 96.40 $ -
38300 Drainage lymph node lesion A 0 010 Y $ 204.97 $ 285.36
38305 Drainage lymph node lesion A 0 090 Y $ 536.96 $ -
38308 Incision of lymph channels A 0 090 Y Y $ 538.36 $ -
38380 Thoracic duct procedure A 0 090 Y Y $ 625.01 $ -
38381 Thoracic duct procedure A 0 090 Y Y $ 1,029.38 $ -
38382 Thoracic duct procedure A 0 090 Y Y $ 845.64 $ -
38500 Biopsy/removal lymph nodes A 0 010 Y Y $ 299.28 $ 364.36
38505 Needle biopsy lymph nodes A 0 000 Y Y $ 76.56 $ 122.50
38510 Biopsy/removal lymph nodes A 0 010 Y Y $ 494.51 $ 579.07
38520 Biopsy/removal lymph nodes A 0 090 Y Y $ 551.23 $ -
38525 Biopsy/removal lymph nodes A 0 090 Y Y $ 513.30 $ -
38530 Biopsy/removal lymph nodes A 0 090 Y Y Y $ 661.55 $ -
38542 Explore deep node(s) neck A 0 090 Y Y Y $ 595.43 $ -
38550 Removal neck/armpit lesion A 0 090 Y $ 590.56 $ -
38555 Removal neck/armpit lesion A 0 090 Y Y $ 1,210.00 $ -
38562 Removal pelvic lymph nodes A 0 090 Y Y $ 813.97 $ -
38564 Removal abdomen lymph nodes A 0 090 Y Y $ 841.46 $ -
38570 Laparoscopy lymph node biop A 0 010 Y Y Y 49320 $ 614.92 $ -
38571 Laparoscopy lymphadenectomy A 0 010 Y Y Y $ 871.74 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
38572 Laparoscopy lymphadenectomy A 0 010 Y Y Y $ 1,090.98 $ -

38589 Laparoscope proc lymphatic C 0 YYY Y Y Y Y $ - $ -
38700 Removal of lymph nodes neck A 0 090 Y Y Y $ 903.76 $ -
38720 Removal of lymph nodes neck A 0 090 Y Y Y $ 1,549.64 $ -
38724 Removal of lymph nodes neck A 0 090 Y Y Y $ 1,648.13 $ -
38740 Remove armpit lymph nodes A 0 090 Y Y Y $ 825.46 $ -
38745 Remove armpit lymph nodes A 0 090 Y Y Y $ 1,055.14 $ -
38746 Remove thoracic lymph nodes A 0 ZZZ Y $ 293.02 $ -
38747 Remove abdominal lymph nodes A 0 ZZZ Y $ 336.52 $ -
38760 Remove groin lymph nodes A 0 090 Y Y Y $ 1,016.16 $ -
38765 Remove groin lymph nodes A 0 090 Y Y Y $ 1,554.86 $ -
38770 Remove pelvis lymph nodes A 0 090 Y Y Y $ 899.23 $ -
38780 Remove abdomen lymph nodes A 0 090 Y Y $ 1,177.28 $ -
38790 Inject for lymphatic x-ray A 0 000 Y Y $ 98.14 $ -
38792 Ra tracer id of sentinl node A 0 000 Y Y $ 43.85 $ -
38794 Access thoracic lymph duct A 0 090 Y $ 307.63 $ -
38900 Io map of sent lymph node A 0 ZZZ Y Y $ 171.91 $ 171.91
38999 Blood/lymph system procedure C 0 YYY Y Y $ - $ -
39000 Exploration of chest A 0 090 Y Y $ 612.13 $ -
39010 Exploration of chest A 0 090 Y Y $ 1,023.82 $ -
39200 Resect mediastinal cyst A 0 090 Y Y $ 1,142.83 $ -
39220 Resect mediastinal tumor A 0 090 Y Y $ 1,464.04 $ -
39400 Mediastinoscopy incl biopsy A 0 010 Y $ 641.36 $ -
39499 Chest procedure C 0 YYY Y Y Y $ - $ -
39501 Repair diaphragm laceration A 0 090 Y Y $ 1,043.65 $ -
39503 Repair of diaphragm hernia A 0 090 Y Y $ 7,681.75 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
39545 Revision of diaphragm A 0 090 Y Y $ 1,142.14 $ -

39560 Resect diaphragm simple A 0 090 Y Y $ 975.79 $ -
39561 Resect diaphragm complex A 0 090 Y Y $ 1,535.03 $ -
39599 Diaphragm surgery procedure C 0 YYY Y Y Y $ - $ -
4000F Tobacco use txmnt counseling M 9 XXX $ - $ -
4001F Tobacco use txmnt pharmacol M 9 XXX $ - $ -
4003F Pt ed write/oral pts w/ hf M 9 XXX $ - $ -
4004F Pt tobacco screen rcvd tlk M 9 XXX $ - $ -
4005F Pharm thx for op rxd M 9 XXX $ - $ -
4008F Beta-blocker therapy rxd/tkn M 9 XXX $ - $ -
4010F ACE/ARB therapy rxd/taken M 9 XXX $ - $ -
4011F Oral antiplatelet therapy rx I 9 XXX $ - $ -
4012F Warfarin therapy rx M 9 XXX $ - $ -
4013F Statin therapy/currently tkn M 9 XXX $ - $ -
4014F Written discharge instr prvd M 9 XXX $ - $ -
4015F Persist asthma medicine ctrl M 9 XXX $ - $ -
4016F Anti-inflm/anlgsc agent rx M 9 XXX $ - $ -
4017F Gi prophylaxis for nsaid rx M 9 XXX $ - $ -
4018F Therapy exercise joint rx M 9 XXX $ - $ -
4019F Doc recpt counsl vit d/calc+ M 9 XXX $ - $ -
4025F Inhaled bronchodilator rx M 9 XXX $ - $ -
4030F Oxygen therapy rx M 9 XXX $ - $ -
4033F Pulmonary rehab rec M 9 XXX $ - $ -
4035F Influenza imm rec M 9 XXX $ - $ -
4037F Influenza imm order/admin M 9 XXX $ - $ -
4040F Pneumoc vac/admin/rcvd M 9 XXX $ - $ -
4041F Doc order cefazolin/cefurox M 9 XXX $ - $ -
4042F Doc antibio not given M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
4043F Doc order given stop antibio M 9 XXX $ - $ -

4044F Doc order given vte prophylx M 9 XXX $ - $ -
4045F Empiric antibiotic rx M 9 XXX $ - $ -
4046F Doc antibio given b/4 surg M 9 XXX $ - $ -
40490 Biopsy of lip A 0 000 Y $ 84.56 $ 131.54
4049F Doc order given stop antibio M 9 XXX $ - $ -
40500 Partial excision of lip A 0 090 Y $ 393.59 $ 515.39
4050F Ht care plan doc M 9 XXX $ - $ -
4051F Referred for an AV fistula M 9 XXX $ - $ -
40525 Reconstruct lip with flap A 0 090 Y $ 628.14 $ -
40527 Reconstruct lip with flap A 0 090 Y $ 689.39 $ -
4052F Hemodialysis via AV fistula M 9 XXX $ - $ -
40530 Partial removal of lip A 0 090 Y $ 451.01 $ 569.33
4053F Hemodialysis via AV graft X 9 XXX $ - $ -
4054F Hemodialysis via catheter X 9 XXX $ - $ -
4055F Pt rcvng periton dialysis X 9 XXX $ - $ -
4056F Approp oral rehyd recommd X 9 XXX $ - $ -
4058F Ped gastro ed given caregvr M 9 XXX $ - $ -
4060F Psych svcs provided M 9 XXX $ - $ -
4062F Pt referral psych docd M 9 XXX $ - $ -
4063F Antidepres rxthxpy not rxd M 9 XXX $ - $ -
4064F Antidepressant rx M 9 XXX $ - $ -
40650 Repair lip A 0 090 Y $ 328.16 $ 444.40
40652 Repair lip A 0 090 Y $ 393.59 $ 510.17

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
40654 Repair lip A 0 090 Y $ 475.02 $ 599.60

4065F Antipsychotic rx M 9 XXX $ - $ -
4066F ECT provided M 9 XXX $ - $ -
4067F Pt referral for ect docd M 9 XXX $ - $ -
4069F Vte prophylaxis rcvd M 9 XXX $ - $ -
40700 Repair cleft lip/nasal A 0 090 Y $ 1,042.26 $ -
40701 Repair cleft lip/nasal A 0 090 Y Y $ 1,275.07 $ -
40702 Repair cleft lip/nasal A 0 090 Y Y $ 853.99 $ -
4070F Dvt prophylx recvd day 2 M 9 XXX $ - $ -
40720 Repair cleft lip/nasal A 0 090 Y Y $ 1,212.78 $ -
4073F Oral antiplat thx rx dischrg I 9 XXX $ - $ -
4075F Anticoag thx rx at dischrg M 9 XXX $ - $ -
40761 Repair cleft lip/nasal A 0 090 Y $ 1,234.01 $ -
4077F Doc t-pa admin considered M 9 XXX $ - $ -
40799 Lip surgery procedure C 0 YYY Y Y Y $ - $ -
4079F Doc rehab svcs considered M 9 XXX $ - $ -
40800 Drainage of mouth lesion A 0 010 Y $ 133.98 $ 201.14
40804 Removal foreign body mouth A 0 010 Y $ 135.37 $ 207.06
40805 Removal foreign body mouth A 0 010 Y $ 236.64 $ 349.04
40806 Incision of lip fold A 0 000 Y $ 37.58 $ 132.59
40808 Biopsy of mouth lesion A 0 010 Y $ 108.58 $ 175.04
40810 Excision of mouth lesion A 0 010 Y $ 132.59 $ 199.75
40812 Excise/repair mouth lesion A 0 010 Y $ 206.71 $ 283.27
40814 Excise/repair mouth lesion A 0 090 Y $ 319.81 $ 386.28
40818 Excise oral mucosa for graft A 0 090 Y $ 278.40 $ 349.39
40819 Excise lip or cheek fold A 0 090 Y $ 242.21 $ 303.80

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
40820 Treatment of mouth lesion A 0 010 Y $ 171.91 $ 251.95

40830 Repair mouth laceration A 0 010 Y $ 178.18 $ 261.35
40831 Repair mouth laceration A 0 010 Y $ 242.56 $ 335.12
40840 Reconstruction of mouth A 0 090 Y Y $ 670.94 $ 827.54
40842 Reconstruction of mouth A 0 090 Y $ 686.60 $ 828.59
40843 Reconstruction of mouth A 0 090 Y Y $ 1,014.42 $ 1,206.17
40844 Reconstruction of mouth A 0 090 Y Y $ 1,323.44 $ 1,537.81
40845 Reconstruction of mouth R 0 090 Y $ 1,362.07 $ 1,563.91
4084F Aspirin recvd w/in 24 hrs M 9 XXX $ - $ -
4086F Aspirin/clopidogrel rxd M 9 XXX $ - $ -
40899 Mouth surgery procedure C 0 YYY Y Y $ - $ -
4090F Pt rcvng epo thxpy M 9 XXX $ - $ -
4095F Pt not rcvng epo thxpy M 9 XXX $ - $ -
4100F Biphos thxpy vein ord/recvd M 9 XXX $ - $ -
41010 Incision of tongue fold A 0 010 Y $ 113.45 $ 197.32
41019 Place needles h&n for rt A 0 000 Y Y $ 491.72 $ -
41100 Biopsy of tongue A 0 010 Y $ 117.97 $ 170.17
41105 Biopsy of tongue A 0 010 Y $ 120.76 $ 171.91

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
41108 Biopsy of floor of mouth A 0 010 Y $ 95.70 $ 145.46

4110F Int mam art used for cabg M 9 XXX $ - $ -
41110 Excision of tongue lesion A 0 010 Y $ 141.64 $ 211.93
41114 Excision of tongue lesion A 0 090 Y $ 690.43 $ -
41115 Excision of tongue fold A 0 010 Y $ 156.25 $ 245.69
41120 Partial removal of tongue A 0 090 Y Y $ 1,096.20 $ -
41130 Partial removal of tongue A 0 090 Y Y $ 1,386.43 $ -
41135 Tongue and neck surgery A 0 090 Y Y $ 2,348.65 $ -
41140 Removal of tongue A 0 090 Y Y $ 2,357.70 $ -
41145 Tongue removal neck surgery A 0 090 Y Y $ 2,988.97 $ -
41150 Tongue mouth jaw surgery A 0 090 Y Y $ 2,380.32 $ -
41153 Tongue mouth neck surgery A 0 090 Y Y $ 2,591.90 $ -
41155 Tongue jaw & neck surgery A 0 090 Y Y $ 3,293.82 $ -
4115F Beta blckr admin w/in 24 hrs M 9 XXX $ - $ -
4120F Antibiot rxd/given M 9 XXX $ - $ -
4124F Antibiot not rxd/given M 9 XXX $ - $ -
41250 Repair tongue laceration A 0 010 Y $ 167.74 $ 257.87
4130F Topical prep rx aoe M 9 XXX $ - $ -
4131F Syst antimicrobial thx rx M 9 XXX $ - $ -
4132F No syst antimicrobial thx rx M 9 XXX $ - $ -
4133F Antihist/decong rx/recom M 9 XXX $ - $ -
4134F No antihist/decong rx/recom M 9 XXX $ - $ -
4135F Systemic corticosteroids rx M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
4136F Syst corticosteroids not rx M 9 XXX $ - $ -

4140F Inhaled corticosteroids rxd M 9 XXX $ - $ -
4142F Corticoster sparng txmnt rxd M 9 XXX $ - $ -
4144F Alt long-term cntrl med rxd M 9 XXX $ - $ -
4145F 2+ anti-hyprtnsv agents tkn M 9 XXX $ - $ -
4148F Hep A vac injxn admin/recvd M 9 XXX $ - $ -
4149F Hep B vac injxn admin/recvd M 9 XXX $ - $ -
41500 Fixation of tongue A 0 090 Y $ 461.10 $ -
4150F Pt recvng antivir txmnt hepc M 9 XXX $ - $ -
41510 Tongue to lip surgery A 0 090 Y $ 415.16 $ -
41512 Tongue suspension A 0 090 Y $ 617.70 $ -
4151F Pt not recvng antiv hep c M 9 XXX $ - $ -
41520 Reconstruction tongue fold A 0 090 Y $ 262.39 $ 341.74
41530 Tongue base vol reduction A 0 010 Y $ 402.29 $ 2,912.06
4153F Combo pegintf/rib rx M 9 XXX $ - $ -
4155F Hep A vac series prev recvd M 9 XXX $ - $ -
4157F Hep B vac series prev recvd M 9 XXX $ - $ -
4158F Pt edu re alcoh drnkng done M 9 XXX $ - $ -
41599 Tongue and mouth surgery C 0 YYY Y Y $ - $ -
4159F Contrcp talk b/4 antiv txmnt M 9 XXX $ - $ -
4163F Pt couns 4 txmnt opt prost M 9 XXX $ - $ -
4164F Adjv hrmnl thxpy rxd M 9 XXX $ - $ -
4165F 3d-crt/imrt received M 9 XXX $ - $ -
4167F Hd bed tilted 1st day vent M 9 XXX $ - $ -
4168F Pt care icu&vent w/in 24hrs M 9 XXX $ - $ -
4169F No pt care ICU/vent in 24hrs M 9 XXX $ - $ -
4171F Pt rcvng esa thxpy M 9 XXX $ - $ -
4172F Pt not rcvng esa thxpy M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
4174F Couns potent glauc impct M 9 XXX $ - $ -

4175F Vis of >= 20/40 w/in 90 days M 9 XXX $ - $ -
4176F Talk re uv light pt/crgvr M 9 XXX $ - $ -
4177F Talk pt/crgvr re areds prev M 9 XXX $ - $ -
4178F Antid glbln rcvd w/in 26wks M 9 XXX $ - $ -
4179F Tamoxifen/AI prescribed M 9 XXX $ - $ -
41800 Drainage of gum lesion A 0 010 Y $ 148.94 $ 249.86
41805 Removal foreign body gum A 0 010 Y $ 167.39 $ 230.72
41806 Removal foreign body jawbone A 0 010 Y $ 286.40 $ 368.18
4180F Adjv thxpyrxd/rcvd colon ca M 9 XXX $ - $ -
4181F Conformal radn thxpy rcvd M 9 XXX $ - $ -
41820 Excision gum each quadrant N 0 000 Y $ - $ -
41821 Excision of gum flap N 0 000 Y $ - $ -
41822 Excision of gum lesion N 0 010 Y $ 192.44 $ 284.32
4182F No conformal radn thxpy M 9 XXX $ - $ -
41830 Removal of gum tissue N 0 010 Y $ 295.10 $ 385.93
41850 Treatment of gum lesion N 0 000 Y $ - $ -
4185F Continuous ppi or h2ra rcvd M 9 XXX $ - $ -
4186F No cont ppi or h2ra rcvd M 9 XXX $ - $ -
41870 Gum graft N 0 000 Y $ - $ -
41872 Repair gum N 0 090 Y $ 316.68 $ 422.47
41874 Repair tooth socket N 0 090 Y $ 265.18 $ 363.66
4187F Anti rheum drugthxpyrxd/gvn M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
4188F Approp ACE/ARB tstng done M 9 XXX $ - $ -

41899 Dental surgery procedure C 0 YYY Y Y $ - $ -
4189F Approp digoxin tstng done M 9 XXX $ - $ -
4190F Approp diuretic tstng done M 9 XXX $ - $ -
4191F Approp anticonvuls tstng M 9 XXX $ - $ -
4192F Pt not rcvng glucoco thxpy M 9 XXX $ - $ -
4193F Pt rcvng<10mg daily predniso M 9 XXX $ - $ -
4194F Pt rcvng>10mg daily predniso M 9 XXX $ - $ -
4195F Pt rcvng anti-rheum thxpy RA M 9 XXX $ - $ -
4196F Ptnot rcvng anti-rhm thxpyRA M 9 XXX $ - $ -
42000 Drainage mouth roof lesion A 0 010 Y $ 109.97 $ 155.90
4200F External beam to prost only M 9 XXX $ - $ -
4201F Extrnl beam other than prost M 9 XXX $ - $ -
42100 Biopsy roof of mouth A 0 010 Y $ 116.93 $ 151.73
42104 Excision lesion mouth roof A 0 010 Y $ 148.60 $ 213.67
4210F Ace/arb thxpy for mos/> M 9 XXX $ - $ -
42120 Remove palate/lesion A 0 090 Y Y $ 1,055.83 $ -
42140 Excision of uvula A 0 090 Y $ 164.60 $ 250.91
42145 Repair palate pharynx/uvula A 0 090 Y $ 766.99 $ -
42160 Treatment mouth roof lesion A 0 010 Y $ 158.69 $ 233.51
42180 Repair palate A 0 010 Y $ 200.80 $ 253.34
42182 Repair palate A 0 010 Y $ 284.66 $ 340.69
42200 Reconstruct cleft palate A 0 090 Y Y $ 943.08 $ -
4220F Digoxin thxpy for 6 mos/> M 9 XXX $ - $ -
42210 Reconstruct cleft palate A 0 090 Y Y $ 1,285.86 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

4221F Diuretic thxpy for 6 mos/> M 9 XXX $ - $ -
42226 Lengthening of palate A 0 090 Y Y $ 952.13 $ -
42227 Lengthening of palate A 0 090 Y Y $ 902.71 $ -
42235 Repair palate A 0 090 Y Y $ 771.86 $ -
42260 Repair nose to lip fistula A 0 090 Y Y $ 735.67 $ 869.65
42280 Preparation palate mold A 0 010 Y $ 132.24 $ 178.52
42281 Insertion palate prosthesis A 0 010 Y $ 164.26 $ 211.24
42299 Palate/uvula surgery C 0 YYY Y Y Y $ - $ -
42300 Drainage of salivary gland A 0 010 Y $ 166.00 $ 215.76
42305 Drainage of salivary gland A 0 090 Y $ 476.06 $ -
4230F Anticonv thxpy for 6 mos/> M 9 XXX $ - $ -
42330 Removal of salivary stone A 0 010 Y $ 180.26 $ 238.73
42400 Biopsy of salivary gland A 0 000 Y $ 58.81 $ 103.70
42405 Biopsy of salivary gland A 0 010 Y $ 247.43 $ 310.42
42408 Excision of salivary cyst A 0 090 Y $ 358.44 $ 469.80
42409 Drainage of salivary cyst A 0 090 Y Y $ 240.12 $ 337.91
4240F Instr xrcz 4bk pn >12 weeks M 9 XXX $ - $ -
42410 Excise parotid gland/lesion A 0 090 Y Y $ 708.18 $ -
42415 Excise parotid gland/lesion A 0 090 Y Y $ 1,197.82 $ -
42425 Excise parotid gland/lesion A 0 090 Y Y $ 947.95 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

4242F Sprvsd xrcz bk pn >12 weeks M 9 XXX $ - $ -
42440 Excise submaxillary gland A 0 090 Y Y $ 460.75 $ -
42450 Excise sublingual gland A 0 090 Y $ 390.11 $ 471.54
4245F Pt instr nrml lifest M 9 XXX $ - $ -
4248F Pt instr no bd rest 4 days/> M 9 XXX $ - $ -
42500 Repair salivary duct A 0 090 Y $ 370.27 $ 449.27
42505 Repair salivary duct A 0 090 Y $ 492.07 $ 581.51
42507 Parotid duct diversion A 0 090 Y Y $ 548.10 $ -
42509 Parotid duct diversion A 0 090 Y $ 1,011.64 $ -
4250F Wrmng 4 surg normothermia M 9 XXX $ - $ -
42550 Injection for salivary x-ray A 0 000 Y $ 68.56 $ 132.24
4255F Anesth 60 min/> as docd M 9 XXX $ - $ -
4256F Anesthe <60 min as docd M 9 XXX $ - $ -
42600 Closure of salivary fistula A 0 090 Y $ 383.50 $ 499.38
4260F Wound srfc culturetech used M 9 XXX $ - $ -
4261F Tech other than surfc cultr M 9 XXX $ - $ -
42650 Dilation of salivary duct A 0 000 Y $ 63.34 $ 85.26
4265F Wet-dry dressings rx recmd M 9 XXX $ - $ -
42660 Dilation of salivary duct A 0 000 Y $ 84.22 $ 108.92
42665 Ligation of salivary duct A 0 090 Y $ 223.42 $ 317.03
4266F No wet-dry drssings rx recmd M 9 XXX $ - $ -
4267F Comprssion thxpy prescribed M 9 XXX $ - $ -
4268F Pt ed re comp thxpy rcvd M 9 XXX $ - $ -
42699 Salivary surgery procedure C 0 YYY Y Y Y $ - $ -
4269F Appropos mthd offloading Rxd M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
42700 Drainage of tonsil abscess A 0 010 Y $ 147.20 $ 193.84

4270F Pt rcvng anti r-viral thxpy M 9 XXX $ - $ -
4271F Pt rcvng anti r-viral thxpy M 9 XXX $ - $ -
42720 Drainage of throat abscess A 0 010 Y $ 441.96 $ 495.90
42725 Drainage of throat abscess A 0 090 Y Y $ 897.49 $ -
4274F Flu immuno admind rcvd M 9 XXX $ - $ -
4276F Potent antivir thxpy Rxd M 9 XXX $ - $ -
4279F PCP prophylaxis Rxd M 9 XXX $ - $ -
42800 Biopsy of throat A 0 010 Y $ 122.50 $ 163.56
42802 Biopsy of throat A 0 010 Y $ 144.42 $ 233.51
42804 Biopsy of upper nose/throat A 0 010 Y $ 120.06 $ 194.88
42806 Biopsy of upper nose/throat A 0 010 Y $ 143.38 $ 223.07
42808 Excise pharynx lesion A 0 010 Y $ 178.52 $ 235.94
42809 Remove pharynx foreign body A 0 010 Y $ 146.16 $ 181.31
4280F PCP prophylax Rxd 3mon low % M 9 XXX $ - $ -
42810 Excision of neck cyst A 0 090 Y Y $ 305.20 $ 393.24
42815 Excision of neck cyst A 0 090 Y Y $ 608.30 $ -
42820 Remove tonsils and adenoids A 0 090 Y $ 318.42 $ -
42821 Remove tonsils and adenoids A 0 090 Y $ 331.64 $ -
42825 Removal of tonsils A 0 090 Y $ 265.87 $ -
42826 Removal of tonsils A 0 090 Y $ 273.88 $ -
42830 Removal of adenoids A 0 090 Y $ 223.42 $ -
42842 Extensive surgery of throat A 0 090 Y $ 1,057.92 $ -
42844 Extensive surgery of throat A 0 090 Y Y $ 1,470.30 $ -
42845 Extensive surgery of throat A 0 090 Y Y $ 2,439.13 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
42860 Excision of tonsil tags A 0 090 Y $ 201.84 $ -

42870 Excision of lingual tonsil A 0 090 Y $ 595.43 $ -
42890 Partial removal of pharynx A 0 090 Y Y $ 1,533.64 $ -
42892 Revision of pharyngeal walls A 0 090 Y Y $ 2,044.50 $ -
42894 Revision of pharyngeal walls A 0 090 Y Y $ 2,590.51 $ -
42900 Repair throat wound A 0 010 Y $ 378.97 $ -
4290F Pt scrned for inj drug use M 9 XXX $ - $ -
4293F Pt scrnd hgh-risk sex behav M 9 XXX $ - $ -
42950 Reconstruction of throat A 0 090 Y Y $ 832.76 $ -
42953 Repair throat esophagus A 0 090 Y Y $ 999.80 $ -
42955 Surgical opening of throat A 0 090 Y Y $ 784.39 $ -
42960 Control throat bleeding A 0 010 Y $ 185.14 $ -
42961 Control throat bleeding A 0 090 Y Y $ 456.58 $ -
42962 Control throat bleeding A 0 090 Y $ 568.63 $ -
42970 Control nose/throat bleeding A 0 090 Y $ 448.92 $ -
42971 Control nose/throat bleeding A 0 090 Y Y $ 502.16 $ -
42972 Control nose/throat bleeding A 0 090 Y Y $ 566.20 $ -
42999 Throat surgery procedure C 0 YYY Y Y $ - $ -
4300F Pt rcvng warf thxpy M 9 XXX $ - $ -
4301F Pt not rcvng warf thxpy M 9 XXX $ - $ -
43020 Incision of esophagus A 0 090 Y Y $ 595.43 $ -
43030 Throat muscle surgery A 0 090 Y Y $ 588.82 $ -
43045 Incision of esophagus A 0 090 Y Y $ 1,676.66 $ -
4305F Pt ed re ft care inspct rcvd M 9 XXX $ - $ -
4306F Pt tlk psych & Rx opd addic M 9 XXX $ - $ -
43100 Excision of esophagus lesion A 0 090 Y Y $ 695.30 $ -
43101 Excision of esophagus lesion A 0 090 Y Y $ 1,300.48 $ -
43107 Removal of esophagus A 0 090 Y Y $ 3,243.71 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

43112 Removal of esophagus A 0 090 Y Y Y $ 3,475.82 $ -
43113 Removal of esophagus A 0 090 Y Y Y $ 5,722.16 $ -
43116 Partial removal of esophagus A 0 090 Y Y $ 5,918.78 $ -
43117 Partial removal of esophagus A 0 090 Y Y Y $ 3,180.02 $ -
43130 Removal of esophagus pouch A 0 090 Y Y $ 912.46 $ -
43135 Removal of esophagus pouch A 0 090 Y Y $ 1,918.52 $ -
43200 Esophagus endoscopy A 0 000 Y $ 117.97 $ 215.41
43201 Esoph scope w/submucous inj A 0 000 Y 43200 $ 146.51 $ 302.76
43202 Esophagus endoscopy biopsy A 0 000 Y 43200 $ 133.63 $ 281.88
43204 Esoph scope w/sclerosis inj A 0 000 Y 43200 $ 258.22 $ -
43205 Esophagus endoscopy/ligation A 0 000 Y 43200 $ 259.61 $ -
4320F Pt talk psychsoc&rx oh dpnd M 9 XXX $ - $ -
43215 Esophagus endoscopy A 0 000 Y 43200 $ 181.31 $ -
43216 Esophagus endoscopy/lesion A 0 000 Y 43200 $ 166.00 $ 225.85
43217 Esophagus endoscopy A 0 000 Y 43200 $ 203.23 $ 386.63
43219 Esophagus endoscopy A 0 000 Y 43200 $ 202.54 $ -
43220 Esoph endoscopy dilation A 0 000 Y 43200 $ 146.16 $ -
43227 Esoph endoscopy repair A 0 000 Y 43200 $ 245.34 $ -
43228 Esoph endoscopy ablation A 0 000 Y 43200 $ 261.00 $ -
4322F Crgvr prov w/ ed addl rsrcs M 9 XXX $ - $ -
43231 Esoph endoscopy w/us exam A 0 000 Y Y 43235 $ 220.98 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
43232 Esoph endoscopy w/us fn bx A 0 000 Y Y 43235 $ 305.20 $ -

43234 Upper gi endoscopy exam A 0 000 Y $ 143.38 $ 283.97
43235 Uppr gi endoscopy diagnosis A 0 000 Y $ 168.78 $ 301.02
43236 Uppr gi scope w/submuc inj A 0 000 Y 43235 $ 201.14 $ 377.93
43237 Endoscopic us exam esoph A 0 000 Y 43235 $ 272.48 $ -
43238 Uppr gi endoscopy w/us fn bx A 0 000 Y 43235 $ 340.34 $ -
43239 Upper gi endoscopy biopsy A 0 000 Y 43235 $ 197.66 $ 347.65
43240 Esoph endoscope w/drain cyst A 0 000 Y 43235 $ 462.49 $ -
43241 Upper GI endoscopy with tube A 0 000 Y 43235 $ 180.26 $ -
43242 Uppr gi endoscopy w/us fn bx A 0 000 Y 43235 $ 491.72 $ -
43243 Upper gi endoscopy & inject A 0 000 Y 43235 $ 310.42 $ -
43244 Upper GI endoscopy/ligation A 0 000 Y 43235 $ 340.69 $ -
43245 Uppr gi scope dilate strictr A 0 000 Y 43235 $ 220.28 $ -
43246 Place gastrostomy tube A 0 000 Y Y 43235 $ 296.84 $ -
43247 Operative upper GI endoscopy A 0 000 Y 43235 $ 233.51 $ -
43248 Uppr gi endoscopy/guide wire A 0 000 Y 43235 $ 216.11 $ -
4324F Pt queried prkns complic M 9 XXX $ - $ -
43250 Upper GI endoscopy/tumor A 0 000 Y 43235 $ 223.07 $ -
43256 Uppr gi endoscopy w/stent A 0 000 Y 43235 $ 297.89 $ -
43257 Uppr gi scope w/thrml txmnt A 0 000 Y 43235 $ 371.32 $ -
43259 Endoscopic ultrasound exam A 0 000 Y 43235 $ 350.44 $ -
4325F Med txmnt options rvwd w/pt M 9 XXX $ - $ -
43260 Endo cholangiopancreatograph A 0 000 Y $ 401.24 $ -
43261 Endo cholangiopancreatograph A 0 000 Y 43260 $ 421.08 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

4326F Pt asked re symp auto dysfxn M 9 XXX $ - $ -
43273 Endoscopic pancreatoscopy A 0 ZZZ $ 148.25 $ -
43279 Lap myotomy heller A 0 090 Y Y $ 1,604.63 $ -
43280 Laparoscopy fundoplasty A 0 090 Y Y $ 1,331.45 $ -
43281 Lap paraesophag hern repair A 0 090 Y Y $ 1,931.75 $ -
43282 Lap paraesoph her rpr w/mesh A 0 090 Y Y $ 2,174.65 $ -
43283 Lap esoph lengthening A 0 ZZZ Y $ 202.54 $ -
43289 Laparoscope proc esoph C 0 YYY Y Y Y Y $ - $ -
4328F Pt asked re sleep disturb M 9 XXX $ - $ -
43300 Repair of esophagus A 0 090 Y Y $ 681.38 $ -
43305 Repair esophagus and fistula A 0 090 Y Y $ 1,231.57 $ -
4330F Cnslng epi spec sfty issues M 9 XXX $ - $ -
43310 Repair of esophagus A 0 090 Y Y $ 1,946.02 $ -
43312 Repair esophagus and fistula A 0 090 Y Y $ 2,129.41 $ -
43313 Esophagoplasty congenital A 0 090 Y Y $ 3,661.66 $ -
43314 Tracheo-esophagoplasty cong A 0 090 Y Y $ 3,327.58 $ -
43320 Fuse esophagus & stomach A 0 090 Y Y $ 1,714.60 $ -
43325 Revise esophagus & stomach A 0 090 Y Y $ 1,666.57 $ -
43327 Esoph fundoplasty lap A 0 090 Y Y $ 1,005.37 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
43328 Esoph fundoplasty thor A 0 090 Y Y $ 1,544.77 $ -

43330 Esophagomyotomy abdominal A 0 090 Y Y $ 1,625.51 $ -
43331 Esophagomyotomy thoracic A 0 090 Y Y $ 1,742.09 $ -
43332 Transab esoph hiat hern rpr A 0 090 Y Y $ 1,445.94 $ -
43333 Transab esoph hiat hern rpr A 0 090 Y Y $ 1,571.22 $ -
43334 Transthor diaphrag hern rpr A 0 090 Y Y $ 1,596.97 $ -
43335 Transthor diaphrag hern rpr A 0 090 Y Y $ 1,721.21 $ -
43336 Thorabd diaphr hern repair A 0 090 Y Y $ 1,910.17 $ -
43337 Thorabd diaphr hern repair A 0 090 Y Y $ 2,076.52 $ -
43338 Esoph lengthening A 0 ZZZ Y $ 165.65 $ -
43340 Fuse esophagus & intestine A 0 090 Y Y $ 1,693.72 $ -
43341 Fuse esophagus & intestine A 0 090 Y Y $ 1,828.74 $ -
43350 Surgical opening esophagus A 0 090 Y Y $ 1,515.89 $ -
43360 Gastrointestinal repair A 0 090 Y Y $ 3,038.39 $ -
43361 Gastrointestinal repair A 0 090 Y Y $ 3,329.66 $ -
43400 Ligate esophagus veins A 0 090 Y Y $ 1,714.94 $ -
43401 Esophagus surgery for veins A 0 090 Y Y $ 1,917.13 $ -
43405 Ligate/staple esophagus A 0 090 Y Y $ 1,819.34 $ -
4340F Cnslng chldbrng women epi M 9 XXX $ - $ -
43410 Repair esophagus wound A 0 090 Y Y $ 1,342.93 $ -
43415 Repair esophagus wound A 0 090 Y Y $ 3,267.02 $ -
43420 Repair esophagus opening A 0 090 Y $ 1,141.09 $ -
43425 Repair esophagus opening A 0 090 Y Y $ 1,825.26 $ -
43450 Dilate esophagus A 0 000 Y $ 102.31 $ 161.12

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

43460 Pressure treatment esophagus A 0 000 Y $ 256.13 $ -
43496 Free jejunum flap microvasc C 0 090 Y Y $ - $ -
43499 Esophagus surgery procedure C 0 YYY Y Y $ - $ -
43500 Surgical opening of stomach A 0 090 Y Y $ 955.96 $ -
43501 Surgical repair of stomach A 0 090 Y Y $ 1,653.70 $ -
43502 Surgical repair of stomach A 0 090 Y Y $ 1,875.37 $ -
4350F Cnslng provided symp mngmnt M 9 XXX $ - $ -
43510 Surgical opening of stomach A 0 090 Y Y $ 1,073.93 $ -
43520 Incision of pyloric muscle A 0 090 Y Y $ 855.04 $ -
43605 Biopsy of stomach A 0 090 Y Y $ 1,016.16 $ -
43610 Excision of stomach lesion A 0 090 Y Y $ 1,200.60 $ -
43611 Excision of stomach lesion A 0 090 Y Y $ 1,491.18 $ -
43620 Removal of stomach A 0 090 Y Y $ 2,442.61 $ -
43631 Removal of stomach partial A 0 090 Y Y $ 1,785.94 $ -
43635 Removal of stomach partial A 0 ZZZ Y $ 140.59 $ -
43640 Vagotomy & pylorus repair A 0 090 Y Y $ 1,438.63 $ -
43641 Vagotomy & pylorus repair A 0 090 Y Y $ 1,466.12 $ -
43644 Lap gastric bypass/roux-en-y A 0 090 Y Y $ 2,135.33 $ -
43645 Lap gastr bypass incl smll i A 0 090 Y Y $ 2,292.28 $ -
43647 Lap impl electrode antrum C 0 YYY Y Y $ - $ -
43648 Lap revise/remv eltrd antrum C 0 YYY Y Y $ - $ -
43651 Laparoscopy vagus nerve A 0 090 Y Y $ 784.74 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
43652 Laparoscopy vagus nerve A 0 090 Y Y $ 923.94 $ -

43653 Laparoscopy gastrostomy A 0 090 Y Y $ 677.21 $ -
43659 Laparoscope proc stom C 0 YYY Y Y Y Y $ - $ -
43752 Nasal/orogastric w/stent A 0 000 $ 44.89 $ -
43753 Tx gastro intub w/asp A 0 000 Y $ 21.92 $ -
43754 Dx gastr intub w/asp spec A 0 000 Y $ 32.71 $ 77.26
43755 Dx gastr intub w/asp specs A 0 000 Y $ 60.55 $ 119.71
43756 Dx duod intub w/asp spec A 0 000 Y $ 52.20 $ 207.41
43757 Dx duod intub w/asp specs A 0 000 Y $ 79.69 $ 294.41
43760 Change gastrostomy tube A 0 000 Y $ 58.12 $ 408.90
43761 Reposition gastrostomy tube A 0 000 Y $ 117.97 $ 130.50
43770 Lap place gastr adj device A 0 090 Y Y $ 1,355.11 $ -
43771 Lap revise gastr adj device A 0 090 Y Y $ 1,551.04 $ -
43772 Lap rmvl gastr adj device A 0 090 Y Y $ 1,168.58 $ -
43773 Lap replace gastr adj device A 0 090 Y Y $ 1,550.69 $ -
43774 Lap rmvl gastr adj all parts A 0 090 Y Y $ 1,174.15 $ -
43775 Lap sleeve gastrectomy N 9 XXX $ 1,587.58 $ -
43800 Reconstruction of pylorus A 0 090 Y Y $ 1,141.44 $ -
43810 Fusion of stomach and bowel A 0 090 Y Y $ 1,244.10 $ -
43830 Place gastrostomy tube A 0 090 Y Y $ 831.72 $ -
43831 Place gastrostomy tube A 0 090 Y Y $ 696.70 $ -
43832 Place gastrostomy tube A 0 090 Y Y $ 1,278.20 $ -
43840 Repair of stomach lesion A 0 090 Y Y $ 1,663.79 $ -
43842 V-band gastroplasty N 9 090 $ 1,197.12 $ -
43843 Gastroplasty w/o v-band A 0 090 Y Y Y $ 1,565.30 $ -
43845 Gastroplasty duodenal switch A 0 090 Y Y $ 2,411.99 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
43846 Gastric bypass for obesity A 0 090 Y Y $ 1,999.96 $ -

43847 Gastric bypass incl small i A 0 090 Y Y $ 2,212.24 $ -
43848 Revision gastroplasty A 0 090 Y Y $ 2,376.84 $ -
43850 Revise stomach-bowel fusion A 0 090 Y Y $ 2,005.52 $ -
43870 Repair stomach opening A 0 090 Y Y $ 855.73 $ -
43880 Repair stomach-bowel fistula A 0 090 Y Y $ 1,963.07 $ -
43881 Impl/redo electrd antrum C 0 YYY Y Y $ - $ -
43882 Revise/remove electrd antrum C 0 YYY Y Y $ - $ -
43886 Revise gastric port open A 0 090 Y Y $ 410.64 $ -
43887 Remove gastric port open A 0 090 Y Y $ 373.75 $ -
43888 Change gastric port open A 0 090 Y Y $ 534.18 $ -
43999 Stomach surgery procedure C 0 YYY Y Y $ - $ -
44005 Freeing of bowel adhesion A 0 090 Y Y $ 1,339.45 $ -
4400F Rehab thxpy options w/pt M 9 XXX $ - $ -
44010 Incision of small bowel A 0 090 Y Y $ 1,056.18 $ -
44015 Insert needle cath bowel A 0 ZZZ Y $ 181.31 $ -
44020 Explore small intestine A 0 090 Y Y $ 1,189.81 $ -
44021 Decompress small bowel A 0 090 Y Y $ 1,200.25 $ -
44025 Incision of large bowel A 0 090 Y Y $ 1,206.52 $ -
44050 Reduce bowel obstruction A 0 090 Y Y $ 1,140.05 $ -
44055 Correct malrotation of bowel A 0 090 Y Y $ 1,848.92 $ -
44100 Biopsy of bowel A 0 000 Y $ 133.63 $ -
44110 Excise intestine lesion(s) A 0 090 Y Y $ 1,031.47 $ -
44111 Excision of bowel lesion(s) A 0 090 Y Y $ 1,203.04 $ -
44120 Removal of small intestine A 0 090 Y Y $ 1,500.92 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
44121 Removal of small intestine A 0 ZZZ Y $ 302.76 $ -

44125 Removal of small intestine A 0 090 Y Y $ 1,440.72 $ -
44126 Enterectomy w/o taper cong A 0 090 Y Y $ 3,047.78 $ -
44127 Enterectomy w/taper cong A 0 090 Y Y $ 3,536.38 $ -
44128 Enterectomy cong add-on A 0 ZZZ Y $ 306.59 $ -
44130 Bowel to bowel fusion A 0 090 Y Y $ 1,598.71 $ -
44132 Enterectomy cadaver donor A 0 XXX $ - $ -
44133 Enterectomy live donor A 0 XXX $ - $ -
44135 Intestine transplnt cadaver A 0 XXX $ - $ -
44136 Intestine transplant live A 0 XXX $ - $ -
44137 Remove intestinal allograft C 0 XXX Y Y $ - $ -
44139 Mobilization of colon A 0 ZZZ Y $ 150.68 $ -
44140 Partial removal of colon A 0 090 Y Y $ 1,637.34 $ -
44150 Removal of colon A 0 090 Y Y $ 2,247.04 $ -
44151 Removal of colon/ileostomy A 0 090 Y Y $ 2,609.30 $ -
44157 Colectomy w/ileoanal anast A 0 090 Y Y $ 2,660.11 $ -
44158 Colectomy w/neo-rectum pouch A 0 090 Y Y $ 2,729.71 $ -
44160 Removal of colon A 0 090 Y Y $ 1,512.41 $ -
44180 Lap enterolysis A 0 090 Y Y $ 1,121.26 $ -
44186 Lap jejunostomy A 0 090 Y Y $ 791.35 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
44187 Lap ileo/jejuno-stomy A 0 090 Y Y $ 1,301.87 $ -

44188 Lap colostomy A 0 090 Y Y $ 1,457.08 $ -
44202 Lap enterectomy A 0 090 Y Y $ 1,698.24 $ -
44203 Lap resect s/intestine addl A 0 ZZZ Y $ 305.89 $ -
44204 Laparo partial colectomy A 0 090 Y Y $ 1,875.72 $ -
44205 Lap colectomy part w/ileum A 0 090 Y Y $ 1,627.25 $ -
44206 Lap part colectomy w/stoma A 0 090 Y Y $ 2,146.46 $ -
44207 L colectomy/coloproctostomy A 0 090 Y Y $ 2,228.24 $ -
44208 L colectomy/coloproctostomy A 0 090 Y Y $ 2,392.85 $ -
44210 Laparo total proctocolectomy A 0 090 Y Y $ 2,160.38 $ -
44211 Lap colectomy w/proctectomy A 0 090 Y Y $ 2,755.12 $ -
44212 Laparo total proctocolectomy A 0 090 Y Y $ 2,456.88 $ -
44213 Lap mobil splenic fl add-on A 0 ZZZ Y $ 234.20 $ -
44227 Lap close enterostomy A 0 090 Y Y $ 2,048.68 $ -
44238 Laparoscope proc intestine C 0 YYY Y Y Y Y $ - $ -
44300 Open bowel to skin A 0 090 Y Y $ 1,026.25 $ -
44310 Ileostomy/jejunostomy A 0 090 Y Y $ 1,261.85 $ -
44312 Revision of ileostomy A 0 090 Y $ 691.82 $ -
44314 Revision of ileostomy A 0 090 Y Y $ 1,202.69 $ -
44316 Devise bowel pouch A 0 090 Y Y $ 1,734.78 $ -
44320 Colostomy A 0 090 Y Y $ 1,458.47 $ -
44322 Colostomy with biopsies A 0 090 Y Y $ 1,149.44 $ -
44340 Revision of colostomy A 0 090 Y $ 730.10 $ -
44345 Revision of colostomy A 0 090 Y Y $ 1,265.68 $ -
44346 Revision of colostomy A 0 090 Y Y $ 1,424.02 $ -
44360 Small bowel endoscopy A 0 000 Y $ 180.61 $ -
44361 Small bowel endoscopy/biopsy A 0 000 Y 44360 $ 198.01 $ -
44363 Small bowel endoscopy A 0 000 Y 44360 $ 239.42 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

44370 Small bowel endoscopy/stent A 0 000 Y 44360 $ 328.51 $ -
44377 Small bowel endoscopy/biopsy A 0 000 Y 44376 $ 373.40 $ -
44379 S bowel endoscope w/stent A 0 000 Y 44376 $ 506.34 $ -
44383 Ileoscopy w/stent A 0 000 Y $ 183.74 $ -
44385 Endoscopy of bowel pouch A 0 000 Y $ 122.15 $ 254.04
44386 Endoscopy bowel pouch/biop A 0 000 Y $ 147.55 $ 344.17
44388 Colonoscopy A 0 000 Y $ 195.23 $ 357.74
44389 Colonoscopy with biopsy A 0 000 Y 44388 $ 216.46 $ 404.38
44390 Colonoscopy for foreign body A 0 000 Y 44388 $ 254.04 $ 456.92
44391 Colonoscopy for bleeding A 0 000 Y 44388 $ 292.32 $ 514.69
44392 Colonoscopy & polypectomy A 0 000 Y 44388 $ 261.35 $ 455.53
44393 Colonoscopy lesion removal A 0 000 Y 44388 $ 327.47 $ 528.26
44394 Colonoscopy w/snare A 0 000 Y 44388 $ 300.67 $ 516.08
44397 Colonoscopy w/stent A 0 000 Y 44388 $ 317.72 $ -
44500 Intro gastrointestinal tube A 0 000 $ 26.45 $ -
4450F Self-care ed provided to pt M 9 XXX $ - $ -
44602 Suture small intestine A 0 090 Y Y $ 1,739.65 $ -
44603 Suture small intestine A 0 090 Y Y $ 1,988.82 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
44604 Suture large intestine A 0 090 Y Y $ 1,297.34 $ -

44605 Repair of bowel lesion A 0 090 Y Y $ 1,602.19 $ -
44615 Intestinal stricturoplasty A 0 090 Y Y $ 1,314.74 $ -
44620 Repair bowel opening A 0 090 Y Y $ 1,043.30 $ -
44640 Repair bowel-skin fistula A 0 090 Y Y $ 1,719.82 $ -
44650 Repair bowel fistula A 0 090 Y Y $ 1,779.32 $ -
44660 Repair bowel-bladder fistula A 0 090 Y Y $ 1,576.79 $ -
44661 Repair bowel-bladder fistula A 0 090 Y Y $ 1,881.29 $ -
44680 Surgical revision intestine A 0 090 Y Y $ 1,322.75 $ -
44700 Suspend bowel w/prosthesis A 0 090 Y Y $ 1,204.08 $ -
44701 Intraop colon lavage add-on A 0 ZZZ Y $ 207.06 $ -
4470F Icd counseling provided M 9 XXX $ - $ -
44715 Prepare donor intestine C 0 XXX Y Y $ - $ -
44720 Prep donor intestine/venous A 0 XXX Y Y $ 262.04 $ -
44721 Prep donor intestine/artery A 0 XXX Y Y $ 487.90 $ -
44799 Unlisted procedure intestine C 0 YYY Y Y $ - $ -
44800 Excision of bowel pouch A 0 090 Y Y $ 911.06 $ -
4480F Pt rcvng ace/arb b-blockertx M 9 XXX $ - $ -
4481F Pt rcvng ace/arb blker<3mons M 9 XXX $ - $ -
44820 Excision of mesentery lesion A 0 090 Y Y $ 1,016.51 $ -
44850 Repair of mesentery A 0 090 Y Y $ 906.19 $ -
44899 Bowel surgery procedure C 0 YYY Y Y Y $ - $ -
44900 Drain app abscess open A 0 090 Y Y $ 937.51 $ -
44901 Drain app abscess percut A 0 000 Y $ 190.01 $ 841.46
44950 Appendectomy A 0 090 Y Y $ 783.35 $ -
44955 Appendectomy add-on A 0 ZZZ Y $ 105.10 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
44960 Appendectomy A 0 090 Y Y $ 1,069.75 $ -

44970 Laparoscopy appendectomy A 0 090 Y Y Y $ 718.97 $ -
44979 Laparoscope proc app C 0 YYY Y Y Y Y $ - $ -
45000 Drainage of pelvic abscess A 0 090 Y $ 479.54 $ -
45005 Drainage of rectal abscess A 0 010 Y $ 176.09 $ 269.35
4500F Ref to outpt card rehab prog M 9 XXX $ - $ -
45020 Drainage of rectal abscess A 0 090 Y $ 658.42 $ -
45100 Biopsy of rectum A 0 090 Y $ 332.69 $ -
45108 Removal of anorectal lesion A 0 090 Y $ 427.34 $ -
4510F Prev cardrehab qualcardevent M 9 XXX $ - $ -
45110 Removal of rectum A 0 090 Y Y $ 2,211.54 $ -
45111 Partial removal of rectum A 0 090 Y Y $ 1,310.57 $ -
45113 Partial proctectomy A 0 090 Y Y $ 2,440.52 $ -
45119 Remove rectum w/reservoir A 0 090 Y Y $ 2,311.07 $ -
45121 Removal of rectum and colon A 0 090 Y Y $ 2,131.50 $ -
45123 Partial proctectomy A 0 090 Y Y $ 1,303.26 $ -
45126 Pelvic exenteration A 0 090 Y Y $ 3,560.04 $ -
45130 Excision of rectal prolapse A 0 090 Y Y $ 1,277.16 $ -
45135 Excision of rectal prolapse A 0 090 Y Y $ 1,663.79 $ -
45136 Excise ileoanal reservior A 0 090 Y Y $ 2,057.72 $ -
45150 Excision of rectal stricture A 0 090 Y $ 430.82 $ -
45160 Excision of rectal lesion A 0 090 Y Y $ 1,231.22 $ -
45171 Exc rect tum transanal part A 0 090 Y Y $ 683.47 $ -
45172 Exc rect tum transanal full A 0 090 Y Y $ 945.52 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
45190 Destruction rectal tumor A 0 090 Y $ 790.31 $ -

4525F Neuropsychia interven order M 9 XXX $ - $ -
4526F Neuropsychia interven rcvd M 9 XXX $ - $ -
45300 Proctosigmoidoscopy dx A 0 000 Y $ 59.51 $ 116.58
45303 Proctosigmoidoscopy dilate A 0 000 Y 45300 $ 106.84 $ 827.54
45305 Proctosigmoidoscopy w/bx A 0 000 Y 45300 $ 92.92 $ 191.05
45307 Proctosigmoidoscopy fb A 0 000 Y 45300 $ 124.24 $ 228.98
45308 Proctosigmoidoscopy removal A 0 000 Y 45300 $ 103.01 $ 204.28
45317 Proctosigmoidoscopy bleed A 0 000 Y 45300 $ 137.81 $ 240.82
45320 Proctosigmoidoscopy ablate A 0 000 Y 45300 $ 127.02 $ 237.68
45321 Proctosigmoidoscopy volvul A 0 000 Y 45300 $ 128.41 $ -
45327 Proctosigmoidoscopy w/stent A 0 000 Y 45300 $ 149.99 $ -
45330 Diagnostic sigmoidoscopy A 0 000 Y $ 70.99 $ 137.81
45331 Sigmoidoscopy and biopsy A 0 000 Y 45330 $ 86.30 $ 166.00
45332 Sigmoidoscopy w/fb removal A 0 000 Y 45330 $ 129.11 $ 287.45
45333 Sigmoidoscopy & polypectomy A 0 000 Y 45330 $ 128.41 $ 290.93
45334 Sigmoidoscopy for bleeding A 0 000 Y 45330 $ 187.57 $ -
45335 Sigmoidoscopy w/submuc inj A 0 000 Y 45330 $ 106.49 $ 261.35
45337 Sigmoidoscopy & decompress A 0 000 Y 45330 $ 166.34 $ -
45338 Sigmoidoscopy w/tumr remove A 0 000 Y 45330 $ 162.86 $ 319.46
45339 Sigmoidoscopy w/ablate tumr A 0 000 Y 45330 $ 216.46 $ 350.78
45340 Sig w/balloon dilation A 0 000 Y 45330 $ 135.02 $ 452.40
45341 Sigmoidoscopy w/ultrasound A 0 000 Y $ 179.92 $ -
45342 Sigmoidoscopy w/us guide bx A 0 000 Y $ 277.01 $ -
45345 Sigmoidoscopy w/stent A 0 000 Y 45330 $ 201.49 $ -
45355 Surgical colonoscopy A 0 000 Y $ 243.25 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
45378 Diagnostic colonoscopy A 0 000 Y $ 255.08 $ 409.60

45378 53 Diagnostic colonoscopy A 0 000 Y $ 70.99 $ 137.81
45379 Colonoscopy w/fb removal A 0 000 Y 45378 $ 317.72 $ 519.91
45380 Colonoscopy and biopsy A 0 000 Y 45378 $ 302.06 $ 485.81
45381 Colonoscopy submucous inj A 0 000 Y 45378 $ 286.06 $ 479.89
45382 Colonoscopy/control bleeding A 0 000 Y 45378 $ 383.84 $ 630.92
45383 Lesion removal colonoscopy A 0 000 Y 45378 $ 394.98 $ 596.47
45384 Lesion remove colonoscopy A 0 000 Y 45378 $ 318.07 $ 488.94
45385 Lesion removal colonoscopy A 0 000 Y 45378 $ 359.14 $ 551.93
45386 Colonoscopy dilate stricture A 0 000 Y 45378 $ 312.50 $ 666.77
45387 Colonoscopy w/stent A 0 000 Y 45378 $ 400.90 $ -
45391 Colonoscopy w/endoscope us A 0 000 Y 45378 $ 341.04 $ -
45392 Colonoscopy w/endoscopic fnb A 0 000 Y 45378 $ 445.79 $ -
45395 Lap removal of rectum A 0 090 Y Y $ 2,352.48 $ -
45397 Lap remove rectum w/pouch A 0 090 Y Y $ 2,504.56 $ -
45400 Laparoscopic proc A 0 090 Y Y $ 1,373.90 $ -
45402 Lap proctopexy w/sig resect A 0 090 Y Y $ 1,832.92 $ -
45499 Laparoscope proc rectum C 0 YYY Y Y Y $ - $ -
45500 Repair of rectum A 0 090 Y $ 582.20 $ -
45505 Repair of rectum A 0 090 Y $ 664.68 $ -
45520 Treatment of rectal prolapse A 0 000 Y $ 42.46 $ 136.42
45540 Correct rectal prolapse A 0 090 Y Y $ 1,247.93 $ -
45541 Correct rectal prolapse A 0 090 Y Y $ 1,074.62 $ -
45550 Repair rectum/remove sigmoid A 0 090 Y Y $ 1,738.96 $ -
45560 Repair of rectocele A 0 090 Y Y $ 802.49 $ -
45562 Exploration/repair of rectum A 0 090 Y Y $ 1,312.66 $ -
45563 Exploration/repair of rectum A 0 090 Y Y $ 1,992.30 $ -
45800 Repair rect/bladder fistula A 0 090 Y Y $ 1,401.40 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
45805 Repair fistula w/colostomy A 0 090 Y Y $ 1,766.45 $ -

45820 Repair rectourethral fistula A 0 090 Y Y $ 1,253.50 $ -
45825 Repair fistula w/colostomy A 0 090 Y Y $ 1,647.08 $ -
45900 Reduction of rectal prolapse A 0 010 Y $ 232.46 $ -
45905 Dilation of anal sphincter A 0 010 Y $ 188.96 $ -
45910 Dilation of rectal narrowing A 0 010 Y $ 220.28 $ -
45915 Remove rectal obstruction A 0 010 Y $ 249.52 $ 334.43
45990 Surg dx exam anorectal A 0 000 Y Y $ 125.63 $ -
45999 Rectum surgery procedure C 0 YYY Y Y $ - $ -
46020 Placement of seton A 0 010 Y $ 257.17 $ 290.58
46030 Removal of rectal marker A 0 010 Y $ 101.96 $ 141.98
46040 Incision of rectal abscess A 0 090 Y $ 462.14 $ 559.58
46045 Incision of rectal abscess A 0 090 Y $ 489.29 $ -
46050 Incision of anal abscess A 0 010 Y $ 108.58 $ 194.18
46060 Incision of rectal abscess A 0 090 Y $ 529.31 $ -
46070 Incision of anal septum A 0 090 Y $ 230.72 $ -
46080 Incision of anal sphincter A 0 010 Y $ 188.62 $ 262.04
46083 Incise external hemorrhoid A 0 010 Y $ 117.97 $ 177.13
46200 Removal of anal fissure A 0 090 Y $ 342.08 $ 437.09
46220 Excise anal ext tag/papilla A 0 010 Y $ 133.63 $ 205.67
46221 Ligation of hemorrhoid(s) A 0 010 Y $ 207.06 $ 270.74
46230 Removal of anal tags A 0 010 Y $ 199.40 $ 282.58
46250 Remove ext hem groups 2+ A 0 090 Y $ 353.92 $ 474.67
46255 Remove int/ext hem 1 group A 0 090 Y $ 401.94 $ 527.92
46257 Remove in/ex hem grp & fiss A 0 090 Y $ 472.93 $ -
46258 Remove in/ex hem grp w/fistu A 0 090 Y $ 538.01 $ -
46260 Remove in/ex hem groups 2+ A 0 090 Y $ 538.01 $ -
46261 Remove in/ex hem grps & fiss A 0 090 Y $ 596.47 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
46262 Remove in/ex hem grps w/fist A 0 090 Y $ 625.01 $ -

46270 Remove anal fist subq A 0 090 Y $ 434.30 $ 528.61
46275 Remove anal fist inter A 0 090 Y $ 455.53 $ 555.41
46280 Remove anal fist complex A 0 090 Y $ 519.56 $ -
46285 Remove anal fist 2 stage A 0 090 Y $ 447.53 $ 543.23
46288 Repair anal fistula A 0 090 Y $ 609.35 $ -
46320 Removal of hemorrhoid clot A 0 010 Y $ 127.02 $ 186.88
46500 Injection into hemorrhoid(s) A 0 010 Y $ 141.64 $ 229.33
46505 Chemodenervation anal musc A 0 010 Y Y $ 267.61 $ 306.24
46600 Diagnostic anoscopy A 0 000 Y $ 43.50 $ 83.17
46604 Anoscopy and dilation A 0 000 Y 46600 $ 74.47 $ 529.31
46606 Anoscopy and biopsy A 0 000 Y 46600 $ 90.48 $ 215.76
46608 Anoscopy remove for body A 0 000 Y 46600 $ 95.00 $ 223.76
46610 Anoscopy remove lesion A 0 000 Y 46600 $ 95.35 $ 218.20
46611 Anoscopy A 0 000 Y 46600 $ 95.70 $ 174.70
46612 Anoscopy remove lesions A 0 000 Y 46600 $ 114.14 $ 258.22
46614 Anoscopy control bleeding A 0 000 Y 46600 $ 72.04 $ 124.93
46615 Anoscopy A 0 000 Y 46600 $ 112.06 $ 155.90
46700 Repair of anal stricture A 0 090 Y $ 733.93 $ -
46705 Repair of anal stricture A 0 090 Y Y $ 508.43 $ -
46706 Repr of anal fistula w/glue A 0 010 Y $ 187.92 $ -
46707 Repair anorectal fist w/plug A 0 090 Y $ 502.86 $ -
46710 Repr per/vag pouch sngl proc A 0 090 Y Y $ 1,319.62 $ -
46712 Repr per/vag pouch dbl proc A 0 090 Y Y $ 2,105.40 $ -
46715 Rep perf anoper fistu A 0 090 Y Y $ 494.51 $ -
46716 Rep perf anoper/vestib fistu A 0 090 Y Y $ 1,152.23 $ -
46730 Construction of absent anus A 0 090 Y Y $ 1,843.01 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

46742 Repair of imperforated anus A 0 090 Y Y $ 2,969.14 $ -
46744 Repair of cloacal anomaly A 0 090 Y Y $ 3,821.04 $ -
46750 Repair of anal sphincter A 0 090 Y Y $ 870.70 $ -
46751 Repair of anal sphincter A 0 090 Y Y $ 690.78 $ -
46753 Reconstruction of anus A 0 090 Y $ 664.33 $ -
46754 Removal of suture from anus A 0 010 Y $ 244.30 $ 301.37
46760 Repair of anal sphincter A 0 090 Y Y $ 1,212.78 $ -
46761 Repair of anal sphincter A 0 090 Y Y $ 1,066.62 $ -
46762 Implant artificial sphincter A 0 090 Y Y $ 1,028.34 $ -
46900 Destruction anal lesion(s) A 0 010 Y $ 151.73 $ 236.29
46916 Cryosurgery anal lesion(s) A 0 010 Y $ 155.56 $ 229.33
46917 Laser surgery anal lesions A 0 010 Y $ 150.68 $ 430.82
46922 Excision of anal lesion(s) A 0 010 Y $ 153.12 $ 262.04
46930 Destroy internal hemorrhoids A 0 090 Y $ 156.95 $ 206.02
46940 Treatment of anal fissure A 0 010 Y $ 166.69 $ 234.20
46942 Treatment of anal fissure A 0 010 Y $ 148.94 $ 216.80
46945 Remove by ligat int hem grp A 0 090 Y $ 232.46 $ 299.28
46946 Remove by ligat int hem grps A 0 090 Y $ 240.12 $ 311.81
46947 Hemorrhoidopexy by stapling A 0 090 Y $ 441.26 $ -
46999 Anus surgery procedure C 0 YYY Y Y $ - $ -
47000 Needle biopsy of liver A 0 000 Y $ 113.10 $ 252.30
47001 Needle biopsy liver add-on A 0 ZZZ $ 128.76 $ -
47010 Open drainage liver lesion A 0 090 Y Y $ 1,441.07 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
47011 Percut drain liver lesion A 0 000 Y $ 203.58 $ -

47015 Inject/aspirate liver cyst A 0 090 Y Y $ 1,402.44 $ -
47100 Wedge biopsy of liver A 0 090 Y Y $ 1,001.89 $ -
47120 Partial removal of liver A 0 090 Y Y $ 2,849.08 $ -
47122 Extensive removal of liver A 0 090 Y Y $ 4,248.38 $ -
47133 Removal of donor liver C 9 XXX $ - $ -
47135 Transplantation of liver A 0 090 Y Y Y $ 6,043.37 $ -
47136 Transplantation of liver A 0 090 Y Y Y $ 5,116.30 $ -
47140 Partial removal donor liver A 0 090 Y Y Y $ 4,323.20 $ -
47141 Partial removal donor liver A 0 090 Y Y Y $ 4,065.68 $ -
47142 Partial removal donor liver A 0 090 Y Y $ 5,789.68 $ -
47143 Prep donor liver whole C 0 XXX Y Y $ - $ -
47144 Prep donor liver 3-segment C 0 090 Y Y $ - $ -
47145 Prep donor liver lobe split C 0 XXX Y Y $ - $ -
47146 Prep donor liver/venous A 0 XXX Y Y $ 416.90 $ -
47147 Prep donor liver/arterial A 0 XXX Y Y $ 485.11 $ -
47300 Surgery for liver lesion A 0 090 Y Y $ 1,369.03 $ -
47350 Repair liver wound A 0 090 Y Y $ 1,666.22 $ -
47370 Laparo ablate liver tumor rf A 0 090 Y Y $ 1,499.53 $ -
47371 Laparo ablate liver cryosurg A 0 090 Y Y $ 1,541.99 $ -
47379 Laparoscope procedure liver C 0 YYY Y Y Y $ - $ -
47380 Open ablate liver tumor rf A 0 090 Y Y $ 1,746.61 $ -
47381 Open ablate liver tumor cryo A 0 090 Y Y $ 1,824.22 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
47382 Percut ablate liver rf A 0 010 Y $ 865.48 $ 4,357.66

47399 Liver surgery procedure C 0 YYY Y Y $ - $ -
47400 Incision of liver duct A 0 090 Y Y $ 2,651.76 $ -
47420 Incision of bile duct A 0 090 Y Y $ 1,635.60 $ -
47425 Incision of bile duct A 0 090 Y Y $ 1,664.48 $ -
47460 Incise bile duct sphincter A 0 090 Y Y $ 1,545.47 $ -
47480 Incision of gallbladder A 0 090 Y Y $ 1,032.86 $ -
47490 Incision of gallbladder A 0 010 Y $ 353.57 $ -
47500 Injection for liver x-rays A 0 000 Y $ 109.62 $ -
47505 Injection for liver x-rays A 0 000 Y $ 41.76 $ -
47510 Insert catheter bile duct A 0 090 Y $ 508.43 $ -
47511 Insert bile duct drain A 0 090 Y Y $ 633.01 $ -
47525 Change bile duct catheter A 0 000 Y Y $ 96.40 $ 454.14
47530 Revise/reinsert bile tube A 0 090 Y $ 382.45 $ 1,303.26
47550 Bile duct endoscopy add-on A 0 ZZZ Y $ 208.10 $ -
47552 Biliary endoscopy thru skin A 0 000 Y $ 351.83 $ -
47553 Biliary endoscopy thru skin A 0 000 Y 47552 $ 353.22 $ -
47560 Laparoscopy w/cholangio A 0 000 Y $ 340.34 $ -
47561 Laparo w/cholangio/biopsy A 0 000 Y $ 367.84 $ -
47562 Laparoscopic cholecystectomy A 0 090 Y Y $ 899.93 $ -
47563 Laparo cholecystectomy/graph A 0 090 Y Y $ 867.56 $ -
47564 Laparo cholecystectomy/explr A 0 090 Y Y $ 1,336.67 $ -
47570 Laparo cholecystoenterostomy A 0 090 Y Y $ 941.69 $ -
47579 Laparoscope proc biliary C 0 YYY Y Y Y Y $ - $ -
47600 Removal of gallbladder A 0 090 Y Y $ 1,311.61 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

47630 Remove bile duct stone A 0 090 Y $ 615.96 $ -
47700 Exploration of bile ducts A 0 090 Y Y $ 1,267.07 $ -
47701 Bile duct revision A 0 090 Y $ 2,133.94 $ -
47711 Excision of bile duct tumor A 0 090 Y Y $ 1,903.91 $ -
47712 Excision of bile duct tumor A 0 090 Y Y $ 2,461.75 $ -
47715 Excision of bile duct cyst A 0 090 Y Y $ 1,615.42 $ -
47720 Fuse gallbladder & bowel A 0 090 Y Y $ 1,389.22 $ -
47721 Fuse upper gi structures A 0 090 Y Y $ 1,647.08 $ -
47760 Fuse bile ducts and bowel A 0 090 Y Y $ 2,766.60 $ -
47765 Fuse liver ducts & bowel A 0 090 Y Y $ 3,749.00 $ -
47800 Reconstruction of bile ducts A 0 090 Y Y $ 1,934.53 $ -
47801 Placement bile duct support A 0 090 Y Y $ 1,159.54 $ -
47802 Fuse liver duct & intestine A 0 090 Y Y $ 1,859.71 $ -
47900 Suture bile duct injury A 0 090 Y Y $ 1,658.57 $ -
47999 Bile tract surgery procedure C 0 YYY Y Y $ - $ -
48000 Drainage of abdomen A 0 090 Y Y $ 2,239.38 $ -
48001 Placement of drain pancreas A 0 090 Y Y $ 2,862.65 $ -
48020 Removal of pancreatic stone A 0 090 Y Y $ 1,432.37 $ -
48100 Biopsy of pancreas open A 0 090 Y Y $ 1,071.49 $ -
48102 Needle biopsy pancreas A 0 010 Y $ 266.92 $ 520.26

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
48105 Resect/debride pancreas A 0 090 Y Y $ 3,521.41 $ -

48120 Removal of pancreas lesion A 0 090 Y Y $ 1,351.28 $ -
48140 Partial removal of pancreas A 0 090 Y Y $ 1,915.74 $ -
48146 Pancreatectomy A 0 090 Y Y $ 2,285.32 $ -
48148 Removal of pancreatic duct A 0 090 Y Y $ 1,519.02 $ -
48155 Removal of pancreas A 0 090 Y Y $ 2,204.58 $ -
48160 Pancreas removal/transplant A 9 XXX $ - $ -
48400 Injection intraop add-on A 0 ZZZ $ 127.72 $ -
48500 Surgery of pancreatic cyst A 0 090 Y Y $ 1,386.08 $ -
48510 Drain pancreatic pseudocyst A 0 090 Y Y $ 1,300.13 $ -
48511 Drain pancreatic pseudocyst A 0 000 Y $ 220.63 $ 851.21
48520 Fuse pancreas cyst and bowel A 0 090 Y Y $ 1,338.41 $ -
48540 Fuse pancreas cyst and bowel A 0 090 Y Y $ 1,607.41 $ -
48545 Pancreatorrhaphy A 0 090 Y Y $ 1,644.30 $ -
48547 Duodenal exclusion A 0 090 Y Y $ 2,206.67 $ -
48548 Fuse pancreas and bowel A 0 090 Y Y $ 2,047.28 $ -
48550 Donor pancreatectomy C 9 XXX $ - $ -
48551 Prep donor pancreas C 0 XXX Y Y $ - $ -
48552 Prep donor pancreas/venous A 0 XXX Y Y $ 296.84 $ -
48554 Transpl allograft pancreas R 0 090 Y Y Y Y $ 3,010.55 $ -
48556 Removal allograft pancreas A 0 090 Y Y Y Y $ 1,520.06 $ -
48999 Pancreas surgery procedure C 0 YYY Y Y Y $ - $ -
49000 Exploration of abdomen A 0 090 Y Y $ 930.20 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
49002 Reopening of abdomen A 0 090 Y Y $ 1,276.81 $ -

49010 Exploration behind abdomen A 0 090 Y Y $ 1,147.70 $ -
49020 Drain abdominal abscess A 0 090 Y Y $ 1,931.75 $ -
49021 Drain abdominal abscess A 0 000 Y $ 185.14 $ 805.27
49040 Drain open abdom abscess A 0 090 Y Y $ 1,214.87 $ -
49041 Drain percut abdom abscess A 0 000 Y $ 220.28 $ 841.46
49060 Drain open retrop abscess A 0 090 Y $ 1,335.62 $ -
49061 Drain percut retroper absc A 0 000 Y $ 202.54 $ 819.19
49062 Drain to peritoneal cavity A 0 090 Y Y $ 897.84 $ -
49082 Abd paracentesis A 0 000 Y $ 74.47 $ 153.82
49083 Abd paracentesis w/imaging A 0 000 Y $ 115.88 $ 286.75
49084 Peritoneal lavage A 0 000 Y $ 108.23 $ -
49180 Biopsy abdominal mass A 0 000 Y $ 95.35 $ 158.69
49203 Exc abd tum 5 cm or less A 0 090 Y Y $ 1,441.07 $ -
49204 Exc abd tum over 5 cm A 0 090 Y Y $ 1,844.05 $ -
49205 Exc abd tum over 10 cm A 0 090 Y Y $ 2,133.94 $ -
49215 Excise sacral spine tumor A 0 090 Y Y $ 2,683.78 $ -
49220 Multiple surgery abdomen A 0 090 Y Y $ 1,185.29 $ -
49250 Excision of umbilicus A 0 090 Y $ 692.87 $ -
49255 Removal of omentum A 0 090 Y Y $ 945.86 $ -
49320 Diag laparo separate proc A 0 010 Y Y $ 389.76 $ -
49321 Laparoscopy biopsy A 0 010 Y Y Y 49320 $ 415.86 $ -
49322 Laparoscopy aspiration A 0 010 Y Y Y 49320 $ 442.66 $ -
49323 Laparo drain lymphocele A 0 090 Y Y Y 49320 $ 778.48 $ -
49324 Lap insert tunnel ip cath A 0 010 Y Y Y 49320 $ 477.80 $ -
49325 Lap revision perm ip cath A 0 010 Y Y Y 49320 $ 514.69 $ -
49326 Lap w/omentopexy add-on A 0 ZZZ Y $ 239.08 $ -
49327 Lap ins device for rt A 0 ZZZ Y $ 163.21 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
49329 Laparo proc abdm/per/oment C 0 YYY Y Y Y Y $ - $ -

49400 Air injection into abdomen A 0 000 Y $ 111.01 $ 153.47
49402 Remove foreign body adbomen A 0 090 Y $ 1,036.00 $ -
49411 Ins mark abd/pel for rt perq A 0 000 Y $ 212.63 $ 517.82
49412 Ins device for rt guide open A 0 ZZZ $ 101.62 $ -
49418 Insert tun ip cath perc A 0 000 Y $ 269.35 $ 1,423.32
49419 Insert tun ip cath w/port A 0 090 Y $ 512.26 $ -
49421 Ins tun ip cath for dial opn A 0 000 Y $ 303.11 $ -
49422 Remove tunneled ip cath A 0 010 Y $ 464.93 $ -
49423 Exchange drainage catheter A 0 000 Y $ 79.34 $ 503.21
49424 Assess cyst contrast inject A 0 000 Y $ 42.80 $ 137.46
49425 Insert abdomen-venous drain A 0 090 Y Y $ 926.03 $ -
49426 Revise abdomen-venous shunt A 0 090 Y $ 763.86 $ -
49427 Injection abdominal shunt A 0 000 Y $ 51.16 $ -
49428 Ligation of shunt A 0 010 Y $ 565.50 $ -
49429 Removal of shunt A 0 010 Y $ 549.49 $ -
49435 Insert subq exten to ip cath A 0 ZZZ Y $ 151.38 $ -
49436 Embedded ip cath exit-site A 0 010 Y Y $ 220.98 $ -
49440 Place gastrostomy tube perc A 0 010 Y $ 253.34 $ 983.10
49441 Place duod/jej tube perc A 0 010 Y $ 287.80 $ 1,090.98
49442 Place cecostomy tube perc A 0 010 Y $ 234.20 $ 886.70
49446 Change g-tube to g-j perc A 0 000 Y $ 182.35 $ 905.84
49450 Replace g/c tube perc A 0 000 Y $ 73.78 $ 608.30
49451 Replace duod/jej tube perc A 0 000 Y $ 104.75 $ 648.67
49452 Replace g-j tube perc A 0 000 Y $ 157.99 $ 805.62
49460 Fix g/colon tube w/device A 0 000 Y $ 54.29 $ 675.47
49465 Fluoro exam of g/colon tube A 0 000 Y $ 33.06 $ 155.21
49491 Rpr hern preemie reduc A 0 090 Y Y Y $ 937.51 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
49492 Rpr ing hern premie blocked A 0 090 Y Y Y $ 1,160.23 $ -

49495 Rpr ing hernia baby reduc A 0 090 Y Y Y $ 485.81 $ -
49496 Rpr ing hernia baby blocked A 0 090 Y Y Y $ 738.80 $ -
49500 Rpr ing hernia init reduce A 0 090 Y Y Y $ 478.50 $ -
49501 Rpr ing hernia init blocked A 0 090 Y Y Y $ 723.84 $ -
49505 Prp i/hern init reduc >5 yr A 0 090 Y Y Y $ 617.70 $ -
49507 Prp i/hern init block >5 yr A 0 090 Y Y Y $ 702.96 $ -
49520 Rerepair ing hernia reduce A 0 090 Y Y Y $ 759.34 $ -
49521 Rerepair ing hernia blocked A 0 090 Y Y Y $ 865.48 $ -
49525 Repair ing hernia sliding A 0 090 Y Y Y $ 684.52 $ -
49540 Repair lumbar hernia A 0 090 Y Y Y $ 810.84 $ -
49550 Rpr rem hernia init reduce A 0 090 Y Y Y $ 689.39 $ -
49553 Rpr fem hernia init blocked A 0 090 Y Y Y $ 758.99 $ -
49555 Rerepair fem hernia reduce A 0 090 Y Y Y $ 717.92 $ -
49557 Rerepair fem hernia blocked A 0 090 Y Y Y $ 874.18 $ -
49560 Rpr ventral hern init reduc A 0 090 Y Y Y $ 890.18 $ -
49561 Rpr ventral hern init block A 0 090 Y Y Y $ 1,134.13 $ -
49565 Rerepair ventrl hern reduce A 0 090 Y Y Y $ 928.81 $ -
49566 Rerepair ventrl hern block A 0 090 Y Y Y $ 1,148.05 $ -
49568 Hernia repair w/mesh A 0 ZZZ Y $ 337.91 $ -
49570 Rpr epigastric hern reduce A 0 090 Y Y Y $ 488.94 $ -
49572 Rpr epigastric hern blocked A 0 090 Y Y Y $ 611.78 $ -
49580 Rpr umbil hern reduc < 5 yr A 0 090 Y Y $ 381.76 $ -
49582 Rpr umbil hern block < 5 yr A 0 090 Y Y $ 569.33 $ -
49585 Rpr umbil hern reduc > 5 yr A 0 090 Y Y $ 522.70 $ -
49587 Rpr umbil hern block > 5 yr A 0 090 Y Y $ 563.06 $ -
49590 Repair spigelian hernia A 0 090 Y Y Y $ 684.86 $ -
49600 Repair umbilical lesion A 0 090 Y Y $ 881.48 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
49605 Repair umbilical lesion A 0 090 Y Y $ 6,185.35 $ -

49606 Repair umbilical lesion A 0 090 Y Y $ 1,393.04 $ -
49650 Lap ing hernia repair init A 0 090 Y Y Y $ 504.25 $ -
49651 Lap ing hernia repair recur A 0 090 Y Y Y $ 660.85 $ -
49652 Lap vent/abd hernia repair A 0 090 Y Y Y $ 706.79 $ -
49653 Lap vent/abd hern proc comp A 0 090 Y Y Y $ 886.01 $ -
49654 Lap inc hernia repair A 0 090 Y Y Y $ 806.32 $ -
49655 Lap inc hern repair comp A 0 090 Y Y Y $ 984.84 $ -
49656 Lap inc hernia repair recur A 0 090 Y Y Y $ 875.22 $ -
49657 Lap inc hern recur comp A 0 090 Y Y Y $ 1,261.15 $ -
49659 Laparo proc hernia repair C 0 YYY Y Y Y Y $ - $ -
49900 Repair of abdominal wall A 0 090 Y Y $ 964.66 $ -
49904 Omental flap extra-abdom A 0 090 Y Y $ 1,754.96 $ -
49905 Omental flap intra-abdom A 0 ZZZ Y Y $ 435.70 $ -
49906 Free omental flap microvasc C 0 090 Y $ - $ -
49999 Abdomen surgery procedure C 0 YYY Y Y $ - $ -
50010 Exploration of kidney A 0 090 Y Y $ 837.98 $ -
50020 Renal abscess open drain A 0 090 Y $ 1,185.64 $ -
50021 Renal abscess percut drain A 0 000 Y $ 184.79 $ 852.60
50040 Drainage of kidney A 0 090 Y $ 1,014.77 $ -
50045 Exploration of kidney A 0 090 Y Y $ 1,012.33 $ -
5005F Pt counsld on exam for moles M 9 XXX $ - $ -
50060 Removal of kidney stone A 0 090 Y Y $ 1,244.45 $ -
50065 Incision of kidney A 0 090 Y Y $ 1,319.62 $ -
50070 Incision of kidney A 0 090 Y Y $ 1,324.84 $ -
50075 Removal of kidney stone A 0 090 Y Y $ 1,599.41 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
50080 Removal of kidney stone A 0 090 Y Y $ 951.08 $ -

50081 Removal of kidney stone A 0 090 Y Y Y $ 1,401.05 $ -
50100 Revise kidney blood vessels A 0 090 Y Y $ 1,168.58 $ -
5010F Macul result to phy mng dm M 9 XXX $ - $ -
50120 Exploration of kidney A 0 090 Y Y Y $ 1,032.52 $ -
50125 Explore and drain kidney A 0 090 Y Y Y $ 1,108.38 $ -
50130 Removal of kidney stone A 0 090 Y Y Y $ 1,127.17 $ -
50135 Exploration of kidney A 0 090 Y Y Y $ 1,225.31 $ -
5015F Doc fx & test/txmnt for op M 9 XXX $ - $ -
50200 Renal biopsy perq A 0 000 Y Y $ 161.82 $ 552.28
50205 Renal biopsy open A 0 090 Y Y Y $ 900.62 $ -
5020F Txmnts 2 main Dr by 1 mon M 9 XXX $ - $ -
50220 Remove kidney open A 0 090 Y Y Y $ 1,172.76 $ -
50225 Removal kidney open complex A 0 090 Y Y Y $ 1,328.66 $ -
50230 Removal kidney open radical A 0 090 Y Y Y Y $ 1,417.06 $ -
50234 Removal of kidney & ureter A 0 090 Y Y $ 1,434.11 $ -
50236 Removal of kidney & ureter A 0 090 Y Y $ 1,606.02 $ -
50240 Partial removal of kidney A 0 090 Y Y $ 1,452.55 $ -
50250 Cryoablate renal mass open A 0 090 Y Y $ 1,335.62 $ -
50280 Removal of kidney lesion A 0 090 Y Y $ 1,056.18 $ -
50290 Removal of kidney lesion A 0 090 Y Y $ 969.18 $ -
50300 Remove cadaver donor kidney C 9 XXX $ - $ -
50320 Remove kidney living donor A 0 090 Y Y Y $ 1,652.65 $ -
50323 Prep cadaver renal allograft C 0 XXX Y Y $ - $ -
50325 Prep donor renal graft C 0 XXX Y Y $ - $ -
50327 Prep renal graft/venous A 0 XXX Y Y $ 269.00 $ -
50328 Prep renal graft/arterial A 0 XXX Y Y $ 234.55 $ -
50329 Prep renal graft/ureteral A 0 XXX Y Y $ 205.67 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
50340 Removal of kidney A 0 090 Y Y Y $ 1,122.30 $ -

50360 Transplantation of kidney A 0 090 Y Y Y Y $ 3,069.01 $ -
50365 Transplantation of kidney A 0 090 Y Y Y Y Y $ 3,490.09 $ -
50370 Remove transplanted kidney A 0 090 Y Y $ 1,420.54 $ -
50380 Reimplantation of kidney A 0 090 Y Y $ 2,392.85 $ -
50382 Change ureter stent percut A 0 000 Y Y $ 304.50 $ 1,136.22
50384 Remove ureter stent percut A 0 000 Y Y $ 277.36 $ 938.90
50385 Change stent via transureth A 0 000 Y Y $ 256.82 $ 1,091.33
50386 Remove stent via transureth A 0 000 Y Y $ 193.14 $ 714.44
50387 Change ext/int ureter stent A 0 000 Y Y $ 111.36 $ 521.30
50389 Remove renal tube w/fluoro A 0 000 Y Y $ 60.20 $ 282.23
50390 Drainage of kidney lesion A 0 000 Y Y $ 107.53 $ -
50391 Instll rx agnt into rnal tub A 0 000 Y $ 111.01 $ 131.89
50392 Insert kidney drain A 0 000 Y Y $ 195.23 $ -
50393 Insert ureteral tube A 0 000 Y Y $ 237.68 $ -
50394 Injection for kidney x-ray A 0 000 Y Y $ 51.85 $ 96.74
50395 Create passage to kidney A 0 000 Y Y $ 198.36 $ -
50396 Measure kidney pressure A 0 000 Y Y $ 126.67 $ -
50398 Change kidney tube A 0 000 Y Y $ 79.34 $ 465.62
50400 Revision of kidney/ureter A 0 090 Y Y $ 1,269.16 $ -
50405 Revision of kidney/ureter A 0 090 Y Y $ 1,529.46 $ -
50500 Repair of kidney wound A 0 090 Y Y $ 1,571.22 $ -
5050F Plan 2 main dr by 1 month M 9 XXX $ - $ -
50520 Close kidney-skin fistula A 0 090 Y Y $ 1,129.96 $ -
50525 Repair renal-abdomen fistula A 0 090 Y Y $ 1,763.32 $ -
50526 Repair renal-abdomen fistula A 0 090 Y Y $ 1,485.26 $ -
50540 Revision of horseshoe kidney A 0 090 Y Y $ 1,248.62 $ -
50541 Laparo ablate renal cyst A 0 090 Y Y $ 1,011.29 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
50542 Laparo ablate renal mass A 0 090 Y Y $ 1,278.20 $ -

50543 Laparo partial nephrectomy A 0 090 Y Y Y $ 1,635.95 $ -
50544 Laparoscopy pyeloplasty A 0 090 Y Y $ 1,374.95 $ -
50545 Laparo radical nephrectomy A 0 090 Y Y Y $ 1,484.57 $ -
50546 Laparoscopic nephrectomy A 0 090 Y Y Y $ 1,327.27 $ -
50547 Laparo removal donor kidney A 0 090 Y Y Y $ 1,899.04 $ -
50548 Laparo remove w/ureter A 0 090 Y Y Y $ 1,485.96 $ -
50549 Laparoscope proc renal C 0 YYY Y Y Y Y $ - $ -
50551 Kidney endoscopy A 0 000 Y Y $ 325.03 $ 381.06
50553 Kidney endoscopy A 0 000 Y Y $ 354.26 $ 413.77
50555 Kidney endoscopy & biopsy A 0 000 Y Y 50551 $ 377.23 $ 437.78
50557 Kidney endoscopy & treatment A 0 000 Y Y 50551 $ 382.45 $ 445.09
50561 Kidney endoscopy & treatment A 0 000 Y Y 50551 $ 438.48 $ 508.08
50562 Renal scope w/tumor resect A 0 090 Y Y $ 640.67 $ -
50570 Kidney endoscopy A 0 000 Y Y $ 543.58 $ -
50572 Kidney endoscopy A 0 000 Y Y 50570 $ 591.25 $ -
50574 Kidney endoscopy & biopsy A 0 000 Y Y 50570 $ 629.18 $ -
50575 Kidney endoscopy A 0 000 Y Y 50570 $ 794.83 $ -
50576 Kidney endoscopy & treatment A 0 000 Y Y 50570 $ 626.05 $ -
50580 Kidney endoscopy & treatment A 0 000 Y Y 50570 $ 675.82 $ -
50590 Fragmenting of kidney stone A 0 090 Y Y $ 610.74 $ 823.72
50592 Perc rf ablate renal tumor A 0 010 Y Y $ 395.68 $ 2,867.87
50593 Perc cryo ablate renal tum A 0 010 Y Y Y $ 523.39 $ 4,087.61
50600 Exploration of ureter A 0 090 Y Y Y $ 1,023.82 $ -
50605 Insert ureteral support A 0 090 Y Y Y $ 1,136.22 $ -
5060F Fndngs mammo 2pt w/in 3 days M 9 XXX $ - $ -
50610 Removal of ureter stone A 0 090 Y Y Y $ 1,031.12 $ -
50620 Removal of ureter stone A 0 090 Y Y Y $ 985.88 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
5062F Mammo result com to pt 5 day M 9 XXX $ - $ -

50630 Removal of ureter stone A 0 090 Y Y Y $ 970.92 $ -
50650 Removal of ureter A 0 090 Y Y $ 1,135.52 $ -
50660 Removal of ureter A 0 090 Y Y $ 1,248.62 $ -
50684 Injection for ureter x-ray A 0 000 Y Y $ 52.20 $ 118.32
50686 Measure ureter pressure A 0 000 Y $ 104.40 $ 147.20
50688 Change of ureter tube/stent A 0 010 Y $ 83.17 $ -
50690 Injection for ureter x-ray A 0 000 Y $ 73.43 $ 97.09
50700 Revision of ureter A 0 090 Y Y $ 1,007.46 $ -
50715 Release of ureter A 0 090 Y Y Y $ 1,364.86 $ -
50722 Release of ureter A 0 090 Y Y $ 1,245.14 $ -
50725 Release/revise ureter A 0 090 Y Y $ 1,198.51 $ -
50727 Revise ureter A 0 090 Y Y Y $ 544.27 $ -
50728 Revise ureter A 0 090 Y Y Y $ 752.03 $ -
50740 Fusion of ureter & kidney A 0 090 Y Y $ 1,501.27 $ -
50750 Fusion of ureter & kidney A 0 090 Y Y $ 1,261.15 $ -
50760 Fusion of ureters A 0 090 Y Y $ 1,286.21 $ -
50770 Splicing of ureters A 0 090 Y Y $ 1,251.41 $ -
50780 Reimplant ureter in bladder A 0 090 Y Y Y $ 1,237.14 $ -
50782 Reimplant ureter in bladder A 0 090 Y Y Y Y $ 1,433.76 $ -
50783 Reimplant ureter in bladder A 0 090 Y Y Y Y $ 1,222.52 $ -
50785 Reimplant ureter in bladder A 0 090 Y Y Y $ 1,331.10 $ -
50800 Implant ureter in bowel A 0 090 Y Y Y $ 1,017.55 $ -
50810 Fusion of ureter & bowel A 0 090 Y Y $ 1,703.81 $ -
50815 Urine shunt to intestine A 0 090 Y Y Y $ 1,333.54 $ -
50820 Construct bowel bladder A 0 090 Y Y Y $ 1,465.08 $ -
50825 Construct bowel bladder A 0 090 Y Y $ 1,833.26 $ -
50830 Revise urine flow A 0 090 Y Y $ 1,975.60 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
50840 Replace ureter by bowel A 0 090 Y Y Y $ 1,342.58 $ -

50845 Appendico-vesicostomy A 0 090 Y Y $ 1,360.33 $ -
50860 Transplant ureter to skin A 0 090 Y Y Y $ 1,027.99 $ -
50900 Repair of ureter A 0 090 Y Y $ 919.07 $ -
50920 Closure ureter/skin fistula A 0 090 Y Y $ 959.09 $ -
50930 Closure ureter/bowel fistula A 0 090 Y Y $ 1,509.28 $ -
50940 Release of ureter A 0 090 Y Y Y $ 963.96 $ -
50945 Laparoscopy ureterolithotomy A 0 090 Y Y Y $ 1,065.23 $ -
50947 Laparo new ureter/bladder A 0 090 Y Y Y $ 1,515.19 $ -
50948 Laparo new ureter/bladder A 0 090 Y Y Y $ 1,400.00 $ -
50949 Laparoscope proc ureter C 0 YYY Y Y Y Y $ - $ -
50951 Endoscopy of ureter A 0 000 Y Y $ 338.26 $ 397.76
50953 Endoscopy of ureter A 0 000 Y Y 50951 $ 372.71 $ 423.52
50955 Ureter endoscopy & biopsy A 0 000 Y Y 50951 $ 400.55 $ 455.53
50957 Ureter endoscopy & treatment A 0 000 Y Y 50951 $ 391.15 $ 454.84
50961 Ureter endoscopy & treatment A 0 000 Y Y 50951 $ 351.13 $ 410.64
50970 Ureter endoscopy A 0 000 Y Y $ 409.25 $ -
50972 Ureter endoscopy & catheter A 0 000 Y Y $ 396.72 $ -
50974 Ureter endoscopy & biopsy A 0 000 Y Y 50970 $ 523.74 $ -
50976 Ureter endoscopy & treatment A 0 000 Y Y 50970 $ 516.43 $ -
50980 Ureter endoscopy & treatment A 0 000 Y Y $ 392.89 $ -
5100F Rsk fx ref w/n 24 hrs xray M 9 XXX $ - $ -
51020 Incise & treat bladder A 0 090 Y Y $ 504.95 $ -
51030 Incise & treat bladder A 0 090 Y $ 497.99 $ -
51040 Incise & drain bladder A 0 090 Y Y $ 306.94 $ -
51045 Incise bladder/drain ureter A 0 090 Y Y $ 546.36 $ -
51050 Removal of bladder stone A 0 090 Y Y $ 508.43 $ -
51060 Removal of ureter stone A 0 090 Y Y $ 628.14 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
51065 Remove ureter calculus A 0 090 Y $ 625.36 $ -

51080 Drainage of bladder abscess A 0 090 Y Y $ 436.04 $ -
51100 Drain bladder by needle A 0 000 Y $ 43.85 $ 62.99
51101 Drain bladder by trocar/cath A 0 000 Y $ 60.20 $ 123.54
51102 Drain bl w/cath insertion A 0 000 Y $ 162.86 $ 234.20
51500 Removal of bladder cyst A 0 090 Y Y $ 717.23 $ -
51520 Removal of bladder lesion A 0 090 Y Y $ 638.58 $ -
51535 Repair of ureter lesion A 0 090 Y Y Y $ 842.16 $ -
51550 Partial removal of bladder A 0 090 Y Y $ 1,090.98 $ -
51555 Partial removal of bladder A 0 090 Y Y $ 1,417.40 $ -
51565 Revise bladder & ureter(s) A 0 090 Y Y $ 1,425.06 $ -
51570 Removal of bladder A 0 090 Y Y $ 1,630.38 $ -
51575 Removal of bladder & nodes A 0 090 Y Y $ 2,004.48 $ -
51580 Remove bladder/revise tract A 0 090 Y Y $ 2,082.08 $ -
51585 Removal of bladder & nodes A 0 090 Y Y $ 2,321.16 $ -
51596 Remove bladder/create pouch A 0 090 Y Y $ 2,591.21 $ -
51597 Removal of pelvic structures A 0 090 Y Y $ 2,550.84 $ -
51600 Injection for bladder x-ray A 0 000 Y $ 48.37 $ 174.00
51605 Preparation for bladder xray A 0 000 Y $ 40.02 $ -
51610 Injection for bladder x-ray A 0 000 Y $ 68.21 $ 106.49
51700 Irrigation of bladder A 0 000 Y $ 48.72 $ 82.82
51701 Insert bladder catheter A 0 000 Y $ 29.93 $ 54.98
51702 Insert temp bladder cath A 0 000 Y $ 32.36 $ 69.25
51703 Insert bladder cath complex A 0 000 Y $ 88.39 $ 132.24

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
51705 Change of bladder tube A 0 000 Y $ 55.68 $ 87.35

51710 Change of bladder tube A 0 000 Y $ 83.17 $ 94.66
51715 Endoscopic injection/implant A 0 000 Y $ 222.02 $ 299.98
51720 Treatment of bladder lesion A 0 000 Y $ 87.70 $ 113.45
51725 Simple cystometrogram A 1 000 Y $ - $ 187.57
51725 26 Simple cystometrogram A 1 000 Y $ 82.48 $ 82.48
51725 TC Simple cystometrogram A 1 000 Y $ - $ 105.10
51726 Complex cystometrogram A 1 000 Y $ - $ 270.74
51726 26 Complex cystometrogram A 1 000 Y $ 93.26 $ 93.26
51726 TC Complex cystometrogram A 1 000 Y $ - $ 177.48
51727 Cystometrogram w/up A 1 000 Y $ - $ 297.19
51727 26 Cystometrogram w/up A 1 000 Y $ 120.76 $ 120.76
51727 TC Cystometrogram w/up A 1 000 Y $ - $ 176.44
51728 Cystometrogram w/vp A 1 000 Y $ - $ 292.67
51728 26 Cystometrogram w/vp A 1 000 Y $ 114.14 $ 114.14
51728 TC Cystometrogram w/vp A 1 000 Y $ - $ 178.52
51729 Cystometrogram w/vp&up A 1 000 Y $ - $ 323.99
51729 26 Cystometrogram w/vp&up A 1 000 Y $ 140.24 $ 140.24
51729 TC Cystometrogram w/vp&up A 1 000 Y $ - $ 183.40
51736 Urine flow measurement A 1 XXX Y $ - $ 20.88
51736 26 Urine flow measurement A 1 XXX Y $ 10.44 $ 10.44
51736 TC Urine flow measurement A 1 XXX Y $ - $ 10.79
51741 Electro-uroflowmetry first A 1 XXX Y $ - $ 24.01
51741 26 Electro-uroflowmetry first A 1 XXX Y $ 12.18 $ 12.18
51741 TC Electro-uroflowmetry first A 1 XXX Y $ - $ 11.83
51784 Anal/urinary muscle study A 1 000 Y $ - $ 188.96
51784 26 Anal/urinary muscle study A 1 000 Y $ 82.82 $ 82.82
51784 TC Anal/urinary muscle study A 1 000 Y $ - $ 106.14

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
51785 Anal/urinary muscle study A 1 000 Y $ - $ 220.28

51785 26 Anal/urinary muscle study A 1 000 Y $ 83.87 $ 83.87
51785 TC Anal/urinary muscle study A 1 000 Y $ - $ 136.42
51792 Urinary reflex study A 1 000 Y $ - $ 205.32
51792 26 Urinary reflex study A 1 000 Y $ 61.25 $ 61.25
51792 TC Urinary reflex study A 1 000 Y $ - $ 143.72
51797 Intraabdominal pressure test A 1 ZZZ $ - $ 113.45
51797 26 Intraabdominal pressure test A 1 ZZZ $ 42.46 $ 42.46
51797 TC Intraabdominal pressure test A 1 ZZZ $ - $ 71.34
51798 Us urine capacity measure A 0 XXX $ - $ 17.40
51800 Revision of bladder/urethra A 0 090 Y Y $ 1,149.10 $ -
51820 Revision of urinary tract A 0 090 Y Y $ 1,171.37 $ -
51840 Attach bladder/urethra A 0 090 Y Y $ 750.29 $ -
51841 Attach bladder/urethra A 0 090 Y Y $ 897.14 $ -
51845 Repair bladder neck A 0 090 Y Y $ 655.98 $ -
51860 Repair of bladder wound A 0 090 Y Y $ 858.17 $ -
51865 Repair of bladder wound A 0 090 Y Y $ 1,006.07 $ -
51880 Repair of bladder opening A 0 090 Y Y $ 523.74 $ -
51900 Repair bladder/vagina lesion A 0 090 Y Y $ 898.19 $ -
51920 Close bladder-uterus fistula A 0 090 Y Y $ 820.93 $ -
51925 Hysterectomy/bladder repair A 0 090 Y Y $ 1,210.69 $ -
51940 Correction of bladder defect A 0 090 Y Y $ 1,790.11 $ -
51960 Revision of bladder & bowel A 0 090 Y Y $ 1,536.07 $ -
51980 Construct bladder opening A 0 090 Y Y $ 772.21 $ -
51990 Laparo urethral suspension A 0 090 Y Y $ 864.43 $ -
51992 Laparo sling operation A 0 090 Y Y $ 994.58 $ -
51999 Laparoscope proc bla C 0 YYY Y $ - $ -
52000 Cystoscopy A 0 000 Y $ 138.16 $ 206.02

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
52001 Cystoscopy removal of clots A 0 000 Y 52000 $ 317.03 $ 390.11

52005 Cystoscopy & ureter catheter A 0 000 Y 52000 $ 145.81 $ 270.74
52007 Cystoscopy and biopsy A 0 000 Y Y 52000 $ 182.00 $ 451.36
5200F Eval appros surg thxpy epi M 9 XXX $ - $ -
52010 Cystoscopy & duct catheter A 0 000 Y 52000 $ 180.96 $ 370.27
52204 Cystoscopy w/biopsy(s) A 0 000 Y 52000 $ 155.56 $ 368.88
52214 Cystoscopy and treatment A 0 000 Y 52000 $ 221.33 $ 589.86
52234 Cystoscopy and treatment A 0 000 Y 52000 $ 270.05 $ -
52250 Cystoscopy and radiotracer A 0 000 Y 52000 $ 267.61 $ -
52270 Cystoscopy & revise urethra A 0 000 Y 52000 $ 200.10 $ 360.53
52275 Cystoscopy & revise urethra A 0 000 Y 52000 $ 273.53 $ 489.64
52282 Cystoscopy implant stent A 0 000 Y 52000 $ 375.49 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
52317 Remove bladder stone A 0 000 Y 52000 $ 384.89 $ 815.36

52318 Remove bladder stone A 0 000 Y 52000 $ 524.09 $ -
52320 Cystoscopy and treatment A 0 000 Y Y 52000 $ 271.79 $ -
52325 Cystoscopy stone removal A 0 000 Y Y 52000 $ 355.66 $ -
52327 Cystoscopy inject material A 0 000 Y Y 52000 $ 294.06 $ -
52330 Cystoscopy and treatment A 0 000 Y Y 52000 $ 291.62 $ 557.15
52332 Cystoscopy and treatment A 0 000 Y Y 52000 $ 170.52 $ 467.71
52334 Create passage to kidney A 0 000 Y Y 52000 $ 283.97 $ -
52341 Cysto w/ureter stricture tx A 0 000 Y Y 52000 $ 317.72 $ -
52342 Cysto w/up stricture tx A 0 000 Y Y 52000 $ 344.87 $ -
52343 Cysto w/renal stricture tx A 0 000 Y Y 52000 $ 385.58 $ -
52344 Cysto/uretero stricture tx A 0 000 Y Y 52000 $ 417.25 $ -
52345 Cysto/uretero w/up stricture A 0 000 Y 52351 $ 444.40 $ -
52346 Cystouretero w/renal strict A 0 000 Y 52351 $ 504.25 $ -
52351 Cystouretero & or pyeloscope A 0 000 Y $ 344.52 $ -
52352 Cystouretero w/stone remove A 0 000 Y Y 52351 $ 405.77 $ -
52353 Cystouretero w/lithotripsy A 0 000 Y Y 52351 $ 465.28 $ -
52354 Cystouretero w/biopsy A 0 000 Y Y 52351 $ 431.17 $ -
52355 Cystouretero w/excise tumor A 0 000 Y Y 52351 $ 515.04 $ -
52400 Cystouretero w/congen repr A 0 090 Y 52000 $ 522.70 $ -
52402 Cystourethro cut ejacul duct A 0 000 Y 52000 $ 296.15 $ -
52450 Incision of prostate A 0 090 Y $ 502.51 $ -
52500 Revision of bladder neck A 0 090 Y $ 522.70 $ -
5250F Asthma discharge plan presnt M 9 XXX $ - $ -
52601 Prostatectomy (TURP) A 0 090 Y $ 919.07 $ -
52630 Remove prostate regrowth A 0 090 Y $ 428.39 $ -
52640 Relieve bladder contracture A 0 090 Y $ 327.12 $ -
52647 Laser surgery of prostate A 0 090 Y $ 700.87 $ 1,778.28

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
52648 Laser surgery of prostate A 0 090 Y $ 750.29 $ 1,833.96

52649 Prostate laser enucleation A 0 090 Y $ 902.71 $ -
52700 Drainage of prostate abscess A 0 090 Y $ 475.72 $ -
53000 Incision of urethra A 0 010 Y $ 158.69 $ -
53040 Drainage of urethra abscess A 0 090 Y $ 421.43 $ -
53060 Drainage of urethra abscess A 0 010 Y $ 194.53 $ 210.89
53080 Drainage of urinary leakage A 0 090 Y $ 452.75 $ -
53085 Drainage of urinary leakage A 0 090 Y Y $ 734.28 $ -
53200 Biopsy of urethra A 0 000 Y $ 156.60 $ 168.43
53210 Removal of urethra A 0 090 Y Y $ 839.38 $ -
53215 Removal of urethra A 0 090 Y Y $ 1,012.68 $ -
53220 Treatment of urethra lesion A 0 090 Y $ 487.90 $ -
53230 Removal of urethra lesion A 0 090 Y Y $ 671.29 $ -
53235 Removal of urethra lesion A 0 090 Y Y $ 684.52 $ -
53240 Surgery for urethra pouch A 0 090 Y $ 455.53 $ -
53250 Removal of urethra gland A 0 090 Y $ 514.69 $ -
53260 Treatment of urethra lesion A 0 010 Y $ 199.06 $ 217.50
53265 Treatment of urethra lesion A 0 010 Y $ 203.58 $ 231.77
53270 Removal of urethra gland A 0 010 Y $ 222.37 $ 241.16
53275 Repair of urethra defect A 0 010 Y $ 285.36 $ -
53400 Revise urethra stage 1 A 0 090 Y Y $ 875.57 $ -
53405 Revise urethra stage 2 A 0 090 Y Y $ 951.43 $ -
53410 Reconstruction of urethra A 0 090 Y Y $ 1,065.58 $ -
53420 Reconstruct urethra stage 1 A 0 090 Y $ 907.93 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
53425 Reconstruct urethra stage 2 A 0 090 Y Y $ 1,023.82 $ -

53431 Reconstruct urethra/bladder A 0 090 Y Y $ 1,260.46 $ -
53440 Male sling procedure A 0 090 Y Y $ 830.33 $ -
53442 Remove/revise male sling A 0 090 Y Y $ 843.55 $ -
53444 Insert tandem cuff A 0 090 Y Y $ 862.69 $ -
53445 Insert uro/ves nck sphincter A 0 090 Y Y $ 826.85 $ -
53446 Remove uro sphincter A 0 090 Y Y $ 695.30 $ -
53447 Remove/replace ur sphincter A 0 090 Y Y $ 879.74 $ -
53448 Remov/replc ur sphinctr comp A 0 090 Y Y $ 1,398.26 $ -
53449 Repair uro sphincter A 0 090 Y Y $ 663.64 $ -
53450 Revision of urethra A 0 090 Y $ 437.78 $ -
53460 Revision of urethra A 0 090 Y $ 489.98 $ -
53500 Urethrlys transvag w/ scope A 0 090 Y Y $ 833.46 $ -
53502 Repair of urethra injury A 0 090 Y $ 522.35 $ -
53505 Repair of urethra injury A 0 090 Y Y $ 523.39 $ -
53520 Repair of urethra defect A 0 090 Y $ 598.21 $ -
53600 Dilate urethra stricture A 0 000 Y $ 69.60 $ 86.65
53605 Dilate urethra stricture A 0 000 Y $ 70.99 $ -
53660 Dilation of urethra A 0 000 Y $ 44.89 $ 70.64
53661 Dilation of urethra A 0 000 Y $ 44.20 $ 69.60
53665 Dilation of urethra A 0 000 Y $ 43.50 $ -
53850 Prostatic microwave thermotx A 0 090 Y $ 618.40 $ 1,961.68

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
53852 Prostatic rf thermotx A 0 090 Y $ 673.73 $ 1,907.74

53855 Insert prost urethral stent A 0 000 Y $ 90.48 $ 662.24
53860 Transurethral rf treatment A 0 090 Y $ 275.96 $ 1,368.68
53899 Urology surgery procedure C 0 YYY Y Y $ - $ -
54000 Slitting of prepuce A 0 010 Y $ 111.36 $ 148.25
54001 Slitting of prepuce A 0 010 Y $ 149.29 $ 190.70
54015 Drain penis lesion A 0 010 Y $ 336.52 $ -
54050 Destruction penis lesion(s) A 0 010 Y $ 108.58 $ 131.20
54056 Cryosurgery penis lesion(s) A 0 010 Y $ 116.23 $ 141.98
54057 Laser surg penis lesion(s) A 0 010 Y $ 96.40 $ 133.63
54060 Excision of penis lesion(s) A 0 010 Y $ 139.90 $ 184.09
54100 Biopsy of penis A 0 000 Y $ 137.46 $ 199.06
54105 Biopsy of penis A 0 010 Y $ 228.64 $ 274.92
54110 Treatment of penis lesion A 0 090 Y Y $ 675.82 $ -
54111 Treat penis lesion graft A 0 090 Y Y $ 872.78 $ -
54112 Treat penis lesion graft A 0 090 Y Y $ 1,021.73 $ -
54115 Treatment of penis lesion A 0 090 Y Y $ 452.75 $ 476.41
54120 Partial removal of penis A 0 090 Y Y $ 685.91 $ -
54125 Removal of penis A 0 090 Y Y $ 890.88 $ -
54130 Remove penis & nodes A 0 090 Y Y $ 1,305.00 $ -
54135 Remove penis & nodes A 0 090 Y Y $ 1,693.37 $ -
54150 Circumcision w/regionl block A 0 000 Y $ 113.10 $ 166.69
54160 Circumcision neonate A 0 010 Y $ 155.56 $ 223.42
54161 Circum 28 days or older A 0 010 Y $ 213.67 $ -
54162 Lysis penil circumic lesion A 0 010 Y $ 214.02 $ 267.96
54163 Repair of circumcision A 0 010 Y $ 231.42 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
54164 Frenulotomy of penis A 0 010 Y $ 203.93 $ -

54200 Treatment of penis lesion A 0 010 Y $ 85.96 $ 106.49
54205 Treatment of penis lesion A 0 090 Y Y $ 572.46 $ -
54220 Treatment of penis lesion A 0 000 Y $ 149.29 $ 209.50
54230 Prepare penis study A 0 000 Y $ 84.56 $ 99.18
54231 Dynamic cavernosometry A 0 000 Y $ 126.67 $ 146.86
54235 Penile injection A 0 000 Y $ 77.95 $ 92.22
54240 Penis study A 1 000 $ - $ 98.83
54240 26 Penis study A 1 000 $ 67.86 $ 67.86
54240 TC Penis study A 1 000 $ - $ 30.97
54250 Penis study A 1 000 $ - $ 126.67
54250 26 Penis study A 1 000 $ 115.88 $ 115.88
54250 TC Penis study A 1 000 $ - $ 10.79
54300 Revision of penis A 0 090 Y Y $ 696.70 $ -
54308 Reconstruction of urethra A 0 090 Y Y $ 794.14 $ -
54328 Revise penis/urethra A 0 090 Y Y $ 1,022.08 $ -
54340 Secondary urethral surgery A 0 090 Y Y $ 611.44 $ -
54344 Secondary urethral surgery A 0 090 Y Y $ 1,034.95 $ -
54348 Secondary urethral surgery A 0 090 Y Y $ 1,052.35 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
54352 Reconstruct urethra/penis A 0 090 Y Y $ 1,556.95 $ -

54360 Penis plastic surgery A 0 090 Y Y $ 785.09 $ -
54380 Repair penis A 0 090 Y Y $ 941.34 $ -
54385 Repair penis A 0 090 Y Y $ 1,137.96 $ -
54390 Repair penis and bladder A 0 090 Y Y $ 1,368.68 $ -
54400 Insert semi-rigid prosthesis A 0 090 Y $ 572.46 $ -
54401 Insert self-contd prosthesis A 0 090 Y $ 699.83 $ -
54405 Insert multi-comp penis pros A 0 090 Y Y $ 881.83 $ -
54406 Remove muti-comp penis pros A 0 090 Y Y $ 792.40 $ -
54408 Repair multi-comp penis pros A 0 090 Y Y $ 858.86 $ -
54410 Remove/replace penis prosth A 0 090 Y Y $ 934.38 $ -
54411 Remov/replc penis pros comp A 0 090 Y Y $ 1,115.34 $ -
54415 Remove self-contd penis pros A 0 090 Y Y $ 567.94 $ -
54416 Remv/repl penis contain pros A 0 090 Y Y $ 765.95 $ -
54417 Remv/replc penis pros compl A 0 090 Y Y $ 978.58 $ -
54435 Revision of penis A 0 090 Y $ 444.74 $ -
54440 Repair of penis C 0 090 Y Y $ - $ -
54450 Preputial stretching A 0 000 Y $ 62.99 $ 73.78
54500 Biopsy of testis A 0 000 Y Y $ 80.39 $ -
54505 Biopsy of testis A 0 010 Y Y $ 225.85 $ -
54512 Excise lesion testis A 0 090 Y Y $ 585.34 $ -
54520 Removal of testis A 0 090 Y Y $ 357.40 $ -
54522 Orchiectomy partial A 0 090 Y Y Y $ 636.49 $ -
54530 Removal of testis A 0 090 Y Y Y $ 548.10 $ -
54535 Extensive testis surgery A 0 090 Y Y Y $ 804.92 $ -
54550 Exploration for testis A 0 090 Y Y Y $ 529.66 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
54560 Exploration for testis A 0 090 Y Y Y $ 773.60 $ -

54600 Reduce testis torsion A 0 090 Y Y $ 485.46 $ -
54620 Suspension of testis A 0 010 Y Y $ 324.34 $ -
54640 Suspension of testis A 0 090 Y Y $ 519.91 $ -
54650 Orchiopexy (Fowler-Stephens) A 0 090 Y Y Y $ 768.73 $ -
54660 Revision of testis A 0 090 Y Y $ 377.93 $ -
54670 Repair testis injury A 0 090 Y Y $ 432.56 $ -
54680 Relocation of testis(es) A 0 090 Y Y Y $ 852.95 $ -
54690 Laparoscopy orchiectomy A 0 090 Y Y Y $ 893.32 $ -
54692 Laparoscopy orchiopexy A 0 090 Y Y $ 827.20 $ -
54699 Laparoscope proc testis C 0 YYY Y Y Y Y $ - $ -
54700 Drainage of scrotum A 0 010 Y $ 232.81 $ -
54800 Biopsy of epididymis A 0 000 Y $ 151.03 $ -
54830 Remove epididymis lesion A 0 090 Y $ 401.59 $ -
54840 Remove epididymis lesion A 0 090 Y $ 344.87 $ -
54860 Removal of epididymis A 0 090 Y $ 449.62 $ -
54861 Removal of epididymis A 0 090 Y $ 608.65 $ -
54865 Explore epididymis A 0 090 Y $ 382.10 $ -
54900 Fusion of spermatic ducts A 0 090 Y $ 816.41 $ -
54901 Fusion of spermatic ducts A 0 090 Y $ 1,095.50 $ -
55000 Drainage of hydrocele A 0 000 Y $ 91.18 $ 120.41
55040 Removal of hydrocele A 0 090 Y $ 368.53 $ -
55041 Removal of hydroceles A 0 090 Y $ 554.02 $ -
55060 Repair of hydrocele A 0 090 Y Y $ 412.38 $ -
55100 Drainage of scrotum abscess A 0 010 Y $ 179.92 $ 223.76
55110 Explore scrotum A 0 090 Y $ 420.73 $ -
55120 Removal of scrotum lesion A 0 090 Y $ 386.98 $ -
55150 Removal of scrotum A 0 090 Y Y $ 532.44 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
55175 Revision of scrotum A 0 090 Y $ 390.11 $ -

55180 Revision of scrotum A 0 090 Y $ 760.03 $ -
55200 Incision of sperm duct A 0 090 Y $ 296.50 $ 445.79
55250 Removal of sperm duct(s) A 0 090 Y $ 238.73 $ 386.28
55300 Prepare sperm duct x-ray A 0 000 Y $ 203.93 $ -
55400 Repair of sperm duct A 0 090 Y Y Y $ 538.70 $ -
55450 Ligation of sperm duct A 0 010 Y $ 275.96 $ 369.23
55500 Removal of hydrocele A 0 090 Y $ 443.35 $ -
55520 Removal of sperm cord lesion A 0 090 Y Y $ 529.66 $ -
55530 Revise spermatic cord veins A 0 090 Y Y $ 384.54 $ -
55535 Revise spermatic cord veins A 0 090 Y Y Y $ 460.06 $ -
55540 Revise hernia & sperm veins A 0 090 Y Y $ 635.45 $ -
55550 Laparo ligate spermatic vein A 0 090 Y Y Y $ 457.27 $ -
55559 Laparo proc spermatic cord C 0 YYY Y Y Y Y $ - $ -
55600 Incise sperm duct pouch A 0 090 Y Y $ 452.05 $ -
55605 Incise sperm duct pouch A 0 090 Y Y $ 554.02 $ -
55650 Remove sperm duct pouch A 0 090 Y Y Y $ 776.04 $ -
55680 Remove sperm pouch lesion A 0 090 Y $ 366.79 $ -
55700 Biopsy of prostate A 0 000 Y $ 153.47 $ 224.46
55705 Biopsy of prostate A 0 010 Y $ 288.49 $ -
55706 Prostate saturation sampling A 0 010 Y Y $ 383.84 $ -
55720 Drainage of prostate abscess A 0 090 Y Y $ 484.76 $ -
55725 Drainage of prostate abscess A 0 090 Y Y $ 637.54 $ -
55801 Removal of prostate A 0 090 Y Y $ 1,190.86 $ -
55810 Extensive prostate surgery A 0 090 Y Y $ 1,452.90 $ -
55821 Removal of prostate A 0 090 Y Y $ 954.56 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
55831 Removal of prostate A 0 090 Y Y $ 1,031.47 $ -

55860 Surgical exposure prostate A 0 090 Y $ 952.13 $ -
55866 Laparo radical prostatectomy A 0 090 Y Y $ 1,906.34 $ -
55870 Electroejaculation A 0 000 Y $ 156.95 $ 184.79
55873 Cryoablate prostate A 0 090 Y $ 866.52 $ 5,864.84
55875 Transperi needle place pros A 0 090 Y $ 825.11 $ -
55876 Place rt device/marker pros A 0 000 Y Y $ 107.88 $ 137.81
55899 Genital surgery procedure C 0 YYY Y Y $ - $ -
55920 Place needles pelvic for rt A 0 000 Y $ 477.46 $ -
55970 Sex transformation m to f N 9 XXX $ - $ -
55980 Sex transformation f to m N 9 XXX $ - $ -
56405 I & D of vulva/perineum A 0 010 Y Y $ 122.50 $ 123.89
56420 Drainage of gland abscess A 0 010 Y $ 106.14 $ 132.59
56440 Surgery for vulva lesion A 0 010 Y $ 213.32 $ -
56441 Lysis of labial lesion(s) A 0 010 Y $ 153.47 $ 158.69
56442 Hymenotomy A 0 000 Y $ 54.29 $ -
56501 Destroy vulva lesions sim A 0 010 Y $ 129.46 $ 143.03
56515 Destroy vulva lesion/s compl A 0 010 Y $ 228.64 $ 250.21
56605 Biopsy of vulva/perineum A 0 000 Y Y $ 72.73 $ 91.52
56606 Biopsy of vulva/perineum A 0 ZZZ Y $ 34.45 $ 41.41
56620 Partial removal of vulva A 0 090 Y Y $ 578.72 $ -
56625 Complete removal of vulva A 0 090 Y Y $ 704.35 $ -
56630 Extensive vulva surgery A 0 090 Y Y $ 1,054.79 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
56631 Extensive vulva surgery A 0 090 Y Y Y $ 1,335.28 $ -

56700 Partial removal of hymen A 0 010 Y Y $ 216.46 $ -
56740 Remove vagina gland lesion A 0 010 Y $ 350.78 $ -
56800 Repair of vagina A 0 010 Y Y $ 280.84 $ -
56805 Repair clitoris A 0 090 Y Y $ 1,373.90 $ -
56810 Repair of perineum A 0 010 Y Y Y $ 303.11 $ -
56820 Exam of vulva w/scope A 0 000 Y $ 103.01 $ 124.58
56821 Exam/biopsy of vulva w/scope A 0 000 Y $ 137.81 $ 164.95
57000 Exploration of vagina A 0 010 Y $ 216.46 $ -
57010 Drainage of pelvic abscess A 0 090 Y $ 506.34 $ -
57020 Drainage of pelvic fluid A 0 000 Y $ 99.88 $ 110.32
57022 I & d vaginal hematoma pp A 0 010 Y $ 196.27 $ -
57023 I & d vag hematoma non-ob A 0 010 Y $ 367.49 $ -
57061 Destroy vag lesions simple A 0 010 Y $ 109.62 $ 123.19
57065 Destroy vag lesions complex A 0 010 Y $ 198.01 $ 215.76
57100 Biopsy of vagina A 0 000 Y $ 79.34 $ 98.48
57105 Biopsy of vagina A 0 010 Y $ 140.94 $ 149.29
57106 Remove vagina wall partial A 0 090 Y Y $ 554.02 $ -
57107 Remove vagina tissue part A 0 090 Y Y $ 1,681.54 $ -
57109 Vaginectomy partial w/nodes A 0 090 Y Y $ 1,928.96 $ -
57110 Remove vagina wall complete A 0 090 Y Y $ 1,069.06 $ -
57111 Remove vagina tissue compl A 0 090 Y Y $ 1,933.14 $ -
57112 Vaginectomy w/nodes compl A 0 090 Y Y $ 1,753.92 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
57120 Closure of vagina A 0 090 Y Y $ 595.78 $ -

57130 Remove vagina lesion A 0 010 Y Y $ 184.44 $ 200.45
57135 Remove vagina lesion A 0 010 Y $ 199.06 $ 215.41
57150 Treat vagina infection A 0 000 Y $ 34.45 $ 49.42
57155 Insert uteri tandems/ovoids A 0 000 Y Y $ 303.11 $ 431.52
57156 Ins vag brachytx device A 0 000 Y $ 152.42 $ 193.49
57160 Insert pessary/other device A 0 000 Y $ 57.07 $ 82.13
57170 Fitting of diaphragm/cap A 0 000 Y $ 57.77 $ 69.95
57180 Treat vaginal bleeding A 0 010 Y $ 122.15 $ 152.42
57210 Repair vagina/perineum A 0 090 Y Y $ 420.04 $ -
57220 Revision of urethra A 0 090 Y Y $ 367.14 $ -
57230 Repair of urethral lesion A 0 090 Y Y $ 463.88 $ -
57240 Repair bladder & vagina A 0 090 Y Y $ 765.95 $ -
57250 Repair rectum & vagina A 0 090 Y Y $ 793.09 $ -
57265 Extensive repair of vagina A 0 090 Y Y $ 1,079.84 $ -
57267 Insert mesh/pelvic flr addon A 0 ZZZ Y $ 306.24 $ -
57268 Repair of bowel bulge A 0 090 Y Y $ 555.76 $ -
57270 Repair of bowel pouch A 0 090 Y Y $ 945.17 $ -
57280 Suspension of vagina A 0 090 Y Y $ 1,123.34 $ -
57282 Colpopexy extraperitoneal A 0 090 Y Y $ 575.24 $ -
57283 Colpopexy intraperitoneal A 0 090 Y Y $ 814.32 $ -
57284 Repair paravag defect open A 0 090 Y Y Y $ 956.30 $ -
57285 Repair paravag defect vag A 0 090 Y Y Y $ 788.92 $ -
57287 Revise/remove sling repair A 0 090 Y Y $ 762.82 $ -
57288 Repair bladder defect A 0 090 Y Y $ 804.58 $ -
57289 Repair bladder & vagina A 0 090 Y Y $ 783.00 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
57291 Construction of vagina A 0 090 Y Y $ 695.30 $ -

57292 Construct vagina with graft A 0 090 Y Y $ 974.40 $ -
57295 Revise vag graft via vagina A 0 090 Y Y $ 552.62 $ -
57296 Revise vag graft open abd A 0 090 Y Y $ 1,137.61 $ -
57300 Repair rectum-vagina fistula A 0 090 Y Y $ 646.24 $ -
57305 Repair rectum-vagina fistula A 0 090 Y Y $ 1,116.73 $ -
57307 Fistula repair & colostomy A 0 090 Y Y $ 1,296.30 $ -
57308 Fistula repair transperine A 0 090 Y Y $ 756.20 $ -
57310 Repair urethrovaginal lesion A 0 090 Y Y $ 490.33 $ -
57311 Repair urethrovaginal lesion A 0 090 Y Y $ 561.32 $ -
57320 Repair bladder-vagina lesion A 0 090 Y Y $ 587.42 $ -
57330 Repair bladder-vagina lesion A 0 090 Y Y $ 799.70 $ -
57335 Repair vagina A 0 090 Y Y $ 1,355.46 $ -
57400 Dilation of vagina A 0 000 Y $ 158.34 $ -
57410 Pelvic examination A 0 000 Y $ 125.28 $ -
57415 Remove vaginal foreign body A 0 010 Y $ 180.61 $ -
57420 Exam of vagina w/scope A 0 000 Y $ 107.18 $ 129.46
57421 Exam/biopsy of vag w/scope A 0 000 Y $ 147.90 $ 176.09
57423 Repair paravag defect lap A 0 090 Y Y Y $ 1,102.46 $ -
57425 Laparoscopy surg colpopexy A 0 090 Y Y $ 1,144.57 $ -
57426 Revise prosth vag graft lap A 0 090 Y Y $ 1,009.20 $ -
57452 Exam of cervix w/scope A 0 000 Y $ 106.49 $ 120.76
57454 Bx/curett of cervix w/scope A 0 000 Y 57452 $ 160.78 $ 175.39
57455 Biopsy of cervix w/scope A 0 000 Y 57452 $ 133.28 $ 160.78
57456 Endocerv curettage w/scope A 0 000 Y 57452 $ 124.58 $ 151.73
57460 Bx of cervix w/scope leep A 0 000 Y 57452 $ 195.58 $ 302.06
57461 Conz of cervix w/scope leep A 0 000 Y 57452 $ 229.33 $ 345.91
57500 Biopsy of cervix A 0 000 Y $ 88.04 $ 133.98

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
57505 Endocervical curettage A 0 010 Y $ 101.96 $ 110.66

57510 Cauterization of cervix A 0 010 Y $ 135.02 $ 148.60
57511 Cryocautery of cervix A 0 010 Y $ 151.73 $ 162.86
57513 Laser surgery of cervix A 0 010 Y $ 152.08 $ 161.47
57520 Conization of cervix A 0 090 Y $ 312.50 $ 341.04
57522 Conization of cervix A 0 090 Y $ 281.18 $ 298.24
57530 Removal of cervix A 0 090 Y Y $ 396.37 $ -
57531 Removal of cervix radical A 0 090 Y Y $ 2,065.03 $ -
57540 Removal of residual cervix A 0 090 Y Y $ 926.03 $ -
57545 Remove cervix/repair pelvis A 0 090 Y Y $ 976.84 $ -
57550 Removal of residual cervix A 0 090 Y Y $ 475.02 $ -
57555 Remove cervix/repair vagina A 0 090 Y Y $ 707.48 $ -
57556 Remove cervix repair bowel A 0 090 Y Y $ 656.33 $ -
57558 D&c of cervical stump A 0 010 Y $ 131.20 $ 140.59
57700 Revision of cervix A 0 090 Y $ 350.44 $ -
57720 Revision of cervix A 0 090 Y Y $ 352.18 $ -
57800 Dilation of cervical canal A 0 000 Y $ 55.68 $ 65.42
58100 Biopsy of uterus lining A 0 000 Y $ 105.10 $ 123.89
58110 Bx done w/colposcopy add-on A 0 ZZZ $ 49.07 $ 55.33
58120 Dilation and curettage A 0 010 Y $ 257.17 $ 289.54
58140 Myomectomy abdom method A 0 090 Y Y $ 1,106.99 $ -
58145 Myomectomy vag method A 0 090 Y Y $ 639.97 $ -
58146 Myomectomy abdom complex A 0 090 Y Y $ 1,388.17 $ -
58150 Total hysterectomy A 0 090 Y Y $ 1,192.60 $ -
58152 Total hysterectomy A 0 090 Y Y $ 1,499.53 $ -
58180 Partial hysterectomy A 0 090 Y Y $ 1,143.18 $ -
58200 Extensive hysterectomy A 0 090 Y Y $ 1,576.09 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
58240 Removal of pelvis contents A 0 090 Y Y $ 3,356.11 $ -

58260 Vaginal hysterectomy A 0 090 Y Y $ 984.14 $ -
58262 Vag hyst including t/o A 0 090 Y Y Y $ 1,101.42 $ -
58263 Vag hyst w/t/o & vag repair A 0 090 Y Y Y $ 1,186.33 $ -
58267 Vag hyst w/urinary repair A 0 090 Y Y $ 1,265.68 $ -
58270 Vag hyst w/enterocele repair A 0 090 Y Y $ 1,053.05 $ -
58275 Hysterectomy/revise vagina A 0 090 Y Y $ 1,178.33 $ -
58280 Hysterectomy/revise vagina A 0 090 Y Y $ 1,259.41 $ -
58290 Vag hyst complex A 0 090 Y Y $ 1,382.95 $ -
58291 Vag hyst incl t/o complex A 0 090 Y Y Y $ 1,499.53 $ -
58292 Vag hyst t/o & repair compl A 0 090 Y Y Y $ 1,582.36 $ -
58293 Vag hyst w/uro repair compl A 0 090 Y Y $ 1,647.78 $ -
58294 Vag hyst w/enterocele compl A 0 090 Y Y $ 1,467.86 $ -
58300 Insert intrauterine device A 9 XXX $ 53.94 $ 70.64
58301 Remove intrauterine device A 0 000 Y $ 83.52 $ 107.18
58321 Artificial insemination A 0 000 Y $ 48.02 $ 72.04
58322 Artificial insemination A 0 000 Y $ 71.34 $ 94.66
58323 Sperm washing A 0 000 Y $ 15.31 $ 18.79
58340 Catheter for hysterography A 0 000 Y $ 64.03 $ 117.62
58345 Reopen fallopian tube A 0 010 Y Y Y Y $ 330.25 $ -
58346 Insert heyman uteri capsule A 0 090 Y $ 470.84 $ -
58350 Reopen fallopian tube A 0 010 Y $ 88.74 $ 103.70
58353 Endometr ablate thermal A 0 010 Y Y $ 258.91 $ 967.09
58356 Endometrial cryoablation A 0 010 Y Y Y $ 422.12 $ 1,797.07
58400 Suspension of uterus A 0 090 Y Y $ 504.25 $ -
58410 Suspension of uterus A 0 090 Y Y $ 956.65 $ -
58520 Repair of ruptured uterus A 0 090 Y Y $ 1,009.20 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
58540 Revision of uterus A 0 090 Y Y $ 1,085.06 $ -

58541 Lsh uterus 250 g or less A 0 090 Y Y Y 49320 $ 1,023.82 $ -
58542 Lsh w/t/o ut 250 g or less A 0 090 Y Y Y $ 1,148.75 $ -
58543 Lsh uterus above 250 g A 0 090 Y Y Y $ 1,169.28 $ -
58544 Lsh w/t/o uterus above 250 g A 0 090 Y Y Y $ 1,268.81 $ -
58545 Laparoscopic myomectomy A 0 090 Y Y Y $ 1,073.93 $ -
58546 Laparo-myomectomy complex A 0 090 Y Y Y $ 1,357.55 $ -
58548 Lap radical hyst A 0 090 Y Y Y $ 2,160.04 $ -
58550 Laparo-asst vag hysterectomy A 0 090 Y Y Y 49320 $ 1,052.35 $ -
58552 Laparo-vag hyst incl t/o A 0 090 Y Y Y $ 1,171.72 $ -
58553 Laparo-vag hyst complex A 0 090 Y Y Y $ 1,365.55 $ -
58554 Laparo-vag hyst w/t/o compl A 0 090 Y Y Y $ 1,578.88 $ -
58555 Hysteroscopy dx sep proc A 0 000 Y Y $ 227.59 $ 310.76
58558 Hysteroscopy biopsy A 0 000 Y Y 58555 $ 321.20 $ 416.21
58559 Hysteroscopy lysis A 0 000 Y Y 58555 $ 415.51 $ -
58560 Hysteroscopy resect septum A 0 000 Y Y Y 58555 $ 468.41 $ -
58561 Hysteroscopy remove myoma A 0 000 Y Y 58555 $ 662.94 $ -
58562 Hysteroscopy remove fb A 0 000 Y Y 58555 $ 349.74 $ 437.44
58563 Hysteroscopy ablation A 0 000 Y Y 58555 $ 415.16 $ 1,594.54
58565 Hysteroscopy sterilization A 0 090 Y Y 58555 $ 510.86 $ 1,774.80
58570 Tlh uterus 250 g or less A 0 090 Y Y Y $ 1,105.25 $ -
58571 Tlh w/t/o 250 g or less A 0 090 Y Y Y $ 1,230.53 $ -
58572 Tlh uterus over 250 g A 0 090 Y Y Y $ 1,381.91 $ -
58573 Tlh w/t/o uterus over 250 g A 0 090 Y Y Y $ 1,580.96 $ -
58578 Laparo proc uterus C 0 YYY Y Y Y Y $ - $ -
58579 Hysteroscope procedure C 0 YYY Y Y Y Y $ - $ -
58600 Division of fallopian tube A 0 090 Y Y $ 429.08 $ -
58605 Division of fallopian tube A 0 090 Y Y $ 384.19 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
58611 Ligate oviduct(s) add-on A 0 ZZZ Y $ 94.31 $ -

58615 Occlude fallopian tube(s) A 0 010 Y Y $ 287.80 $ -
58660 Laparoscopy lysis A 0 090 Y Y Y 49320 $ 809.10 $ -
58661 Laparoscopy remove adnexa A 0 010 Y Y Y Y 49320 $ 773.95 $ -
58662 Laparoscopy excise lesions A 0 090 Y Y Y 49320 $ 842.86 $ -
58670 Laparoscopy tubal cautery A 0 090 Y Y 49320 $ 429.78 $ -
58671 Laparoscopy tubal block A 0 090 Y Y 49320 $ 429.78 $ -
58672 Laparoscopy fimbrioplasty A 0 090 Y Y Y 49320 $ 882.88 $ -
58673 Laparoscopy salpingostomy A 0 090 Y Y Y 49320 $ 958.04 $ -
58679 Laparo proc oviduct-ovary C 0 YYY Y Y Y Y $ - $ -
58700 Removal of fallopian tube A 0 090 Y Y $ 935.42 $ -
58720 Removal of ovary/tube(s) A 0 090 Y Y $ 863.74 $ -
58740 Adhesiolysis tube ovary A 0 090 Y Y $ 1,052.00 $ -
58750 Repair oviduct A 0 090 Y Y $ 1,078.80 $ -
58752 Revise ovarian tube(s) A 0 090 Y Y $ 900.97 $ -
58760 Fimbrioplasty A 0 090 Y Y Y $ 966.05 $ -
58770 Create new tubal opening A 0 090 Y Y Y $ 1,014.77 $ -
58800 Drainage of ovarian cyst(s) A 0 090 Y $ 344.52 $ 361.92
58805 Drainage of ovarian cyst(s) A 0 090 Y Y $ 470.84 $ -
58820 Drain ovary abscess open A 0 090 Y Y $ 358.79 $ -
58822 Drain ovary abscess percut A 0 090 Y Y $ 907.93 $ -
58823 Drain pelvic abscess percut A 0 000 Y $ 193.49 $ 833.81
58825 Transposition ovary(s) A 0 090 Y Y $ 834.85 $ -
58900 Biopsy of ovary(s) A 0 090 Y Y $ 532.79 $ -
58920 Partial removal of ovary(s) A 0 090 Y Y $ 831.02 $ -
58925 Removal of ovarian cyst(s) A 0 090 Y Y $ 887.05 $ -
58940 Removal of ovary(s) A 0 090 Y Y $ 616.31 $ -
58943 Removal of ovary(s) A 0 090 Y Y $ 1,369.38 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
58950 Resect ovarian malignancy A 0 090 Y Y $ 1,298.04 $ -

58953 Tah rad dissect for debulk A 0 090 Y Y $ 2,339.26 $ -
58954 Tah rad debulk/lymph remove A 0 090 Y Y $ 2,534.48 $ -
58956 Bso omentectomy w/tah A 0 090 Y Y $ 1,593.49 $ -
58957 Resect recurrent gyn mal A 0 090 Y Y $ 1,842.31 $ -
58958 Resect recur gyn mal w/lym A 0 090 Y Y $ 1,997.17 $ -
58960 Exploration of abdomen A 0 090 Y Y $ 1,110.82 $ -
58970 Retrieval of oocyte A 0 000 Y $ 202.19 $ 221.33
58974 Transfer of embryo C 0 000 Y Y $ - $ -
58976 Transfer of embryo A 0 000 Y Y $ 216.80 $ 245.69
58999 Genital surgery procedure C 0 YYY Y Y $ - $ -
59000 Amniocentesis diagnostic A 0 000 Y $ 108.58 $ 147.55
59001 Amniocentesis therapeutic A 0 000 Y $ 246.04 $ -
59012 Fetal cord puncture prenatal A 0 000 Y $ 276.31 $ -
59015 Chorion biopsy A 0 000 Y $ 179.92 $ 199.75
59020 Fetal contract stress test A 1 000 $ - $ 78.30
59020 26 Fetal contract stress test A 1 000 $ 48.72 $ 48.72
59020 TC Fetal contract stress test A 1 000 $ - $ 29.58
59025 Fetal non-stress test A 1 000 $ - $ 54.64
59025 26 Fetal non-stress test A 1 000 $ 38.28 $ 38.28
59025 TC Fetal non-stress test A 1 000 $ - $ 16.36
59030 Fetal scalp blood sample A 0 000 Y $ 103.70 $ -
59050 Fetal monitor w/report A 0 XXX $ 70.64 $ -
59051 Fetal monitor/interpret only A 0 XXX $ 59.16 $ -
59070 Transabdom amnioinfus w/us A 0 000 Y Y $ 427.00 $ 512.26
59072 Umbilical cord occlud w/us A 0 000 Y $ 717.92 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
59074 Fetal fluid drainage w/us A 0 000 Y Y $ 431.87 $ 519.91

59076 Fetal shunt placement w/us A 0 000 Y Y $ 715.49 $ -
59100 Remove uterus lesion A 0 090 Y Y $ 1,117.78 $ -
59120 Treat ectopic pregnancy A 0 090 Y Y $ 1,065.92 $ -
59130 Treat ectopic pregnancy A 0 090 Y $ 869.30 $ -
59135 Treat ectopic pregnancy A 0 090 Y $ 878.70 $ -
59140 Treat ectopic pregnancy A 0 090 Y Y $ 372.36 $ -
59160 D & c after delivery A 0 010 Y $ 232.12 $ 258.91
59200 Insert cervical dilator A 0 000 Y $ 62.99 $ 86.65
59300 Episiotomy or vaginal repair A 0 000 Y $ 198.36 $ 236.64
59350 Repair of uterus A 0 000 Y Y $ 389.76 $ -
59400 Obstetrical care A 0 MMM Y $ 2,722.75 $ -
59412 Antepartum manipulation A 0 MMM $ 140.24 $ -
59414 Deliver placenta A 0 MMM Y $ 127.02 $ -
59425 Antepartum care only A 0 MMM $ 488.94 $ 573.16
59426 Antepartum care only A 0 MMM $ 857.47 $ 1,015.81
59430 Care after delivery A 0 MMM Y $ 191.05 $ 223.07
59510 Cesarean delivery A 0 MMM Y $ 3,037.69 $ -
59514 Cesarean delivery only A 0 MMM Y Y $ 1,269.16 $ -
59515 Cesarean delivery A 0 MMM Y $ 1,715.64 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
59525 Remove uterus after cesarean A 0 ZZZ Y $ 673.73 $ -

59610 Vbac delivery A 0 MMM Y $ 2,890.14 $ -
59612 Vbac delivery only A 0 MMM Y $ 1,270.55 $ -
59614 Vbac care after delivery A 0 MMM Y $ 1,566.00 $ -
59618 Attempted vbac delivery A 0 MMM Y $ 3,093.72 $ -
59620 Attempted vbac delivery only A 0 MMM Y Y $ 1,321.01 $ -
59622 Attempted vbac after care A 0 MMM Y $ 1,772.71 $ -
59812 Treatment of miscarriage A 0 090 Y $ 384.54 $ 403.33
59820 Care of miscarriage A 0 090 Y $ 451.36 $ 471.54
59821 Treatment of miscarriage A 0 090 Y $ 460.75 $ 482.33
59830 Treat uterus infection A 0 090 Y $ 573.16 $ -
59840 Abortion A 0 010 Y $ 262.39 $ 269.70
59841 Abortion A 0 010 Y $ 479.20 $ 497.64
59850 Abortion A 0 090 Y $ 356.70 $ -
59851 Abortion A 0 090 Y $ 520.26 $ -
59852 Abortion A 0 090 Y $ 515.04 $ -
59855 Abortion A 0 090 Y $ 550.88 $ -
59856 Abortion A 0 090 Y $ 652.85 $ -
59857 Abortion A 0 090 Y $ 536.96 $ -
59866 Abortion (mpr) A 0 000 Y Y $ 225.85 $ -
59870 Evacuate mole of uterus A 0 090 Y Y $ 604.48 $ -
59871 Remove cerclage suture A 0 000 Y $ 179.22 $ -
59897 Fetal invas px w/us C 0 YYY Y $ - $ -
59898 Laparo proc ob care/deliver C 0 YYY Y Y Y Y $ - $ -
59899 Maternity care procedure C 0 YYY Y Y Y $ - $ -
60000 Drain thyroid/tongue cyst A 0 010 Y $ 154.86 $ 169.13
6005F Care level rationale doc M 9 XXX $ - $ -
60100 Biopsy of thyroid A 0 000 Y $ 88.04 $ 115.19

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
6010F Dysphag test done b/4 eating M 9 XXX $ - $ -

6015F Dysphag test done b/4 eating M 9 XXX $ - $ -
60200 Remove thyroid lesion A 0 090 Y Y $ 757.60 $ -
6020F Npo (nothing-mouth) ordered M 9 XXX $ - $ -
60210 Partial thyroid excision A 0 090 Y Y $ 834.50 $ -
60212 Partial thyroid excision A 0 090 Y Y $ 1,203.38 $ -
60220 Partial removal of thyroid A 0 090 Y Y $ 826.50 $ -
60225 Partial removal of thyroid A 0 090 Y Y $ 1,089.24 $ -
60240 Removal of thyroid A 0 090 Y Y $ 1,091.68 $ -
60254 Extensive thyroid surgery A 0 090 Y Y $ 1,950.54 $ -
60260 Repeat thyroid surgery A 0 090 Y Y Y $ 1,290.38 $ -
60280 Remove thyroid duct lesion A 0 090 Y Y $ 483.02 $ -
60281 Remove thyroid duct lesion A 0 090 Y Y $ 646.93 $ -
60300 Aspir/inj thyroid cyst A 0 000 Y $ 56.03 $ 110.66
6030F Max sterile barriers follwd M 9 XXX $ - $ -
6040F Appro rad ds dvcs techs docd M 9 XXX $ - $ -
6045F Radxps in end rprt4fluro pxd M 9 XXX $ - $ -
60500 Explore parathyroid glands A 0 090 Y Y $ 1,152.58 $ -
60502 Re-explore parathyroids A 0 090 Y Y $ 1,543.73 $ -
60505 Explore parathyroid glands A 0 090 Y Y $ 1,674.58 $ -
60512 Autotransplant parathyroid A 0 ZZZ Y $ 298.93 $ -
60520 Removal of thymus gland A 0 090 Y Y $ 1,258.72 $ -
60540 Explore adrenal gland A 0 090 Y Y Y $ 1,243.06 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
60545 Explore adrenal gland A 0 090 Y Y $ 1,444.90 $ -

60600 Remove carotid body lesion A 0 090 Y Y $ 1,801.60 $ -
60605 Remove carotid body lesion A 0 090 Y Y $ 1,895.21 $ -
60650 Laparoscopy adrenalectomy A 0 090 Y Y Y $ 1,429.58 $ -
60659 Laparo proc endocrine C 0 YYY Y Y Y $ - $ -
60699 Endocrine surgery procedure C 0 YYY Y Y Y $ - $ -
6070F Pt asked/cnsld aed effects M 9 XXX $ - $ -
6080F Pt/caregiver queried falls M 9 XXX $ - $ -
6090F Pt/caregiver counsel safety M 9 XXX $ - $ -
61000 Remove cranial cavity fluid A 0 000 Y $ 112.75 $ -
61001 Remove cranial cavity fluid A 0 000 Y $ 152.08 $ -
6100F Verify pt site pxd docd M 9 XXX $ - $ -
6101F Safety counseling dementia M 9 XXX $ - $ -
61020 Remove brain cavity fluid A 0 000 Y $ 167.74 $ -
61026 Injection into brain canal A 0 000 Y $ 150.68 $ -
6102F Safety counseling dem order M 9 XXX $ - $ -
61050 Remove brain canal fluid A 0 000 Y $ 105.79 $ -
61055 Injection into brain canal A 0 000 $ 150.34 $ -
61070 Brain canal shunt procedure A 0 000 Y $ 93.96 $ -
61105 Twist drill hole A 0 090 Y $ 584.29 $ -
61107 Drill skull for implantation A 0 000 $ 447.53 $ -
61108 Drill skull for drainage A 0 090 Y $ 1,183.55 $ -
6110F Counsel prov driving risks M 9 XXX $ - $ -
61120 Burr hole for puncture A 0 090 Y $ 978.23 $ -
61140 Pierce skull for biopsy A 0 090 Y Y $ 1,683.97 $ -
61150 Pierce skull for drainage A 0 090 Y $ 1,829.78 $ -
61151 Pierce skull for drainage A 0 090 Y $ 1,329.01 $ -
61154 Pierce skull & remove clot A 0 090 Y Y Y $ 1,690.24 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
61156 Pierce skull for drainage A 0 090 Y Y $ 1,685.02 $ -

61210 Pierce skull implant device A 0 000 Y $ 523.04 $ -
61215 Insert brain-fluid device A 0 090 Y $ 637.54 $ -
61250 Pierce skull & explore A 0 090 Y Y Y $ 1,147.36 $ -
61253 Pierce skull & explore A 0 090 Y Y $ 921.16 $ -
61304 Open skull for exploration A 0 090 Y Y $ 2,214.67 $ -
61305 Open skull for exploration A 0 090 Y Y $ 2,738.06 $ -
61312 Open skull for drainage A 0 090 Y Y $ 2,849.42 $ -
61316 Implt cran bone flap to abdo A 0 ZZZ $ 123.89 $ -
61322 Decompressive craniotomy A 0 090 Y Y $ 3,240.92 $ -
61323 Decompressive lobectomy A 0 090 Y $ 3,275.03 $ -
61330 Decompress eye socket A 0 090 Y Y Y $ 2,439.48 $ -
61332 Explore/biopsy eye socket A 0 090 Y Y $ 2,735.98 $ -
61333 Explore orbit/remove lesion A 0 090 Y Y $ 2,800.36 $ -
61334 Explore orbit/remove object A 0 090 Y Y $ 1,749.74 $ -
61340 Subtemporal decompression A 0 090 Y Y Y $ 1,951.58 $ -
61343 Incise skull (press relief) A 0 090 Y Y $ 3,003.94 $ -
61345 Relieve cranial pressure A 0 090 Y Y $ 2,785.74 $ -
61440 Incise skull for surgery A 0 090 Y Y $ 2,732.50 $ -
61458 Incise skull for brain wound A 0 090 Y Y $ 2,734.24 $ -
61460 Incise skull for surgery A 0 090 Y Y Y $ 2,870.65 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

61490 Incise skull for surgery A 0 090 Y Y Y $ 2,591.56 $ -
61500 Removal of skull lesion A 0 090 Y Y $ 1,730.60 $ -
61501 Remove infected skull bone A 0 090 Y Y $ 1,467.52 $ -
6150F Pt notrcvng1st antitnf txmnt M 9 XXX $ - $ -
61510 Removal of brain lesion A 0 090 Y Y $ 2,962.18 $ -
61512 Remove brain lining lesion A 0 090 Y Y $ 3,501.92 $ -
61514 Removal of brain abscess A 0 090 Y Y $ 2,594.69 $ -
61517 Implt brain chemotx add-on A 0 ZZZ $ 123.19 $ -
61519 Remove brain lining lesion A 0 090 Y Y $ 4,061.16 $ -
61520 Removal of brain lesion A 0 090 Y Y Y $ 5,027.56 $ -
61522 Removal of brain abscess A 0 090 Y Y $ 2,994.19 $ -
61531 Implant brain electrodes A 0 090 Y Y Y $ 1,628.64 $ -
61533 Implant brain electrodes A 0 090 Y Y $ 2,065.38 $ -
61535 Remove brain electrodes A 0 090 Y Y $ 1,322.05 $ -
61537 Removal of brain tissue A 0 090 Y Y $ 3,390.91 $ -
61541 Incision of brain tissue A 0 090 Y Y $ 2,939.21 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

61544 Remove & treat brain lesion A 0 090 Y Y $ 2,578.33 $ -
61545 Excision of brain tumor A 0 090 Y Y $ 4,374.71 $ -
61546 Removal of pituitary gland A 0 090 Y Y $ 3,161.93 $ -
61548 Removal of pituitary gland A 0 090 Y Y Y $ 2,016.66 $ -
61550 Release of skull seams A 0 090 Y Y $ 1,034.60 $ -
61552 Release of skull seams A 0 090 Y Y $ 1,310.22 $ -
61556 Incise skull/sutures A 0 090 Y Y $ 2,310.02 $ -
61557 Incise skull/sutures A 0 090 Y Y $ 2,270.00 $ -
61558 Excision of skull/sutures A 0 090 Y Y $ 2,549.80 $ -
61559 Excision of skull/sutures A 0 090 Y Y $ 1,956.11 $ -
61563 Excision of skull tumor A 0 090 Y Y $ 2,707.09 $ -
61564 Excision of skull tumor A 0 090 Y Y $ 3,294.52 $ -
61567 Incision of brain tissue A 0 090 Y Y $ 3,516.19 $ -
61570 Remove foreign body brain A 0 090 Y Y $ 2,536.57 $ -
61571 Incise skull for brain wound A 0 090 Y Y $ 2,712.66 $ -
61575 Skull base/brainstem surgery A 0 090 Y Y $ 3,435.11 $ -
61576 Skull base/brainstem surgery A 0 090 Y Y $ 4,057.68 $ -
61580 Craniofacial approach skull A 0 090 Y Y Y $ 2,792.35 $ -
61581 Craniofacial approach skull A 0 090 Y Y Y Y $ 2,935.38 $ -
61584 Orbitocranial approach/skull A 0 090 Y Y Y Y $ 3,714.20 $ -
61586 Resect nasopharynx skull A 0 090 Y Y Y $ 3,044.65 $ -
61590 Infratemporal approach/skull A 0 090 Y Y Y Y $ 3,574.66 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
61591 Infratemporal approach/skull A 0 090 Y Y Y Y $ 3,710.38 $ -

61595 Transtemporal approach/skull A 0 090 Y Y Y $ 2,802.79 $ -
61596 Transcochlear approach/skull A 0 090 Y Y Y Y $ 2,751.29 $ -
61597 Transcondylar approach/skull A 0 090 Y Y Y Y $ 3,942.84 $ -
61598 Transpetrosal approach/skull A 0 090 Y Y Y $ 3,694.02 $ -
61600 Resect/excise cranial lesion A 0 090 Y Y Y $ 2,510.47 $ -
61609 Transect artery sinus A 0 ZZZ Y Y $ 860.60 $ -
61610 Transect artery sinus A 0 ZZZ Y Y $ 2,589.12 $ -
61611 Transect artery sinus A 0 ZZZ Y Y $ 401.59 $ -
61612 Transect artery sinus A 0 ZZZ Y Y $ 1,500.92 $ -
61613 Remove aneurysm sinus A 0 090 Y Y Y Y $ 4,407.07 $ -
61615 Resect/excise lesion skull A 0 090 Y Y Y $ 2,533.79 $ -
61616 Resect/excise lesion skull A 0 090 Y Y Y $ 4,303.02 $ -
61618 Repair dura A 0 090 Y Y Y $ 1,697.20 $ -
61619 Repair dura A 0 090 Y Y Y $ 1,917.48 $ -
61623 Endovasc tempory vessel occl A 0 000 Y $ 679.64 $ -
61624 Transcath occlusion cns A 0 000 Y $ 1,357.90 $ -
61626 Transcath occlusion non-cns A 0 000 Y $ 989.02 $ -
61630 Intracranial angioplasty A 0 XXX Y Y $ 1,532.94 $ -
61635 Intracran angioplsty w/stent A 0 XXX Y Y $ 1,635.60 $ -
61640 Dilate ic vasospasm init N 9 000 $ 658.42 $ -
61641 Dilate ic vasospasm add-on N 9 ZZZ $ 231.77 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
61642 Dilate ic vasospasm add-on N 9 ZZZ $ 462.49 $ -

61680 Intracranial vessel surgery A 0 090 Y Y $ 3,094.07 $ -
61697 Brain aneurysm repr complx A 0 090 Y Y $ 5,847.44 $ -
61698 Brain aneurysm repr complx A 0 090 Y Y $ 6,433.13 $ -
61700 Brain aneurysm repr simple A 0 090 Y Y $ 4,722.36 $ -
61702 Inner skull vessel surgery A 0 090 Y Y $ 5,573.92 $ -
61703 Clamp neck artery A 0 090 Y Y $ 1,831.87 $ -
61705 Revise circulation to head A 0 090 Y Y $ 3,576.74 $ -
61708 Revise circulation to head A 0 090 Y Y $ 2,200.06 $ -
61710 Revise circulation to head A 0 090 Y $ 2,399.81 $ -
61711 Fusion of skull arteries A 0 090 Y Y $ 3,592.40 $ -
61720 Incise skull/brain surgery A 0 090 Y $ 1,702.76 $ -
61735 Incise skull/brain surgery A 0 090 Y $ 2,139.16 $ -
61750 Incise skull/brain biopsy A 0 090 Y $ 1,902.17 $ -
61751 Brain biopsy w/ct/mr guide A 0 090 Y $ 1,840.22 $ -
61760 Implant brain electrodes A 0 090 Y Y $ 2,140.55 $ -
61770 Incise skull for treatment A 0 090 Y $ 2,189.62 $ -
61781 Scan proc cranial intra A 0 ZZZ $ 327.12 $ -
61782 Scan proc cranial extra A 0 ZZZ $ 255.43 $ -
61783 Scan proc spinal A 0 ZZZ $ 327.12 $ -
61790 Treat trigeminal nerve A 0 090 Y $ 1,147.36 $ -
61791 Treat trigeminal tract A 0 090 Y $ 1,469.95 $ -
61796 Srs cranial lesion simple A 0 090 Y $ 1,308.48 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
61797 Srs cran les simple addl A 0 ZZZ Y $ 301.72 $ -

61798 Srs cranial lesion complex A 0 090 Y $ 1,800.20 $ -
61799 Srs cran les complex addl A 0 ZZZ Y $ 415.86 $ -
61800 Apply srs headframe add-on A 0 ZZZ Y $ 202.88 $ -
61850 Implant neuroelectrodes A 0 090 Y Y $ 1,316.14 $ -
61863 Implant neuroelectrode A 0 090 Y Y Y $ 2,020.14 $ -
61864 Implant neuroelectrde addl A 0 ZZZ Y $ 404.38 $ -
61867 Implant neuroelectrode A 0 090 Y Y Y $ 3,128.17 $ -
61868 Implant neuroelectrde addl A 0 ZZZ Y $ 712.01 $ -
61880 Revise/remove neuroelectrode A 0 090 Y Y Y $ 729.76 $ -
61885 Insrt/redo neurostim 1 array A 0 090 Y Y $ 659.46 $ -
61886 Implant neurostim arrays A 0 090 Y $ 1,071.14 $ -
61888 Revise/remove neuroreceiver A 0 010 Y Y $ 504.25 $ -
62000 Treat skull fracture A 0 090 Y $ 1,255.58 $ -
62005 Treat skull fracture A 0 090 Y Y $ 1,711.12 $ -
62010 Treatment of head injury A 0 090 Y Y $ 2,069.90 $ -
62100 Repair brain fluid leakage A 0 090 Y Y $ 2,130.11 $ -
62115 Reduction of skull defect A 0 090 Y Y $ 1,297.34 $ -
62120 Repair skull cavity lesion A 0 090 Y Y $ 1,843.36 $ -
62121 Incise skull repair A 0 090 Y Y $ 2,260.26 $ -
62140 Repair of skull defect A 0 090 Y Y $ 1,368.68 $ -
62141 Repair of skull defect A 0 090 Y Y $ 1,510.32 $ -
62142 Remove skull plate/flap A 0 090 Y Y $ 1,167.19 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
62143 Replace skull plate/flap A 0 090 Y Y $ 1,388.87 $ -

62145 Repair of skull & brain A 0 090 Y Y $ 1,924.79 $ -
62146 Repair of skull with graft A 0 090 Y Y $ 1,679.45 $ -
62147 Repair of skull with graft A 0 090 Y Y $ 1,983.60 $ -
62148 Retr bone flap to fix skull A 0 ZZZ $ 178.87 $ -
62160 Neuroendoscopy add-on A 0 ZZZ $ 270.05 $ -
62161 Dissect brain w/scope A 0 090 Y Y $ 2,051.11 $ -
62162 Remove colloid cyst w/scope A 0 090 Y Y $ 2,571.37 $ -
62163 Zneuroendoscopy w/fb removal A 0 090 Y Y $ 1,634.90 $ -
62164 Remove brain tumor w/scope A 0 090 Y Y $ 2,828.89 $ -
62165 Remove pituit tumor w/scope A 0 090 Y $ 1,986.04 $ -
62180 Establish brain cavity shunt A 0 090 Y Y $ 2,173.61 $ -
62190 Establish brain cavity shunt A 0 090 Y $ 1,222.18 $ -
62194 Replace/irrigate catheter A 0 010 Y $ 420.38 $ -
62201 Brain cavity shunt w/scope A 0 090 Y $ 1,596.28 $ -
62225 Replace/irrigate catheter A 0 090 Y $ 663.64 $ -
62230 Replace/revise brain shunt A 0 090 Y Y $ 1,115.69 $ -
62252 Csf shunt reprogram A 1 XXX $ - $ 101.62
62252 26 Csf shunt reprogram A 1 XXX $ 63.34 $ 63.34
62252 TC Csf shunt reprogram A 1 XXX $ - $ 38.28
62256 Remove brain cavity shunt A 0 090 Y Y $ 772.21 $ -
62258 Replace brain cavity shunt A 0 090 Y Y $ 1,503.71 $ -
62263 Epidural lysis mult sessions A 0 010 Y $ 346.61 $ 636.84
62264 Epidural lysis on single day A 0 010 Y $ 253.34 $ 418.30

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
62267 Interdiscal perq aspir dx A 0 000 Y $ 173.65 $ 249.52

62268 Drain spinal cord cyst A 0 000 Y $ 281.53 $ 312.50
62269 Needle biopsy spinal cord A 0 000 Y $ 296.15 $ 337.56
62270 Spinal fluid tap diagnostic A 0 000 Y $ 92.57 $ 159.04
62272 Drain cerebro spinal fluid A 0 000 Y $ 106.84 $ 204.28
62273 Inject epidural patch A 0 000 Y $ 123.54 $ 173.65
62280 Treat spinal cord lesion A 0 010 Y $ 197.32 $ 339.65
62281 Treat spinal cord lesion A 0 010 Y $ 165.30 $ 248.12
62282 Treat spinal canal lesion A 0 010 Y $ 156.60 $ 286.06
62284 Injection for myelogram A 0 000 Y $ 95.35 $ 193.49
62287 Percutaneous diskectomy A 0 090 Y $ 587.77 $ -
62290 Inject for spine disk x-ray A 0 000 Y $ 186.53 $ 331.30
62291 Inject for spine disk x-ray A 0 000 Y $ 177.83 $ 313.55
62292 Injection into disk lesion A 0 090 Y $ 592.99 $ -
62294 Injection into spinal artery A 0 090 Y $ 835.20 $ -
62310 Inject spine c/t A 0 000 Y $ 113.45 $ 231.77
62311 Inject spine l/s (cd) A 0 000 Y $ 91.87 $ 194.53
62318 Inject spine w/cath c/t A 0 000 Y $ 109.62 $ 235.94
62319 Inject spine w/cath l/s (cd) A 0 000 Y $ 104.75 $ 179.57
62350 Implant spinal canal cath A 0 010 Y $ 457.27 $ -
62351 Implant spinal canal cath A 0 090 Y Y Y $ 1,090.98 $ -
62355 Remove spinal canal catheter A 0 010 Y $ 289.54 $ -
62360 Insert spine infusion device A 0 010 Y $ 357.74 $ -
62361 Implant spine infusion pump A 0 010 Y $ 404.03 $ -
62362 Implant spine infusion pump A 0 010 Y $ 452.75 $ -
62365 Remove spine infusion device A 0 010 Y $ 331.99 $ -
62367 Analyze spine infus pump A 0 XXX $ 27.49 $ 41.06
62368 Analyze sp inf pump w/reprog A 0 XXX $ 35.50 $ 53.24

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
62369 Anal sp inf pmp w/reprg&fill A 0 XXX $ 36.19 $ 112.06

62370 Anl sp inf pmp w/mdreprg&fil A 0 XXX $ 49.07 $ 119.71
63001 Removal of spinal lamina A 0 090 Y Y Y $ 1,628.99 $ -
63020 Neck spine disk surgery A 0 090 Y Y Y Y $ 1,511.02 $ -
63030 Low back disk surgery A 0 090 Y Y Y Y $ 1,221.83 $ -
63035 Spinal disk surgery add-on A 0 ZZZ Y Y Y $ 255.43 $ -
63040 Laminotomy single cervical A 0 090 Y Y Y Y $ 1,837.09 $ -
63042 Laminotomy single lumbar A 0 090 Y Y Y Y $ 1,647.08 $ -
63043 Laminotomy addl cervical C 0 ZZZ Y Y Y $ - $ -
63044 Laminotomy addl lumbar C 0 ZZZ Y Y Y $ - $ -
63048 Remove spinal lamina add-on A 0 ZZZ Y Y $ 286.06 $ -
63050 Cervical laminoplasty A 0 090 Y Y Y $ 2,111.32 $ -
63051 C-laminoplasty w/graft/plate A 0 090 Y Y Y $ 2,206.67 $ -
63055 Decompress spinal cord A 0 090 Y Y $ 2,160.38 $ -
63057 Decompress spine cord add-on A 0 ZZZ Y $ 430.82 $ -
63066 Decompress spine cord add-on A 0 ZZZ Y $ 294.06 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
63075 Neck spine disk surgery A 0 090 Y Y Y $ 1,794.29 $ -

63076 Neck spine disk surgery A 0 ZZZ Y Y $ 341.39 $ -
63077 Spine disk surgery thorax A 0 090 Y Y Y $ 1,889.99 $ -
63078 Spine disk surgery thorax A 0 ZZZ Y Y $ 245.69 $ -
63081 Removal of vertebral body A 0 090 Y Y Y $ 2,315.59 $ -
63082 Remove vertebral body add-on A 0 ZZZ Y Y $ 364.01 $ -
63085 Removal of vertebral body A 0 090 Y Y Y Y $ 2,440.87 $ -
63086 Remove vertebral body add-on A 0 ZZZ Y Y Y $ 254.39 $ -
63101 Removal of vertebral body A 0 090 Y Y $ 3,059.62 $ -
63103 Remove vertebral body add-on A 0 ZZZ Y $ 383.84 $ -
63170 Incise spinal cord tract(s) A 0 090 Y Y $ 2,148.20 $ -
63172 Drainage of spinal cyst A 0 090 Y Y $ 1,906.69 $ -
63173 Drainage of spinal cyst A 0 090 Y Y $ 2,344.48 $ -
63180 Revise spinal cord ligaments A 0 090 Y Y $ 1,989.86 $ -
63182 Revise spinal cord ligaments A 0 090 Y Y $ 2,181.96 $ -
63185 Incise spinal column/nerves A 0 090 Y Y $ 1,601.84 $ -
63190 Incise spinal column/nerves A 0 090 Y Y $ 1,535.72 $ -
63191 Incise spinal column/nerves A 0 090 Y Y Y $ 1,464.04 $ -
63194 Incise spinal column & cord A 0 090 Y Y $ 1,427.84 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

63200 Release of spinal cord A 0 090 Y Y $ 2,058.77 $ -
63250 Revise spinal cord vessels A 0 090 Y Y $ 4,099.44 $ -
63265 Excise intraspinal lesion A 0 090 Y Y $ 2,234.86 $ -
63275 Biopsy/excise spinal tumor A 0 090 Y Y $ 2,418.25 $ -
63295 Repair of laminectomy defect A 0 ZZZ Y Y $ 471.19 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

63308 Remove vertebral body add-on A 0 ZZZ Y $ 434.65 $ -
63600 Remove spinal cord lesion A 0 090 Y $ 991.45 $ -
63610 Stimulation of spinal cord A 0 000 Y $ 467.71 $ 656.68
63615 Remove lesion of spinal cord A 0 090 Y $ 1,665.53 $ -
63620 Srs spinal lesion A 0 090 Y $ 1,447.33 $ -
63621 Srs spinal lesion addl A 0 ZZZ Y $ 345.91 $ -
63650 Implant neuroelectrodes A 0 010 Y $ 450.66 $ -
63661 Remove spine eltrd perq aray A 0 010 Y Y $ 360.88 $ 594.38
63662 Remove spine eltrd plate A 0 090 Y Y $ 851.21 $ -
63663 Revise spine eltrd perq aray A 0 010 Y Y $ 532.79 $ 855.04
63664 Revise spine eltrd plate A 0 090 Y Y $ 875.22 $ -
63685 Insrt/redo spine n generator A 0 010 Y Y $ 413.42 $ -
63688 Revise/remove neuroreceiver A 0 010 Y $ 423.86 $ -
63700 Repair of spinal herniation A 0 090 Y Y $ 1,724.34 $ -
63707 Repair spinal fluid leakage A 0 090 Y Y $ 1,139.00 $ -
63709 Repair spinal fluid leakage A 0 090 Y Y $ 1,400.00 $ -
63710 Graft repair of spine defect A 0 090 Y Y $ 1,434.80 $ -
63740 Install spinal shunt A 0 090 Y Y $ 1,234.01 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
63741 Install spinal shunt A 0 090 Y Y $ 769.08 $ -

63744 Revision of spinal shunt A 0 090 Y Y $ 881.14 $ -
63746 Removal of spinal shunt A 0 090 Y $ 769.78 $ -
64400 N block inj trigeminal A 0 000 Y Y $ 78.30 $ 120.76
64402 N block inj facial A 0 000 Y Y $ 84.91 $ 121.80
64405 N block inj occipital A 0 000 Y Y $ 73.43 $ 103.01
64408 N block inj vagus A 0 000 Y Y $ 87.00 $ 111.36
64410 N block inj phrenic A 0 000 Y Y $ 109.27 $ 164.26
64412 N block inj spinal accessor A 0 000 Y Y $ 85.61 $ 148.94
64413 N block inj cervical plexus A 0 000 Y Y $ 91.87 $ 128.41
64415 N block inj brachial plexus A 0 000 Y Y $ 73.08 $ 121.80
64416 N block cont infuse b plex A 0 000 Y Y $ 89.09 $ -
64417 N block inj axillary A 0 000 Y Y $ 76.56 $ 129.11
64418 N block inj suprascapular A 0 000 Y Y $ 79.34 $ 134.33
64420 N block inj intercost sng A 0 000 Y $ 73.43 $ 122.50
64421 N block inj intercost mlt A 0 000 Y Y $ 105.10 $ 175.74
64425 N block inj ilio-ing/hypogi A 0 000 Y Y $ 106.14 $ 139.20
64430 N block inj pudendal A 0 000 Y Y $ 89.09 $ 138.16
64435 N block inj paracervical A 0 000 Y Y $ 98.83 $ 146.51
64445 N block inj sciatic sng A 0 000 Y Y $ 83.52 $ 136.07
64446 N blk inj sciatic cont inf A 0 000 Y Y $ 89.78 $ -
64447 N block inj fem single A 0 000 Y Y $ 72.73 $ 121.80
64448 N block inj fem cont inf A 0 000 Y Y $ 79.69 $ -
64449 N block inj lumbar plexus A 0 000 Y Y $ 92.22 $ -
64450 N block other peripheral A 0 000 Y Y $ 74.12 $ 104.75
64455 N block inj plantar digit A 0 000 Y Y $ 41.06 $ 51.50
64479 Inj foramen epidural c/t A 0 000 Y Y $ 147.55 $ 254.74
64480 Inj foramen epidural add-on A 0 ZZZ Y $ 77.26 $ 127.02

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
64483 Inj foramen epidural l/s A 0 000 Y Y $ 117.62 $ 227.59

64484 Inj foramen epidural add-on A 0 ZZZ Y $ 56.38 $ 96.40
64490 Inj paravert f jnt c/t 1 lev A 0 000 Y Y Y $ 119.71 $ 196.97
64491 Inj paravert f jnt c/t 2 lev A 0 ZZZ Y Y $ 67.51 $ 98.14
64492 Inj paravert f jnt c/t 3 lev A 0 ZZZ Y Y $ 67.86 $ 98.83
64493 Inj paravert f jnt l/s 1 lev A 0 000 Y Y Y $ 98.14 $ 172.61
64494 Inj paravert f jnt l/s 2 lev A 0 ZZZ Y Y $ 56.03 $ 87.70
64495 Inj paravert f jnt l/s 3 lev A 0 ZZZ Y Y $ 56.72 $ 88.39
64505 N block spenopalatine gangl A 0 000 Y $ 85.96 $ 100.22
64508 N block carotid sinus s/p A 0 000 Y $ 91.18 $ 98.83
64510 N block stellate ganglion A 0 000 Y $ 75.86 $ 128.76
64517 N block inj hypogas plxs A 0 000 Y $ 132.24 $ 182.00
64520 N block lumbar/thoracic A 0 000 Y $ 83.87 $ 183.40
64530 N block inj celiac pelus A 0 000 Y $ 98.14 $ 190.01
64550 Apply neurostimulator A 0 000 $ 9.05 $ 15.31
64553 Implant neuroelectrodes A 0 010 Y $ 185.14 $ 229.33
64561 Implant neuroelectrodes A 0 010 Y Y $ 441.96 $ 855.38
64566 Neuroeltrd stim post tibial A 0 000 Y $ 32.36 $ 120.41
64568 Inc for vagus n elect impl A 0 090 Y Y $ 690.43 $ -
64569 Revise/repl vagus n eltrd A 0 090 Y Y Y $ 917.68 $ -
64570 Remove vagus n eltrd A 0 090 Y Y Y $ 804.23 $ -
64580 Implant neuroelectrodes A 0 090 Y Y $ 354.26 $ -
64585 Revise/remove neuroelectrode A 0 010 Y $ 159.38 $ 263.44
64590 Insrt/redo pn/gastr stimul A 0 010 Y $ 175.74 $ 270.40

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
64595 Revise/rmv pn/gastr stimul A 0 010 Y $ 137.81 $ 254.04

64600 Injection treatment of nerve A 0 010 Y $ 248.47 $ 409.94
64611 Chemodenerv saliv glands A 0 010 Y $ 107.18 $ 116.23
64612 Destroy nerve face muscle A 0 010 Y Y $ 201.49 $ 213.67
64613 Destroy nerve neck muscle A 0 010 Y Y $ 187.22 $ 201.14
64614 Destroy nerve extrem musc A 0 010 Y Y $ 178.87 $ 197.32
64632 N block inj common digit A 0 010 Y Y $ 73.08 $ 86.65
64633 Destroy cerv/thor facet jnt A 0 010 Y Y $ 246.04 $ 429.43
64634 Destroy c/th facet jnt addl A 0 ZZZ Y $ 75.52 $ 191.05
64635 Destroy lumb/sac facet jnt A 0 010 Y Y $ 240.82 $ 421.78
64636 Destroy l/s facet jnt addl A 0 ZZZ Y $ 65.08 $ 171.22
64640 Injection treatment of nerve A 0 010 Y Y $ 177.83 $ 220.28
64650 Chemodenerv eccrine glands A 0 000 Y $ 46.98 $ 105.44
64653 Chemodenerv eccrine glands A 0 000 Y $ 69.60 $ 133.98
64702 Revise finger/toe nerve A 0 090 Y $ 542.18 $ -
64704 Revise hand/foot nerve A 0 090 Y Y $ 336.52 $ -
64708 Revise arm/leg nerve A 0 090 Y Y $ 549.49 $ -
64712 Revision of sciatic nerve A 0 090 Y Y $ 625.36 $ -
64713 Revision of arm nerve(s) A 0 090 Y Y $ 901.67 $ -
64714 Revise low back nerve(s) A 0 090 Y Y $ 762.82 $ -
64716 Revision of cranial nerve A 0 090 Y Y $ 588.12 $ -
64718 Revise ulnar nerve at elbow A 0 090 Y $ 662.24 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
64719 Revise ulnar nerve at wrist A 0 090 Y $ 440.92 $ -

64721 Carpal tunnel surgery A 0 090 Y Y $ 468.06 $ 470.50
64722 Relieve pressure on nerve(s) A 0 090 Y Y $ 398.11 $ -
64726 Release foot/toe nerve A 0 090 Y $ 283.62 $ -
64727 Internal nerve revision A 0 ZZZ $ 223.76 $ -
64732 Incision of brow nerve A 0 090 Y Y $ 545.66 $ -
64734 Incision of cheek nerve A 0 090 Y $ 465.97 $ -
64736 Incision of chin nerve A 0 090 Y Y $ 586.73 $ -
64738 Incision of jaw nerve A 0 090 Y Y $ 653.89 $ -
64740 Incision of tongue nerve A 0 090 Y Y $ 492.07 $ -
64742 Incision of facial nerve A 0 090 Y Y $ 502.16 $ -
64744 Incise nerve back of head A 0 090 Y Y $ 612.83 $ -
64746 Incise diaphragm nerve A 0 090 Y Y $ 537.66 $ -
64752 Incision of vagus nerve A 0 090 Y Y $ 635.45 $ -
64755 Incision of stomach nerves A 0 090 Y Y $ 1,120.21 $ -
64760 Incision of vagus nerve A 0 090 Y Y $ 603.78 $ -
64761 Incision of pelvis nerve A 0 090 Y Y Y $ 509.47 $ -
64763 Incise hip/thigh nerve A 0 090 Y Y Y $ 614.57 $ -
64766 Incise hip/thigh nerve A 0 090 Y Y Y $ 623.62 $ -
64771 Sever cranial nerve A 0 090 Y Y $ 635.80 $ -
64772 Incision of spinal nerve A 0 090 Y Y $ 686.26 $ -
64774 Remove skin nerve lesion A 0 090 Y $ 471.89 $ -
64776 Remove digit nerve lesion A 0 090 Y $ 430.48 $ -
64778 Digit nerve surgery add-on A 0 ZZZ $ 223.07 $ -
64782 Remove limb nerve lesion A 0 090 Y $ 493.81 $ -
64783 Limb nerve surgery add-on A 0 ZZZ $ 241.86 $ -
64784 Remove nerve lesion A 0 090 Y $ 845.99 $ -
64786 Remove sciatic nerve lesion A 0 090 Y Y $ 1,266.37 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
64787 Implant nerve end A 0 ZZZ $ 287.10 $ -

64788 Remove skin nerve lesion A 0 090 Y $ 454.49 $ -
64790 Removal of nerve lesion A 0 090 Y $ 999.80 $ -
64792 Removal of nerve lesion A 0 090 Y Y $ 1,571.92 $ -
64795 Biopsy of nerve A 0 000 Y $ 249.86 $ -
64802 Remove sympathetic nerves A 0 090 Y Y Y $ 578.72 $ -
64820 Remove sympathetic nerves A 0 090 Y $ 859.91 $ -
64821 Remove sympathetic nerves A 0 090 Y Y $ 801.44 $ -
64831 Repair of digit nerve A 0 090 Y $ 764.90 $ -
64832 Repair nerve add-on A 0 ZZZ $ 405.07 $ -
64834 Repair of hand or foot nerve A 0 090 Y $ 839.03 $ -
64835 Repair of hand or foot nerve A 0 090 Y Y $ 940.99 $ -
64836 Repair of hand or foot nerve A 0 090 Y Y $ 941.34 $ -
64837 Repair nerve add-on A 0 ZZZ Y $ 396.72 $ -
64840 Repair of leg nerve A 0 090 Y Y $ 904.10 $ -
64856 Repair/transpose nerve A 0 090 Y $ 1,179.72 $ -
64857 Repair arm/leg nerve A 0 090 Y Y $ 1,223.57 $ -
64858 Repair sciatic nerve A 0 090 Y Y $ 1,312.66 $ -
64859 Nerve surgery A 0 ZZZ Y $ 317.38 $ -
64861 Repair of arm nerves A 0 090 Y Y $ 1,583.05 $ -
64862 Repair of low back nerves A 0 090 Y Y $ 2,052.16 $ -
64864 Repair of facial nerve A 0 090 Y Y $ 958.74 $ -
64865 Repair of facial nerve A 0 090 Y Y $ 1,219.74 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
64866 Fusion of facial/other nerve A 0 090 Y Y $ 1,240.27 $ -

64872 Subsequent repair of nerve A 0 ZZZ Y $ 132.24 $ -
64874 Repair & revise nerve add-on A 0 ZZZ Y $ 189.66 $ -
64876 Repair nerve/shorten bone A 0 ZZZ Y $ 228.98 $ -
64885 Nerve graft head or neck A 0 090 Y Y $ 1,221.83 $ -
64886 Nerve graft head or neck A 0 090 Y Y $ 1,432.37 $ -
64890 Nerve graft hand or foot A 0 090 Y Y $ 1,304.65 $ -
64892 Nerve graft arm or leg A 0 090 Y Y $ 1,268.11 $ -
64901 Nerve graft add-on A 0 ZZZ Y $ 760.38 $ -
64902 Nerve graft add-on A 0 ZZZ Y $ 879.05 $ -
64905 Nerve pedicle transfer A 0 090 Y Y $ 1,212.78 $ -
64907 Nerve pedicle transfer A 0 090 Y Y $ 1,161.62 $ -
64910 Nerve repair w/allograft A 0 090 Y Y $ 927.42 $ -
64911 Neurorraphy w/vein autograft A 0 090 Y Y $ 1,192.25 $ -
64999 Nervous system surgery C 0 YYY Y Y $ - $ -
65091 Revise eye A 0 090 Y Y $ 699.83 $ -
65093 Revise eye with implant A 0 090 Y Y $ 690.78 $ -
65101 Removal of eye A 0 090 Y Y $ 809.45 $ -
65103 Remove eye/insert implant A 0 090 Y Y $ 849.12 $ -
65105 Remove eye/attach implant A 0 090 Y Y Y $ 940.64 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
65110 Removal of eye A 0 090 Y Y Y $ 1,261.50 $ -

65112 Remove eye/revise socket A 0 090 Y Y Y $ 1,472.74 $ -
65114 Remove eye/revise socket A 0 090 Y Y Y $ 1,549.99 $ -
65125 Revise ocular implant A 0 090 Y Y $ 320.16 $ 456.23
65130 Insert ocular implant A 0 090 Y Y $ 806.66 $ -
65135 Insert ocular implant A 0 090 Y Y $ 818.50 $ -
65140 Attach ocular implant A 0 090 Y Y $ 821.98 $ -
65150 Revise ocular implant A 0 090 Y Y $ 539.05 $ -
65155 Reinsert ocular implant A 0 090 Y Y $ 941.69 $ -
65175 Removal of ocular implant A 0 090 Y Y $ 663.29 $ -
65205 Remove foreign body from eye A 0 000 Y Y $ 48.72 $ 58.46
65235 Remove foreign body from eye A 0 090 Y Y $ 741.59 $ -
65260 Remove foreign body from eye A 0 090 Y Y Y $ 911.76 $ -
65265 Remove foreign body from eye A 0 090 Y Y Y $ 1,268.81 $ -
65270 Repair of eye wound A 0 010 Y Y $ 150.68 $ 254.39
65273 Repair of eye wound A 0 090 Y Y $ 365.75 $ -
65280 Repair of eye wound A 0 090 Y Y $ 775.00 $ -
65285 Repair of eye wound A 0 090 Y Y $ 1,237.84 $ -
65290 Repair of eye socket wound A 0 090 Y Y $ 563.41 $ -
65400 Removal of eye lesion A 0 090 Y Y $ 627.79 $ 690.78
65410 Biopsy of cornea A 0 000 Y Y $ 124.24 $ 156.25

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

65430 Corneal smear A 0 000 Y Y $ 113.45 $ 122.50
65435 Curette/treat cornea A 0 000 Y Y $ 77.60 $ 85.96
65436 Curette/treat cornea A 0 090 Y Y $ 411.34 $ 423.86
65450 Treatment of corneal lesion A 0 090 Y Y $ 325.73 $ 328.86
65600 Revision of cornea A 0 090 Y Y $ 359.14 $ 400.90
65710 Corneal transplant A 0 090 Y Y Y $ 1,165.10 $ -
65756 Corneal trnspl endothelial A 0 090 Y Y Y $ 1,143.18 $ -
65757 Prep corneal endo allograft C 0 ZZZ $ - $ -
65760 Revision of cornea N 9 XXX $ - $ -
65765 Revision of cornea N 9 XXX $ - $ -
65767 Corneal tissue transplant N 9 XXX $ - $ -
65770 Revise cornea with implant A 0 090 Y Y Y $ 2,011.79 $ -
65771 Radial keratotomy N 9 XXX $ - $ -
65772 Correction of astigmatism A 0 090 Y Y $ 418.30 $ 455.18
65775 Correction of astigmatism A 0 090 Y Y $ 523.39 $ -
65778 Cover eye w/membrane A 0 010 Y Y $ 83.17 $ 1,166.15
65779 Cover eye w/membrane suture A 0 010 Y Y $ 311.46 $ 1,086.46
65780 Ocular reconst transplant A 0 090 Y Y $ 911.76 $ -
65781 Ocular reconst transplant A 0 090 Y Y Y $ 1,280.29 $ -
65782 Ocular reconst transplant A 0 090 Y Y $ 1,330.06 $ -
65800 Drainage of eye A 0 000 Y Y $ 142.33 $ 157.30
65810 Drainage of eye A 0 090 Y Y $ 490.33 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
65820 Relieve inner eye pressure A 0 090 Y Y $ 704.35 $ -

65850 Incision of eye A 0 090 Y Y $ 942.04 $ -
65855 Laser surgery of eye A 0 010 Y Y $ 325.03 $ 359.14
65860 Incise inner eye adhesions A 0 090 Y Y $ 368.18 $ 414.12
65865 Incise inner eye adhesions A 0 090 Y Y $ 445.09 $ -
65900 Remove eye lesion A 0 090 Y Y Y $ 917.68 $ -
65920 Remove implant of eye A 0 090 Y Y $ 814.67 $ -
65930 Remove blood clot from eye A 0 090 Y Y $ 710.96 $ -
66020 Injection treatment of eye A 0 010 Y Y $ 123.89 $ 169.13
66030 Injection treatment of eye A 0 010 Y Y $ 114.14 $ 159.73
66130 Remove eye lesion A 0 090 Y Y $ 674.77 $ 779.87
66150 Glaucoma surgery A 0 090 Y Y $ 823.02 $ -
66165 Glaucoma surgery A 0 090 Y Y Y $ 806.66 $ -
66170 Glaucoma surgery A 0 090 Y Y Y $ 1,234.70 $ -
66172 Incision of eye A 0 090 Y Y Y $ 1,555.91 $ -
66174 Translum dil eye canal A 0 090 Y Y Y $ 1,084.72 $ -
66175 Trnslum dil eye canal w/stnt A 0 090 Y Y Y $ 1,424.02 $ -
66180 Implant eye shunt A 0 090 Y Y Y $ 1,233.31 $ -
66185 Revise eye shunt A 0 090 Y Y Y $ 825.80 $ -
66220 Repair eye lesion A 0 090 Y Y Y $ 772.21 $ -
66225 Repair/graft eye lesion A 0 090 Y Y $ 1,075.67 $ -
66250 Follow-up surgery of eye A 0 090 Y Y $ 631.97 $ 790.66
66500 Incision of iris A 0 090 Y Y $ 328.51 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
66505 Incision of iris A 0 090 Y Y $ 360.88 $ -

66600 Remove iris and lesion A 0 090 Y Y $ 787.52 $ -
66605 Removal of iris A 0 090 Y Y $ 1,011.98 $ -
66625 Removal of iris A 0 090 Y Y $ 445.79 $ -
66680 Repair iris & ciliary body A 0 090 Y Y $ 592.99 $ -
66682 Repair iris & ciliary body A 0 090 Y Y $ 703.31 $ -
66700 Destruction ciliary body A 0 090 Y Y $ 389.41 $ 435.70
66710 Ciliary transsleral therapy A 0 090 Y Y $ 450.31 $ 489.29
66711 Ciliary endoscopic ablation A 0 090 Y Y 66710 $ 603.08 $ -
66761 Revision of iris A 0 010 Y Y $ 268.66 $ 314.59
66762 Revision of iris A 0 090 Y Y $ 438.48 $ 478.85
66770 Removal of inner eye lesion A 0 090 Y Y $ 456.23 $ 493.12
66820 Incision secondary cataract A 0 090 Y Y $ 408.20 $ -
66821 After cataract laser surgery A 0 090 Y Y $ 322.60 $ 338.26
66825 Reposition intraocular lens A 0 090 Y Y $ 776.04 $ -
66830 Removal of lens lesion A 0 090 Y Y $ 680.69 $ -
66840 Removal of lens material A 0 090 Y Y $ 797.96 $ -
66920 Extraction of lens A 0 090 Y Y $ 720.71 $ -
66982 Cataract surgery complex A 0 090 Y Y $ 1,165.10 $ -
66983 Cataract surg w/iol 1 stage A 0 090 Y Y $ 727.67 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
66984 Cataract surg w/iol 1 stage A 0 090 Y Y $ 836.24 $ -

66985 Insert lens prosthesis A 0 090 Y Y $ 800.40 $ -
66986 Exchange lens prosthesis A 0 090 Y Y $ 952.82 $ -
66990 Ophthalmic endoscope add-on A 0 ZZZ $ 89.09 $ -
66999 Eye surgery procedure C 0 YYY Y Y Y $ - $ -
67005 Partial removal of eye fluid A 0 090 Y Y $ 542.88 $ -
67010 Partial removal of eye fluid A 0 090 Y Y $ 571.76 $ -
67015 Release of eye fluid A 0 090 Y Y $ 604.13 $ -
67025 Replace eye fluid A 0 090 Y Y $ 700.18 $ 777.78
67027 Implant eye drug system A 0 090 Y Y Y $ 955.96 $ -
67028 Injection eye drug A 0 000 Y Y $ 112.40 $ 122.15
67030 Incise inner eye strands A 0 090 Y Y $ 495.90 $ -
67031 Laser surgery eye strands A 0 090 Y Y $ 369.23 $ 395.33
67036 Removal of inner eye fluid A 0 090 Y Y Y $ 1,023.82 $ -
67039 Laser treatment of retina A 0 090 Y Y Y $ 1,389.22 $ -
67040 Laser treatment of retina A 0 090 Y Y Y $ 1,514.84 $ -
67041 Vit for macular pucker A 0 090 Y Y Y $ 1,428.89 $ -
67042 Vit for macular hole A 0 090 Y Y Y $ 1,641.17 $ -
67043 Vit for membrane dissect A 0 090 Y Y Y $ 1,823.52 $ -
67101 Repair detached retina A 0 090 Y Y $ 749.24 $ 839.03
67107 Repair detached retina A 0 090 Y Y Y $ 1,370.77 $ -
67108 Repair detached retina A 0 090 Y Y Y $ 1,725.73 $ -
67112 Rerepair detached retina A 0 090 Y Y Y $ 1,421.58 $ -
67113 Repair retinal detach cplx A 0 090 Y Y Y $ 1,882.33 $ -
67115 Release encircling material A 0 090 Y Y $ 510.86 $ -
67120 Remove eye implant material A 0 090 Y Y $ 633.01 $ 714.79

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
67121 Remove eye implant material A 0 090 Y Y Y $ 1,018.25 $ -

67141 Treatment of retina A 0 090 Y Y $ 537.31 $ 567.24
67145 Treatment of retina A 0 090 Y Y $ 519.56 $ 543.92
67208 Treatment of retinal lesion A 0 090 Y Y $ 550.19 $ 567.59
67218 Treatment of retinal lesion A 0 090 Y Y $ 1,343.98 $ -
67220 Treatment of choroid lesion A 0 090 Y Y $ 585.68 $ 618.40
67221 Ocular photodynamic ther A 0 000 Y $ 238.38 $ 299.98
67225 Eye photodynamic ther add-on A 0 ZZZ $ 27.49 $ 28.88
67228 Treatment of retinal lesion A 0 090 Y Y $ 1,066.27 $ 1,129.26
67229 Tr retinal les preterm inf A 0 090 Y Y $ 1,086.46 $ -
67250 Reinforce eye wall A 0 090 Y Y $ 846.68 $ -
67255 Reinforce/graft eye wall A 0 090 Y Y Y $ 940.30 $ -
67299 Eye surgery procedure C 0 YYY Y Y Y $ - $ -
67311 Revise eye muscle A 0 090 Y Y $ 657.02 $ -
67312 Revise two eye muscles A 0 090 Y Y $ 824.06 $ -
67314 Revise eye muscle A 0 090 Y Y $ 740.20 $ -
67316 Revise two eye muscles A 0 090 Y Y $ 927.07 $ -
67318 Revise eye muscle(s) A 0 090 Y Y $ 669.20 $ -
67320 Revise eye muscle(s) add-on A 0 ZZZ $ 320.16 $ -
67331 Eye surgery follow-up add-on A 0 ZZZ $ 360.88 $ -
67332 Rerevise eye muscles add-on A 0 ZZZ $ 391.85 $ -
67334 Revise eye muscle w/suture A 0 ZZZ $ 298.58 $ -
67335 Eye suture during surgery A 0 ZZZ $ 175.04 $ -
67340 Revise eye muscle add-on A 0 ZZZ Y $ 355.66 $ -
67343 Release eye tissue A 0 090 Y Y $ 743.33 $ -
67345 Destroy nerve of eye muscle A 0 010 Y Y $ 271.79 $ 291.28

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
67346 Biopsy eye muscle A 0 000 Y Y $ 240.82 $ -

67399 Eye muscle surgery procedure C 0 YYY Y Y Y Y $ - $ -
67400 Explore/biopsy eye socket A 0 090 Y Y $ 1,025.21 $ -
67405 Explore/drain eye socket A 0 090 Y Y $ 806.32 $ -
67412 Explore/treat eye socket A 0 090 Y Y $ 935.08 $ -
67413 Explore/treat eye socket A 0 090 Y Y Y $ 954.56 $ -
67414 Explr/decompress eye socket A 0 090 Y Y Y $ 1,385.04 $ -
67415 Aspiration orbital contents A 0 000 Y Y $ 117.97 $ -
67420 Explore/treat eye socket A 0 090 Y Y Y $ 1,866.67 $ -
67430 Explore/treat eye socket A 0 090 Y Y Y $ 1,179.72 $ -
67440 Explore/drain eye socket A 0 090 Y Y Y $ 1,239.58 $ -
67445 Explr/decompress eye socket A 0 090 Y Y Y $ 1,621.68 $ -
67450 Explore/biopsy eye socket A 0 090 Y Y Y $ 1,286.90 $ -
67500 Inject/treat eye socket A 0 000 Y Y $ 79.00 $ 85.26
67550 Insert eye socket implant A 0 090 Y Y $ 1,082.63 $ -
67560 Revise eye socket implant A 0 090 Y Y $ 1,015.81 $ -
67570 Decompress optic nerve A 0 090 Y Y Y $ 1,561.13 $ -
67599 Orbit surgery procedure C 0 YYY Y Y Y Y $ - $ -
67700 Drainage of eyelid abscess A 0 010 Y Y $ 124.58 $ 249.17
67710 Incision of eyelid A 0 010 Y Y $ 107.53 $ 211.93
67715 Incision of eyelid fold A 0 010 Y Y $ 122.15 $ 227.59
67800 Remove eyelid lesion A 0 010 Y $ 115.54 $ 135.02
67801 Remove eyelid lesions A 0 010 Y $ 156.25 $ 179.57
67805 Remove eyelid lesions A 0 010 Y $ 190.70 $ 220.98
67808 Remove eyelid lesion(s) A 0 090 Y $ 414.47 $ -
67810 Biopsy of eyelid A 0 000 Y Y $ 103.01 $ 209.15

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
67820 Revise eyelashes A 0 000 Y Y $ 58.12 $ 55.68

67835 Revise eyelashes A 0 090 Y Y $ 502.16 $ -
67840 Remove eyelid lesion A 0 010 Y Y $ 173.65 $ 270.40
67850 Treat eyelid lesion A 0 010 Y Y $ 144.42 $ 210.89
67875 Closure of eyelid by suture A 0 000 Y Y $ 110.32 $ 171.56
67880 Revision of eyelid A 0 090 Y Y $ 405.77 $ 479.54
67900 Repair brow defect A 0 090 Y Y $ 573.16 $ 681.04
67901 Repair eyelid defect A 0 090 Y Y $ 660.85 $ 795.53
67902 Repair eyelid defect A 0 090 Y Y $ 833.81 $ -
67906 Repair eyelid defect A 0 090 Y Y $ 488.24 $ -
67909 Revise eyelid defect A 0 090 Y Y $ 498.68 $ 579.07
67911 Revise eyelid defect A 0 090 Y Y $ 636.49 $ -
67912 Correction eyelid w/implant A 0 090 Y Y $ 525.48 $ 855.73
67930 Repair eyelid wound A 0 010 Y Y $ 287.80 $ 390.11

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
67935 Repair eyelid wound A 0 090 Y Y $ 521.30 $ 645.89

67938 Remove eyelid foreign body A 0 010 Y Y $ 123.54 $ 228.29
67971 Reconstruction of eyelid A 0 090 Y Y $ 841.46 $ -
67973 Reconstruction of eyelid A 0 090 Y Y Y $ 1,092.02 $ -
67974 Reconstruction of eyelid A 0 090 Y Y Y $ 1,089.94 $ -
67975 Reconstruction of eyelid A 0 090 Y Y $ 794.48 $ -
67999 Revision of eyelid C 0 YYY Y Y Y $ - $ -
68020 Incise/drain eyelid lining A 0 010 Y Y $ 116.93 $ 124.24
68040 Treatment of eyelid lesions A 0 000 Y Y $ 63.68 $ 73.43
68100 Biopsy of eyelid lining A 0 000 Y Y $ 106.49 $ 165.30
68110 Remove eyelid lining lesion A 0 010 Y Y $ 166.00 $ 229.33
68200 Treat eyelid by injection A 0 000 Y Y $ 38.98 $ 44.89
68320 Revise/graft eyelid lining A 0 090 Y Y $ 604.13 $ 756.90
68325 Revise/graft eyelid lining A 0 090 Y Y $ 753.07 $ -
68330 Revise eyelid lining A 0 090 Y Y $ 520.96 $ 639.28
68340 Separate eyelid adhesions A 0 090 Y Y $ 451.01 $ 571.07
68360 Revise eyelid lining A 0 090 Y Y $ 465.28 $ 563.76
68362 Revise eyelid lining A 0 090 Y Y $ 750.64 $ -
68371 Harvest eye tissue alograft A 0 010 Y Y $ 389.76 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
68399 Eyelid lining surgery C 0 YYY Y Y Y $ - $ -

68400 Incise/drain tear gland A 0 010 Y Y $ 151.73 $ 274.92
68420 Incise/drain tear sac A 0 010 Y Y $ 178.87 $ 302.76
68440 Incise tear duct opening A 0 010 Y Y $ 106.14 $ 110.32
68500 Removal of tear gland A 0 090 Y Y $ 1,170.32 $ -
68505 Partial removal tear gland A 0 090 Y Y $ 1,109.42 $ -
68510 Biopsy of tear gland A 0 000 Y Y $ 353.92 $ 480.94
68520 Removal of tear sac A 0 090 Y Y $ 715.49 $ -
68525 Biopsy of tear sac A 0 000 Y Y $ 326.08 $ -
68530 Clearance of tear duct A 0 010 Y Y $ 302.41 $ 442.66
68540 Remove tear gland lesion A 0 090 Y Y $ 967.79 $ -
68550 Remove tear gland lesion A 0 090 Y Y $ 1,049.92 $ -
68700 Repair tear ducts A 0 090 Y Y $ 689.04 $ -
68705 Revise tear duct opening A 0 010 Y Y $ 187.92 $ 245.69
68720 Create tear sac drain A 0 090 Y Y Y $ 832.76 $ -
68745 Create tear duct drain A 0 090 Y Y Y $ 868.61 $ -
68750 Create tear duct drain A 0 090 Y Y Y $ 894.01 $ -
68760 Close tear duct opening A 0 010 Y Y $ 162.52 $ 208.10
68761 Close tear duct opening A 0 010 Y Y $ 126.32 $ 149.64
68770 Close tear system fistula A 0 090 Y Y $ 713.05 $ -
68801 Dilate tear duct opening A 0 010 Y Y $ 109.27 $ 123.19
68810 Probe nasolacrimal duct A 0 010 Y Y $ 204.28 $ 247.78
68811 Probe nasolacrimal duct A 0 010 Y Y $ 230.03 $ -
68815 Probe nasolacrimal duct A 0 010 Y Y $ 286.06 $ 443.00
68816 Probe nl duct w/balloon A 0 010 Y Y $ 281.18 $ 676.16
68840 Explore/irrigate tear ducts A 0 010 Y Y $ 125.28 $ 134.68
68850 Injection for tear sac x-ray A 0 000 Y Y $ 55.33 $ 59.51
68899 Tear duct system surgery C 0 YYY Y Y Y $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
69000 Drain external ear lesion A 0 010 Y $ 129.11 $ 186.53

69005 Drain external ear lesion A 0 010 Y $ 171.22 $ 220.98
69020 Drain outer ear canal lesion A 0 010 Y $ 148.94 $ 228.64
69090 Pierce earlobes N 9 XXX $ - $ -
69100 Biopsy of external ear A 0 000 Y $ 55.33 $ 100.22
69105 Biopsy of external ear canal A 0 000 Y $ 67.86 $ 135.72
69110 Remove external ear partial A 0 090 Y $ 344.17 $ 459.01
69120 Removal of external ear A 0 090 Y $ 420.38 $ -
69140 Remove ear canal lesion(s) A 0 090 Y $ 894.01 $ -
69145 Remove ear canal lesion(s) A 0 090 Y $ 259.96 $ 388.37
69150 Extensive ear canal surgery A 0 090 Y $ 1,140.05 $ -
69155 Extensive ear/neck surgery A 0 090 Y Y $ 1,817.26 $ -
69200 Clear outer ear canal A 0 000 Y Y $ 61.94 $ 120.06
69205 Clear outer ear canal A 0 010 Y $ 107.18 $ -
69210 Remove impacted ear wax A 0 000 Y $ 36.54 $ 52.55
69220 Clean out mastoid cavity A 0 000 Y Y $ 66.12 $ 132.59
69222 Clean out mastoid cavity A 0 010 Y Y $ 141.98 $ 215.41
69300 Revise external ear A 0 YYY Y Y $ 516.78 $ 724.88
69310 Rebuild outer ear canal A 0 090 Y $ 1,122.30 $ -
69320 Rebuild outer ear canal A 0 090 Y Y $ 1,603.24 $ -
69399 Outer ear surgery procedure C 0 YYY Y Y $ - $ -
69400 Inflate middle ear canal A 0 000 Y $ 66.12 $ 140.94
69401 Inflate middle ear canal A 0 000 Y $ 51.85 $ 84.56
69405 Catheterize middle ear canal A 0 010 Y $ 208.80 $ 268.66
69420 Incision of eardrum A 0 010 Y Y $ 127.02 $ 189.66
69421 Incision of eardrum A 0 010 Y Y $ 158.69 $ -
69424 Remove ventilating tube A 0 000 Y Y $ 66.47 $ 125.63
69433 Create eardrum opening A 0 010 Y Y $ 139.90 $ 201.49

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
69436 Create eardrum opening A 0 010 Y Y $ 172.26 $ -

69440 Exploration of middle ear A 0 090 Y Y $ 721.40 $ -
69450 Eardrum revision A 0 090 Y Y $ 563.06 $ -
69501 Mastoidectomy A 0 090 Y Y $ 780.91 $ -
69502 Mastoidectomy A 0 090 Y Y $ 1,048.18 $ -
69505 Remove mastoid structures A 0 090 Y Y $ 1,257.32 $ -
69511 Extensive mastoid surgery A 0 090 Y Y $ 1,292.12 $ -
69530 Extensive mastoid surgery A 0 090 Y Y Y $ 1,758.79 $ -
69535 Remove part of temporal bone A 0 090 Y Y $ 2,940.25 $ -
69540 Remove ear lesion A 0 010 Y Y $ 131.20 $ 203.58
69550 Remove ear lesion A 0 090 Y Y Y $ 1,084.72 $ -
69601 Mastoid surgery revision A 0 090 Y Y $ 1,119.86 $ -
69605 Mastoid surgery revision A 0 090 Y Y Y $ 1,652.65 $ -
69610 Repair of eardrum A 0 010 Y Y $ 325.03 $ 408.20
69620 Repair of eardrum A 0 090 Y Y $ 518.17 $ 699.83
69631 Repair eardrum structures A 0 090 Y Y $ 928.12 $ -
69632 Rebuild eardrum structures A 0 090 Y Y $ 1,142.14 $ -
69635 Repair eardrum structures A 0 090 Y Y $ 1,277.86 $ -
69641 Revise middle ear & mastoid A 0 090 Y Y $ 1,110.47 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

69650 Release middle ear bone A 0 090 Y Y $ 851.21 $ -
69660 Revise middle ear bone A 0 090 Y Y $ 996.32 $ -
69661 Revise middle ear bone A 0 090 Y Y $ 1,296.30 $ -
69662 Revise middle ear bone A 0 090 Y Y $ 1,250.02 $ -
69666 Repair middle ear structures A 0 090 Y Y $ 857.12 $ -
69667 Repair middle ear structures A 0 090 Y Y $ 858.86 $ -
69670 Remove mastoid air cells A 0 090 Y Y Y $ 1,006.07 $ -
69676 Remove middle ear nerve A 0 090 Y Y $ 876.96 $ -
69700 Close mastoid fistula A 0 090 Y Y $ 730.80 $ -
69710 Implant/replace hearing aid N 9 XXX $ - $ -
69711 Remove/repair hearing aid N 0 090 Y Y Y $ 918.72 $ -
69714 Implant temple bone w/stimul A 0 090 Y Y $ 1,161.62 $ -
69715 Temple bne implnt w/stimulat A 0 090 Y Y $ 1,451.51 $ -
69717 Temple bone implant revision A 0 090 Y Y $ 1,226.35 $ -
69718 Revise temple bone implant A 0 090 Y Y $ 1,467.52 $ -
69720 Release facial nerve A 0 090 Y Y $ 1,262.89 $ -
69725 Release facial nerve A 0 090 Y Y Y $ 2,067.12 $ -
69740 Repair facial nerve A 0 090 Y Y Y $ 1,269.85 $ -
69745 Repair facial nerve A 0 090 Y Y Y $ 1,348.50 $ -
69799 Middle ear surgery procedure C 0 YYY Y Y Y $ - $ -
69801 Incise inner ear A 0 000 Y Y $ 215.41 $ 205.67
69805 Explore inner ear A 0 090 Y Y Y $ 1,147.01 $ -
69806 Explore inner ear A 0 090 Y Y $ 1,020.68 $ -
69820 Establish inner ear window A 0 090 Y Y Y $ 914.20 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
69840 Revise inner ear window A 0 090 Y Y Y $ 884.96 $ -

69905 Remove inner ear A 0 090 Y Y $ 978.58 $ -
69910 Remove inner ear & mastoid A 0 090 Y Y $ 1,105.25 $ -
69915 Incise inner ear nerve A 0 090 Y Y Y $ 1,698.24 $ -
69930 Implant cochlear device A 0 090 Y Y $ 1,343.63 $ -
69949 Inner ear surgery procedure C 0 YYY Y Y Y $ - $ -
69950 Incise inner ear nerve A 0 090 Y Y Y $ 1,986.38 $ -
69955 Release facial nerve A 0 090 Y Y Y $ 2,181.26 $ -
69960 Release inner ear canal A 0 090 Y Y Y $ 2,132.89 $ -
69970 Remove inner ear lesion A 0 090 Y Y Y $ 2,370.58 $ -
69979 Temporal bone surgery C 0 YYY Y Y Y $ - $ -
69990 Microsurgery add-on A 0 ZZZ Y $ 302.06 $ -
70010 Contrast x-ray of brain A 0 XXX $ 104.75 $ 104.75
70015 Contrast x-ray of brain A 1 XXX $ - $ 145.12
70015 26 Contrast x-ray of brain A 1 XXX $ 61.94 $ 61.94
70015 TC Contrast x-ray of brain A 1 XXX $ - $ 83.17
70030 X-ray eye for foreign body A 1 XXX $ - $ 27.14
70030 26 X-ray eye for foreign body A 1 XXX $ 8.70 $ 8.70
70030 TC X-ray eye for foreign body A 1 XXX $ - $ 18.79
70100 X-ray exam of jaw A 1 XXX $ - $ 32.36
70100 26 X-ray exam of jaw A 1 XXX $ 9.05 $ 9.05
70100 TC X-ray exam of jaw A 1 XXX $ - $ 22.97
7010F Pt info into recall system M 9 XXX $ - $ -
70110 X-ray exam of jaw A 1 XXX $ - $ 37.24
70110 26 X-ray exam of jaw A 1 XXX $ 12.53 $ 12.53
70110 TC X-ray exam of jaw A 1 XXX $ - $ 24.71
70120 X-ray exam of mastoids A 1 XXX $ - $ 34.10
70120 26 X-ray exam of mastoids A 1 XXX $ 9.40 $ 9.40

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
70120 TC X-ray exam of mastoids A 1 XXX $ - $ 24.36

70130 X-ray exam of mastoids A 1 XXX $ - $ 52.55
70130 26 X-ray exam of mastoids A 1 XXX $ 16.70 $ 16.70
70130 TC X-ray exam of mastoids A 1 XXX $ - $ 36.19
70134 X-ray exam of middle ear A 1 XXX $ - $ 51.85
70134 26 X-ray exam of middle ear A 1 XXX $ 17.40 $ 17.40
70134 TC X-ray exam of middle ear A 1 XXX $ - $ 34.45
70140 X-ray exam of facial bones A 1 XXX $ - $ 28.88
70140 26 X-ray exam of facial bones A 1 XXX $ 10.09 $ 10.09
70140 TC X-ray exam of facial bones A 1 XXX $ - $ 18.79
70150 X-ray exam of facial bones A 1 XXX $ - $ 39.67
70150 26 X-ray exam of facial bones A 1 XXX $ 12.88 $ 12.88
70150 TC X-ray exam of facial bones A 1 XXX $ - $ 27.14
70160 X-ray exam of nasal bones A 1 XXX $ - $ 31.32
70160 26 X-ray exam of nasal bones A 1 XXX $ 8.70 $ 8.70
70160 TC X-ray exam of nasal bones A 1 XXX $ - $ 22.62
70170 X-ray exam of tear duct C 1 XXX $ 320.51 $ 320.51
70170 26 X-ray exam of tear duct A 1 XXX $ 16.70 $ 16.70
70170 TC X-ray exam of tear duct C 1 XXX $ 304.50 $ 304.50
70190 X-ray exam of eye sockets A 1 XXX $ - $ 33.76
70190 26 X-ray exam of eye sockets A 1 XXX $ 10.79 $ 10.79
70190 TC X-ray exam of eye sockets A 1 XXX $ - $ 22.97
70200 X-ray exam of eye sockets A 1 XXX $ - $ 40.72
70200 26 X-ray exam of eye sockets A 1 XXX $ 13.57 $ 13.57
70200 TC X-ray exam of eye sockets A 1 XXX $ - $ 27.14
7020F Mammo assess cat in dbase M 9 XXX $ - $ -
70210 X-ray exam of sinuses A 1 XXX $ - $ 29.23
70210 26 X-ray exam of sinuses A 1 XXX $ 8.70 $ 8.70

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
70210 TC X-ray exam of sinuses A 1 XXX $ - $ 20.53

70220 X-ray exam of sinuses A 1 XXX $ - $ 36.89
70220 26 X-ray exam of sinuses A 1 XXX $ 12.53 $ 12.53
70220 TC X-ray exam of sinuses A 1 XXX $ - $ 24.36
70240 X-ray exam pituitary saddle A 1 XXX $ - $ 28.54
70240 26 X-ray exam pituitary saddle A 1 XXX $ 9.74 $ 9.74
70240 TC X-ray exam pituitary saddle A 1 XXX $ - $ 18.79
70250 X-ray exam of skull A 1 XXX $ - $ 34.80
70250 26 X-ray exam of skull A 1 XXX $ 12.18 $ 12.18
70250 TC X-ray exam of skull A 1 XXX $ - $ 22.62
7025F Pt infosys alarm 4 nxt mammo M 9 XXX $ - $ -
70260 X-ray exam of skull A 1 XXX $ - $ 44.20
70260 26 X-ray exam of skull A 1 XXX $ 16.70 $ 16.70
70260 TC X-ray exam of skull A 1 XXX $ - $ 27.49
70300 X-ray exam of teeth A 1 XXX $ - $ 14.96
70300 26 X-ray exam of teeth A 1 XXX $ 6.26 $ 6.26
70300 TC X-ray exam of teeth A 1 XXX $ - $ 8.70
70310 X-ray exam of teeth A 1 XXX $ - $ 35.15
70310 26 X-ray exam of teeth A 1 XXX $ 8.70 $ 8.70
70310 TC X-ray exam of teeth A 1 XXX $ - $ 26.45
70320 Full mouth x-ray of teeth A 1 XXX $ - $ 46.98
70320 26 Full mouth x-ray of teeth A 1 XXX $ 11.83 $ 11.83
70320 TC Full mouth x-ray of teeth A 1 XXX $ - $ 35.50
70328 X-ray exam of jaw joint A 1 XXX $ - $ 29.23
70328 26 X-ray exam of jaw joint A 1 XXX $ 9.05 $ 9.05
70328 TC X-ray exam of jaw joint A 1 XXX $ - $ 20.18
70330 X-ray exam of jaw joints A 1 XXX $ - $ 44.89
70330 26 X-ray exam of jaw joints A 1 XXX $ 12.53 $ 12.53

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
70330 TC X-ray exam of jaw joints A 1 XXX $ - $ 32.71

70332 X-ray exam of jaw joint A 1 XXX $ - $ 70.99
70332 26 X-ray exam of jaw joint A 1 XXX $ 27.49 $ 27.49
70332 TC X-ray exam of jaw joint A 1 XXX $ - $ 43.50
70336 Magnetic image jaw joint A 1 XXX Y $ - $ 366.10
70336 26 Magnetic image jaw joint A 1 XXX Y $ 74.47 $ 74.47
70336 TC Magnetic image jaw joint A 1 XXX Y $ - $ 291.62
70350 X-ray head for orthodontia A 1 XXX $ - $ 20.88
70350 26 X-ray head for orthodontia A 1 XXX $ 9.74 $ 9.74
70350 TC X-ray head for orthodontia A 1 XXX $ - $ 11.14
70355 Panoramic x-ray of jaws A 1 XXX $ - $ 20.88
70355 26 Panoramic x-ray of jaws A 1 XXX $ 10.79 $ 10.79
70355 TC Panoramic x-ray of jaws A 1 XXX $ - $ 10.09
70360 X-ray exam of neck A 1 XXX $ - $ 25.75
70360 26 X-ray exam of neck A 1 XXX $ 8.70 $ 8.70
70360 TC X-ray exam of neck A 1 XXX $ - $ 17.40
70370 Throat x-ray & fluoroscopy A 1 XXX $ - $ 77.60
70370 26 Throat x-ray & fluoroscopy A 1 XXX $ 15.66 $ 15.66
70370 TC Throat x-ray & fluoroscopy A 1 XXX $ - $ 61.94
70371 Speech evaluation complex A 1 XXX $ - $ 88.04
70371 26 Speech evaluation complex A 1 XXX $ 41.06 $ 41.06
70371 TC Speech evaluation complex A 1 XXX $ - $ 46.98
70373 Contrast x-ray of larynx A 1 XXX $ - $ 72.73
70373 26 Contrast x-ray of larynx A 1 XXX $ 20.53 $ 20.53
70373 TC Contrast x-ray of larynx A 1 XXX $ - $ 52.20
70380 X-ray exam of salivary gland A 1 XXX $ - $ 37.24
70380 26 X-ray exam of salivary gland A 1 XXX $ 9.40 $ 9.40
70380 TC X-ray exam of salivary gland A 1 XXX $ - $ 27.84

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
70390 X-ray exam of salivary duct A 1 XXX $ - $ 93.61

70390 26 X-ray exam of salivary duct A 1 XXX $ 20.18 $ 20.18
70390 TC X-ray exam of salivary duct A 1 XXX $ - $ 73.43
70450 Ct head/brain w/o dye A 1 XXX Y $ - $ 164.60
70450 26 Ct head/brain w/o dye A 1 XXX Y $ 42.46 $ 42.46
70450 TC Ct head/brain w/o dye A 1 XXX Y $ - $ 122.15
70460 Ct head/brain w/dye A 1 XXX Y $ - $ 214.37
70460 26 Ct head/brain w/dye A 1 XXX Y $ 56.03 $ 56.03
70460 TC Ct head/brain w/dye A 1 XXX Y $ - $ 158.34
70470 Ct head/brain w/o & w/dye A 1 XXX Y $ - $ 231.07
70470 26 Ct head/brain w/o & w/dye A 1 XXX Y $ 64.38 $ 64.38
70470 TC Ct head/brain w/o & w/dye A 1 XXX Y $ - $ 166.69
70480 Ct orbit/ear/fossa w/o dye A 1 XXX Y $ - $ 269.35
70480 26 Ct orbit/ear/fossa w/o dye A 1 XXX Y $ 65.08 $ 65.08
70480 TC Ct orbit/ear/fossa w/o dye A 1 XXX Y $ - $ 204.28
70481 Ct orbit/ear/fossa w/dye A 1 XXX Y $ - $ 311.81
70481 26 Ct orbit/ear/fossa w/dye A 1 XXX Y $ 70.30 $ 70.30
70481 TC Ct orbit/ear/fossa w/dye A 1 XXX Y $ - $ 241.16
70482 Ct orbit/ear/fossa w/o&w/dye A 1 XXX Y $ - $ 346.96
70482 26 Ct orbit/ear/fossa w/o&w/dye A 1 XXX Y $ 73.43 $ 73.43
70482 TC Ct orbit/ear/fossa w/o&w/dye A 1 XXX Y $ - $ 273.88
70486 Ct maxillofacial w/o dye A 1 XXX Y $ - $ 223.07
70486 26 Ct maxillofacial w/o dye A 1 XXX Y $ 56.72 $ 56.72
70486 TC Ct maxillofacial w/o dye A 1 XXX Y $ - $ 166.34
70487 Ct maxillofacial w/dye A 1 XXX Y $ - $ 268.66
70487 26 Ct maxillofacial w/dye A 1 XXX Y $ 65.77 $ 65.77
70487 TC Ct maxillofacial w/dye A 1 XXX Y $ - $ 202.88
70488 Ct maxillofacial w/o & w/dye A 1 XXX Y $ - $ 323.64

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
70488 26 Ct maxillofacial w/o & w/dye A 1 XXX Y $ 72.04 $ 72.04

70488 TC Ct maxillofacial w/o & w/dye A 1 XXX Y $ - $ 251.60
70490 Ct soft tissue neck w/o dye A 1 XXX Y $ - $ 219.94
70490 26 Ct soft tissue neck w/o dye A 1 XXX Y $ 65.08 $ 65.08
70490 TC Ct soft tissue neck w/o dye A 1 XXX Y $ - $ 154.86
70491 Ct soft tissue neck w/dye A 1 XXX Y $ - $ 263.09
70491 26 Ct soft tissue neck w/dye A 1 XXX Y $ 69.25 $ 69.25
70491 TC Ct soft tissue neck w/dye A 1 XXX Y $ - $ 193.49
70492 Ct sft tsue nck w/o & w/dye A 1 XXX Y $ - $ 314.59
70492 26 Ct sft tsue nck w/o & w/dye A 1 XXX Y $ 73.43 $ 73.43
70492 TC Ct sft tsue nck w/o & w/dye A 1 XXX Y $ - $ 241.16
70496 Ct angiography head A 1 XXX Y $ 528.61 $ 493.46
70496 26 Ct angiography head A 1 XXX Y $ 89.09 $ 89.09
70496 TC Ct angiography head A 1 XXX Y $ 437.78 $ 404.38
70498 Ct angiography neck A 1 XXX Y $ 528.61 $ 505.99
70498 26 Ct angiography neck A 1 XXX Y $ 89.09 $ 89.09
70498 TC Ct angiography neck A 1 XXX Y $ 437.78 $ 416.56
70540 Mri orbit/face/neck w/o dye A 1 XXX Y $ - $ 407.51
70540 26 Mri orbit/face/neck w/o dye A 1 XXX Y $ 68.90 $ 68.90
70540 TC Mri orbit/face/neck w/o dye A 1 XXX Y $ - $ 338.60
70542 Mri orbit/face/neck w/dye A 1 XXX Y $ - $ 459.01
70542 26 Mri orbit/face/neck w/dye A 1 XXX Y $ 83.17 $ 83.17
70542 TC Mri orbit/face/neck w/dye A 1 XXX Y $ - $ 375.84
70543 Mri orbt/fac/nck w/o & w/dye A 1 XXX Y $ - $ 580.46
70543 26 Mri orbt/fac/nck w/o & w/dye A 1 XXX Y $ 108.58 $ 108.58
70543 TC Mri orbt/fac/nck w/o & w/dye A 1 XXX Y $ - $ 471.54
70544 Mr angiography head w/o dye A 1 XXX Y $ - $ 450.31
70544 26 Mr angiography head w/o dye A 1 XXX Y $ 61.25 $ 61.25

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
70544 TC Mr angiography head w/o dye A 1 XXX Y $ - $ 389.06

70545 Mr angiography head w/dye A 1 XXX Y $ - $ 443.00
70545 26 Mr angiography head w/dye A 1 XXX Y $ 60.90 $ 60.90
70545 TC Mr angiography head w/dye A 1 XXX Y $ - $ 382.10
70546 Mr angiograph head w/o&w/dye A 1 XXX Y $ - $ 691.48
70546 26 Mr angiograph head w/o&w/dye A 1 XXX Y $ 92.22 $ 92.22
70546 TC Mr angiograph head w/o&w/dye A 1 XXX Y $ - $ 598.91
70547 Mr angiography neck w/o dye A 1 XXX Y $ - $ 449.62
70547 26 Mr angiography neck w/o dye A 1 XXX Y $ 61.25 $ 61.25
70547 TC Mr angiography neck w/o dye A 1 XXX Y $ - $ 388.37
70548 Mr angiography neck w/dye A 1 XXX Y $ - $ 474.32
70548 26 Mr angiography neck w/dye A 1 XXX Y $ 61.25 $ 61.25
70548 TC Mr angiography neck w/dye A 1 XXX Y $ - $ 413.08
70549 Mr angiograph neck w/o&w/dye A 1 XXX Y $ - $ 691.82
70549 26 Mr angiograph neck w/o&w/dye A 1 XXX Y $ 91.18 $ 91.18
70549 TC Mr angiograph neck w/o&w/dye A 1 XXX Y $ - $ 600.65
70551 Mri brain w/o dye A 1 XXX Y $ - $ 425.26
70551 26 Mri brain w/o dye A 1 XXX Y $ 74.82 $ 74.82
70551 TC Mri brain w/o dye A 1 XXX Y $ - $ 350.78
70552 Mri brain w/dye A 1 XXX Y $ - $ 477.46
70552 26 Mri brain w/dye A 1 XXX Y $ 91.52 $ 91.52
70552 TC Mri brain w/dye A 1 XXX Y $ - $ 385.93
70553 Mri brain w/o & w/dye A 1 XXX Y $ - $ 581.51
70553 26 Mri brain w/o & w/dye A 1 XXX Y $ 120.76 $ 120.76
70553 TC Mri brain w/o & w/dye A 1 XXX Y $ - $ 460.75
70554 Fmri brain by tech A 1 XXX Y $ - $ 479.54
70554 26 Fmri brain by tech A 1 XXX Y $ 107.88 $ 107.88
70554 TC Fmri brain by tech A 1 XXX Y $ - $ 371.66

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
70555 Fmri brain by phys/psych C 1 XXX $ - $ -

70555 26 Fmri brain by phys/psych A 1 XXX $ 140.94 $ 140.94
70555 TC Fmri brain by phys/psych C 1 XXX $ - $ -
70557 Mri brain w/o dye C 1 XXX $ 630.58 $ 630.58
70557 26 Mri brain w/o dye A 1 XXX $ 250.56 $ 250.56
70557 TC Mri brain w/o dye C 1 XXX $ 437.78 $ 437.78
70558 Mri brain w/dye C 1 XXX $ 735.67 $ 735.67
70558 26 Mri brain w/dye A 1 XXX $ 176.78 $ 176.78
70558 TC Mri brain w/dye C 1 XXX $ 563.76 $ 563.76
70559 Mri brain w/o & w/dye C 1 XXX $ 863.74 $ 863.74
70559 26 Mri brain w/o & w/dye A 1 XXX $ 177.83 $ 177.83
70559 TC Mri brain w/o & w/dye C 1 XXX $ 690.78 $ 690.78
71010 Chest x-ray A 1 XXX $ - $ 22.62
71010 26 Chest x-ray A 1 XXX $ 9.05 $ 9.05
71010 TC Chest x-ray A 1 XXX $ - $ 13.57
71015 Chest x-ray A 1 XXX $ - $ 28.88
71015 26 Chest x-ray A 1 XXX $ 10.44 $ 10.44
71020 Chest x-ray A 1 XXX $ - $ 28.88
71020 26 Chest x-ray A 1 XXX $ 10.79 $ 10.79
71021 Chest x-ray A 1 XXX $ - $ 35.50
71021 26 Chest x-ray A 1 XXX $ 13.22 $ 13.22
71022 Chest x-ray A 1 XXX $ - $ 44.20
71022 26 Chest x-ray A 1 XXX $ 15.31 $ 15.31
71023 Chest x-ray and fluoroscopy A 1 XXX $ - $ 61.94

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
71023 26 Chest x-ray and fluoroscopy A 1 XXX $ 18.10 $ 18.10

71023 TC Chest x-ray and fluoroscopy A 1 XXX $ - $ 43.85
71030 Chest x-ray A 1 XXX $ - $ 42.80
71030 26 Chest x-ray A 1 XXX $ 14.96 $ 14.96
71034 Chest x-ray and fluoroscopy A 1 XXX $ - $ 79.00
71034 26 Chest x-ray and fluoroscopy A 1 XXX $ 21.92 $ 21.92
71034 TC Chest x-ray and fluoroscopy A 1 XXX $ - $ 57.07
71035 Chest x-ray A 1 XXX $ - $ 33.41
71035 26 Chest x-ray A 1 XXX $ 9.05 $ 9.05
71040 Contrast x-ray of bronchi A 1 XXX $ - $ 87.35
71040 26 Contrast x-ray of bronchi A 1 XXX $ 26.80 $ 26.80
71040 TC Contrast x-ray of bronchi A 1 XXX $ - $ 60.90
71060 Contrast x-ray of bronchi A 1 XXX $ - $ 130.15
71060 26 Contrast x-ray of bronchi A 1 XXX $ 37.58 $ 37.58
71060 TC Contrast x-ray of bronchi A 1 XXX $ - $ 92.92
71100 X-ray exam of ribs A 1 XXX $ - $ 30.97
71100 26 X-ray exam of ribs A 1 XXX $ 11.14 $ 11.14
71100 TC X-ray exam of ribs A 1 XXX $ - $ 19.84
71101 X-ray exam of ribs/chest A 1 XXX $ - $ 36.89
71101 26 X-ray exam of ribs/chest A 1 XXX $ 13.22 $ 13.22
71101 TC X-ray exam of ribs/chest A 1 XXX $ - $ 24.01
71110 X-ray exam of ribs A 1 XXX $ - $ 38.28
71110 26 X-ray exam of ribs A 1 XXX $ 13.22 $ 13.22
71110 TC X-ray exam of ribs A 1 XXX $ - $ 24.71
71111 X-ray exam of ribs/chest A 1 XXX $ - $ 49.07
71111 26 X-ray exam of ribs/chest A 1 XXX $ 15.66 $ 15.66

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
71111 TC X-ray exam of ribs/chest A 1 XXX $ - $ 33.41

71120 X-ray exam of breastbone A 1 XXX $ - $ 29.93
71120 26 X-ray exam of breastbone A 1 XXX $ 10.09 $ 10.09
71120 TC X-ray exam of breastbone A 1 XXX $ - $ 19.84
71130 X-ray exam of breastbone A 1 XXX $ - $ 35.15
71130 26 X-ray exam of breastbone A 1 XXX $ 11.14 $ 11.14
71130 TC X-ray exam of breastbone A 1 XXX $ - $ 24.01
71250 Ct thorax w/o dye A 1 XXX Y $ - $ 209.50
71250 26 Ct thorax w/o dye A 1 XXX Y $ 51.50 $ 51.50
71250 TC Ct thorax w/o dye A 1 XXX Y $ - $ 157.99
71260 Ct thorax w/dye A 1 XXX Y $ - $ 260.65
71260 26 Ct thorax w/dye A 1 XXX Y $ 63.34 $ 63.34
71260 TC Ct thorax w/dye A 1 XXX Y $ - $ 197.32
71270 Ct thorax w/o & w/dye A 1 XXX Y $ - $ 316.68
71270 26 Ct thorax w/o & w/dye A 1 XXX Y $ 69.25 $ 69.25
71270 TC Ct thorax w/o & w/dye A 1 XXX Y $ - $ 247.08
71275 Ct angiography chest A 1 XXX Y $ - $ 397.42
71275 26 Ct angiography chest A 1 XXX Y $ 97.79 $ 97.79
71275 TC Ct angiography chest A 1 XXX Y $ - $ 299.63
71550 Mri chest w/o dye A 1 XXX Y $ - $ 466.32
71550 26 Mri chest w/o dye A 1 XXX Y $ 73.78 $ 73.78
71550 TC Mri chest w/o dye A 1 XXX Y $ - $ 392.89
71551 Mri chest w/dye A 1 XXX Y $ - $ 523.74
71551 26 Mri chest w/dye A 1 XXX Y $ 88.39 $ 88.39
71551 TC Mri chest w/dye A 1 XXX Y $ - $ 435.35
71552 Mri chest w/o & w/dye A 1 XXX Y $ - $ 671.64
71552 26 Mri chest w/o & w/dye A 1 XXX Y $ 114.14 $ 114.14
71552 TC Mri chest w/o & w/dye A 1 XXX Y $ - $ 557.50

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
71555 Mri angio chest w or w/o dye A 1 XXX Y $ - $ 460.06

71555 26 Mri angio chest w or w/o dye A 1 XXX Y $ 92.22 $ 92.22
71555 TC Mri angio chest w or w/o dye A 1 XXX Y $ - $ 367.84
72010 X-ray exam of spine A 1 XXX $ - $ 72.38
72010 26 X-ray exam of spine A 1 XXX $ 24.01 $ 24.01
72010 TC X-ray exam of spine A 1 XXX $ - $ 48.37
72020 X-ray exam of spine A 1 XXX $ - $ 22.97
72020 26 X-ray exam of spine A 1 XXX $ 8.00 $ 8.00
72020 TC X-ray exam of spine A 1 XXX $ - $ 14.96
72040 X-ray exam of neck spine A 1 XXX $ - $ 38.63
72040 26 X-ray exam of neck spine A 1 XXX $ 13.57 $ 13.57
72040 TC X-ray exam of neck spine A 1 XXX $ - $ 25.40
72069 X-ray exam of trunk spine A 1 XXX $ - $ 37.24
72069 26 X-ray exam of trunk spine A 1 XXX $ 13.57 $ 13.57
72069 TC X-ray exam of trunk spine A 1 XXX $ - $ 24.01
72070 X-ray exam of thoracic spine A 1 XXX $ - $ 32.02
72070 26 X-ray exam of thoracic spine A 1 XXX $ 11.14 $ 11.14
72070 TC X-ray exam of thoracic spine A 1 XXX $ - $ 20.88

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

72100 X-ray exam of lower spine A 1 XXX $ - $ 36.54
72100 26 X-ray exam of lower spine A 1 XXX $ 13.57 $ 13.57
72100 TC X-ray exam of lower spine A 1 XXX $ - $ 22.97
72125 Ct neck spine w/o dye A 1 XXX Y $ - $ 212.98
72125 26 Ct neck spine w/o dye A 1 XXX Y $ 53.59 $ 53.59
72125 TC Ct neck spine w/o dye A 1 XXX Y $ - $ 159.73
72126 Ct neck spine w/dye A 1 XXX Y $ - $ 260.65
72126 26 Ct neck spine w/dye A 1 XXX Y $ 62.29 $ 62.29
72126 TC Ct neck spine w/dye A 1 XXX Y $ - $ 198.36
72127 Ct neck spine w/o & w/dye A 1 XXX Y $ - $ 310.42
72127 26 Ct neck spine w/o & w/dye A 1 XXX Y $ 64.03 $ 64.03

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
72127 TC Ct neck spine w/o & w/dye A 1 XXX Y $ - $ 246.38

72128 Ct chest spine w/o dye A 1 XXX Y $ - $ 209.50
72128 26 Ct chest spine w/o dye A 1 XXX Y $ 50.46 $ 50.46
72128 TC Ct chest spine w/o dye A 1 XXX Y $ - $ 159.04
72129 Ct chest spine w/dye A 1 XXX Y $ - $ 260.65
72129 26 Ct chest spine w/dye A 1 XXX Y $ 62.29 $ 62.29
72129 TC Ct chest spine w/dye A 1 XXX Y $ - $ 198.36
72130 Ct chest spine w/o & w/dye A 1 XXX Y $ - $ 312.50
72130 26 Ct chest spine w/o & w/dye A 1 XXX Y $ 64.38 $ 64.38
72130 TC Ct chest spine w/o & w/dye A 1 XXX Y $ - $ 248.12
72131 Ct lumbar spine w/o dye A 1 XXX Y $ - $ 209.15
72131 26 Ct lumbar spine w/o dye A 1 XXX Y $ 50.46 $ 50.46
72131 TC Ct lumbar spine w/o dye A 1 XXX Y $ - $ 158.34
72132 Ct lumbar spine w/dye A 1 XXX Y $ - $ 260.30
72132 26 Ct lumbar spine w/dye A 1 XXX Y $ 62.29 $ 62.29
72132 TC Ct lumbar spine w/dye A 1 XXX Y $ - $ 198.01
72133 Ct lumbar spine w/o & w/dye A 1 XXX Y $ - $ 312.16
72133 26 Ct lumbar spine w/o & w/dye A 1 XXX Y $ 64.38 $ 64.38
72133 TC Ct lumbar spine w/o & w/dye A 1 XXX Y $ - $ 247.78
72141 Mri neck spine w/o dye A 1 XXX Y $ - $ 384.89
72141 26 Mri neck spine w/o dye A 1 XXX Y $ 82.48 $ 82.48
72141 TC Mri neck spine w/o dye A 1 XXX Y $ - $ 302.41
72142 Mri neck spine w/dye A 1 XXX Y $ - $ 485.46
72142 26 Mri neck spine w/dye A 1 XXX Y $ 98.14 $ 98.14
72142 TC Mri neck spine w/dye A 1 XXX Y $ - $ 387.32
72146 Mri chest spine w/o dye A 1 XXX Y $ - $ 387.67
72146 26 Mri chest spine w/o dye A 1 XXX Y $ 82.48 $ 82.48
72146 TC Mri chest spine w/o dye A 1 XXX Y $ - $ 305.20

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
72147 Mri chest spine w/dye A 1 XXX Y $ - $ 435.35

72147 26 Mri chest spine w/dye A 1 XXX Y $ 98.14 $ 98.14
72147 TC Mri chest spine w/dye A 1 XXX Y $ - $ 337.21
72148 Mri lumbar spine w/o dye A 1 XXX Y $ - $ 382.10
72148 26 Mri lumbar spine w/o dye A 1 XXX Y $ 77.26 $ 77.26
72148 TC Mri lumbar spine w/o dye A 1 XXX Y $ - $ 304.85
72149 Mri lumbar spine w/dye A 1 XXX Y $ - $ 473.28
72149 26 Mri lumbar spine w/dye A 1 XXX Y $ 91.87 $ 91.87
72149 TC Mri lumbar spine w/dye A 1 XXX Y $ - $ 381.41
72156 Mri neck spine w/o & w/dye A 1 XXX Y $ - $ 583.60
72156 26 Mri neck spine w/o & w/dye A 1 XXX Y $ 132.24 $ 132.24
72156 TC Mri neck spine w/o & w/dye A 1 XXX Y $ - $ 451.36
72157 Mri chest spine w/o & w/dye A 1 XXX Y $ - $ 548.45
72157 26 Mri chest spine w/o & w/dye A 1 XXX Y $ 132.24 $ 132.24
72157 TC Mri chest spine w/o & w/dye A 1 XXX Y $ - $ 416.21
72158 Mri lumbar spine w/o & w/dye A 1 XXX Y $ - $ 573.16
72158 26 Mri lumbar spine w/o & w/dye A 1 XXX Y $ 123.19 $ 123.19
72158 TC Mri lumbar spine w/o & w/dye A 1 XXX Y $ - $ 449.96
72159 Mr angio spine w/o&w/dye N 1 XXX Y $ - $ 475.02
72159 26 Mr angio spine w/o&w/dye N 1 XXX Y $ 87.70 $ 87.70
72159 TC Mr angio spine w/o&w/dye N 1 XXX Y $ - $ 387.32
72170 X-ray exam of pelvis A 1 XXX $ - $ 27.14
72170 26 X-ray exam of pelvis A 1 XXX $ 11.14 $ 11.14
72170 TC X-ray exam of pelvis A 1 XXX $ - $ 16.01
72190 X-ray exam of pelvis A 1 XXX $ - $ 41.76
72190 26 X-ray exam of pelvis A 1 XXX $ 13.22 $ 13.22
72190 TC X-ray exam of pelvis A 1 XXX $ - $ 28.54
72191 Ct angiograph pelv w/o&w/dye A 1 XXX Y $ - $ 408.90

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
72191 26 Ct angiograph pelv w/o&w/dye A 1 XXX Y $ 93.96 $ 93.96

72191 TC Ct angiograph pelv w/o&w/dye A 1 XXX Y $ - $ 314.94
72192 Ct pelvis w/o dye A 1 XXX Y $ - $ 203.23
72192 26 Ct pelvis w/o dye A 1 XXX Y $ 54.29 $ 54.29
72192 TC Ct pelvis w/o dye A 1 XXX Y $ - $ 148.94
72193 Ct pelvis w/dye A 1 XXX Y $ - $ 247.08
72193 26 Ct pelvis w/dye A 1 XXX Y $ 59.51 $ 59.51
72193 TC Ct pelvis w/dye A 1 XXX Y $ - $ 187.22
72194 Ct pelvis w/o & w/dye A 1 XXX Y $ - $ 313.55
72194 26 Ct pelvis w/o & w/dye A 1 XXX Y $ 62.29 $ 62.29
72194 TC Ct pelvis w/o & w/dye A 1 XXX Y $ - $ 251.26
72195 Mri pelvis w/o dye A 1 XXX Y $ - $ 424.56
72195 26 Mri pelvis w/o dye A 1 XXX Y $ 76.21 $ 76.21
72195 TC Mri pelvis w/o dye A 1 XXX Y $ - $ 348.00
72196 Mri pelvis w/dye A 1 XXX Y $ - $ 470.50
72196 26 Mri pelvis w/dye A 1 XXX Y $ 88.39 $ 88.39
72196 TC Mri pelvis w/dye A 1 XXX Y $ - $ 382.10
72197 Mri pelvis w/o & w/dye A 1 XXX Y $ - $ 592.99
72197 26 Mri pelvis w/o & w/dye A 1 XXX Y $ 113.80 $ 113.80
72197 TC Mri pelvis w/o & w/dye A 1 XXX Y $ - $ 479.20
72198 Mr angio pelvis w/o & w/dye A 1 XXX Y $ - $ 460.40
72198 26 Mr angio pelvis w/o & w/dye A 1 XXX Y $ 91.18 $ 91.18
72198 TC Mr angio pelvis w/o & w/dye A 1 XXX Y $ - $ 369.23
72200 X-ray exam sacroiliac joints A 1 XXX $ - $ 28.54
72200 26 X-ray exam sacroiliac joints A 1 XXX $ 8.70 $ 8.70
72200 TC X-ray exam sacroiliac joints A 1 XXX $ - $ 19.49
72202 X-ray exam sacroiliac joints A 1 XXX $ - $ 32.71
72202 26 X-ray exam sacroiliac joints A 1 XXX $ 9.40 $ 9.40

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
72202 TC X-ray exam sacroiliac joints A 1 XXX $ - $ 22.97

72220 X-ray exam of tailbone A 1 XXX $ - $ 27.49
72220 26 X-ray exam of tailbone A 1 XXX $ 8.70 $ 8.70
72220 TC X-ray exam of tailbone A 1 XXX $ - $ 18.79
72240 Contrast x-ray of neck spine A 1 XXX $ - $ 127.72
72240 26 Contrast x-ray of neck spine A 1 XXX $ 45.94 $ 45.94
72240 TC Contrast x-ray of neck spine A 1 XXX $ - $ 81.43
72255 Contrast x-ray thorax spine A 1 XXX $ - $ 121.10
72255 26 Contrast x-ray thorax spine A 1 XXX $ 45.24 $ 45.24
72255 TC Contrast x-ray thorax spine A 1 XXX $ - $ 75.86
72265 Contrast x-ray lower spine A 1 XXX $ - $ 122.15
72265 26 Contrast x-ray lower spine A 1 XXX $ 41.76 $ 41.76
72265 TC Contrast x-ray lower spine A 1 XXX $ - $ 80.39
72270 Contrast x-ray spine A 1 XXX $ - $ 191.40
72270 26 Contrast x-ray spine A 1 XXX $ 67.51 $ 67.51
72270 TC Contrast x-ray spine A 1 XXX $ - $ 123.89
72275 Epidurography A 1 XXX $ - $ 109.97
72275 26 Epidurography A 1 XXX $ 39.67 $ 39.67
72275 TC Epidurography A 1 XXX $ - $ 70.30
72285 X-ray c/t spine disk A 1 XXX $ - $ 124.93
72285 26 X-ray c/t spine disk A 1 XXX $ 59.51 $ 59.51
72285 TC X-ray c/t spine disk A 1 XXX $ - $ 65.77
72291 Perq verte/sacroplsty fluor C 1 XXX $ - $ -
72291 26 Perq verte/sacroplsty fluor A 1 XXX $ 85.61 $ 85.61
72291 TC Perq verte/sacroplsty fluor C 1 XXX $ - $ -
72292 Perq verte/sacroplsty ct C 1 XXX $ - $ -
72292 26 Perq verte/sacroplsty ct A 1 XXX $ 85.61 $ 85.61
72292 TC Perq verte/sacroplsty ct C 1 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
72295 X-ray of lower spine disk A 1 XXX $ - $ 109.27

72295 26 X-ray of lower spine disk A 1 XXX $ 43.50 $ 43.50
72295 TC X-ray of lower spine disk A 1 XXX $ - $ 66.12
73000 X-ray exam of collar bone A 1 XXX $ - $ 27.49
73000 26 X-ray exam of collar bone A 1 XXX $ 8.70 $ 8.70
73000 TC X-ray exam of collar bone A 1 XXX $ - $ 19.14
73010 X-ray exam of shoulder blade A 1 XXX $ - $ 31.67
73010 26 X-ray exam of shoulder blade A 1 XXX $ 11.48 $ 11.48
73010 TC X-ray exam of shoulder blade A 1 XXX $ - $ 20.18
73020 X-ray exam of shoulder A 1 XXX $ - $ 23.32
73020 26 X-ray exam of shoulder A 1 XXX $ 8.00 $ 8.00
73020 TC X-ray exam of shoulder A 1 XXX $ - $ 15.31
73030 X-ray exam of shoulder A 1 XXX $ - $ 30.97
73030 26 X-ray exam of shoulder A 1 XXX $ 11.83 $ 11.83
73030 TC X-ray exam of shoulder A 1 XXX $ - $ 19.14
73040 Contrast x-ray of shoulder A 1 XXX $ - $ 100.22
73040 26 Contrast x-ray of shoulder A 1 XXX $ 28.88 $ 28.88
73040 TC Contrast x-ray of shoulder A 1 XXX $ - $ 71.34
73050 X-ray exam of shoulders A 1 XXX $ - $ 39.32
73050 26 X-ray exam of shoulders A 1 XXX $ 12.88 $ 12.88
73050 TC X-ray exam of shoulders A 1 XXX $ - $ 26.10
73060 X-ray exam of humerus A 1 XXX $ - $ 27.84
73060 26 X-ray exam of humerus A 1 XXX $ 8.70 $ 8.70
73060 TC X-ray exam of humerus A 1 XXX $ - $ 19.14
73070 X-ray exam of elbow A 1 XXX $ - $ 27.14
73070 26 X-ray exam of elbow A 1 XXX $ 8.35 $ 8.35
73070 TC X-ray exam of elbow A 1 XXX $ - $ 19.14
73080 X-ray exam of elbow A 1 XXX $ - $ 32.02

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
73080 26 X-ray exam of elbow A 1 XXX $ 8.70 $ 8.70

73080 TC X-ray exam of elbow A 1 XXX $ - $ 22.97
73085 Contrast x-ray of elbow A 1 XXX $ - $ 93.26
73085 26 Contrast x-ray of elbow A 1 XXX $ 28.54 $ 28.54
73085 TC Contrast x-ray of elbow A 1 XXX $ - $ 64.73
73090 X-ray exam of forearm A 1 XXX $ - $ 26.45
73090 26 X-ray exam of forearm A 1 XXX $ 8.35 $ 8.35
73090 TC X-ray exam of forearm A 1 XXX $ - $ 18.10
73092 X-ray exam of arm infant A 1 XXX $ - $ 26.80
73092 26 X-ray exam of arm infant A 1 XXX $ 8.35 $ 8.35
73092 TC X-ray exam of arm infant A 1 XXX $ - $ 18.44
73100 X-ray exam of wrist A 1 XXX $ - $ 32.02
73100 26 X-ray exam of wrist A 1 XXX $ 11.14 $ 11.14
73100 TC X-ray exam of wrist A 1 XXX $ - $ 20.88
73110 X-ray exam of wrist A 1 XXX $ - $ 34.80
73110 26 X-ray exam of wrist A 1 XXX $ 8.70 $ 8.70
73110 TC X-ray exam of wrist A 1 XXX $ - $ 26.10
73115 Contrast x-ray of wrist A 1 XXX $ - $ 104.75
73115 26 Contrast x-ray of wrist A 1 XXX $ 29.58 $ 29.58
73115 TC Contrast x-ray of wrist A 1 XXX $ - $ 75.17
73120 X-ray exam of hand A 1 XXX $ - $ 26.80
73120 26 X-ray exam of hand A 1 XXX $ 8.70 $ 8.70
73120 TC X-ray exam of hand A 1 XXX $ - $ 18.10
73130 X-ray exam of hand A 1 XXX $ - $ 30.62
73130 26 X-ray exam of hand A 1 XXX $ 8.70 $ 8.70
73130 TC X-ray exam of hand A 1 XXX $ - $ 21.58
73140 X-ray exam of finger(s) A 1 XXX $ - $ 30.97
73140 26 X-ray exam of finger(s) A 1 XXX $ 7.31 $ 7.31

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
73140 TC X-ray exam of finger(s) A 1 XXX $ - $ 23.66

73200 Ct upper extremity w/o dye A 1 XXX Y $ - $ 208.10
73200 26 Ct upper extremity w/o dye A 1 XXX Y $ 52.90 $ 52.90
73200 TC Ct upper extremity w/o dye A 1 XXX Y $ - $ 155.21
73201 Ct upper extremity w/dye A 1 XXX Y $ - $ 253.34
73201 26 Ct upper extremity w/dye A 1 XXX Y $ 59.51 $ 59.51
73201 TC Ct upper extremity w/dye A 1 XXX Y $ - $ 193.49
73202 Ct uppr extremity w/o&w/dye A 1 XXX Y $ - $ 321.90
73202 26 Ct uppr extremity w/o&w/dye A 1 XXX Y $ 62.29 $ 62.29
73202 TC Ct uppr extremity w/o&w/dye A 1 XXX Y $ - $ 259.61
73206 Ct angio upr extrm w/o&w/dye A 1 XXX Y $ - $ 360.53
73206 26 Ct angio upr extrm w/o&w/dye A 1 XXX Y $ 89.78 $ 89.78
73206 TC Ct angio upr extrm w/o&w/dye A 1 XXX Y $ - $ 270.74
73218 Mri upper extremity w/o dye A 1 XXX Y $ - $ 417.95
73218 26 Mri upper extremity w/o dye A 1 XXX Y $ 67.86 $ 67.86
73218 TC Mri upper extremity w/o dye A 1 XXX Y $ - $ 349.74
73219 Mri upper extremity w/dye A 1 XXX Y $ - $ 463.19
73219 26 Mri upper extremity w/dye A 1 XXX Y $ 83.52 $ 83.52
73219 TC Mri upper extremity w/dye A 1 XXX Y $ - $ 379.67
73220 Mri uppr extremity w/o&w/dye A 1 XXX Y $ - $ 589.16
73220 26 Mri uppr extremity w/o&w/dye A 1 XXX Y $ 109.27 $ 109.27
73220 TC Mri uppr extremity w/o&w/dye A 1 XXX Y $ - $ 479.89
73221 Mri joint upr extrem w/o dye A 1 XXX Y $ - $ 401.24
73221 26 Mri joint upr extrem w/o dye A 1 XXX Y $ 71.69 $ 71.69
73221 TC Mri joint upr extrem w/o dye A 1 XXX Y $ - $ 329.56
73222 Mri joint upr extrem w/dye A 1 XXX Y $ - $ 435.35
73222 26 Mri joint upr extrem w/dye A 1 XXX Y $ 83.52 $ 83.52
73222 TC Mri joint upr extrem w/dye A 1 XXX Y $ - $ 351.83

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
73223 Mri joint upr extr w/o&w/dye A 1 XXX Y $ - $ 557.50

73223 26 Mri joint upr extr w/o&w/dye A 1 XXX Y $ 109.27 $ 109.27
73223 TC Mri joint upr extr w/o&w/dye A 1 XXX Y $ - $ 448.22
73225 Mr angio upr extr w/o&w/dye N 1 XXX Y $ - $ 456.92
73225 26 Mr angio upr extr w/o&w/dye N 1 XXX Y $ 84.22 $ 84.22
73225 TC Mr angio upr extr w/o&w/dye N 1 XXX Y $ - $ 372.71
73500 X-ray exam of hip A 1 XXX $ - $ 27.84
73500 26 X-ray exam of hip A 1 XXX $ 11.14 $ 11.14
73500 TC X-ray exam of hip A 1 XXX $ - $ 16.70
73510 X-ray exam of hip A 1 XXX $ - $ 38.63
73510 TC X-ray exam of hip A 1 XXX $ - $ 25.40
73520 X-ray exam of hips A 1 XXX $ - $ 40.37
73520 26 X-ray exam of hips A 1 XXX $ 15.31 $ 15.31
73520 TC X-ray exam of hips A 1 XXX $ - $ 25.06
73525 Contrast x-ray of hip A 1 XXX $ - $ 97.09
73525 26 Contrast x-ray of hip A 1 XXX $ 29.93 $ 29.93
73525 TC Contrast x-ray of hip A 1 XXX $ - $ 67.16
73530 X-ray exam of hip C 1 XXX $ - $ -
73530 TC X-ray exam of hip C 1 XXX $ - $ -
73540 X-ray exam of pelvis & hips A 1 XXX $ - $ 42.80
73540 26 X-ray exam of pelvis & hips A 1 XXX $ 12.88 $ 12.88
73540 TC X-ray exam of pelvis & hips A 1 XXX $ - $ 29.58
73550 X-ray exam of thigh A 1 XXX $ - $ 28.88
73550 26 X-ray exam of thigh A 1 XXX $ 11.14 $ 11.14
73550 TC X-ray exam of thigh A 1 XXX $ - $ 17.75
73560 X-ray exam of knee 1 or 2 A 1 XXX $ - $ 31.32

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
73560 26 X-ray exam of knee 1 or 2 A 1 XXX $ 11.48 $ 11.48

73560 TC X-ray exam of knee 1 or 2 A 1 XXX $ - $ 19.84
73562 X-ray exam of knee 3 A 1 XXX $ - $ 36.54
73562 26 X-ray exam of knee 3 A 1 XXX $ 11.83 $ 11.83
73562 TC X-ray exam of knee 3 A 1 XXX $ - $ 24.71
73564 X-ray exam knee 4 or more A 1 XXX $ - $ 42.11
73564 26 X-ray exam knee 4 or more A 1 XXX $ 13.57 $ 13.57
73564 TC X-ray exam knee 4 or more A 1 XXX $ - $ 28.54
73565 X-ray exam of knees A 1 XXX $ - $ 35.15
73565 26 X-ray exam of knees A 1 XXX $ 11.83 $ 11.83
73565 TC X-ray exam of knees A 1 XXX $ - $ 23.32
73580 Contrast x-ray of knee joint A 1 XXX $ - $ 124.93
73580 26 Contrast x-ray of knee joint A 1 XXX $ 31.32 $ 31.32
73580 TC Contrast x-ray of knee joint A 1 XXX $ - $ 93.61
73590 X-ray exam of lower leg A 1 XXX $ - $ 26.45
73590 26 X-ray exam of lower leg A 1 XXX $ 8.70 $ 8.70
73590 TC X-ray exam of lower leg A 1 XXX $ - $ 17.75
73592 X-ray exam of leg infant A 1 XXX $ - $ 30.28
73592 26 X-ray exam of leg infant A 1 XXX $ 8.70 $ 8.70
73592 TC X-ray exam of leg infant A 1 XXX $ - $ 21.92
73600 X-ray exam of ankle A 1 XXX $ - $ 27.49
73600 26 X-ray exam of ankle A 1 XXX $ 8.70 $ 8.70
73600 TC X-ray exam of ankle A 1 XXX $ - $ 19.14
73610 X-ray exam of ankle A 1 XXX $ - $ 31.32
73610 26 X-ray exam of ankle A 1 XXX $ 8.70 $ 8.70
73610 TC X-ray exam of ankle A 1 XXX $ - $ 22.62
73615 Contrast x-ray of ankle A 1 XXX $ - $ 100.92
73615 26 Contrast x-ray of ankle A 1 XXX $ 29.93 $ 29.93

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
73615 TC Contrast x-ray of ankle A 1 XXX $ - $ 70.99

73620 X-ray exam of foot A 1 XXX $ - $ 26.10
73620 26 X-ray exam of foot A 1 XXX $ 8.00 $ 8.00
73620 TC X-ray exam of foot A 1 XXX $ - $ 18.10
73630 X-ray exam of foot A 1 XXX $ - $ 29.93
73630 26 X-ray exam of foot A 1 XXX $ 8.70 $ 8.70
73630 TC X-ray exam of foot A 1 XXX $ - $ 21.23
73650 X-ray exam of heel A 1 XXX $ - $ 27.14
73650 26 X-ray exam of heel A 1 XXX $ 8.35 $ 8.35
73650 TC X-ray exam of heel A 1 XXX $ - $ 18.79
73660 X-ray exam of toe(s) A 1 XXX $ - $ 28.19
73660 26 X-ray exam of toe(s) A 1 XXX $ 6.96 $ 6.96
73660 TC X-ray exam of toe(s) A 1 XXX $ - $ 21.23
73700 Ct lower extremity w/o dye A 1 XXX Y $ - $ 208.45
73700 26 Ct lower extremity w/o dye A 1 XXX Y $ 52.55 $ 52.55
73700 TC Ct lower extremity w/o dye A 1 XXX Y $ - $ 155.90
73701 Ct lower extremity w/dye A 1 XXX Y $ - $ 255.78
73701 26 Ct lower extremity w/dye A 1 XXX Y $ 59.51 $ 59.51
73701 TC Ct lower extremity w/dye A 1 XXX Y $ - $ 196.27
73702 Ct lwr extremity w/o&w/dye A 1 XXX Y $ - $ 321.55
73702 26 Ct lwr extremity w/o&w/dye A 1 XXX Y $ 62.29 $ 62.29
73702 TC Ct lwr extremity w/o&w/dye A 1 XXX Y $ - $ 259.26
73706 Ct angio lwr extr w/o&w/dye A 1 XXX Y $ - $ 400.90
73706 26 Ct angio lwr extr w/o&w/dye A 1 XXX Y $ 97.09 $ 97.09
73706 TC Ct angio lwr extr w/o&w/dye A 1 XXX Y $ - $ 303.80
73718 Mri lower extremity w/o dye A 1 XXX Y $ - $ 413.08
73718 26 Mri lower extremity w/o dye A 1 XXX Y $ 68.90 $ 68.90
73718 TC Mri lower extremity w/o dye A 1 XXX Y $ - $ 344.17

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
73719 Mri lower extremity w/dye A 1 XXX Y $ - $ 464.23

73719 26 Mri lower extremity w/dye A 1 XXX Y $ 83.52 $ 83.52
73719 TC Mri lower extremity w/dye A 1 XXX Y $ - $ 381.06
73720 Mri lwr extremity w/o&w/dye A 1 XXX Y $ - $ 591.95
73720 26 Mri lwr extremity w/o&w/dye A 1 XXX Y $ 108.92 $ 108.92
73720 TC Mri lwr extremity w/o&w/dye A 1 XXX Y $ - $ 483.02
73721 Mri jnt of lwr extre w/o dye A 1 XXX Y $ - $ 409.60
73721 26 Mri jnt of lwr extre w/o dye A 1 XXX Y $ 71.69 $ 71.69
73721 TC Mri jnt of lwr extre w/o dye A 1 XXX Y $ - $ 337.91
73722 Mri joint of lwr extr w/dye A 1 XXX Y $ - $ 445.79
73722 26 Mri joint of lwr extr w/dye A 1 XXX Y $ 84.91 $ 84.91
73722 TC Mri joint of lwr extr w/dye A 1 XXX Y $ - $ 360.88
73723 Mri joint lwr extr w/o&w/dye A 1 XXX Y $ - $ 558.19
73723 26 Mri joint lwr extr w/o&w/dye A 1 XXX Y $ 108.92 $ 108.92
73723 TC Mri joint lwr extr w/o&w/dye A 1 XXX Y $ - $ 449.27
73725 Mr ang lwr ext w or w/o dye R 1 XXX Y $ - $ 461.45
73725 26 Mr ang lwr ext w or w/o dye R 1 XXX Y $ 92.22 $ 92.22
73725 TC Mr ang lwr ext w or w/o dye R 1 XXX Y $ - $ 369.58
74000 X-ray exam of abdomen A 1 XXX $ - $ 24.01
74000 26 X-ray exam of abdomen A 1 XXX $ 9.05 $ 9.05
74000 TC X-ray exam of abdomen A 1 XXX $ - $ 14.62
74022 X-ray exam series abdomen A 1 XXX $ - $ 44.89

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
74022 26 X-ray exam series abdomen A 1 XXX $ 15.31 $ 15.31

74022 TC X-ray exam series abdomen A 1 XXX $ - $ 29.23
74150 Ct abdomen w/o dye A 1 XXX Y $ - $ 209.15
74150 26 Ct abdomen w/o dye A 1 XXX Y $ 60.90 $ 60.90
74150 TC Ct abdomen w/o dye A 1 XXX Y $ - $ 148.25
74160 Ct abdomen w/dye A 1 XXX Y $ - $ 280.84
74160 26 Ct abdomen w/dye A 1 XXX Y $ 64.38 $ 64.38
74160 TC Ct abdomen w/dye A 1 XXX Y $ - $ 216.46
74170 Ct abdomen w/o & w/dye A 1 XXX Y $ - $ 369.23
74170 26 Ct abdomen w/o & w/dye A 1 XXX Y $ 71.34 $ 71.34
74170 TC Ct abdomen w/o & w/dye A 1 XXX Y $ - $ 297.89
74174 Ct angio abd&pelv w/o&w/dye A 1 XXX Y $ - $ 499.03
74174 26 Ct angio abd&pelv w/o&w/dye A 1 XXX Y $ 111.71 $ 111.71
74174 TC Ct angio abd&pelv w/o&w/dye A 1 XXX Y $ - $ 387.32
74175 Ct angio abdom w/o & w/dye A 1 XXX Y $ - $ 433.96
74175 26 Ct angio abdom w/o & w/dye A 1 XXX Y $ 98.14 $ 98.14
74175 TC Ct angio abdom w/o & w/dye A 1 XXX Y $ - $ 335.82
74176 Ct abd & pelvis A 1 XXX Y $ - $ 209.15
74176 26 Ct abd & pelvis A 1 XXX Y $ 87.35 $ 87.35
74176 TC Ct abd & pelvis A 1 XXX Y $ - $ 121.45
74177 Ct abd & pelv w/contrast A 1 XXX Y $ - $ 320.86
74177 26 Ct abd & pelv w/contrast A 1 XXX Y $ 90.83 $ 90.83
74177 TC Ct abd & pelv w/contrast A 1 XXX Y $ - $ 230.03
74178 Ct abd & pelv 1/> regns A 1 XXX Y $ - $ 405.42
74178 26 Ct abd & pelv 1/> regns A 1 XXX Y $ 101.62 $ 101.62
74178 TC Ct abd & pelv 1/> regns A 1 XXX Y $ - $ 303.80
74181 Mri abdomen w/o dye A 1 XXX Y $ - $ 377.58
74181 26 Mri abdomen w/o dye A 1 XXX Y $ 74.12 $ 74.12

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
74181 TC Mri abdomen w/o dye A 1 XXX Y $ - $ 303.80

74182 Mri abdomen w/dye A 1 XXX Y $ - $ 512.26
74182 26 Mri abdomen w/dye A 1 XXX Y $ 88.39 $ 88.39
74182 TC Mri abdomen w/dye A 1 XXX Y $ - $ 424.21
74183 Mri abdomen w/o & w/dye A 1 XXX Y $ - $ 594.04
74183 26 Mri abdomen w/o & w/dye A 1 XXX Y $ 113.80 $ 113.80
74183 TC Mri abdomen w/o & w/dye A 1 XXX Y $ - $ 480.24
74185 Mri angio abdom w orw/o dye N 1 XXX Y $ - $ 459.36
74185 26 Mri angio abdom w orw/o dye N 1 XXX Y $ 91.18 $ 91.18
74185 TC Mri angio abdom w orw/o dye N 1 XXX Y $ - $ 368.18
74190 X-ray exam of peritoneum C 1 XXX $ 329.90 $ 329.90
74190 26 X-ray exam of peritoneum A 1 XXX $ 25.75 $ 25.75
74190 TC X-ray exam of peritoneum C 1 XXX $ 304.50 $ 304.50
74210 Contrst x-ray exam of throat A 1 XXX $ - $ 71.69
74210 26 Contrst x-ray exam of throat A 1 XXX $ 17.40 $ 17.40
74210 TC Contrst x-ray exam of throat A 1 XXX $ - $ 54.29
74220 Contrast x-ray esophagus A 1 XXX $ - $ 83.87
74220 26 Contrast x-ray esophagus A 1 XXX $ 23.66 $ 23.66
74220 TC Contrast x-ray esophagus A 1 XXX $ - $ 60.20
74230 Cine/vid x-ray throat/esoph A 1 XXX $ - $ 85.61
74230 26 Cine/vid x-ray throat/esoph A 1 XXX $ 27.14 $ 27.14
74230 TC Cine/vid x-ray throat/esoph A 1 XXX $ - $ 58.46
74235 Remove esophagus obstruction C 1 XXX $ - $ -
74235 26 Remove esophagus obstruction A 1 XXX $ 69.25 $ 69.25
74235 TC Remove esophagus obstruction C 1 XXX $ - $ -
74240 X-ray exam upper gi tract A 1 XXX $ - $ 106.49
74240 26 X-ray exam upper gi tract A 1 XXX $ 35.50 $ 35.50
74240 TC X-ray exam upper gi tract A 1 XXX $ - $ 70.99

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

74246 Contrst x-ray uppr gi tract A 1 XXX $ - $ 118.67
74246 26 Contrst x-ray uppr gi tract A 1 XXX $ 35.15 $ 35.15
74246 TC Contrst x-ray uppr gi tract A 1 XXX $ - $ 83.17
74250 X-ray exam of small bowel A 1 XXX $ - $ 99.18
74250 26 X-ray exam of small bowel A 1 XXX $ 24.36 $ 24.36
74250 TC X-ray exam of small bowel A 1 XXX $ - $ 74.82
74251 X-ray exam of small bowel A 1 XXX $ 220.28 $ 220.28
74251 TC X-ray exam of small bowel A 1 XXX $ 184.44 $ 184.44
74260 X-ray exam of small bowel A 1 XXX $ 136.07 $ 136.07
74260 TC X-ray exam of small bowel A 1 XXX $ 109.97 $ 109.97
74261 Ct colonography dx A 1 XXX Y $ 370.62 $ 370.62
74261 26 Ct colonography dx A 1 XXX Y $ 118.67 $ 118.67
74261 TC Ct colonography dx A 1 XXX Y $ 248.47 $ 248.47
74262 Ct colonography dx w/dye A 1 XXX Y $ 517.82 $ 517.82

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
74262 26 Ct colonography dx w/dye A 1 XXX Y $ 127.02 $ 127.02

74262 TC Ct colonography dx w/dye A 1 XXX Y $ 388.37 $ 388.37
74263 Ct colonography screening N 1 XXX $ - $ 706.79
74263 26 Ct colonography screening N 1 XXX $ 116.93 $ 116.93
74263 TC Ct colonography screening N 1 XXX $ - $ 589.86
74270 Contrast x-ray exam of colon A 1 XXX $ 146.16 $ 142.33
74270 26 Contrast x-ray exam of colon A 1 XXX $ 35.15 $ 35.15
74270 TC Contrast x-ray exam of colon A 1 XXX $ 110.32 $ 107.18
74280 Contrast x-ray exam of colon A 1 XXX $ - $ 196.62
74280 TC Contrast x-ray exam of colon A 1 XXX $ - $ 146.86
74283 Contrast x-ray exam of colon A 1 XXX $ - $ 190.01
74283 TC Contrast x-ray exam of colon A 1 XXX $ - $ 94.31
74290 Contrast x-ray gallbladder A 1 XXX $ - $ 63.34
74290 26 Contrast x-ray gallbladder A 1 XXX $ 15.31 $ 15.31
74290 TC Contrast x-ray gallbladder A 1 XXX $ - $ 47.68
74291 Contrast x-rays gallbladder A 1 XXX $ - $ 60.55
74291 26 Contrast x-rays gallbladder A 1 XXX $ 10.09 $ 10.09
74291 TC Contrast x-rays gallbladder A 1 XXX $ - $ 50.46
74300 X-ray bile ducts/pancreas C 1 XXX $ - $ -
74300 26 X-ray bile ducts/pancreas A 1 XXX $ 19.49 $ 19.49
74300 TC X-ray bile ducts/pancreas C 1 XXX $ - $ -
74301 X-rays at surgery add-on C 1 ZZZ $ - $ -
74301 26 X-rays at surgery add-on A 1 ZZZ $ 12.88 $ 12.88
74301 TC X-rays at surgery add-on C 1 ZZZ $ - $ -
74305 X-ray bile ducts/pancreas C 1 XXX $ 327.12 $ 327.12
74305 26 X-ray bile ducts/pancreas A 1 XXX $ 23.32 $ 23.32

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
74305 TC X-ray bile ducts/pancreas C 1 XXX $ 304.50 $ 304.50

74320 Contrast x-ray of bile ducts A 1 XXX $ - $ 95.70
74320 26 Contrast x-ray of bile ducts A 1 XXX $ 27.49 $ 27.49
74320 TC Contrast x-ray of bile ducts A 1 XXX $ - $ 68.21
74327 X-ray bile stone removal A 1 XXX $ - $ 134.33
74327 26 X-ray bile stone removal A 1 XXX $ 44.89 $ 44.89
74327 TC X-ray bile stone removal A 1 XXX $ - $ 89.78
74328 X-ray bile duct endoscopy C 1 XXX $ - $ -
74328 26 X-ray bile duct endoscopy A 1 XXX $ 37.58 $ 37.58
74328 TC X-ray bile duct endoscopy C 1 XXX $ - $ -
74329 X-ray for pancreas endoscopy C 1 XXX $ - $ -
74329 26 X-ray for pancreas endoscopy A 1 XXX $ 37.58 $ 37.58
74329 TC X-ray for pancreas endoscopy C 1 XXX $ - $ -
74330 X-ray bile/panc endoscopy C 1 XXX $ - $ -
74330 26 X-ray bile/panc endoscopy A 1 XXX $ 48.72 $ 48.72
74330 TC X-ray bile/panc endoscopy C 1 XXX $ - $ -
74340 X-ray guide for GI tube C 1 XXX $ - $ -
74340 26 X-ray guide for GI tube A 1 XXX $ 28.54 $ 28.54
74340 TC X-ray guide for GI tube C 1 XXX $ - $ -
74355 X-ray guide intestinal tube C 1 XXX $ - $ -
74355 26 X-ray guide intestinal tube A 1 XXX $ 42.80 $ 42.80
74355 TC X-ray guide intestinal tube C 1 XXX $ - $ -
74360 X-ray guide gi dilation C 1 XXX $ - $ -
74360 26 X-ray guide gi dilation A 1 XXX $ 30.62 $ 30.62
74360 TC X-ray guide gi dilation C 1 XXX $ - $ -
74363 X-ray bile duct dilation C 1 XXX $ - $ -
74363 26 X-ray bile duct dilation A 1 XXX $ 48.37 $ 48.37
74363 TC X-ray bile duct dilation C 1 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
74400 Contrst x-ray urinary tract A 1 XXX $ - $ 103.01

74400 26 Contrst x-ray urinary tract A 1 XXX $ 25.06 $ 25.06
74400 TC Contrst x-ray urinary tract A 1 XXX $ - $ 77.95
74420 Contrst x-ray urinary tract C 1 XXX $ 256.13 $ 256.13
74420 TC Contrst x-ray urinary tract C 1 XXX $ 236.99 $ 236.99
74425 Contrst x-ray urinary tract C 1 XXX $ 255.78 $ 255.78
74425 TC Contrst x-ray urinary tract C 1 XXX $ 236.99 $ 236.99
74430 Contrast x-ray bladder A 1 XXX $ - $ 46.63
74430 26 Contrast x-ray bladder A 1 XXX $ 15.31 $ 15.31
74430 TC Contrast x-ray bladder A 1 XXX $ - $ 31.32
74440 X-ray male genital tract A 1 XXX $ - $ 76.91
74440 26 X-ray male genital tract A 1 XXX $ 20.18 $ 20.18
74440 TC X-ray male genital tract A 1 XXX $ - $ 56.72
74445 X-ray exam of penis C 1 XXX $ 298.24 $ 298.24
74445 26 X-ray exam of penis A 1 XXX $ 62.64 $ 62.64
74445 TC X-ray exam of penis C 1 XXX $ 236.99 $ 236.99
74450 X-ray urethra/bladder C 1 XXX $ 254.74 $ 254.74
74450 26 X-ray urethra/bladder A 1 XXX $ 18.10 $ 18.10
74450 TC X-ray urethra/bladder C 1 XXX $ 236.99 $ 236.99
74455 X-ray urethra/bladder A 1 XXX $ - $ 79.69

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
74455 26 X-ray urethra/bladder A 1 XXX $ 16.01 $ 16.01

74455 TC X-ray urethra/bladder A 1 XXX $ - $ 63.68
74470 X-ray exam of kidney lesion C 1 XXX $ 332.69 $ 332.69
74470 26 X-ray exam of kidney lesion A 1 XXX $ 28.54 $ 28.54
74470 TC X-ray exam of kidney lesion C 1 XXX $ 304.50 $ 304.50
74475 X-ray control cath insert A 1 XXX $ - $ 96.74
74475 26 X-ray control cath insert A 1 XXX $ 27.49 $ 27.49
74475 TC X-ray control cath insert A 1 XXX $ - $ 69.60
74480 X-ray control cath insert A 1 XXX $ - $ 96.74
74480 26 X-ray control cath insert A 1 XXX $ 27.49 $ 27.49
74480 TC X-ray control cath insert A 1 XXX $ - $ 69.60
74485 X-ray guide gu dilation A 1 XXX $ - $ 96.74
74485 26 X-ray guide gu dilation A 1 XXX $ 27.49 $ 27.49
74485 TC X-ray guide gu dilation A 1 XXX $ - $ 69.60
74710 X-ray measurement of pelvis A 1 XXX $ - $ 35.84
74710 26 X-ray measurement of pelvis A 1 XXX $ 16.36 $ 16.36
74710 TC X-ray measurement of pelvis A 1 XXX $ - $ 19.49
74740 X-ray female genital tract A 1 XXX $ - $ 72.04
74740 26 X-ray female genital tract A 1 XXX $ 18.10 $ 18.10
74740 TC X-ray female genital tract A 1 XXX $ - $ 53.94
74742 X-ray fallopian tube C 1 XXX $ - $ -
74742 26 X-ray fallopian tube A 1 XXX $ 33.06 $ 33.06
74742 TC X-ray fallopian tube C 1 XXX $ - $ -
74775 X-ray exam of perineum C 1 XXX $ 269.70 $ 269.70
74775 26 X-ray exam of perineum A 1 XXX $ 33.06 $ 33.06
74775 TC X-ray exam of perineum C 1 XXX $ 236.99 $ 236.99
75557 Cardiac mri for morph A 1 XXX Y $ - $ 371.66
75557 26 Cardiac mri for morph A 1 XXX Y $ 117.28 $ 117.28

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
75557 TC Cardiac mri for morph A 1 XXX Y $ - $ 254.39

75559 Cardiac mri w/stress img A 1 XXX Y $ - $ 522.70
75559 26 Cardiac mri w/stress img A 1 XXX Y $ 147.20 $ 147.20
75559 TC Cardiac mri w/stress img A 1 XXX Y $ - $ 375.49
75561 Cardiac mri for morph w/dye A 1 XXX Y $ - $ 495.90
75561 26 Cardiac mri for morph w/dye A 1 XXX Y $ 129.46 $ 129.46
75561 TC Cardiac mri for morph w/dye A 1 XXX Y $ - $ 366.10
75563 Card mri w/stress img & dye A 1 XXX Y $ - $ 593.69
75563 26 Card mri w/stress img & dye A 1 XXX Y $ 149.64 $ 149.64
75563 TC Card mri w/stress img & dye A 1 XXX Y $ - $ 444.05
75565 Card mri veloc flow mapping A 1 ZZZ $ - $ 58.81
75565 26 Card mri veloc flow mapping A 1 ZZZ $ 12.18 $ 12.18
75565 TC Card mri veloc flow mapping A 1 ZZZ $ - $ 46.63
75571 Ct hrt w/o dye w/ca test A 1 XXX Y $ 87.70 $ 87.70
75571 26 Ct hrt w/o dye w/ca test A 1 XXX Y $ 26.80 $ 26.80
75571 TC Ct hrt w/o dye w/ca test A 1 XXX Y $ 59.16 $ 59.16
75572 Ct hrt w/3d image A 1 XXX Y $ - $ 278.75
75572 26 Ct hrt w/3d image A 1 XXX Y $ 82.48 $ 82.48
75572 TC Ct hrt w/3d image A 1 XXX Y $ - $ 196.27
75573 Ct hrt w/3d image congen A 1 XXX Y $ - $ 383.84
75573 26 Ct hrt w/3d image congen A 1 XXX Y $ 121.10 $ 121.10
75573 TC Ct hrt w/3d image congen A 1 XXX Y $ - $ 262.74
75574 Ct angio hrt w/3d image A 1 XXX Y $ - $ 412.03
75574 26 Ct angio hrt w/3d image A 1 XXX Y $ 114.49 $ 114.49
75574 TC Ct angio hrt w/3d image A 1 XXX Y $ - $ 297.54
75600 Contrast x-ray exam of aorta A 1 XXX $ - $ 213.67
75600 26 Contrast x-ray exam of aorta A 1 XXX $ 25.75 $ 25.75
75600 TC Contrast x-ray exam of aorta A 1 XXX $ - $ 187.92

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

75630 X-ray aorta leg arteries A 1 XXX $ - $ 204.97
75630 26 X-ray aorta leg arteries A 1 XXX $ 90.83 $ 90.83
75630 TC X-ray aorta leg arteries A 1 XXX $ - $ 114.14
75635 Ct angio abdominal arteries A 1 XXX Y $ - $ 449.62
75635 26 Ct angio abdominal arteries A 1 XXX Y $ 120.76 $ 120.76
75635 TC Ct angio abdominal arteries A 1 XXX Y $ - $ 328.86
75650 Artery x-rays head & neck A 1 XXX $ - $ 192.10
75650 26 Artery x-rays head & neck A 1 XXX $ 77.60 $ 77.60
75650 TC Artery x-rays head & neck A 1 XXX $ - $ 114.49
75658 Artery x-rays arm A 1 XXX $ - $ 194.53
75658 26 Artery x-rays arm A 1 XXX $ 66.12 $ 66.12
75658 TC Artery x-rays arm A 1 XXX $ - $ 128.41

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

75676 Artery x-rays neck A 1 XXX $ - $ 204.62
75676 26 Artery x-rays neck A 1 XXX $ 71.34 $ 71.34
75676 TC Artery x-rays neck A 1 XXX $ - $ 133.28
75680 Artery x-rays neck A 1 XXX $ - $ 232.12
75680 26 Artery x-rays neck A 1 XXX $ 85.96 $ 85.96
75680 TC Artery x-rays neck A 1 XXX $ - $ 146.16
75685 Artery x-rays spine A 1 XXX $ - $ 204.62
75685 26 Artery x-rays spine A 1 XXX $ 68.21 $ 68.21
75685 TC Artery x-rays spine A 1 XXX $ - $ 136.42
75705 Artery x-rays spine A 1 XXX $ - $ 246.38
75705 26 Artery x-rays spine A 1 XXX $ 106.49 $ 106.49
75705 TC Artery x-rays spine A 1 XXX $ - $ 139.90
75710 Artery x-rays arm/leg A 1 XXX $ - $ 187.22
75710 26 Artery x-rays arm/leg A 1 XXX $ 56.03 $ 56.03
75710 TC Artery x-rays arm/leg A 1 XXX $ - $ 131.20
75716 Artery x-rays arms/legs A 1 XXX $ - $ 225.50
75716 26 Artery x-rays arms/legs A 1 XXX $ 69.25 $ 69.25
75716 TC Artery x-rays arms/legs A 1 XXX $ - $ 156.25
75726 Artery x-rays abdomen A 1 XXX $ - $ 188.96
75726 26 Artery x-rays abdomen A 1 XXX $ 59.51 $ 59.51
75726 TC Artery x-rays abdomen A 1 XXX $ - $ 129.46
75731 Artery x-rays adrenal gland A 1 XXX $ - $ 179.57
75731 26 Artery x-rays adrenal gland A 1 XXX $ 56.38 $ 56.38
75731 TC Artery x-rays adrenal gland A 1 XXX $ - $ 123.19
75733 Artery x-rays adrenals A 1 XXX $ - $ 216.11
75733 26 Artery x-rays adrenals A 1 XXX $ 64.38 $ 64.38

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
75733 TC Artery x-rays adrenals A 1 XXX $ - $ 151.73

75736 Artery x-rays pelvis A 1 XXX $ - $ 184.09
75736 26 Artery x-rays pelvis A 1 XXX $ 56.03 $ 56.03
75736 TC Artery x-rays pelvis A 1 XXX $ - $ 128.06
75741 Artery x-rays lung A 1 XXX $ - $ 177.13
75741 26 Artery x-rays lung A 1 XXX $ 66.82 $ 66.82
75741 TC Artery x-rays lung A 1 XXX $ - $ 109.97
75743 Artery x-rays lungs A 1 XXX $ - $ 203.23
75743 26 Artery x-rays lungs A 1 XXX $ 84.91 $ 84.91
75743 TC Artery x-rays lungs A 1 XXX $ - $ 117.97
75746 Artery x-rays lung A 1 XXX $ - $ 182.00
75746 26 Artery x-rays lung A 1 XXX $ 58.81 $ 58.81
75746 TC Artery x-rays lung A 1 XXX $ - $ 123.19
75756 Artery x-rays chest A 1 XXX $ - $ 211.58
75756 26 Artery x-rays chest A 1 XXX $ 76.56 $ 76.56
75756 TC Artery x-rays chest A 1 XXX $ - $ 135.02
75774 Artery x-ray each vessel A 1 ZZZ $ - $ 117.28
75774 26 Artery x-ray each vessel A 1 ZZZ $ 19.14 $ 19.14
75774 TC Artery x-ray each vessel A 1 ZZZ $ - $ 98.14
75791 Av dialysis shunt imaging A 1 XXX $ - $ 305.54
75791 26 Av dialysis shunt imaging A 1 XXX $ 84.91 $ 84.91
75791 TC Av dialysis shunt imaging A 1 XXX $ - $ 220.63
75801 Lymph vessel x-ray arm/leg C 1 XXX $ 566.54 $ 566.54
75801 26 Lymph vessel x-ray arm/leg A 1 XXX $ 57.07 $ 57.07
75801 TC Lymph vessel x-ray arm/leg C 1 XXX $ 517.82 $ 517.82
75803 Lymph vessel x-ray arms/legs C 1 XXX $ 580.12 $ 580.12
75803 26 Lymph vessel x-ray arms/legs A 1 XXX $ 63.68 $ 63.68
75803 TC Lymph vessel x-ray arms/legs C 1 XXX $ 517.82 $ 517.82

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
75805 Lymph vessel x-ray trunk C 1 XXX $ 560.98 $ 560.98

75805 26 Lymph vessel x-ray trunk A 1 XXX $ 44.20 $ 44.20
75805 TC Lymph vessel x-ray trunk C 1 XXX $ 517.82 $ 517.82
75807 Lymph vessel x-ray trunk C 1 XXX $ 580.12 $ 580.12
75807 26 Lymph vessel x-ray trunk A 1 XXX $ 63.68 $ 63.68
75807 TC Lymph vessel x-ray trunk C 1 XXX $ 517.82 $ 517.82
75809 Nonvascular shunt x-ray A 1 XXX $ - $ 94.66
75809 26 Nonvascular shunt x-ray A 1 XXX $ 24.71 $ 24.71
75809 TC Nonvascular shunt x-ray A 1 XXX $ - $ 69.95
75810 Vein x-ray spleen/liver C 1 XXX $ 2,749.55 $ 2,749.55
75810 26 Vein x-ray spleen/liver A 1 XXX $ 62.29 $ 62.29
75810 TC Vein x-ray spleen/liver C 1 XXX $ 2,688.30 $ 2,688.30
75820 Vein x-ray arm/leg A 1 XXX $ - $ 116.58
75820 26 Vein x-ray arm/leg A 1 XXX $ 35.84 $ 35.84
75820 TC Vein x-ray arm/leg A 1 XXX $ - $ 80.74
75822 Vein x-ray arms/legs A 1 XXX $ - $ 145.81
75822 26 Vein x-ray arms/legs A 1 XXX $ 54.98 $ 54.98
75822 TC Vein x-ray arms/legs A 1 XXX $ - $ 91.18
75825 Vein x-ray trunk A 1 XXX $ - $ 166.00
75825 26 Vein x-ray trunk A 1 XXX $ 59.16 $ 59.16
75825 TC Vein x-ray trunk A 1 XXX $ - $ 106.84
75827 Vein x-ray chest A 1 XXX $ - $ 167.74
75827 26 Vein x-ray chest A 1 XXX $ 57.77 $ 57.77
75827 TC Vein x-ray chest A 1 XXX $ - $ 109.97
75831 Vein x-ray kidney A 1 XXX $ - $ 187.92
75831 26 Vein x-ray kidney A 1 XXX $ 77.60 $ 77.60
75831 TC Vein x-ray kidney A 1 XXX $ - $ 110.32
75833 Vein x-ray kidneys A 1 XXX $ - $ 198.01

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
75833 26 Vein x-ray kidneys A 1 XXX $ 73.78 $ 73.78

75833 TC Vein x-ray kidneys A 1 XXX $ - $ 124.24
75840 Vein x-ray adrenal gland A 1 XXX $ - $ 186.88
75840 26 Vein x-ray adrenal gland A 1 XXX $ 77.95 $ 77.95
75840 TC Vein x-ray adrenal gland A 1 XXX $ - $ 108.92
75842 Vein x-ray adrenal glands A 1 XXX $ - $ 200.80
75842 26 Vein x-ray adrenal glands A 1 XXX $ 75.52 $ 75.52
75842 TC Vein x-ray adrenal glands A 1 XXX $ - $ 124.93
75860 Vein x-ray neck A 1 XXX $ - $ 171.22
75860 26 Vein x-ray neck A 1 XXX $ 60.20 $ 60.20
75860 TC Vein x-ray neck A 1 XXX $ - $ 111.01
75870 Vein x-ray skull A 1 XXX $ - $ 168.43
75870 26 Vein x-ray skull A 1 XXX $ 58.81 $ 58.81
75870 TC Vein x-ray skull A 1 XXX $ - $ 109.62
75872 Vein x-ray skull A 1 XXX $ - $ 248.12
75872 26 Vein x-ray skull A 1 XXX $ 62.64 $ 62.64
75872 TC Vein x-ray skull A 1 XXX $ - $ 185.14
75880 Vein x-ray eye socket A 1 XXX $ - $ 121.10
75880 26 Vein x-ray eye socket A 1 XXX $ 35.50 $ 35.50
75880 TC Vein x-ray eye socket A 1 XXX $ - $ 85.61
75885 Vein x-ray liver A 1 XXX $ - $ 182.70
75885 26 Vein x-ray liver A 1 XXX $ 73.08 $ 73.08
75885 TC Vein x-ray liver A 1 XXX $ - $ 109.62

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

75893 Venous sampling by catheter A 1 XXX $ - $ 134.68
75893 26 Venous sampling by catheter A 1 XXX $ 25.06 $ 25.06
75893 TC Venous sampling by catheter A 1 XXX $ - $ 109.62
75894 X-rays transcath therapy C 1 XXX $ - $ -
75894 26 X-rays transcath therapy A 1 XXX $ 76.21 $ 76.21
75894 TC X-rays transcath therapy C 1 XXX $ - $ -
75896 X-rays transcath therapy C 1 XXX $ - $ -
75896 26 X-rays transcath therapy A 1 XXX $ 76.56 $ 76.56
75896 TC X-rays transcath therapy C 1 XXX $ - $ -
75898 Follow-up angiography C 1 XXX $ 188.62 $ 188.62
75898 26 Follow-up angiography A 1 XXX $ 96.40 $ 96.40
75898 TC Follow-up angiography C 1 XXX $ 97.79 $ 97.79
75900 Intravascular cath exchange C 1 XXX $ - $ -
75900 26 Intravascular cath exchange A 1 XXX $ 27.14 $ 27.14
75900 TC Intravascular cath exchange C 1 XXX $ - $ -
75901 Remove cva device obstruct A 1 XXX $ - $ 154.86
75901 26 Remove cva device obstruct A 1 XXX $ 25.06 $ 25.06
75901 TC Remove cva device obstruct A 1 XXX $ - $ 129.80
75902 Remove cva lumen obstruct A 1 XXX $ - $ 72.73
75902 26 Remove cva lumen obstruct A 1 XXX $ 21.58 $ 21.58
75902 TC Remove cva lumen obstruct A 1 XXX $ - $ 51.16
75945 Intravascular us C 1 XXX $ 217.85 $ 217.85
75945 26 Intravascular us A 1 XXX $ 23.32 $ 23.32
75945 TC Intravascular us C 1 XXX $ 196.27 $ 196.27

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
75946 Intravascular us add-on C 1 ZZZ $ - $ -

75946 26 Intravascular us add-on A 1 ZZZ $ 25.40 $ 25.40
75946 TC Intravascular us add-on C 1 ZZZ $ - $ -
75952 Endovasc repair abdom aorta C 1 XXX $ - $ -
75952 26 Endovasc repair abdom aorta A 1 XXX $ 291.97 $ 291.97
75952 TC Endovasc repair abdom aorta C 1 XXX $ - $ -
75953 Abdom aneurysm endovas rpr C 1 XXX $ - $ -
75953 26 Abdom aneurysm endovas rpr A 1 XXX $ 89.78 $ 89.78
75953 TC Abdom aneurysm endovas rpr C 1 XXX $ - $ -
75954 Iliac aneurysm endovas rpr C 1 XXX $ - $ -
75954 26 Iliac aneurysm endovas rpr A 1 XXX $ 144.07 $ 144.07
75954 TC Iliac aneurysm endovas rpr C 1 XXX $ - $ -
75956 Xray endovasc thor ao repr C 1 XXX $ - $ -
75956 26 Xray endovasc thor ao repr A 1 XXX $ 465.97 $ 465.97
75956 TC Xray endovasc thor ao repr C 1 XXX $ - $ -
75957 Xray endovasc thor ao repr C 1 XXX $ - $ -
75957 26 Xray endovasc thor ao repr A 1 XXX $ 397.07 $ 397.07
75957 TC Xray endovasc thor ao repr C 1 XXX $ - $ -
75958 Xray place prox ext thor ao C 1 XXX $ - $ -
75958 26 Xray place prox ext thor ao A 1 XXX $ 265.52 $ 265.52
75958 TC Xray place prox ext thor ao C 1 XXX $ - $ -
75959 Xray place dist ext thor ao C 1 XXX $ - $ -
75959 26 Xray place dist ext thor ao A 1 XXX $ 242.21 $ 242.21
75959 TC Xray place dist ext thor ao C 1 XXX $ - $ -
75960 Transcath iv stent rs&i A 1 XXX $ - $ 145.46
75960 26 Transcath iv stent rs&i A 1 XXX $ 41.76 $ 41.76
75960 TC Transcath iv stent rs&i A 1 XXX $ - $ 103.36
75961 Retrieval broken catheter A 1 XXX $ - $ 336.52

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
75961 26 Retrieval broken catheter A 1 XXX $ 217.50 $ 217.50

75961 TC Retrieval broken catheter A 1 XXX $ - $ 119.36
75962 Repair arterial blockage A 1 XXX $ - $ 157.99
75962 26 Repair arterial blockage A 1 XXX $ 27.14 $ 27.14
75962 TC Repair arterial blockage A 1 XXX $ - $ 130.85
75964 Repair artery blockage each A 1 ZZZ $ - $ 104.40
75964 26 Repair artery blockage each A 1 ZZZ $ 20.53 $ 20.53
75964 TC Repair artery blockage each A 1 ZZZ $ - $ 83.87
75966 Repair arterial blockage A 1 XXX $ - $ 198.36
75966 26 Repair arterial blockage A 1 XXX $ 66.47 $ 66.47
75966 TC Repair arterial blockage A 1 XXX $ - $ 131.89
75968 Repair artery blockage each A 1 ZZZ $ - $ 98.14
75968 26 Repair artery blockage each A 1 ZZZ $ 17.40 $ 17.40
75968 TC Repair artery blockage each A 1 ZZZ $ - $ 81.08
75970 Vascular biopsy C 1 XXX $ - $ -
75970 26 Vascular biopsy A 1 XXX $ 44.89 $ 44.89
75970 TC Vascular biopsy C 1 XXX $ - $ -
75978 Repair venous blockage A 1 XXX $ - $ 161.47
75978 26 Repair venous blockage A 1 XXX $ 27.14 $ 27.14
75978 TC Repair venous blockage A 1 XXX $ - $ 134.33
75980 Contrast xray exam bile duct C 1 XXX $ - $ -
75980 26 Contrast xray exam bile duct A 1 XXX $ 77.26 $ 77.26
75980 TC Contrast xray exam bile duct C 1 XXX $ - $ -
75982 Contrast xray exam bile duct C 1 XXX $ - $ -
75982 26 Contrast xray exam bile duct A 1 XXX $ 77.26 $ 77.26
75982 TC Contrast xray exam bile duct C 1 XXX $ - $ -
75984 Xray control catheter change A 1 XXX $ - $ 105.79
75984 26 Xray control catheter change A 1 XXX $ 36.54 $ 36.54

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
75984 TC Xray control catheter change A 1 XXX $ - $ 69.25

75989 Abscess drainage under x-ray A 1 XXX $ - $ 122.84
75989 26 Abscess drainage under x-ray A 1 XXX $ 58.46 $ 58.46
75989 TC Abscess drainage under x-ray A 1 XXX $ - $ 64.38
76000 Fluoroscope examination A 1 XXX $ - $ 58.12
76000 26 Fluoroscope examination A 1 XXX $ 8.70 $ 8.70
76000 TC Fluoroscope examination A 1 XXX $ - $ 49.42
76001 Fluoroscope exam extensive C 1 XXX $ - $ -
76001 26 Fluoroscope exam extensive A 1 XXX $ 39.67 $ 39.67
76001 TC Fluoroscope exam extensive C 1 XXX $ - $ -
76010 X-ray nose to rectum A 1 XXX $ - $ 25.75
76010 26 X-ray nose to rectum A 1 XXX $ 9.05 $ 9.05
76010 TC X-ray nose to rectum A 1 XXX $ - $ 16.70
76080 X-ray exam of fistula A 1 XXX $ - $ 58.46
76080 26 X-ray exam of fistula A 1 XXX $ 27.49 $ 27.49
76080 TC X-ray exam of fistula A 1 XXX $ - $ 30.97
76098 X-ray exam breast specimen A 1 XXX $ - $ 18.44
76098 26 X-ray exam breast specimen A 1 XXX $ 8.35 $ 8.35
76098 TC X-ray exam breast specimen A 1 XXX $ - $ 10.09
76100 X-ray exam of body section A 1 XXX $ - $ 104.40
76100 26 X-ray exam of body section A 1 XXX $ 33.41 $ 33.41
76100 TC X-ray exam of body section A 1 XXX $ - $ 71.34
76101 Complex body section x-ray A 1 XXX $ - $ 152.42
76101 26 Complex body section x-ray A 1 XXX $ 38.63 $ 38.63
76101 TC Complex body section x-ray A 1 XXX $ - $ 113.45
76102 Complex body section x-rays A 1 XXX $ - $ 203.58
76102 26 Complex body section x-rays A 1 XXX $ 40.72 $ 40.72
76102 TC Complex body section x-rays A 1 XXX $ - $ 162.86

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
76120 Cine/video x-rays A 1 XXX $ - $ 71.34

76120 26 Cine/video x-rays A 1 XXX $ 20.18 $ 20.18
76120 TC Cine/video x-rays A 1 XXX $ - $ 51.16
76125 Cine/video x-rays add-on C 1 ZZZ $ - $ -
76125 26 Cine/video x-rays add-on A 1 ZZZ $ 16.01 $ 16.01
76125 TC Cine/video x-rays add-on C 1 ZZZ $ - $ -
76140 X-ray consultation I 9 XXX $ - $ -
76376 3d render w/o postprocess A 1 XXX $ - $ 59.16
76376 26 3d render w/o postprocess A 1 XXX $ 10.09 $ 10.09
76376 TC 3d render w/o postprocess A 1 XXX $ - $ 49.07
76377 3d rendering w/postprocess A 1 XXX $ - $ 82.13
76377 26 3d rendering w/postprocess A 1 XXX $ 39.67 $ 39.67
76377 TC 3d rendering w/postprocess A 1 XXX $ - $ 42.46
76380 CAT scan follow-up study A 1 XXX $ - $ 162.17
76380 26 CAT scan follow-up study A 1 XXX $ 48.37 $ 48.37
76380 TC CAT scan follow-up study A 1 XXX $ - $ 113.80
76390 Mr spectroscopy N 1 XXX $ - $ 422.47
76390 26 Mr spectroscopy N 1 XXX $ 69.25 $ 69.25
76390 TC Mr spectroscopy N 1 XXX $ - $ 353.22
76496 Fluoroscopic procedure C 1 XXX $ - $ -
76496 26 Fluoroscopic procedure C 1 XXX $ - $ -
76496 TC Fluoroscopic procedure C 1 XXX $ 109.97 $ 109.97
76497 Ct procedure C 1 XXX $ - $ -
76497 26 Ct procedure C 1 XXX $ - $ -
76497 TC Ct procedure C 1 XXX $ 138.16 $ 138.16
76498 Mri procedure C 1 XXX $ - $ -
76498 26 Mri procedure C 1 XXX $ - $ -
76498 TC Mri procedure C 1 XXX $ 437.78 $ 437.78

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
76499 Radiographic procedure C 1 XXX $ - $ -

76499 26 Radiographic procedure C 1 XXX $ - $ -
76499 TC Radiographic procedure C 1 XXX $ 58.12 $ 58.12
76506 Echo exam of head A 1 XXX $ 114.49 $ 114.14
76506 26 Echo exam of head A 1 XXX $ 32.71 $ 32.71
76506 TC Echo exam of head A 1 XXX $ 81.43 $ 81.43
76510 Ophth us b & quant a A 1 XXX $ - $ 176.78
76510 26 Ophth us b & quant a A 1 XXX $ 108.92 $ 108.92
76510 TC Ophth us b & quant a A 1 XXX $ - $ 67.86
76511 Ophth us quant a only A 1 XXX $ - $ 91.87
76511 26 Ophth us quant a only A 1 XXX $ 48.72 $ 48.72
76511 TC Ophth us quant a only A 1 XXX $ - $ 42.80
76512 Ophth us b w/non-quant a A 1 XXX $ - $ 87.35
76512 26 Ophth us b w/non-quant a A 1 XXX $ 52.20 $ 52.20
76512 TC Ophth us b w/non-quant a A 1 XXX $ - $ 35.15
76513 Echo exam of eye water bath A 1 XXX $ - $ 82.48
76513 26 Echo exam of eye water bath A 1 XXX $ 33.06 $ 33.06
76513 TC Echo exam of eye water bath A 1 XXX $ - $ 49.42
76514 Echo exam of eye thickness A 1 XXX $ - $ 14.96
76514 26 Echo exam of eye thickness A 1 XXX $ 9.74 $ 9.74
76514 TC Echo exam of eye thickness A 1 XXX $ - $ 5.22
76516 Echo exam of eye A 1 XXX $ - $ 68.21
76516 26 Echo exam of eye A 1 XXX $ 28.54 $ 28.54
76516 TC Echo exam of eye A 1 XXX $ - $ 39.67

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

76536 Us exam of head and neck A 1 XXX $ - $ 110.32
76536 26 Us exam of head and neck A 1 XXX $ 28.19 $ 28.19
76536 TC Us exam of head and neck A 1 XXX $ - $ 82.13
76604 Us exam chest A 1 XXX Y $ - $ 81.78
76604 26 Us exam chest A 1 XXX Y $ 27.49 $ 27.49
76604 TC Us exam chest A 1 XXX Y $ - $ 54.29
76645 Us exam breast(s) A 1 XXX $ - $ 90.83
76645 26 Us exam breast(s) A 1 XXX $ 28.54 $ 28.54
76645 TC Us exam breast(s) A 1 XXX $ - $ 62.29
76700 Us exam abdom complete A 1 XXX Y $ - $ 129.80
76700 26 Us exam abdom complete A 1 XXX Y $ 40.72 $ 40.72
76700 TC Us exam abdom complete A 1 XXX Y $ - $ 89.09
76705 Echo exam of abdomen A 1 XXX Y $ - $ 99.18
76705 26 Echo exam of abdomen A 1 XXX Y $ 29.58 $ 29.58
76705 TC Echo exam of abdomen A 1 XXX Y $ - $ 69.60
76770 Us exam abdo back wall comp A 1 XXX Y $ - $ 123.19
76770 26 Us exam abdo back wall comp A 1 XXX Y $ 37.58 $ 37.58
76770 TC Us exam abdo back wall comp A 1 XXX Y $ - $ 85.61
76775 Us exam abdo back wall lim A 1 XXX Y $ - $ 101.27
76775 26 Us exam abdo back wall lim A 1 XXX Y $ 29.23 $ 29.23
76775 TC Us exam abdo back wall lim A 1 XXX Y $ - $ 72.04
76776 Us exam k transpl w/doppler A 1 XXX Y $ - $ 140.24
76776 26 Us exam k transpl w/doppler A 1 XXX Y $ 38.28 $ 38.28
76776 TC Us exam k transpl w/doppler A 1 XXX Y $ - $ 101.96
76800 Us exam spinal canal A 1 XXX $ - $ 123.19
76800 26 Us exam spinal canal A 1 XXX $ 54.64 $ 54.64

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
76800 TC Us exam spinal canal A 1 XXX $ - $ 68.56

76801 Ob us < 14 wks single fetus A 1 XXX $ - $ 119.71
76801 26 Ob us < 14 wks single fetus A 1 XXX $ 48.02 $ 48.02
76801 TC Ob us < 14 wks single fetus A 1 XXX $ - $ 71.34
76802 Ob us < 14 wks addl fetus A 1 ZZZ $ - $ 66.12
76802 26 Ob us < 14 wks addl fetus A 1 ZZZ $ 40.72 $ 40.72
76802 TC Ob us < 14 wks addl fetus A 1 ZZZ $ - $ 25.40
76805 Ob us >/= 14 wks sngl fetus A 1 XXX $ - $ 137.11
76805 26 Ob us >/= 14 wks sngl fetus A 1 XXX $ 48.02 $ 48.02
76805 TC Ob us >/= 14 wks sngl fetus A 1 XXX $ - $ 89.09
76810 Ob us >/= 14 wks addl fetus A 1 ZZZ $ - $ 92.57
76810 26 Ob us >/= 14 wks addl fetus A 1 ZZZ $ 47.68 $ 47.68
76810 TC Ob us >/= 14 wks addl fetus A 1 ZZZ $ - $ 44.54
76811 Ob us detailed sngl fetus A 1 XXX $ - $ 177.83
76811 26 Ob us detailed sngl fetus A 1 XXX $ 92.92 $ 92.92
76811 TC Ob us detailed sngl fetus A 1 XXX $ - $ 84.91
76812 Ob us detailed addl fetus A 1 ZZZ $ 174.00 $ 174.00
76812 26 Ob us detailed addl fetus A 1 ZZZ $ 87.00 $ 87.00
76812 TC Ob us detailed addl fetus A 1 ZZZ $ 81.43 $ 81.43
76813 Ob us nuchal meas 1 gest A 1 XXX $ - $ 118.32
76813 26 Ob us nuchal meas 1 gest A 1 XXX $ 58.12 $ 58.12
76813 TC Ob us nuchal meas 1 gest A 1 XXX $ - $ 59.86
76814 Ob us nuchal meas add-on A 1 XXX $ - $ 77.95
76814 26 Ob us nuchal meas add-on A 1 XXX $ 48.72 $ 48.72
76814 TC Ob us nuchal meas add-on A 1 XXX $ - $ 29.23
76815 Ob us limited fetus(s) A 1 XXX $ - $ 83.87
76815 26 Ob us limited fetus(s) A 1 XXX $ 30.28 $ 30.28
76815 TC Ob us limited fetus(s) A 1 XXX $ - $ 53.24

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
76816 Ob us follow-up per fetus A 1 XXX $ - $ 110.66

76816 26 Ob us follow-up per fetus A 1 XXX $ 42.46 $ 42.46
76816 TC Ob us follow-up per fetus A 1 XXX $ - $ 68.21
76817 Transvaginal us obstetric A 1 XXX $ - $ 96.05
76817 26 Transvaginal us obstetric A 1 XXX $ 37.24 $ 37.24
76817 TC Transvaginal us obstetric A 1 XXX $ - $ 58.81
76818 Fetal biophys profile w/nst A 1 XXX $ - $ 114.84
76818 26 Fetal biophys profile w/nst A 1 XXX $ 51.50 $ 51.50
76818 TC Fetal biophys profile w/nst A 1 XXX $ - $ 62.99
76819 Fetal biophys profil w/o nst A 1 XXX $ - $ 85.61
76819 26 Fetal biophys profil w/o nst A 1 XXX $ 38.63 $ 38.63
76819 TC Fetal biophys profil w/o nst A 1 XXX $ - $ 47.33
76820 Umbilical artery echo A 1 XXX $ - $ 41.41
76820 26 Umbilical artery echo A 1 XXX $ 24.01 $ 24.01
76820 TC Umbilical artery echo A 1 XXX $ - $ 17.75
76821 Middle cerebral artery echo A 1 XXX $ - $ 90.83
76821 26 Middle cerebral artery echo A 1 XXX $ 35.50 $ 35.50
76821 TC Middle cerebral artery echo A 1 XXX $ - $ 55.33
76825 Echo exam of fetal heart A 1 XXX $ - $ 201.84
76825 26 Echo exam of fetal heart A 1 XXX $ 80.39 $ 80.39
76825 TC Echo exam of fetal heart A 1 XXX $ - $ 121.45

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

76830 Transvaginal us non-ob A 1 XXX $ - $ 115.88
76830 26 Transvaginal us non-ob A 1 XXX $ 34.45 $ 34.45
76830 TC Transvaginal us non-ob A 1 XXX $ - $ 81.43
76831 Echo exam uterus A 1 XXX Y $ - $ 117.28
76831 26 Echo exam uterus A 1 XXX Y $ 36.19 $ 36.19
76831 TC Echo exam uterus A 1 XXX Y $ - $ 81.08
76856 Us exam pelvic complete A 1 XXX Y $ - $ 114.84
76856 26 Us exam pelvic complete A 1 XXX Y $ 34.10 $ 34.10
76856 TC Us exam pelvic complete A 1 XXX Y $ - $ 80.74
76857 Us exam pelvic limited A 1 XXX Y $ - $ 91.18
76857 26 Us exam pelvic limited A 1 XXX Y $ 20.53 $ 20.53
76857 TC Us exam pelvic limited A 1 XXX Y $ - $ 70.64
76870 Us exam scrotum A 1 XXX Y $ - $ 114.84
76870 26 Us exam scrotum A 1 XXX Y $ 33.06 $ 33.06
76870 TC Us exam scrotum A 1 XXX Y $ - $ 81.78
76872 Us transrectal A 1 XXX $ - $ 125.28
76872 26 Us transrectal A 1 XXX $ 35.50 $ 35.50
76872 TC Us transrectal A 1 XXX $ - $ 89.78
76873 Echograp trans r pros study A 1 XXX $ - $ 164.60
76873 26 Echograp trans r pros study A 1 XXX $ 78.65 $ 78.65
76873 TC Echograp trans r pros study A 1 XXX $ - $ 85.96
76881 Us xtr non-vasc complete A 1 XXX $ - $ 111.71
76881 26 Us xtr non-vasc complete A 1 XXX $ 32.02 $ 32.02
76881 TC Us xtr non-vasc complete A 1 XXX $ - $ 79.69
76882 Us xtr non-vasc lmtd A 1 XXX $ - $ 36.19
76882 26 Us xtr non-vasc lmtd A 1 XXX $ 26.10 $ 26.10

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
76882 TC Us xtr non-vasc lmtd A 1 XXX $ - $ 10.09

76885 Us exam infant hips dynamic A 1 XXX $ 120.06 $ 120.06
76885 26 Us exam infant hips dynamic A 1 XXX $ 37.93 $ 37.93
76885 TC Us exam infant hips dynamic A 1 XXX $ 81.43 $ 81.43
76886 Us exam infant hips static A 1 XXX $ - $ 94.66
76886 26 Us exam infant hips static A 1 XXX $ 28.54 $ 28.54
76886 TC Us exam infant hips static A 1 XXX $ - $ 66.12
76930 Echo guide cardiocentesis A 1 XXX $ - $ 79.00
76930 26 Echo guide cardiocentesis A 1 XXX $ 31.67 $ 31.67
76930 TC Echo guide cardiocentesis A 1 XXX $ - $ 47.33
76932 Echo guide for heart biopsy C 1 XXX $ - $ -
76932 26 Echo guide for heart biopsy A 1 XXX $ 35.15 $ 35.15
76932 TC Echo guide for heart biopsy C 1 XXX $ - $ -
76936 Echo guide for artery repair A 1 XXX $ 245.34 $ 245.34
76936 26 Echo guide for artery repair A 1 XXX $ 113.45 $ 113.45
76936 TC Echo guide for artery repair A 1 XXX $ 138.16 $ 138.16
76937 Us guide vascular access A 1 ZZZ $ - $ 34.80
76937 26 Us guide vascular access A 1 ZZZ $ 16.70 $ 16.70
76937 TC Us guide vascular access A 1 ZZZ $ - $ 18.10
76940 Us guide tissue ablation C 1 XXX $ - $ -
76940 26 Us guide tissue ablation A 1 XXX $ 122.50 $ 122.50
76940 TC Us guide tissue ablation C 1 XXX $ - $ -
76941 Echo guide for transfusion C 1 XXX $ - $ -
76941 26 Echo guide for transfusion A 1 XXX $ 72.04 $ 72.04
76941 TC Echo guide for transfusion C 1 XXX $ - $ -
76942 Echo guide for biopsy A 1 XXX $ - $ 182.35
76942 26 Echo guide for biopsy A 1 XXX $ 34.45 $ 34.45
76942 TC Echo guide for biopsy A 1 XXX $ - $ 147.90

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
76945 Echo guide villus sampling C 1 XXX $ - $ -

76945 26 Echo guide villus sampling A 1 XXX $ 35.50 $ 35.50
76945 TC Echo guide villus sampling C 1 XXX $ - $ -
76946 Echo guide for amniocentesis A 1 XXX $ - $ 33.41
76946 26 Echo guide for amniocentesis A 1 XXX $ 18.44 $ 18.44
76946 TC Echo guide for amniocentesis A 1 XXX $ - $ 14.96
76948 Echo guide ova aspiration A 1 XXX $ - $ 35.84
76948 26 Echo guide ova aspiration A 1 XXX $ 20.88 $ 20.88
76948 TC Echo guide ova aspiration A 1 XXX $ - $ 14.96
76950 Echo guidance radiotherapy A 1 XXX $ - $ 52.90
76950 26 Echo guidance radiotherapy A 1 XXX $ 29.58 $ 29.58
76950 TC Echo guidance radiotherapy A 1 XXX $ - $ 23.32
76965 Echo guidance radiotherapy A 1 XXX $ - $ 101.62
76965 26 Echo guidance radiotherapy A 1 XXX $ 69.25 $ 69.25
76965 TC Echo guidance radiotherapy A 1 XXX $ - $ 32.36
76970 Ultrasound exam follow-up A 1 XXX $ - $ 93.61
76970 26 Ultrasound exam follow-up A 1 XXX $ 22.27 $ 22.27
76970 TC Ultrasound exam follow-up A 1 XXX $ - $ 71.34
76975 GI endoscopic ultrasound C 1 XXX $ 242.21 $ 242.21
76975 26 GI endoscopic ultrasound A 1 XXX $ 47.33 $ 47.33
76975 TC GI endoscopic ultrasound C 1 XXX $ 196.27 $ 196.27
76977 Us bone density measure A 1 XXX $ - $ 9.40
76977 26 Us bone density measure A 1 XXX $ 3.48 $ 3.48
76977 TC Us bone density measure A 1 XXX $ - $ 5.92
76998 Us guide intraop C 1 XXX $ - $ -
76998 26 Us guide intraop A 1 XXX $ 83.17 $ 83.17
76998 TC Us guide intraop C 1 XXX $ - $ -
76999 Echo examination procedure C 1 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
76999 26 Echo examination procedure C 1 XXX $ - $ -

76999 TC Echo examination procedure C 1 XXX $ - $ -
77001 Fluoroguide for vein device A 1 ZZZ $ - $ 106.49
77001 26 Fluoroguide for vein device A 1 ZZZ $ 20.18 $ 20.18
77001 TC Fluoroguide for vein device A 1 ZZZ $ - $ 86.30
77002 Needle localization by xray A 1 XXX $ - $ 72.38
77002 26 Needle localization by xray A 1 XXX $ 28.19 $ 28.19
77002 TC Needle localization by xray A 1 XXX $ - $ 44.20
77003 Fluoroguide for spine inject A 1 XXX $ - $ 60.90
77003 26 Fluoroguide for spine inject A 1 XXX $ 30.62 $ 30.62
77003 TC Fluoroguide for spine inject A 1 XXX $ - $ 30.28
77011 Ct scan for localization A 1 XXX $ - $ 315.64
77011 26 Ct scan for localization A 1 XXX $ 59.86 $ 59.86
77011 TC Ct scan for localization A 1 XXX $ - $ 255.78
77012 Ct scan for needle biopsy A 1 XXX $ - $ 134.33
77012 26 Ct scan for needle biopsy A 1 XXX $ 56.03 $ 56.03
77012 TC Ct scan for needle biopsy A 1 XXX $ - $ 78.30
77013 Ct guide for tissue ablation C 1 XXX $ - $ -
77013 26 Ct guide for tissue ablation A 1 XXX $ 219.24 $ 219.24
77013 TC Ct guide for tissue ablation C 1 XXX $ - $ -
77014 Ct scan for therapy guide A 1 XXX $ - $ 129.80
77014 26 Ct scan for therapy guide A 1 XXX $ 42.80 $ 42.80
77014 TC Ct scan for therapy guide A 1 XXX $ - $ 87.00
77021 Mr guidance for needle place A 1 XXX $ - $ 371.32
77021 26 Mr guidance for needle place A 1 XXX $ 80.39 $ 80.39
77021 TC Mr guidance for needle place A 1 XXX $ - $ 290.93
77022 Mri for tissue ablation C 1 XXX $ - $ -
77022 26 Mri for tissue ablation A 1 XXX $ 229.68 $ 229.68

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
77022 TC Mri for tissue ablation C 1 XXX $ - $ -

77031 Stereotact guide for brst bx A 1 XXX $ - $ 142.33
77031 26 Stereotact guide for brst bx A 1 XXX $ 84.56 $ 84.56
77031 TC Stereotact guide for brst bx A 1 XXX $ - $ 57.77
77032 Guidance for needle breast A 1 XXX $ - $ 51.85
77032 26 Guidance for needle breast A 1 XXX $ 28.19 $ 28.19
77032 TC Guidance for needle breast A 1 XXX $ - $ 23.66
77051 Computer dx mammogram add-on A 1 ZZZ $ - $ 11.14
77051 26 Computer dx mammogram add-on A 1 ZZZ $ 3.83 $ 3.83
77051 TC Computer dx mammogram add-on A 1 ZZZ $ - $ 7.66
77052 Comp screen mammogram add-on A 1 ZZZ $ - $ 11.14
77052 26 Comp screen mammogram add-on A 1 ZZZ $ 3.83 $ 3.83
77052 TC Comp screen mammogram add-on A 1 ZZZ $ - $ 7.66
77053 X-ray of mammary duct A 1 XXX $ - $ 57.42
77053 26 X-ray of mammary duct A 1 XXX $ 17.05 $ 17.05
77053 TC X-ray of mammary duct A 1 XXX $ - $ 40.37
77054 X-ray of mammary ducts A 1 XXX $ - $ 79.00
77054 26 X-ray of mammary ducts A 1 XXX $ 23.32 $ 23.32
77054 TC X-ray of mammary ducts A 1 XXX $ - $ 55.68
77055 Mammogram one breast A 1 XXX $ - $ 82.13
77055 26 Mammogram one breast A 1 XXX $ 35.84 $ 35.84
77055 TC Mammogram one breast A 1 XXX $ - $ 45.94
77056 Mammogram both breasts A 1 XXX $ - $ 104.40
77056 26 Mammogram both breasts A 1 XXX $ 44.54 $ 44.54
77056 TC Mammogram both breasts A 1 XXX $ - $ 59.86
77057 Mammogram screening A 1 XXX $ - $ 76.56
77057 26 Mammogram screening A 1 XXX $ 35.84 $ 35.84
77057 TC Mammogram screening A 1 XXX $ - $ 40.72

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
77058 Mri one breast A 1 XXX Y $ - $ 612.13

77058 26 Mri one breast A 1 XXX Y $ 83.52 $ 83.52
77058 TC Mri one breast A 1 XXX Y $ - $ 528.61
77059 Mri both breasts A 1 XXX Y $ - $ 623.62
77059 26 Mri both breasts A 1 XXX Y $ 83.52 $ 83.52
77059 TC Mri both breasts A 1 XXX Y $ - $ 540.44
77071 X-ray stress view A 2 XXX $ 50.81 $ 50.81
77072 X-rays for bone age A 1 XXX $ - $ 22.62
77072 26 X-rays for bone age A 1 XXX $ 9.40 $ 9.40
77072 TC X-rays for bone age A 1 XXX $ - $ 12.88
77073 X-rays bone length studies A 1 XXX $ - $ 38.98
77073 26 X-rays bone length studies A 1 XXX $ 17.05 $ 17.05
77073 TC X-rays bone length studies A 1 XXX $ - $ 21.92
77074 X-rays bone survey limited A 1 XXX $ - $ 65.42
77074 26 X-rays bone survey limited A 1 XXX $ 23.32 $ 23.32
77074 TC X-rays bone survey limited A 1 XXX $ - $ 42.11
77075 X-rays bone survey complete A 1 XXX $ - $ 95.70
77075 26 X-rays bone survey complete A 1 XXX $ 27.49 $ 27.49
77075 TC X-rays bone survey complete A 1 XXX $ - $ 67.86
77076 X-rays bone survey infant A 1 XXX $ - $ 100.57
77076 26 X-rays bone survey infant A 1 XXX $ 35.84 $ 35.84
77076 TC X-rays bone survey infant A 1 XXX $ - $ 64.38
77077 Joint survey single view A 1 XXX $ - $ 41.76
77077 26 Joint survey single view A 1 XXX $ 19.14 $ 19.14
77077 TC Joint survey single view A 1 XXX $ - $ 22.62
77078 Ct bone density axial A 1 XXX $ 105.10 $ 105.10
77078 26 Ct bone density axial A 1 XXX $ 12.18 $ 12.18
77078 TC Ct bone density axial A 1 XXX $ 92.57 $ 92.57

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
77080 Dxa bone density axial A 1 XXX $ - $ 50.81

77080 26 Dxa bone density axial A 1 XXX $ 10.09 $ 10.09
77080 TC Dxa bone density axial A 1 XXX $ - $ 40.72
77081 Dxa bone density/peripheral A 1 XXX $ - $ 27.14
77081 26 Dxa bone density/peripheral A 1 XXX $ 11.14 $ 11.14
77081 TC Dxa bone density/peripheral A 1 XXX $ - $ 16.01
77082 Dxa bone density vert fx A 1 XXX $ - $ 27.14
77082 26 Dxa bone density vert fx A 1 XXX $ 8.70 $ 8.70
77082 TC Dxa bone density vert fx A 1 XXX $ - $ 18.10
77084 Magnetic image bone marrow A 1 XXX $ - $ 433.26
77084 26 Magnetic image bone marrow A 1 XXX $ 82.48 $ 82.48
77084 TC Magnetic image bone marrow A 1 XXX $ - $ 351.13
77261 Radiation therapy planning A 2 XXX $ 75.52 $ 75.52
77280 Set radiation therapy field A 1 XXX $ - $ 165.65
77280 26 Set radiation therapy field A 1 XXX $ 35.15 $ 35.15
77280 TC Set radiation therapy field A 1 XXX $ - $ 130.50
77299 Radiation therapy planning C 1 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
77299 26 Radiation therapy planning C 1 XXX $ - $ -

77299 TC Radiation therapy planning C 1 XXX $ - $ -
77300 Radiation therapy dose plan A 1 XXX $ - $ 63.68
77300 26 Radiation therapy dose plan A 1 XXX $ 31.32 $ 31.32
77300 TC Radiation therapy dose plan A 1 XXX $ - $ 32.36
77301 Radiotherapy dose plan imrt A 1 XXX $ - $ 1,772.36
77301 26 Radiotherapy dose plan imrt A 1 XXX $ 406.46 $ 406.46
77301 TC Radiotherapy dose plan imrt A 1 XXX $ - $ 1,365.90
77305 Teletx isodose plan simple A 1 XXX $ - $ 59.51
77305 26 Teletx isodose plan simple A 1 XXX $ 35.15 $ 35.15
77305 TC Teletx isodose plan simple A 1 XXX $ - $ 24.36
77310 Teletx isodose plan intermed A 1 XXX $ - $ 85.26
77310 26 Teletx isodose plan intermed A 1 XXX $ 52.90 $ 52.90
77310 TC Teletx isodose plan intermed A 1 XXX $ - $ 32.36
77315 Teletx isodose plan complex A 1 XXX $ - $ 130.50
77315 26 Teletx isodose plan complex A 1 XXX $ 78.30 $ 78.30
77315 TC Teletx isodose plan complex A 1 XXX $ - $ 52.55
77321 Special teletx port plan A 1 XXX $ - $ 92.22
77321 26 Special teletx port plan A 1 XXX $ 47.33 $ 47.33
77321 TC Special teletx port plan A 1 XXX $ - $ 44.54
77326 Brachytx isodose calc simp A 1 XXX $ - $ 132.24
77326 26 Brachytx isodose calc simp A 1 XXX $ 46.28 $ 46.28
77326 TC Brachytx isodose calc simp A 1 XXX $ - $ 85.96
77327 Brachytx isodose calc interm A 1 XXX $ - $ 186.53
77327 26 Brachytx isodose calc interm A 1 XXX $ 70.64 $ 70.64
77327 TC Brachytx isodose calc interm A 1 XXX $ - $ 116.23
77328 Brachytx isodose plan compl A 1 XXX $ - $ 251.95
77328 26 Brachytx isodose plan compl A 1 XXX $ 105.44 $ 105.44

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
77328 TC Brachytx isodose plan compl A 1 XXX $ - $ 146.51

77331 Special radiation dosimetry A 1 XXX $ - $ 60.90
77331 26 Special radiation dosimetry A 1 XXX $ 43.85 $ 43.85
77331 TC Special radiation dosimetry A 1 XXX $ - $ 17.05
77332 Radiation treatment aid(s) A 1 XXX $ - $ 71.34
77332 26 Radiation treatment aid(s) A 1 XXX $ 27.49 $ 27.49
77332 TC Radiation treatment aid(s) A 1 XXX $ - $ 43.85
77336 Radiation physics consult A 3 XXX $ - $ 40.37
77338 Design mlc device for imrt A 1 XXX $ - $ 459.71
77338 26 Design mlc device for imrt A 1 XXX $ 218.54 $ 218.54
77338 TC Design mlc device for imrt A 1 XXX $ - $ 241.16
77370 Radiation physics consult A 3 XXX $ - $ 99.53
77371 Srs multisource C 3 XXX $ - $ -
77372 Srs linear based A 3 XXX $ - $ 713.40
77373 Sbrt delivery A 3 XXX $ - $ 1,357.20
77399 External radiation dosimetry C 1 XXX $ - $ -
77399 26 External radiation dosimetry C 1 XXX $ - $ -
77399 TC External radiation dosimetry C 1 XXX $ - $ -
77401 Radiation treatment delivery A 3 XXX $ - $ 19.49

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

77417 Radiology port film(s) A 3 XXX $ - $ 12.88
77418 Radiation tx delivery imrt A 3 XXX $ - $ 403.68
77421 Stereoscopic x-ray guidance A 1 XXX $ - $ 76.91
77421 26 Stereoscopic x-ray guidance A 1 XXX $ 18.44 $ 18.44
77421 TC Stereoscopic x-ray guidance A 1 XXX $ - $ 58.12
77422 Neutron beam tx simple A 3 XXX $ - $ 215.06
77423 Neutron beam tx complex A 3 XXX $ - $ 222.37
77424 Io rad tx delivery by x-ray X 9 XXX $ - $ -
77425 Io rad tx deliver by elctrns X 9 XXX $ - $ -
77427 Radiation tx management x5 A 2 XXX $ 188.96 $ 188.96
77431 Radiation therapy management A 2 XXX $ 103.01 $ 103.01
77432 Stereotactic radiation trmt A 2 XXX $ 432.22 $ 432.22
77435 Sbrt management A 2 XXX $ 649.37 $ 657.02
77469 Io radiation tx management A 0 XXX $ 319.46 $ -
77470 Special radiation treatment A 1 XXX $ - $ 166.34
77470 26 Special radiation treatment A 1 XXX $ 105.44 $ 105.44
77470 TC Special radiation treatment A 1 XXX $ - $ 60.90
77499 Radiation therapy management C 1 XXX $ - $ -
77499 26 Radiation therapy management C 1 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
77499 TC Radiation therapy management C 1 XXX $ - $ -

77520 Proton trmt simple w/o comp C 3 XXX $ - $ -
77522 Proton trmt simple w/comp C 3 XXX $ - $ -
77523 Proton trmt intermediate C 3 XXX $ - $ -
77525 Proton treatment complex C 3 XXX $ - $ -
77600 Hyperthermia treatment N 1 XXX $ - $ 368.53
77600 26 Hyperthermia treatment N 1 XXX $ 78.30 $ 78.30
77600 TC Hyperthermia treatment N 1 XXX $ - $ 290.58
77750 Infuse radioactive materials A 1 090 $ - $ 345.22
77750 26 Infuse radioactive materials A 1 090 $ 254.74 $ 254.74
77750 TC Infuse radioactive materials A 1 090 $ - $ 90.48
77761 Apply intrcav radiat simple A 1 090 $ - $ 350.78
77761 26 Apply intrcav radiat simple A 1 090 $ 195.23 $ 195.23
77761 TC Apply intrcav radiat simple A 1 090 $ - $ 155.21
77762 Apply intrcav radiat interm A 1 090 $ - $ 472.93
77762 26 Apply intrcav radiat interm A 1 090 $ 293.36 $ 293.36

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
77762 TC Apply intrcav radiat interm A 1 090 $ - $ 179.57

77763 Apply intrcav radiat compl A 1 090 $ - $ 673.38
77763 26 Apply intrcav radiat compl A 1 090 $ 439.52 $ 439.52
77763 TC Apply intrcav radiat compl A 1 090 $ - $ 233.86
77776 Apply interstit radiat simpl A 1 090 $ - $ 406.46
77776 26 Apply interstit radiat simpl A 1 090 Y $ 246.73 $ 246.73
77776 TC Apply interstit radiat simpl A 1 090 $ - $ 159.73
77777 Apply interstit radiat inter A 1 090 $ - $ 562.02
77777 26 Apply interstit radiat inter A 1 090 Y $ 396.02 $ 396.02
77777 TC Apply interstit radiat inter A 1 090 $ - $ 166.00
77778 Apply interstit radiat compl A 1 090 $ - $ 816.76
77778 26 Apply interstit radiat compl A 1 090 Y $ 576.98 $ 576.98
77778 TC Apply interstit radiat compl A 1 090 $ - $ 240.12
77785 Hdr brachytx 1 channel A 1 XXX $ - $ 212.98
77785 26 Hdr brachytx 1 channel A 1 XXX $ 72.04 $ 72.04
77785 TC Hdr brachytx 1 channel A 1 XXX $ - $ 140.94
77786 Hdr brachytx 2-12 channel A 1 XXX $ - $ 508.78
77786 26 Hdr brachytx 2-12 channel A 1 XXX $ 163.91 $ 163.91
77786 TC Hdr brachytx 2-12 channel A 1 XXX $ - $ 344.87
77787 Hdr brachytx over 12 chan A 1 XXX $ - $ 840.77
77787 26 Hdr brachytx over 12 chan A 1 XXX $ 250.56 $ 250.56
77787 TC Hdr brachytx over 12 chan A 1 XXX $ - $ 590.21
77789 Apply surface radiation A 1 000 $ - $ 105.10
77789 26 Apply surface radiation A 1 000 $ 57.07 $ 57.07
77789 TC Apply surface radiation A 1 000 $ - $ 47.68
77790 Radiation handling A 1 XXX $ - $ 86.30
77790 26 Radiation handling A 1 XXX $ 51.50 $ 51.50
77790 TC Radiation handling A 1 XXX $ - $ 34.45

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
77799 Radium/radioisotope therapy C 1 XXX $ - $ -

77799 26 Radium/radioisotope therapy C 1 XXX $ - $ -
77799 TC Radium/radioisotope therapy C 1 XXX $ - $ -
78000 Thyroid single uptake A 1 XXX $ - $ 65.77
78000 26 Thyroid single uptake A 1 XXX $ 9.40 $ 9.40
78000 TC Thyroid single uptake A 1 XXX $ - $ 56.03
78001 Thyroid multiple uptakes A 1 XXX $ - $ 84.91
78001 26 Thyroid multiple uptakes A 1 XXX $ 12.88 $ 12.88
78001 TC Thyroid multiple uptakes A 1 XXX $ - $ 72.38
78003 Thyroid suppress/stimul A 1 XXX $ - $ 73.43
78003 26 Thyroid suppress/stimul A 1 XXX $ 15.66 $ 15.66
78003 TC Thyroid suppress/stimul A 1 XXX $ - $ 57.77
78006 Thyroid imaging with uptake A 1 XXX $ - $ 216.11
78006 26 Thyroid imaging with uptake A 1 XXX $ 25.06 $ 25.06
78006 TC Thyroid imaging with uptake A 1 XXX $ - $ 191.05
78007 Thyroid image mult uptakes A 1 XXX $ - $ 205.67
78007 26 Thyroid image mult uptakes A 1 XXX $ 25.40 $ 25.40
78007 TC Thyroid image mult uptakes A 1 XXX $ - $ 180.26
78010 Thyroid imaging A 1 XXX $ - $ 149.99
78010 26 Thyroid imaging A 1 XXX $ 18.10 $ 18.10
78010 TC Thyroid imaging A 1 XXX $ - $ 131.54
78011 Thyroid imaging with flow A 1 XXX $ - $ 162.17
78011 26 Thyroid imaging with flow A 1 XXX $ 23.32 $ 23.32
78011 TC Thyroid imaging with flow A 1 XXX $ - $ 138.50
78015 Thyroid met imaging A 1 XXX $ - $ 196.97
78015 26 Thyroid met imaging A 1 XXX $ 33.76 $ 33.76
78015 TC Thyroid met imaging A 1 XXX $ - $ 163.21
78016 Thyroid met imaging/studies A 1 XXX $ - $ 265.87

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
78016 26 Thyroid met imaging/studies A 1 XXX $ 36.54 $ 36.54

78016 TC Thyroid met imaging/studies A 1 XXX $ - $ 228.98
78018 Thyroid met imaging body A 1 XXX $ - $ 283.62
78018 26 Thyroid met imaging body A 1 XXX $ 41.76 $ 41.76
78018 TC Thyroid met imaging body A 1 XXX $ - $ 241.86
78020 Thyroid met uptake A 1 ZZZ $ - $ 78.30
78020 26 Thyroid met uptake A 1 ZZZ $ 28.88 $ 28.88
78020 TC Thyroid met uptake A 1 ZZZ $ - $ 49.42
78070 Parathyroid nuclear imaging A 1 XXX $ - $ 146.51
78070 26 Parathyroid nuclear imaging A 1 XXX $ 40.37 $ 40.37
78070 TC Parathyroid nuclear imaging A 1 XXX $ - $ 106.14
78075 Adrenal nuclear imaging A 1 XXX $ - $ 377.23
78075 26 Adrenal nuclear imaging A 1 XXX $ 36.19 $ 36.19
78075 TC Adrenal nuclear imaging A 1 XXX $ - $ 341.04
78099 Endocrine nuclear procedure C 1 XXX $ - $ -
78099 26 Endocrine nuclear procedure C 1 XXX $ - $ -
78099 TC Endocrine nuclear procedure C 1 XXX $ - $ -
78102 Bone marrow imaging ltd A 1 XXX $ - $ 152.42
78102 26 Bone marrow imaging ltd A 1 XXX $ 27.49 $ 27.49
78102 TC Bone marrow imaging ltd A 1 XXX $ - $ 124.93
78103 Bone marrow imaging mult A 1 XXX $ - $ 200.45
78103 26 Bone marrow imaging mult A 1 XXX $ 36.89 $ 36.89
78103 TC Bone marrow imaging mult A 1 XXX $ - $ 163.21
78104 Bone marrow imaging body A 1 XXX $ - $ 223.42
78104 26 Bone marrow imaging body A 1 XXX $ 39.32 $ 39.32
78104 TC Bone marrow imaging body A 1 XXX $ - $ 183.74
78110 Plasma volume single A 1 XXX $ - $ 77.26
78110 26 Plasma volume single A 1 XXX $ 9.40 $ 9.40

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
78110 TC Plasma volume single A 1 XXX $ - $ 67.86

78111 Plasma volume multiple A 1 XXX $ - $ 75.86
78111 26 Plasma volume multiple A 1 XXX $ 10.09 $ 10.09
78111 TC Plasma volume multiple A 1 XXX $ - $ 65.77
78120 Red cell mass single A 1 XXX $ - $ 79.69
78120 26 Red cell mass single A 1 XXX $ 11.48 $ 11.48
78120 TC Red cell mass single A 1 XXX $ - $ 68.21
78121 Red cell mass multiple A 1 XXX $ - $ 89.09
78121 26 Red cell mass multiple A 1 XXX $ 15.31 $ 15.31
78121 TC Red cell mass multiple A 1 XXX $ - $ 73.78
78122 Blood volume A 1 XXX $ - $ 93.26
78122 26 Blood volume A 1 XXX $ 20.18 $ 20.18
78122 TC Blood volume A 1 XXX $ - $ 73.08
78130 Red cell survival study A 1 XXX $ - $ 142.68
78130 26 Red cell survival study A 1 XXX $ 31.67 $ 31.67
78130 TC Red cell survival study A 1 XXX $ - $ 111.01
78135 Red cell survival kinetics A 1 XXX $ - $ 318.77
78135 26 Red cell survival kinetics A 1 XXX $ 33.41 $ 33.41
78135 TC Red cell survival kinetics A 1 XXX $ - $ 285.71
78140 Red cell sequestration A 1 XXX $ - $ 124.93
78140 26 Red cell sequestration A 1 XXX $ 31.67 $ 31.67
78140 TC Red cell sequestration A 1 XXX $ - $ 93.26
78185 Spleen imaging A 1 XXX $ - $ 184.44
78185 26 Spleen imaging A 1 XXX $ 18.79 $ 18.79
78185 TC Spleen imaging A 1 XXX $ - $ 165.65
78190 Platelet survival kinetics A 1 XXX $ 264.13 $ 264.13
78190 26 Platelet survival kinetics A 1 XXX $ 54.29 $ 54.29
78190 TC Platelet survival kinetics A 1 XXX $ 207.41 $ 207.41

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
78191 Platelet survival A 1 XXX $ - $ 152.42

78191 26 Platelet survival A 1 XXX $ 31.67 $ 31.67
78191 TC Platelet survival A 1 XXX $ - $ 120.76
78195 Lymph system imaging A 1 XXX $ - $ 322.60
78195 26 Lymph system imaging A 1 XXX $ 60.55 $ 60.55
78195 TC Lymph system imaging A 1 XXX $ - $ 262.04
78199 Blood/lymph nuclear exam C 1 XXX $ - $ -
78199 26 Blood/lymph nuclear exam C 1 XXX $ - $ -
78199 TC Blood/lymph nuclear exam C 1 XXX $ - $ -
78201 Liver imaging A 1 XXX $ - $ 167.39
78201 26 Liver imaging A 1 XXX $ 23.32 $ 23.32
78201 TC Liver imaging A 1 XXX $ - $ 144.07
78202 Liver imaging with flow A 1 XXX $ - $ 183.05
78202 26 Liver imaging with flow A 1 XXX $ 22.97 $ 22.97
78202 TC Liver imaging with flow A 1 XXX $ - $ 160.08
78205 Liver imaging (3D) A 1 XXX $ - $ 199.06
78205 26 Liver imaging (3D) A 1 XXX $ 35.50 $ 35.50
78205 TC Liver imaging (3D) A 1 XXX $ - $ 163.56
78206 Liver image (3d) with flow A 1 XXX $ - $ 309.37
78206 26 Liver image (3d) with flow A 1 XXX $ 46.63 $ 46.63
78206 TC Liver image (3d) with flow A 1 XXX $ - $ 262.74
78215 Liver and spleen imaging A 1 XXX $ - $ 174.70
78215 26 Liver and spleen imaging A 1 XXX $ 25.06 $ 25.06
78215 TC Liver and spleen imaging A 1 XXX $ - $ 149.64
78216 Liver & spleen image/flow A 1 XXX $ - $ 115.19
78216 26 Liver & spleen image/flow A 1 XXX $ 28.19 $ 28.19
78216 TC Liver & spleen image/flow A 1 XXX $ - $ 87.35
78226 Hepatobiliary system imaging A 1 XXX $ - $ 287.45

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
78226 26 Hepatobiliary system imaging A 1 XXX $ 36.54 $ 36.54

78226 TC Hepatobiliary system imaging A 1 XXX $ - $ 250.91
78227 Hepatobil syst image w/drug A 1 XXX $ 424.56 $ 391.85
78227 26 Hepatobil syst image w/drug A 1 XXX $ 43.50 $ 43.50
78227 TC Hepatobil syst image w/drug A 1 XXX $ 379.67 $ 348.35
78230 Salivary gland imaging A 1 XXX $ - $ 153.82
78230 26 Salivary gland imaging A 1 XXX $ 23.32 $ 23.32
78230 TC Salivary gland imaging A 1 XXX $ - $ 130.50
78231 Serial salivary imaging A 1 XXX $ - $ 114.14
78231 26 Serial salivary imaging A 1 XXX $ 24.36 $ 24.36
78231 TC Serial salivary imaging A 1 XXX $ - $ 89.78
78232 Salivary gland function exam A 1 XXX $ - $ 98.83
78232 26 Salivary gland function exam A 1 XXX $ 22.27 $ 22.27
78232 TC Salivary gland function exam A 1 XXX $ - $ 76.21
78258 Esophageal motility study A 1 XXX $ - $ 208.80
78258 26 Esophageal motility study A 1 XXX $ 36.19 $ 36.19
78258 TC Esophageal motility study A 1 XXX $ - $ 172.61
78261 Gastric mucosa imaging A 1 XXX $ - $ 226.90
78261 26 Gastric mucosa imaging A 1 XXX $ 35.15 $ 35.15
78261 TC Gastric mucosa imaging A 1 XXX $ - $ 191.75
78262 Gastroesophageal reflux exam A 1 XXX $ - $ 222.37
78262 26 Gastroesophageal reflux exam A 1 XXX $ 31.32 $ 31.32
78262 TC Gastroesophageal reflux exam A 1 XXX $ - $ 191.40
78264 Gastric emptying study A 1 XXX $ - $ 259.61
78264 26 Gastric emptying study A 1 XXX $ 39.67 $ 39.67
78264 TC Gastric emptying study A 1 XXX $ - $ 219.94
78267 Breath tst attain/anal c-14 X 9 XXX $ - $ -
78268 Breath test analysis c-14 X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
78270 Vit B-12 absorption exam A 1 XXX $ - $ 73.43

78270 26 Vit B-12 absorption exam A 1 XXX $ 10.09 $ 10.09
78270 TC Vit B-12 absorption exam A 1 XXX $ - $ 63.34
78271 Vit b-12 absrp exam int fac A 1 XXX $ - $ 78.65
78271 26 Vit b-12 absrp exam int fac A 1 XXX $ 10.09 $ 10.09
78271 TC Vit b-12 absrp exam int fac A 1 XXX $ - $ 68.56
78272 Vit b-12 absorp combined A 1 XXX $ - $ 82.13
78272 26 Vit b-12 absorp combined A 1 XXX $ 13.22 $ 13.22
78272 TC Vit b-12 absorp combined A 1 XXX $ - $ 68.90
78278 Acute GI blood loss imaging A 1 XXX $ - $ 312.85
78278 26 Acute GI blood loss imaging A 1 XXX $ 49.42 $ 49.42
78278 TC Acute GI blood loss imaging A 1 XXX $ - $ 263.44
78282 GI protein loss exam C 1 XXX $ 335.47 $ 335.47
78282 26 GI protein loss exam A 1 XXX $ 20.18 $ 20.18
78282 TC GI protein loss exam C 1 XXX $ 315.29 $ 315.29
78290 Meckels divert exam A 1 XXX $ - $ 294.41
78290 26 Meckels divert exam A 1 XXX $ 34.45 $ 34.45
78290 TC Meckels divert exam A 1 XXX $ - $ 259.96
78291 Leveen/shunt patency exam A 1 XXX $ - $ 230.03
78291 26 Leveen/shunt patency exam A 1 XXX $ 44.20 $ 44.20
78291 TC Leveen/shunt patency exam A 1 XXX $ - $ 185.83
78299 GI nuclear procedure C 1 XXX $ - $ -
78299 26 GI nuclear procedure C 1 XXX $ - $ -
78299 TC GI nuclear procedure C 1 XXX $ - $ -
78300 Bone imaging limited area A 1 XXX $ - $ 161.47
78300 26 Bone imaging limited area A 1 XXX $ 30.97 $ 30.97
78300 TC Bone imaging limited area A 1 XXX $ - $ 130.50
78305 Bone imaging multiple areas A 1 XXX $ - $ 212.63

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
78305 26 Bone imaging multiple areas A 1 XXX $ 41.06 $ 41.06

78305 TC Bone imaging multiple areas A 1 XXX $ - $ 171.56
78306 Bone imaging whole body A 1 XXX $ - $ 227.94
78306 26 Bone imaging whole body A 1 XXX $ 42.46 $ 42.46
78306 TC Bone imaging whole body A 1 XXX $ - $ 185.48
78315 Bone imaging 3 phase A 1 XXX $ - $ 312.50
78315 26 Bone imaging 3 phase A 1 XXX $ 50.46 $ 50.46
78315 TC Bone imaging 3 phase A 1 XXX $ - $ 262.04
78320 Bone imaging (3D) A 1 XXX $ - $ 214.72
78320 26 Bone imaging (3D) A 1 XXX $ 51.16 $ 51.16
78320 TC Bone imaging (3D) A 1 XXX $ - $ 163.56
78350 Bone mineral single photon N 1 XXX $ - $ 30.97
78350 26 Bone mineral single photon N 1 XXX $ 11.14 $ 11.14
78350 TC Bone mineral single photon N 1 XXX $ - $ 19.84
78351 Bone mineral dual photon N 9 XXX $ 14.96 $ 14.62
78399 Musculoskeletal nuclear exam C 1 XXX $ - $ -
78399 26 Musculoskeletal nuclear exam C 1 XXX $ - $ -
78399 TC Musculoskeletal nuclear exam C 1 XXX $ - $ -
78414 Non-imaging heart function C 1 XXX $ - $ -
78414 26 Non-imaging heart function A 1 XXX $ 24.01 $ 24.01
78414 TC Non-imaging heart function C 1 XXX $ - $ -
78428 Cardiac shunt imaging A 1 XXX $ - $ 171.56
78428 26 Cardiac shunt imaging A 1 XXX $ 38.28 $ 38.28
78428 TC Cardiac shunt imaging A 1 XXX $ - $ 133.28
78445 Vascular flow imaging A 1 XXX $ - $ 155.21
78445 26 Vascular flow imaging A 1 XXX $ 22.27 $ 22.27
78445 TC Vascular flow imaging A 1 XXX $ - $ 133.28
78451 Ht muscle image spect sing A 1 XXX $ - $ 318.77

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
78451 26 Ht muscle image spect sing A 1 XXX $ 66.12 $ 66.12

78451 TC Ht muscle image spect sing A 1 XXX $ - $ 252.65
78452 Ht muscle image spect mult A 1 XXX $ - $ 441.61
78452 26 Ht muscle image spect mult A 1 XXX $ 76.91 $ 76.91
78452 TC Ht muscle image spect mult A 1 XXX $ - $ 364.70
78453 Ht muscle image planar sing A 1 XXX $ - $ 274.57
78453 26 Ht muscle image planar sing A 1 XXX $ 49.07 $ 49.07
78453 TC Ht muscle image planar sing A 1 XXX $ - $ 225.50
78454 Ht musc image planar mult A 1 XXX $ - $ 390.11
78454 26 Ht musc image planar mult A 1 XXX $ 64.03 $ 64.03
78454 TC Ht musc image planar mult A 1 XXX $ - $ 326.08
78456 Acute venous thrombus image A 1 XXX $ 242.56 $ 242.56
78456 26 Acute venous thrombus image A 1 XXX $ 49.42 $ 49.42
78456 TC Acute venous thrombus image A 1 XXX $ 190.36 $ 190.36
78457 Venous thrombosis imaging A 1 XXX $ - $ 184.44
78457 26 Venous thrombosis imaging A 1 XXX $ 38.63 $ 38.63
78457 TC Venous thrombosis imaging A 1 XXX $ - $ 146.16
78458 Ven thrombosis images bilat A 1 XXX $ - $ 174.70
78458 26 Ven thrombosis images bilat A 1 XXX $ 43.50 $ 43.50
78458 TC Ven thrombosis images bilat A 1 XXX $ - $ 131.20
78459 Heart muscle imaging (PET) C 1 XXX $ 1,418.45 $ 1,418.45
78459 26 Heart muscle imaging (PET) A 1 XXX $ 77.26 $ 77.26
78459 TC Heart muscle imaging (PET) C 1 XXX $ 1,341.19 $ 1,341.19
78466 Heart infarct image A 1 XXX $ - $ 160.08
78466 26 Heart infarct image A 1 XXX $ 34.45 $ 34.45
78466 TC Heart infarct image A 1 XXX $ - $ 125.63
78468 Heart infarct image (ef) A 1 XXX $ - $ 192.79
78468 26 Heart infarct image (ef) A 1 XXX $ 39.67 $ 39.67

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
78468 TC Heart infarct image (ef) A 1 XXX $ - $ 153.12

78469 Heart infarct image (3D) A 1 XXX $ - $ 218.20
78469 26 Heart infarct image (3D) A 1 XXX $ 44.89 $ 44.89
78469 TC Heart infarct image (3D) A 1 XXX $ - $ 173.30
78472 Gated heart planar single A 1 XXX $ - $ 220.63
78472 26 Gated heart planar single A 1 XXX $ 48.37 $ 48.37
78472 TC Gated heart planar single A 1 XXX $ - $ 172.26
78473 Gated heart multiple A 1 XXX $ - $ 285.01
78473 26 Gated heart multiple A 1 XXX $ 72.04 $ 72.04
78473 TC Gated heart multiple A 1 XXX $ - $ 212.98
78481 Heart first pass single A 1 XXX $ - $ 179.22
78481 26 Heart first pass single A 1 XXX $ 48.02 $ 48.02
78481 TC Heart first pass single A 1 XXX $ - $ 131.20
78483 Heart first pass multiple A 1 XXX $ - $ 247.08
78483 26 Heart first pass multiple A 1 XXX $ 72.73 $ 72.73
78483 TC Heart first pass multiple A 1 XXX $ - $ 174.35
78491 Heart image (pet) single C 1 XXX $ 1,419.49 $ 1,419.49
78491 26 Heart image (pet) single A 1 XXX $ 77.95 $ 77.95
78491 TC Heart image (pet) single C 1 XXX $ 1,341.19 $ 1,341.19
78492 Heart image (pet) multiple C 1 XXX $ 1,440.02 $ 1,440.02
78492 26 Heart image (pet) multiple A 1 XXX $ 97.79 $ 97.79
78492 TC Heart image (pet) multiple C 1 XXX $ 1,341.19 $ 1,341.19
78494 Heart image spect A 1 XXX $ - $ 224.46
78494 26 Heart image spect A 1 XXX $ 58.12 $ 58.12
78494 TC Heart image spect A 1 XXX $ - $ 166.34
78496 Heart first pass add-on A 1 ZZZ $ - $ 58.12
78496 26 Heart first pass add-on A 1 ZZZ $ 24.01 $ 24.01
78496 TC Heart first pass add-on A 1 ZZZ $ - $ 34.10

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
78499 Cardiovascular nuclear exam C 1 XXX $ - $ -

78499 26 Cardiovascular nuclear exam C 1 XXX $ - $ -
78499 TC Cardiovascular nuclear exam C 1 XXX $ - $ -
78579 Lung ventilation imaging A 1 XXX $ - $ 154.51
78579 26 Lung ventilation imaging A 1 XXX $ 24.36 $ 24.36
78579 TC Lung ventilation imaging A 1 XXX $ - $ 129.80
78580 Lung perfusion imaging A 1 XXX $ - $ 199.40
78580 26 Lung perfusion imaging A 1 XXX $ 36.19 $ 36.19
78580 TC Lung perfusion imaging A 1 XXX $ - $ 163.21
78582 Lung ventilat&perfus imaging A 1 XXX $ - $ 284.32
78582 26 Lung ventilat&perfus imaging A 1 XXX $ 51.85 $ 51.85
78582 TC Lung ventilat&perfus imaging A 1 XXX $ - $ 232.46
78597 Lung perfusion differential A 1 XXX $ - $ 173.65
78597 26 Lung perfusion differential A 1 XXX $ 34.45 $ 34.45
78597 TC Lung perfusion differential A 1 XXX $ - $ 139.20
78598 Lung perf&ventilat diferentl A 1 XXX $ - $ 265.18
78598 26 Lung perf&ventilat diferentl A 1 XXX $ 39.67 $ 39.67
78598 TC Lung perf&ventilat diferentl A 1 XXX $ - $ 225.50
78599 Respiratory nuclear exam C 1 XXX $ - $ -
78599 26 Respiratory nuclear exam C 1 XXX $ - $ -
78599 TC Respiratory nuclear exam C 1 XXX $ - $ -
78600 Brain image < 4 views A 1 XXX $ - $ 162.17
78600 26 Brain image < 4 views A 1 XXX $ 20.88 $ 20.88
78600 TC Brain image < 4 views A 1 XXX $ - $ 141.29
78601 Brain image w/flow < 4 views A 1 XXX $ - $ 192.10
78601 26 Brain image w/flow < 4 views A 1 XXX $ 25.75 $ 25.75
78601 TC Brain image w/flow < 4 views A 1 XXX $ - $ 166.34
78605 Brain image 4+ views A 1 XXX $ - $ 178.52

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
78605 26 Brain image 4+ views A 1 XXX $ 27.14 $ 27.14

78605 TC Brain image 4+ views A 1 XXX $ - $ 151.73
78606 Brain image w/flow 4 + views A 1 XXX $ - $ 293.71
78606 26 Brain image w/flow 4 + views A 1 XXX $ 29.58 $ 29.58
78606 TC Brain image w/flow 4 + views A 1 XXX $ - $ 264.13
78607 Brain imaging (3D) A 1 XXX $ - $ 327.12
78607 26 Brain imaging (3D) A 1 XXX $ 59.16 $ 59.16
78607 TC Brain imaging (3D) A 1 XXX $ - $ 267.96
78608 Brain imaging (PET) C 1 XXX $ 1,418.10 $ 1,418.10
78608 26 Brain imaging (PET) A 1 XXX $ 77.26 $ 77.26
78608 TC Brain imaging (PET) C 1 XXX $ 1,341.19 $ 1,341.19
78609 Brain imaging (PET) N 1 XXX $ - $ 79.34
78609 26 Brain imaging (PET) N 1 XXX $ 79.34 $ 79.34
78609 TC Brain imaging (PET) N 1 XXX $ - $ -
78610 Brain flow imaging only A 1 XXX $ - $ 157.99
78610 26 Brain flow imaging only A 1 XXX $ 14.62 $ 14.62
78610 TC Brain flow imaging only A 1 XXX $ - $ 143.38
78630 Cerebrospinal fluid scan A 1 XXX $ - $ 304.15
78630 26 Cerebrospinal fluid scan A 1 XXX $ 33.41 $ 33.41
78630 TC Cerebrospinal fluid scan A 1 XXX $ - $ 270.74
78635 CSF ventriculography A 1 XXX $ - $ 294.06
78635 26 CSF ventriculography A 1 XXX $ 28.54 $ 28.54
78635 TC CSF ventriculography A 1 XXX $ - $ 265.52
78645 CSF shunt evaluation A 1 XXX $ - $ 285.71
78645 26 CSF shunt evaluation A 1 XXX $ 28.19 $ 28.19
78645 TC CSF shunt evaluation A 1 XXX $ - $ 257.17
78647 Cerebrospinal fluid scan A 1 XXX $ - $ 308.33
78647 26 Cerebrospinal fluid scan A 1 XXX $ 44.54 $ 44.54

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
78647 TC Cerebrospinal fluid scan A 1 XXX $ - $ 263.78

78650 CSF leakage imaging A 1 XXX $ - $ 295.80
78650 26 CSF leakage imaging A 1 XXX $ 30.97 $ 30.97
78650 TC CSF leakage imaging A 1 XXX $ - $ 264.83
78660 Nuclear exam of tear flow A 1 XXX $ - $ 167.74
78660 26 Nuclear exam of tear flow A 1 XXX $ 27.49 $ 27.49
78660 TC Nuclear exam of tear flow A 1 XXX $ - $ 139.90
78699 Nervous system nuclear exam C 1 XXX $ - $ -
78699 26 Nervous system nuclear exam C 1 XXX $ - $ -
78699 TC Nervous system nuclear exam C 1 XXX $ - $ -
78700 Kidney imaging morphol A 1 XXX $ - $ 160.08
78700 26 Kidney imaging morphol A 1 XXX $ 23.32 $ 23.32
78700 TC Kidney imaging morphol A 1 XXX $ - $ 136.42
78701 Kidney imaging with flow A 1 XXX $ - $ 192.44
78701 26 Kidney imaging with flow A 1 XXX $ 25.06 $ 25.06
78701 TC Kidney imaging with flow A 1 XXX $ - $ 167.39
78707 K flow/funct image w/o drug A 1 XXX $ - $ 212.98
78707 26 K flow/funct image w/o drug A 1 XXX $ 46.63 $ 46.63
78707 TC K flow/funct image w/o drug A 1 XXX $ - $ 166.69
78708 K flow/funct image w/drug A 1 XXX $ - $ 160.78
78708 26 K flow/funct image w/drug A 1 XXX $ 58.81 $ 58.81
78708 TC K flow/funct image w/drug A 1 XXX $ - $ 101.96
78709 K flow/funct image multiple A 1 XXX $ - $ 333.38
78709 26 K flow/funct image multiple A 1 XXX $ 69.60 $ 69.60
78709 TC K flow/funct image multiple A 1 XXX $ - $ 263.78
78710 Kidney imaging (3D) A 1 XXX $ - $ 190.01
78710 26 Kidney imaging (3D) A 1 XXX $ 29.23 $ 29.23
78710 TC Kidney imaging (3D) A 1 XXX $ - $ 160.78

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
78725 Kidney function study A 1 XXX $ - $ 95.00

78725 26 Kidney function study A 1 XXX $ 17.75 $ 17.75
78725 TC Kidney function study A 1 XXX $ - $ 77.60
78730 Urinary bladder retention A 1 ZZZ $ - $ 68.56
78730 26 Urinary bladder retention A 1 ZZZ $ 8.35 $ 8.35
78730 TC Urinary bladder retention A 1 ZZZ $ - $ 60.55
78740 Ureteral reflux study A 1 XXX $ - $ 206.71
78740 26 Ureteral reflux study A 1 XXX $ 29.23 $ 29.23
78740 TC Ureteral reflux study A 1 XXX $ - $ 177.48
78761 Testicular imaging w/flow A 1 XXX $ - $ 193.14
78761 26 Testicular imaging w/flow A 1 XXX $ 36.19 $ 36.19
78761 TC Testicular imaging w/flow A 1 XXX $ - $ 156.95
78799 Genitourinary nuclear exam C 1 XXX $ - $ -
78799 26 Genitourinary nuclear exam C 1 XXX $ - $ -
78799 TC Genitourinary nuclear exam C 1 XXX $ - $ -
78800 Tumor imaging limited area A 1 XXX $ - $ 172.61
78800 26 Tumor imaging limited area A 1 XXX $ 34.10 $ 34.10
78800 TC Tumor imaging limited area A 1 XXX $ - $ 138.50
78801 Tumor imaging mult areas A 1 XXX $ - $ 222.72
78801 26 Tumor imaging mult areas A 1 XXX $ 39.32 $ 39.32
78801 TC Tumor imaging mult areas A 1 XXX $ - $ 183.40
78802 Tumor imaging whole body A 1 XXX Y $ - $ 291.28
78802 26 Tumor imaging whole body A 1 XXX Y $ 42.11 $ 42.11
78802 TC Tumor imaging whole body A 1 XXX Y $ - $ 249.17
78803 Tumor imaging (3D) A 1 XXX Y $ - $ 311.46
78803 26 Tumor imaging (3D) A 1 XXX Y $ 52.55 $ 52.55
78803 TC Tumor imaging (3D) A 1 XXX Y $ - $ 258.91
78804 Tumor imaging whole body A 1 XXX $ - $ 513.30

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
78804 26 Tumor imaging whole body A 1 XXX $ 52.20 $ 52.20

78804 TC Tumor imaging whole body A 1 XXX $ - $ 461.10
78805 Abscess imaging ltd area A 1 XXX $ - $ 167.39
78805 26 Abscess imaging ltd area A 1 XXX $ 36.54 $ 36.54
78805 TC Abscess imaging ltd area A 1 XXX $ - $ 130.85
78806 Abscess imaging whole body A 1 XXX Y $ - $ 300.67
78806 26 Abscess imaging whole body A 1 XXX Y $ 42.11 $ 42.11
78806 TC Abscess imaging whole body A 1 XXX Y $ - $ 258.56
78807 Nuclear localization/abscess A 1 XXX Y $ - $ 311.11
78807 26 Nuclear localization/abscess A 1 XXX Y $ 51.50 $ 51.50
78807 TC Nuclear localization/abscess A 1 XXX Y $ - $ 259.61
78808 Iv inj ra drug dx study A 5 XXX $ - $ 39.67
78811 Pet image ltd area C 1 XXX $ 1,424.71 $ 1,424.71
78811 26 Pet image ltd area A 1 XXX $ 88.39 $ 88.39
78811 TC Pet image ltd area C 1 XXX $ 1,341.19 $ 1,341.19
78812 Pet image skull-thigh C 1 XXX $ 1,442.46 $ 1,442.46
78812 26 Pet image skull-thigh A 1 XXX $ 103.01 $ 103.01
78812 TC Pet image skull-thigh C 1 XXX $ 1,341.19 $ 1,341.19
78813 Pet image full body C 1 XXX $ 1,447.33 $ 1,447.33
78813 26 Pet image full body A 1 XXX $ 108.92 $ 108.92
78813 TC Pet image full body C 1 XXX $ 1,341.19 $ 1,341.19
78814 Pet image w/ct lmtd C 1 XXX $ 1,457.77 $ 1,457.77
78814 26 Pet image w/ct lmtd A 1 XXX $ 119.71 $ 119.71
78814 TC Pet image w/ct lmtd C 1 XXX $ 1,341.19 $ 1,341.19
78815 Pet image w/ct skull-thigh C 1 XXX $ 1,469.95 $ 1,469.95
78815 26 Pet image w/ct skull-thigh A 1 XXX $ 132.24 $ 132.24
78815 TC Pet image w/ct skull-thigh C 1 XXX $ 1,341.19 $ 1,341.19
78816 Pet image w/ct full body C 1 XXX $ 1,471.34 $ 1,471.34

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
78816 26 Pet image w/ct full body A 1 XXX $ 133.28 $ 133.28

78816 TC Pet image w/ct full body C 1 XXX $ 1,341.19 $ 1,341.19
78999 Nuclear diagnostic exam C 1 XXX $ - $ -
78999 26 Nuclear diagnostic exam C 1 XXX $ - $ -
78999 TC Nuclear diagnostic exam C 1 XXX $ - $ -
79005 Nuclear rx oral admin A 1 XXX $ - $ 131.54
79005 26 Nuclear rx oral admin A 1 XXX $ 87.00 $ 87.00
79005 TC Nuclear rx oral admin A 1 XXX $ - $ 44.54
79101 Nuclear rx iv admin A 1 XXX $ - $ 147.55
79101 26 Nuclear rx iv admin A 1 XXX $ 99.53 $ 99.53
79101 TC Nuclear rx iv admin A 1 XXX $ - $ 47.68
79200 Nuclear rx intracav admin A 1 XXX $ - $ 158.69
79200 26 Nuclear rx intracav admin A 1 XXX $ 101.62 $ 101.62
79200 TC Nuclear rx intracav admin A 1 XXX $ - $ 57.07
79300 Nuclr rx interstit colloid C 1 XXX $ - $ -
79300 26 Nuclr rx interstit colloid A 1 XXX $ 90.83 $ 90.83
79300 TC Nuclr rx interstit colloid C 1 XXX $ - $ -
79403 Hematopoietic nuclear tx A 1 XXX $ - $ 186.18
79403 26 Hematopoietic nuclear tx A 1 XXX $ 111.36 $ 111.36
79403 TC Hematopoietic nuclear tx A 1 XXX $ - $ 74.47
79440 Nuclear rx intra-articular A 1 XXX $ - $ 147.20
79440 26 Nuclear rx intra-articular A 1 XXX $ 97.79 $ 97.79
79440 TC Nuclear rx intra-articular A 1 XXX $ - $ 49.42
79445 Nuclear rx intra-arterial C 1 XXX $ - $ -
79445 26 Nuclear rx intra-arterial A 1 XXX $ 127.02 $ 127.02
79445 TC Nuclear rx intra-arterial C 1 XXX $ - $ -
79999 Nuclear medicine therapy C 1 XXX $ - $ -
79999 26 Nuclear medicine therapy C 1 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
79999 TC Nuclear medicine therapy C 1 XXX $ - $ -

80047 Metabolic panel ionized ca X 9 XXX $ - $ -
80048 Metabolic panel total ca X 9 XXX $ - $ -
80050 General health panel X 9 XXX $ - $ -
80051 Electrolyte panel X 9 XXX $ - $ -
80053 Comprehen metabolic panel X 9 XXX $ - $ -
80055 Obstetric panel X 9 XXX $ - $ -
80061 Lipid panel X 9 XXX $ - $ -
80069 Renal function panel X 9 XXX $ - $ -
80074 Acute hepatitis panel X 9 XXX $ - $ -
80076 Hepatic function panel X 9 XXX $ - $ -
80100 Drug screen qualitate/multi X 9 XXX $ - $ -
80101 Drug screen single x 9 XXX $ - $ -
80102 Drug confirmation X 9 XXX $ - $ -
80103 Drug analysis tissue prep X 9 XXX $ - $ -
80104 Drug scrn 1+ class nonchromo X 9 XXX $ - $ -
80150 Assay of amikacin X 9 XXX $ - $ -
80152 Assay of amitriptyline X 9 XXX $ - $ -
80154 Assay of benzodiazepines X 9 XXX $ - $ -
80156 Assay carbamazepine total X 9 XXX $ - $ -
80157 Assay carbamazepine free X 9 XXX $ - $ -
80158 Assay of cyclosporine X 9 XXX $ - $ -
80160 Assay of desipramine X 9 XXX $ - $ -
80162 Assay of digoxin X 9 XXX $ - $ -
80164 Assay dipropylacetic acid X 9 XXX $ - $ -
80166 Assay of doxepin X 9 XXX $ - $ -
80168 Assay of ethosuximide X 9 XXX $ - $ -
80170 Assay of gentamicin X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
80172 Assay of gold X 9 XXX $ - $ -

80173 Assay of haloperidol X 9 XXX $ - $ -
80174 Assay of imipramine X 9 XXX $ - $ -
80176 Assay of lidocaine X 9 XXX $ - $ -
80178 Assay of lithium X 9 XXX $ - $ -
80182 Assay of nortriptyline X 9 XXX $ - $ -
80184 Assay of phenobarbital X 9 XXX $ - $ -
80185 Assay of phenytoin total X 9 XXX $ - $ -
80186 Assay of phenytoin free X 9 XXX $ - $ -
80188 Assay of primidone X 9 XXX $ - $ -
80190 Assay of procainamide X 9 XXX $ - $ -
80192 Assay of procainamide X 9 XXX $ - $ -
80194 Assay of quinidine X 9 XXX $ - $ -
80195 Assay of sirolimus X 9 XXX $ - $ -
80196 Assay of salicylate X 9 XXX $ - $ -
80197 Assay of tacrolimus X 9 XXX $ - $ -
80198 Assay of theophylline X 9 XXX $ - $ -
80200 Assay of tobramycin X 9 XXX $ - $ -
80201 Assay of topiramate X 9 XXX $ - $ -
80202 Assay of vancomycin X 9 XXX $ - $ -
80299 Quantitative assay drug X 9 XXX $ - $ -
80400 Acth stimulation panel X 9 XXX $ - $ -
80408 Aldosterone suppression eval X 9 XXX $ - $ -
80410 Calcitonin stimul panel X 9 XXX $ - $ -
80412 CRH stimulation panel X 9 XXX $ - $ -
80414 Testosterone response X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
80415 Estradiol response panel X 9 XXX $ - $ -

80416 Renin stimulation panel X 9 XXX $ - $ -
80417 Renin stimulation panel X 9 XXX $ - $ -
80418 Pituitary evaluation panel X 9 XXX $ - $ -
80420 Dexamethasone panel X 9 XXX $ - $ -
80422 Glucagon tolerance panel X 9 XXX $ - $ -
80424 Glucagon tolerance panel X 9 XXX $ - $ -
80426 Gonadotropin hormone panel X 9 XXX $ - $ -
80428 Growth hormone panel X 9 XXX $ - $ -
80430 Growth hormone panel X 9 XXX $ - $ -
80432 Insulin suppression panel X 9 XXX $ - $ -
80434 Insulin tolerance panel X 9 XXX $ - $ -
80435 Insulin tolerance panel X 9 XXX $ - $ -
80436 Metyrapone panel X 9 XXX $ - $ -
80438 TRH stimulation panel X 9 XXX $ - $ -
80500 Lab pathology consultation A 0 XXX $ 19.49 $ 20.88
80502 Lab pathology consultation A 0 XXX $ 64.03 $ 65.77
81000 Urinalysis nonauto w/scope X 9 XXX $ - $ -
81001 Urinalysis auto w/scope X 9 XXX $ - $ -
81002 Urinalysis nonauto w/o scope X 9 XXX $ - $ -
81003 Urinalysis auto w/o scope X 9 XXX $ - $ -
81005 Urinalysis X 9 XXX $ - $ -
81007 Urine screen for bacteria X 9 XXX $ - $ -
81015 Microscopic exam of urine X 9 XXX $ - $ -
81020 Urinalysis glass test X 9 XXX $ - $ -
81025 Urine pregnancy test X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
81050 Urinalysis volume measure X 9 XXX $ - $ -

81099 Urinalysis test procedure X 9 XXX $ - $ -
81200 Aspa gene X 9 XXX $ - $ -
81205 Bckdhb gene X 9 XXX $ - $ -
81206 Bcr/abl1 gene major bp X 9 XXX $ - $ -
81207 Bcr/abl1 gene minor bp X 9 XXX $ - $ -
81208 Bcr/abl1 gene other bp X 9 XXX $ - $ -
81209 Blm gene X 9 XXX $ - $ -
81210 Braf gene X 9 XXX $ - $ -
81211 Brca1&2 seq & com dup/del X 9 XXX $ - $ -
81212 Brca1&2 185&5385&6174 var X 9 XXX $ - $ -
81213 Brca1&2 uncom dup/del var X 9 XXX $ - $ -
81214 Brca1 full seq & com dup/del X 9 XXX $ - $ -
81215 Brca1 gene known fam variant X 9 XXX $ - $ -
81216 Brca2 gene full sequence X 9 XXX $ - $ -
81217 Brca2 gene known fam variant X 9 XXX $ - $ -
81220 Cftr gene com variants X 9 XXX $ - $ -
81221 Cftr gene known fam variants X 9 XXX $ - $ -
81222 Cftr gene dup/delet variants X 9 XXX $ - $ -
81223 Cftr gene full sequence X 9 XXX $ - $ -
81224 Cftr gene intron poly t X 9 XXX $ - $ -
81225 Cyp2c19 gene com variants X 9 XXX $ - $ -
81226 Cyp2d6 gene com variants X 9 XXX $ - $ -
81227 Cyp2c9 gene com variants X 9 XXX $ - $ -
81228 Cytogen micrarray copy nmbr X 9 XXX $ - $ -
81229 Cytogen m array copy no&snp X 9 XXX $ - $ -
81240 F2 gene X 9 XXX $ - $ -
81241 F5 gene X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
81242 Fancc gene X 9 XXX $ - $ -

81243 Fmr1 gene detection X 9 XXX $ - $ -
81244 Fmr1 gene characterization X 9 XXX $ - $ -
81245 Flt3 gene X 9 XXX $ - $ -
81250 G6pc gene X 9 XXX $ - $ -
81251 Gba gene X 9 XXX $ - $ -
81255 Hexa gene X 9 XXX $ - $ -
81256 Hfe gene X 9 XXX $ - $ -
81257 Hba1/hba2 gene X 9 XXX $ - $ -
81260 Ikbkap gene X 9 XXX $ - $ -
81261 Igh gene rearrange amp meth X 9 XXX $ - $ -
81262 Igh gene rearrang dir probe X 9 XXX $ - $ -
81263 Igh vari regional mutation X 9 XXX $ - $ -
81264 Igk rearrangeabn clonal pop X 9 XXX $ - $ -
81265 Str markers specimen anal X 9 XXX $ - $ -
81266 Str markers spec anal addl X 9 XXX $ - $ -
81267 Chimerism anal no cell selec X 9 XXX $ - $ -
81268 Chimerism anal w/cell select X 9 XXX $ - $ -
81270 Jak2 gene X 9 XXX $ - $ -
81275 Kras gene X 9 XXX $ - $ -
81280 Long qt synd gene full seq X 9 XXX $ - $ -
81281 Long qt synd known fam var X 9 XXX $ - $ -
81282 Long qt syn gene dup/dlt var X 9 XXX $ - $ -
81290 Mcoln1 gene X 9 XXX $ - $ -
81291 Mthfr gene X 9 XXX $ - $ -
81292 Mlh1 gene full seq X 9 XXX $ - $ -
81293 Mlh1 gene known variants X 9 XXX $ - $ -
81294 Mlh1 gene dup/delete variant X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
81295 Msh2 gene full seq X 9 XXX $ - $ -

81296 Msh2 gene known variants X 9 XXX $ - $ -
81297 Msh2 gene dup/delete variant X 9 XXX $ - $ -
81298 Msh6 gene full seq X 9 XXX $ - $ -
81299 Msh6 gene known variants X 9 XXX $ - $ -
81300 Msh6 gene dup/delete variant X 9 XXX $ - $ -
81301 Microsatellite instability X 9 XXX $ - $ -
81302 Mecp2 gene full seq X 9 XXX $ - $ -
81303 Mecp2 gene known variant X 9 XXX $ - $ -
81304 Mecp2 gene dup/delet variant X 9 XXX $ - $ -
81310 Npm1 gene X 9 XXX $ - $ -
81315 Pml/raralpha com breakpoints X 9 XXX $ - $ -
81316 Pml/raralpha 1 breakpoint X 9 XXX $ - $ -
81317 Pms2 gene full seq analysis X 9 XXX $ - $ -
81318 Pms2 known familial variants X 9 XXX $ - $ -
81319 Pms2 gene dup/delet variants X 9 XXX $ - $ -
81330 Smpd1 gene common variants X 9 XXX $ - $ -
81331 Snrpn/ube3a gene X 9 XXX $ - $ -
81332 Serpina1 gene X 9 XXX $ - $ -
81340 Trb@ gene rearrange amplify X 9 XXX $ - $ -
81341 Trb@ gene rearrange dirprobe X 9 XXX $ - $ -
81342 Trg gene rearrangement anal X 9 XXX $ - $ -
81350 Ugt1a1 gene X 9 XXX $ - $ -
81355 Vkorc1 gene X 9 XXX $ - $ -
81370 Hla i & ii typing lr X 9 XXX $ - $ -
81371 Hla i & ii type verify lr X 9 XXX $ - $ -
81372 Hla i typing complete lr X 9 XXX $ - $ -
81373 Hla i typing 1 locus lr X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
81374 Hla i typing 1 antigen lr X 9 XXX $ - $ -

81375 Hla ii typing ag equiv lr X 9 XXX $ - $ -
81376 Hla ii typing 1 locus lr X 9 XXX $ - $ -
81377 Hla ii type 1 ag equiv lr X 9 XXX $ - $ -
81378 Hla i & ii typing hr X 9 XXX $ - $ -
81379 Hla i typing complete hr X 9 XXX $ - $ -
81380 Hla i typing 1 locus hr X 9 XXX $ - $ -
81381 Hla i typing 1 allele hr X 9 XXX $ - $ -
81382 Hla ii typing 1 loc hr X 9 XXX $ - $ -
81383 Hla ii typing 1 allele hr X 9 XXX $ - $ -
81400 Mopath procedure level 1 X 9 XXX $ - $ -
82000 Assay of blood acetaldehyde X 9 XXX $ - $ -
82003 Assay of acetaminophen X 9 XXX $ - $ -
82009 Test for acetone/ketones X 9 XXX $ - $ -
82010 Acetone assay X 9 XXX $ - $ -
82013 Acetylcholinesterase assay X 9 XXX $ - $ -
82016 Acylcarnitines qual X 9 XXX $ - $ -
82017 Acylcarnitines quant X 9 XXX $ - $ -
82024 Assay of acth X 9 XXX $ - $ -
82030 Assay of adp & amp X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
82040 Assay of serum albumin X 9 XXX $ - $ -

82042 Assay of urine albumin X 9 XXX $ - $ -
82043 Microalbumin quantitative X 9 XXX $ - $ -
82044 Microalbumin semiquant X 9 XXX $ - $ -
82045 Albumin ischemia modified X 9 XXX $ - $ -
82055 Assay of ethanol X 9 XXX $ - $ -
82075 Assay of breath ethanol X 9 XXX $ - $ -
82085 Assay of aldolase X 9 XXX $ - $ -
82088 Assay of aldosterone X 9 XXX $ - $ -
82101 Assay of urine alkaloids X 9 XXX $ - $ -
82103 Alpha-1-antitrypsin total X 9 XXX $ - $ -
82104 Alpha-1-antitrypsin pheno X 9 XXX $ - $ -
82105 Alpha-fetoprotein serum X 9 XXX $ - $ -
82106 Alpha-fetoprotein amniotic X 9 XXX $ - $ -
82107 Alpha-fetoprotein l3 X 9 XXX $ - $ -
82108 Assay of aluminum X 9 XXX $ - $ -
82120 Amines vaginal fluid qual X 9 XXX $ - $ -
82127 Amino acid single qual X 9 XXX $ - $ -
82128 Amino acids mult qual X 9 XXX $ - $ -
82131 Amino acids single quant X 9 XXX $ - $ -
82135 Assay aminolevulinic acid X 9 XXX $ - $ -
82136 Amino acids quant 2-5 X 9 XXX $ - $ -
82139 Amino acids quan 6 or more X 9 XXX $ - $ -
82140 Assay of ammonia X 9 XXX $ - $ -
82143 Amniotic fluid scan X 9 XXX $ - $ -
82145 Assay of amphetamines X 9 XXX $ - $ -
82150 Assay of amylase X 9 XXX $ - $ -
82154 Androstanediol glucuronide X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
82157 Assay of androstenedione X 9 XXX $ - $ -

82160 Assay of androsterone X 9 XXX $ - $ -
82163 Assay of angiotensin II X 9 XXX $ - $ -
82164 Angiotensin I enzyme test X 9 XXX $ - $ -
82172 Assay of apolipoprotein X 9 XXX $ - $ -
82175 Assay of arsenic X 9 XXX $ - $ -
82180 Assay of ascorbic acid X 9 XXX $ - $ -
82190 Atomic absorption X 9 XXX $ - $ -
82205 Assay of barbiturates X 9 XXX $ - $ -
82232 Assay of beta-2 protein X 9 XXX $ - $ -
82239 Bile acids total X 9 XXX $ - $ -
82240 Bile acids cholylglycine X 9 XXX $ - $ -
82247 Bilirubin total X 9 XXX $ - $ -
82248 Bilirubin direct X 9 XXX $ - $ -
82252 Fecal bilirubin test X 9 XXX $ - $ -
82261 Assay of biotinidase X 9 XXX $ - $ -
82270 Occult blood feces X 9 XXX $ - $ -
82271 Occult blood other sources X 9 XXX $ - $ -
82272 Occult bld feces 1-3 tests X 9 XXX $ - $ -
82274 Assay test for blood fecal X 9 XXX $ - $ -
82286 Assay of bradykinin X 9 XXX $ - $ -
82300 Assay of cadmium X 9 XXX $ - $ -
82306 Vitamin d 25 hydroxy X 9 XXX $ - $ -
82308 Assay of calcitonin X 9 XXX $ - $ -
82310 Assay of calcium X 9 XXX $ - $ -
82330 Assay of calcium X 9 XXX $ - $ -
82331 Calcium infusion test X 9 XXX $ - $ -
82340 Assay of calcium in urine X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
82355 Calculus analysis qual X 9 XXX $ - $ -

82360 Calculus assay quant X 9 XXX $ - $ -
82365 Calculus spectroscopy X 9 XXX $ - $ -
82370 X-ray assay calculus X 9 XXX $ - $ -
82373 Assay c-d transfer measure X 9 XXX $ - $ -
82374 Assay blood carbon dioxide X 9 XXX $ - $ -
82375 Assay carboxyhb quant X 9 XXX $ - $ -
82376 Assay carboxyhb qual X 9 XXX $ - $ -
82378 Carcinoembryonic antigen X 9 XXX $ - $ -
82379 Assay of carnitine X 9 XXX $ - $ -
82380 Assay of carotene X 9 XXX $ - $ -
82382 Assay urine catecholamines X 9 XXX $ - $ -
82383 Assay blood catecholamines X 9 XXX $ - $ -
82384 Assay three catecholamines X 9 XXX $ - $ -
82387 Assay of cathepsin-d X 9 XXX $ - $ -
82390 Assay of ceruloplasmin X 9 XXX $ - $ -
82397 Chemiluminescent assay X 9 XXX $ - $ -
82415 Assay of chloramphenicol X 9 XXX $ - $ -
82435 Assay of blood chloride X 9 XXX $ - $ -
82436 Assay of urine chloride X 9 XXX $ - $ -
82438 Assay other fluid chlorides X 9 XXX $ - $ -
82441 Test for chlorohydrocarbons X 9 XXX $ - $ -
82465 Assay bld/serum cholesterol X 9 XXX $ - $ -
82480 Assay serum cholinesterase X 9 XXX $ - $ -
82482 Assay rbc cholinesterase X 9 XXX $ - $ -
82485 Assay chondroitin sulfate X 9 XXX $ - $ -
82486 Gas/liquid chromatography X 9 XXX $ - $ -
82487 Paper chromatography X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
82488 Paper chromatography X 9 XXX $ - $ -

82489 Thin layer chromatography X 9 XXX $ - $ -
82491 Chromotography quant sing X 9 XXX $ - $ -
82492 Chromotography quant mult X 9 XXX $ - $ -
82495 Assay of chromium X 9 XXX $ - $ -
82507 Assay of citrate X 9 XXX $ - $ -
82520 Assay of cocaine X 9 XXX $ - $ -
82523 Collagen crosslinks X 9 XXX $ - $ -
82525 Assay of copper X 9 XXX $ - $ -
82528 Assay of corticosterone X 9 XXX $ - $ -
82530 Cortisol free X 9 XXX $ - $ -
82533 Total cortisol X 9 XXX $ - $ -
82540 Assay of creatine X 9 XXX $ - $ -
82541 Column chromotography qual X 9 XXX $ - $ -
82542 Column chromotography quant X 9 XXX $ - $ -
82543 Column chromotograph/isotope X 9 XXX $ - $ -
82544 Column chromotograph/isotope X 9 XXX $ - $ -
82550 Assay of ck (cpk) X 9 XXX $ - $ -
82552 Assay of cpk in blood X 9 XXX $ - $ -
82553 Creatine mb fraction X 9 XXX $ - $ -
82554 Creatine isoforms X 9 XXX $ - $ -
82565 Assay of creatinine X 9 XXX $ - $ -
82570 Assay of urine creatinine X 9 XXX $ - $ -
82575 Creatinine clearance test X 9 XXX $ - $ -
82585 Assay of cryofibrinogen X 9 XXX $ - $ -
82595 Assay of cryoglobulin X 9 XXX $ - $ -
82600 Assay of cyanide X 9 XXX $ - $ -
82607 Vitamin B-12 X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
82608 B-12 binding capacity X 9 XXX $ - $ -

82610 Cystatin c X 9 XXX $ - $ -
82615 Test for urine cystines X 9 XXX $ - $ -
82626 Dehydroepiandrosterone X 9 XXX $ - $ -
82627 Dehydroepiandrosterone X 9 XXX $ - $ -
82633 Desoxycorticosterone X 9 XXX $ - $ -
82634 Deoxycortisol X 9 XXX $ - $ -
82638 Assay of dibucaine number X 9 XXX $ - $ -
82646 Assay of dihydrocodeinone X 9 XXX $ - $ -
82649 Assay of dihydromorphinone X 9 XXX $ - $ -
82651 Assay of dihydrotestosterone X 9 XXX $ - $ -
82652 Vit d 1 25-dihydroxy X 9 XXX $ - $ -
82654 Assay of dimethadione X 9 XXX $ - $ -
82656 Pancreatic elastase fecal X 9 XXX $ - $ -
82657 Enzyme cell activity X 9 XXX $ - $ -
82658 Enzyme cell activity ra X 9 XXX $ - $ -
82664 Electrophoretic test X 9 XXX $ - $ -
82666 Assay of epiandrosterone X 9 XXX $ - $ -
82668 Assay of erythropoietin X 9 XXX $ - $ -
82670 Assay of estradiol X 9 XXX $ - $ -
82671 Assay of estrogens X 9 XXX $ - $ -
82672 Assay of estrogen X 9 XXX $ - $ -
82677 Assay of estriol X 9 XXX $ - $ -
82679 Assay of estrone X 9 XXX $ - $ -
82690 Assay of ethchlorvynol X 9 XXX $ - $ -
82693 Assay of ethylene glycol X 9 XXX $ - $ -
82696 Assay of etiocholanolone X 9 XXX $ - $ -
82705 Fats/lipids feces qual X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
82710 Fats/lipids feces quant X 9 XXX $ - $ -

82715 Assay of fecal fat X 9 XXX $ - $ -
82725 Assay of blood fatty acids X 9 XXX $ - $ -
82726 Long chain fatty acids X 9 XXX $ - $ -
82728 Assay of ferritin X 9 XXX $ - $ -
82731 Assay of fetal fibronectin X 9 XXX $ - $ -
82735 Assay of fluoride X 9 XXX $ - $ -
82742 Assay of flurazepam X 9 XXX $ - $ -
82746 Blood folic acid serum X 9 XXX $ - $ -
82747 Assay of folic acid rbc X 9 XXX $ - $ -
82757 Assay of semen fructose X 9 XXX $ - $ -
82759 Assay of rbc galactokinase X 9 XXX $ - $ -
82760 Assay of galactose X 9 XXX $ - $ -
82775 Assay galactose transferase X 9 XXX $ - $ -
82776 Galactose transferase test X 9 XXX $ - $ -
82784 Assay iga/igd/igg/igm each X 9 XXX $ - $ -
82785 Assay of ige X 9 XXX $ - $ -
82787 Igg 1 2 3 or 4 each X 9 XXX $ - $ -
82800 Blood pH X 9 XXX $ - $ -
82803 Blood gases any combination X 9 XXX $ - $ -
82805 Blood gases w/o2 saturation X 9 XXX $ - $ -
82810 Blood gases o2 sat only X 9 XXX $ - $ -
82820 Hemoglobin-oxygen affinity X 9 XXX $ - $ -
82930 Gastric analy w/ph ea spec X 9 XXX $ - $ -
82938 Gastrin test X 9 XXX $ - $ -
82941 Assay of gastrin X 9 XXX $ - $ -
82943 Assay of glucagon X 9 XXX $ - $ -
82945 Glucose other fluid X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
82946 Glucagon tolerance test X 9 XXX $ - $ -

82947 Assay glucose blood quant X 9 XXX $ - $ -
82948 Reagent strip/blood glucose X 9 XXX $ - $ -
82950 Glucose test X 9 XXX $ - $ -
82951 Glucose tolerance test (GTT) X 9 XXX $ - $ -
82952 GTT-added samples X 9 XXX $ - $ -
82953 Glucose-tolbutamide test X 9 XXX $ - $ -
82955 Assay of g6pd enzyme X 9 XXX $ - $ -
82960 Test for G6PD enzyme X 9 XXX $ - $ -
82962 Glucose blood test X 9 XXX $ - $ -
82963 Assay of glucosidase X 9 XXX $ - $ -
82965 Assay of gdh enzyme X 9 XXX $ - $ -
82975 Assay of glutamine X 9 XXX $ - $ -
82977 Assay of GGT X 9 XXX $ - $ -
82978 Assay of glutathione X 9 XXX $ - $ -
82979 Assay rbc glutathione X 9 XXX $ - $ -
82980 Assay of glutethimide X 9 XXX $ - $ -
82985 Glycated protein X 9 XXX $ - $ -
83001 Gonadotropin (FSH) X 9 XXX $ - $ -
83002 Gonadotropin (LH) X 9 XXX $ - $ -
83003 Assay growth hormone (hgh) X 9 XXX $ - $ -
83008 Assay of guanosine X 9 XXX $ - $ -
83009 H pylori (c-13) blood X 9 XXX $ - $ -
83010 Assay of haptoglobin quant X 9 XXX $ - $ -
83012 Assay of haptoglobins X 9 XXX $ - $ -
83013 H pylori (c-13) breath X 9 XXX $ - $ -
83014 H pylori drug admin X 9 XXX $ - $ -
83015 Heavy metal screen X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
83018 Quantitative screen metals X 9 XXX $ - $ -

83020 Hemoglobin electrophoresis X 9 XXX $ - $ -
83020 26 Hemoglobin electrophoresis A 6 XXX $ 20.88 $ 20.88
83021 Hemoglobin chromotography X 9 XXX $ - $ -
83026 Hemoglobin copper sulfate X 9 XXX $ - $ -
83030 Fetal hemoglobin chemical X 9 XXX $ - $ -
83033 Fetal hemoglobin assay qual X 9 XXX $ - $ -
83036 Glycosylated hemoglobin test X 9 XXX $ - $ -
83037 Glycosylated hb home device X 9 XXX $ - $ -
83045 Blood methemoglobin test X 9 XXX $ - $ -
83050 Blood methemoglobin assay X 9 XXX $ - $ -
83051 Assay of plasma hemoglobin X 9 XXX $ - $ -
83055 Blood sulfhemoglobin test X 9 XXX $ - $ -
83060 Blood sulfhemoglobin assay X 9 XXX $ - $ -
83065 Assay of hemoglobin heat X 9 XXX $ - $ -
83068 Hemoglobin stability screen X 9 XXX $ - $ -
83069 Assay of urine hemoglobin X 9 XXX $ - $ -
83070 Assay of hemosiderin qual X 9 XXX $ - $ -
83071 Assay of hemosiderin quant X 9 XXX $ - $ -
83080 Assay of b hexosaminidase X 9 XXX $ - $ -
83088 Assay of histamine X 9 XXX $ - $ -
83090 Assay of homocystine X 9 XXX $ - $ -
83150 Assay of for hva X 9 XXX $ - $ -
83491 Assay of corticosteroids X 9 XXX $ - $ -
83497 Assay of 5-hiaa X 9 XXX $ - $ -
83498 Assay of progesterone X 9 XXX $ - $ -
83500 Assay free hydroxyproline X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
83505 Assay total hydroxyproline X 9 XXX $ - $ -

83516 Immunoassay nonantibody X 9 XXX $ - $ -
83518 Immunoassay dipstick X 9 XXX $ - $ -
83519 Ria nonantibody X 9 XXX $ - $ -
83520 Immunoassay quant nos nonab X 9 XXX $ - $ -
83525 Assay of insulin X 9 XXX $ - $ -
83527 Assay of insulin X 9 XXX $ - $ -
83528 Assay of intrinsic factor X 9 XXX $ - $ -
83540 Assay of iron X 9 XXX $ - $ -
83550 Iron binding test X 9 XXX $ - $ -
83570 Assay of idh enzyme X 9 XXX $ - $ -
83582 Assay of ketogenic steroids X 9 XXX $ - $ -
83586 Assay 17- ketosteroids X 9 XXX $ - $ -
83593 Fractionation ketosteroids X 9 XXX $ - $ -
83605 Assay of lactic acid X 9 XXX $ - $ -
83615 Lactate (LD) (LDH) enzyme X 9 XXX $ - $ -
83625 Assay of ldh enzymes X 9 XXX $ - $ -
83630 Lactoferrin fecal (qual) X 9 XXX $ - $ -
83631 Lactoferrin fecal (quant) X 9 XXX $ - $ -
83632 Placental lactogen X 9 XXX $ - $ -
83633 Test urine for lactose X 9 XXX $ - $ -
83634 Assay of urine for lactose X 9 XXX $ - $ -
83655 Assay of lead X 9 XXX $ - $ -
83661 L/s ratio fetal lung X 9 XXX $ - $ -
83662 Foam stability fetal lung X 9 XXX $ - $ -
83663 Fluoro polarize fetal lung X 9 XXX $ - $ -
83664 Lamellar bdy fetal lung X 9 XXX $ - $ -
83670 Assay of lap enzyme X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
83690 Assay of lipase X 9 XXX $ - $ -

83695 Assay of lipoprotein(a) X 9 XXX $ - $ -
83698 Assay lipoprotein pla2 X 9 XXX $ - $ -
83700 Lipopro bld electrophoretic X 9 XXX $ - $ -
83701 Lipoprotein bld hr fraction X 9 XXX $ - $ -
83704 Lipoprotein bld by nmr X 9 XXX $ - $ -
83718 Assay of lipoprotein X 9 XXX $ - $ -
83719 Assay of blood lipoprotein X 9 XXX $ - $ -
83721 Assay of blood lipoprotein X 9 XXX $ - $ -
83727 Assay of lrh hormone X 9 XXX $ - $ -
83735 Assay of magnesium X 9 XXX $ - $ -
83775 Assay of md enzyme X 9 XXX $ - $ -
83785 Assay of manganese X 9 XXX $ - $ -
83788 Mass spectrometry qual X 9 XXX $ - $ -
83789 Mass spectrometry quant X 9 XXX $ - $ -
83805 Assay of meprobamate X 9 XXX $ - $ -
83825 Assay of mercury X 9 XXX $ - $ -
83835 Assay of metanephrines X 9 XXX $ - $ -
83840 Assay of methadone X 9 XXX $ - $ -
83857 Assay of methemalbumin X 9 XXX $ - $ -
83858 Assay of methsuximide X 9 XXX $ - $ -
83861 Microfluid analy tears X 9 XXX $ - $ -
83864 Mucopolysaccharides X 9 XXX $ - $ -
83866 Mucopolysaccharides screen X 9 XXX $ - $ -
83872 Assay synovial fluid mucin X 9 XXX $ - $ -
83873 Assay of csf protein X 9 XXX $ - $ -
83874 Assay of myoglobin X 9 XXX $ - $ -
83876 Assay myeloperoxidase X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
83880 Natriuretic peptide X 9 XXX $ - $ -

83883 Assay nephelometry not spec X 9 XXX $ - $ -
83885 Assay of nickel X 9 XXX $ - $ -
83887 Assay of nicotine X 9 XXX $ - $ -
83890 Molecule isolate X 9 XXX $ - $ -
83891 Molecule isolate nucleic X 9 XXX $ - $ -
83892 Molecular diagnostics X 9 XXX $ - $ -
83893 Molecule dot/slot/blot X 9 XXX $ - $ -
83894 Molecule gel electrophor X 9 XXX $ - $ -
83897 Molecule nucleic transfer X 9 XXX $ - $ -
83898 Molecule nucleic ampli each X 9 XXX $ - $ -
83900 Molecule nucleic ampli 2 seq X 9 XXX $ - $ -
83901 Molecule nucleic ampli addon X 9 XXX $ - $ -
83903 Molecule mutation scan X 9 XXX $ - $ -
83904 Molecule mutation identify X 9 XXX $ - $ -
83907 Lyse cells for nucleic ext X 9 XXX $ - $ -
83908 Nucleic acid signal ampli X 9 XXX $ - $ -
83909 Nucleic acid high resolute X 9 XXX $ - $ -
83912 Genetic examination X 9 XXX $ - $ -
83912 26 Genetic examination A 6 XXX $ 19.84 $ 19.84
83913 Molecular rna stabilization X 9 XXX $ - $ -
83914 Mutation ident ola/sbce/aspe X 9 XXX $ - $ -
83915 Assay of nucleotidase X 9 XXX $ - $ -
83916 Oligoclonal bands X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
83918 Organic acids total quant X 9 XXX $ - $ -

83919 Organic acids qual each X 9 XXX $ - $ -
83921 Organic acid single quant X 9 XXX $ - $ -
83925 Assay of opiates X 9 XXX $ - $ -
83930 Assay of blood osmolality X 9 XXX $ - $ -
83935 Assay of urine osmolality X 9 XXX $ - $ -
83937 Assay of osteocalcin X 9 XXX $ - $ -
83945 Assay of oxalate X 9 XXX $ - $ -
83950 Oncoprotein her-2/neu X 9 XXX $ - $ -
83951 Oncoprotein dcp X 9 XXX $ - $ -
83970 Assay of parathormone X 9 XXX $ - $ -
83986 Assay ph body fluid nos X 9 XXX $ - $ -
83987 Exhaled breath condensate X 9 XXX $ - $ -
83992 Assay for phencyclidine X 9 XXX $ - $ -
83993 Assay for calprotectin fecal X 9 XXX $ - $ -
84022 Assay of phenothiazine X 9 XXX $ - $ -
84030 Assay of blood pku X 9 XXX $ - $ -
84035 Assay of phenylketones X 9 XXX $ - $ -
84060 Assay acid phosphatase X 9 XXX $ - $ -
84061 Phosphatase forensic exam X 9 XXX $ - $ -
84066 Assay prostate phosphatase X 9 XXX $ - $ -
84075 Assay alkaline phosphatase X 9 XXX $ - $ -
84078 Assay alkaline phosphatase X 9 XXX $ - $ -
84080 Assay alkaline phosphatases X 9 XXX $ - $ -
84081 Amniotic fluid enzyme test X 9 XXX $ - $ -
84085 Assay of rbc pg6d enzyme X 9 XXX $ - $ -
84087 Assay phosphohexose enzymes X 9 XXX $ - $ -
84100 Assay of phosphorus X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
84105 Assay of urine phosphorus X 9 XXX $ - $ -

84106 Test for porphobilinogen X 9 XXX $ - $ -
84110 Assay of porphobilinogen X 9 XXX $ - $ -
84112 Placenta alpha micro ig c/v X 9 XXX $ - $ -
84119 Test urine for porphyrins X 9 XXX $ - $ -
84120 Assay of urine porphyrins X 9 XXX $ - $ -
84126 Assay of feces porphyrins X 9 XXX $ - $ -
84127 Assay of feces porphyrins X 9 XXX $ - $ -
84132 Assay of serum potassium X 9 XXX $ - $ -
84133 Assay of urine potassium X 9 XXX $ - $ -
84134 Assay of prealbumin X 9 XXX $ - $ -
84135 Assay of pregnanediol X 9 XXX $ - $ -
84138 Assay of pregnanetriol X 9 XXX $ - $ -
84140 Assay of pregnenolone X 9 XXX $ - $ -
84143 Assay of 17-hydroxypregneno X 9 XXX $ - $ -
84145 Procalcitonin (pct) X 9 XXX $ - $ -
84146 Assay of prolactin X 9 XXX $ - $ -
84150 Assay of prostaglandin X 9 XXX $ - $ -
84152 Assay of psa complexed X 9 XXX $ - $ -
84153 Assay of psa total X 9 XXX $ - $ -
84154 Assay of psa free X 9 XXX $ - $ -
84155 Assay of protein serum X 9 XXX $ - $ -
84156 Assay of protein urine X 9 XXX $ - $ -
84157 Assay of protein other X 9 XXX $ - $ -
84160 Assay of protein any source X 9 XXX $ - $ -
84163 Pappa serum X 9 XXX $ - $ -
84165 Protein e-phoresis serum X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
84165 26 Protein e-phoresis serum A 6 XXX $ 20.53 $ 20.53

84166 Protein e-phoresis/urine/csf X 9 XXX $ - $ -
84166 26 Protein e-phoresis/urine/csf A 6 XXX $ 20.53 $ 20.53
84181 Western blot test X 9 XXX $ - $ -
84181 26 Western blot test A 6 XXX $ 20.53 $ 20.53
84182 Protein western blot test X 9 XXX $ - $ -
84182 26 Protein western blot test A 6 XXX $ 19.49 $ 19.49
84202 Assay RBC protoporphyrin X 9 XXX $ - $ -
84203 Test RBC protoporphyrin X 9 XXX $ - $ -
84206 Assay of proinsulin X 9 XXX $ - $ -
84207 Assay of vitamin b-6 X 9 XXX $ - $ -
84210 Assay of pyruvate X 9 XXX $ - $ -
84220 Assay of pyruvate kinase X 9 XXX $ - $ -
84228 Assay of quinine X 9 XXX $ - $ -
84233 Assay of estrogen X 9 XXX $ - $ -
84235 Assay of endocrine hormone X 9 XXX $ - $ -
84238 Assay nonendocrine receptor X 9 XXX $ - $ -
84244 Assay of renin X 9 XXX $ - $ -
84255 Assay of selenium X 9 XXX $ - $ -
84260 Assay of serotonin X 9 XXX $ - $ -
84270 Assay of sex hormone globul X 9 XXX $ - $ -
84275 Assay of sialic acid X 9 XXX $ - $ -
84285 Assay of silica X 9 XXX $ - $ -
84295 Assay of serum sodium X 9 XXX $ - $ -
84300 Assay of urine sodium X 9 XXX $ - $ -
84302 Assay of sweat sodium X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
84305 Assay of somatomedin X 9 XXX $ - $ -

84307 Assay of somatostatin X 9 XXX $ - $ -
84311 Spectrophotometry X 9 XXX $ - $ -
84315 Body fluid specific gravity X 9 XXX $ - $ -
84375 Chromatogram assay sugars X 9 XXX $ - $ -
84376 Sugars single qual X 9 XXX $ - $ -
84377 Sugars multiple qual X 9 XXX $ - $ -
84378 Sugars single quant X 9 XXX $ - $ -
84379 Sugars multiple quant X 9 XXX $ - $ -
84392 Assay of urine sulfate X 9 XXX $ - $ -
84402 Assay of testosterone X 9 XXX $ - $ -
84403 Assay of total testosterone X 9 XXX $ - $ -
84430 Assay of thiocyanate X 9 XXX $ - $ -
84431 Thromboxane urine X 9 XXX $ - $ -
84432 Assay of thyroglobulin X 9 XXX $ - $ -
84436 Assay of total thyroxine X 9 XXX $ - $ -
84437 Assay of neonatal thyroxine X 9 XXX $ - $ -
84439 Assay of free thyroxine X 9 XXX $ - $ -
84442 Assay of thyroid activity X 9 XXX $ - $ -
84443 Assay thyroid stim hormone X 9 XXX $ - $ -
84445 Assay of tsi X 9 XXX $ - $ -
84446 Assay of vitamin e X 9 XXX $ - $ -
84449 Assay of transcortin X 9 XXX $ - $ -
84450 Transferase (AST) (SGOT) X 9 XXX $ - $ -
84460 Alanine amino (ALT) (SGPT) X 9 XXX $ - $ -
84466 Assay of transferrin X 9 XXX $ - $ -
84478 Assay of triglycerides X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
84479 Assay of thyroid (t3 or t4) X 9 XXX $ - $ -

84480 Assay triiodothyronine (t3) X 9 XXX $ - $ -
84481 Free assay (FT-3) X 9 XXX $ - $ -
84482 T3 reverse X 9 XXX $ - $ -
84484 Assay of troponin quant X 9 XXX $ - $ -
84485 Assay duodenal fluid trypsin X 9 XXX $ - $ -
84488 Test feces for trypsin X 9 XXX $ - $ -
84490 Assay of feces for trypsin X 9 XXX $ - $ -
84510 Assay of tyrosine X 9 XXX $ - $ -
84512 Assay of troponin qual X 9 XXX $ - $ -
84520 Assay of urea nitrogen X 9 XXX $ - $ -
84525 Urea nitrogen semi-quant X 9 XXX $ - $ -
84540 Assay of urine/urea-n X 9 XXX $ - $ -
84545 Urea-N clearance test X 9 XXX $ - $ -
84550 Assay of blood/uric acid X 9 XXX $ - $ -
84560 Assay of urine/uric acid X 9 XXX $ - $ -
84577 Assay of feces/urobilinogen X 9 XXX $ - $ -
84578 Test urine urobilinogen X 9 XXX $ - $ -
84580 Assay of urine urobilinogen X 9 XXX $ - $ -
84583 Assay of urine urobilinogen X 9 XXX $ - $ -
84585 Assay of urine vma X 9 XXX $ - $ -
84586 Assay of vip X 9 XXX $ - $ -
84588 Assay of vasopressin X 9 XXX $ - $ -
84590 Assay of vitamin a X 9 XXX $ - $ -
84591 Assay of nos vitamin X 9 XXX $ - $ -
84597 Assay of vitamin k X 9 XXX $ - $ -
84600 Assay of volatiles X 9 XXX $ - $ -
84620 Xylose tolerance test X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
84630 Assay of zinc X 9 XXX $ - $ -

84681 Assay of c-peptide X 9 XXX $ - $ -
84702 Chorionic gonadotropin test X 9 XXX $ - $ -
84703 Chorionic gonadotropin assay X 9 XXX $ - $ -
84704 Hcg free betachain test X 9 XXX $ - $ -
84830 Ovulation tests X 9 XXX $ - $ -
84999 Clinical chemistry test X 9 XXX $ - $ -
85002 Bleeding time test X 9 XXX $ - $ -
85004 Automated diff wbc count X 9 XXX $ - $ -
85007 Bl smear w/diff wbc count X 9 XXX $ - $ -
85008 Bl smear w/o diff wbc count X 9 XXX $ - $ -
85009 Manual diff wbc count b-coat X 9 XXX $ - $ -
85013 Spun microhematocrit X 9 XXX $ - $ -
85014 Hematocrit X 9 XXX $ - $ -
85018 Hemoglobin X 9 XXX $ - $ -
85025 Complete cbc w/auto diff wbc X 9 XXX $ - $ -
85027 Complete cbc automated X 9 XXX $ - $ -
85032 Manual cell count each X 9 XXX $ - $ -
85041 Automated rbc count X 9 XXX $ - $ -
85044 Manual reticulocyte count X 9 XXX $ - $ -
85045 Automated reticulocyte count X 9 XXX $ - $ -
85046 Reticyte/hgb concentrate X 9 XXX $ - $ -
85048 Automated leukocyte count X 9 XXX $ - $ -
85049 Automated platelet count X 9 XXX $ - $ -
85055 Reticulated platelet assay X 9 XXX $ - $ -
85060 Blood smear interpretation A 8 XXX $ 24.36 $ 24.36
85097 Bone marrow interpretation A 0 XXX $ 48.02 $ 79.34
85130 Chromogenic substrate assay X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
85170 Blood clot retraction X 9 XXX $ - $ -

85175 Blood clot lysis time X 9 XXX $ - $ -
85210 Blood clot factor II test X 9 XXX $ - $ -
85220 Blood clot factor V test X 9 XXX $ - $ -
85230 Blood clot factor VII test X 9 XXX $ - $ -
85240 Blood clot factor VIII test X 9 XXX $ - $ -
85250 Blood clot factor IX test X 9 XXX $ - $ -
85260 Blood clot factor X test X 9 XXX $ - $ -
85270 Blood clot factor XI test X 9 XXX $ - $ -
85280 Blood clot factor XII test X 9 XXX $ - $ -
85290 Blood clot factor XIII test X 9 XXX $ - $ -
85291 Blood clot factor XIII test X 9 XXX $ - $ -
85292 Blood clot factor assay X 9 XXX $ - $ -
85293 Blood clot factor assay X 9 XXX $ - $ -
85300 Antithrombin III test X 9 XXX $ - $ -
85301 Antithrombin III test X 9 XXX $ - $ -
85302 Blood clot inhibitor antigen X 9 XXX $ - $ -
85303 Blood clot inhibitor test X 9 XXX $ - $ -
85305 Blood clot inhibitor assay X 9 XXX $ - $ -
85306 Blood clot inhibitor test X 9 XXX $ - $ -
85307 Assay activated protein c X 9 XXX $ - $ -
85335 Factor inhibitor test X 9 XXX $ - $ -
85337 Thrombomodulin X 9 XXX $ - $ -
85345 Coagulation time X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

85360 Euglobulin lysis X 9 XXX $ - $ -
85362 Fibrin degradation products X 9 XXX $ - $ -
85366 Fibrinogen test X 9 XXX $ - $ -
85370 Fibrinogen test X 9 XXX $ - $ -
85378 Fibrin degrade semiquant X 9 XXX $ - $ -
85379 Fibrin degradation quant X 9 XXX $ - $ -
85380 Fibrin degradation vte X 9 XXX $ - $ -
85384 Fibrinogen X 9 XXX $ - $ -
85385 Fibrinogen X 9 XXX $ - $ -
85390 Fibrinolysins screen X 9 XXX $ - $ -
85390 26 Fibrinolysins screen A 6 XXX $ 20.88 $ 20.88
85396 Clotting assay whole blood A 0 XXX $ 20.53 $ -
85397 Clotting funct activity X 9 XXX $ - $ -
85400 Fibrinolytic plasmin X 9 XXX $ - $ -
85410 Fibrinolytic antiplasmin X 9 XXX $ - $ -
85415 Fibrinolytic plasminogen X 9 XXX $ - $ -
85441 Heinz bodies direct X 9 XXX $ - $ -
85445 Heinz bodies induced X 9 XXX $ - $ -
85460 Hemoglobin fetal X 9 XXX $ - $ -
85461 Hemoglobin fetal X 9 XXX $ - $ -
85475 Hemolysin X 9 XXX $ - $ -
85520 Heparin assay X 9 XXX $ - $ -
85525 Heparin neutralization X 9 XXX $ - $ -
85530 Heparin-protamine tolerance X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
85536 Iron stain peripheral blood X 9 XXX $ - $ -

85540 Wbc alkaline phosphatase X 9 XXX $ - $ -
85547 RBC mechanical fragility X 9 XXX $ - $ -
85549 Muramidase X 9 XXX $ - $ -
85555 RBC osmotic fragility X 9 XXX $ - $ -
85557 RBC osmotic fragility X 9 XXX $ - $ -
85576 Blood platelet aggregation X 9 XXX $ - $ -
85576 26 Blood platelet aggregation A 6 XXX $ 20.88 $ 20.88
85597 Phospholipid pltlt neutraliz X 9 XXX $ - $ -
85598 Hexagnal phosph pltlt neutrl X 9 XXX $ - $ -
85610 Prothrombin time X 9 XXX $ - $ -
85611 Prothrombin test X 9 XXX $ - $ -
85612 Viper venom prothrombin time X 9 XXX $ - $ -
85613 Russell viper venom diluted X 9 XXX $ - $ -
85635 Reptilase test X 9 XXX $ - $ -
85651 Rbc sed rate nonautomated X 9 XXX $ - $ -
85652 Rbc sed rate automated X 9 XXX $ - $ -
85660 RBC sickle cell test X 9 XXX $ - $ -
85670 Thrombin time plasma X 9 XXX $ - $ -
85675 Thrombin time titer X 9 XXX $ - $ -
85705 Thromboplastin inhibition X 9 XXX $ - $ -
85730 Thromboplastin time partial X 9 XXX $ - $ -
85732 Thromboplastin time partial X 9 XXX $ - $ -
85810 Blood viscosity examination X 9 XXX $ - $ -
85999 Hematology procedure X 9 XXX $ - $ -
86000 Agglutinins febrile X 9 XXX $ - $ -
86001 Allergen specific igg X 9 XXX $ - $ -
86003 Allergen specific IgE X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
86005 Allergen specific IgE X 9 XXX $ - $ -

86021 WBC antibody identification X 9 XXX $ - $ -
86022 Platelet antibodies X 9 XXX $ - $ -
86023 Immunoglobulin assay X 9 XXX $ - $ -
86038 Antinuclear antibodies X 9 XXX $ - $ -
86039 Antinuclear antibodies (ANA) X 9 XXX $ - $ -
86060 Antistreptolysin o titer X 9 XXX $ - $ -
86063 Antistreptolysin o screen X 9 XXX $ - $ -
86077 Physician blood bank service A 0 XXX $ 49.07 $ 51.85
86140 C-reactive protein X 9 XXX $ - $ -
86141 C-reactive protein hs X 9 XXX $ - $ -
86146 Glycoprotein antibody X 9 XXX $ - $ -
86147 Cardiolipin antibody X 9 XXX $ - $ -
86148 Phospholipid antibody X 9 XXX $ - $ -
86155 Chemotaxis assay X 9 XXX $ - $ -
86156 Cold agglutinin screen X 9 XXX $ - $ -
86157 Cold agglutinin titer X 9 XXX $ - $ -
86160 Complement antigen X 9 XXX $ - $ -
86161 Complement/function activity X 9 XXX $ - $ -
86162 Complement total (ch50) X 9 XXX $ - $ -
86171 Complement fixation each X 9 XXX $ - $ -
86185 Counterimmunoelectrophoresis X 9 XXX $ - $ -
86200 Ccp antibody X 9 XXX $ - $ -
86215 Deoxyribonuclease antibody X 9 XXX $ - $ -
86225 DNA antibody X 9 XXX $ - $ -
86226 Dna antibody single strand X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
86235 Nuclear antigen antibody X 9 XXX $ - $ -

86243 Fc receptor X 9 XXX $ - $ -
86255 Fluorescent antibody screen X 9 XXX $ - $ -
86255 26 Fluorescent antibody screen A 6 XXX $ 20.88 $ 20.88
86256 Fluorescent antibody titer X 9 XXX $ - $ -
86256 26 Fluorescent antibody titer A 6 XXX $ 18.10 $ 18.10
86277 Growth hormone antibody X 9 XXX $ - $ -
86280 Hemagglutination inhibition X 9 XXX $ - $ -
86294 Immunoassay tumor qual X 9 XXX $ - $ -
86300 Immunoassay tumor ca 15-3 X 9 XXX $ - $ -
86301 Immunoassay tumor ca 19-9 X 9 XXX $ - $ -
86304 Immunoassay tumor ca 125 X 9 XXX $ - $ -
86305 Human epididymis protein 4 X 9 XXX $ - $ -
86308 Heterophile antibodies X 9 XXX $ - $ -
86316 Immunoassay tumor other X 9 XXX $ - $ -
86317 Immunoassay infectious agent X 9 XXX $ - $ -
86318 Immunoassay infectious agent X 9 XXX $ - $ -
86320 Serum immunoelectrophoresis X 9 XXX $ - $ -
86320 26 Serum immunoelectrophoresis A 6 XXX $ 18.10 $ 18.10
86325 Other immunoelectrophoresis X 9 XXX $ - $ -
86325 26 Other immunoelectrophoresis A 6 XXX $ 18.10 $ 18.10
86327 Immunoelectrophoresis assay X 9 XXX $ - $ -
86327 26 Immunoelectrophoresis assay A 6 XXX $ 22.97 $ 22.97
86329 Immunodiffusion X 9 XXX $ - $ -
86331 Immunodiffusion ouchterlony X 9 XXX $ - $ -
86332 Immune complex assay X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
86334 Immunofix e-phoresis serum X 9 XXX $ - $ -

86334 26 Immunofix e-phoresis serum A 6 XXX $ 20.53 $ 20.53
86335 Immunfix e-phorsis/urine/csf X 9 XXX $ - $ -
86335 26 Immunfix e-phorsis/urine/csf A 6 XXX $ 20.53 $ 20.53
86336 Inhibin A X 9 XXX $ - $ -
86337 Insulin antibodies X 9 XXX $ - $ -
86340 Intrinsic factor antibody X 9 XXX $ - $ -
86341 Islet cell antibody X 9 XXX $ - $ -
86343 Leukocyte histamine release X 9 XXX $ - $ -
86344 Leukocyte phagocytosis X 9 XXX $ - $ -
86352 Cell function assay w/stim X 9 XXX $ - $ -
86353 Lymphocyte transformation X 9 XXX $ - $ -
86355 B cells total count X 9 XXX $ - $ -
86356 Mononuclear cell antigen X 9 XXX $ - $ -
86357 Nk cells total count X 9 XXX $ - $ -
86359 T cells total count X 9 XXX $ - $ -
86360 T cell absolute count/ratio X 9 XXX $ - $ -
86361 T cell absolute count X 9 XXX $ - $ -
86367 Stem cells total count X 9 XXX $ - $ -
86376 Microsomal antibody X 9 XXX $ - $ -
86378 Migration inhibitory factor X 9 XXX $ - $ -
86382 Neutralization test viral X 9 XXX $ - $ -
86384 Nitroblue tetrazolium dye X 9 XXX $ - $ -
86386 Nuclear matrix protein 22 X 9 XXX $ - $ -
86403 Particle agglutination test X 9 XXX $ - $ -
86406 Particle agglutination test X 9 XXX $ - $ -
86430 Rheumatoid factor test X 9 XXX $ - $ -
86431 Rheumatoid factor quant X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
86480 Tb test cell immun measure X 9 XXX $ - $ -

86481 Tb ag response t-cell susp X 9 XXX $ - $ -
86485 Skin test candida C 3 XXX $ - $ -
86486 Skin test nos antigen A 3 XXX $ - $ 5.57
86490 Coccidioidomycosis skin test A 3 XXX $ - $ 6.26
86510 Histoplasmosis skin test A 3 XXX $ - $ 6.26
86580 TB intradermal test A 3 XXX $ - $ 7.66
86590 Streptokinase antibody X 9 XXX $ - $ -
86592 Syphilis test non-trep qual X 9 XXX $ - $ -
86593 Syphilis test non-trep quant X 9 XXX $ - $ -
86602 Antinomyces antibody X 9 XXX $ - $ -
86603 Adenovirus antibody X 9 XXX $ - $ -
86606 Aspergillus antibody X 9 XXX $ - $ -
86609 Bacterium antibody X 9 XXX $ - $ -
86611 Bartonella antibody X 9 XXX $ - $ -
86612 Blastomyces antibody X 9 XXX $ - $ -
86615 Bordetella antibody X 9 XXX $ - $ -
86617 Lyme disease antibody X 9 XXX $ - $ -
86618 Lyme disease antibody X 9 XXX $ - $ -
86619 Borrelia antibody X 9 XXX $ - $ -
86622 Brucella antibody X 9 XXX $ - $ -
86625 Campylobacter antibody X 9 XXX $ - $ -
86628 Candida antibody X 9 XXX $ - $ -
86631 Chlamydia antibody X 9 XXX $ - $ -
86632 Chlamydia igm antibody X 9 XXX $ - $ -
86635 Coccidioides antibody X 9 XXX $ - $ -
86638 Q fever antibody X 9 XXX $ - $ -
86641 Cryptococcus antibody X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
86644 CMV antibody X 9 XXX $ - $ -

86645 Cmv antibody igm X 9 XXX $ - $ -
86648 Diphtheria antibody X 9 XXX $ - $ -
86651 Encephalitis antibody X 9 XXX $ - $ -
86658 Enterovirus antibody X 9 XXX $ - $ -
86663 Epstein-barr antibody X 9 XXX $ - $ -
86666 Ehrlichia antibody X 9 XXX $ - $ -
86668 Francisella tularensis X 9 XXX $ - $ -
86671 Fungus antibody X 9 XXX $ - $ -
86674 Giardia lamblia antibody X 9 XXX $ - $ -
86677 Helicobacter pylori X 9 XXX $ - $ -
86682 Helminth antibody X 9 XXX $ - $ -
86684 Hemophilus influenza X 9 XXX $ - $ -
86687 Htlv-i antibody X 9 XXX $ - $ -
86688 Htlv-ii antibody X 9 XXX $ - $ -
86689 HTLV/HIV confirmatory test X 9 XXX $ - $ -
86692 Hepatitis delta agent X 9 XXX $ - $ -
86694 Herpes simplex test X 9 XXX $ - $ -
86695 Herpes simplex test X 9 XXX $ - $ -
86696 Herpes simplex type 2 X 9 XXX $ - $ -
86698 Histoplasma X 9 XXX $ - $ -
86701 HIV-1 X 9 XXX $ - $ -
86702 HIV-2 X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
86703 Hiv-1/hiv-2 single result X 9 XXX $ - $ -

86704 Hep b core antibody total X 9 XXX $ - $ -
86705 Hep b core antibody igm X 9 XXX $ - $ -
86706 Hep b surface antibody X 9 XXX $ - $ -
86707 Hep be antibody X 9 XXX $ - $ -
86708 Hep a antibody total X 9 XXX $ - $ -
86709 Hep a antibody igm X 9 XXX $ - $ -
86710 Influenza virus antibody X 9 XXX $ - $ -
86713 Legionella antibody X 9 XXX $ - $ -
86717 Leishmania antibody X 9 XXX $ - $ -
86720 Leptospira antibody X 9 XXX $ - $ -
86723 Listeria monocytogenes ab X 9 XXX $ - $ -
86727 Lymph choriomeningitis ab X 9 XXX $ - $ -
86729 Lympho venereum antibody X 9 XXX $ - $ -
86732 Mucormycosis antibody X 9 XXX $ - $ -
86735 Mumps antibody X 9 XXX $ - $ -
86738 Mycoplasma antibody X 9 XXX $ - $ -
86741 Neisseria meningitidis X 9 XXX $ - $ -
86744 Nocardia antibody X 9 XXX $ - $ -
86747 Parvovirus antibody X 9 XXX $ - $ -
86750 Malaria antibody X 9 XXX $ - $ -
86753 Protozoa antibody nos X 9 XXX $ - $ -
86756 Respiratory virus antibody X 9 XXX $ - $ -
86757 Rickettsia antibody X 9 XXX $ - $ -
86759 Rotavirus antibody X 9 XXX $ - $ -
86762 Rubella antibody X 9 XXX $ - $ -
86765 Rubeola antibody X 9 XXX $ - $ -
86768 Salmonella antibody X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
86771 Shigella antibody X 9 XXX $ - $ -

86774 Tetanus antibody X 9 XXX $ - $ -
86777 Toxoplasma antibody X 9 XXX $ - $ -
86778 Toxoplasma antibody igm X 9 XXX $ - $ -
86780 Treponema pallidum X 9 XXX $ - $ -
86784 Trichinella antibody X 9 XXX $ - $ -
86787 Varicella-zoster antibody X 9 XXX $ - $ -
86788 West nile virus ab igm X 9 XXX $ - $ -
86789 West nile virus antibody X 9 XXX $ - $ -
86790 Virus antibody nos X 9 XXX $ - $ -
86793 Yersinia antibody X 9 XXX $ - $ -
86800 Thyroglobulin antibody X 9 XXX $ - $ -
86803 Hepatitis c ab test X 9 XXX $ - $ -
86804 Hep c ab test confirm X 9 XXX $ - $ -
86805 Lymphocytotoxicity assay X 9 XXX $ - $ -
86806 Lymphocytotoxicity assay X 9 XXX $ - $ -
86807 Cytotoxic antibody screening X 9 XXX $ - $ -
86808 Cytotoxic antibody screening X 9 XXX $ - $ -
86812 Hla typing a b or c X 9 XXX $ - $ -
86813 Hla typing a b or c X 9 XXX $ - $ -
86816 Hla typing dr/dq X 9 XXX $ - $ -
86817 Hla typing dr/dq X 9 XXX $ - $ -
86821 Lymphocyte culture mixed X 9 XXX $ - $ -
86822 Lymphocyte culture primed X 9 XXX $ - $ -
86825 Hla x-math non-cytotoxic X 9 XXX $ - $ -
86826 Hla x-match noncytotoxc addl X 9 XXX $ - $ -
86849 Immunology procedure X 9 XXX $ - $ -
86850 RBC antibody screen X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
86860 RBC antibody elution X 9 XXX $ - $ -

86870 RBC antibody identification X 9 XXX $ - $ -
86880 Coombs test direct X 9 XXX $ - $ -
86885 Coombs test indirect qual X 9 XXX $ - $ -
86886 Coombs test indirect titer X 9 XXX $ - $ -
86890 Autologous blood process X 9 XXX $ - $ -
86891 Autologous blood op salvage X 9 XXX $ - $ -
86900 Blood typing abo X 9 XXX $ - $ -
86901 Blood typing rh (d) X 9 XXX $ - $ -
86902 Blood type antigen donor ea X 9 XXX $ - $ -
86904 Blood typing patient serum X 9 XXX $ - $ -
86905 Blood typing rbc antigens X 9 XXX $ - $ -
86906 Blood typing rh phenotype X 9 XXX $ - $ -
86910 Blood typing paternity test N 9 XXX $ - $ -
86911 Blood typing antigen system N 9 XXX $ - $ -
86920 Compatibility test spin X 9 XXX $ - $ -
86921 Compatibility test incubate X 9 XXX $ - $ -
86922 Compatibility test antiglob X 9 XXX $ - $ -
86923 Compatibility test electric X 9 XXX $ - $ -
86927 Plasma fresh frozen X 9 XXX $ - $ -
86930 Frozen blood prep X 9 XXX $ - $ -
86931 Frozen blood thaw X 9 XXX $ - $ -
86932 Frozen blood freeze/thaw X 9 XXX $ - $ -
86940 Hemolysins/agglutinins auto X 9 XXX $ - $ -
86941 Hemolysins/agglutinins X 9 XXX $ - $ -
86945 Blood product/irradiation X 9 XXX $ - $ -
86950 Leukacyte transfusion X 9 XXX $ - $ -
86960 Vol reduction of blood/prod X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
86965 Pooling blood platelets X 9 XXX $ - $ -

86970 RBC pretreatment X 9 XXX $ - $ -
86975 Rbc pretreatment serum X 9 XXX $ - $ -
86985 Split blood or products X 9 XXX $ - $ -
86999 Transfusion procedure X 9 XXX $ - $ -
87001 Small animal inoculation X 9 XXX $ - $ -
87003 Small animal inoculation X 9 XXX $ - $ -
87015 Specimen concentration X 9 XXX $ - $ -
87040 Blood culture for bacteria X 9 XXX $ - $ -
87045 Feces culture bacteria X 9 XXX $ - $ -
87046 Stool cultr bacteria each X 9 XXX $ - $ -
87070 Culture bacteria other X 9 XXX $ - $ -
87071 Culture bacteri aerobic othr X 9 XXX $ - $ -
87073 Culture bacteria anaerobic X 9 XXX $ - $ -
87075 Cultr bacteria except blood X 9 XXX $ - $ -
87076 Culture anaerobe ident each X 9 XXX $ - $ -
87077 Culture aerobic identify X 9 XXX $ - $ -
87081 Culture screen only X 9 XXX $ - $ -
87084 Culture of specimen by kit X 9 XXX $ - $ -
87086 Urine culture/colony count X 9 XXX $ - $ -
87088 Urine bacteria culture X 9 XXX $ - $ -
87101 Skin fungi culture X 9 XXX $ - $ -
87102 Fungus isolation culture X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
87103 Blood fungus culture X 9 XXX $ - $ -

87106 Fungi identification yeast X 9 XXX $ - $ -
87107 Fungi identification mold X 9 XXX $ - $ -
87109 Mycoplasma X 9 XXX $ - $ -
87110 Chlamydia culture X 9 XXX $ - $ -
87116 Mycobacteria culture X 9 XXX $ - $ -
87118 Mycobacteric identification X 9 XXX $ - $ -
87140 Culture type immunofluoresc X 9 XXX $ - $ -
87143 Culture typing glc/hplc X 9 XXX $ - $ -
87147 Culture type immunologic X 9 XXX $ - $ -
87149 Dna/rna direct probe X 9 XXX $ - $ -
87150 Dna/rna amplified probe X 9 XXX $ - $ -
87152 Culture type pulse field gel X 9 XXX $ - $ -
87153 Dna/rna sequencing X 9 XXX $ - $ -
87158 Culture typing added method X 9 XXX $ - $ -
87164 Dark field examination X 9 XXX $ - $ -
87164 26 Dark field examination A 6 XXX $ 20.53 $ 20.53
87166 Dark field examination X 9 XXX $ - $ -
87168 Macroscopic exam arthropod X 9 XXX $ - $ -
87169 Macroscopic exam parasite X 9 XXX $ - $ -
87172 Pinworm exam X 9 XXX $ - $ -
87176 Tissue homogenization cultr X 9 XXX $ - $ -
87177 Ova and parasites smears X 9 XXX $ - $ -
87181 Microbe susceptible diffuse X 9 XXX $ - $ -
87184 Microbe susceptible disk X 9 XXX $ - $ -
87185 Microbe susceptible enzyme X 9 XXX $ - $ -
87186 Microbe susceptible mic X 9 XXX $ - $ -
87187 Microbe susceptible mlc X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
87188 Microbe suscept macrobroth X 9 XXX $ - $ -

87190 Microbe suscept mycobacteri X 9 XXX $ - $ -
87197 Bactericidal level serum X 9 XXX $ - $ -
87205 Smear gram stain X 9 XXX $ - $ -
87206 Smear fluorescent/acid stai X 9 XXX $ - $ -
87207 Smear special stain X 9 XXX $ - $ -
87207 26 Smear special stain A 6 XXX $ 20.88 $ 20.88
87209 Smear complex stain X 9 XXX $ - $ -
87210 Smear wet mount saline/ink X 9 XXX $ - $ -
87220 Tissue exam for fungi X 9 XXX $ - $ -
87230 Assay toxin or antitoxin X 9 XXX $ - $ -
87250 Virus inoculate eggs/animal X 9 XXX $ - $ -
87252 Virus inoculation tissue X 9 XXX $ - $ -
87253 Virus inoculate tissue addl X 9 XXX $ - $ -
87254 Virus inoculation shell via X 9 XXX $ - $ -
87255 Genet virus isolate hsv X 9 XXX $ - $ -
87260 Adenovirus ag if X 9 XXX $ - $ -
87265 Pertussis ag if X 9 XXX $ - $ -
87267 Enterovirus antibody dfa X 9 XXX $ - $ -
87269 Giardia ag if X 9 XXX $ - $ -
87270 Chlamydia trachomatis ag if X 9 XXX $ - $ -
87271 Cytomegalovirus dfa X 9 XXX $ - $ -
87272 Cryptosporidium ag if X 9 XXX $ - $ -
87273 Herpes simplex 2 ag if X 9 XXX $ - $ -
87274 Herpes simplex 1 ag if X 9 XXX $ - $ -
87275 Influenza b ag if X 9 XXX $ - $ -
87276 Influenza a ag if X 9 XXX $ - $ -
87277 Legionella micdadei ag if X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
87278 Legion pneumophilia ag if X 9 XXX $ - $ -

87279 Parainfluenza ag if X 9 XXX $ - $ -
87280 Respiratory syncytial ag if X 9 XXX $ - $ -
87281 Pneumocystis carinii ag if X 9 XXX $ - $ -
87283 Rubeola ag if X 9 XXX $ - $ -
87285 Treponema pallidum ag if X 9 XXX $ - $ -
87290 Varicella zoster ag if X 9 XXX $ - $ -
87299 Antibody detection nos if X 9 XXX $ - $ -
87300 Ag detection polyval if X 9 XXX $ - $ -
87301 Adenovirus ag eia X 9 XXX $ - $ -
87305 Aspergillus ag eia X 9 XXX $ - $ -
87320 Chylmd trach ag eia X 9 XXX $ - $ -
87324 Clostridium ag eia X 9 XXX $ - $ -
87327 Cryptococcus neoform ag eia X 9 XXX $ - $ -
87328 Cryptosporidium ag eia X 9 XXX $ - $ -
87329 Giardia ag eia X 9 XXX $ - $ -
87332 Cytomegalovirus ag eia X 9 XXX $ - $ -
87335 E coli 0157 ag eia X 9 XXX $ - $ -
87336 Entamoeb hist dispr ag eia X 9 XXX $ - $ -
87337 Entamoeb hist group ag eia X 9 XXX $ - $ -
87338 Hpylori stool eia X 9 XXX $ - $ -
87339 H pylori ag eia X 9 XXX $ - $ -
87340 Hepatitis b surface ag eia X 9 XXX $ - $ -
87341 Hepatitis b surface ag eia X 9 XXX $ - $ -
87350 Hepatitis be ag eia X 9 XXX $ - $ -
87380 Hepatitis delta ag eia X 9 XXX $ - $ -
87385 Histoplasma capsul ag eia X 9 XXX $ - $ -
87389 Hiv-1 ag w/hiv-1 & hiv-2 ab X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
87390 Hiv-1 ag eia X 9 XXX $ - $ -

87391 Hiv-2 ag eia X 9 XXX $ - $ -
87400 Influenza a/b ag eia X 9 XXX $ - $ -
87420 Resp syncytial ag eia X 9 XXX $ - $ -
87425 Rotavirus ag eia X 9 XXX $ - $ -
87427 Shiga-like toxin ag eia X 9 XXX $ - $ -
87430 Strep a ag eia X 9 XXX $ - $ -
87449 Ag detect nos eia mult X 9 XXX $ - $ -
87450 Ag detect nos eia single X 9 XXX $ - $ -
87451 Ag detect polyval eia mult X 9 XXX $ - $ -
87470 Bartonella dna dir probe X 9 XXX $ - $ -
87471 Bartonella dna amp probe X 9 XXX $ - $ -
87472 Bartonella dna quant X 9 XXX $ - $ -
87475 Lyme dis dna dir probe X 9 XXX $ - $ -
87476 Lyme dis dna amp probe X 9 XXX $ - $ -
87477 Lyme dis dna quant X 9 XXX $ - $ -
87480 Candida dna dir probe X 9 XXX $ - $ -
87481 Candida dna amp probe X 9 XXX $ - $ -
87482 Candida dna quant X 9 XXX $ - $ -
87485 Chylmd pneum dna dir probe X 9 XXX $ - $ -
87486 Chylmd pneum dna amp probe X 9 XXX $ - $ -
87487 Chylmd pneum dna quant X 9 XXX $ - $ -
87490 Chylmd trach dna dir probe X 9 XXX $ - $ -
87491 Chylmd trach dna amp probe X 9 XXX $ - $ -
87492 Chylmd trach dna quant X 9 XXX $ - $ -
87493 C diff amplified probe X 9 XXX $ - $ -
87495 Cytomeg dna dir probe X 9 XXX $ - $ -
87496 Cytomeg dna amp probe X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
87497 Cytomeg dna quant X 9 XXX $ - $ -

87498 Enterovirus dna amp probe X 9 XXX $ - $ -
87500 Vanomycin dna amp probe X 9 XXX $ - $ -
87501 Influenza dna amp prob 1+ X 9 XXX $ - $ -
87502 Influenza dna amp probe X 9 XXX $ - $ -
87503 Influenza dna amp prob addl X 9 XXX $ - $ -
87510 Gardner vag dna dir probe X 9 XXX $ - $ -
87511 Gardner vag dna amp probe X 9 XXX $ - $ -
87512 Gardner vag dna quant X 9 XXX $ - $ -
87515 Hepatitis b dna dir probe X 9 XXX $ - $ -
87516 Hepatitis b dna amp probe X 9 XXX $ - $ -
87517 Hepatitis b dna quant X 9 XXX $ - $ -
87520 Hepatitis c rna dir probe X 9 XXX $ - $ -
87521 Hepatitis c rna amp probe X 9 XXX $ - $ -
87522 Hepatitis c rna quant X 9 XXX $ - $ -
87525 Hepatitis g dna dir probe X 9 XXX $ - $ -
87526 Hepatitis g dna amp probe X 9 XXX $ - $ -
87527 Hepatitis g dna quant X 9 XXX $ - $ -
87528 Hsv dna dir probe X 9 XXX $ - $ -
87529 Hsv dna amp probe X 9 XXX $ - $ -
87530 Hsv dna quant X 9 XXX $ - $ -
87531 Hhv-6 dna dir probe X 9 XXX $ - $ -
87532 Hhv-6 dna amp probe X 9 XXX $ - $ -
87533 Hhv-6 dna quant X 9 XXX $ - $ -
87534 Hiv-1 dna dir probe X 9 XXX $ - $ -
87535 Hiv-1 dna amp probe X 9 XXX $ - $ -
87536 Hiv-1 dna quant X 9 XXX $ - $ -
87537 Hiv-2 dna dir probe X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
87538 Hiv-2 dna amp probe X 9 XXX $ - $ -

87539 Hiv-2 dna quant X 9 XXX $ - $ -
87540 Legion pneumo dna dir prob X 9 XXX $ - $ -
87541 Legion pneumo dna amp prob X 9 XXX $ - $ -
87542 Legion pneumo dna quant X 9 XXX $ - $ -
87550 Mycobacteria dna dir probe X 9 XXX $ - $ -
87551 Mycobacteria dna amp probe X 9 XXX $ - $ -
87552 Mycobacteria dna quant X 9 XXX $ - $ -
87555 M.tuberculo dna dir probe X 9 XXX $ - $ -
87556 M.tuberculo dna amp probe X 9 XXX $ - $ -
87557 M.tuberculo dna quant X 9 XXX $ - $ -
87560 M.avium-intra dna dir prob X 9 XXX $ - $ -
87561 M.avium-intra dna amp prob X 9 XXX $ - $ -
87562 M.avium-intra dna quant X 9 XXX $ - $ -
87580 M.pneumon dna dir probe X 9 XXX $ - $ -
87581 M.pneumon dna amp probe X 9 XXX $ - $ -
87582 M.pneumon dna quant X 9 XXX $ - $ -
87590 N.gonorrhoeae dna dir prob X 9 XXX $ - $ -
87591 N.gonorrhoeae dna amp prob X 9 XXX $ - $ -
87592 N.gonorrhoeae dna quant X 9 XXX $ - $ -
87620 Hpv dna dir probe X 9 XXX $ - $ -
87621 Hpv dna amp probe X 9 XXX $ - $ -
87622 Hpv dna quant X 9 XXX $ - $ -
87640 Staph a dna amp probe X 9 XXX $ - $ -
87641 Mr-staph dna amp probe X 9 XXX $ - $ -
87650 Strep a dna dir probe X 9 XXX $ - $ -
87651 Strep a dna amp probe X 9 XXX $ - $ -
87652 Strep a dna quant X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
87653 Strep b dna amp probe X 9 XXX $ - $ -

87660 Trichomonas vagin dir probe X 9 XXX $ - $ -
87797 Detect agent nos dna dir X 9 XXX $ - $ -
87798 Detect agent nos dna amp X 9 XXX $ - $ -
87799 Detect agent nos dna quant X 9 XXX $ - $ -
87800 Detect agnt mult dna direc X 9 XXX $ - $ -
87801 Detect agnt mult dna ampli X 9 XXX $ - $ -
87802 Strep b assay w/optic X 9 XXX $ - $ -
87803 Clostridium toxin a w/optic X 9 XXX $ - $ -
87804 Influenza assay w/optic X 9 XXX $ - $ -
87807 Rsv assay w/optic X 9 XXX $ - $ -
87808 Trichomonas assay w/optic X 9 XXX $ - $ -
87809 Adenovirus assay w/optic X 9 XXX $ - $ -
87810 Chylmd trach assay w/optic X 9 XXX $ - $ -
87850 N. gonorrhoeae assay w/optic X 9 XXX $ - $ -
87880 Strep a assay w/optic X 9 XXX $ - $ -
87899 Agent nos assay w/optic X 9 XXX $ - $ -
87900 Phenotype infect agent drug X 9 XXX $ - $ -
87901 Genotype dna hiv reverse t X 9 XXX $ - $ -
87902 Genotype dna hepatitis c X 9 XXX $ - $ -
87903 Phenotype dna hiv w/culture X 9 XXX $ - $ -
87904 Phenotype dna hiv w/clt add X 9 XXX $ - $ -
87905 Sialidase enzyme assay X 9 XXX $ - $ -
87906 Genotype dna hiv reverse t X 9 XXX $ - $ -
87999 Microbiology procedure X 9 XXX $ - $ -
88000 Autopsy (necropsy) gross N 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

88020 Autopsy (necropsy) complete N 9 XXX $ - $ -
88036 Limited autopsy N 9 XXX $ - $ -
88037 Limited autopsy N 9 XXX $ - $ -
88040 Forensic autopsy (necropsy) N 9 XXX $ - $ -
88045 Coroners autopsy (necropsy) N 9 XXX $ - $ -
88099 Necropsy (autopsy) procedure N 9 XXX $ - $ -
88104 Cytopath fl nongyn smears A 1 XXX $ - $ 61.60
88104 26 Cytopath fl nongyn smears A 1 XXX $ 26.45 $ 26.45
88104 TC Cytopath fl nongyn smears A 1 XXX $ - $ 35.15
88106 Cytopath fl nongyn filter A 1 XXX $ - $ 65.08
88106 26 Cytopath fl nongyn filter A 1 XXX $ 18.44 $ 18.44
88106 TC Cytopath fl nongyn filter A 1 XXX $ - $ 46.63
88108 Cytopath concentrate tech A 1 XXX $ - $ 63.68
88108 26 Cytopath concentrate tech A 1 XXX $ 21.23 $ 21.23
88108 TC Cytopath concentrate tech A 1 XXX $ - $ 42.80
88112 Cytopath cell enhance tech A 1 XXX $ - $ 96.74
88112 26 Cytopath cell enhance tech A 1 XXX $ 56.72 $ 56.72
88112 TC Cytopath cell enhance tech A 1 XXX $ - $ 40.02
88120 Cytp urne 3-5 probes ea spec A 1 XXX $ - $ 411.68
88120 26 Cytp urne 3-5 probes ea spec A 1 XXX $ 52.20 $ 52.20
88120 TC Cytp urne 3-5 probes ea spec A 1 XXX $ - $ 359.48

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
88121 Cytp urine 3-5 probes cmptr A 1 XXX $ - $ 353.57

88121 26 Cytp urine 3-5 probes cmptr A 1 XXX $ 46.28 $ 46.28
88121 TC Cytp urine 3-5 probes cmptr A 1 XXX $ - $ 307.28
88125 Forensic cytopathology A 1 XXX $ - $ 21.58
88125 26 Forensic cytopathology A 1 XXX $ 12.88 $ 12.88
88125 TC Forensic cytopathology A 1 XXX $ - $ 8.70
88130 Sex chromatin identification X 9 XXX $ - $ -
88140 Sex chromatin identification X 9 XXX $ - $ -
88141 Cytopath c/v interpret A 2 XXX $ 29.23 $ 29.23
88142 Cytopath c/v thin layer X 9 XXX $ - $ -
88143 Cytopath c/v thin layer redo X 9 XXX $ - $ -
88147 Cytopath c/v automated X 9 XXX $ - $ -
88148 Cytopath c/v auto rescreen X 9 XXX $ - $ -
88150 Cytopath c/v manual X 9 XXX $ - $ -
88152 Cytopath c/v auto redo X 9 XXX $ - $ -
88153 Cytopath c/v redo X 9 XXX $ - $ -
88154 Cytopath c/v select X 9 XXX $ - $ -
88155 Cytopath c/v index add-on X 9 XXX $ - $ -
88160 Cytopath smear other source A 1 XXX $ - $ 51.50
88160 26 Cytopath smear other source A 1 XXX $ 23.66 $ 23.66
88160 TC Cytopath smear other source A 1 XXX $ - $ 27.49
88164 Cytopath tbs c/v manual X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
88165 Cytopath tbs c/v redo X 9 XXX $ - $ -

88166 Cytopath tbs c/v auto redo X 9 XXX $ - $ -
88167 Cytopath tbs c/v select X 9 XXX $ - $ -
88172 Cytp dx eval fna 1st ea site A 1 XXX $ - $ 49.76
88172 26 Cytp dx eval fna 1st ea site A 1 XXX $ 32.71 $ 32.71
88172 TC Cytp dx eval fna 1st ea site A 1 XXX $ - $ 17.05
88173 Cytopath eval fna report A 1 XXX $ - $ 128.41
88173 26 Cytopath eval fna report A 1 XXX $ 67.16 $ 67.16
88173 TC Cytopath eval fna report A 1 XXX $ - $ 61.25
88174 Cytopath c/v auto in fluid X 9 XXX $ - $ -
88175 Cytopath c/v auto fluid redo X 9 XXX $ - $ -
88177 Cytp fna eval ea addl A 1 ZZZ $ - $ 27.14
88177 26 Cytp fna eval ea addl A 1 ZZZ $ 20.53 $ 20.53
88177 TC Cytp fna eval ea addl A 1 ZZZ $ - $ 6.61
88182 Cell marker study A 1 XXX $ - $ 95.35
88182 26 Cell marker study A 1 XXX $ 35.15 $ 35.15
88182 TC Cell marker study A 1 XXX $ - $ 60.20
88184 Flowcytometry/ tc 1 marker A 3 XXX $ - $ 70.99
88185 Flowcytometry/tc add-on A 3 ZZZ $ - $ 43.15
88187 Flowcytometry/read 2-8 A 2 XXX $ 69.95 $ 69.95
88188 Flowcytometry/read 9-15 A 2 XXX $ 87.35 $ 87.35
88189 Flowcytometry/read 16 & > A 2 XXX $ 107.53 $ 107.53
88199 Cytopathology procedure X 1 XXX $ - $ -
88199 26 Cytopathology procedure X 1 XXX $ - $ -
88199 TC Cytopathology procedure X 1 XXX $ - $ -
88230 Tissue culture lymphocyte X 9 XXX $ - $ -
88233 Tissue culture skin/biopsy X 9 XXX $ - $ -
88235 Tissue culture placenta X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
88237 Tissue culture bone marrow X 9 XXX $ - $ -

88239 Tissue culture tumor X 9 XXX $ - $ -
88240 Cell cryopreserve/storage X 9 XXX $ - $ -
88241 Frozen cell preparation X 9 XXX $ - $ -
88245 Chromosome analysis 20-25 X 9 XXX $ - $ -
88249 Chromosome analysis 100 X 9 XXX $ - $ -
88267 Chromosome analys placenta X 9 XXX $ - $ -
88269 Chromosome analys amniotic X 9 XXX $ - $ -
88271 Cytogenetics dna probe X 9 XXX $ - $ -
88272 Cytogenetics 3-5 X 9 XXX $ - $ -
88280 Chromosome karyotype study X 9 XXX $ - $ -
88283 Chromosome banding study X 9 XXX $ - $ -
88285 Chromosome count additional X 9 XXX $ - $ -
88289 Chromosome study additional X 9 XXX $ - $ -
88291 Cyto/molecular report A 2 XXX $ 29.93 $ 29.93
88299 Cytogenetic study X 0 XXX $ - $ -
88300 Surgical path gross A 1 XXX $ - $ 26.10
88300 26 Surgical path gross A 1 XXX $ 4.87 $ 4.87
88300 TC Surgical path gross A 1 XXX $ - $ 20.88
88302 Tissue exam by pathologist A 1 XXX $ - $ 49.76

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
88302 26 Tissue exam by pathologist A 1 XXX $ 6.96 $ 6.96

88302 TC Tissue exam by pathologist A 1 XXX $ - $ 42.80
88311 Decalcify tissue A 1 XXX $ - $ 19.14
88311 26 Decalcify tissue A 1 XXX $ 12.18 $ 12.18
88311 TC Decalcify tissue A 1 XXX $ - $ 6.96
88312 Special stains group 1 A 1 XXX $ - $ 83.52
88312 26 Special stains group 1 A 1 XXX $ 25.40 $ 25.40
88312 TC Special stains group 1 A 1 XXX $ - $ 58.12
88313 Special stains group 2 A 1 XXX $ - $ 58.46
88313 26 Special stains group 2 A 1 XXX $ 11.83 $ 11.83
88313 TC Special stains group 2 A 1 XXX $ - $ 46.63
88314 Histochemical stains add-on A 1 XXX $ - $ 71.69
88314 26 Histochemical stains add-on A 1 XXX $ 21.58 $ 21.58
88314 TC Histochemical stains add-on A 1 XXX $ - $ 50.11
88319 Enzyme histochemistry A 1 XXX $ - $ 89.09
88319 26 Enzyme histochemistry A 1 XXX $ 27.14 $ 27.14

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
88319 TC Enzyme histochemistry A 1 XXX $ - $ 61.60

88321 Microslide consultation A 0 XXX $ 84.56 $ 92.57
88323 Microslide consultation A 1 XXX $ - $ 129.11
88323 26 Microslide consultation A 1 XXX $ 81.08 $ 81.08
88323 TC Microslide consultation A 1 XXX $ - $ 48.02
88325 Comprehensive review of data A 0 XXX $ 127.72 $ 188.96
88329 Path consult introp A 0 XXX $ 35.84 $ 51.50
88331 Path consult intraop 1 bloc A 1 XXX $ - $ 85.61
88331 26 Path consult intraop 1 bloc A 1 XXX $ 56.38 $ 56.38
88331 TC Path consult intraop 1 bloc A 1 XXX $ - $ 29.23
88332 Path consult intraop addl A 1 XXX $ - $ 38.98
88332 26 Path consult intraop addl A 1 XXX $ 28.54 $ 28.54
88332 TC Path consult intraop addl A 1 XXX $ - $ 10.79
88333 Intraop cyto path consult 1 A 1 XXX $ - $ 92.22
88333 26 Intraop cyto path consult 1 A 1 XXX $ 59.86 $ 59.86
88333 TC Intraop cyto path consult 1 A 1 XXX $ - $ 32.71
88334 Intraop cyto path consult 2 A 1 XXX $ - $ 57.77
88334 26 Intraop cyto path consult 2 A 1 XXX $ 37.24 $ 37.24
88334 TC Intraop cyto path consult 2 A 1 XXX $ - $ 20.88
88342 Immunohistochemistry A 1 XXX $ - $ 96.74
88342 26 Immunohistochemistry A 1 XXX $ 41.06 $ 41.06
88342 TC Immunohistochemistry A 1 XXX $ - $ 55.68
88346 Immunofluorescent study A 1 XXX $ - $ 93.26
88346 26 Immunofluorescent study A 1 XXX $ 39.67 $ 39.67
88346 TC Immunofluorescent study A 1 XXX $ - $ 53.59
88347 Immunofluorescent study A 1 XXX $ - $ 68.21
88347 26 Immunofluorescent study A 1 XXX $ 36.19 $ 36.19
88347 TC Immunofluorescent study A 1 XXX $ - $ 32.36

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
88348 Electron microscopy A 1 XXX $ - $ 613.52

88348 26 Electron microscopy A 1 XXX $ 72.04 $ 72.04
88348 TC Electron microscopy A 1 XXX $ - $ 541.49
88349 Scanning electron microscopy A 1 XXX $ - $ 342.08
88349 26 Scanning electron microscopy A 1 XXX $ 38.63 $ 38.63
88349 TC Scanning electron microscopy A 1 XXX $ - $ 303.46
88355 Analysis skeletal muscle A 1 XXX $ - $ 178.18
88355 26 Analysis skeletal muscle A 1 XXX $ 82.48 $ 82.48
88355 TC Analysis skeletal muscle A 1 XXX $ - $ 95.70
88356 Analysis nerve A 1 XXX $ - $ 260.65
88356 26 Analysis nerve A 1 XXX $ 133.63 $ 133.63
88356 TC Analysis nerve A 1 XXX $ - $ 126.67
88358 Analysis tumor A 1 XXX $ - $ 72.04
88358 26 Analysis tumor A 1 XXX $ 42.46 $ 42.46
88358 TC Analysis tumor A 1 XXX $ - $ 29.23
88360 Tumor immunohistochem/manual A 1 XXX $ - $ 110.66
88360 26 Tumor immunohistochem/manual A 1 XXX $ 51.16 $ 51.16
88360 TC Tumor immunohistochem/manual A 1 XXX $ - $ 59.51
88361 Tumor immunohistochem/comput A 1 XXX $ - $ 138.16
88361 26 Tumor immunohistochem/comput A 1 XXX $ 56.38 $ 56.38
88361 TC Tumor immunohistochem/comput A 1 XXX $ - $ 81.78
88362 Nerve teasing preparations A 1 XXX $ - $ 278.05
88362 26 Nerve teasing preparations A 1 XXX $ 109.62 $ 109.62
88362 TC Nerve teasing preparations A 1 XXX $ - $ 168.43
88363 Xm archive tissue molec anal A 0 XXX $ 17.75 $ 34.45
88365 Insitu hybridization (fish) A 1 XXX $ - $ 149.29
88365 26 Insitu hybridization (fish) A 1 XXX $ 56.03 $ 56.03
88365 TC Insitu hybridization (fish) A 1 XXX $ - $ 93.26

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
88367 Insitu hybridization auto A 1 XXX $ - $ 234.90

88367 26 Insitu hybridization auto A 1 XXX $ 61.60 $ 61.60
88367 TC Insitu hybridization auto A 1 XXX $ - $ 173.30
88368 Insitu hybridization manual A 1 XXX $ - $ 198.36
88368 26 Insitu hybridization manual A 1 XXX $ 61.94 $ 61.94
88368 TC Insitu hybridization manual A 1 XXX $ - $ 136.42
88371 Protein western blot tissue X 9 XXX $ - $ -
88371 26 Protein western blot tissue A 6 XXX $ 20.18 $ 20.18
88372 Protein analysis w/probe X 9 XXX $ - $ -
88372 26 Protein analysis w/probe A 6 XXX $ 18.10 $ 18.10
88380 Microdissection laser A 1 XXX $ - $ 166.34
88380 26 Microdissection laser A 1 XXX $ 73.78 $ 73.78
88380 TC Microdissection laser A 1 XXX $ - $ 92.57
88381 Microdissection manual A 1 XXX $ - $ 145.46
88381 26 Microdissection manual A 1 XXX $ 51.16 $ 51.16
88381 TC Microdissection manual A 1 XXX $ - $ 94.66
88384 Eval molecular probes 11-50 C 1 XXX $ - $ -
88384 26 Eval molecular probes 11-50 C 1 XXX $ - $ -
88384 TC Eval molecular probes 11-50 C 1 XXX $ - $ -
88385 Eval molecul probes 51-250 A 1 XXX $ - $ 479.20
88385 26 Eval molecul probes 51-250 A 1 XXX $ 63.34 $ 63.34
88385 TC Eval molecul probes 51-250 A 1 XXX $ - $ 415.86
88386 Eval molecul probes 251-500 A 1 XXX $ - $ 543.23
88386 26 Eval molecul probes 251-500 A 1 XXX $ 83.87 $ 83.87
88386 TC Eval molecul probes 251-500 A 1 XXX $ - $ 459.71
88387 Tiss exam molecular study A 1 XXX $ - $ 34.10
88387 26 Tiss exam molecular study A 1 XXX $ 27.84 $ 27.84
88387 TC Tiss exam molecular study A 1 XXX $ - $ 6.26

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
88388 Tiss ex molecul study add-on A 1 XXX $ - $ 29.93

88388 26 Tiss ex molecul study add-on A 1 XXX $ 21.92 $ 21.92
88388 TC Tiss ex molecul study add-on A 1 XXX $ - $ 7.66
88399 Surgical pathology procedure C 1 XXX $ - $ -
88399 26 Surgical pathology procedure C 1 XXX $ - $ -
88399 TC Surgical pathology procedure C 1 XXX $ - $ -
88720 Bilirubin total transcut X 9 XXX $ - $ -
88738 Hgb quant transcutaneous X 9 XXX $ - $ -
88740 Transcutaneous carboxyhb X 9 XXX $ - $ -
88741 Transcutaneous methb X 9 XXX $ - $ -
88749 In vivo lab service X 9 XXX $ - $ -
89049 Chct for mal hyperthermia A 0 XXX $ 70.30 $ 239.08
89050 Body fluid cell count X 9 XXX $ - $ -
89051 Body fluid cell count X 9 XXX $ - $ -
89055 Leukocyte assessment fecal X 9 XXX $ - $ -
89060 Exam synovial fluid crystals X 9 XXX $ - $ -
89060 26 Exam synovial fluid crystals A 6 XXX $ 20.53 $ 20.53
89125 Specimen fat stain X 9 XXX $ - $ -
89160 Exam feces for meat fibers X 9 XXX $ - $ -
89190 Nasal smear for eosinophils X 9 XXX $ - $ -
89220 Sputum specimen collection A 3 XXX $ - $ 14.62
89230 Collect sweat for test A 3 XXX $ - $ 3.13
89240 Pathology lab procedure C 0 XXX $ - $ -
89250 Cultr oocyte/embryo <4 days X 9 XXX $ - $ -
89251 Cultr oocyte/embryo <4 days X 9 XXX $ - $ -
89253 Embryo hatching X 9 XXX $ - $ -
89254 Oocyte identification X 9 XXX $ - $ -
89255 Prepare embryo for transfer X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
89257 Sperm identification X 9 XXX $ - $ -

89258 Cryopreservation embryo(s) X 9 XXX $ - $ -
89259 Cryopreservation sperm X 9 XXX $ - $ -
89260 Sperm isolation simple X 9 XXX $ - $ -
89261 Sperm isolation complex X 9 XXX $ - $ -
89264 Identify sperm tissue X 9 XXX $ - $ -
89268 Insemination of oocytes X 9 XXX $ - $ -
89272 Extended culture of oocytes X 9 XXX $ - $ -
89280 Assist oocyte fertilization X 9 XXX $ - $ -
89281 Assist oocyte fertilization X 9 XXX $ - $ -
89290 Biopsy oocyte polar body X 9 XXX $ - $ -
89291 Biopsy oocyte polar body X 9 XXX $ - $ -
89300 Semen analysis w/huhner X 9 XXX $ - $ -
89310 Semen analysis w/count X 9 XXX $ - $ -
89320 Semen anal vol/count/mot X 9 XXX $ - $ -
89321 Semen anal sperm detection X 9 XXX $ - $ -
89322 Semen anal strict criteria X 9 XXX $ - $ -
89325 Sperm antibody test X 9 XXX $ - $ -
89329 Sperm evaluation test X 9 XXX $ - $ -
89330 Evaluation cervical mucus X 9 XXX $ - $ -
89331 Retrograde ejaculation anal X 9 XXX $ - $ -
89335 Cryopreserve testicular tiss X 9 XXX $ - $ -
89342 Storage/year embryo(s) X 9 XXX $ - $ -
89343 Storage/year sperm/semen X 9 XXX $ - $ -
89344 Storage/year reprod tissue X 9 XXX $ - $ -
89346 Storage/year oocyte(s) X 9 XXX $ - $ -
89352 Thawing cryopresrved embryo X 9 XXX $ - $ -
89353 Thawing cryopresrved sperm X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
89354 Thaw cryoprsvrd reprod tiss X 9 XXX $ - $ -

89356 Thawing cryopresrved oocyte X 9 XXX $ - $ -
89398 Unlisted reprod med lab proc X 9 XXX $ - $ -
90281 Human ig im I 9 XXX $ - $ -
90283 Human ig iv I 9 XXX $ - $ -
90284 Human ig sc X 9 XXX $ - $ -
90287 Botulinum antitoxin I 9 XXX $ - $ -
90288 Botulism ig iv I 9 XXX $ - $ -
90291 Cmv ig iv I 9 XXX $ - $ -
90296 Diphtheria antitoxin I 9 XXX $ - $ -
90371 Hep b ig im I 9 XXX $ - $ -
90375 Rabies ig im/sc I 9 XXX $ - $ -
90376 Rabies ig heat treated I 9 XXX $ - $ -
90378 Rsv mab im 50mg I 9 XXX $ - $ -
90384 Rh ig full-dose im I 9 XXX $ - $ -
90385 Rh ig minidose im I 9 XXX $ - $ -
90386 Rh ig iv I 9 XXX $ - $ -
90389 Tetanus ig im I 9 XXX $ - $ -
90393 Vaccina ig im I 9 XXX $ - $ -
90396 Varicella-zoster ig im I 9 XXX $ - $ -
90399 Immune globulin I 9 XXX $ - $ -
90460 Im admin 1st/only component A 0 XXX $ - $ 22.27 $ 12.00
90461 Im admin each addl component N 0 ZZZ $ - $ 12.18
90471 Immunization admin A 5 XXX $ - $ 22.27 $ 12.00
90472 Immunization admin each add A 5 ZZZ $ - $ 11.48 $ 12.00
90473 Immune admin oral/nasal A 0 XXX $ - $ 20.53 $ 12.00
90474 Immune admin oral/nasal addl A 0 ZZZ $ - $ 11.48 $ 12.00
90476 Adenovirus vaccine type 4 I 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
90477 Adenovirus vaccine type 7 I 9 XXX $ - $ -

90581 Anthrax vaccine sc or im I 9 XXX $ - $ -
90585 Bcg vaccine percut I 9 XXX $ - $ -
90586 Bcg vaccine intravesical I 9 XXX $ - $ -
90632 Hep a vaccine adult im I 9 XXX $ - $ -
90633 Hep a vacc ped/adol 2 dose I 9 XXX $ - $ -
90634 Hep a vacc ped/adol 3 dose I 9 XXX $ - $ -
90636 Hep a/hep b vacc adult im I 9 XXX $ - $ -
90644 Meningoccl hib vac 4 dose im I 9 XXX $ - $ -
90645 Hib vaccine hboc im I 9 XXX $ - $ -
90646 Hib vaccine prp-d im I 9 XXX $ - $ -
90647 Hib vaccine prp-omp im I 9 XXX $ - $ -
90648 Hib vaccine prp-t im I 9 XXX $ - $ -
90649 Hpv vaccine 4 valent im I 9 XXX $ - $ -
90650 Hpv vaccine 2 valent im I 9 XXX $ - $ -
90654 Flu vaccine no preserv id I 9 XXX $ - $ -
90655 Flu vaccine no preserv 6-35m I 9 XXX $ - $ -
90656 Flu vaccine no preserv 3 & > i 9 XXX $ - $ -
90657 Flu vaccine 3 yrs im I 9 XXX $ - $ -
90658 Flu vaccine 3 yrs & > im I 9 XXX $ - $ -
90660 Flu vaccine nasal I 9 XXX $ - $ -
90661 Flu vacc cell cult prsv free I 9 XXX $ - $ -
90662 Flu vacc prsv free inc antig I 9 XXX $ - $ -
90664 Flu vacc pandemic intranasal I 9 XXX $ - $ -
90665 Lyme disease vaccine im I 9 XXX $ - $ -
90666 Flu vac pandem prsrv free im I 9 XXX $ - $ -
90667 Flu vac pandemic adjuvant im i 9 XXX $ - $ -
90668 Flu vac pandemic splt im I 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
90669 Pneumococcal vacc 7 val im I 9 XXX $ - $ -

90670 Pneumococcal vacc 13 val im I 9 XXX $ - $ -
90675 Rabies vaccine im I 9 XXX $ - $ -
90676 Rabies vaccine id I 9 XXX $ - $ -
90680 Rotovirus vacc 3 dose oral I 9 XXX $ - $ -
90681 Rotavirus vacc 2 dose oral I 9 XXX $ - $ -
90690 Typhoid vaccine oral I 9 XXX $ - $ -
90691 Typhoid vaccine im I 9 XXX $ - $ -
90692 Typhoid vaccine h-p sc/id I 9 XXX $ - $ -
90693 Typhoid vaccine akd sc I 9 XXX $ - $ -
90696 Dtap-ipv vacc 4-6 yr im I 9 XXX $ - $ -
90698 Dtap-hib-ip vaccine im I 9 XXX $ - $ -
90700 Dtap vaccine < 7 yrs im I 9 XXX $ - $ -
90701 Dtp vaccine im I 9 XXX $ - $ -
90702 Dt vaccine < 7 im I 9 XXX $ - $ -
90703 Tetanus vaccine im I 9 XXX $ - $ -
90704 Mumps vaccine sc I 9 XXX $ - $ -
90705 Measles vaccine sc I 9 XXX $ - $ -
90706 Rubella vaccine sc I 9 XXX $ - $ -
90707 Mmr vaccine sc I 9 XXX $ - $ -
90708 Measles-rubella vaccine sc I 9 XXX $ - $ -
90710 Mmrv vaccine sc I 9 XXX $ - $ -
90712 Oral poliovirus vaccine I 9 XXX $ - $ -
90713 Poliovirus ipv sc/im I 9 XXX $ - $ -
90714 Td vaccine no prsrv >/= 7 im I 9 XXX $ - $ -
90715 Tdap vaccine >7 im I 9 XXX $ - $ -
90716 Chicken pox vaccine sc I 9 XXX $ - $ -
90717 Yellow fever vaccine sc I 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
90718 Td vaccine > 7 im I 9 XXX $ - $ -

90719 Diphtheria vaccine im I 9 XXX $ - $ -
90720 Dtp/hib vaccine im I 9 XXX $ - $ -
90721 Dtap/hib vaccine im I 9 XXX $ - $ -
90723 Dtap-hep b-ipv vaccine im I 9 XXX $ - $ -
90725 Cholera vaccine injectable I 9 XXX $ - $ -
90727 Plague vaccine im I 9 XXX $ - $ -
90732 Pneumococcal vaccine I 9 XXX $ - $ -
90733 Meningococcal vaccine sc I 9 XXX $ - $ -
90734 Meningococcal vaccine im I 9 XXX $ - $ -
90735 Encephalitis vaccine sc I 9 XXX $ - $ -
90736 Zoster vacc sc I 9 XXX $ - $ -
90738 Inactivated je vacc im I 9 XXX $ - $ -
90740 Hepb vacc ill pat 3 dose im I 9 XXX $ - $ -
90743 Hep b vacc adol 2 dose im I 9 XXX $ - $ -
90744 Hepb vacc ped/adol 3 dose im I 9 XXX $ - $ -
90746 Hep b vaccine adult im I 9 XXX $ - $ -
90747 Hepb vacc ill pat 4 dose im I 9 XXX $ - $ -
90748 Hep b/hib vaccine im I 9 XXX $ - $ -
90749 Vaccine toxoid I 9 XXX $ - $ -
90801 Psy dx interview A 0 XXX $ 124.24 $ 151.73
90802 Intac psy dx interview A 0 XXX $ 133.63 $ 165.30
90804 Psytx office 20-30 min A 0 XXX $ 50.81 $ 61.25
90805 Psytx off 20-30 min w/e&m A 0 XXX $ 59.51 $ 71.69
90806 Psytx off 45-50 min A 0 XXX $ 78.30 $ 84.22
90807 Psytx off 45-50 min w/e&m A 0 XXX $ 88.39 $ 100.57
90808 Psytx office 75-80 min A 0 XXX $ 117.28 $ 123.19
90809 Psytx off 75-80 w/e&m A 0 XXX $ 130.50 $ 141.64

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
90810 Intac psytx off 20-30 min A 0 XXX $ 56.38 $ 64.03

90811 Intac psytx 20-30 w/e&m A 0 XXX $ 66.47 $ 82.13
90813 Intac psytx 45-50 min w/e&m A 0 XXX $ 92.92 $ 108.23
90815 Intac psytx 75-80 w/e&m A 0 XXX $ 137.11 $ 152.08
90816 Psytx hosp 20-30 min A 0 XXX $ 54.98 $ 53.59
90817 Psytx hosp 20-30 min w/e&m A 0 XXX $ 64.38 $ 64.03
90823 Intac psytx hosp 20-30 min A 0 XXX $ 59.86 $ 58.46
90824 Intac psytx hsp 20-30 w/e&m A 0 XXX $ 71.34 $ 70.64
90845 Psychoanalysis A 0 XXX $ 91.18 $ 93.26
90846 Family psytx w/o patient A 0 XXX $ 81.08 $ 84.22
90847 Family psytx w/patient A 0 XXX $ 96.40 $ 103.70
90849 Multiple family group psytx R 0 XXX $ 28.88 $ 32.71
90853 Group psychotherapy A 0 XXX $ 29.58 $ 32.02
90857 Intac group psytx A 0 XXX $ 30.97 $ 36.19
90862 Medication management A 0 XXX $ 45.24 $ 57.42
90865 Narcosynthesis A 0 XXX $ 128.06 $ 157.30
90867 Tcranial magn stim tx plan A 0 000 $ 176.44 $ 323.29
90868 Tcranial magn stim tx deli A 0 000 $ 24.01 $ 147.90

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
90869 Tcran magn stim redetemine A 0 000 $ 123.19 $ 383.15

90870 Electroconvulsive therapy A 0 000 $ 111.36 $ 163.91
90875 Psychophysiological therapy N 9 XXX $ 64.03 $ 73.78
90876 Psychophysiological therapy N 9 XXX $ 99.88 $ 109.62
90880 Hypnotherapy N 0 XXX $ 93.61 $ 99.18
90882 Environmental manipulation N 9 XXX $ - $ -
90885 Psy evaluation of records B 9 XXX $ 52.20 $ 52.20
90887 Consultation with family B 9 XXX $ 78.65 $ 89.09
90889 Preparation of report B 9 XXX $ - $ -
90899 Psychiatric service/therapy C 0 XXX $ - $ -
90901 Biofeedback train any meth A 0 000 $ 20.18 $ 35.84
90911 Biofeedback peri/uro/rectal A 0 000 $ 48.02 $ 82.48
90935 Hemodialysis one evaluation A 0 000 $ 75.52 $ -
90937 Hemodialysis repeated eval A 0 000 $ 107.18 $ -
90940 Hemodialysis access study X 9 XXX $ - $ -
90945 Dialysis one evaluation A 0 000 $ 84.91 $ -
90947 Dialysis repeated eval A 0 000 $ 128.76 $ -
90951 Esrd serv 4 visits p mo <2 A 0 XXX $ 963.26 $ 963.26
90952 Esrd serv 2-3 vsts p mo <2 C 0 XXX $ - $ -
90953 Esrd serv 1 visit p mo <2 C 0 XXX $ - $ -
90954 Esrd serv 4 vsts p mo 2-11 A 0 XXX $ 825.46 $ 825.46
90955 Esrd srv 2-3 vsts p mo 2-11 A 0 XXX $ 463.88 $ 463.88
90956 Esrd srv 1 visit p mo 2-11 A 0 XXX $ 320.16 $ 320.16
90957 Esrd srv 4 vsts p mo 12-19 A 0 XXX $ 658.76 $ 658.76
90958 Esrd srv 2-3 vsts p mo 12-19 A 0 XXX $ 445.09 $ 445.09
90959 Esrd serv 1 vst p mo 12-19 A 0 XXX $ 297.19 $ 297.19
90960 Esrd srv 4 visits p mo 20+ A 0 XXX $ 290.23 $ 290.23
90961 Esrd srv 2-3 vsts p mo 20+ A 0 XXX $ 241.51 $ 241.51

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
90962 Esrd serv 1 visit p mo 20+ A 0 XXX $ 183.40 $ 183.40

90963 Esrd home pt serv p mo <2 A 0 XXX $ 557.50 $ 557.50
90964 Esrd home pt serv p mo 2-11 A 0 XXX $ 480.24 $ 480.24
90965 Esrd home pt serv p mo 12-19 A 0 XXX $ 457.27 $ 457.27
90966 Esrd home pt serv p mo 20+ A 0 XXX $ 240.47 $ 240.47
90967 Esrd home pt serv p day <2 A 0 XXX $ 17.75 $ 17.75
90968 Esrd home pt srv p day 2-11 A 0 XXX $ 14.96 $ 14.96
90969 Esrd home pt srv p day 12-19 A 0 XXX $ 14.62 $ 14.62
90970 Esrd home pt serv p day 20+ A 0 XXX $ 8.00 $ 8.00
90989 Dialysis training complete X 9 XXX $ - $ -
90993 Dialysis training incompl X 9 XXX $ - $ -
90997 Hemoperfusion A 0 000 $ 91.87 $ -
90999 Dialysis procedure C 0 XXX $ - $ -
91010 Esophagus motility study A 1 000 $ - $ 171.56
91010 26 Esophagus motility study A 1 000 $ 69.95 $ 69.95
91010 TC Esophagus motility study A 1 000 $ - $ 101.27
91013 Esophgl motil w/stim/perfus A 1 ZZZ $ - $ 22.97
91013 26 Esophgl motil w/stim/perfus A 1 ZZZ $ 9.74 $ 9.74
91013 TC Esophgl motil w/stim/perfus A 1 ZZZ $ - $ 13.22
91020 Gastric motility studies A 1 000 $ - $ 221.33
91020 26 Gastric motility studies A 1 000 $ 77.95 $ 77.95
91020 TC Gastric motility studies A 1 000 $ - $ 143.38
91022 Duodenal motility study A 1 000 $ - $ 166.34
91022 26 Duodenal motility study A 1 000 $ 76.56 $ 76.56
91022 TC Duodenal motility study A 1 000 $ - $ 89.78
91030 Acid perfusion of esophagus A 1 000 $ - $ 130.50
91030 26 Acid perfusion of esophagus A 1 000 $ 49.07 $ 49.07
91030 TC Acid perfusion of esophagus A 1 000 $ - $ 81.43

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
91034 Gastroesophageal reflux test A 1 000 $ - $ 178.18

91034 26 Gastroesophageal reflux test A 1 000 $ 51.50 $ 51.50
91034 TC Gastroesophageal reflux test A 1 000 $ - $ 126.32
91035 G-esoph reflx tst w/electrod A 1 000 $ - $ 440.57
91035 26 G-esoph reflx tst w/electrod A 1 000 $ 84.91 $ 84.91
91035 TC G-esoph reflx tst w/electrod A 1 000 $ - $ 355.66
91037 Esoph imped function test A 1 000 $ - $ 153.82
91037 26 Esoph imped function test A 1 000 $ 55.33 $ 55.33
91037 TC Esoph imped function test A 1 000 $ - $ 98.48
91038 Esoph imped funct test > 1h A 1 000 $ - $ 349.74
91038 26 Esoph imped funct test > 1h A 1 000 $ 59.51 $ 59.51
91038 TC Esoph imped funct test > 1h A 1 000 $ - $ 290.58
91040 Esoph balloon distension tst A 1 000 $ - $ 278.75
91040 26 Esoph balloon distension tst A 1 000 $ 47.68 $ 47.68
91040 TC Esoph balloon distension tst A 1 000 $ - $ 231.07
91065 Breath hydrogen test A 1 000 $ - $ 78.30
91065 26 Breath hydrogen test A 1 000 $ 10.79 $ 10.79
91065 TC Breath hydrogen test A 1 000 $ - $ 67.51
91110 Gi tract capsule endoscopy A 1 XXX $ - $ 827.54
91110 26 Gi tract capsule endoscopy A 1 XXX $ 196.27 $ 196.27
91110 TC Gi tract capsule endoscopy A 1 XXX $ - $ 631.27
91111 Esophageal capsule endoscopy A 1 XXX $ - $ 657.37
91111 26 Esophageal capsule endoscopy A 1 XXX $ 53.59 $ 53.59
91111 TC Esophageal capsule endoscopy A 1 XXX $ - $ 603.78
91117 Colon motility 6 hr study A 0 000 $ 172.61 $ 163.56
91120 Rectal sensation test A 1 XXX $ - $ 358.09
91120 26 Rectal sensation test A 1 XXX $ 54.29 $ 54.29
91120 TC Rectal sensation test A 1 XXX $ - $ 304.15

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
91122 Anal pressure record A 1 000 $ - $ 209.84

91122 26 Anal pressure record A 1 000 $ 92.22 $ 92.22
91122 TC Anal pressure record A 1 000 $ - $ 117.62
91132 Electrogastrography A 1 XXX $ - $ 141.29
91132 26 Electrogastrography A 1 XXX $ 28.88 $ 28.88
91132 TC Electrogastrography A 1 XXX $ - $ 112.40
91133 Electrogastrography w/test A 1 XXX $ - $ 164.60
91133 26 Electrogastrography w/test A 1 XXX $ 37.24 $ 37.24
91133 TC Electrogastrography w/test A 1 XXX $ - $ 127.72
91299 Gastroenterology procedure C 1 XXX $ - $ -
91299 26 Gastroenterology procedure C 1 XXX $ - $ -
91299 TC Gastroenterology procedure C 1 XXX $ - $ -
92002 Eye exam new patient A 0 XXX $ 50.11 $ 76.91
92004 Eye exam new patient A 0 XXX $ 101.96 $ 141.29
92012 Eye exam established pat A 0 XXX $ 53.94 $ 80.39
92014 Eye exam & treatment A 0 XXX $ 81.78 $ 116.93
92015 Refraction N 9 XXX $ 20.88 $ 24.01
92018 New eye exam & treatment A 0 XXX $ 143.72 $ -
92019 Eye exam & treatment A 0 XXX $ 68.90 $ -
92020 Special eye evaluation A 0 XXX $ 21.92 $ 26.80
92025 Corneal topography A 1 XXX $ - $ 34.10
92025 26 Corneal topography A 1 XXX $ 18.79 $ 18.79
92025 TC Corneal topography A 1 XXX $ - $ 15.66
92060 Special eye evaluation A 1 XXX $ - $ 59.86
92060 26 Special eye evaluation A 1 XXX $ 37.58 $ 37.58
92060 TC Special eye evaluation A 1 XXX $ - $ 22.27
92065 Orthoptic/pleoptic training A 1 XXX $ - $ 47.33
92065 26 Orthoptic/pleoptic training A 1 XXX $ 17.75 $ 17.75

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
92065 TC Orthoptic/pleoptic training A 1 XXX $ - $ 29.58

92071 Contact lens fitting for tx A 0 XXX $ 33.76 $ 37.24
92072 Fit contac lens for managmnt A 0 XXX $ 99.88 $ 120.06
92081 Visual field examination(s) A 1 XXX $ - $ 46.28
92081 26 Visual field examination(s) A 1 XXX $ 18.10 $ 18.10
92081 TC Visual field examination(s) A 1 XXX $ - $ 28.19
92100 Serial tonometry exam(s) A 0 XXX $ 50.46 $ 88.74
92132 Cmptr ophth dx img ant segmt A 1 XXX $ - $ 36.54
92132 26 Cmptr ophth dx img ant segmt A 1 XXX $ 21.58 $ 21.58
92132 TC Cmptr ophth dx img ant segmt A 1 XXX $ - $ 14.96
92133 Cmptr ophth img optic nerve A 1 XXX $ - $ 43.85
92133 26 Cmptr ophth img optic nerve A 1 XXX $ 29.23 $ 29.23
92133 TC Cmptr ophth img optic nerve A 1 XXX $ - $ 14.62
92134 Cptr ophth dx img post segmt A 1 XXX $ - $ 43.85
92134 26 Cptr ophth dx img post segmt A 1 XXX $ 29.23 $ 29.23
92134 TC Cptr ophth dx img post segmt A 1 XXX $ - $ 14.62
92136 Ophthalmic biometry A 1 XXX $ - $ 77.95
92136 26 Ophthalmic biometry A 1 XXX $ 28.88 $ 28.88
92136 TC Ophthalmic biometry A 1 XXX $ - $ 49.42
92140 Glaucoma provocative tests A 0 XXX $ 27.14 $ 56.72
92225 Special eye exam initial A 0 XXX $ 22.27 $ 26.45
92226 Special eye exam subsequent A 0 XXX $ 18.10 $ 22.27

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
92227 Remote dx retinal imaging A 9 XXX $ - $ 11.14

92228 Remote retinal imaging mgmt A 1 XXX $ - $ 32.71
92228 26 Remote retinal imaging mgmt A 1 XXX $ 20.18 $ 20.18
92228 TC Remote retinal imaging mgmt A 1 XXX $ - $ 12.53
92230 Eye exam with photos A 0 XXX $ 33.76 $ 54.98
92235 Eye exam with photos A 1 XXX $ - $ 123.54
92235 26 Eye exam with photos A 1 XXX $ 44.89 $ 44.89
92235 TC Eye exam with photos A 1 XXX $ - $ 78.30
92240 Icg angiography A 1 XXX $ - $ 218.89
92240 26 Icg angiography A 1 XXX $ 59.86 $ 59.86
92240 TC Icg angiography A 1 XXX $ - $ 159.04
92250 Eye exam with photos A 1 XXX $ - $ 68.56
92250 26 Eye exam with photos A 1 XXX $ 22.62 $ 22.62
92250 TC Eye exam with photos A 1 XXX $ - $ 45.94
92260 Ophthalmoscopy/dynamometry A 0 XXX $ 11.14 $ 17.40
92265 Eye muscle evaluation A 1 XXX $ - $ 74.82
92265 26 Eye muscle evaluation A 1 XXX $ 42.11 $ 42.11
92265 TC Eye muscle evaluation A 1 XXX $ - $ 32.71
92270 Electro-oculography A 1 XXX $ - $ 84.91
92270 26 Electro-oculography A 1 XXX $ 41.06 $ 41.06
92270 TC Electro-oculography A 1 XXX $ - $ 44.20
92275 Electroretinography A 1 XXX $ - $ 137.46
92275 26 Electroretinography A 1 XXX $ 56.03 $ 56.03
92275 TC Electroretinography A 1 XXX $ - $ 81.43
92283 Color vision examination A 1 XXX $ - $ 46.98
92283 26 Color vision examination A 1 XXX $ 9.05 $ 9.05
92283 TC Color vision examination A 1 XXX $ - $ 37.58
92284 Dark adaptation eye exam A 1 XXX $ - $ 54.29

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
92284 26 Dark adaptation eye exam A 1 XXX $ 12.18 $ 12.18

92284 TC Dark adaptation eye exam A 1 XXX $ - $ 42.46
92285 Eye photography A 1 XXX $ - $ 22.97
92285 26 Eye photography A 1 XXX $ 4.18 $ 4.18
92285 TC Eye photography A 1 XXX $ - $ 18.79
92286 Internal eye photography A 1 XXX $ - $ 108.58
92286 26 Internal eye photography A 1 XXX $ 33.76 $ 33.76
92286 TC Internal eye photography A 1 XXX $ - $ 74.82
92287 Internal eye photography A 0 XXX $ 45.94 $ 110.32
92310 Contact lens fitting N 9 XXX $ 62.29 $ 92.22
92314 Prescription of contact lens N 9 XXX $ 35.84 $ 72.73
92325 Modification of contact lens N 5 XXX $ - $ 32.71
92326 Replacement of contact lens N 5 XXX $ - $ 30.97
92340 Fitting of spectacles N 9 XXX $ 20.18 $ 34.45
92352 Special spectacles fitting N 9 XXX $ 20.18 $ 38.63
92353 Special spectacles fitting N 9 XXX $ 26.10 $ 44.54
92354 Special spectacles fitting N 9 XXX $ - $ 30.62
92355 Special spectacles fitting N 9 XXX $ - $ 26.80
92358 Eye prosthesis service N 9 XXX $ - $ 11.83
92370 Repair & adjust spectacles N 9 XXX $ 18.10 $ 30.28

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
92371 Repair & adjust spectacles N 9 XXX $ - $ 11.14

92499 Eye service or procedure C 1 XXX $ - $ -
92499 26 Eye service or procedure C 1 XXX $ - $ -
92499 TC Eye service or procedure C 1 XXX $ - $ -
92502 Ear and throat examination A 0 000 $ 95.70 $ -
92504 Ear microscopy examination A 0 XXX $ 9.74 $ 27.84
92506 Speech/hearing evaluation A 7 XXX Y $ - $ 148.25
92507 Speech/hearing therapy A 7 XXX Y $ - $ 75.52
92508 Speech/hearing therapy A 7 XXX Y $ - $ 21.58
92511 Nasopharyngoscopy A 0 000 $ 47.68 $ 128.06
92512 Nasal function studies A 0 XXX $ 29.23 $ 57.77
92516 Facial nerve function test A 0 XXX $ 24.36 $ 65.08
92520 Laryngeal function studies A 0 XXX $ 41.41 $ 66.47
92526 Oral function therapy A 7 XXX Y $ - $ 82.82
92531 Spontaneous nystagmus study B 9 XXX $ - $ -
92532 Positional nystagmus test B 9 XXX $ - $ -
92533 Caloric vestibular test B 9 XXX $ - $ -
92534 Optokinetic nystagmus test B 9 XXX $ - $ -
92540 Basic vestibular evaluation A 1 XXX $ - $ 96.05
92540 26 Basic vestibular evaluation A 1 XXX $ 76.56 $ 76.56
92540 TC Basic vestibular evaluation A 1 XXX $ - $ 19.49
92541 Spontaneous nystagmus test A 1 XXX $ - $ 35.15
92541 26 Spontaneous nystagmus test A 1 XXX $ 19.84 $ 19.84
92541 TC Spontaneous nystagmus test A 1 XXX $ - $ 15.66
92542 Positional nystagmus test A 1 XXX $ - $ 33.76
92542 26 Positional nystagmus test A 1 XXX $ 16.70 $ 16.70
92542 TC Positional nystagmus test A 1 XXX $ - $ 17.05
92543 Caloric vestibular test A 1 XXX $ - $ 18.79

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
92543 26 Caloric vestibular test A 1 XXX $ 5.92 $ 5.92

92543 TC Caloric vestibular test A 1 XXX $ - $ 12.53
92544 Optokinetic nystagmus test A 1 XXX $ - $ 28.19
92544 26 Optokinetic nystagmus test A 1 XXX $ 13.22 $ 13.22
92544 TC Optokinetic nystagmus test A 1 XXX $ - $ 14.96
92545 Oscillating tracking test A 1 XXX $ - $ 26.45
92545 26 Oscillating tracking test A 1 XXX $ 12.18 $ 12.18
92545 TC Oscillating tracking test A 1 XXX $ - $ 14.27
92546 Sinusoidal rotational test A 1 XXX $ - $ 89.09
92546 26 Sinusoidal rotational test A 1 XXX $ 14.62 $ 14.62
92546 TC Sinusoidal rotational test A 1 XXX $ - $ 74.47
92547 Supplemental electrical test A 3 ZZZ $ 5.92 $ 5.92
92548 Posturography A 1 XXX $ - $ 93.26
92548 26 Posturography A 1 XXX $ 24.71 $ 24.71
92548 TC Posturography A 1 XXX $ - $ 68.90
92550 Tympanometry & reflex thresh A 7 XXX $ - $ 20.18
92551 Pure tone hearing test air N 9 XXX $ - $ 10.79
92552 Pure tone audiometry air A 3 XXX $ - $ 26.10
92553 Audiometry air & bone A 3 XXX $ - $ 31.32
92555 Speech threshold audiometry A 3 XXX $ - $ 19.14
92556 Speech audiometry complete A 3 XXX $ - $ 29.58
92557 Comprehensive hearing test A 7 XXX $ 34.45 $ 38.63
92558 Evoked auditory test qual X 9 XXX $ - $ -
92559 Group audiometric testing N 9 XXX $ - $ -
92560 Bekesy audiometry screen N 9 XXX $ - $ -
92561 Bekesy audiometry diagnosis A 3 XXX $ - $ 31.32
92562 Loudness balance test A 3 XXX $ - $ 33.76
92563 Tone decay hearing test A 3 XXX $ - $ 26.10

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
92564 Sisi hearing test A 3 XXX $ - $ 22.62

92565 Stenger test pure tone A 3 XXX $ - $ 14.27
92567 Tympanometry A 7 XXX $ 11.48 $ 14.62
92568 Acoustic refl threshold tst A 7 XXX $ 15.66 $ 15.66
92570 Acoustic immitance testing A 7 XXX $ 30.28 $ 32.36
92571 Filtered speech hearing test A 3 XXX $ - $ 21.58
92572 Staggered spondaic word test A 3 XXX $ - $ 27.49
92575 Sensorineural acuity test A 3 XXX $ - $ 56.03
92576 Synthetic sentence test A 3 XXX $ - $ 29.58
92577 Stenger test speech A 3 XXX $ - $ 16.01
92579 Visual audiometry (vra) A 7 XXX $ 38.28 $ 42.11
92582 Conditioning play audiometry A 3 XXX $ - $ 54.64
92583 Select picture audiometry A 3 XXX $ - $ 40.37
92584 Electrocochleography A 3 XXX $ - $ 61.25
92585 Auditor evoke potent compre A 1 XXX $ - $ 109.27
92585 26 Auditor evoke potent compre A 1 XXX $ 24.71 $ 24.71
92585 TC Auditor evoke potent compre A 1 XXX $ - $ 84.56
92586 Auditor evoke potent limit A 3 XXX $ - $ 68.90
92587 Evoked auditory test limited A 1 XXX $ - $ 28.88
92587 26 Evoked auditory test limited A 1 XXX $ 19.49 $ 19.49
92587 TC Evoked auditory test limited A 1 XXX $ - $ 9.40
92588 Evoked auditory tst complete A 1 XXX $ - $ 41.41
92588 26 Evoked auditory tst complete A 1 XXX $ 28.19 $ 28.19
92588 TC Evoked auditory tst complete A 1 XXX $ - $ 13.22
92590 Hearing aid exam one ear N 9 XXX $ - $ -
92591 Hearing aid exam both ears N 9 XXX $ - $ -
92592 Hearing aid check one ear N 9 XXX $ - $ -
92593 Hearing aid check both ears N 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
92594 Electro hearng aid test one N 9 XXX $ - $ -

92595 Electro hearng aid tst both N 9 XXX $ - $ -
92596 Ear protector evaluation A 3 XXX $ - $ 37.58
92597 Oral speech device eval A 7 XXX Y $ - $ 82.13
92601 Cochlear implt f/up exam < 7 A 7 XXX $ 125.98 $ 142.33
92602 Reprogram cochlear implt < 7 A 7 XXX $ 73.08 $ 89.78
92603 Cochlear implt f/up exam 7 > A 7 XXX $ 124.24 $ 143.38
92604 Reprogram cochlear implt 7 > A 7 XXX $ 67.86 $ 83.87
92605 Ex for nonspeech device rx B 9 XXX $ 89.44 $ 92.92
92606 Non-speech device service B 9 XXX $ 71.34 $ 81.08
92607 Ex for speech device rx 1hr A 7 XXX Y $ - $ 138.16
92608 Ex for speech device rx addl A 7 ZZZ $ - $ 45.59
92609 Use of speech device service A 7 XXX Y $ - $ 98.83
92610 Evaluate swallowing function A 7 XXX $ 68.90 $ 88.04
92611 Motion fluoroscopy/swallow A 7 XXX $ - $ 96.40
92612 Endoscopy swallow tst (fees) A 0 XXX $ 69.25 $ 155.90
92613 Endoscopy swallow tst (fees) A 0 XXX $ 38.63 $ 38.63
92614 Laryngoscopic sensory test A 0 XXX $ 69.60 $ 140.94
92615 Eval laryngoscopy sense tst A 0 XXX $ 34.10 $ 34.10
92616 Fees w/laryngeal sense test A 0 XXX $ 101.62 $ 190.36
92617 Interprt fees/laryngeal test A 0 XXX $ 42.46 $ 42.46
92618 Ex for nonspeech dev rx add B 9 ZZZ $ 32.71 $ 33.41
92620 Auditory function 60 min A 9 XXX $ 80.39 $ 87.70
92621 Auditory function + 15 min A 9 ZZZ $ 17.75 $ 20.53
92625 Tinnitus assessment A 9 XXX $ 60.90 $ 66.12
92626 Eval aud rehab status A 9 XXX $ 77.60 $ 87.00
92627 Eval aud status rehab add-on A 9 ZZZ $ 17.75 $ 20.88
92630 Aud rehab pre-ling hear loss C 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
92633 Aud rehab postling hear loss C 9 XXX $ - $ -

92640 Aud brainstem implt programg A 9 XXX $ 124.24 $ 136.42
92700 Ent procedure/service C 0 XXX $ - $ -
92950 Heart/lung resuscitation cpr A 0 000 $ 201.84 $ 298.24
92953 Temporary external pacing A 0 000 $ 11.14 $ -
92960 Cardioversion electric ext A 0 000 $ 127.37 $ 207.41
92961 Cardioversion electric int A 0 000 $ 267.96 $ -
92970 Cardioassist internal A 0 000 $ 186.88 $ -
92971 Cardioassist external A 0 000 $ 98.14 $ -
92973 Percut coronary thrombectomy A 0 ZZZ $ 232.12 $ -
92974 Cath place cardio brachytx A 0 ZZZ $ 212.63 $ -
92975 Dissolve clot heart vessel A 0 000 Y $ 514.34 $ -
92977 Dissolve clot heart vessel A 5 XXX $ - $ 106.14
92978 Intravasc us heart add-on C 1 ZZZ $ - $ -
92978 26 Intravasc us heart add-on A 1 ZZZ $ 96.40 $ 96.40
92978 TC Intravasc us heart add-on C 1 ZZZ $ - $ -
92979 Intravasc us heart add-on C 1 ZZZ $ - $ -
92979 26 Intravasc us heart add-on A 1 ZZZ $ 77.60 $ 77.60
92979 TC Intravasc us heart add-on C 1 ZZZ $ - $ -
92980 Insert intracoronary stent A 0 000 Y $ 1,059.66 $ -
92981 Insert intracoronary stent A 0 ZZZ $ 294.76 $ -
92982 Coronary artery dilation A 0 000 Y $ 783.35 $ -
92984 Coronary artery dilation A 0 ZZZ $ 210.19 $ -
92986 Revision of aortic valve A 0 090 Y $ 1,712.86 $ -
92987 Revision of mitral valve A 0 090 Y $ 1,766.10 $ -
92990 Revision of pulmonary valve A 0 090 Y $ 1,377.73 $ -
92992 Revision of heart chamber C 0 090 Y Y $ - $ -
92993 Revision of heart chamber C 0 090 Y Y $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
92995 Coronary atherectomy A 0 000 Y $ 863.39 $ -

92996 Coronary atherectomy add-on A 0 ZZZ $ 231.42 $ -
92997 Pul art balloon repr percut A 0 000 Y $ 847.38 $ -
92998 Pul art balloon repr percut A 0 ZZZ $ 423.52 $ -
93000 Electrocardiogram complete A 4 XXX $ - $ 18.79
93005 Electrocardiogram tracing A 3 XXX $ - $ 9.74
93010 Electrocardiogram report A 2 XXX $ 8.70 $ 8.70
93015 Cardiovascular stress test A 4 XXX $ - $ 81.08
93016 Cardiovascular stress test A 2 XXX $ 21.58 $ 21.58
93017 Cardiovascular stress test A 3 XXX $ - $ 44.54
93018 Cardiovascular stress test A 2 XXX $ 14.96 $ 14.96
93024 Cardiac drug stress test A 1 XXX $ - $ 106.49
93024 26 Cardiac drug stress test A 1 XXX $ 58.12 $ 58.12
93024 TC Cardiac drug stress test A 1 XXX $ - $ 48.72
93025 Microvolt t-wave assess A 1 XXX $ - $ 160.08
93025 26 Microvolt t-wave assess A 1 XXX $ 37.93 $ 37.93
93025 TC Microvolt t-wave assess A 1 XXX $ - $ 122.15
93040 Rhythm ECG with report A 4 XXX $ - $ 13.22
93041 Rhythm ecg tracing A 3 XXX $ - $ 5.92
93042 Rhythm ecg report A 2 XXX $ 7.66 $ 7.66
93224 Ecg monit/reprt up to 48 hrs A 4 XXX $ - $ 88.74
93227 Ecg monit/reprt up to 48 hrs A 2 XXX $ 25.75 $ 25.75
93228 Remote 30 day ecg rev/report A 2 XXX $ 26.80 $ 26.80
93229 Remote 30 day ecg tech supp A 3 XXX $ - $ 588.12
93268 ECG record/review A 4 XXX $ - $ 206.71
93270 Remote 30 day ecg rev/report A 3 XXX $ - $ 11.14

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
93271 Ecg/monitoring and analysis A 3 XXX $ - $ 171.22

93272 Ecg/review interpret only A 2 XXX $ 24.36 $ 24.36
93278 ECG/signal-averaged A 1 XXX $ - $ 30.97
93278 26 ECG/signal-averaged A 1 XXX $ 12.88 $ 12.88
93278 TC ECG/signal-averaged A 1 XXX $ - $ 18.10
93279 Pm device progr eval sngl A 1 XXX $ - $ 49.42
93279 26 Pm device progr eval sngl A 1 XXX $ 33.41 $ 33.41
93279 TC Pm device progr eval sngl A 1 XXX $ - $ 16.01
93280 Pm device progr eval dual A 1 XXX $ - $ 57.07
93280 26 Pm device progr eval dual A 1 XXX $ 38.98 $ 38.98
93280 TC Pm device progr eval dual A 1 XXX $ - $ 18.10
93281 Pm device progr eval multi A 1 XXX $ - $ 65.77
93281 26 Pm device progr eval multi A 1 XXX $ 44.89 $ 44.89
93281 TC Pm device progr eval multi A 1 XXX $ - $ 20.88
93282 Icd device prog eval 1 sngl A 1 XXX $ - $ 60.90
93282 26 Icd device prog eval 1 sngl A 1 XXX $ 42.46 $ 42.46
93282 TC Icd device prog eval 1 sngl A 1 XXX $ - $ 18.79
93283 Icd device progr eval dual A 1 XXX $ - $ 78.65
93283 26 Icd device progr eval dual A 1 XXX $ 57.42 $ 57.42
93283 TC Icd device progr eval dual A 1 XXX $ - $ 21.23
93284 Icd device progr eval mult A 1 XXX $ - $ 86.65
93284 26 Icd device progr eval mult A 1 XXX $ 62.29 $ 62.29
93284 TC Icd device progr eval mult A 1 XXX $ - $ 24.36
93285 Ilr device eval progr A 1 XXX $ - $ 40.02
93285 26 Ilr device eval progr A 1 XXX $ 25.06 $ 25.06
93285 TC Ilr device eval progr A 1 XXX $ - $ 14.62
93286 Pre-op pm device eval A 1 XXX $ - $ 25.06
93286 26 Pre-op pm device eval A 1 XXX $ 14.27 $ 14.27

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
93286 TC Pre-op pm device eval A 1 XXX $ - $ 10.79

93287 Pre-op icd device eval A 1 XXX $ - $ 33.06
93287 26 Pre-op icd device eval A 1 XXX $ 21.23 $ 21.23
93287 TC Pre-op icd device eval A 1 XXX $ - $ 11.83
93288 Pm device eval in person A 1 XXX $ - $ 36.19
93288 26 Pm device eval in person A 1 XXX $ 20.88 $ 20.88
93288 TC Pm device eval in person A 1 XXX $ - $ 14.96
93289 Icd device interrogate A 1 XXX $ - $ 63.34
93289 26 Icd device interrogate A 1 XXX $ 45.24 $ 45.24
93289 TC Icd device interrogate A 1 XXX $ - $ 18.10
93290 Icm device eval A 1 XXX $ - $ 29.23
93290 26 Icm device eval A 1 XXX $ 20.18 $ 20.18
93290 TC Icm device eval A 1 XXX $ - $ 9.05
93291 Ilr device interrogate A 1 XXX $ - $ 34.45
93291 26 Ilr device interrogate A 1 XXX $ 20.88 $ 20.88
93291 TC Ilr device interrogate A 1 XXX $ - $ 13.57
93292 Wcd device interrogate A 1 XXX $ - $ 31.32
93292 26 Wcd device interrogate A 1 XXX $ 20.88 $ 20.88
93292 TC Wcd device interrogate A 1 XXX $ - $ 10.44
93293 Pm phone r-strip device eval A 1 XXX $ - $ 49.42
93293 26 Pm phone r-strip device eval A 1 XXX $ 15.31 $ 15.31
93293 TC Pm phone r-strip device eval A 1 XXX $ - $ 34.10
93294 Pm device interrogate remote A 2 XXX $ 34.45 $ 34.45
93295 Icd device interrogat remote A 2 XXX $ 68.21 $ 68.21
93296 Pm/icd remote tech serv A 3 XXX $ - $ 26.10
93297 Icm device interrogat remote A 2 XXX $ 26.45 $ 26.45
93298 Ilr device interrogat remote A 2 XXX $ 27.49 $ 27.49
93299 Icm/ilr remote tech serv C 3 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
93303 Echo transthoracic A 1 XXX $ - $ 186.53

93303 26 Echo transthoracic A 1 XXX $ 64.03 $ 64.03
93303 TC Echo transthoracic A 1 XXX $ - $ 122.50
93304 Echo transthoracic A 1 XXX $ - $ 121.10
93304 26 Echo transthoracic A 1 XXX $ 37.24 $ 37.24
93304 TC Echo transthoracic A 1 XXX $ - $ 83.87
93306 Tte w/doppler complete A 1 XXX $ - $ 190.70
93306 26 Tte w/doppler complete A 1 XXX $ 64.38 $ 64.38
93306 TC Tte w/doppler complete A 1 XXX $ - $ 126.32
93307 Tte w/o doppler complete A 1 XXX $ - $ 119.71
93307 26 Tte w/o doppler complete A 1 XXX $ 45.94 $ 45.94
93307 TC Tte w/o doppler complete A 1 XXX $ - $ 74.12
93308 Tte f-up or lmtd A 1 XXX $ - $ 90.48
93308 26 Tte f-up or lmtd A 1 XXX $ 25.40 $ 25.40
93308 TC Tte f-up or lmtd A 1 XXX $ - $ 65.08
93312 Echo transesophageal A 1 XXX $ - $ 286.06
93312 26 Echo transesophageal A 1 XXX $ 106.14 $ 106.14
93312 TC Echo transesophageal A 1 XXX $ - $ 179.92
93313 Echo transesophageal A 0 XXX $ 45.94 $ -
93314 Echo transesophageal A 1 XXX $ - $ 254.39
93314 TC Echo transesophageal A 1 XXX $ - $ 193.84
93315 Echo transesophageal C 1 XXX $ 658.42 $ 658.42
93315 TC Echo transesophageal C 1 XXX $ 508.08 $ 508.08
93316 Echo transesophageal A 0 XXX $ 47.68 $ -
93317 Echo transesophageal C 1 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
93317 TC Echo transesophageal C 1 XXX $ - $ -

93318 Echo transesophageal intraop C 1 XXX $ 871.74 $ 871.74
93318 26 Echo transesophageal intraop A 1 XXX $ 131.89 $ 131.89
93318 TC Echo transesophageal intraop C 1 XXX $ 750.29 $ 750.29
93320 Doppler echo exam heart A 1 ZZZ $ - $ 49.42
93320 26 Doppler echo exam heart A 1 ZZZ $ 18.44 $ 18.44
93320 TC Doppler echo exam heart A 1 ZZZ $ - $ 30.97
93321 Doppler echo exam heart A 1 ZZZ $ - $ 25.06
93321 26 Doppler echo exam heart A 1 ZZZ $ 8.00 $ 8.00
93321 TC Doppler echo exam heart A 1 ZZZ $ - $ 17.40
93325 Doppler color flow add-on A 1 ZZZ $ - $ 26.10
93325 26 Doppler color flow add-on A 1 ZZZ $ 4.52 $ 4.52
93325 TC Doppler color flow add-on A 1 ZZZ $ - $ 21.58
93350 Stress tte only A 1 XXX $ - $ 187.92
93350 26 Stress tte only A 1 XXX $ 72.73 $ 72.73
93350 TC Stress tte only A 1 XXX $ - $ 114.84
93351 Stress tte complete A 1 XXX $ - $ 220.63
93351 26 Stress tte complete A 1 XXX $ 86.65 $ 86.65
93351 TC Stress tte complete A 1 XXX $ - $ 133.98
93352 Admin ecg contrast agent A 0 ZZZ $ - $ 31.32
93451 Right heart cath A 1 000 Y $ - $ 745.42
93451 26 Right heart cath A 1 000 Y $ 188.27 $ 188.27
93451 TC Right heart cath A 1 000 $ - $ 557.15
93452 Left hrt cath w/ventrclgrphy A 1 000 Y $ - $ 864.08
93452 26 Left hrt cath w/ventrclgrphy A 1 000 Y $ 331.64 $ 331.64
93452 TC Left hrt cath w/ventrclgrphy A 1 000 $ - $ 532.09
93453 R&l hrt cath w/ventriclgrphy A 1 000 Y $ - $ 1,129.61
93453 26 R&l hrt cath w/ventriclgrphy A 1 000 Y $ 432.91 $ 432.91

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
93453 TC R&l hrt cath w/ventriclgrphy A 1 000 $ - $ 696.70

93454 Coronary artery angio s&i A 1 000 Y $ - $ 887.05
93454 26 Coronary artery angio s&i A 1 000 Y $ 333.38 $ 333.38
93454 TC Coronary artery angio s&i A 1 000 $ - $ 553.67
93455 Coronary art/grft angio s&i A 1 000 Y $ - $ 1,033.56
93455 26 Coronary art/grft angio s&i A 1 000 Y $ 383.84 $ 383.84
93455 TC Coronary art/grft angio s&i A 1 000 $ - $ 649.72
93456 R hrt coronary artery angio A 1 000 Y $ - $ 1,111.16
93456 26 R hrt coronary artery angio A 1 000 Y $ 424.56 $ 424.56
93456 TC R hrt coronary artery angio A 1 000 $ - $ 686.60
93457 R hrt art/grft angio A 1 000 Y $ - $ 1,258.02
93457 26 R hrt art/grft angio A 1 000 Y $ 476.76 $ 476.76
93457 TC R hrt art/grft angio A 1 000 $ - $ 781.61
93458 L hrt artery/ventricle angio A 1 000 Y $ - $ 1,072.19
93458 26 L hrt artery/ventricle angio A 1 000 Y $ 406.81 $ 406.81
93458 TC L hrt artery/ventricle angio A 1 000 $ - $ 665.72
93459 L hrt art/grft angio A 1 000 Y $ - $ 1,184.94
93459 26 L hrt art/grft angio A 1 000 Y $ 455.88 $ 455.88
93459 TC L hrt art/grft angio A 1 000 $ - $ 728.71
93460 R&l hrt art/ventricle angio A 1 000 Y $ - $ 1,272.98
93460 26 R&l hrt art/ventricle angio A 1 000 Y $ 507.38 $ 507.38
93460 TC R&l hrt art/ventricle angio A 1 000 $ - $ 765.60
93461 R&l hrt art/ventricle angio A 1 000 Y $ - $ 1,454.29
93461 26 R&l hrt art/ventricle angio A 1 000 Y $ 561.32 $ 561.32
93461 TC R&l hrt art/ventricle angio A 1 000 $ - $ 892.97
93462 L hrt cath trnsptl puncture A 0 ZZZ $ 257.52 $ 257.52
93463 Drug admin & hemodynmic meas A 0 ZZZ $ 133.28 $ 133.28
93464 Exercise w/hemodynamic meas A 1 ZZZ $ - $ 265.52

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
93464 26 Exercise w/hemodynamic meas A 1 ZZZ $ 117.97 $ 117.97

93464 TC Exercise w/hemodynamic meas A 1 ZZZ $ - $ 147.55
93503 Insert/place heart catheter A 0 000 $ 150.68 $ -
93505 Biopsy of heart lining A 1 000 Y $ - $ 779.87
93505 26 Biopsy of heart lining A 1 000 Y $ 295.80 $ 295.80
93505 TC Biopsy of heart lining A 1 000 $ - $ 484.07
93530 Rt heart cath congenital C 1 000 Y $ - $ -
93530 26 Rt heart cath congenital A 1 000 Y $ 297.89 $ 297.89
93530 TC Rt heart cath congenital C 1 000 $ - $ -
93531 R & l heart cath congenital C 1 000 Y $ - $ -
93531 26 R & l heart cath congenital A 1 000 Y $ 589.16 $ 589.16
93531 TC R & l heart cath congenital C 1 000 $ - $ -
93561 Cardiac output measurement C 1 000 $ - $ -
93561 26 Cardiac output measurement A 1 000 $ 26.80 $ 26.80
93561 TC Cardiac output measurement C 1 000 $ - $ -
93562 Card output measure subsq C 1 000 $ - $ -
93562 26 Card output measure subsq A 1 000 $ 8.00 $ 8.00
93562 TC Card output measure subsq C 1 000 $ - $ -
93563 Inject congenital card cath A 0 ZZZ $ 60.55 $ 60.55
93564 Inject hrt congntl art/grft A 0 ZZZ $ 62.64 $ 62.64
93565 Inject l ventr/atrial angio A 0 ZZZ $ 47.33 $ 47.33
93566 Inject r ventr/atrial angio A 0 ZZZ $ 46.98 $ 163.21

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
93567 Inject suprvlv aortography A 0 ZZZ $ 52.20 $ 134.33

93568 Inject pulm art hrt cath A 0 ZZZ $ 48.37 $ 148.94
93571 Heart flow reserve measure C 1 ZZZ $ - $ -
93571 26 Heart flow reserve measure A 1 ZZZ $ 95.35 $ 95.35
93571 TC Heart flow reserve measure C 1 ZZZ $ - $ -
93572 Heart flow reserve measure C 1 ZZZ $ - $ -
93572 26 Heart flow reserve measure A 1 ZZZ $ 78.30 $ 78.30
93572 TC Heart flow reserve measure C 1 ZZZ $ - $ -
93580 Transcath closure of asd A 0 000 Y $ 1,285.16 $ -
93581 Transcath closure of vsd A 0 000 Y $ 1,727.47 $ -
93600 Bundle of His recording C 1 000 $ - $ -
93600 26 Bundle of His recording A 1 000 $ 148.60 $ 148.60
93600 TC Bundle of His recording C 1 000 $ - $ -
93602 Intra-atrial recording C 1 000 $ - $ -
93602 26 Intra-atrial recording A 1 000 $ 148.60 $ 148.60
93602 TC Intra-atrial recording C 1 000 $ - $ -
93603 Right ventricular recording C 1 000 $ - $ -
93603 26 Right ventricular recording A 1 000 $ 148.60 $ 148.60
93603 TC Right ventricular recording C 1 000 $ - $ -
93609 Map tachycardia add-on C 1 ZZZ $ - $ -
93609 26 Map tachycardia add-on A 1 ZZZ $ 354.26 $ 354.26
93609 TC Map tachycardia add-on C 1 ZZZ $ - $ -
93610 Intra-atrial pacing C 1 000 $ - $ -
93610 26 Intra-atrial pacing A 1 000 $ 212.63 $ 212.63
93610 TC Intra-atrial pacing C 1 000 $ - $ -
93612 Intraventricular pacing C 1 000 $ - $ -
93612 26 Intraventricular pacing A 1 000 $ 211.93 $ 211.93
93612 TC Intraventricular pacing C 1 000 $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
93613 Electrophys map 3d add-on A 0 ZZZ $ 495.55 $ -

93615 Esophageal recording C 1 000 $ - $ -
93615 26 Esophageal recording A 1 000 $ 50.81 $ 50.81
93615 TC Esophageal recording C 1 000 $ - $ -
93616 Esophageal recording C 1 000 $ - $ -
93616 26 Esophageal recording A 1 000 $ 73.08 $ 73.08
93616 TC Esophageal recording C 1 000 $ - $ -
93618 Heart rhythm pacing C 1 000 $ - $ -
93618 26 Heart rhythm pacing A 1 000 $ 299.98 $ 299.98
93618 TC Heart rhythm pacing C 1 000 $ - $ -
93619 Electrophysiology evaluation C 1 000 Y $ - $ -
93619 26 Electrophysiology evaluation A 1 000 Y $ 519.56 $ 519.56
93619 TC Electrophysiology evaluation C 1 000 $ - $ -
93621 Electrophysiology evaluation C 1 ZZZ $ - $ -
93621 26 Electrophysiology evaluation A 1 ZZZ $ 147.90 $ 147.90
93621 TC Electrophysiology evaluation C 1 ZZZ $ - $ -
93622 Electrophysiology evaluation C 1 ZZZ $ - $ -
93622 26 Electrophysiology evaluation A 1 ZZZ $ 218.89 $ 218.89
93622 TC Electrophysiology evaluation C 1 ZZZ $ - $ -
93623 Stimulation pacing heart C 1 ZZZ $ - $ -
93623 26 Stimulation pacing heart A 1 ZZZ $ 203.23 $ 203.23
93623 TC Stimulation pacing heart C 1 ZZZ $ - $ -
93624 Electrophysiologic study C 1 000 Y $ - $ -
93624 26 Electrophysiologic study A 1 000 Y $ - $ 341.39
93624 TC Electrophysiologic study C 1 000 $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
93631 Heart pacing mapping C 1 000 $ - $ -

93631 26 Heart pacing mapping A 1 000 $ 543.23 $ 543.23
93631 TC Heart pacing mapping C 1 000 $ - $ -
93640 Evaluation heart device C 1 000 Y $ - $ -
93640 26 Evaluation heart device A 1 000 Y $ 248.47 $ 248.47
93640 TC Evaluation heart device C 1 000 $ - $ -
93642 Electrophysiology evaluation A 1 000 Y $ - $ 381.41
93642 TC Electrophysiology evaluation A 1 000 $ - $ 136.42
93650 Ablate heart dysrhythm focus A 0 000 Y $ 750.98 $ -
93651 Ablate heart dysrhythm focus A 0 000 Y $ 1,151.53 $ -
93652 Ablate heart dysrhythm focus A 0 000 Y $ 1,253.15 $ -
93660 Tilt table evaluation A 1 000 Y $ - $ 149.64
93660 26 Tilt table evaluation A 1 000 Y $ 94.66 $ 94.66
93660 TC Tilt table evaluation A 1 000 $ - $ 54.64
93662 Intracardiac ecg (ice) C 1 ZZZ $ - $ -
93662 26 Intracardiac ecg (ice) A 1 ZZZ $ 151.38 $ 151.38
93662 TC Intracardiac ecg (ice) C 1 ZZZ $ - $ -
93668 Peripheral vascular rehab N 9 XXX $ - $ 17.05
93701 Bioimpedance cv analysis A 3 XXX $ - $ 22.62
93724 Analyze pacemaker system A 1 000 $ - $ 276.66
93724 26 Analyze pacemaker system A 1 000 $ 244.30 $ 244.30
93724 TC Analyze pacemaker system A 1 000 $ - $ 32.36
93740 Temperature gradient studies B 9 XXX $ 11.14 $ 11.14
93745 Set-up cardiovert-defibrill C 1 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
93745 26 Set-up cardiovert-defibrill C 1 XXX $ - $ -

93745 TC Set-up cardiovert-defibrill C 1 XXX $ - $ -
93750 Interrogation vad in person A 0 XXX $ 46.28 $ 53.59
93770 Measure venous pressure B 9 XXX $ 10.79 $ 10.79
93784 Ambulatory BP monitoring A 4 XXX $ - $ 54.29
93786 Ambulatory BP recording A 3 XXX $ - $ 27.49
93788 Ambulatory BP analysis A 3 XXX $ - $ 8.35
93790 Review/report BP recording A 2 XXX $ 18.44 $ 18.44
93797 Cardiac rehab A 0 000 $ 9.40 $ 16.01
93798 Cardiac rehab/monitor A 0 000 $ 13.92 $ 23.66
93799 Cardiovascular procedure C 1 XXX $ - $ -
93799 26 Cardiovascular procedure C 1 XXX $ - $ -
93799 TC Cardiovascular procedure C 1 XXX $ - $ -
93880 Extracranial study A 1 XXX $ 227.59 $ 220.63
93880 26 Extracranial study A 1 XXX $ 31.32 $ 31.32
93880 TC Extracranial study A 1 XXX $ 196.27 $ 189.31
93882 Extracranial study A 1 XXX $ - $ 158.34
93882 26 Extracranial study A 1 XXX $ 23.32 $ 23.32
93882 TC Extracranial study A 1 XXX $ - $ 135.02
93886 Intracranial study A 1 XXX $ 245.34 $ 245.34
93886 26 Intracranial study A 1 XXX $ 46.98 $ 46.98
93886 TC Intracranial study A 1 XXX $ 196.62 $ 196.62
93888 Intracranial study A 1 XXX $ 114.14 $ 114.14
93888 26 Intracranial study A 1 XXX $ 32.71 $ 32.71
93888 TC Intracranial study A 1 XXX $ 81.43 $ 81.43
93890 Tcd vasoreactivity study A 1 XXX $ 176.78 $ 176.78
93890 26 Tcd vasoreactivity study A 1 XXX $ 49.76 $ 49.76
93890 TC Tcd vasoreactivity study A 1 XXX $ 124.93 $ 124.93

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
93892 Tcd emboli detect w/o inj A 1 XXX $ 184.44 $ 184.44

93892 26 Tcd emboli detect w/o inj A 1 XXX $ 57.42 $ 57.42
93892 TC Tcd emboli detect w/o inj A 1 XXX $ 124.58 $ 124.58
93893 Tcd emboli detect w/inj A 1 XXX $ 184.79 $ 184.79
93893 26 Tcd emboli detect w/inj A 1 XXX $ 57.77 $ 57.77
93893 TC Tcd emboli detect w/inj A 1 XXX $ 124.58 $ 124.58
93922 Upr/l xtremity art 2 levels A 1 XXX $ - $ 91.18
93922 26 Upr/l xtremity art 2 levels A 1 XXX $ 12.18 $ 12.18
93922 TC Upr/l xtremity art 2 levels A 1 XXX $ - $ 79.00
93923 Upr/lxtr art stdy 3+ lvls A 1 XXX $ - $ 143.03
93923 26 Upr/lxtr art stdy 3+ lvls A 1 XXX $ 24.36 $ 24.36
93923 TC Upr/lxtr art stdy 3+ lvls A 1 XXX $ - $ 118.67
93924 Lwr xtr vasc stdy bilat A 1 XXX $ - $ 178.87
93924 26 Lwr xtr vasc stdy bilat A 1 XXX $ 26.80 $ 26.80
93924 TC Lwr xtr vasc stdy bilat A 1 XXX $ - $ 151.73
93925 Lower extremity study A 1 XXX $ 226.55 $ 226.55
93925 26 Lower extremity study A 1 XXX $ 30.28 $ 30.28
93925 TC Lower extremity study A 1 XXX $ 196.27 $ 196.27
93926 Lower extremity study A 1 XXX $ 145.81 $ 145.81
93926 26 Lower extremity study A 1 XXX $ 22.62 $ 22.62
93926 TC Lower extremity study A 1 XXX $ 124.58 $ 124.58
93930 Upper extremity study A 1 XXX $ 220.63 $ 220.63
93930 26 Upper extremity study A 1 XXX $ 25.06 $ 25.06
93930 TC Upper extremity study A 1 XXX $ 196.27 $ 196.27
93931 Upper extremity study A 1 XXX $ 141.29 $ 141.29
93931 26 Upper extremity study A 1 XXX $ 17.05 $ 17.05
93931 TC Upper extremity study A 1 XXX $ 124.58 $ 124.58
93965 Extremity study A 1 XXX $ - $ 112.75

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
93965 26 Extremity study A 1 XXX $ 18.79 $ 18.79

93965 TC Extremity study A 1 XXX $ - $ 93.96
93970 Extremity study A 1 XXX $ 232.46 $ 231.07
93970 TC Extremity study A 1 XXX $ 196.27 $ 193.49
93971 Extremity study A 1 XXX $ 148.60 $ 137.81
93971 TC Extremity study A 1 XXX $ 124.58 $ 113.45
93975 Vascular study A 1 XXX $ 291.28 $ 291.28
93975 26 Vascular study A 1 XXX $ 95.70 $ 95.70
93975 TC Vascular study A 1 XXX $ 196.27 $ 196.27
93976 Vascular study A 1 XXX $ - $ 198.01
93976 TC Vascular study A 1 XXX $ - $ 135.37
93980 Penile vascular study A 1 XXX $ - $ 159.73
93980 26 Penile vascular study A 1 XXX $ 64.03 $ 64.03
93980 TC Penile vascular study A 1 XXX $ - $ 95.70
93981 Penile vascular study A 1 XXX $ - $ 105.10
93981 26 Penile vascular study A 1 XXX $ 22.97 $ 22.97
93981 TC Penile vascular study A 1 XXX $ - $ 81.78
93982 Aneurysm pressure sens study R 0 XXX $ - $ 42.46
93990 Doppler flow testing A 1 XXX $ 138.50 $ 138.50

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
93990 26 Doppler flow testing A 1 XXX $ 15.31 $ 15.31

93990 TC Doppler flow testing A 1 XXX $ 124.58 $ 124.58
93998 Noninvas vasc dx study proc C 0 XXX Y $ - $ -
94002 Vent mgmt inpat init day A 0 XXX $ 100.57 $ -
94003 Vent mgmt inpat subq day A 0 XXX $ 70.64 $ -
94004 Vent mgmt nf per day A 0 XXX $ 51.50 $ -
94005 Home vent mgmt supervision B 9 XXX $ - $ 92.92
94010 Breathing capacity test A 1 XXX $ - $ 33.06
94010 26 Breathing capacity test A 1 XXX $ 8.70 $ 8.70
94010 TC Breathing capacity test A 1 XXX $ - $ 24.36
94011 Spirometry up to 2 yrs old A 0 XXX $ 106.49 $ -
94012 Spirmtry w/brnchdil inf-2 yr A 0 XXX $ 169.13 $ -
94013 Meas lung vol thru 2 yrs A 0 XXX $ 34.45 $ -
94014 Patient recorded spirometry A 4 XXX $ - $ 44.20
94015 Patient recorded spirometry A 3 XXX $ - $ 20.88
94016 Review patient spirometry A 2 XXX $ 23.32 $ 23.32
94060 Evaluation of wheezing A 1 XXX $ - $ 54.64
94060 26 Evaluation of wheezing A 1 XXX $ 12.88 $ 12.88
94060 TC Evaluation of wheezing A 1 XXX $ - $ 41.76
94070 Evaluation of wheezing A 1 XXX $ - $ 57.77
94070 26 Evaluation of wheezing A 1 XXX $ 29.58 $ 29.58
94070 TC Evaluation of wheezing A 1 XXX $ - $ 28.19
94150 Vital capacity test B 1 XXX $ - $ 23.32
94150 26 Vital capacity test B 1 XXX $ 4.52 $ 4.52
94150 TC Vital capacity test B 1 XXX $ - $ 19.14
94200 Lung function test (MBC/MVV) A 1 XXX $ - $ 23.66
94200 26 Lung function test (MBC/MVV) A 1 XXX $ 5.92 $ 5.92
94200 TC Lung function test (MBC/MVV) A 1 XXX $ - $ 17.75

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
94250 Expired gas collection A 1 XXX $ - $ 24.71

94250 26 Expired gas collection A 1 XXX $ 5.92 $ 5.92
94250 TC Expired gas collection A 1 XXX $ - $ 18.79
94375 Respiratory flow volume loop A 1 XXX $ - $ 36.19
94375 26 Respiratory flow volume loop A 1 XXX $ 14.62 $ 14.62
94375 TC Respiratory flow volume loop A 1 XXX $ - $ 21.58
94400 CO2 breathing response curve A 1 XXX $ - $ 51.85
94400 26 CO2 breathing response curve A 1 XXX $ 18.44 $ 18.44
94400 TC CO2 breathing response curve A 1 XXX $ - $ 33.06
94450 Hypoxia response curve A 1 XXX $ - $ 57.77
94450 26 Hypoxia response curve A 1 XXX $ 18.79 $ 18.79
94450 TC Hypoxia response curve A 1 XXX $ - $ 38.98
94452 Hast w/report A 1 XXX $ - $ 52.55
94452 26 Hast w/report A 1 XXX $ 14.27 $ 14.27
94452 TC Hast w/report A 1 XXX $ - $ 37.93
94453 Hast w/oxygen titrate A 1 XXX $ - $ 70.64
94453 26 Hast w/oxygen titrate A 1 XXX $ 18.44 $ 18.44
94453 TC Hast w/oxygen titrate A 1 XXX $ - $ 52.55
94610 Surfactant admin thru tube A 0 XXX $ 61.94 $ 61.94
94620 Pulmonary stress test/simple A 1 XXX $ - $ 57.07
94620 26 Pulmonary stress test/simple A 1 XXX $ 31.32 $ 31.32
94620 TC Pulmonary stress test/simple A 1 XXX $ - $ 26.10
94621 Pulm stress test/complex A 1 XXX $ - $ 150.34
94621 26 Pulm stress test/complex A 1 XXX $ 68.56 $ 68.56
94621 TC Pulm stress test/complex A 1 XXX $ - $ 81.78
94640 Airway inhalation treatment A 5 XXX $ - $ 16.01
94642 Aerosol inhalation treatment C 5 XXX $ - $ -
94644 Cbt 1st hour A 5 XXX $ - $ 37.58

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
94645 Cbt each addl hour A 5 XXX $ - $ 12.88

94660 Pos airway pressure cpap A 0 XXX $ 39.32 $ 59.51
94662 Neg press ventilation cnp A 0 XXX $ 38.28 $ -
94664 Evaluate pt use of inhaler A 5 XXX $ - $ 15.31
94667 Chest wall manipulation A 5 XXX $ - $ 21.23
94668 Chest wall manipulation A 5 XXX $ - $ 20.88
94680 Exhaled air analysis o2 A 1 XXX $ - $ 53.24
94680 26 Exhaled air analysis o2 A 1 XXX $ 12.88 $ 12.88
94680 TC Exhaled air analysis o2 A 1 XXX $ - $ 40.72
94681 Exhaled air analysis o2/co2 A 1 XXX $ - $ 48.37
94681 26 Exhaled air analysis o2/co2 A 1 XXX $ 9.74 $ 9.74
94681 TC Exhaled air analysis o2/co2 A 1 XXX $ - $ 38.63
94690 Exhaled air analysis A 1 XXX $ - $ 46.28
94690 26 Exhaled air analysis A 1 XXX $ 4.52 $ 4.52
94690 TC Exhaled air analysis A 1 XXX $ - $ 41.76
94726 Pulm funct tst plethysmograp A 1 XXX $ - $ 49.42
94726 26 Pulm funct tst plethysmograp A 1 XXX $ 12.53 $ 12.53
94726 TC Pulm funct tst plethysmograp A 1 XXX $ - $ 36.89
94727 Pulm function test by gas A 1 XXX $ - $ 38.63
94727 26 Pulm function test by gas A 1 XXX $ 12.53 $ 12.53
94727 TC Pulm function test by gas A 1 XXX $ - $ 26.10
94728 Pulm funct test oscillometry A 1 XXX $ - $ 38.63
94728 26 Pulm funct test oscillometry A 1 XXX $ 12.53 $ 12.53
94728 TC Pulm funct test oscillometry A 1 XXX $ - $ 26.10
94729 C02/membane diffuse capacity A 1 ZZZ $ - $ 47.68
94729 26 C02/membane diffuse capacity A 1 ZZZ $ 8.70 $ 8.70
94729 TC C02/membane diffuse capacity A 1 ZZZ $ - $ 39.32
94750 Pulmonary compliance study A 1 XXX $ - $ 70.64

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
94750 26 Pulmonary compliance study A 1 XXX $ 11.14 $ 11.14

94750 TC Pulmonary compliance study A 1 XXX $ - $ 59.51
94760 Measure blood oxygen level B 3 XXX $ - $ 3.48
94761 Measure blood oxygen level B 3 XXX $ - $ 4.87
94762 Measure blood oxygen level A 3 XXX $ - $ 13.92
94770 Exhaled carbon dioxide test A 0 XXX $ 16.70 $ 16.70
94772 Breath recording infant C 1 XXX $ - $ -
94772 26 Breath recording infant C 1 XXX $ - $ -
94772 TC Breath recording infant C 1 XXX $ - $ -
94774 Ped home apnea rec compl C 4 YYY $ - $ -
94775 Ped home apnea rec hk-up C 3 YYY $ - $ -
94776 Ped home apnea rec downld C 3 YYY $ - $ -
94777 Ped home apnea rec report C 2 YYY $ - $ -
94780 Car seat/bed test 60 min A 0 XXX $ 24.71 $ 47.68
94781 Car seat/bed test + 30 min A 0 ZZZ $ 8.70 $ 18.44
94799 Pulmonary service/procedure C 1 XXX $ - $ -
94799 26 Pulmonary service/procedure C 1 XXX $ - $ -
94799 TC Pulmonary service/procedure C 1 XXX $ - $ -
95004 Percut allergy skin tests A 0 XXX $ - $ 6.26
95010 Percut allergy titrate test A 0 XXX $ 5.92 $ 11.83
95012 Exhaled nitric oxide meas A 5 XXX $ - $ 18.10
95015 Id allergy titrate-drug/bug A 0 XXX $ 3.83 $ 7.31
95024 Id allergy test drug/bug A 0 XXX $ 1.74 $ 7.66
95027 Id allergy titrate-airborne A 0 XXX $ - $ 5.22
95028 Id allergy test-delayed type A 3 XXX $ - $ 12.53
95044 Allergy patch tests A 5 XXX $ - $ 5.92
95052 Photo patch test A 5 XXX $ - $ 6.61
95056 Photosensitivity tests A 5 XXX $ - $ 37.93

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
95060 Eye allergy tests A 3 XXX $ 27.84 $ 27.84

95065 Nose allergy test A 3 XXX $ 22.27 $ 22.27
95070 Bronchial allergy tests A 3 XXX $ - $ 29.93
95071 Bronchial allergy tests A 3 XXX $ - $ 58.46
95075 Ingestion challenge test A 0 XXX $ 46.98 $ 61.25
95115 Immunotherapy one injection A 5 XXX $ - $ 9.40
95117 Immunotherapy injections A 5 XXX $ - $ 10.79
95120 Immunotherapy one injection N 9 XXX $ - $ -
95125 Immunotherapy many antigens N 9 XXX $ - $ -
95130 Immunotherapy insect venom N 9 XXX $ - $ -
95131 Immunotherapy insect venoms N 9 XXX $ - $ -
95144 Antigen therapy services A 0 XXX $ 3.83 $ 11.83
95180 Rapid desensitization A 0 XXX $ 101.62 $ 130.50
95199 Allergy immunology services C 0 XXX $ - $ -
95250 Glucose monitoring cont A 3 XXX $ - $ 134.68
95251 Gluc monitor cont phys i&r A 2 XXX $ 42.80 $ 42.80
95800 Slp stdy unattended A 1 XXX $ - $ 145.46
95800 26 Slp stdy unattended A 1 XXX $ 51.16 $ 51.16

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
95800 TC Slp stdy unattended A 1 XXX $ - $ 94.66

95801 Slp stdy unatnd w/anal A 1 XXX $ - $ 82.13
95801 26 Slp stdy unatnd w/anal A 1 XXX $ 48.72 $ 48.72
95801 TC Slp stdy unatnd w/anal A 1 XXX $ - $ 33.41
95803 Actigraphy testing A 1 XXX $ - $ 148.60
95803 26 Actigraphy testing A 1 XXX $ 44.89 $ 44.89
95803 TC Actigraphy testing A 1 XXX $ - $ 103.70
95805 Multiple sleep latency test A 1 XXX $ - $ 366.10
95805 26 Multiple sleep latency test A 1 XXX $ 59.16 $ 59.16
95805 TC Multiple sleep latency test A 1 XXX $ - $ 306.94
95806 Sleep study unatt&resp efft A 1 XXX $ - $ 168.43
95806 26 Sleep study unatt&resp efft A 1 XXX $ 62.64 $ 62.64
95806 TC Sleep study unatt&resp efft A 1 XXX $ - $ 105.79
95807 Sleep study attended A 1 XXX $ - $ 440.92
95807 26 Sleep study attended A 1 XXX $ 62.64 $ 62.64
95807 TC Sleep study attended A 1 XXX $ - $ 377.93
95808 Polysomnography 1-3 A 1 XXX $ - $ 591.25
95808 26 Polysomnography 1-3 A 1 XXX $ 88.04 $ 88.04
95808 TC Polysomnography 1-3 A 1 XXX $ - $ 503.56
95810 Polysomnography 4 or more A 1 XXX $ - $ 590.90
95810 26 Polysomnography 4 or more A 1 XXX $ 123.19 $ 123.19
95810 TC Polysomnography 4 or more A 1 XXX $ - $ 467.71
95811 Polysomnography w/cpap A 1 XXX $ - $ 630.23
95811 26 Polysomnography w/cpap A 1 XXX $ 129.11 $ 129.11
95811 TC Polysomnography w/cpap A 1 XXX $ - $ 501.47
95812 Eeg 41-60 minutes A 1 XXX $ - $ 321.90
95812 26 Eeg 41-60 minutes A 1 XXX $ 54.29 $ 54.29
95812 TC Eeg 41-60 minutes A 1 XXX $ - $ 267.26

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
95813 Eeg over 1 hour A 1 XXX $ - $ 377.58

95813 26 Eeg over 1 hour A 1 XXX $ 87.35 $ 87.35
95813 TC Eeg over 1 hour A 1 XXX $ - $ 290.23
95816 Eeg awake and drowsy A 1 XXX $ - $ 297.19
95816 26 Eeg awake and drowsy A 1 XXX $ 55.68 $ 55.68
95816 TC Eeg awake and drowsy A 1 XXX $ - $ 241.86
95819 Eeg awake and asleep A 1 XXX $ - $ 335.12
95819 26 Eeg awake and asleep A 1 XXX $ 54.29 $ 54.29
95819 TC Eeg awake and asleep A 1 XXX $ - $ 280.49
95822 Eeg coma or sleep only A 1 XXX $ - $ 306.59
95822 26 Eeg coma or sleep only A 1 XXX $ 54.29 $ 54.29
95822 TC Eeg coma or sleep only A 1 XXX $ - $ 252.30
95824 Eeg cerebral death only C 1 XXX $ - $ -
95824 26 Eeg cerebral death only A 1 XXX $ 39.67 $ 39.67
95824 TC Eeg cerebral death only C 1 XXX $ - $ -
95827 Eeg all night recording A 1 XXX $ - $ 584.64
95827 26 Eeg all night recording A 1 XXX $ 55.68 $ 55.68
95827 TC Eeg all night recording A 1 XXX $ - $ 528.96
95829 Surgery electrocorticogram A 1 XXX $ - $ 1,462.99
95829 26 Surgery electrocorticogram A 1 XXX $ 304.50 $ 304.50
95829 TC Surgery electrocorticogram A 1 XXX $ - $ 1,158.49
95830 Insert electrodes for EEG A 0 XXX $ 93.26 $ 190.36
95831 Limb muscle testing manual A 0 XXX $ 16.36 $ 27.84
95832 Hand muscle testing manual A 0 XXX $ 17.05 $ 26.45
95833 Body muscle testing manual A 0 XXX $ 21.23 $ 34.45
95834 Body muscle testing manual A 0 XXX $ 30.62 $ 46.28
95851 Range of motion measurements A 0 XXX $ 8.00 $ 17.05
95852 Range of motion measurements A 0 XXX $ 6.26 $ 14.96

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
95857 Cholinesterase challenge A 0 XXX $ 29.93 $ 48.72

95860 Muscle test one limb A 1 XXX $ - $ 89.09
95860 26 Muscle test one limb A 1 XXX $ 48.72 $ 48.72
95860 TC Muscle test one limb A 1 XXX $ - $ 40.37
95861 Muscle test 2 limbs A 1 XXX $ - $ 130.50
95861 26 Muscle test 2 limbs A 1 XXX $ 78.30 $ 78.30
95861 TC Muscle test 2 limbs A 1 XXX $ - $ 52.55
95865 Muscle test larynx A 1 XXX $ - $ 116.93
95865 26 Muscle test larynx A 1 XXX $ 79.00 $ 79.00
95865 TC Muscle test larynx A 1 XXX $ - $ 37.93
95866 Muscle test hemidiaphragm A 1 XXX Y $ - $ 105.44
95866 26 Muscle test hemidiaphragm A 1 XXX Y $ 63.68 $ 63.68
95866 TC Muscle test hemidiaphragm A 1 XXX Y $ - $ 41.41
95867 Muscle test cran nerv unilat A 1 XXX $ - $ 84.56
95867 26 Muscle test cran nerv unilat A 1 XXX $ 40.02 $ 40.02
95867 TC Muscle test cran nerv unilat A 1 XXX $ - $ 44.54
95868 Muscle test cran nerve bilat A 1 XXX $ - $ 113.45
95868 26 Muscle test cran nerve bilat A 1 XXX $ 59.16 $ 59.16
95868 TC Muscle test cran nerve bilat A 1 XXX $ - $ 54.29
95869 Muscle test thor paraspinal A 1 XXX $ - $ 61.25
95869 26 Muscle test thor paraspinal A 1 XXX $ 18.10 $ 18.10
95869 TC Muscle test thor paraspinal A 1 XXX $ - $ 42.80

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
95870 Muscle test nonparaspinal A 1 XXX $ - $ 58.81

95870 26 Muscle test nonparaspinal A 1 XXX $ 18.44 $ 18.44
95870 TC Muscle test nonparaspinal A 1 XXX $ - $ 40.37
95872 Muscle test one fiber A 1 XXX $ - $ 180.61
95872 26 Muscle test one fiber A 1 XXX $ 144.77 $ 144.77
95872 TC Muscle test one fiber A 1 XXX $ - $ 36.19
95873 Guide nerv destr elec stim A 1 ZZZ $ - $ 59.86
95873 26 Guide nerv destr elec stim A 1 ZZZ $ 19.49 $ 19.49
95873 TC Guide nerv destr elec stim A 1 ZZZ $ - $ 40.72
95874 Guide nerv destr needle emg A 1 ZZZ $ - $ 57.07
95874 26 Guide nerv destr needle emg A 1 ZZZ $ 18.79 $ 18.79
95874 TC Guide nerv destr needle emg A 1 ZZZ $ - $ 38.28
95875 Limb exercise test A 1 XXX $ - $ 104.75
95875 26 Limb exercise test A 1 XXX $ 56.38 $ 56.38
95875 TC Limb exercise test A 1 XXX $ - $ 48.37
95885 Musc tst done w/nerv tst lim A 1 ZZZ $ - $ 50.46
95885 26 Musc tst done w/nerv tst lim A 1 ZZZ $ 17.40 $ 17.40
95885 TC Musc tst done w/nerv tst lim A 1 ZZZ $ - $ 33.06
95886 Musc test done w/n test comp A 1 ZZZ $ - $ 81.78
95886 26 Musc test done w/n test comp A 1 ZZZ $ 46.98 $ 46.98
95886 TC Musc test done w/n test comp A 1 ZZZ $ - $ 34.80
95887 Musc tst done w/n tst nonext A 1 ZZZ $ - $ 72.04
95887 26 Musc tst done w/n tst nonext A 1 ZZZ $ 36.54 $ 36.54
95887 TC Musc tst done w/n tst nonext A 1 ZZZ $ - $ 35.50
95900 Motor nerve conduction test A 1 XXX $ - $ 58.12
95900 26 Motor nerve conduction test A 1 XXX $ 20.88 $ 20.88
95900 TC Motor nerve conduction test A 1 XXX $ - $ 37.24
95903 Motor nerve conduction test A 1 XXX $ - $ 69.95

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
95903 26 Motor nerve conduction test A 1 XXX $ 31.32 $ 31.32

95903 TC Motor nerve conduction test A 1 XXX $ - $ 38.63
95904 Sense nerve conduction test A 1 XXX $ - $ 51.50
95904 26 Sense nerve conduction test A 1 XXX $ 17.05 $ 17.05
95904 TC Sense nerve conduction test A 1 XXX $ - $ 34.45
95905 Motor/sens nrve conduct test A 1 XXX $ - $ 59.16
95905 26 Motor/sens nrve conduct test A 1 XXX $ 3.48 $ 3.48
95905 TC Motor/sens nrve conduct test A 1 XXX $ - $ 55.68
95920 Intraop nerve test add-on A 1 ZZZ $ - $ 158.69
95920 26 Intraop nerve test add-on A 1 ZZZ $ 107.18 $ 107.18
95920 TC Intraop nerve test add-on A 1 ZZZ $ - $ 51.50
95921 Autonomic nerv function test A 1 XXX $ - $ 79.00
95921 26 Autonomic nerv function test A 1 XXX $ 44.54 $ 44.54
95921 TC Autonomic nerv function test A 1 XXX $ - $ 34.45
95925 Somatosensory testing A 1 XXX $ - $ 145.12
95925 26 Somatosensory testing A 1 XXX $ 26.10 $ 26.10
95925 TC Somatosensory testing A 1 XXX $ - $ 119.02

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

95928 C motor evoked uppr limbs A 1 XXX $ - $ 231.42
95928 26 C motor evoked uppr limbs A 1 XXX $ 77.26 $ 77.26
95928 TC C motor evoked uppr limbs A 1 XXX $ - $ 154.16
95929 C motor evoked lwr limbs A 1 XXX $ - $ 234.90
95929 26 C motor evoked lwr limbs A 1 XXX $ 77.26 $ 77.26
95929 TC C motor evoked lwr limbs A 1 XXX $ - $ 157.64
95930 Visual evoked potential test A 1 XXX $ - $ 131.20
95930 26 Visual evoked potential test A 1 XXX $ 17.40 $ 17.40
95930 TC Visual evoked potential test A 1 XXX $ - $ 113.80
95933 Blink reflex test A 1 XXX $ - $ 74.82
95933 26 Blink reflex test A 1 XXX $ 30.62 $ 30.62
95933 TC Blink reflex test A 1 XXX $ - $ 44.20
95934 H-reflex test A 1 XXX Y $ - $ 56.38
95934 26 H-reflex test A 1 XXX Y $ 24.71 $ 24.71
95934 TC H-reflex test A 1 XXX Y $ - $ 31.32
95936 H-reflex test A 1 XXX Y $ - $ 46.28
95936 26 H-reflex test A 1 XXX Y $ 26.80 $ 26.80
95936 TC H-reflex test A 1 XXX Y $ - $ 19.49
95937 Neuromuscular junction test A 1 XXX $ - $ 66.12
95937 26 Neuromuscular junction test A 1 XXX $ 34.45 $ 34.45
95937 TC Neuromuscular junction test A 1 XXX $ - $ 31.67
95939 C motor evoked upr&lwr limbs A 1 XXX $ - $ 415.51
95939 26 C motor evoked upr&lwr limbs A 1 XXX $ 117.28 $ 117.28
95939 TC C motor evoked upr&lwr limbs A 1 XXX $ - $ 298.24

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
95950 Ambulatory eeg monitoring A 1 XXX $ - $ 268.31

95950 26 Ambulatory eeg monitoring A 1 XXX $ 77.26 $ 77.26
95950 TC Ambulatory eeg monitoring A 1 XXX $ - $ 190.70
95951 EEG monitoring/videorecord C 1 XXX $ - $ -
95951 26 EEG monitoring/videorecord A 1 XXX $ 331.30 $ 331.30
95951 TC EEG monitoring/videorecord C 1 XXX $ - $ -
95953 EEG monitoring/computer A 1 XXX $ - $ 393.59
95953 26 EEG monitoring/computer A 1 XXX $ 159.38 $ 159.38
95953 TC EEG monitoring/computer A 1 XXX $ - $ 234.20
95954 EEG monitoring/giving drugs A 1 XXX $ - $ 367.84
95954 26 EEG monitoring/giving drugs A 1 XXX $ 120.76 $ 120.76
95954 TC EEG monitoring/giving drugs A 1 XXX $ - $ 247.08
95955 EEG during surgery A 1 XXX $ - $ 173.30
95955 26 EEG during surgery A 1 XXX $ 51.16 $ 51.16
95955 TC EEG during surgery A 1 XXX $ - $ 122.15
95956 Eeg monitor technol attended A 1 XXX $ - $ 1,042.96
95956 26 Eeg monitor technol attended A 1 XXX $ 180.96 $ 180.96
95956 TC Eeg monitor technol attended A 1 XXX $ - $ 862.00
95957 EEG digital analysis A 1 XXX $ - $ 346.26
95957 26 EEG digital analysis A 1 XXX $ 102.31 $ 102.31
95957 TC EEG digital analysis A 1 XXX $ - $ 243.60
95958 EEG monitoring/function test A 1 XXX $ - $ 461.80
95958 26 EEG monitoring/function test A 1 XXX $ 219.59 $ 219.59
95958 TC EEG monitoring/function test A 1 XXX $ - $ 242.21
95961 Electrode stimulation brain A 1 XXX $ - $ 256.48
95961 26 Electrode stimulation brain A 1 XXX $ 154.16 $ 154.16
95961 TC Electrode stimulation brain A 1 XXX $ - $ 102.31
95962 Electrode stim brain add-on A 1 ZZZ $ - $ 227.94

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
95962 26 Electrode stim brain add-on A 1 ZZZ $ 163.91 $ 163.91

95962 TC Electrode stim brain add-on A 1 ZZZ $ - $ 64.03
95965 Meg spontaneous C 1 XXX $ - $ -
95965 26 Meg spontaneous A 1 XXX $ 444.40 $ 444.40
95965 TC Meg spontaneous C 1 XXX $ - $ -
95966 Meg evoked single C 1 XXX $ - $ -
95966 26 Meg evoked single A 1 XXX $ 220.63 $ 220.63
95966 TC Meg evoked single C 1 XXX $ - $ -
95967 Meg evoked each addl C 1 ZZZ $ - $ -
95967 26 Meg evoked each addl A 1 ZZZ $ 194.18 $ 194.18
95967 TC Meg evoked each addl C 1 ZZZ $ - $ -
95970 Analyze neurostim no prog A 0 XXX $ 25.06 $ 59.51
95971 Analyze neurostim simple A 0 XXX $ 43.50 $ 58.46
95972 Analyze neurostim complex A 0 XXX $ 84.91 $ 110.66
95973 Analyze neurostim complex A 0 ZZZ $ 51.85 $ 63.68
95974 Cranial neurostim complex A 0 XXX $ 167.04 $ 197.66
95975 Cranial neurostim complex A 0 ZZZ $ 92.22 $ 105.10
95978 Analyze neurostim brain/1h A 0 XXX $ 205.32 $ 244.99
95979 Analyz neurostim brain addon A 0 ZZZ $ 91.87 $ 104.40
95980 Io anal gast n-stim init A 0 XXX $ 56.38 $ -
95981 Io anal gast n-stim subsq A 0 XXX $ 18.79 $ 30.97
95982 Io ga n-stim subsq w/reprog A 0 XXX $ 37.24 $ 50.46
95990 Spin/brain pump refil & main A 5 XXX $ - $ 75.17
95991 Spin/brain pump refil & main A 0 XXX $ 40.72 $ 106.49
95992 Canalith repositioning proc A 0 XXX $ 39.67 $ 43.50
95999 Neurological procedure C 0 XXX $ - $ -
96000 Motion analysis video/3d A 7 XXX $ 98.83 $ -
96001 Motion test w/ft press meas A 7 XXX $ 103.70 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
96002 Dynamic surface emg A 0 XXX $ 22.27 $ -

96003 Dynamic fine wire emg A 0 XXX $ 20.18 $ -
96004 Phys review of motion tests A 2 XXX $ 116.58 $ 116.58
96020 Functional brain mapping C 1 XXX $ - $ -
96020 26 Functional brain mapping A 1 XXX $ 188.62 $ 188.62
96020 TC Functional brain mapping C 1 XXX $ - $ -
96040 Genetic counseling 30 min B 9 XXX $ - $ 41.76
96101 Psycho testing by psych/phys A 0 XXX $ 79.34 $ 83.87
96102 Psycho testing by technician A 0 XXX $ 24.01 $ 67.86
96103 Psycho testing admin by comp A 0 XXX $ 25.40 $ 58.46
96105 Assessment of aphasia A 0 XXX $ - $ 97.79
96110 Developmental screen X 9 XXX $ - $ -
96111 Developmental test extend A 0 XXX $ 126.67 $ 131.20
96116 Neurobehavioral status exam A 0 XXX $ 88.04 $ 92.92
96118 Neuropsych tst by psych/phys A 0 XXX $ 78.65 $ 93.61
96119 Neuropsych testing by tec A 0 XXX $ 22.62 $ 62.29
96120 Neuropsych tst admin w/comp A 0 XXX $ 25.40 $ 80.04
96125 Cognitive test by hc pro A 7 XXX Y $ - $ 97.79
96150 Assess hlth/behave init A 0 XXX $ 20.18 $ 20.53
96151 Assess hlth/behave subseq A 0 XXX $ 19.49 $ 19.84
96152 Intervene hlth/behave indiv A 0 XXX $ 18.44 $ 18.79
96153 Intervene hlth/behave group A 0 XXX $ 5.22 $ 5.22
96154 Interv hlth/behav fam w/pt A 0 XXX $ 18.10 $ 18.44
96155 Interv hlth/behav fam no pt N 9 XXX $ 23.32 $ 23.66
96360 Hydration iv infusion init A 5 XXX $ - $ 51.85
96361 Hydrate iv infusion add-on A 5 ZZZ $ - $ 14.27
96365 Ther/proph/diag iv inf init A 5 XXX $ - $ 65.08
96366 Ther/proph/diag iv inf addon A 5 ZZZ $ - $ 19.84

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
96367 Tx/proph/dg addl seq iv inf A 5 ZZZ $ - $ 29.23

96368 Ther/diag concurrent inf A 5 ZZZ $ - $ 17.75
96369 Sc ther infusion up to 1 hr A 5 XXX $ - $ 162.17
96370 Sc ther infusion addl hr A 5 ZZZ $ - $ 14.96
96371 Sc ther infusion reset pump A 5 ZZZ $ - $ 73.78
96372 Ther/proph/diag inj sc/im T 5 XXX $ - $ 22.27
96373 Ther/proph/diag inj ia A 5 XXX $ - $ 18.44
96374 Ther/proph/diag inj iv push A 5 XXX $ - $ 50.81
96375 Tx/pro/dx inj new drug addon A 5 ZZZ $ - $ 20.18
96376 Tx/pro/dx inj same drug adon X 9 ZZZ $ - $ -
96379 Ther/prop/diag inj/inf proc C 0 XXX $ - $ -
96401 Chemo anti-neopl sq/im A 5 XXX $ - $ 66.47
96402 Chemo hormon antineopl sq/im A 5 XXX $ - $ 30.28
96405 Chemo intralesional up to 7 A 0 000 Y $ 30.62 $ 76.91
96406 Chemo intralesional over 7 A 0 000 Y $ 44.54 $ 109.62
96409 Chemo iv push sngl drug A 5 XXX $ - $ 99.53
96411 Chemo iv push addl drug A 5 ZZZ $ - $ 56.38
96413 Chemo iv infusion 1 hr A 5 XXX $ - $ 122.84
96415 Chemo iv infusion addl hr A 5 ZZZ $ - $ 27.84
96416 Chemo prolong infuse w/pump A 5 XXX $ - $ 123.89
96417 Chemo iv infus each addl seq A 5 ZZZ $ - $ 63.68
96420 Chemo ia push tecnique A 5 XXX $ - $ 98.48
96422 Chemo ia infusion up to 1 hr A 5 XXX $ - $ 153.47
96423 Chemo ia infuse each addl hr A 5 ZZZ $ - $ 70.99
96425 Chemotherapy infusion method A 5 XXX $ - $ 162.17
96440 Chemotherapy intracavitary A 0 000 $ 177.48 $ 758.29
96446 Chemotx admn prtl cavity A 5 XXX $ 25.75 $ 170.52
96450 Chemotherapy into cns A 0 000 $ 85.96 $ 175.04

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
96521 Refill/maint portable pump A 5 XXX $ - $ 121.10

96522 Refill/maint pump/resvr syst A 5 XXX $ - $ 99.18
96523 Irrig drug delivery device T 5 XXX $ - $ 22.27
96542 Chemotherapy injection A 0 XXX $ 42.46 $ 111.01
96549 Chemotherapy unspecified C 0 XXX $ - $ -
96567 Photodynamic tx skin A 5 XXX $ - $ 116.58
96570 Photodynmc tx 30 min add-on A 0 ZZZ $ 69.60 $ 69.60
96571 Photodynamic tx addl 15 min A 0 ZZZ $ 28.54 $ 28.54
96900 Ultraviolet light therapy A 5 XXX $ - $ 19.14
96902 Trichogram B 9 XXX $ 22.27 $ 22.62
96904 Whole body photography A 5 XXX $ - $ 61.25
96910 Photochemotherapy with UV-B A 5 XXX $ - $ 61.94
96912 Photochemotherapy with UV-A A 5 XXX $ - $ 79.34
96913 Photochemotherapy uv-a or b A 5 XXX $ - $ 109.97
96920 Laser tx skin < 250 sq cm A 0 000 Y $ 65.42 $ 157.30
96921 Laser tx skin 250-500 sq cm A 0 000 Y $ 65.77 $ 159.73
96922 Laser tx skin > 500 sq cm A 0 000 Y $ 118.67 $ 229.33
96999 Dermatological procedure C 0 XXX $ - $ -
97001 Pt evaluation A 7 XXX Y $ - $ 72.04
97002 Pt re-evaluation A 7 XXX Y $ - $ 40.02
97003 Ot evaluation A 7 XXX Y $ - $ 79.69
97004 Ot re-evaluation A 7 XXX Y $ - $ 48.37
97005 Athletic train eval N 9 XXX $ - $ -
97006 Athletic train reeval N 9 XXX $ - $ -
97010 Hot or cold packs therapy B 9 XXX $ - $ 5.92
97012 Mechanical traction therapy A 7 XXX Y $ - $ 15.31
97014 Electric stimulation therapy A 9 XXX $ - $ 14.62
97016 Vasopneumatic device therapy A 7 XXX Y $ - $ 17.40

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
97018 Paraffin bath therapy A 7 XXX Y $ - $ 9.74

97022 Whirlpool therapy A 7 XXX Y $ - $ 20.53
97024 Diathermy eg microwave A 7 XXX Y $ - $ 6.61
97026 Infrared therapy A 7 XXX Y $ - $ 5.92
97028 Ultraviolet therapy A 7 XXX Y $ - $ 7.31
97032 Electrical stimulation A 7 XXX Y $ - $ 17.75
97033 Electric current therapy A 7 XXX Y $ - $ 28.19
97034 Contrast bath therapy A 7 XXX Y $ - $ 16.36
97035 Ultrasound therapy A 7 XXX Y $ - $ 12.18
97036 Hydrotherapy A 7 XXX Y $ - $ 28.54
97039 Physical therapy treatment C 7 XXX $ - $ -
97110 Therapeutic exercises A 7 XXX Y $ - $ 28.88
97112 Neuromuscular reeducation A 7 XXX Y $ - $ 29.93
97113 Aquatic therapy/exercises A 7 XXX Y $ - $ 37.58
97116 Gait training therapy A 7 XXX Y $ - $ 25.75
97124 Massage therapy A 7 XXX Y $ - $ 23.66
97139 Physical medicine procedure C 7 XXX $ - $ -
97140 Manual therapy A 7 XXX Y $ - $ 27.14
97150 Group therapeutic procedures A 7 XXX Y $ - $ 18.79
97530 Therapeutic activities A 7 XXX Y $ - $ 31.32
97532 Cognitive skills development A 7 XXX $ - $ 24.71
97533 Sensory integration A 7 XXX Y $ - $ 26.80
97535 Self care mngment training A 7 XXX Y $ - $ 31.32
97537 Community/work reintegration A 7 XXX Y $ - $ 27.49
97542 Wheelchair mngment training A 7 XXX Y $ - $ 28.19
97545 Work hardening A 7 XXX $ - $ -
97546 Work hardening add-on A 7 ZZZ $ - $ -
97597 Rmvl devital tis 20 cm/< A 0 000 $ 26.80 $ 70.30

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
97598 Rmvl devital tis addl 20 cm< A 0 ZZZ $ 13.22 $ 24.71

97602 Wound(s) care non-selective B 9 XXX $ - $ -
97605 Neg press wound tx < 50 cm A 0 XXX $ 32.36 $ 44.20
97606 Neg press wound tx > 50 cm A 0 XXX $ 36.54 $ 48.37
97750 Physical performance test A 7 XXX Y $ - $ 32.02
97755 Assistive technology assess A 7 XXX Y $ - $ 35.15
97760 Orthotic mgmt and training A 7 XXX Y $ - $ 35.84
97761 Prosthetic training A 7 XXX Y $ - $ 31.67
97762 C/o for orthotic/prosth use A 7 XXX Y $ - $ 39.67
97799 Physical medicine procedure C 7 XXX $ - $ -
97802 Medical nutrition indiv in A 0 XXX $ 32.02 $ 33.76
97803 Med nutrition indiv subseq A 0 XXX $ 27.84 $ 29.93
97804 Medical nutrition group A 0 XXX $ 14.27 $ 14.62
97810 Acupunct w/o stimul 15 min N 9 XXX $ 32.02 $ 36.54 NC 7/1/2012
97811 Acupunct w/o stimul addl 15m N 9 ZZZ $ 26.10 $ 27.84 NC 7/1/2012
97813 Acupunct w/stimul 15 min N 9 XXX $ 34.10 $ 38.63 NC 7/1/2012
97814 Acupunct w/stimul addl 15m N 9 ZZZ $ 29.58 $ 32.02 NC 7/1/2012
98925 Osteopathic manipulation A 0 000 $ 24.36 $ 30.62
98940 Chiropractic manipulation A 0 000 $ 20.53 $ 24.71
98943 Chiropractic manipulation A 9 XXX $ 21.92 $ 24.71
98960 Self-mgmt educ & train 1 pt B 9 XXX $ - $ 24.01
98961 Self-mgmt educ/train 2-4 pt B 9 XXX $ - $ 12.18

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
98962 Self-mgmt educ/train 5-8 pt B 9 XXX $ - $ 9.40

98966 Hc pro phone call 5-10 min N 9 XXX $ 12.53 $ 13.57
98969 Online service by hc pro N 9 XXX $ - $ -
99000 Specimen handling B 9 XXX $ - $ -
99001 Specimen handling B 9 XXX $ - $ -
99002 Device handling B 9 XXX $ - $ -
99024 Postop follow-up visit B 9 XXX $ - $ -
99026 In-hospital on call service N 9 XXX $ - $ -
99027 Out-of-hosp on call service N 9 XXX $ - $ -
99050 Medical services after hrs B 9 XXX $ - $ -
99051 Med serv eve/wkend/holiday B 9 XXX $ - $ -
99053 Med serv 10pm-8am 24 hr fac B 9 XXX $ - $ -
99056 Med service out of office B 9 XXX $ - $ -
99058 Office emergency care B 9 XXX $ - $ -
99060 Out of office emerg med serv B 9 XXX $ - $ -
99070 Special supplies B 9 XXX $ - $ -
99071 Patient education materials B 9 XXX $ - $ -
99075 Medical testimony N 9 XXX $ - $ -
99078 Group health education B 9 XXX $ - $ -
99080 Special reports or forms B 9 XXX $ - $ -
99082 Unusual physician travel C 0 XXX $ - $ -
99090 Computer data analysis B 9 XXX $ - $ -
99091 Collect/review data from pt B 9 XXX $ - $ 57.77
99100 Special anesthesia service B 9 ZZZ $ - $ -
99116 Anesthesia with hypothermia B 9 ZZZ $ - $ -
99135 Special anesthesia procedure B 9 ZZZ $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
99140 Emergency anesthesia B 9 ZZZ $ - $ -

99143 Mod cs by same phys < 5 yrs C 0 XXX $ - $ -
99144 Mod cs by same phys 5 yrs + C 0 XXX $ - $ -
99145 Mod cs by same phys add-on C 0 ZZZ $ - $ -
99148 Mod cs diff phys < 5 yrs C 0 XXX $ - $ -
99149 Mod cs diff phys 5 yrs + C 0 XXX $ - $ -
99150 Mod cs diff phys add-on C 0 ZZZ $ - $ -
99170 Anogenital exam child A 0 000 Y $ 93.96 $ 132.24
99172 Ocular function screen N 9 XXX $ - $ -
99173 Visual acuity screen N 9 XXX $ - $ 3.48
99174 Ocular photoscreening N 9 XXX $ - $ 25.40
99175 Induction of vomiting A 5 XXX $ - $ 17.05
99183 Hyperbaric oxygen therapy A 0 XXX $ 134.68 $ 216.46
99190 Special pump services X 9 XXX $ - $ -
99195 Phlebotomy A 5 XXX $ - $ 83.17
99199 Special service/proc/report C 0 XXX $ - $ -
99201 Office/outpatient visit new A 0 XXX $ 27.49 $ 41.76
99201 TC Office/outpatient visit new A $ 14.27

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
99211 Office/outpatient visit est A 0 XXX $ 9.40 $ 18.44

99211 TC Office/outpatient visit est A $ 9.04
99217 Observation care discharge A 0 XXX $ 72.38 $ -
99218 Initial observation care A 0 XXX $ 99.18 $ -
99221 Initial hospital care A 0 XXX $ 107.88 $ -
99224 Subsequent observation care A 0 XXX $ 41.76 $ -
99231 Subsequent hospital care A 0 XXX $ 40.02 $ -
99234 Observ/hosp same date A 0 XXX $ 142.33 $ -
99238 Hospital discharge day A 0 XXX $ 70.99 $ -
99239 Hospital discharge day A 0 XXX $ 105.79 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
99241 Office consultation N 9 XXX $ 36.54 $ 48.72

99251 Inpatient consultation N 9 XXX $ 50.81 $ -
99281 Emergency dept visit A 0 XXX $ 21.92 $ -
99288 Direct advanced life support B 9 XXX $ - $ -
99291 Critical care first hour A 0 XXX $ 234.55 $ 276.66
99292 Critical care addl 30 min A 0 ZZZ $ 118.32 $ 127.37
99304 Nursing facility care init A 0 XXX $ 96.05 $ 96.05
99307 Nursing fac care subseq A 0 XXX $ 43.15 $ 43.15
99315 Nursing fac discharge day A 0 XXX $ 72.04 $ 72.04
99316 Nursing fac discharge day A 0 XXX $ 102.31 $ 102.31
99318 Annual nursing fac assessmnt A 0 XXX $ 94.66 $ 94.66

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
99324 Domicil/r-home visit new pat A 0 XXX $ - $ 57.07

99334 Domicil/r-home visit est pat A 0 XXX $ - $ 60.55
99339 Domicil/r-home care supervis B 9 XXX $ - $ 76.91
99340 Domicil/r-home care supervis B 9 XXX $ - $ 108.92
99341 Home visit new patient A 0 XXX $ - $ 56.72
99347 Home visit est patient A 0 XXX $ - $ 56.72
99354 Prolonged service office A 0 ZZZ $ 93.61 $ 99.53
99355 Prolonged service office A 0 ZZZ $ 92.22 $ 97.79
99356 Prolonged service inpatient A 0 ZZZ $ 92.57 $ -
99357 Prolonged service inpatient A 0 ZZZ $ 92.22 $ -
99358 Prolong service w/o contact B 9 XXX $ 112.40 $ 112.40
99359 Prolong serv w/o contact add B 9 ZZZ $ 54.64 $ 54.64
99360 Physician standby services N 9 XXX $ 63.68 $ -
99363 Anticoag mgmt init B 9 XXX $ 87.35 $ 122.84

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
99364 Anticoag mgmt subseq B 9 XXX $ 33.06 $ 42.11

99366 Team conf w/pat by hc pro B 9 XXX $ 42.80 $ 43.50
99367 Team conf w/o pat by phys B 9 XXX $ 57.77 $ -
99368 Team conf w/o pat by hc pro B 9 XXX $ 37.24 $ -
99374 Home health care supervision B 9 XXX $ 57.77 $ 69.25
99375 Home health care supervision A 9 XXX $ 93.26 $ 105.79
99377 Hospice care supervision B 9 XXX $ 57.77 $ 69.25
99378 Hospice care supervision A 9 XXX $ 93.96 $ 106.84
99379 Nursing fac care supervision B 9 XXX $ 57.77 $ 69.25
99380 Nursing fac care supervision A 9 XXX $ 91.18 $ 104.75
99381 Init pm e/m new pat inf A 9 XXX $ 78.65 $ 107.18
99381 TC Init pm e/m new pat inf A $ 28.53
99382 Init pm e/m new pat 1-4 yrs A 9 XXX $ 82.13 $ 110.66
99382 TC Init pm e/m new pat 1-4 yrs A $ 28.53
99383 Prev visit new age 5-11 A 9 XXX $ 87.70 $ 115.54
99383 TC Prev visit new age 5-11 A $ 27.84
99386 TC Prev Visit new age 40-64 A $ 28.19
99387 Init pm e/m new pat 65+ yrs A 9 XXX $ 131.89 $ 163.21
99387 TC Init pm e/m new pat 65+ yrs A $ 31.32
99391 Per pm reeval est pat inf A 9 XXX $ 71.69 $ 95.35
99391 TC Per pm reeval est pat inf A $ 23.66
99392 Prev visit est age 1-4 A 9 XXX $ 78.65 $ 102.66
99392 TC Prev visit est age 1-4 A $ 24.01

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

99397 Per pm reeval est pat 65+ yr A 9 XXX $ 105.10 $ 132.59
99397 TC Per pm reeval est pat 65+ yr A $ 27.49
99401 Preventive counseling indiv A 9 XXX $ 25.40 $ 35.15
99401 TC Preventive counseling indiv A $ 9.75
99406 Behav chng smoking 3-10 min A 0 XXX $ 11.83 $ 13.57
99406 TC Behav chng smoking 3-10 min A $ 1.74
99407 Behav chng smoking > 10 min A 0 XXX $ 26.10 $ 27.49
99407 TC Behav chng smoking > 10 min A $ 1.39
99408 Audit/dast 15-30 min N 9 XXX $ 34.10 $ 35.50
99409 Audit/dast over 30 min N 9 XXX $ 68.21 $ 69.95
99411 Preventive counseling group N 9 XXX $ 8.00 $ 14.96
99412 Preventive counseling group N 9 XXX $ 12.53 $ 19.49
99420 Health risk assessment test N 9 XXX $ - $ 9.74
99429 Unlisted preventive service N 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
99441 Phone e/m by phys 5-10 min N 9 XXX $ 12.53 $ 13.57

99444 Online e/m by phys N 9 XXX $ - $ -
99450 Basic life disability exam N 9 XXX $ - $ -
99455 Work related disability exam N 0 XXX $ - $ -
99456 Disability examination N 0 XXX $ - $ -
99460 Init nb em per day hosp A 0 XXX $ 95.00 $ -
99461 Init nb em per day non-fac A 0 XXX $ 66.12 $ 92.22
99462 Sbsq nb em per day hosp A 0 XXX $ 43.85 $ -
99463 Same day nb discharge A 0 XXX $ 112.75 $ -
99464 Attendance at delivery A 0 XXX $ 73.78 $ -
99465 Nb resuscitation A 0 XXX $ 155.21 $ -
99466 Ped crit care transport A 0 XXX $ 336.17 $ -
99467 Ped crit care transport addl A 0 ZZZ $ 123.89 $ -
99468 Neonate crit care initial A 0 XXX $ 980.32 $ -
99469 Neonate crit care subsq A 0 XXX $ 416.90 $ -
99471 Ped critical care initial A 0 XXX $ 801.79 $ -
99472 Ped critical care subsq A 0 XXX $ 410.29 $ -
99475 Ped crit care age 2-5 init A 0 XXX $ 590.56 $ 590.56
99476 Ped crit care age 2-5 subsq A 0 XXX $ 357.74 $ 357.74
99477 Init day hosp neonate care A 0 XXX $ 351.83 $ -
99478 Ic lbw inf < 1500 gm subsq A 0 XXX $ 142.68 $ -
99479 Ic lbw inf 1500-2500 g subsq A 0 XXX $ 130.50 $ -
99480 Ic inf pbw 2501-5000 g subsq A 0 XXX $ 123.89 $ -
99499 Unlisted e&m service C 0 XXX $ - $ -
99500 Home visit prenatal X 9 XXX $ - $ -
99501 Home visit postnatal X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
99502 Home visit nb care X 9 XXX $ - $ -

99503 Home visit resp therapy X 9 XXX $ - $ -
99504 Home visit mech ventilator X 9 XXX $ - $ -
99505 Home visit stoma care X 9 XXX $ - $ -
99506 Home visit im injection X 9 XXX $ - $ -
99507 Home visit cath maintain X 9 XXX $ - $ -
99509 Home visit day life activity X 9 XXX $ - $ -
99510 Home visit sing/m/fam couns X 9 XXX $ - $ -
99511 Home visit fecal/enema mgmt X 9 XXX $ - $ -
99512 Home visit for hemodialysis X 9 XXX $ - $ -
99600 Home visit nos X 9 XXX $ - $ -
99601 Home infusion/visit 2 hrs X 9 XXX $ - $ -
99602 Home infusion each addtl hr I 9 XXX $ - $ -
99605 Mtms by pharm np 15 min X 9 XXX $ - $ -
99606 Mtms by pharm est 15 min X 9 XXX $ - $ -
99607 Mtms by pharm addl 15 min X 9 XXX $ - $ -
A0021 Outside state ambulance serv X 9 XXX $ - $ -
A0080 Noninterest escort in non er X 9 XXX $ - $ -
A0090 Interest escort in non er X 9 XXX $ - $ -
A0100 Nonemergency transport taxi X 9 XXX $ - $ -
A0110 Nonemergency transport bus X 9 XXX $ - $ -
A0120 Noner transport mini-bus X 9 XXX $ - $ -
A0130 Noner transport wheelch van X 9 XXX $ - $ -
A0140 Nonemergency transport air X 9 XXX $ - $ -
A0160 Noner transport case worker X 9 XXX $ - $ -
A0170 Transport parking fees/tolls X 9 XXX $ - $ -
A0180 Noner transport lodgng recip X 9 XXX $ - $ -
A0190 Noner transport meals recip X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
A0200 Noner transport lodgng escrt X 9 XXX $ - $ -

A0210 Noner transport meals escort X 9 XXX $ - $ -
A0225 Neonatal emergency transport X 9 XXX $ - $ -
A0380 Basic life support mileage X 9 XXX $ - $ -
A0382 Basic support routine suppls X 9 XXX $ - $ -
A0384 Bls defibrillation supplies X 9 XXX $ - $ -
A0390 Advanced life support mileag X 9 XXX $ - $ -
A0392 Als defibrillation supplies X 9 XXX $ - $ -
A0394 Als IV drug therapy supplies X 9 XXX $ - $ -
A0396 Als esophageal intub suppls X 9 XXX $ - $ -
A0398 Als routine disposble suppls X 9 XXX $ - $ -
A0420 Ambulance waiting 1/2 hr X 9 XXX $ - $ -
A0422 Ambulance 02 life sustaining X 9 XXX $ - $ -
A0424 Extra ambulance attendant X 9 XXX $ - $ -
A0425 Ground mileage X 9 XXX $ - $ -
A0426 Als 1 X 9 XXX $ - $ -
A0427 ALS1-emergency X 9 XXX $ - $ -
A0428 bls X 9 XXX $ - $ -
A0429 BLS-emergency X 9 XXX $ - $ -
A0430 Fixed wing air transport X 9 XXX $ - $ -
A0431 Rotary wing air transport X 9 XXX $ - $ -
A0432 PI volunteer ambulance co X 9 XXX $ - $ -
A0433 als 2 X 9 XXX $ - $ -
A0434 Specialty care transport X 9 XXX $ - $ -
A0435 Fixed wing air mileage X 9 XXX $ - $ -
A0436 Rotary wing air mileage X 9 XXX $ - $ -
A0888 Noncovered ambulance mileage N 9 XXX $ - $ -
A0998 Ambulance response/treatment X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
A0999 Unlisted ambulance service X 9 XXX $ - $ -

A4206 1 CC sterile syringe&needle X 9 XXX $ - $ -
A4209 5+ CC sterile syringe&needle X 9 XXX $ - $ -
A4210 Nonneedle injection device N 9 XXX $ - $ -
A4211 Supp for self-adm injections X 9 XXX $ - $ -
A4212 Non coring needle or stylet X 9 XXX $ - $ -
A4213 20+ CC syringe only X 9 XXX $ - $ -
A4215 Sterile needle X 9 XXX $ - $ -
A4216 Sterile water/saline, 10 ml X 9 XXX $ - $ -
A4217 Sterile water/saline, 500 ml X 9 XXX $ - $ -
A4218 Sterile saline or water X 9 XXX $ - $ -
A4220 Infusion pump refill kit X 9 XXX $ - $ -
A4221 Maint drug infus cath per wk X 9 XXX $ - $ -
A4222 Infusion supplies with pump X 9 XXX $ - $ -
A4223 Infusion supplies w/o pump X 9 XXX $ - $ -
A4230 Infus insulin pump non needl X 9 XXX $ - $ -
A4231 Infusion insulin pump needle X 9 XXX $ - $ -
A4232 Syringe w/needle insulin 3cc X 9 XXX $ - $ -
A4233 Alkalin batt for glucose mon X 9 XXX $ - $ -
A4234 J-cell batt for glucose mon X 9 XXX $ - $ -
A4235 Lithium batt for glucose mon X 9 XXX $ - $ -
A4236 Silvr oxide batt glucose mon X 9 XXX $ - $ -
A4244 Alcohol or peroxide per pint X 9 XXX $ - $ -
A4245 Alcohol wipes per box X 9 XXX $ - $ -
A4246 Betadine/phisohex solution X 9 XXX $ - $ -
A4247 Betadine/iodine swabs/wipes X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
A4248 Chlorhexidine antisept X 9 XXX $ - $ -

A4250 Urine reagent strips/tablets N 9 XXX $ - $ -
A4252 Blood ketone test or strip N 9 XXX $ - $ -
A4253 Blood glucose/reagent strips X 9 XXX $ - $ -
A4255 Glucose monitor platforms X 9 XXX $ - $ -
A4256 Calibrator solution/chips X 9 XXX $ - $ -
A4257 Replace Lensshield Cartridge X 9 XXX $ - $ -
A4258 Lancet device each X 9 XXX $ - $ -
A4259 Lancets per box X 9 XXX $ - $ -
A4261 Cervical cap contraceptive X 9 XXX $ - $ -
A4262 Temporary tear duct plug B 9 XXX $ - $ -
A4263 Permanent tear duct plug B 9 XXX $ - $ -
A4264 Intratubal occlusion device I 9 XXX $ - $ -
A4265 Paraffin X 9 XXX $ - $ -
A4266 Diaphragm X 9 XXX $ - $ -
A4267 Male condom X 9 XXX $ - $ -
A4268 Female condom X 9 XXX $ - $ -
A4269 Spermicide X 9 XXX $ - $ -
A4270 Disposable endoscope sheath B 9 XXX $ - $ -
A4280 Brst prsths adhsv attchmnt X 9 XXX $ - $ -
A4281 Replacement breastpump tube X 9 XXX $ - $ -
A4282 Replacement breastpump adpt X 9 XXX $ - $ -
A4283 Replacement breastpump cap X 9 XXX $ - $ -
A4284 Replcmnt breast pump shield X 9 XXX $ - $ -
A4285 Replcmnt breast pump bottle X 9 XXX $ - $ -
A4286 Replcmnt breastpump lok ring X 9 XXX $ - $ -
A4290 Sacral nerve stim test lead X 9 XXX $ - $ -
A4300 Cath impl vasc access portal B 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
A4301 Implantable access syst perc B 9 XXX $ - $ -

A4305 Drug delivery system >=50 ML B 9 XXX $ - $ -
A4306 Drug delivery system <=50 ml B 9 XXX $ - $ -
A4310 Insert tray w/o bag/cath B 9 XXX $ - $ -
A4311 Catheter w/o bag 2-way latex B 9 XXX $ - $ -
A4312 Cath w/o bag 2-way silicone B 9 XXX $ - $ -
A4313 Catheter w/bag 3-way B 9 XXX $ - $ -
A4314 Cath w/drainage 2-way latex B 9 XXX $ - $ -
A4315 Cath w/drainage 2-way silcne B 9 XXX $ - $ -
A4316 Cath w/drainage 3-way B 9 XXX $ - $ -
A4320 Irrigation tray B 9 XXX $ - $ -
A4321 Cath therapeutic irrig agent X 9 XXX $ - $ -
A4322 Irrigation syringe B 9 XXX $ - $ -
A4326 Male external catheter B 9 XXX $ - $ -
A4327 Fem urinary collect dev cup B 9 XXX $ - $ -
A4328 Fem urinary collect pouch B 9 XXX $ - $ -
A4330 Stool collection pouch B 9 XXX $ - $ -
A4331 Extension drainage tubing X 9 XXX $ - $ -
A4332 Lube sterile packet X 9 XXX $ - $ -
A4333 Urinary cath anchor device X 9 XXX $ - $ -
A4334 Urinary cath leg strap X 9 XXX $ - $ -
A4335 Incontinence supply B 9 XXX $ - $ -
A4336 Urethral insert X 9 XXX $ - $ -
A4338 Indwelling catheter latex B 9 XXX $ - $ -
A4340 Indwelling catheter special B 9 XXX $ - $ -
A4344 Cath indw foley 2 way silicn B 9 XXX $ - $ -
A4346 Cath indw foley 3 way B 9 XXX $ - $ -
A4349 Disposable male external cat X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
A4351 Straight tip urine catheter B 9 XXX $ - $ -

A4352 Coude tip urinary catheter B 9 XXX $ - $ -
A4353 Intermittent urinary cath X 9 XXX $ - $ -
A4354 Cath insertion tray w/bag B 9 XXX $ - $ -
A4355 Bladder irrigation tubing B 9 XXX $ - $ -
A4356 Ext ureth clmp or compr dvc B 9 XXX $ - $ -
A4357 Bedside drainage bag B 9 XXX $ - $ -
A4358 Urinary leg or abdomen bag B 9 XXX $ - $ -
A4360 Disposable ext urethral dev X 9 XXX $ - $ -
A4361 Ostomy face plate B 9 XXX $ - $ -
A4362 Solid skin barrier B 9 XXX $ - $ -
A4363 Ostomy clamp, replacement X 9 XXX $ - $ -
A4364 Adhesive, liquid or equal B 9 XXX $ - $ -
A4366 Ostomy vent X 9 XXX $ - $ -
A4367 Ostomy belt B 9 XXX $ - $ -
A4368 Ostomy filter X 9 XXX $ - $ -
A4369 Skin barrier liquid per oz X 9 XXX $ - $ -
A4371 Skin barrier powder per oz X 9 XXX $ - $ -
A4372 Skin barrier solid 4x4 equiv X 9 XXX $ - $ -
A4373 Skin barrier with flange X 9 XXX $ - $ -
A4375 Drainable plastic pch w fcpl X 9 XXX $ - $ -
A4376 Drainable rubber pch w fcplt X 9 XXX $ - $ -
A4377 Drainable plstic pch w/o fp X 9 XXX $ - $ -
A4378 Drainable rubber pch w/o fp X 9 XXX $ - $ -
A4379 Urinary plastic pouch w fcpl X 9 XXX $ - $ -
A4380 Urinary rubber pouch w fcplt X 9 XXX $ - $ -
A4381 Urinary plastic pouch w/o fp X 9 XXX $ - $ -
A4382 Urinary hvy plstc pch w/o fp X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
A4383 Urinary rubber pouch w/o fp X 9 XXX $ - $ -

A4384 Ostomy faceplt/silicone ring X 9 XXX $ - $ -
A4385 Ost skn barrier sld ext wear X 9 XXX $ - $ -
A4387 Ost clsd pouch w att st barr X 9 XXX $ - $ -
A4388 Drainable pch w ex wear barr X 9 XXX $ - $ -
A4389 Drainable pch w st wear barr X 9 XXX $ - $ -
A4390 Drainable pch ex wear convex X 9 XXX $ - $ -
A4391 Urinary pouch w ex wear barr X 9 XXX $ - $ -
A4392 Urinary pouch w st wear barr X 9 XXX $ - $ -
A4393 Urine pch w ex wear bar conv X 9 XXX $ - $ -
A4394 Ostomy pouch liq deodorant X 9 XXX $ - $ -
A4395 Ostomy pouch solid deodorant X 9 XXX $ - $ -
A4396 Peristomal hernia supprt blt X 9 XXX $ - $ -
A4397 Irrigation supply sleeve B 9 XXX $ - $ -
A4398 Ostomy irrigation bag B 9 XXX $ - $ -
A4399 Ostomy irrig cone/cath w brs B 9 XXX $ - $ -
A4400 Ostomy irrigation set B 9 XXX $ - $ -
A4402 Lubricant per ounce B 9 XXX $ - $ -
A4404 Ostomy ring each B 9 XXX $ - $ -
A4405 Nonpectin based ostomy paste X 9 XXX $ - $ -
A4406 Pectin based ostomy paste X 9 XXX $ - $ -
A4407 Ext wear ost skn barr <=4sq" X 9 XXX $ - $ -
A4408 Ext wear ost skn barr >4sq" X 9 XXX $ - $ -
A4409 Ost skn barr convex <=4 sq i X 9 XXX $ - $ -
A4410 Ost skn barr extnd >4 sq X 9 XXX $ - $ -
A4411 Ost skn barr extnd =4sq X 9 XXX $ - $ -
A4412 Ost pouch drain high output X 9 XXX $ - $ -
A4413 2 pc drainable ost pouch X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
A4414 Ost sknbar w/o conv<=4 sq in X 9 XXX $ - $ -

A4415 Ost skn barr w/o conv >4 sqi X 9 XXX $ - $ -
A4416 Ost pch clsd w barrier/filtr X 9 XXX $ - $ -
A4417 Ost pch w bar/bltinconv/fltr X 9 XXX $ - $ -
A4418 Ost pch clsd w/o bar w filtr X 9 XXX $ - $ -
A4419 Ost pch for bar w flange/flt X 9 XXX $ - $ -
A4420 Ost pch clsd for bar w lk fl X 9 XXX $ - $ -
A4421 Ostomy supply misc X 9 XXX $ - $ -
A4422 Ost pouch absorbent material X 9 XXX $ - $ -
A4423 Ost pch for bar w lk fl/fltr X 9 XXX $ - $ -
A4424 Ost pch drain w bar & filter X 9 XXX $ - $ -
A4425 Ost pch drain for barrier fl X 9 XXX $ - $ -
A4426 Ost pch drain 2 piece system X 9 XXX $ - $ -
A4427 Ost pch drain/barr lk flng/f X 9 XXX $ - $ -
A4428 Urine ost pouch w faucet/tap X 9 XXX $ - $ -
A4429 Urine ost pouch w bltinconv X 9 XXX $ - $ -
A4430 Ost urine pch w b/bltin conv X 9 XXX $ - $ -
A4431 Ost pch urine w barrier/tapv X 9 XXX $ - $ -
A4432 Os pch urine w bar/fange/tap X 9 XXX $ - $ -
A4433 Urine ost pch bar w lock fln X 9 XXX $ - $ -
A4434 Ost pch urine w lock flng/ft X 9 XXX $ - $ -
A4450 Non-waterproof tape X 9 XXX $ - $ -
A4452 Waterproof tape X 9 XXX $ - $ -
A4455 Adhesive remover per ounce B 9 XXX $ - $ -
A4456 Adhesive remover, wipes X 9 XXX $ - $ -
A4458 Reusable enema bag X 9 XXX $ - $ -
A4461 Surgicl dress hold non-reuse X 9 XXX $ - $ -
A4463 Surgical dress holder reuse X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
A4465 Non-elastic extremity binder B 9 XXX $ - $ -

A4466 Elastic garment/covering I 9 XXX $ - $ -
A4470 Gravlee jet washer B 9 XXX $ - $ -
A4480 Vabra aspirator B 9 XXX $ - $ -
A4481 Tracheostoma filter X 9 XXX $ - $ -
A4483 Moisture exchanger X 9 XXX $ - $ -
A4490 Above knee surgical stocking X 9 XXX $ - $ -
A4495 Thigh length surg stocking X 9 XXX $ - $ -
A4500 Below knee surgical stocking X 9 XXX $ - $ -
A4510 Full length surg stocking X 9 XXX $ - $ -
A4520 Incontinence garment anytype X 9 XXX $ - $ -
A4550 Surgical trays B 9 XXX $ - $ -
A4554 Disposable underpads N 9 XXX $ - $ -
A4556 Electrodes, pair B 9 XXX $ - $ -
A4557 Lead wires, pair B 9 XXX $ - $ -
A4558 Conductive gel or paste B 9 XXX $ - $ -
A4559 Coupling gel or paste X 9 XXX $ - $ -
A4561 Pessary rubber, any type X 9 XXX $ - $ -
A4562 Pessary, non rubber,any type X 9 XXX $ - $ -
A4565 Slings X 9 XXX $ - $ -
A4566 Should sling/vest/abrestrain X 9 XXX $ - $ -
A4570 Splint X 9 XXX $ - $ -
A4575 Hyperbaric o2 chamber disps N 9 XXX $ - $ -
A4580 Cast supplies (plaster) X 9 XXX $ - $ -
A4590 Special casting material X 9 XXX $ - $ -
A4595 TENS suppl 2 lead per month X 9 XXX $ - $ -
A4600 Sleeve, inter limb comp dev X 9 XXX $ - $ -
A4601 Lith ion batt, non-pros use X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
A4604 Tubing with heating element X 9 XXX $ - $ -

A4605 Trach suction cath close sys X 9 XXX $ - $ -
A4606 Oxygen probe used w oximeter X 9 XXX $ - $ -
A4608 Transtracheal oxygen cath X 9 XXX $ - $ -
A4611 Heavy duty battery X 9 XXX $ - $ -
A4612 Battery cables X 9 XXX $ - $ -
A4613 Battery charger X 9 XXX $ - $ -
A4614 Hand-held PEFR meter X 9 XXX $ - $ -
A4615 Cannula nasal X 9 XXX $ - $ -
A4616 Tubing (oxygen) per foot X 9 XXX $ - $ -
A4617 Mouth piece X 9 XXX $ - $ -
A4618 Breathing circuits X 9 XXX $ - $ -
A4619 Face tent X 9 XXX $ - $ -
A4620 Variable concentration mask X 9 XXX $ - $ -
A4623 Tracheostomy inner cannula X 9 XXX $ - $ -
A4624 Tracheal suction tube X 9 XXX $ - $ -
A4625 Trach care kit for new trach X 9 XXX $ - $ -
A4626 Tracheostomy cleaning brush X 9 XXX $ - $ -
A4627 Spacer bag/reservoir N 9 XXX $ - $ -
A4628 Oropharyngeal suction cath X 9 XXX $ - $ -
A4629 Tracheostomy care kit X 9 XXX $ - $ -
A4630 Repl bat t.e.n.s. own by pt X 9 XXX $ - $ -
A4633 Uvl replacement bulb X 9 XXX $ - $ -
A4634 Replacement bulb th lightbox X 9 XXX $ - $ -
A4635 Underarm crutch pad X 9 XXX $ - $ -
A4636 Handgrip for cane etc X 9 XXX $ - $ -
A4637 Repl tip cane/crutch/walker X 9 XXX $ - $ -
A4638 Repl batt pulse gen sys X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
A4639 Infrared ht sys replcmnt pad X 9 XXX $ - $ -

A4640 Alternating pressure pad X 9 XXX $ - $ -
A4641 Radiopharm dx agent noc C 0 XXX $ - $ -
A4642 In111 satumomab C 0 XXX $ - $ -
A4648 Implantable tissue marker X 9 XXX $ - $ -
A4649 Surgical supplies B 9 XXX $ - $ -
A4650 Implant radiation dosimeter X 9 XXX $ - $ -
A4651 Calibrated microcap tube X 9 XXX $ - $ -
A4652 Microcapillary tube sealant X 9 XXX $ - $ -
A4653 PD catheter anchor belt X 9 XXX $ - $ -
A4657 Syringe w/wo needle X 9 XXX $ - $ -
A4660 Sphyg/bp app w cuff and stet X 9 XXX $ - $ -
A4663 Dialysis blood pressure cuff X 9 XXX $ - $ -
A4670 Automatic bp monitor, dial N 9 XXX $ - $ -
A4671 Disposable cycler set X 9 XXX $ - $ -
A4672 Drainage ext line, dialysis X 9 XXX $ - $ -
A4673 Ext line w easy lock connect X 9 XXX $ - $ -
A4674 Chem/antisept solution, 8oz X 9 XXX $ - $ -
A4680 Activated carbon filter, ea X 9 XXX $ - $ -
A4690 Dialyzer, each X 9 XXX $ - $ -
A4706 Bicarbonate conc sol per gal X 9 XXX $ - $ -
A4707 Bicarbonate conc pow per pac X 9 XXX $ - $ -
A4708 Acetate conc sol per gallon X 9 XXX $ - $ -
A4709 Acid conc sol per gallon X 9 XXX $ - $ -
A4714 Treated water per gallon X 9 XXX $ - $ -
A4719 Y "Y set" tubing X 9 XXX $ - $ -
A4720 Dialysat sol fld vol > 249cc X 9 XXX $ - $ -
A4721 Dialysat sol fld vol > 999cc X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
A4722 Dialys sol fld vol > 1999cc X 9 XXX $ - $ -

A4728 Dialysate solution, non-dex X 9 XXX $ - $ -
A4730 Fistula cannulation set, ea X 9 XXX $ - $ -
A4736 Topical anesthetic, per gram X 9 XXX $ - $ -
A4737 Inj anesthetic per 10 ml X 9 XXX $ - $ -
A4740 Shunt accessory X 9 XXX $ - $ -
A4750 Art or venous blood tubing X 9 XXX $ - $ -
A4755 Comb art/venous blood tubing X 9 XXX $ - $ -
A4760 Dialysate sol test kit, each X 9 XXX $ - $ -
A4765 Dialysate conc pow per pack X 9 XXX $ - $ -
A4766 Dialysate conc sol add 10 ml X 9 XXX $ - $ -
A4770 Blood collection tube/vacuum X 9 XXX $ - $ -
A4771 Serum clotting time tube X 9 XXX $ - $ -
A4772 Blood glucose test strips X 9 XXX $ - $ -
A4773 Occult blood test strips X 9 XXX $ - $ -
A4774 Ammonia test strips X 9 XXX $ - $ -
A4802 Protamine sulfate per 50 mg X 9 XXX $ - $ -
A4860 Disposable catheter tips X 9 XXX $ - $ -
A4870 Plumb/elec wk hm hemo equip X 9 XXX $ - $ -
A4890 Repair/maint cont hemo equip X 0 XXX $ - $ -
A4911 Drain bag/bottle X 9 XXX $ - $ -
A4913 Misc dialysis supplies noc X 9 XXX $ - $ -
A4918 Venous pressure clamp X 9 XXX $ - $ -
A4927 Non-sterile gloves X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
A4928 Surgical mask X 9 XXX $ - $ -

A4929 Tourniquet for dialysis, ea X 9 XXX $ - $ -
A4930 Sterile, gloves per pair X 9 XXX $ - $ -
A4931 Reusable oral thermometer X 9 XXX $ - $ -
A4932 Reusable rectal thermometer X 9 XXX $ - $ -
A5051 Pouch clsd w barr attached B 9 XXX $ - $ -
A5052 Clsd ostomy pouch w/o barr B 9 XXX $ - $ -
A5053 Clsd ostomy pouch faceplate B 9 XXX $ - $ -
A5054 Clsd ostomy pouch w/flange B 9 XXX $ - $ -
A5055 Stoma cap B 9 XXX $ - $ -
A5056 1 pc ost pouch w filter X 9 XXX $ - $ -
A5057 1 pc ost pou w built-in conv X 9 XXX $ - $ -
A5061 Pouch drainable w barrier at B 9 XXX $ - $ -
A5062 Drnble ostomy pouch w/o barr B 9 XXX $ - $ -
A5063 Drain ostomy pouch w/flange B 9 XXX $ - $ -
A5071 Urinary pouch w/barrier B 9 XXX $ - $ -
A5072 Urinary pouch w/o barrier B 9 XXX $ - $ -
A5073 Urinary pouch on barr w/flng B 9 XXX $ - $ -
A5081 Continent stoma plug B 9 XXX $ - $ -
A5082 Continent stoma catheter B 9 XXX $ - $ -
A5083 Stoma absorptive cover X 9 XXX $ - $ -
A5093 Ostomy accessory convex inse B 9 XXX $ - $ -
A5102 Bedside drain btl w/wo tube B 9 XXX $ - $ -
A5105 Urinary suspensory B 9 XXX $ - $ -
A5112 Urinary leg bag B 9 XXX $ - $ -
A5113 Latex leg strap B 9 XXX $ - $ -
A5114 Foam/fabric leg strap B 9 XXX $ - $ -
A5120 Skin barrier, wipe or swab X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
A5121 Solid skin barrier 6x6 B 9 XXX $ - $ -

A5122 Solid skin barrier 8x8 B 9 XXX $ - $ -
A5126 Disk/foam pad +or- adhesive B 9 XXX $ - $ -
A5131 Appliance cleaner B 9 XXX $ - $ -
A5200 Percutaneous catheter anchor X 9 XXX $ - $ -
A5500 Diab shoe for density insert X 9 XXX $ - $ -
A5501 Diabetic custom molded shoe X 9 XXX $ - $ -
A5503 Diabetic shoe w/roller/rockr X 9 XXX $ - $ -
A5504 Diabetic shoe with wedge X 9 XXX $ - $ -
A5505 Diab shoe w/metatarsal bar X 9 XXX $ - $ -
A5506 Diabetic shoe w/off set heel X 9 XXX $ - $ -
A5507 Modification diabetic shoe X 9 XXX $ - $ -
A5508 Diabetic deluxe shoe X 9 XXX $ - $ -
A5510 Compression form shoe insert X 9 XXX $ - $ -
A5512 Multi den insert direct form X 9 XXX $ - $ -
A5513 Multi den insert custom mold X 9 XXX $ - $ -
A6000 Wound warming wound cover N 9 XXX $ - $ -
A6010 Collagen based wound filler X 9 XXX $ - $ -
A6011 Collagen gel/paste wound fil X 9 XXX $ - $ -
A6021 Collagen dressing <=16 sq in X 9 XXX $ - $ -
A6022 Collagen drsg>16<=48 sq in X 9 XXX $ - $ -
A6023 Collagen dressing >48 sq in X 9 XXX $ - $ -
A6024 Collagen dsg wound filler X 9 XXX $ - $ -
A6025 Silicone gel sheet, each X 9 XXX $ - $ -
A6154 Wound pouch each B 9 XXX $ - $ -
A6196 Alginate dressing <=16 sq in B 9 XXX $ - $ -
A6197 Alginate drsg >16 <=48 sq in B 9 XXX $ - $ -
A6198 alginate dressing > 48 sq in B 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
A6199 Alginate drsg wound filler B 9 XXX $ - $ -

A6203 Composite drsg <= 16 sq in B 9 XXX $ - $ -
A6204 Composite drsg >16<=48 sq in B 9 XXX $ - $ -
A6205 Composite drsg > 48 sq in B 9 XXX $ - $ -
A6206 Contact layer <= 16 sq in B 9 XXX $ - $ -
A6207 Contact layer >16<= 48 sq in B 9 XXX $ - $ -
A6208 Contact layer > 48 sq in B 9 XXX $ - $ -
A6209 Foam drsg <=16 sq in w/o bdr B 9 XXX $ - $ -
A6210 Foam drg >16<=48 sq in w/o b B 9 XXX $ - $ -
A6211 Foam drg > 48 sq in w/o brdr B 9 XXX $ - $ -
A6212 Foam drg <=16 sq in w/border B 9 XXX $ - $ -
A6213 Foam drg >16<=48 sq in w/bdr B 9 XXX $ - $ -
A6214 Foam drg > 48 sq in w/border B 9 XXX $ - $ -
A6215 Foam dressing wound filler B 9 XXX $ - $ -
A6216 Non-sterile gauze<=16 sq in B 9 XXX $ - $ -
A6217 Non-sterile gauze>16<=48 sq B 9 XXX $ - $ -
A6218 Non-sterile gauze > 48 sq in B 9 XXX $ - $ -
A6219 Gauze <= 16 sq in w/border B 9 XXX $ - $ -
A6220 Gauze >16 <=48 sq in w/bordr B 9 XXX $ - $ -
A6221 Gauze > 48 sq in w/border B 9 XXX $ - $ -
A6222 Gauze <=16 in no w/sal w/o b B 9 XXX $ - $ -
A6223 Gauze >16<=48 no w/sal w/o b B 9 XXX $ - $ -
A6224 Gauze > 48 in no w/sal w/o b B 9 XXX $ - $ -
A6228 Gauze <= 16 sq in water/sal B 9 XXX $ - $ -
A6229 Gauze >16<=48 sq in watr/sal B 9 XXX $ - $ -
A6230 Gauze > 48 sq in water/salne B 9 XXX $ - $ -
A6231 Hydrogel dsg<=16 sq in X 9 XXX $ - $ -
A6232 Hydrogel dsg>16<=48 sq in X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
A6233 Hydrogel dressing >48 sq in X 9 XXX $ - $ -

A6234 Hydrocolld drg <=16 w/o bdr B 9 XXX $ - $ -
A6235 Hydrocolld drg >16<=48 w/o b B 9 XXX $ - $ -
A6236 Hydrocolld drg > 48 in w/o b B 9 XXX $ - $ -
A6237 Hydrocolld drg <=16 in w/bdr B 9 XXX $ - $ -
A6238 Hydrocolld drg >16<=48 w/bdr B 9 XXX $ - $ -
A6239 Hydrocolld drg > 48 in w/bdr B 9 XXX $ - $ -
A6240 Hydrocolld drg filler paste B 9 XXX $ - $ -
A6241 Hydrocolloid drg filler dry B 9 XXX $ - $ -
A6242 Hydrogel drg <=16 in w/o bdr B 9 XXX $ - $ -
A6243 Hydrogel drg >16<=48 w/o bdr B 9 XXX $ - $ -
A6244 Hydrogel drg >48 in w/o bdr B 9 XXX $ - $ -
A6245 Hydrogel drg <= 16 in w/bdr B 9 XXX $ - $ -
A6246 Hydrogel drg >16<=48 in w/b B 9 XXX $ - $ -
A6247 Hydrogel drg > 48 sq in w/b B 9 XXX $ - $ -
A6248 Hydrogel drsg gel filler B 9 XXX $ - $ -
A6250 Skin seal protect moisturizr B 9 XXX $ - $ -
A6251 Absorpt drg <=16 sq in w/o b B 9 XXX $ - $ -
A6252 Absorpt drg >16 <=48 w/o bdr B 9 XXX $ - $ -
A6253 Absorpt drg > 48 sq in w/o b B 9 XXX $ - $ -
A6254 Absorpt drg <=16 sq in w/bdr B 9 XXX $ - $ -
A6255 Absorpt drg >16<=48 in w/bdr B 9 XXX $ - $ -
A6256 Absorpt drg > 48 sq in w/bdr B 9 XXX $ - $ -
A6257 Transparent film <= 16 sq in B 9 XXX $ - $ -
A6258 Transparent film >16<=48 in B 9 XXX $ - $ -
A6259 Transparent film > 48 sq in B 9 XXX $ - $ -
A6260 Wound cleanser any type/size B 9 XXX $ - $ -
A6261 Wound filler gel/paste /oz B 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
A6262 Wound filler dry form / gram B 9 XXX $ - $ -

A6266 Impreg gauze no h20/sal/yard B 9 XXX $ - $ -
A6402 Sterile gauze <= 16 sq in B 9 XXX $ - $ -
A6403 Sterile gauze>16 <= 48 sq in B 9 XXX $ - $ -
A6404 Sterile gauze > 48 sq in B 9 XXX $ - $ -
A6407 Packing strips, non-impreg X 9 XXX $ - $ -
A6410 Sterile eye pad X 9 XXX $ - $ -
A6411 Non-sterile eye pad X 9 XXX $ - $ -
A6412 Occlusive eye patch X 9 XXX $ - $ -
A6413 Adhesive bandage, first-aid N 9 XXX $ - $ -
A6441 Pad band w>=3" <5"/yd X 9 XXX $ - $ -
A6442 Conform band n/s w<3"/yd X 9 XXX $ - $ -
A6443 Conform band n/s w>=3"<5"/yd X 9 XXX $ - $ -
A6444 Conform band n/s w>=5"/yd X 9 XXX $ - $ -
A6445 Conform band s w <3"/yd X 9 XXX $ - $ -
A6446 Conform band s w>=3" <5"/yd X 9 XXX $ - $ -
A6447 Conform band s w >=5"/yd X 9 XXX $ - $ -
A6448 Lt compres band <3"/yd X 9 XXX $ - $ -
A6449 Lt compres band >=3" <5"/yd X 9 XXX $ - $ -
A6450 Lt compres band >=5"/yd X 9 XXX $ - $ -
A6451 Mod compres band w>=3"<5"/yd X 9 XXX $ - $ -
A6452 High compres band w>=3"<5"yd X 9 XXX $ - $ -
A6453 Self-adher band w <3"/yd X 9 XXX $ - $ -
A6454 Self-adher band w>=3" <5"/yd X 9 XXX $ - $ -
A6455 Self-adher band >=5"/yd X 9 XXX $ - $ -
A6456 Zinc paste band w >=3"<5"/yd X 9 XXX $ - $ -
A6457 Tubular dressing X 9 XXX $ - $ -
A6501 Compres burngarment bodysuit X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
A6502 Compres burngarment chinstrp X 9 XXX $ - $ -

A6503 Compres burngarment facehood X 9 XXX $ - $ -
A6504 Cmprsburngarment glove-wrist X 9 XXX $ - $ -
A6505 Cmprsburngarment glove-elbow X 9 XXX $ - $ -
A6506 Cmprsburngrmnt glove-axilla X 9 XXX $ - $ -
A6507 Cmprs burngarment foot-knee X 9 XXX $ - $ -
A6508 Cmprs burngarment foot-thigh X 9 XXX $ - $ -
A6509 Compres burn garment jacket X 9 XXX $ - $ -
A6510 Compres burn garment leotard X 9 XXX $ - $ -
A6511 Compres burn garment panty X 9 XXX $ - $ -
A6512 Compres burn garment, noc X 9 XXX $ - $ -
A6513 Compress burn mask face/neck X 9 XXX $ - $ -
A6530 Compression stocking BK18-30 N 9 XXX $ - $ -
A6531 Compression stocking BK30-40 X 9 XXX $ - $ -
A6532 Compression stocking BK40-50 X 9 XXX $ - $ -
A6533 Gc stocking thighlngth 18-30 N 9 XXX $ - $ -
A6536 Gc stocking full lngth 18-30 N 9 XXX $ - $ -
A6539 Gc stocking waistlngth 18-30 N 9 XXX $ - $ -
A6544 Gc stocking garter belt N 9 XXX $ - $ -
A6545 Grad comp non-elastic BK X 9 XXX $ - $ -
A6549 G compression stocking N 9 XXX $ - $ -
A6550 Neg pres wound ther drsg set X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
A7000 Disposable canister for pump X 9 XXX $ - $ -

A7001 Nondisposable pump canister X 9 XXX $ - $ -
A7002 Tubing used w suction pump X 9 XXX $ - $ -
A7003 Nebulizer administration set X 9 XXX $ - $ -
A7004 Disposable nebulizer sml vol X 9 XXX $ - $ -
A7005 Nondisposable nebulizer set X 9 XXX $ - $ -
A7006 Filtered nebulizer admin set X 9 XXX $ - $ -
A7007 Lg vol nebulizer disposable X 9 XXX $ - $ -
A7008 Disposable nebulizer prefill X 9 XXX $ - $ -
A7009 Nebulizer reservoir bottle X 9 XXX $ - $ -
A7010 Disposable corrugated tubing X 9 XXX $ - $ -
A7011 Nondispos corrugated tubing X 9 XXX $ - $ -
A7012 Nebulizer water collec devic X 9 XXX $ - $ -
A7013 Disposable compressor filter X 9 XXX $ - $ -
A7014 Compressor nondispos filter X 9 XXX $ - $ -
A7015 Aerosol mask used w nebulize X 9 XXX $ - $ -
A7016 Nebulizer dome & mouthpiece X 9 XXX $ - $ -
A7017 Nebulizer not used w oxygen X 9 XXX $ - $ -
A7018 Water distilled w/nebulizer X 9 XXX $ - $ -
A7020 Interface, cough stim device X 9 XXX $ - $ -
A7025 Replace chest compress vest X 9 XXX $ - $ -
A7026 Replace chst cmprss sys hose X 9 XXX $ - $ -
A7027 Combination oral/nasal mask X 9 XXX $ - $ -
A7028 Repl oral cushion combo mask X 9 XXX $ - $ -
A7029 Repl nasal pillow comb mask X 9 XXX $ - $ -
A7030 CPAP full face mask X 9 XXX $ - $ -
A7031 Replacement facemask interfa X 9 XXX $ - $ -
A7032 Replacement nasal cushion X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
A7033 Replacement nasal pillows X 9 XXX $ - $ -

A7034 Nasal application device X 9 XXX $ - $ -
A7035 Pos airway press headgear X 9 XXX $ - $ -
A7036 Pos airway press chinstrap X 9 XXX $ - $ -
A7037 Pos airway pressure tubing X 9 XXX $ - $ -
A7038 Pos airway pressure filter X 9 XXX $ - $ -
A7039 Filter, non disposable w pap X 9 XXX $ - $ -
A7040 One way chest drain valve X 9 XXX $ - $ -
A7041 Water seal drain container X 9 XXX $ - $ -
A7042 Implanted pleural catheter X 9 XXX $ - $ -
A7043 Vacuum drainagebottle/tubing X 9 XXX $ - $ -
A7044 PAP oral interface X 9 XXX $ - $ -
A7045 Repl exhalation port for PAP X 9 XXX $ - $ -
A7046 Repl water chamber, PAP dev X 9 XXX $ - $ -
A7501 Tracheostoma valve w diaphra X 9 XXX $ - $ -
A7502 Replacement diaphragm/fplate X 9 XXX $ - $ -
A7503 HMES filter holder or cap X 9 XXX $ - $ -
A7504 Tracheostoma HMES filter X 9 XXX $ - $ -
A7505 HMES or trach valve housing X 9 XXX $ - $ -
A7506 HMES/trachvalve adhesivedisk X 9 XXX $ - $ -
A7507 Integrated filter & holder X 9 XXX $ - $ -
A7508 Housing & Integrated Adhesiv X 9 XXX $ - $ -
A7509 Heat & moisture exchange sys X 9 XXX $ - $ -
A7520 Trach/laryn tube non-cuffed X 9 XXX $ - $ -
A7521 Trach/laryn tube cuffed X 9 XXX $ - $ -
A7522 Trach/laryn tube stainless X 9 XXX $ - $ -
A7523 Tracheostomy shower protect X 9 XXX $ - $ -
A7524 Tracheostoma stent/stud/bttn X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
A7525 Tracheostomy mask X 9 XXX $ - $ -

A7526 Tracheostomy tube collar X 9 XXX $ - $ -
A7527 Trach/laryn tube plug/stop X 9 XXX $ - $ -
A8000 Soft protect helmet prefab X 9 XXX $ - $ -
A8001 Hard protect helmet prefab X 9 XXX $ - $ -
A8002 Soft protect helmet custom X 9 XXX $ - $ -
A8003 Hard protect helmet custom X 9 XXX $ - $ -
A8004 Repl soft interface, helmet X 9 XXX $ - $ -
A9150 Misc/exper non-prescript dru X 9 XXX $ - $ -
A9152 Single vitamin nos I 9 XXX $ - $ -
A9153 Multi-vitamin nos I 9 XXX $ - $ -
A9155 Artificial saliva X 9 XXX $ - $ -
A9180 Lice treatment, topical I 9 XXX $ - $ -
A9270 Non-covered item or service N 9 XXX $ - $ -
A9272 Disposable mech wound suct X 9 XXX $ - $ -
A9273 Hot/cold h2obot/cap/col/wrap N 9 XXX $ - $ -
A9274 Ext amb insulin delivery sys X 9 XXX $ - $ -
A9275 Disp home glucose monitor N 9 XXX $ - $ -
A9276 Disposable sensor, CGM sys N 9 XXX $ - $ -
A9277 External transmitter, CGM N 9 XXX $ - $ -
A9278 External receiver, CGM sys N 9 XXX $ - $ -
A9279 Monitoring feature/deviceNOC X 9 XXX $ - $ -
A9280 Alert device, noc N 9 XXX $ - $ -
A9281 Reaching/grabbing device N 9 XXX $ - $ -
A9282 Wig any type N 9 XXX $ - $ -
A9283 Foot press off load supp dev N 9 XXX $ - $ -
A9284 Non-electronic spirometer X 9 XXX $ - $ -
A9300 Exercise equipment N 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
A9500 Tc99m sestamibi C 0 XXX $ - $ -

A9501 Technetium TC-99m teboroxime C 0 XXX $ - $ -
A9502 Tc99m tetrofosmin C 0 XXX $ - $ -
A9503 Tc99m medronate C 0 XXX $ - $ -
A9504 Tc99m apcitide C 0 XXX $ - $ -
A9505 TL201 thallium C 0 XXX $ - $ -
A9507 In111 capromab C 0 XXX $ - $ -
A9508 I131 iodobenguate, dx C 0 XXX $ - $ -
A9509 Iodine I-123 sod iodide mil C 0 XXX $ - $ -
A9510 Tc99m disofenin C 0 XXX $ - $ -
A9512 Tc99m pertechnetate C 0 XXX $ - $ -
A9516 Iodine I-123 sod iodide mic C 0 XXX $ - $ -
A9517 I131 iodide cap, rx C 0 XXX $ - $ -
A9521 Tc99m exametazime C 0 XXX $ - $ -
A9524 I131 serum albumin, dx C 0 XXX $ - $ -
A9526 Nitrogen N-13 ammonia C 0 XXX $ - $ -
A9527 Iodine I-125 sodium iodide C 0 XXX $ - $ -
A9528 Iodine I-131 iodide cap, dx C 0 XXX $ - $ -
A9529 I131 iodide sol, dx C 0 XXX $ - $ -
A9530 I131 iodide sol, rx C 0 XXX $ - $ -
A9531 I131 max 100uCi C 0 XXX $ - $ -
A9532 I125 serum albumin, dx C 0 XXX $ - $ -
A9536 Tc99m depreotide C 0 XXX $ - $ -
A9537 Tc99m mebrofenin C 0 XXX $ - $ -
A9538 Tc99m pyrophosphate C 0 XXX $ - $ -
A9539 Tc99m pentetate C 0 XXX $ - $ -
A9540 Tc99m MAA C 0 XXX $ - $ -
A9541 Tc99m sulfur colloid C 0 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
A9542 In111 ibritumomab, dx C 0 XXX $ - $ -

A9543 Y90 ibritumomab, rx C 0 XXX $ - $ -
A9544 I131 tositumomab, dx C 0 XXX $ - $ -
A9545 I131 tositumomab, rx C 0 XXX $ - $ -
A9546 Co57/58 C 0 XXX $ - $ -
A9547 In111 oxyquinoline C 0 XXX $ - $ -
A9548 In111 pentetate C 0 XXX $ - $ -
A9550 Tc99m gluceptate C 0 XXX $ - $ -
A9551 Tc99m succimer C 0 XXX $ - $ -
A9552 F18 fdg C 0 XXX $ - $ -
A9553 Cr51 chromate C 0 XXX $ - $ -
A9554 I125 iothalamate, dx C 0 XXX $ - $ -
A9555 Rb82 rubidium C 0 XXX $ - $ -
A9556 Ga67 gallium C 0 XXX $ - $ -
A9557 Tc99m bicisate C 0 XXX $ - $ -
A9558 Xe133 xenon 10mci C 0 XXX $ - $ -
A9559 Co57 cyano C 0 XXX $ - $ -
A9560 Tc99m labeled rbc C 0 XXX $ - $ -
A9561 Tc99m oxidronate C 0 XXX $ - $ -
A9562 Tc99m mertiatide C 0 XXX $ - $ -
A9563 P32 Na phosphate C 0 XXX $ - $ -
A9564 P32 chromic phosphate C 0 XXX $ - $ -
A9566 Tc99m fanolesomab C 0 XXX $ - $ -
A9567 Technetium TC-99m aerosol C 0 XXX $ - $ -
A9568 Technetium tc99m arcitumomab C 0 XXX $ - $ -
A9569 Technetium TC-99m auto WBC C 0 XXX $ - $ -
A9570 Indium In-111 auto WBC C 0 XXX $ - $ -
A9571 Indium IN-111 auto platelet C 0 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
A9572 Indium In-111 pentetreotide C 0 XXX $ - $ -

A9576 Inj prohance multipack X 9 XXX $ - $ -
A9577 Inj multihance X 9 XXX $ - $ -
A9578 Inj multihance multipack X 9 XXX $ - $ -
A9579 Gad-base MR contrast NOS,1ml X 9 XXX $ - $ -
A9580 Sodium fluoride F-18 C 0 XXX $ - $ -
A9581 Gadoxetate disodium inj X 9 XXX $ - $ -
A9582 Iodine I-123 iobenguane X 9 XXX $ - $ -
A9583 Gadofosveset trisodium inj X 9 XXX $ - $ -
A9584 Iodine I-123 ioflupane X 9 XXX $ - $ -
A9585 Gadobutrol injection X 9 XXX $ - $ -
A9600 Sr89 strontium C 0 XXX $ - $ -
A9604 Sm 153 lexidronam X 9 XXX $ - $ -
A9698 Non-rad contrast materialNOC X 9 XXX $ - $ -
A9699 Radiopharm rx agent noc C 0 XXX $ - $ -
A9700 Echocardiography Contrast X 9 XXX $ - $ -
A9900 Supply/accessory/service X 9 XXX $ - $ -
A9901 Delivery/set up/dispensing X 9 XXX $ - $ -
A9999 DME supply or accessory, nos X 9 XXX $ - $ -
G0008 Admin influenza virus vac X 9 XXX $ - $ -
G0009 Admin pneumococcal vaccine X 9 XXX $ - $ -
G0010 Admin hepatitis b vaccine X 9 XXX $ - $ -
G0027 Semen analysis X 9 XXX $ - $ -
G0101 CA screen;pelvic/breast exam A 0 XXX $ 27.84 $ 36.54
G0102 Prostate ca screening; dre A 0 XXX $ 9.05 $ 18.10
G0103 PSA screening X 9 XXX $ - $ -
G0104 CA screen;flexi sigmoidscope A 0 000 Y $ 70.99 $ 137.81
G0105 Colorectal scrn; hi risk ind A 0 000 Y $ 255.08 $ 409.60

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
G0105 53 Colorectal scrn; hi risk ind A 0 000 Y $ 70.99 $ 137.81

G0106 Colon CA screen;barium enema A 1 XXX $ - $ 194.18
G0106 26 Colon CA screen;barium enema A 1 XXX $ 47.33 $ 47.33
G0106 TC Colon CA screen;barium enema A 1 XXX $ - $ 146.86
G0108 Diab manage trn per indiv A 0 XXX $ - $ 53.94
G0109 Diab manage trn ind/group A 0 XXX $ - $ 16.01
G0117 Glaucoma scrn hgh risk direc A 0 XXX $ - $ 48.37
G0118 Glaucoma scrn hgh risk direc A 0 XXX $ - $ 32.36
G0120 Colon ca scrn; barium enema A 1 XXX $ - $ 194.18
G0120 26 Colon ca scrn; barium enema A 1 XXX $ 47.33 $ 47.33
G0120 TC Colon ca scrn; barium enema A 1 XXX $ - $ 146.86
G0121 Colon ca scrn not hi rsk ind A 0 000 Y $ 255.08 $ 409.60
G0121 53 Colon ca scrn not hi rsk ind A 0 000 Y $ 70.99 $ 137.81
G0122 Colon ca scrn; barium enema X 1 XXX $ - $ 250.91
G0122 26 Colon ca scrn; barium enema X 1 XXX $ 49.76 $ 49.76
G0122 TC Colon ca scrn; barium enema X 1 XXX $ - $ 201.49
G0123 Screen cerv/vag thin layer X 9 XXX $ - $ -
G0124 Screen c/v thin layer by MD A 0 XXX $ 29.23 $ 29.23
G0127 Trim nail(s) A 0 000 Y $ 8.35 $ 20.53
G0128 CORF skilled nursing service N 0 XXX $ - $ 9.74
G0130 Single energy x-ray study A 1 XXX $ - $ 31.67
G0130 26 Single energy x-ray study A 1 XXX $ 11.14 $ 11.14
G0130 TC Single energy x-ray study A 1 XXX $ - $ 20.53
G0141 Scr c/v cyto,autosys and md A 0 XXX $ 29.23 $ 29.23
G0143 Scr c/v cyto,thinlayer,rescr X 9 XXX $ - $ -
G0147 Scr c/v cyto, automated sys X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
G0148 Scr c/v cyto, autosys, rescr X 9 XXX $ - $ -

G0157 HHC PT assistant ea 15 X 9 XXX $ - $ -
G0158 HHC OT assistant ea 15 X 9 XXX $ - $ -
G0159 HHC PT maint ea 15 min X 9 XXX $ - $ -
G0160 HHC Occup Therapy ea 15 X 9 XXX $ - $ -
G0161 HHC SLP ea 15 min X 9 XXX $ - $ -
G0162 HHC RN E&M plan svs, 15 min X 9 XXX $ - $ -
G0163 HHC LPN/RN obs/asses ea 15 X 9 XXX $ - $ -
G0164 HHC lis nurse train ea 15 X 9 XXX $ - $ -
G0166 Extrnl counterpulse, per tx A 0 XXX $ - $ 130.50
G0168 Wound closure by adhesive A 0 000 Y $ 27.14 $ 86.30
G0173 Linear acc stereo radsur com X 9 XXX $ - $ -
G0175 OPPS Service,sched team conf X 9 XXX $ - $ -
G0176 OPPS/PHP;activity therapy X 9 XXX $ - $ -
G0177 OPPS/PHP; train & educ serv X 9 XXX $ - $ -
G0179 MD recertification HHA PT A 0 XXX $ - $ 39.32
G0180 MD certification HHA patient A 0 XXX $ - $ 51.16
G0181 Home health care supervision A 0 XXX $ - $ 105.44
G0182 Hospice care supervision A 0 XXX $ - $ 106.84
G0186 Dstry eye lesn,fdr vssl tech C 0 YYY Y Y Y $ - $ -
G0202 Screeningmammographydigital A 1 XXX $ - $ 125.98
G0202 26 Screeningmammographydigital A 1 XXX $ 36.19 $ 36.19
G0202 TC Screeningmammographydigital A 1 XXX $ - $ 89.78
G0204 Diagnosticmammographydigital A 1 XXX $ - $ 152.08
G0204 26 Diagnosticmammographydigital A 1 XXX $ 44.89 $ 44.89
G0204 TC Diagnosticmammographydigital A 1 XXX $ - $ 107.18
G0206 Diagnosticmammographydigital A 1 XXX $ - $ 120.41
G0206 26 Diagnosticmammographydigital A 1 XXX $ 36.19 $ 36.19

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
G0206 TC Diagnosticmammographydigital A 1 XXX $ - $ 84.56

G0219 PET img wholbod melano nonco N 1 XXX $ - $ -
G0219 26 PET img wholbod melano nonco N 1 XXX $ - $ -
G0219 TC PET img wholbod melano nonco N 1 XXX $ - $ -
G0235 PET not otherwise specified N 1 XXX $ - $ -
G0235 26 PET not otherwise specified N 1 XXX $ - $ -
G0235 TC PET not otherwise specified N 1 XXX $ - $ -
G0237 Therapeutic procd strg endur A 0 XXX $ - $ 9.40
G0238 Oth resp proc, indiv A 5 XXX $ - $ 10.09
G0239 Oth resp proc, group A 5 XXX $ - $ 11.48
G0245 Initial foot exam pt lops A 0 XXX $ 44.20 $ 62.64
G0246 Followup eval of foot pt lop A 0 XXX $ 22.62 $ 36.54
G0247 Routine footcare pt w lops A 0 ZZZ $ 25.75 $ 60.90
G0248 Demonstrate use home inr mon N 3 XXX $ - $ 106.49
G0249 Provide INR test mater/equip N 3 XXX $ - $ 98.14
G0250 MD INR test revie inter mgmt N 2 XXX $ - $ 9.40
G0251 Linear acc based stero radio X 9 XXX $ - $ -
G0252 PET imaging initial dx N 1 XXX $ - $ -
G0252 26 PET imaging initial dx N 1 XXX $ 80.39 $ 80.39
G0252 TC PET imaging initial dx N 1 XXX $ - $ -
G0255 Current percep threshold tst N 1 XXX $ - $ -
G0255 26 Current percep threshold tst N 1 XXX $ - $ -
G0255 TC Current percep threshold tst N 1 XXX $ - $ -
G0257 Unsched dialysis ESRD pt hos X 9 XXX $ - $ -
G0259 Inject for sacroiliac joint X 9 XXX $ - $ -
G0260 Inj for sacroiliac jt anesth X 9 XXX $ - $ -
G0268 Removal of impacted wax md B 0 000 Y $ 32.71 $ 49.42
G0269 Occlusive device in vein art B 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
G0270 MNT subs tx for change dx A 0 XXX $ 27.84 $ 29.93

G0271 Group MNT 2 or more 30 mins A 0 XXX $ 14.27 $ 14.62
G0275 Renal angio, cardiac cath A 0 ZZZ $ 12.88 $ -
G0278 Iliac art angio,cardiac cath A 0 ZZZ $ 12.88 $ -
G0281 Elec stim unattend for press A 7 XXX Y $ - $ 12.88
G0282 Elect stim wound care not pd N 9 XXX $ - $ -
G0283 Elec stim other than wound A 7 XXX Y $ - $ 12.88
G0288 Recon, CTA for surg plan A 3 XXX $ - $ 53.94
G0289 Arthro, loose body + chondro A 0 ZZZ Y $ 106.49 $ -
G0290 Drug-eluting stents, single X 9 XXX $ - $ -
G0291 Drug-eluting stents,each add X 9 XXX $ - $ -
G0293 Non-cov surg proc,clin trial X 9 XXX $ - $ -
G0294 Non-cov proc, clinical trial X 9 XXX $ - $ -
G0295 Electromagnetic therapy onc N 9 XXX $ - $ -
G0302 Pre-op service LVRS complete X 9 XXX $ - $ -
G0303 Pre-op service LVRS 10-15dos X 9 XXX $ - $ -
G0304 Pre-op service LVRS 1-9 dos X 9 XXX $ - $ -
G0305 Post op service LVRS min 6 X 9 XXX $ - $ -
G0306 CBC/diffwbc w/o platelet X 9 XXX $ - $ -
G0307 CBC without platelet X 9 XXX $ - $ -
G0328 Fecal blood scrn immunoassay X 9 XXX $ - $ -
G0329 Electromagntic tx for ulcers A 7 XXX Y $ - $ 9.40
G0333 Dispense fee initial 30 day X 9 XXX $ - $ -
G0337 Hospice evaluation preelecti X 9 XXX $ 75.86 $ 75.86
G0339 Robot lin-radsurg com, first C 0 XXX $ - $ -
G0340 Robt lin-radsurg fractx 2-5 C 0 XXX $ - $ -
G0341 Percutaneous islet celltrans A 0 000 Y $ 349.04 $ 938.56
G0342 Laparoscopy islet cell trans A 0 090 Y Y $ 681.73 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
G0343 Laparotomy islet cell transp A 0 090 Y Y $ 1,173.11 $ -

G0364 Bone marrow aspirate &biopsy A 0 ZZZ $ 9.05 $ 11.83
G0365 Vessel mapping hemo access A 1 XXX $ 209.50 $ 192.10
G0365 26 Vessel mapping hemo access A 1 XXX $ 14.27 $ 14.27
G0365 TC Vessel mapping hemo access A 1 XXX $ 196.27 $ 178.18
G0372 MD service required for PMD A 0 XXX $ 8.70 $ 9.74
G0378 Hospital observation per hr X 9 XXX $ - $ -
G0379 Direct refer hospital observ X 9 XXX $ - $ -
G0389 Ultrasound exam AAA screen A 1 XXX $ - $ 101.27
G0389 26 Ultrasound exam AAA screen A 1 XXX $ 29.23 $ 29.23
G0389 TC Ultrasound exam AAA screen A 1 XXX $ - $ 72.04
G0396 Alcohol/subs interv 15-30mn A 0 XXX $ 34.10 $ 35.50
G0397 Alcohol/subs interv >30 min A 0 XXX $ 68.90 $ 70.30
G0398 Home sleep test/type 2 Porta C 1 XXX $ - $ -
G0398 26 Home sleep test/type 2 Porta C 1 XXX $ - $ -
G0398 TC Home sleep test/type 2 Porta C 1 XXX $ - $ -
G0402 Initial preventive exam A 0 XXX $ 126.67 $ 153.82
G0403 EKG for initial prevent exam A 4 XXX $ - $ 18.79
G0404 EKG tracing for initial prev A 3 XXX $ - $ 9.74
G0405 EKG interpret & report preve A 2 XXX $ 8.70 $ 8.70
G0406 Inpt/tele follow up 15 A 0 XXX $ 40.02 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

G0409 CORF related serv 15 mins ea A 9 XXX $ - $ 9.40
G0410 Grp psych partial hosp 45-50 X 9 XXX $ - $ -
G0411 Inter active grp psych parti X 9 XXX $ - $ -
G0412 Open tx iliac spine uni/bil A 0 090 Y Y Y $ 839.38 $ -
G0413 Pelvic ring fracture uni/bil A 0 090 Y Y Y $ 1,236.79 $ -
G0414 Pelvic ring fx treat int fix A 0 090 Y Y Y $ 1,168.58 $ -
G0415 Open tx post pelvic fxcture A 0 090 Y Y Y $ 1,628.29 $ -
G0416 Sat biopsy prostate 1-20 spc A 1 XXX $ - $ 592.99
G0416 26 Sat biopsy prostate 1-20 spc A 1 XXX $ 178.18 $ 178.18
G0416 TC Sat biopsy prostate 1-20 spc A 1 XXX $ - $ 414.47
G0417 Sat biopsy prostate 21-40 A 1 XXX $ - $ 1,153.97
G0417 26 Sat biopsy prostate 21-40 A 1 XXX $ 345.22 $ 345.22
G0417 TC Sat biopsy prostate 21-40 A 1 XXX $ - $ 808.75
G0418 Sat biopsy prostate 41-60 A 1 XXX $ - $ 1,979.42
G0418 26 Sat biopsy prostate 41-60 A 1 XXX $ 598.91 $ 598.91
G0418 TC Sat biopsy prostate 41-60 A 1 XXX $ - $ 1,380.52
G0419 Sat biopsy prostate: >60 A 1 XXX $ - $ 2,344.82
G0419 26 Sat biopsy prostate: >60 A 1 XXX $ 688.34 $ 688.34
G0419 TC Sat biopsy prostate: >60 A 1 XXX $ - $ 1,656.48
G0420 Ed svc CKD ind per session A 0 XXX $ - $ 109.27
G0421 Ed svc CKD grp per session A 0 XXX $ - $ 25.75
G0422 Intens cardiac rehab w/exerc A 0 XXX $ 94.66 $ 94.66
G0423 Intens cardiac rehab no exer A 0 XXX $ 94.66 $ 94.66
G0424 Pulmonary rehab w exer A 0 XXX $ 16.01 $ 30.28
G0425 Inpt/ED teleconsult30 A 0 XXX $ 108.92 $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
G0428 Collagen Meniscus Implant N 9 XXX $ - $ -

G0429 Dermal filler injection(s) A 0 000 Y $ 89.78 $ 112.75
G0431 Drug screen multiple class X 9 XXX $ - $ -
G0432 EIA HIV-1/HIV-2 screen X 9 XXX $ - $ -
G0433 ELISA HIV-1/HIV-2 screen X 9 XXX $ - $ -
G0434 Drug screen multi drug class X 9 XXX $ - $ -
G0435 Oral HIV-1/HIV-2 screen X 9 XXX $ - $ -
G0436 Tobacco-use counsel 3-10 min A 0 XXX $ 12.18 $ 13.57
G0437 Tobacco-use counsel>10min A 0 XXX $ 26.80 $ 28.88
G0438 PPPS, initial visit A 0 XXX $ - $ 162.86
G0439 PPPS, subseq visit A 0 XXX $ - $ 103.70
G0442 Annual alcohol screen 15 min A 0 XXX $ 9.40 $ 16.36
G0443 Brief alcohol misuse counsel A 0 XXX $ 24.36 $ 26.10
G0444 Depression screen annual A 0 XXX $ 9.40 $ 16.36
G0445 High inten beh couns STD 30m A 0 XXX $ 24.36 $ 26.10
G0446 Intens behave ther cardio dx A 0 XXX $ 24.36 $ 26.10
G0447 Behavior counsel obesity 15m A 0 XXX $ 24.36 $ 26.10
G0448 Place perm pacing cardiovert X 9 XXX $ - $ -
G0449 Annual obesity screen 15 min B 9 XXX $ - $ -
G0450 Screen STI w four lab test B 9 XXX $ - $ -
G0451 Devlopment test interpt&rep A 5 XXX $ - $ 9.40
G0908 HgB > 12 g/dL M 9 XXX $ - $ -
G0909 HbG not doc M 9 XXX $ - $ -
G0910 HgB <= 12 g/dL M 9 XXX $ - $ -
G0911 Assess activity symptoms M 9 XXX $ - $ -
G0912 No assess activity symptoms M 9 XXX $ - $ -
G0913 Improve visual funct M 9 XXX $ - $ -
G0914 Survey not complete M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
G0915 No improve visual funct M 9 XXX $ - $ -

G0916 Satisfy with care M 9 XXX $ - $ -
G0917 Satisfy survey not complete M 9 XXX $ - $ -
G0918 No satisfy with care M 9 XXX $ - $ -
G0919 Flu immunize not avail M 9 XXX $ - $ -
G0920 Type loc act doc M 9 XXX $ - $ -
G0921 Doc pt reas no assess M 9 XXX $ - $ -
G0922 Type loc act not doc M 9 XXX $ - $ -
G3001 Admin + supply, tositumomab X 9 XXX $ - $ -
G8126 Pt treat w/antidepress12wks M 9 XXX $ - $ -
G8127 Pt not treat w/antidepres12w M 9 XXX $ - $ -
G8128 Pt inelig for antidepres med M 9 XXX $ - $ -
G8395 LVEF>=40% doc normal or mild M 9 XXX $ - $ -
G8396 LVEF not performed M 9 XXX $ - $ -
G8397 Dil macula/fundus exam/w doc M 9 XXX $ - $ -
G8398 Dil macular/fundus not perfo M 9 XXX $ - $ -
G8399 Pt w/DXA document or order M 9 XXX $ - $ -
G8400 Pt w/DXA no document or orde M 9 XXX $ - $ -
G8401 Pt inelig osteo screen measu M 9 XXX $ - $ -
G8404 Low extemity neur exam docum M 9 XXX $ - $ -
G8405 Low extemity neur not perfor M 9 XXX $ - $ -
G8406 Pt inelig lower extrem neuro M 9 XXX $ - $ -
G8410 Eval on foot documented M 9 XXX $ - $ -
G8415 Eval on foot not performed M 9 XXX $ - $ -
G8416 Pt inelig footwear evaluatio M 9 XXX $ - $ -
G8417 Calc BMI abv up param f/u M 9 XXX $ - $ -
G8418 Calc BMI blw low param f/u M 9 XXX $ - $ -
G8419 Calc BMI out nrm param nof/u M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
G8420 Calc BMI norm parameters M 9 XXX $ - $ -

G8421 BMI not calculated M 9 XXX $ - $ -
G8422 Pt inelig BMI calculation M 9 XXX $ - $ -
G8427 Doc cur meds by prov M 9 XXX $ - $ -
G8428 Cur meds not document M 9 XXX $ - $ -
G8430 Pt inelig med check M 9 XXX $ - $ -
G8431 Pos clin depres scrn f/u doc M 9 XXX $ - $ -
G8432 Clin depression screen not d M 9 XXX $ - $ -
G8433 Pt inelig; scrn clin dep M 9 XXX $ - $ -
G8442 Pt inelig pain assessment M 9 XXX $ - $ -
G8447 Pt vis doc use EHR cer ATCB M 9 XXX $ - $ -
G8448 Pt vis doc w/PQRI qual EHR M 9 XXX $ - $ -
G8450 Beta-bloc rx pt w/abn lvef M 9 XXX $ - $ -
G8451 Pt w/abn lvef inelig b-bloc M 9 XXX $ - $ -
G8452 Pt w/abn lvef b-bloc no rx M 9 XXX $ - $ -
G8458 Pt inelig geno no antvir tx M 9 XXX $ - $ -
G8459 Doc pt rec antivir treat M 9 XXX $ - $ -
G8460 Pt inelig RNA no antvir tx M 9 XXX $ - $ -
G8461 Pt rec antivir treat hep c M 9 XXX $ - $ -
G8462 Pt inelig couns no antvir tx M 9 XXX $ - $ -
G8463 Pt rec antiviral treat doc M 9 XXX $ - $ -
G8464 Pt inelig; lo to no dter rsk M 9 XXX $ - $ -
G8465 High risk recurrence pro ca M 9 XXX $ - $ -
G8468 ACE/ARB rx pt w/abn lvef M 9 XXX $ - $ -
G8469 Pt w/abn lvef inelig ACE/ARB M 9 XXX $ - $ -
G8470 Pt w/ normal lvef M 9 XXX $ - $ -
G8471 LVEF not performed/doc M 9 XXX $ - $ -
G8472 ACE/ARB no rx pt w/abn lvef M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
G8473 ACE/ARB thxpy rx'd M 9 XXX $ - $ -

G8474 ACE/ARB not rx'd; doc reas M 9 XXX $ - $ -
G8475 ACE/ARB thxpy not rx'd M 9 XXX $ - $ -
G8476 BP sys <130 and dias <80 M 9 XXX $ - $ -
G8477 BP sys>=130 and/or dias >=80 M 9 XXX $ - $ -
G8478 BP not performed/doc M 9 XXX $ - $ -
G8482 Flu immunize order/admin M 9 XXX $ - $ -
G8483 Flu imm no ord/admin doc rea M 9 XXX $ - $ -
G8484 Flu immunize no order/admin M 9 XXX $ - $ -
G8485 Report, Diabetes measures M 9 XXX $ - $ -
G8486 Report, Prev Care Measures M 9 XXX $ - $ -
G8487 Report CKD Measures M 9 XXX $ - $ -
G8489 CAD measures grp M 9 XXX $ - $ -
G8490 RA measures grp M 9 XXX $ - $ -
G8491 HIV/AIDS measures grp M 9 XXX $ - $ -
G8492 Periop Care measures grp M 9 XXX $ - $ -
G8493 Back pain measures grp M 9 XXX $ - $ -
G8494 DM meas qual act perform M 9 XXX $ - $ -
G8495 CKD meas qual act perform M 9 XXX $ - $ -
G8496 Prev Care MG qual act perfrm M 9 XXX $ - $ -
G8497 CABG meas qual act perform M 9 XXX $ - $ -
G8498 CAD meas qual act perform M 9 XXX $ - $ -
G8499 RA meas qual act perform M 9 XXX $ - $ -
G8500 HIV meas qual act perform M 9 XXX $ - $ -
G8501 Perio meas qual act perform M 9 XXX $ - $ -
G8502 Back Pain MG qual act perfrm M 9 XXX $ - $ -
G8506 Pt rec ACE/ARB M 9 XXX $ - $ -
G8509 Pos pain assess no f/u doc M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
G8510 Pt inelig neg scrn depres M 9 XXX $ - $ -

G8511 Clin depres scrn no f/u doc M 9 XXX $ - $ -
G8524 Patch closure conv CEA M 9 XXX $ - $ -
G8525 No patch closure CEA M 9 XXX $ - $ -
G8526 No patch closure conv CEA M 9 XXX $ - $ -
G8530 Auto AV fistula recd M 9 XXX $ - $ -
G8531 Pt inelig; auto AV fistula M 9 XXX $ - $ -
G8532 No auto AV fistula; no reas M 9 XXX $ - $ -
G8535 Pt inelig no eld mal scrn M 9 XXX $ - $ -
G8536 No doc elder mal scrn M 9 XXX $ - $ -
G8539 Doc funct and care plan M 9 XXX $ - $ -
G8540 Pt inelig funct assess M 9 XXX $ - $ -
G8541 No doc cur funct assess M 9 XXX $ - $ -
G8542 Doc funct no deficiencies M 9 XXX $ - $ -
G8543 Cur funct asses; no care pln M 9 XXX $ - $ -
G8544 CABG measures grp M 9 XXX $ - $ -
G8545 HepC measures grp M 9 XXX $ - $ -
G8546 CAP measures grp M 9 XXX $ - $ -
G8547 IVD measures grp M 9 XXX $ - $ -
G8548 HF measures grp M 9 XXX $ - $ -
G8549 HepC MG qual act perform M 9 XXX $ - $ -
G8550 CAP MG qual act perform M 9 XXX $ - $ -
G8551 HF MG qual act perform M 9 XXX $ - $ -
G8552 IVD MG qual act perform M 9 XXX $ - $ -
G8553 Rx certified EHR M 9 XXX $ - $ -
G8556 Ref to doc otolog eval M 9 XXX $ - $ -
G8557 Pt inelig ref otolog eval M 9 XXX $ - $ -
G8558 No ref to doc otolog eval M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
G8559 Pt ref doc oto eval M 9 XXX $ - $ -

G8560 Pt hx act drain prev 90 days M 9 XXX $ - $ -
G8561 Pt inelig for ref oto eval M 9 XXX $ - $ -
G8562 Pt no hx act drain 90 d M 9 XXX $ - $ -
G8563 Pt no ref oto reas no spec M 9 XXX $ - $ -
G8564 Pt ref oto eval M 9 XXX $ - $ -
G8565 Ver doc hear loss M 9 XXX $ - $ -
G8566 Pt inelig ref oto eval M 9 XXX $ - $ -
G8567 Pt no doc hear loss M 9 XXX $ - $ -
G8568 Pt no ref otolo no spec M 9 XXX $ - $ -
G8569 Prol intubation req M 9 XXX $ - $ -
G8570 No prol intub req M 9 XXX $ - $ -
G8571 Ster wd ifx 30 d postop M 9 XXX $ - $ -
G8572 No ster wd ifx M 9 XXX $ - $ -
G8573 Stk CABG M 9 XXX $ - $ -
G8574 No strk CABG M 9 XXX $ - $ -
G8575 Postop ren fail M 9 XXX $ - $ -
G8576 No postop ren fail M 9 XXX $ - $ -
G8577 Reop req bld grft oth M 9 XXX $ - $ -
G8578 No reop req bld grft oth M 9 XXX $ - $ -
G8579 Antplt med disch M 9 XXX $ - $ -
G8580 Antplt med contraind M 9 XXX $ - $ -
G8581 no antplt med disch M 9 XXX $ - $ -
G8582 Bblock disch M 9 XXX $ - $ -
G8583 Bblock contraind M 9 XXX $ - $ -
G8584 No bblock disch M 9 XXX $ - $ -
G8585 Antilipid treat disch M 9 XXX $ - $ -
G8586 Antlip disch contra M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
G8587 No antlipid treat disch M 9 XXX $ - $ -

G8588 Sys BP <140 M 9 XXX $ - $ -
G8589 Sys BP >= 140 M 9 XXX $ - $ -
G8590 Dia BP < 90 M 9 XXX $ - $ -
G8591 Dia BP >= 90 M 9 XXX $ - $ -
G8592 No BP measure M 9 XXX $ - $ -
G8593 Lipid pn results M 9 XXX $ - $ -
G8594 No lipid prof perf M 9 XXX $ - $ -
G8595 Ldl < 100 M 9 XXX $ - $ -
G8596 No LDL perf M 9 XXX $ - $ -
G8597 Ldl >= 100 M 9 XXX $ - $ -
G8598 Asp therp used M 9 XXX $ - $ -
G8599 No asp therp used M 9 XXX $ - $ -
G8600 tPA initi w/in 3 hrs M 9 XXX $ - $ -
G8601 No elig tPA init w/in 3 hrs M 9 XXX $ - $ -
G8602 No tPA init w/in 3 hrs M 9 XXX $ - $ -
G8603 Spok lang comp score M 9 XXX $ - $ -
G8604 No high score spok lang M 9 XXX $ - $ -
G8605 No spok lang comp score M 9 XXX $ - $ -
G8606 Attention score M 9 XXX $ - $ -
G8607 No high score attention M 9 XXX $ - $ -
G8608 No attention score M 9 XXX $ - $ -
G8609 Memory score M 9 XXX $ - $ -
G8610 No high score memory M 9 XXX $ - $ -
G8611 No memory score M 9 XXX $ - $ -
G8612 Moto speech score M 9 XXX $ - $ -
G8613 No high score moto speech M 9 XXX $ - $ -
G8614 No moto speech score M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
G8615 Reading score M 9 XXX $ - $ -

G8616 No high score reading M 9 XXX $ - $ -
G8617 No reading score M 9 XXX $ - $ -
G8618 Spok lang exp score M 9 XXX $ - $ -
G8619 No high score spok lang exp M 9 XXX $ - $ -
G8620 No spok lang exp score M 9 XXX $ - $ -
G8621 Writing score M 9 XXX $ - $ -
G8622 No high score writing M 9 XXX $ - $ -
G8623 No writing score M 9 XXX $ - $ -
G8624 Swallowing score M 9 XXX $ - $ -
G8625 No high score swallowing M 9 XXX $ - $ -
G8626 No swallowing score M 9 XXX $ - $ -
G8627 Surg proc w/in 30 days M 9 XXX $ - $ -
G8628 No surg proc w/in 30 days M 9 XXX $ - $ -
G8629 Doc antibio order b/4 surg M 9 XXX $ - $ -
G8630 Doc antibio given b/4 surg M 9 XXX $ - $ -
G8631 Pt no elg 4 order antbi give M 9 XXX $ - $ -
G8632 Doc no antibi order b/4 surg M 9 XXX $ - $ -
G8633 Pharm ther osteo rx M 9 XXX $ - $ -
G8634 Pt no elg phar ther osteo M 9 XXX $ - $ -
G8635 No pharm ther osteo rx M 9 XXX $ - $ -
G8642 Hrdshp rural w/o internet M 9 XXX $ - $ -
G8643 Hrdshp w/o suff pharm w/eRx M 9 XXX $ - $ -
G8644 EP no prescribe priv M 9 XXX $ - $ -
G8645 Asthma measures grp M 9 XXX $ - $ -
G8646 Asthma MG qual act perform M 9 XXX $ - $ -
G8647 Fun stat score knee >= 0 M 9 XXX $ - $ -
G8648 Fun stat score knee < 0 M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
G8649 Fun stat score knee pt noelg M 9 XXX $ - $ -

G8650 Fun stat score knee not done M 9 XXX $ - $ -
G8651 Fun stat score hip >= 0 M 9 XXX $ - $ -
G8652 Fun stat score hip < 0 M 9 XXX $ - $ -
G8653 Fun stat score hip pt no elg M 9 XXX $ - $ -
G8654 Fun stat score hip not done M 9 XXX $ - $ -
G8655 Fun stat score LE >= 0 M 9 XXX $ - $ -
G8656 Fun stat score LE < 0 M 9 XXX $ - $ -
G8657 Fun stat score LE pt no elg M 9 XXX $ - $ -
G8658 Fun stat score LE not done M 9 XXX $ - $ -
G8659 Fun stat score LS >= 0 M 9 XXX $ - $ -
G8660 Fun stat score LS < 0 M 9 XXX $ - $ -
G8661 Fun stat score LS pt no elg M 9 XXX $ - $ -
G8662 Fun stat score LS not done M 9 XXX $ - $ -
G8663 Fun stat score shdl >=0 M 9 XXX $ - $ -
G8664 Fun stat score shdl < 0 M 9 XXX $ - $ -
G8665 Fun stat score shdl pt no el M 9 XXX $ - $ -
G8666 Fun stat score shdl not done M 9 XXX $ - $ -
G8667 Fun stat score UE >=0 M 9 XXX $ - $ -
G8668 Fun stat score UE < 0 M 9 XXX $ - $ -
G8669 Fun stat score UE pt no elg M 9 XXX $ - $ -
G8670 Fun stat score UE not done M 9 XXX $ - $ -
G8671 Fun stat score neck/TS >=0 M 9 XXX $ - $ -
G8672 Fun stat score neck/TS < 0 M 9 XXX $ - $ -
G8673 Fun stat scor nek/TS pt no e M 9 XXX $ - $ -
G8674 Fun stat scor nek/TS not don M 9 XXX $ - $ -
G8682 LVG test perf M 9 XXX $ - $ -
G8683 Pt not elig for LVF test M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
G8685 LVF test not perf M 9 XXX $ - $ -

G8694 Lvef <40% M 9 XXX $ - $ -
G8695 Lvef >=40% M 9 XXX $ - $ -
G8696 Antithromb thx presc M 9 XXX $ - $ -
G8697 Antithromb no presc doc reas M 9 XXX $ - $ -
G8698 Antithromb no presc no reas M 9 XXX $ - $ -
G8699 Rehab ordered disch M 9 XXX $ - $ -
G8700 Rehab not indicated disch M 9 XXX $ - $ -
G8701 Rehab not ordered M 9 XXX $ - $ -
G8702 Antiobiotics 4 hr prior surg M 9 XXX $ - $ -
G8703 Antibiotics not prior surg M 9 XXX $ - $ -
G8704 ECG performed M 9 XXX $ - $ -
G8705 Med reas no ECG M 9 XXX $ - $ -
G8706 Pt reas no ECG M 9 XXX $ - $ -
G8707 ECG not performed M 9 XXX $ - $ -
G8708 Antibiotic not pres M 9 XXX $ - $ -
G8709 Med reas antibiotic pres M 9 XXX $ - $ -
G8710 Pt pres antibiotic M 9 XXX $ - $ -
G8711 Pres antibiotic M 9 XXX $ - $ -
G8712 Not pres antibiotic M 9 XXX $ - $ -
G8713 SpKt/V great 1.2 Kt/V M 9 XXX $ - $ -
G8714 Hemodialysis 3 times week M 9 XXX $ - $ -
G8715 Hemodialysis not 3 times wk M 9 XXX $ - $ -
G8716 Pt reas not great 1.2Kt/V M 9 XXX $ - $ -
G8717 Less 1.2 Kt/V M 9 XXX $ - $ -
G8718 Great 1.7 Kt/V per week M 9 XXX $ - $ -
G8720 Less 1.7 Kt/V per week M 9 XXX $ - $ -
G8721 Pt, pn, hist grade doc M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
G8722 Med reas pt, pn, not doc M 9 XXX $ - $ -

G8723 Spec sit not prim tumor M 9 XXX $ - $ -
G8724 Pt, pn, hist grade not doc M 9 XXX $ - $ -
G8725 Lipid profile perf doc M 9 XXX $ - $ -
G8726 Doc reas no lipid profile M 9 XXX $ - $ -
G8727 Hemo, perit, or kidney trans M 9 XXX $ - $ -
G8728 Lipid profile not perf M 9 XXX $ - $ -
G8730 Pain doc pos and plan M 9 XXX $ - $ -
G8731 Pain neg no plan M 9 XXX $ - $ -
G8732 No doc of pain M 9 XXX $ - $ -
G8733 Doc pos elder mal scrn plan M 9 XXX $ - $ -
G8734 Doc neg elder mal no plan M 9 XXX $ - $ -
G8735 Eld mal scrn pos no plan M 9 XXX $ - $ -
G8736 LDL-C <100mg/dL M 9 XXX $ - $ -
G8737 LDL-C >=100mg/dL M 9 XXX $ - $ -
G8738 Lvef < 40% M 9 XXX $ - $ -
G8739 Lvef >= 40% M 9 XXX $ - $ -
G8740 LVEF not perfrmd M 9 XXX $ - $ -
G8741 Not tx spoken lang M 9 XXX $ - $ -
G8742 Not tx attention M 9 XXX $ - $ -
G8743 Not tx memory M 9 XXX $ - $ -
G8744 Not tx motor speech M 9 XXX $ - $ -
G8745 Not tx reading M 9 XXX $ - $ -
G8746 Not tx spoken lang express M 9 XXX $ - $ -
G8747 Not tx writing M 9 XXX $ - $ -
G8748 Not tx swallowing M 9 XXX $ - $ -
G8749 Signs of melanoma absent M 9 XXX $ - $ -
G8750 Signs of melanoma present M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
G8751 Smkg status not assess M 9 XXX $ - $ -

G8752 Sys BP less 140 M 9 XXX $ - $ -
G8753 Sys BP > or = 140 M 9 XXX $ - $ -
G8754 Dias BP less 90 M 9 XXX $ - $ -
G8755 Dias BP > or = 90 M 9 XXX $ - $ -
G8756 No BP measure doc M 9 XXX $ - $ -
G8757 COPD MG qual act perform M 9 XXX $ - $ -
G8758 IBD MG qual act perform M 9 XXX $ - $ -
G8759 OSA MG qual act perform M 9 XXX $ - $ -
G8760 Epilepsy MG qual act perform M 9 XXX $ - $ -
G8761 Dementia MG qual act perform M 9 XXX $ - $ -
G8762 PD MG qual act perform M 9 XXX $ - $ -
G8763 Hyperten MG qual act perform M 9 XXX $ - $ -
G8764 Car Prev MG qual act perform M 9 XXX $ - $ -
G8765 Cataract MG qual act perform M 9 XXX $ - $ -
G8767 Lipid panel res doc rev M 9 XXX $ - $ -
G8768 Doc med reas no lipid profle M 9 XXX $ - $ -
G8769 Lipid profile not perform M 9 XXX $ - $ -
G8770 Urine protein test doc rev M 9 XXX $ - $ -
G8771 Doc dx CKD M 9 XXX $ - $ -
G8772 Doc med reas no urine protn M 9 XXX $ - $ -
G8773 No urine protein test M 9 XXX $ - $ -
G8774 Serum creatinine doc rev M 9 XXX $ - $ -
G8775 Doc med reas no serum crtn M 9 XXX $ - $ -
G8776 No serum creatinine test M 9 XXX $ - $ -
G8777 Diabetes screen M 9 XXX $ - $ -
G8778 Doc med reas no diabete scrn M 9 XXX $ - $ -
G8779 No diabetes screen M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
G8780 Counsel diet phys activity M 9 XXX $ - $ -

G8781 Doc med reas no counsel diet M 9 XXX $ - $ -
G8782 No counsel diet phys act M 9 XXX $ - $ -
G8783 BP scrn perf rec interval M 9 XXX $ - $ -
G8784 Pt no elig for BP assess M 9 XXX $ - $ -
G8785 BP scrn no perf at interval M 9 XXX $ - $ -
G8786 Severity of angina assess M 9 XXX $ - $ -
G8787 Angina present M 9 XXX $ - $ -
G8788 Angina absent M 9 XXX $ - $ -
G8789 Severity angina not assess M 9 XXX $ - $ -
G8790 Systolic <130mmHg M 9 XXX $ - $ -
G8791 Systolic 130-139mmHg M 9 XXX $ - $ -
G8792 Systolic >=140mmHg M 9 XXX $ - $ -
G8793 Diastolic <80mmHg M 9 XXX $ - $ -
G8794 Diastolic 80-89mmHg M 9 XXX $ - $ -
G8795 Diastolic >=90mmHg M 9 XXX $ - $ -
G8796 BP not doc M 9 XXX $ - $ -
G8797 Specimen site not esophagus M 9 XXX $ - $ -
G8798 Specimen site not prostate M 9 XXX $ - $ -
G8799 Anticoag ordered M 9 XXX $ - $ -
G8800 Doc reas anticoag not order M 9 XXX $ - $ -
G8801 Anticoag not ordered M 9 XXX $ - $ -
G8802 Pregnancy test order M 9 XXX $ - $ -
G8803 Doc reas no pregnancy test M 9 XXX $ - $ -
G8805 Pregnancy test not order M 9 XXX $ - $ -
G8806 Transab or transvag US M 9 XXX $ - $ -
G8807 Doc reas no US M 9 XXX $ - $ -
G8808 No transab or transvag US M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
G8809 Rh-immunoglobulin order M 9 XXX $ - $ -

G8810 Doc reas no Rh-immuno M 9 XXX $ - $ -
G8811 No Rh-immunoglobulin order M 9 XXX $ - $ -
G8812 Pt not elig CTA, duplex, MRA M 9 XXX $ - $ -
G8813 CTA, duplex, MRA performed M 9 XXX $ - $ -
G8814 No CTA, duplex, MRA M 9 XXX $ - $ -
G8815 Doc reas no statin therapy M 9 XXX $ - $ -
G8816 Statin med pres at disch M 9 XXX $ - $ -
G8817 Doc reas no statin med disch M 9 XXX $ - $ -
G8818 Pt disch to home by day#7 M 9 XXX $ - $ -
G8819 Aneurysm <= 5.5 cm M 9 XXX $ - $ -
G8820 Aneurysm 5.6-6.0 cm M 9 XXX $ - $ -
G8821 Aneurysm not infarenal M 9 XXX $ - $ -
G8822 Male aneurysms >6cm M 9 XXX $ - $ -
G8823 Female aneurysm >6cm M 9 XXX $ - $ -
G8824 Female aneurysm 5.6-6.0 cm M 9 XXX $ - $ -
G8825 Pt not disch to home day#7 M 9 XXX $ - $ -
G8826 Pt disch home day #2 EVAR M 9 XXX $ - $ -
G8827 Aneurysm <= 5.5cm for women M 9 XXX $ - $ -
G8828 Aneurysm <= 5.5cm for men M 9 XXX $ - $ -
G8829 Aneurysm 5.6-6.0 cm for men M 9 XXX $ - $ -
G8830 Aneurysm >6cm for men M 9 XXX $ - $ -
G8831 Aneurysm >-6cm for women M 9 XXX $ - $ -
G8832 Aneurysm 5.6-6.0 women M 9 XXX $ - $ -
G8833 Pt not disch home day#2 EVAR M 9 XXX $ - $ -
G8834 Pt disch home day #2 CEA M 9 XXX $ - $ -
G8835 Asymptom no trans M 9 XXX $ - $ -
G8836 Stroke or TIA <120 days CEA M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
G8837 Stroke or TIA >120 days CEA M 9 XXX $ - $ -

G8838 Not disch home by day #2 M 9 XXX $ - $ -
G8839 Sleep apnea assess M 9 XXX $ - $ -
G8840 Doc reas no sleep apnea M 9 XXX $ - $ -
G8841 No sleep apnea assess M 9 XXX $ - $ -
G8842 AHI or RDI initial dx M 9 XXX $ - $ -
G8843 Doc reas no AHI or RDI M 9 XXX $ - $ -
G8844 No AHI or RDI initial dx M 9 XXX $ - $ -
G8845 Pos Airway Press prescribed M 9 XXX $ - $ -
G8846 Mod or severe OSA M 9 XXX $ - $ -
G8847 Pos Air Press not prescribed M 9 XXX $ - $ -
G8848 Mild OSA M 9 XXX $ - $ -
G8849 Doc reas no Pos Air Press M 9 XXX $ - $ -
G8850 No PAP prescribed M 9 XXX $ - $ -
G8851 Adhere Pos Air Press therapy M 9 XXX $ - $ -
G8852 Pos Air Press prescribe M 9 XXX $ - $ -
G8853 Pos Air Press not prescribe M 9 XXX $ - $ -
G8854 Reas no adhere Pos Air Pres M 9 XXX $ - $ -
G8855 Pos Air Press adhere no perf M 9 XXX $ - $ -
G8856 Ref for oto eval M 9 XXX $ - $ -
G8857 No elig ref for oto eval M 9 XXX $ - $ -
G8858 Not ref for oto eval M 9 XXX $ - $ -
G8859 Corticosteroids 10mg 60 days M 9 XXX $ - $ -
G8860 Corticosteroid 10 mg 60 days M 9 XXX $ - $ -
G8861 DXA ordered for osteo M 9 XXX $ - $ -
G8862 No corticostrd 10mg 60 days M 9 XXX $ - $ -
G8863 No assess bone loss M 9 XXX $ - $ -
G8864 Pneumococcal vaccine admin M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
G8865 Doc med reas no pneumococcal M 9 XXX $ - $ -

G8866 Doc pt reas no pneumococcal M 9 XXX $ - $ -
G8867 No pneumococcal admin M 9 XXX $ - $ -
G8868 1st course antiTNF M 9 XXX $ - $ -
G8869 Doc immun hep B 1st antiTNF M 9 XXX $ - $ -
G8870 HepB admin 1st antiTNF M 9 XXX $ - $ -
G8871 No 1st antiTNF M 9 XXX $ - $ -
G8872 Intraop image confirm excise M 9 XXX $ - $ -
G8873 Specimen not intraop image M 9 XXX $ - $ -
G8874 Tissue not image intraop M 9 XXX $ - $ -
G8875 Breast cancer dx min invsive M 9 XXX $ - $ -
G8876 Doc reas no min inv dx M 9 XXX $ - $ -
G8877 No brst cncr dx min invasive M 9 XXX $ - $ -
G8878 Sent lymph node biopsy M 9 XXX $ - $ -
G8879 Node neg inv brst cncr M 9 XXX $ - $ -
G8880 Doc reas no lymph node biop M 9 XXX $ - $ -
G8881 Brst cncr stage > T1N0M0 M 9 XXX $ - $ -
G8882 No sent lymph node biopsy M 9 XXX $ - $ -
G8883 Rev, comm, track, doc biopsy M 9 XXX $ - $ -
G8884 Doc reas biopsy not review M 9 XXX $ - $ -
G8885 No rev, comm, track biopsy M 9 XXX $ - $ -
G8886 BP under control M 9 XXX $ - $ -
G8887 Doc med reas BP not control M 9 XXX $ - $ -
G8888 BP not under control M 9 XXX $ - $ -
G8889 No doc BP M 9 XXX $ - $ -
G8890 LDL-C under control M 9 XXX $ - $ -
G8891 Doc med reas no LDL-C contrl M 9 XXX $ - $ -
G8892 Doc med reas no LDL-C test M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
G8893 LDL-C not under control M 9 XXX $ - $ -

G8894 LDL-C not performed M 9 XXX $ - $ -
G8895 Anticoag prescribe M 9 XXX $ - $ -
G8896 Doc med reas no anticoag M 9 XXX $ - $ -
G8897 Anticoag not prescribe M 9 XXX $ - $ -
G8898 COPD Measures Group M 9 XXX $ - $ -
G8899 Inflammatory Bowel Dis MG M 9 XXX $ - $ -
G8900 Obstructive Sleep Apnea MG M 9 XXX $ - $ -
G8901 Epilepsy Measures Group M 9 XXX $ - $ -
G8902 Dementia Measures Group M 9 XXX $ - $ -
G8903 Parkinson's Disease MG M 9 XXX $ - $ -
G8904 Hypertension MG M 9 XXX $ - $ -
G8905 Cardiovascular Prevention MG M 9 XXX $ - $ -
G8906 Cataract Measures Group M 9 XXX $ - $ -
G9001 MCCD, initial rate X 9 XXX $ - $ -
G9002 MCCD,maintenance rate X 9 XXX $ - $ -
G9003 MCCD, risk adj hi, initial X 9 XXX $ - $ -
G9004 MCCD, risk adj lo, initial X 9 XXX $ - $ -
G9005 MCCD, risk adj, maintenance X 9 XXX $ - $ -
G9006 MCCD, Home monitoring X 9 XXX $ - $ -
G9007 MCCD, sch team conf X 9 XXX $ - $ -
G9008 Mccd,phys coor-care ovrsght X 9 XXX $ - $ -
G9009 MCCD, risk adj, level 3 X 9 XXX $ - $ -
G9012 Other Specified Case Mgmt X 9 XXX $ - $ -
G9013 ESRD demo bundle level I N 9 XXX $ - $ -
G9014 ESRD demo bundle-level II N 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
G9016 Demo-smoking cessation coun N 9 XXX $ - $ -

G9017 Amantadine HCL 100mg oral X 9 XXX $ - $ -
G9018 Zanamivir,inhalation pwd 10m X 9 XXX $ - $ -
G9019 Oseltamivir phosphate 75mg X 9 XXX $ - $ -
G9020 Rimantadine HCL 100mg oral X 9 XXX $ - $ -
G9033 Amantadine HCL oral brand X 9 XXX $ - $ -
G9034 Zanamivir, inh pwdr, brand X 9 XXX $ - $ -
G9035 Oseltamivir phosp, brand X 9 XXX $ - $ -
G9036 Rimantadine HCL, brand X 9 XXX $ - $ -
G9050 Oncology work-up evaluation X 9 XXX $ - $ -
G9051 Oncology tx decision-mgmt X 9 XXX $ - $ -
G9052 Onc surveillance for disease X 9 XXX $ - $ -
G9053 Onc expectant management pt X 9 XXX $ - $ -
G9054 Onc supervision palliative X 9 XXX $ - $ -
G9055 Onc visit unspecified NOS X 9 XXX $ - $ -
G9056 Onc prac mgmt adheres guide X 9 XXX $ - $ -
G9057 Onc pract mgmt differs trial X 9 XXX $ - $ -
G9058 Onc prac mgmt disagree w/gui X 9 XXX $ - $ -
G9059 Onc prac mgmt pt opt alterna X 9 XXX $ - $ -
G9060 Onc prac mgmt dif pt comorb X 9 XXX $ - $ -
G9061 Onc prac cond noadd by guide X 9 XXX $ - $ -
G9062 Onc prac guide differs nos X 9 XXX $ - $ -
G9063 Onc dx nsclc stgI no progres M 9 XXX $ - $ -
G9064 Onc dx nsclc stg2 no progres M 9 XXX $ - $ -
G9065 Onc dx nsclc stg3A no progre M 9 XXX $ - $ -
G9066 Onc dx nsclc stg3B-4 metasta M 9 XXX $ - $ -
G9067 Onc dx nsclc dx unknown nos M 9 XXX $ - $ -
G9068 Onc dx sclc/nsclc limited M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
G9069 Onc dx sclc/nsclc ext at dx M 9 XXX $ - $ -

G9070 Onc dx sclc/nsclc ext unknwn M 9 XXX $ - $ -
G9071 Onc dx brst stg1-2B HR,nopro M 9 XXX $ - $ -
G9072 Onc dx brst stg1-2 noprogres M 9 XXX $ - $ -
G9073 Onc dx brst stg3-HR, no pro M 9 XXX $ - $ -
G9074 Onc dx brst stg3-noprogress M 9 XXX $ - $ -
G9075 Onc dx brst metastic/ recur M 9 XXX $ - $ -
G9077 Onc dx prostate T1no progres M 9 XXX $ - $ -
G9078 Onc dx prostate T2no progres M 9 XXX $ - $ -
G9079 Onc dx prostate T3b-T4noprog M 9 XXX $ - $ -
G9080 Onc dx prostate w/rise PSA M 9 XXX $ - $ -
G9083 Onc dx prostate unknwn nos M 9 XXX $ - $ -
G9084 Onc dx colon t1-3,n1-2,no pr M 9 XXX $ - $ -
G9085 Onc dx colon T4, N0 w/o prog M 9 XXX $ - $ -
G9086 Onc dx colon T1-4 no dx prog M 9 XXX $ - $ -
G9087 Onc dx colon metas evid dx M 9 XXX $ - $ -
G9088 Onc dx colon metas noevid dx M 9 XXX $ - $ -
G9089 Onc dx colon extent unknown M 9 XXX $ - $ -
G9090 Onc dx rectal T1-2 no progr M 9 XXX $ - $ -
G9091 Onc dx rectal T3 N0 no prog M 9 XXX $ - $ -
G9092 Onc dx rectal T1-3,N1-2noprg M 9 XXX $ - $ -
G9093 Onc dx rectal T4,N,M0 no prg M 9 XXX $ - $ -
G9094 Onc dx rectal M1 w/mets prog M 9 XXX $ - $ -
G9095 Onc dx rectal extent unknwn M 9 XXX $ - $ -
G9096 Onc dx esophag T1-T3 noprog M 9 XXX $ - $ -
G9097 Onc dx esophageal T4 no prog M 9 XXX $ - $ -
G9098 Onc dx esophageal mets recur M 9 XXX $ - $ -
G9099 Onc dx esophageal unknown M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
G9100 Onc dx gastric no recurrence M 9 XXX $ - $ -

G9101 Onc dx gastric p R1-R2noprog M 9 XXX $ - $ -
G9102 Onc dx gastric unresectable M 9 XXX $ - $ -
G9103 Onc dx gastric recurrent M 9 XXX $ - $ -
G9104 Onc dx gastric unknown NOS M 9 XXX $ - $ -
G9105 Onc dx pancreatc p R0 res no M 9 XXX $ - $ -
G9106 Onc dx pancreatc p R1/R2 no M 9 XXX $ - $ -
G9107 Onc dx pancreatic unresectab M 9 XXX $ - $ -
G9108 Onc dx pancreatic unknwn NOS M 9 XXX $ - $ -
G9109 Onc dx head/neck T1-T2no prg M 9 XXX $ - $ -
G9110 Onc dx head/neck T3-4 noprog M 9 XXX $ - $ -
G9111 Onc dx head/neck M1 mets rec M 9 XXX $ - $ -
G9112 Onc dx head/neck ext unknown M 9 XXX $ - $ -
G9113 Onc dx ovarian stg1A-B no pr M 9 XXX $ - $ -
G9114 Onc dx ovarian stg1A-B or 2 M 9 XXX $ - $ -
G9115 Onc dx ovarian stg3/4 noprog M 9 XXX $ - $ -
G9116 Onc dx ovarian recurrence M 9 XXX $ - $ -
G9117 Onc dx ovarian unknown NOS M 9 XXX $ - $ -
G9123 Onc dx CML chronic phase M 9 XXX $ - $ -
G9124 Onc dx CML acceler phase M 9 XXX $ - $ -
G9125 Onc dx CML blast phase M 9 XXX $ - $ -
G9126 Onc dx CML remission M 9 XXX $ - $ -
G9128 Onc dx multi myeloma stage I M 9 XXX $ - $ -
G9129 Onc dx mult myeloma stg2 hig M 9 XXX $ - $ -
G9130 Onc dx multi myeloma unknown M 9 XXX $ - $ -
G9131 Onc dx brst unknown NOS M 9 XXX $ - $ -
G9132 Onc dx prostate mets no cast M 9 XXX $ - $ -
G9133 Onc dx prostate clinical met M 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
G9134 Onc NHLstg 1-2 no relap no M 9 XXX $ - $ -

G9135 Onc dx NHL stg 3-4 not relap M 9 XXX $ - $ -
G9136 Onc dx NHL trans to lg Bcell M 9 XXX $ - $ -
G9137 Onc dx NHL relapse/refractor M 9 XXX $ - $ -
G9138 Onc dx NHL stg unknown M 9 XXX $ - $ -
G9139 Onc dx CML dx status unknown M 9 XXX $ - $ -
G9140 Frontier extended stay demo X 9 XXX $ - $ -
G9141 Influenza A H1N1,admin w cou X 9 XXX $ - $ -
G9142 Influenza A H1N1, vaccine X 9 XXX $ - $ -
G9143 Warfarin respon genetic test X 9 XXX $ - $ -
G9147 Outpt IV insulin tx any mea N 9 XXX $ - $ -
G9156 Evaluation for wheelchair R 9 XXX $ - $ -
H0001 Alcohol and/or drug assess X 9 XXX $ - $ -
H0002 Alcohol and/or drug screenin X 9 XXX $ - $ -
H0003 Alcohol and/or drug screenin X 9 XXX $ - $ -
H0004 Alcohol and/or drug services X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

H0021 Alcohol and/or drug training X 9 XXX $ - $ -
H0022 Alcohol and/or drug interven X 9 XXX $ - $ -
H0023 Alcohol and/or drug outreach X 9 XXX $ - $ -
H0024 Alcohol and/or drug preventi X 9 XXX $ - $ -
H0030 Alcohol and/or drug hotline X 9 XXX $ - $ -
H0031 MH health assess by non-md; behavioral assessment/evaluation
A 9 XXX of targeted behavior and analysis by BCBA
$ - $ 120.00 Autism Services
H0032 MH svc plan dev by non-md; development Aof ABA treatment
9 XXXplan by BCBA $ - $ 58.28 Autism Services
H0033 Oral med adm direct observe X 9 XXX $ - $ -
H0034 Med trng & support per 15min X 9 XXX $ - $ -
H0035 MH partial hosp tx under 24h X 9 XXX $ - $ -
H0036 Comm psy face-face per 15min X 9 XXX $ - $ -
H0037 Comm psy sup tx pgm per diem x 9 XXX $ - $ -
H0038 Self-help/peer svc per 15min X 9 XXX $ - $ -
H0039 Asser com tx face-face/15min X 9 XXX $ - $ -
H0040 Assert comm tx pgm per diem X 9 XXX $ - $ -
H0041 Fos c chld non-ther per diem I 9 XXX $ - $ -
H0042 Fos c chld non-ther per mon X 9 XXX $ - $ -
H0043 Supported housing, per diem X 9 XXX $ - $ -
H0044 Supported housing, per month X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
H0045 Respite not-in-home per diem X 9 XXX $ - $ -

H0046 Mental health service, nos X 9 XXX $ - $ -
H0047 Alcohol/drug abuse svc nos X 9 XXX $ - $ -
H0048 Spec coll non-blood:a/d test X 9 XXX $ - $ -
H0049 Alcohol/drug screening X 9 XXX $ - $ -
H0050 Alcohol/drug service 15 min X 9 XXX $ - $ -
H1000 Prenatal care atrisk assessm I 9 XXX $ - $ -
H1001 Antepartum management X 9 XXX $ - $ -
H1002 Carecoordination prenatal X 9 XXX $ - $ -
H1003 Prenatal at risk education X 9 XXX $ - $ -
H1004 Follow up home visit/prental X 9 XXX $ - $ -
H1005 Prenatalcare enhanced srv pk X 9 XXX $ - $ -
H1010 Nonmed family planning ed X 9 XXX $ - $ -
H1011 Family assessment X 9 XXX $ - $ -
H2000 Comp multidisipln evaluation X 9 XXX $ - $ -
H2001 Rehabilitation program 1/2 d X 9 XXX $ - $ -
H2010 Comprehensive med svc 15 min X 9 XXX $ - $ -
H2011 Crisis interven svc, 15 min X 9 XXX $ - $ -
H2012 Behav hlth day treat, per hr; omdovodia; ABAA omtervemtopm
9 XXX
bu BCBA $ - $ 17.43 Autism Services
H2013 Psych hlth fac svc, per diem X 9 XXX $ - $ -
H2014 Skills train and dev, 15 min; grp ABA intervention
A by BCaBa
9 XXX $ - $ 11.79 Autism Services
H2015 Comp comm supp svc, 15 min X 9 XXX $ - $ -
H2016 Comp comm supp svc, per diem X 9 XXX $ - $ -
H2017 Psysoc rehab svc, per 15 min X 9 XXX $ - $ -
H2018 Psysoc rehab svc, per diem X 9 XXX $ - $ -
H2019 Ther behav svc, per 15 min;individual ABAAintervention 9 by XXX
BCBA $ - $ 17.43 Autism Services
H2020 Ther behav svc, per diem X 9 XXX $ - $ -
H2021 Com wrap-around sv, 15 min X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
H2022 Com wrap-around sv, per diem X 9 XXX $ - $ -

H2023 Supported employ, per 15 min X 9 XXX $ - $ -
H2024 Supported employ, per diem X 9 XXX $ - $ -
H2025 Supp maint employ, 15 min X 9 XXX $ - $ -
H2026 Supp maint employ, per diem X 9 XXX $ - $ -
H2027 Psychoed svc, per 15 min X 9 XXX $ - $ -
H2028 Sex offend tx svc, 15 min X 9 XXX $ - $ -
H2029 Sex offend tx svc, per diem X 9 XXX $ - $ -
H2030 MH clubhouse svc, per 15 min X 9 XXX $ - $ -
H2031 MH clubhouse svc, per diem X 9 XXX $ - $ -
H2032 Activity therapy, per 15 min X 9 XXX $ - $ -
H2033 Multisys ther/juvenile 15min X 9 XXX $ - $ -
H2034 A/D halfway house, per diem X 9 XXX $ - $ -
H2035 A/D tx program, per hour X 9 XXX $ - $ -
H2036 A/D tx program, per diem X 9 XXX $ - $ -
H2037 Dev delay prev dp ch, 15 min X 9 XXX $ - $ -
J0120 Tetracyclin injection X 9 XXX $ - $ -
J0129 Abatacept injection X 9 XXX $ - $ -
J0130 Abciximab injection X 9 XXX $ - $ -
J0131 Acetaminophen injection X 9 XXX $ - $ -
J0132 Acetylcysteine injection X 9 XXX $ - $ -
J0133 Acyclovir injection X 9 XXX $ - $ -
J0135 Adalimumab injection X 9 XXX $ - $ -
J0150 Injection adenosine 6 MG X 9 XXX $ - $ -
J0152 Adenosine injection X 9 XXX $ - $ -
J0171 Adrenalin epinephrine inject X 9 XXX $ - $ -
J0180 Agalsidase beta injection X 9 XXX $ - $ -
J0190 Inj biperiden lactate/5 mg X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
J0200 Alatrofloxacin mesylate X 9 XXX $ - $ -

J0205 Alglucerase injection X 9 XXX $ - $ -
J0207 Amifostine X 9 XXX $ - $ -
J0210 Methyldopate hcl injection X 9 XXX $ - $ -
J0215 Alefacept X 9 XXX $ - $ -
J0220 Alglucosidase alfa injection X 9 XXX $ - $ -
J0221 Lumizyme injection X 9 XXX $ - $ -
J0256 Alpha 1 proteinase inhibitor X 9 XXX $ - $ -
J0257 Glassia injection X 9 XXX $ - $ -
J0270 Alprostadil for injection X 9 XXX $ - $ -
J0275 Alprostadil urethral suppos X 9 XXX $ - $ -
J0278 Amikacin sulfate injection X 9 XXX $ - $ -
J0280 Aminophyllin 250 MG inj X 9 XXX $ - $ -
J0282 Amiodarone HCl X 9 XXX $ - $ -
J0285 Amphotericin B X 9 XXX $ - $ -
J0287 Amphotericin b lipid complex X 9 XXX $ - $ -
J0288 Ampho b cholesteryl sulfate X 9 XXX $ - $ -
J0289 Amphotericin b liposome inj X 9 XXX $ - $ -
J0290 Ampicillin 500 MG inj X 9 XXX $ - $ -
J0295 Ampicillin sodium per 1.5 gm X 9 XXX $ - $ -
J0300 Amobarbital 125 MG inj X 9 XXX $ - $ -
J0330 Succinycholine chloride inj X 9 XXX $ - $ -
J0348 Anidulafungin injection X 9 XXX $ - $ -
J0350 Injection anistreplase 30 u X 9 XXX $ - $ -
J0360 Hydralazine hcl injection X 9 XXX $ - $ -
J0364 Apomorphine hydrochloride X 9 XXX $ - $ -
J0365 Aprotonin, 10,000 kiu X 9 XXX $ - $ -
J0380 Inj metaraminol bitartrate X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
J0390 Chloroquine injection X 9 XXX $ - $ -

J0395 Arbutamine hcl injection X 9 XXX $ - $ -
J0400 Aripiprazole injection X 9 XXX $ - $ -
J0456 Azithromycin X 9 XXX $ - $ -
J0461 Atropine sulfate injection X 9 XXX $ - $ -
J0470 Dimecaprol injection X 9 XXX $ - $ -
J0475 Baclofen 10 MG injection X 9 XXX $ - $ -
J0476 Baclofen intrathecal trial X 9 XXX $ - $ -
J0480 Basiliximab X 9 XXX $ - $ -
J0490 Belimumab injection X 9 XXX $ - $ -
J0500 Dicyclomine injection X 9 XXX $ - $ -
J0515 Inj benztropine mesylate X 9 XXX $ - $ -
J0520 Bethanechol chloride inject X 9 XXX $ - $ -
J0558 PenG benzathine/procaine inj X 9 XXX $ - $ -
J0561 Penicillin g benzathine inj X 9 XXX $ - $ -
J0583 Bivalirudin X 9 XXX $ - $ -
J0585 Injection,onabotulinumtoxinA X 9 XXX $ - $ -
J0586 AbobotulinumtoxinA X 9 XXX $ - $ -
J0587 Inj, rimabotulinumtoxinB X 9 XXX $ - $ -
J0588 Incobotulinumtoxin a X 9 XXX $ - $ -
J0592 Buprenorphine hydrochloride X 9 XXX $ - $ -
J0594 Busulfan injection X 9 XXX $ - $ -
J0595 Butorphanol tartrate 1 mg X 9 XXX $ - $ -
J0597 C-1 esterase, berinert X 9 XXX $ - $ -
J0598 C-1 esterase, cinryze X 9 XXX $ - $ -
J0600 Edetate calcium disodium inj X 9 XXX $ - $ -
J0610 Calcium gluconate injection X 9 XXX $ - $ -
J0620 Calcium glycer & lact/10 ML X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
J0630 Calcitonin salmon injection X 9 XXX $ - $ -

J0636 Inj calcitriol per 0.1 mcg X 9 XXX $ - $ -
J0637 Caspofungin acetate X 9 XXX $ - $ -
J0638 Canakinumab injection X 9 XXX $ - $ -
J0640 Leucovorin calcium injection X 9 XXX $ - $ -
J0641 Levoleucovorin injection X 9 XXX $ - $ -
J0670 Inj mepivacaine HCL/10 ml X 9 XXX $ - $ -
J0690 Cefazolin sodium injection X 9 XXX $ - $ -
J0692 Cefepime HCl for injection X 9 XXX $ - $ -
J0694 Cefoxitin sodium injection X 9 XXX $ - $ -
J0696 Ceftriaxone sodium injection X 9 XXX $ - $ -
J0697 Sterile cefuroxime injection X 9 XXX $ - $ -
J0698 Cefotaxime sodium injection X 9 XXX $ - $ -
J0702 Betamethasone acet&sod phosp X 9 XXX $ - $ -
J0706 Caffeine citrate injection X 9 XXX $ - $ -
J0710 Cephapirin sodium injection X 9 XXX $ - $ -
J0712 Ceftaroline fosamil inj X 9 XXX $ - $ -
J0713 Inj ceftazidime per 500 mg X 9 XXX $ - $ -
J0715 Ceftizoxime sodium / 500 MG X 9 XXX $ - $ -
J0718 Certolizumab pegol inj X 9 XXX $ - $ -
J0720 Chloramphenicol sodium injec X 9 XXX $ - $ -
J0725 Chorionic gonadotropin/1000u X 9 XXX $ - $ -
J0735 Clonidine hydrochloride X 9 XXX $ - $ -
J0740 Cidofovir injection X 9 XXX $ - $ -
J0743 Cilastatin sodium injection X 9 XXX $ - $ -
J0744 Ciprofloxacin iv X 9 XXX $ - $ -
J0745 Inj codeine phosphate /30 MG X 9 XXX $ - $ -
J0760 Colchicine injection X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
J0770 Colistimethate sodium inj X 9 XXX $ - $ -

J0775 Collagenase, clost hist inj X 9 XXX $ - $ -
J0780 Prochlorperazine injection X 9 XXX $ - $ -
J0795 Corticorelin ovine triflutal X 9 XXX $ - $ -
J0800 Corticotropin injection X 9 XXX $ - $ -
J0833 Cosyntropin injection NOS X 9 XXX $ - $ -
J0834 Cosyntropin cortrosyn inj X 9 XXX $ - $ -
J0840 Crotalidae poly immune fab X 9 XXX $ - $ -
J0850 Cytomegalovirus imm IV /vial X 9 XXX $ - $ -
J0878 Daptomycin injection X 9 XXX $ - $ -
J0881 Darbepoetin alfa, non-esrd X 9 XXX $ - $ -
J0882 Darbepoetin alfa, esrd use X 9 XXX $ - $ -
J0885 Epoetin alfa, non-esrd X 9 XXX $ - $ -
J0886 Epoetin alfa 1000 units ESRD X 9 XXX $ - $ -
J0894 Decitabine injection X 9 XXX $ - $ -
J0895 Deferoxamine mesylate inj X 9 XXX $ - $ -
J0897 Denosumab injection X 9 XXX $ - $ -
J0900 Testosterone enanthate inj X 9 XXX $ - $ -
J0945 Brompheniramine maleate inj X 9 XXX $ - $ -
J1000 Depo-estradiol cypionate inj X 9 XXX $ - $ -
J1020 Methylprednisolone 20 MG inj X 9 XXX $ - $ -
J1051 Medroxyprogesterone inj X 9 XXX $ - $ -
J1055 Medrxyprogester acetate inj X 9 XXX $ - $ -
J1056 MA/EC contraceptiveinjection X 9 XXX $ - $ -
J1060 Testosterone cypionate 1 ML X 9 XXX $ - $ -
J1070 Testosterone cypionat 100 MG X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
J1080 Testosterone cypionat 200 MG X 9 XXX $ - $ -

J1094 Inj dexamethasone acetate X 9 XXX $ - $ -
J1100 Dexamethasone sodium phos X 9 XXX $ - $ -
J1110 Inj dihydroergotamine mesylt X 9 XXX $ - $ -
J1120 Acetazolamid sodium injectio X 9 XXX $ - $ -
J1160 Digoxin injection X 9 XXX $ - $ -
J1162 Digoxin immune fab (ovine) X 9 XXX $ - $ -
J1165 Phenytoin sodium injection X 9 XXX $ - $ -
J1170 Hydromorphone injection X 9 XXX $ - $ -
J1180 Dyphylline injection X 9 XXX $ - $ -
J1190 Dexrazoxane HCl injection X 9 XXX $ - $ -
J1200 Diphenhydramine hcl injectio X 9 XXX $ - $ -
J1205 Chlorothiazide sodium inj X 9 XXX $ - $ -
J1212 Dimethyl sulfoxide 50% 50 ML X 9 XXX $ - $ -
J1230 Methadone injection X 9 XXX $ - $ -
J1240 Dimenhydrinate injection X 9 XXX $ - $ -
J1245 Dipyridamole injection X 9 XXX $ - $ -
J1250 Inj dobutamine HCL/250 mg X 9 XXX $ - $ -
J1260 Dolasetron mesylate X 9 XXX $ - $ -
J1265 Dopamine injection X 9 XXX $ - $ -
J1267 Doripenem injection X 9 XXX $ - $ -
J1270 Injection, doxercalciferol X 9 XXX $ - $ -
J1290 Ecallantide injection X 9 XXX $ - $ -
J1300 Eculizumab injection X 9 XXX $ - $ -
J1320 Amitriptyline injection X 9 XXX $ - $ -
J1324 Enfuvirtide injection X 9 XXX $ - $ -
J1325 Epoprostenol injection X 9 XXX $ - $ -
J1327 Eptifibatide injection X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
J1330 Ergonovine maleate injection X 9 XXX $ - $ -

J1335 Ertapenem injection X 9 XXX $ - $ -
J1364 Erythro lactobionate /500 MG X 9 XXX $ - $ -
J1380 Estradiol valerate 10 MG inj X 9 XXX $ - $ -
J1410 Inj estrogen conjugate 25 MG X 9 XXX $ - $ -
J1430 Ethanolamine oleate 100 mg X 9 XXX $ - $ -
J1435 Injection estrone per 1 MG X 9 XXX $ - $ -
J1436 Etidronate disodium inj X 9 XXX $ - $ -
J1438 Etanercept injection X 9 XXX $ - $ -
J1440 Filgrastim 300 mcg injection X 9 XXX $ - $ -
J1441 Filgrastim 480 mcg injection X 9 XXX $ - $ -
J1450 Fluconazole X 9 XXX $ - $ -
J1451 Fomepizole, 15 mg X 9 XXX $ - $ -
J1452 Intraocular Fomivirsen na X 9 XXX $ - $ -
J1453 Fosaprepitant injection X 9 XXX $ - $ -
J1455 Foscarnet sodium injection X 9 XXX $ - $ -
J1457 Gallium nitrate injection X 9 XXX $ - $ -
J1458 Galsulfase injection X 9 XXX $ - $ -
J1459 Inj IVIG privigen 500 mg X 9 XXX $ - $ -
J1460 Gamma globulin 1 CC inj X 9 XXX $ - $ -
J1557 Gammaplex injection X 9 XXX $ - $ -
J1559 Hizentra injection X 9 XXX $ - $ -
J1560 Gamma globulin > 10 CC inj X 9 XXX $ - $ -
J1561 Gamunex/gamunex c X 9 XXX $ - $ -
J1562 Vivaglobin, inj X 9 XXX $ - $ -
J1566 Immune globulin, powder X 9 XXX $ - $ -
J1568 Octagam injection X 9 XXX $ - $ -
J1569 Gammagard liquid injection X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
J1570 Ganciclovir sodium injection X 9 XXX $ - $ -

J1571 Hepagam b im injection X 9 XXX $ - $ -
J1572 Flebogamma injection X 9 XXX $ - $ -
J1573 Hepagam b intravenous, inj X 9 XXX $ - $ -
J1580 Garamycin gentamicin inj X 9 XXX $ - $ -
J1590 Gatifloxacin injection X 9 XXX $ - $ -
J1595 Injection glatiramer acetate X 9 XXX $ - $ -
J1599 Ivig non-lyophilized, NOS X 9 XXX $ - $ -
J1600 Gold sodium thiomaleate inj X 9 XXX $ - $ -
J1610 Glucagon hydrochloride/1 MG X 9 XXX $ - $ -
J1620 Gonadorelin hydroch/ 100 mcg X 9 XXX $ - $ -
J1626 Granisetron hcl injection X 9 XXX $ - $ -
J1630 Haloperidol injection X 9 XXX $ - $ -
J1631 Haloperidol decanoate inj X 9 XXX $ - $ -
J1640 Hemin, 1 mg X 9 XXX $ - $ -
J1642 Inj heparin sodium per 10 u X 9 XXX $ - $ -
J1644 Inj heparin sodium per 1000u X 9 XXX $ - $ -
J1645 Dalteparin sodium X 9 XXX $ - $ -
J1650 Inj enoxaparin sodium X 9 XXX $ - $ -
J1652 Fondaparinux sodium X 9 XXX $ - $ -
J1655 Tinzaparin sodium injection X 9 XXX $ - $ -
J1670 Tetanus immune globulin inj X 9 XXX $ - $ -
J1675 Histrelin acetate X 9 XXX $ - $ -
J1680 Human fibrinogen conc inj X 9 XXX $ - $ -
J1700 Hydrocortisone acetate inj X 9 XXX $ - $ -
J1710 Hydrocortisone sodium ph inj X 9 XXX $ - $ -
J1720 Hydrocortisone sodium succ i X 9 XXX $ - $ -
J1725 Hydroxyprogesterone caproate X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
J1730 Diazoxide injection X 9 XXX $ - $ -

J1740 Ibandronate sodium injection X 9 XXX $ - $ -
J1742 Ibutilide fumarate injection X 9 XXX $ - $ -
J1743 Idursulfase injection X 9 XXX $ - $ -
J1745 Infliximab injection X 9 XXX $ - $ -
J1750 Inj iron dextran X 9 XXX $ - $ -
J1756 Iron sucrose injection X 9 XXX $ - $ -
J1786 Imuglucerase injection X 9 XXX $ - $ -
J1790 Droperidol injection X 9 XXX $ - $ -
J1800 Propranolol injection X 9 XXX $ - $ -
J1810 Droperidol/fentanyl inj X 9 XXX $ - $ -
J1815 Insulin injection X 9 XXX $ - $ -
J1817 Insulin for insulin pump use X 9 XXX $ - $ -
J1826 Interferon Beta-1A inj X 9 XXX $ - $ -
J1830 Interferon beta-1b / .25 MG X 9 XXX $ - $ -
J1835 Itraconazole injection X 9 XXX $ - $ -
J1840 Kanamycin sulfate 500 MG inj X 9 XXX $ - $ -
J1850 Kanamycin sulfate 75 MG inj X 9 XXX $ - $ -
J1885 Ketorolac tromethamine inj X 9 XXX $ - $ -
J1890 Cephalothin sodium injection X 9 XXX $ - $ -
J1930 Lanreotide injection X 9 XXX $ - $ -
J1931 Laronidase injection X 9 XXX $ - $ -
J1940 Furosemide injection X 9 XXX $ - $ -
J1945 Lepirudin X 9 XXX $ - $ -
J1950 Leuprolide acetate /3.75 MG X 9 XXX $ - $ -
J1953 Levetiracetam injection X 9 XXX $ - $ -
J1955 Inj levocarnitine per 1 gm X 9 XXX $ - $ -
J1956 Levofloxacin injection X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
J1960 Levorphanol tartrate inj X 9 XXX $ - $ -

J1980 Hyoscyamine sulfate inj X 9 XXX $ - $ -
J1990 Chlordiazepoxide injection X 9 XXX $ - $ -
J2001 Lidocaine injection X 9 XXX $ - $ -
J2010 Lincomycin injection X 9 XXX $ - $ -
J2020 Linezolid injection X 9 XXX $ - $ -
J2060 Lorazepam injection X 9 XXX $ - $ -
J2150 Mannitol injection X 9 XXX $ - $ -
J2170 Mecasermin injection X 9 XXX $ - $ -
J2175 Meperidine hydrochl /100 MG X 9 XXX $ - $ -
J2180 Meperidine/promethazine inj X 9 XXX $ - $ -
J2185 Meropenem X 9 XXX $ - $ -
J2210 Methylergonovin maleate inj X 9 XXX $ - $ -
J2248 Micafungin sodium injection X 9 XXX $ - $ -
J2250 Inj midazolam hydrochloride X 9 XXX $ - $ -
J2260 Inj milrinone lactate / 5 MG X 9 XXX $ - $ -
J2265 Minocycline hydrochloride X 9 XXX $ - $ -
J2270 Morphine sulfate injection X 9 XXX $ - $ -
J2271 Morphine so4 injection 100mg X 9 XXX $ - $ -
J2275 Morphine sulfate injection X 9 XXX $ - $ -
J2278 Ziconotide injection X 9 XXX $ - $ -
J2280 Inj, moxifloxacin 100 mg X 9 XXX $ - $ -
J2300 Inj nalbuphine hydrochloride X 9 XXX $ - $ -
J2310 Inj naloxone hydrochloride X 9 XXX $ - $ -
J2315 Naltrexone, depot form X 9 XXX $ - $ -
J2320 Nandrolone decanoate 50 MG X 9 XXX $ - $ -
J2323 Natalizumab injection X 9 XXX $ - $ -
J2325 Nesiritide injection X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
J2353 Octreotide injection, depot X 9 XXX $ - $ -

J2354 Octreotide inj, non-depot X 9 XXX $ - $ -
J2355 Oprelvekin injection X 9 XXX $ - $ -
J2357 Omalizumab injection X 9 XXX $ - $ -
J2358 Olanzapine long-acting inj X 9 XXX $ - $ -
J2360 Orphenadrine injection X 9 XXX $ - $ -
J2370 Phenylephrine hcl injection X 9 XXX $ - $ -
J2400 Chloroprocaine hcl injection X 9 XXX $ - $ -
J2405 Ondansetron hcl injection X 9 XXX $ - $ -
J2410 Oxymorphone hcl injection X 9 XXX $ - $ -
J2425 Palifermin injection X 9 XXX $ - $ -
J2426 Paliperidone palmitate inj X 9 XXX $ - $ -
J2430 Pamidronate disodium /30 MG X 9 XXX $ - $ -
J2440 Papaverin hcl injection X 9 XXX $ - $ -
J2460 Oxytetracycline injection X 9 XXX $ - $ -
J2469 Palonosetron hcl X 9 XXX $ - $ -
J2501 Paricalcitol X 9 XXX $ - $ -
J2503 Pegaptanib sodium injection X 9 XXX $ - $ -
J2504 Pegademase bovine, 25 iu X 9 XXX $ - $ -
J2505 Injection, pegfilgrastim 6mg X 9 XXX $ - $ -
J2507 Pegloticase injection X 9 XXX $ - $ -
J2510 Penicillin g procaine inj X 9 XXX $ - $ -
J2513 Pentastarch 10% solution X 9 XXX $ - $ -
J2515 Pentobarbital sodium inj X 9 XXX $ - $ -
J2540 Penicillin g potassium inj X 9 XXX $ - $ -
J2543 Piperacillin/tazobactam X 9 XXX $ - $ -
J2545 Pentamidine non-comp unit X 9 XXX $ - $ -
J2550 Promethazine hcl injection X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
J2560 Phenobarbital sodium inj X 9 XXX $ - $ -

J2562 Plerixafor injection X 9 XXX $ - $ -
J2590 Oxytocin injection X 9 XXX $ - $ -
J2597 Inj desmopressin acetate X 9 XXX $ - $ -
J2650 Prednisolone acetate inj X 9 XXX $ - $ -
J2670 Totazoline hcl injection X 9 XXX $ - $ -
J2675 Inj progesterone per 50 MG X 9 XXX $ - $ -
J2680 Fluphenazine decanoate 25 MG X 9 XXX $ - $ -
J2690 Procainamide hcl injection X 9 XXX $ - $ -
J2700 Oxacillin sodium injeciton X 9 XXX $ - $ -
J2710 Neostigmine methylslfte inj X 9 XXX $ - $ -
J2720 Inj protamine sulfate/10 MG X 9 XXX $ - $ -
J2724 Protein c concentrate X 9 XXX $ - $ -
J2725 Inj protirelin per 250 mcg X 9 XXX $ - $ -
J2730 Pralidoxime chloride inj X 9 XXX $ - $ -
J2760 Phentolaine mesylate inj X 9 XXX $ - $ -
J2765 Metoclopramide hcl injection X 9 XXX $ - $ -
J2770 Quinupristin/dalfopristin X 9 XXX $ - $ -
J2778 Ranibizumab injection X 9 XXX $ - $ -
J2780 Ranitidine hydrochloride inj X 9 XXX $ - $ -
J2783 Rasburicase X 9 XXX $ - $ -
J2785 Regadenoson injection X 9 XXX $ - $ -
J2788 Rho d immune globulin 50 mcg X 9 XXX $ - $ -
J2790 Rho d immune globulin inj X 9 XXX $ - $ -
J2791 Rhophylac injection X 9 XXX $ - $ -
J2792 Rho(D) immune globulin h, sd X 9 XXX $ - $ -
J2793 Rilonacept injection X 9 XXX $ - $ -
J2794 Risperidone, long acting X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
J2795 Ropivacaine HCl injection X 9 XXX $ - $ -

J2796 Romiplostim injection X 9 XXX $ - $ -
J2800 Methocarbamol injection X 9 XXX $ - $ -
J2805 Sincalide injection X 9 XXX $ - $ -
J2810 Inj theophylline per 40 MG X 9 XXX $ - $ -
J2820 Sargramostim injection X 9 XXX $ - $ -
J2850 Inj secretin synthetic human X 9 XXX $ - $ -
J2910 Aurothioglucose injeciton X 9 XXX $ - $ -
J2916 Na ferric gluconate complex X 9 XXX $ - $ -
J2920 Methylprednisolone injection X 9 XXX $ - $ -
J2930 Methylprednisolone injection X 9 XXX $ - $ -
J2940 Somatrem injection X 9 XXX $ - $ -
J2941 Somatropin injection X 9 XXX $ - $ -
J2950 Promazine hcl injection X 9 XXX $ - $ -
J2993 Reteplase injection X 9 XXX $ - $ -
J2995 Inj streptokinase /250000 IU X 9 XXX $ - $ -
J2997 Alteplase recombinant X 9 XXX $ - $ -
J3000 Streptomycin injection X 9 XXX $ - $ -
J3010 Fentanyl citrate injeciton X 9 XXX $ - $ -
J3030 Sumatriptan succinate / 6 MG X 9 XXX $ - $ -
J3070 Pentazocine injection X 9 XXX $ - $ -
J3095 Telavancin injection X 9 XXX $ - $ -
J3101 Tenecteplase injection X 9 XXX $ - $ -
J3105 Terbutaline sulfate inj X 9 XXX $ - $ -
J3110 Teriparatide injection X 9 XXX $ - $ -
J3140 Testosterone suspension inj X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
J3150 Testosteron propionate inj X 9 XXX $ - $ -

J3230 Chlorpromazine hcl injection X 9 XXX $ - $ -
J3240 Thyrotropin injection X 9 XXX $ - $ -
J3243 Tigecycline injection X 9 XXX $ - $ -
J3246 Tirofiban HCl X 9 XXX $ - $ -
J3250 Trimethobenzamide hcl inj X 9 XXX $ - $ -
J3260 Tobramycin sulfate injection X 9 XXX $ - $ -
J3262 Tocilizumab injection X 9 XXX $ - $ -
J3265 Injection torsemide 10 mg/ml X 9 XXX $ - $ -
J3280 Thiethylperazine maleate inj X 9 XXX $ - $ -
J3285 Treprostinil injection X 9 XXX $ - $ -
J3300 Triamcinolone A inj PRS-free X 9 XXX $ - $ -
J3301 Triamcinolone acet inj NOS X 9 XXX $ - $ -
J3302 Triamcinolone diacetate inj X 9 XXX $ - $ -
J3303 Triamcinolone hexacetonl inj X 9 XXX $ - $ -
J3305 Inj trimetrexate glucoronate X 9 XXX $ - $ -
J3310 Perphenazine injeciton X 9 XXX $ - $ -
J3315 Triptorelin pamoate X 9 XXX $ - $ -
J3320 Spectinomycn di-hcl inj X 9 XXX $ - $ -
J3350 Urea injection X 9 XXX $ - $ -
J3355 Urofollitropin, 75 iu X 9 XXX $ - $ -
J3357 Ustekinumab injection X 9 XXX $ - $ -
J3360 Diazepam injection X 9 XXX $ - $ -
J3364 Urokinase 5000 IU injection X 9 XXX $ - $ -
J3365 Urokinase 250,000 IU inj X 9 XXX $ - $ -
J3370 Vancomycin hcl injection X 9 XXX $ - $ -
J3385 Velaglucerase alfa X 9 XXX $ - $ -
J3396 Verteporfin injection X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
J3400 Triflupromazine hcl inj X 9 XXX $ - $ -

J3410 Hydroxyzine hcl injection X 9 XXX $ - $ -
J3411 Thiamine hcl 100 mg X 9 XXX $ - $ -
J3415 Pyridoxine hcl 100 mg X 9 XXX $ - $ -
J3420 Vitamin b12 injection X 9 XXX $ - $ -
J3430 Vitamin k phytonadione inj X 9 XXX $ - $ -
J3465 Injection, voriconazole X 9 XXX $ - $ -
J3470 Hyaluronidase injection X 9 XXX $ - $ -
J3471 Ovine, up to 999 USP units X 9 XXX $ - $ -
J3472 Ovine, 1000 USP units X 9 XXX $ - $ -
J3473 Hyaluronidase recombinant X 9 XXX $ - $ -
J3475 Inj magnesium sulfate X 9 XXX $ - $ -
J3480 Inj potassium chloride X 9 XXX $ - $ -
J3485 Zidovudine X 9 XXX $ - $ -
J3486 Ziprasidone mesylate X 9 XXX $ - $ -
J3487 Zoledronic acid X 9 XXX $ - $ -
J3488 Reclast injection X 9 XXX $ - $ -
J3490 Drugs unclassified injection X 9 XXX $ - $ -
J3520 Edetate disodium per 150 mg N 9 XXX $ - $ -
J3530 Nasal vaccine inhalation X 9 XXX $ - $ -
J3535 Metered dose inhaler drug N 9 XXX $ - $ -
J3570 Laetrile amygdalin vit B17 N 9 XXX $ - $ -
J3590 Unclassified biologics X 9 XXX $ - $ -
J7030 Normal saline solution infus X 9 XXX $ - $ -
J7042 5% dextrose/normal saline X 9 XXX $ - $ -
J7060 5% dextrose/water X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
J7070 D5w infusion X 9 XXX $ - $ -

J7100 Dextran 40 infusion X 9 XXX $ - $ -
J7110 Dextran 75 infusion X 9 XXX $ - $ -
J7120 Ringers lactate infusion X 9 XXX $ - $ -
J7131 Hypertonic saline sol X 9 XXX $ - $ -
J7180 Factor XIII anti-hem factor X 9 XXX $ - $ -
J7183 Wilate injection X 9 XXX $ - $ -
J7185 Xyntha inj X 9 XXX $ - $ -
J7186 Antihemophilic viii/vwf comp X 9 XXX $ - $ -
J7187 Humate-P, inj X 9 XXX $ - $ -
J7189 Factor viia X 9 XXX $ - $ -
J7190 Factor viii X 9 XXX $ - $ -
J7191 Factor VIII (porcine) X 9 XXX $ - $ -
J7192 Factor viii recombinant NOS X 9 XXX $ - $ -
J7193 Factor IX non-recombinant X 9 XXX $ - $ -
J7194 Factor ix complex X 9 XXX $ - $ -
J7195 Factor IX recombinant X 9 XXX $ - $ -
J7196 Antithrombin recombinant X 9 XXX $ - $ -
J7197 Antithrombin iii injection X 9 XXX $ - $ -
J7198 Anti-inhibitor X 9 XXX $ - $ -
J7199 Hemophilia clot factor noc X 9 XXX $ - $ -
J7300 Intraut copper contraceptive C 9 XXX $ - $ -
J7302 Levonorgestrel iu contracept C 9 XXX $ - $ -
J7303 Contraceptive vaginal ring C 9 XXX $ - $ -
J7304 Contraceptive hormone patch C 9 XXX $ - $ -
J7306 Levonorgestrel implant sys C 9 XXX $ - $ -
J7307 Etonogestrel implant system C 9 XXX $ - $ -
J7308 Aminolevulinic acid hcl top X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
J7309 Methyl aminolevulinate, top X 9 XXX $ - $ -

J7310 Ganciclovir long act implant X 9 XXX $ - $ -
J7311 Fluocinolone acetonide implt X 9 XXX $ - $ -
J7312 Dexamethasone intra implant X 9 XXX $ - $ -
J7321 Hyalgan/supartz inj per dose X 9 XXX $ - $ -
J7323 Euflexxa inj per dose X 9 XXX $ - $ -
J7324 Orthovisc inj per dose X 9 XXX $ - $ -
J7325 Synvisc or Synvisc-One X 9 XXX $ - $ -
J7326 Gel-one X 9 XXX $ - $ -
J7330 Cultured chondrocytes implnt X 9 XXX $ - $ -
J7335 Capsaicin 8% patch X 9 XXX $ - $ -
J7500 Azathioprine oral 50mg X 9 XXX $ - $ -
J7501 Azathioprine parenteral X 9 XXX $ - $ -
J7502 Cyclosporine oral 100 mg X 9 XXX $ - $ -
J7504 Lymphocyte immune globulin X 9 XXX $ - $ -
J7505 Monoclonal antibodies X 9 XXX $ - $ -
J7506 Prednisone oral X 9 XXX $ - $ -
J7507 Tacrolimus oral per 1 MG X 9 XXX $ - $ -
J7509 Methylprednisolone oral X 9 XXX $ - $ -
J7510 Prednisolone oral per 5 mg X 9 XXX $ - $ -
J7511 Antithymocyte globuln rabbit X 9 XXX $ - $ -
J7513 Daclizumab, parenteral X 9 XXX $ - $ -
J7515 Cyclosporine oral 25 mg X 9 XXX $ - $ -
J7516 Cyclosporin parenteral 250mg X 9 XXX $ - $ -
J7517 Mycophenolate mofetil oral X 9 XXX $ - $ -
J7518 Mycophenolic acid X 9 XXX $ - $ -
J7520 Sirolimus, oral X 9 XXX $ - $ -
J7525 Tacrolimus injection X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
J7599 Immunosuppressive drug noc X 9 XXX $ - $ -

J7604 Acetylcysteine comp unit X 9 XXX $ - $ -
J7605 Arformoterol non-comp unit X 9 XXX $ - $ -
J7606 Formoterol fumarate, inh X 9 XXX $ - $ -
J7607 Levalbuterol comp con X 9 XXX $ - $ -
J7608 Acetylcysteine non-comp unit X 9 XXX $ - $ -
J7609 Albuterol comp unit X 9 XXX $ - $ -
J7610 Albuterol comp con X 9 XXX $ - $ -
J7611 Albuterol non-comp con X 9 XXX $ - $ -
J7612 Levalbuterol non-comp con X 9 XXX $ - $ -
J7613 Albuterol non-comp unit X 9 XXX $ - $ -
J7614 Levalbuterol non-comp unit X 9 XXX $ - $ -
J7615 Levalbuterol comp unit X 9 XXX $ - $ -
J7620 Albuterol ipratrop non-comp X 9 XXX $ - $ -
J7622 Beclomethasone comp unit X 9 XXX $ - $ -
J7624 Betamethasone comp unit X 9 XXX $ - $ -
J7626 Budesonide non-comp unit X 9 XXX $ - $ -
J7627 Budesonide comp unit X 9 XXX $ - $ -
J7628 Bitolterol mesylate comp con X 9 XXX $ - $ -
J7629 Bitolterol mesylate comp unt X 9 XXX $ - $ -
J7631 Cromolyn sodium noncomp unit X 9 XXX $ - $ -
J7632 Cromolyn sodium comp unit X 9 XXX $ - $ -
J7633 Budesonide non-comp con X 9 XXX $ - $ -
J7634 Budesonide comp con X 9 XXX $ - $ -
J7635 Atropine comp con X 9 XXX $ - $ -
J7636 Atropine comp unit X 9 XXX $ - $ -
J7637 Dexamethasone comp con X 9 XXX $ - $ -
J7638 Dexamethasone comp unit X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
J7639 Dornase alfa non-comp unit X 9 XXX $ - $ -

J7640 Formoterol comp unit X 9 XXX $ - $ -
J7641 Flunisolide comp unit X 9 XXX $ - $ -
J7642 Glycopyrrolate comp con X 9 XXX $ - $ -
J7643 Glycopyrrolate comp unit X 9 XXX $ - $ -
J7644 Ipratropium bromide non-comp X 9 XXX $ - $ -
J7645 Ipratropium bromide comp X 9 XXX $ - $ -
J7647 Isoetharine comp con X 9 XXX $ - $ -
J7648 Isoetharine non-comp con X 9 XXX $ - $ -
J7649 Isoetharine non-comp unit X 9 XXX $ - $ -
J7650 Isoetharine comp unit X 9 XXX $ - $ -
J7657 Isoproterenol comp con X 9 XXX $ - $ -
J7658 Isoproterenol non-comp con X 9 XXX $ - $ -
J7659 Isoproterenol non-comp unit X 9 XXX $ - $ -
J7660 Isoproterenol comp unit X 9 XXX $ - $ -
J7665 Mannitol for inhaler X 9 XXX $ - $ -
J7667 Metaproterenol comp con X 9 XXX $ - $ -
J7668 Metaproterenol non-comp con X 9 XXX $ - $ -
J7669 Metaproterenol non-comp unit X 9 XXX $ - $ -
J7670 Metaproterenol comp unit X 9 XXX $ - $ -
J7674 Methacholine chloride, neb X 9 XXX $ - $ -
J7676 Pentamidine comp unit dose X 9 XXX $ - $ -
J7680 Terbutaline sulf comp con X 9 XXX $ - $ -
J7681 Terbutaline sulf comp unit X 9 XXX $ - $ -
J7682 Tobramycin non-comp unit X 9 XXX $ - $ -
J7683 Triamcinolone comp con X 9 XXX $ - $ -
J7684 Triamcinolone comp unit X 9 XXX $ - $ -
J7685 Tobramycin comp unit X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
J7686 Treprostinil, non-comp unit X 9 XXX $ - $ -

J7699 Inhalation solution for DME X 9 XXX $ - $ -
J7799 Non-inhalation drug for DME X 9 XXX $ - $ -
J8498 Antiemetic rectal/supp NOS X 9 XXX $ - $ -
J8499 Oral prescrip drug non chemo X 9 XXX $ - $ -
J8501 Oral aprepitant X 9 XXX $ - $ -
J8510 Oral busulfan X 9 XXX $ - $ -
J8515 Cabergoline, oral 0.25mg X 9 XXX $ - $ -
J8520 Capecitabine, oral, 150 mg X 9 XXX $ - $ -
J8521 Capecitabine, oral, 500 mg X 9 XXX $ - $ -
J8530 Cyclophosphamide oral 25 MG X 9 XXX $ - $ -
J8540 Oral dexamethasone X 9 XXX $ - $ -
J8560 Etoposide oral 50 MG X 9 XXX $ - $ -
J8561 Oral everolimus X 9 XXX $ - $ -
J8562 Oral fludarabine phosphate X 9 XXX $ - $ -
J8565 Gefitinib oral X 9 XXX $ - $ -
J8597 Antiemetic drug oral NOS X 9 XXX $ - $ -
J8600 Melphalan oral 2 MG X 9 XXX $ - $ -
J8610 Methotrexate oral 2.5 MG X 9 XXX $ - $ -
J8650 Nabilone oral X 9 XXX $ - $ -
J8700 Temozolomide X 9 XXX $ - $ -
J8705 Topotecan oral X 9 XXX $ - $ -
J8999 Oral prescription drug chemo X 9 XXX $ - $ -
J9000 Doxorubicin hcl injection X 9 XXX $ - $ -
J9001 Doxorubicin hcl liposome inj X 9 XXX $ - $ -
J9010 Alemtuzumab injection X 9 XXX $ - $ -
J9015 Aldesleukin injection X 9 XXX $ - $ -
J9017 Arsenic trioxide injection X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
J9020 Asparaginase injection X 9 XXX $ - $ -

J9025 Azacitidine injection X 9 XXX $ - $ -
J9027 Clofarabine injection X 9 XXX $ - $ -
J9031 Bcg live intravesical vac X 9 XXX $ - $ -
J9033 Bendamustine injection X 9 XXX $ - $ -
J9035 Bevacizumab injection X 9 XXX $ - $ -
J9040 Bleomycin sulfate injection X 9 XXX $ - $ -
J9041 Bortezomib injection X 9 XXX $ - $ -
J9043 Cabazitaxel injection X 9 XXX $ - $ -
J9045 Carboplatin injection X 9 XXX $ - $ -
J9050 Carmustine injection X 9 XXX $ - $ -
J9055 Cetuximab injection X 9 XXX $ - $ -
J9060 Cisplatin 10 MG injection X 9 XXX $ - $ -
J9065 Inj cladribine per 1 MG X 9 XXX $ - $ -
J9070 Cyclophosphamide 100 MG inj X 9 XXX $ - $ -
J9098 Cytarabine liposome inj X 9 XXX $ - $ -
J9100 Cytarabine hcl 100 MG inj X 9 XXX $ - $ -
J9120 Dactinomycin injection X 9 XXX $ - $ -
J9130 Dacarbazine 100 mg inj X 9 XXX $ - $ -
J9150 Daunorubicin injection X 9 XXX $ - $ -
J9151 Daunorubicin citrate inj X 9 XXX $ - $ -
J9155 Degarelix injection X 9 XXX $ - $ -
J9160 Denileukin diftitox inj X 9 XXX $ - $ -
J9165 Diethylstilbestrol injection X 9 XXX $ - $ -
J9171 Docetaxel injection X 9 XXX $ - $ -
J9175 Elliotts b solution per ml X 9 XXX $ - $ -
J9178 Inj, epirubicin hcl, 2 mg X 9 XXX $ - $ -
J9179 Eribulin mesylate injection X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
J9181 Etoposide injection X 9 XXX $ - $ -

J9185 Fludarabine phosphate inj X 9 XXX $ - $ -
J9190 Fluorouracil injection X 9 XXX $ - $ -
J9200 Floxuridine injection X 9 XXX $ - $ -
J9201 Gemcitabine hcl injection X 9 XXX $ - $ -
J9202 Goserelin acetate implant X 9 XXX $ - $ -
J9206 Irinotecan injection X 9 XXX $ - $ -
J9207 Ixabepilone injection X 9 XXX $ - $ -
J9208 Ifosfamide injection X 9 XXX $ - $ -
J9209 Mesna injection X 9 XXX $ - $ -
J9211 Idarubicin hcl injection X 9 XXX $ - $ -
J9212 Interferon alfacon-1 inj X 9 XXX $ - $ -
J9213 Interferon alfa-2a inj X 9 XXX $ - $ -
J9214 Interferon alfa-2b inj X 9 XXX $ - $ -
J9215 Interferon alfa-n3 inj X 9 XXX $ - $ -
J9216 Interferon gamma 1-b inj X 9 XXX $ - $ -
J9217 Leuprolide acetate suspnsion X 9 XXX $ - $ -
J9218 Leuprolide acetate injeciton X 9 XXX $ - $ -
J9219 Leuprolide acetate implant X 9 XXX $ - $ -
J9225 Vantas implant X 9 XXX $ - $ -
J9226 Supprelin LA implant X 9 XXX $ - $ -
J9228 Ipilimumab injection X 9 XXX $ - $ -
J9230 Mechlorethamine hcl inj X 9 XXX $ - $ -
J9245 Inj melphalan hydrochl 50 MG X 9 XXX $ - $ -
J9250 Methotrexate sodium inj X 9 XXX $ - $ -
J9260 Methotrexate sodium inj X 9 XXX $ - $ -
J9261 Nelarabine injection X 9 XXX $ - $ -
J9263 Oxaliplatin X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
J9264 Paclitaxel protein bound X 9 XXX $ - $ -

J9265 Paclitaxel injection X 9 XXX $ - $ -
J9266 Pegaspargase injection X 9 XXX $ - $ -
J9268 Pentostatin injection X 9 XXX $ - $ -
J9270 Plicamycin (mithramycin) inj X 9 XXX $ - $ -
J9280 Mitomycin 5 MG inj X 9 XXX $ - $ -
J9293 Mitoxantrone hydrochl / 5 MG X 9 XXX $ - $ -
J9300 Gemtuzumab ozogamicin inj X 9 XXX $ - $ -
J9302 Ofatumumab injection X 9 XXX $ - $ -
J9303 Panitumumab injection X 9 XXX $ - $ -
J9305 Pemetrexed injection X 9 XXX $ - $ -
J9307 Pralatrexate injection X 9 XXX $ - $ -
J9310 Rituximab injection X 9 XXX $ - $ -
J9315 Romidepsin injection X 9 XXX $ - $ -
J9320 Streptozocin injection X 9 XXX $ - $ -
J9328 Temozolomide injection X 9 XXX $ - $ -
J9330 Temsirolimus injection X 9 XXX $ - $ -
J9340 Thiotepa injection X 9 XXX $ - $ -
J9351 Topotecan injection X 9 XXX $ - $ -
J9355 Trastuzumab injection X 9 XXX $ - $ -
J9357 Valrubicin injection X 9 XXX $ - $ -
J9360 Vinblastine sulfate inj X 9 XXX $ - $ -
J9370 Vincristine sulfate 1 MG inj X 9 XXX $ - $ -
J9390 Vinorelbine tartrate inj X 9 XXX $ - $ -
J9395 Injection, Fulvestrant X 9 XXX $ - $ -
J9600 Porfimer sodium injection X 9 XXX $ - $ -
J9999 Chemotherapy drug X 9 XXX $ - $ -
M0064 Visit for drug monitoring A 0 XXX $ 15.66 $ 44.54

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
M0075 Cellular therapy N 9 XXX $ - $ -

M0076 Prolotherapy N 9 XXX $ - $ -
M0100 Intragastric hypothermia N 9 XXX $ - $ -
M0300 IV chelationtherapy N 9 XXX $ - $ -
M0301 Fabric wrapping of aneurysm N 9 XXX $ - $ -
P2028 Cephalin floculation test X 9 XXX $ - $ -
P2029 Congo red blood test X 9 XXX $ - $ -
P2031 Hair analysis N 9 XXX $ - $ -
P2033 Blood thymol turbidity X 9 XXX $ - $ -
P2038 Blood mucoprotein X 9 XXX $ - $ -
P3000 Screen pap by tech w md supv X 9 XXX $ - $ -
P3001 Screening pap smear by phys A 0 XXX $ 29.23 $ 29.23
Q0091 Obtaining screen pap smear A 0 XXX $ 20.53 $ 42.11
Q0092 Set up port xray equipment A 3 XXX $ 19.84 $ 19.84
Q0111 Wet mounts/ w preparations X 9 XXX $ - $ -
Q0112 Potassium hydroxide preps X 9 XXX $ - $ -
Q0113 Pinworm examinations X 9 XXX $ - $ -
Q0114 Fern test X 9 XXX $ - $ -
Q0115 Post-coital mucous exam X 9 XXX $ - $ -
Q0138 Ferumoxytol, non-esrd X 9 XXX $ - $ -
Q0139 Ferumoxytol, esrd use X 9 XXX $ - $ -
Q0144 Azithromycin dihydrate, oral N 9 XXX $ - $ -
Q0162 Ondansetron oral X 9 XXX $ - $ -
Q0163 Diphenhydramine HCl 50mg X 9 XXX $ - $ -
Q0164 Prochlorperazine maleate 5mg X 9 XXX $ - $ -
Q0165 Prochlorperazine maleate10mg X 9 XXX $ - $ -
Q0166 Granisetron hcl 1 mg oral X 9 XXX $ - $ -
Q0167 Dronabinol 2.5mg oral X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
Q0168 Dronabinol 5mg oral X 9 XXX $ - $ -

Q0169 Promethazine HCl 12.5mg oral X 9 XXX $ - $ -
Q0170 Promethazine HCl 25 mg oral X 9 XXX $ - $ -
Q0171 Chlorpromazine HCl 10mg oral X 9 XXX $ - $ -
Q0172 Chlorpromazine HCl 25mg oral X 9 XXX $ - $ -
Q0173 Trimethobenzamide HCl 250mg X 9 XXX $ - $ -
Q0174 Thiethylperazine maleate10mg X 9 XXX $ - $ -
Q0175 Perphenazine 4mg oral X 9 XXX $ - $ -
Q0176 Perphenazine 8mg oral X 9 XXX $ - $ -
Q0177 Hydroxyzine pamoate 25mg X 9 XXX $ - $ -
Q0178 Hydroxyzine pamoate 50mg X 9 XXX $ - $ -
Q0180 Dolasetron mesylate oral X 9 XXX $ - $ -
Q0181 Unspecified oral anti-emetic X 9 XXX $ - $ -
Q0478 Power adapter, combo vad X 9 XXX $ - $ -
Q0479 Power module combo vad, rep X 9 XXX $ - $ -
Q0480 Driver pneumatic vad, rep X 9 XXX $ - $ -
Q0481 Microprcsr cu elec vad, rep X 9 XXX $ - $ -
Q0482 Microprcsr cu combo vad, rep X 9 XXX $ - $ -
Q0483 Monitor elec vad, rep X 9 XXX $ - $ -
Q0484 Monitor elec or comb vad rep X 9 XXX $ - $ -
Q0485 Monitor cable elec vad, rep X 9 XXX $ - $ -
Q0486 Mon cable elec/pneum vad rep X 9 XXX $ - $ -
Q0487 Leads any type vad, rep only X 9 XXX $ - $ -
Q0488 Pwr pack base elec vad, rep X 9 XXX $ - $ -
Q0489 Pwr pck base combo vad, rep X 9 XXX $ - $ -
Q0490 Emr pwr source elec vad, rep X 9 XXX $ - $ -
Q0491 Emr pwr source combo vad rep X 9 XXX $ - $ -
Q0492 Emr pwr cbl elec vad, rep X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
Q0493 Emr pwr cbl combo vad, rep X 9 XXX $ - $ -

Q0494 Emr hd pmp elec/combo, rep X 9 XXX $ - $ -
Q0495 Charger elec/combo vad, rep X 9 XXX $ - $ -
Q0496 Battery elec/combo vad, rep X 9 XXX $ - $ -
Q0497 Bat clps elec/comb vad, rep X 9 XXX $ - $ -
Q0498 Holster elec/combo vad, rep X 9 XXX $ - $ -
Q0499 Belt/vest elec/combo vad rep X 9 XXX $ - $ -
Q0500 Filters elec/combo vad, rep X 9 XXX $ - $ -
Q0501 Shwr cov elec/combo vad, rep X 9 XXX $ - $ -
Q0502 Mobility cart pneum vad, rep X 9 XXX $ - $ -
Q0503 Battery pneum vad replacemnt X 9 XXX $ - $ -
Q0504 Pwr adpt pneum vad, rep veh X 9 XXX $ - $ -
Q0505 Miscl supply/accessory vad X 9 XXX $ - $ -
Q0506 Lith-ion batt elec/pneum VAD X 9 XXX $ - $ -
Q0510 Dispens fee immunosupressive X 9 XXX $ - $ -
Q0511 Sup fee antiem,antica,immuno X 9 XXX $ - $ -
Q0512 Px sup fee anti-can sub pres X 9 XXX $ - $ -
Q0513 Disp fee inhal drugs/30 days X 9 XXX $ - $ -
Q0514 Disp fee inhal drugs/90 days X 9 XXX $ - $ -
Q0515 Sermorelin acetate injection X 9 XXX $ - $ -
Q1004 Ntiol category 4 X 9 XXX $ - $ -
Q1005 Ntiol category 5 X 9 XXX $ - $ -
Q2004 Bladder calculi irrig sol X 9 XXX $ - $ -
Q2009 Fosphenytoin inj PE X 9 XXX $ - $ -
Q2017 Teniposide, 50 mg X 9 XXX $ - $ -
Q2026 Radiesse injection X 9 XXX $ - $ -
Q2027 Sculptra injection X 9 XXX $ - $ -
Q2035 Afluria vacc, 3 yrs & >, im X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
Q2036 Flulaval vacc, 3 yrs & >, im X 9 XXX $ - $ -

Q2037 Fluvirin vacc, 3 yrs & >, im X 9 XXX $ - $ -
Q2038 Fluzone vacc, 3 yrs & >, im X 9 XXX $ - $ -
Q2039 NOS flu vacc, 3 yrs & >, im X 9 XXX $ - $ -
Q2043 Sipuleucel-T auto CD54+ X 9 XXX $ - $ -
Q3001 Brachytherapy Radioelements C 0 XXX $ - $ -
Q3014 Telehealth facility fee X 9 XXX $ - $ -
Q3025 IM inj interferon beta 1-a X 9 XXX $ - $ -
Q3026 Subc inj interferon beta-1a X 9 XXX $ - $ -
Q3031 Collagen skin test B 9 XXX $ - $ -
Q4001 Cast sup body cast plaster X 9 XXX $ - $ -
Q4002 Cast sup body cast fiberglas X 9 XXX $ - $ -
Q4003 Cast sup shoulder cast plstr X 9 XXX $ - $ -
Q4004 Cast sup shoulder cast fbrgl X 9 XXX $ - $ -
Q4005 Cast sup long arm adult plst X 9 XXX $ - $ -
Q4006 Cast sup long arm adult fbrg X 9 XXX $ - $ -
Q4007 Cast sup long arm ped plster X 9 XXX $ - $ -
Q4008 Cast sup long arm ped fbrgls X 9 XXX $ - $ -
Q4009 Cast sup sht arm adult plstr X 9 XXX $ - $ -
Q4010 Cast sup sht arm adult fbrgl X 9 XXX $ - $ -
Q4011 Cast sup sht arm ped plaster X 9 XXX $ - $ -
Q4012 Cast sup sht arm ped fbrglas X 9 XXX $ - $ -
Q4013 Cast sup gauntlet plaster X 9 XXX $ - $ -
Q4014 Cast sup gauntlet fiberglass X 9 XXX $ - $ -
Q4015 Cast sup gauntlet ped plster X 9 XXX $ - $ -
Q4016 Cast sup gauntlet ped fbrgls X 9 XXX $ - $ -
Q4017 Cast sup lng arm splint plst X 9 XXX $ - $ -
Q4018 Cast sup lng arm splint fbrg X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
Q4019 Cast sup lng arm splnt ped p X 9 XXX $ - $ -

Q4020 Cast sup lng arm splnt ped f X 9 XXX $ - $ -
Q4021 Cast sup sht arm splint plst X 9 XXX $ - $ -
Q4022 Cast sup sht arm splint fbrg X 9 XXX $ - $ -
Q4023 Cast sup sht arm splnt ped p X 9 XXX $ - $ -
Q4024 Cast sup sht arm splnt ped f X 9 XXX $ - $ -
Q4025 Cast sup hip spica plaster X 9 XXX $ - $ -
Q4026 Cast sup hip spica fiberglas X 9 XXX $ - $ -
Q4027 Cast sup hip spica ped plstr X 9 XXX $ - $ -
Q4028 Cast sup hip spica ped fbrgl X 9 XXX $ - $ -
Q4029 Cast sup long leg plaster X 9 XXX $ - $ -
Q4030 Cast sup long leg fiberglass X 9 XXX $ - $ -
Q4031 Cast sup lng leg ped plaster X 9 XXX $ - $ -
Q4032 Cast sup lng leg ped fbrgls X 9 XXX $ - $ -
Q4033 Cast sup lng leg cylinder pl X 9 XXX $ - $ -
Q4034 Cast sup lng leg cylinder fb X 9 XXX $ - $ -
Q4035 Cast sup lngleg cylndr ped p X 9 XXX $ - $ -
Q4036 Cast sup lngleg cylndr ped f X 9 XXX $ - $ -
Q4037 Cast sup shrt leg plaster X 9 XXX $ - $ -
Q4038 Cast sup shrt leg fiberglass X 9 XXX $ - $ -
Q4039 Cast sup shrt leg ped plster X 9 XXX $ - $ -
Q4040 Cast sup shrt leg ped fbrgls X 9 XXX $ - $ -
Q4041 Cast sup lng leg splnt plstr X 9 XXX $ - $ -
Q4042 Cast sup lng leg splnt fbrgl X 9 XXX $ - $ -
Q4043 Cast sup lng leg splnt ped p X 9 XXX $ - $ -
Q4044 Cast sup lng leg splnt ped f X 9 XXX $ - $ -
Q4045 Cast sup sht leg splnt plstr X 9 XXX $ - $ -
Q4046 Cast sup sht leg splnt fbrgl X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
Q4047 Cast sup sht leg splnt ped p X 9 XXX $ - $ -

Q4048 Cast sup sht leg splnt ped f X 9 XXX $ - $ -
Q4049 Finger splint, static X 9 XXX $ - $ -
Q4050 Cast supplies unlisted X 9 XXX $ - $ -
Q4051 Splint supplies misc X 9 XXX $ - $ -
Q4074 Iloprost non-comp unit dose X 9 XXX $ - $ -
Q4081 Epoetin alfa, 100 units ESRD X 9 XXX $ - $ -
Q4082 Drug/bio NOC part B drug CAP X 9 XXX $ - $ -
Q4100 Skin substitute, NOS X 9 XXX $ - $ -
Q4101 Apligraf X 9 XXX $ - $ -
Q4102 Oasis wound matrix X 9 XXX $ - $ -
Q4103 Oasis burn matrix X 9 XXX $ - $ -
Q4104 Integra BMWD X 9 XXX $ - $ -
Q4105 Integra DRT X 9 XXX $ - $ -
Q4106 Dermagraft X 9 XXX $ - $ -
Q4107 Graftjacket X 9 XXX $ - $ -
Q4108 Integra matrix X 9 XXX $ - $ -
Q4110 Primatrix X 9 XXX $ - $ -
Q4111 Gammagraft X 9 XXX $ - $ -
Q4112 Cymetra injectable X 9 XXX $ - $ -
Q4113 Graftjacket xpress X 9 XXX $ - $ -
Q4114 Integra flowable wound matri X 9 XXX $ - $ -
Q4115 Alloskin X 9 XXX $ - $ -
Q4116 Alloderm X 9 XXX $ - $ -
Q4117 Hyalomatrix X 9 XXX $ - $ -
Q4118 Matristem micromatrix X 9 XXX $ - $ -
Q4119 Matristem wound matrix X 9 XXX $ - $ -
Q4120 Matristem burn matrix X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
Q4121 Theraskin X 9 XXX $ - $ -

Q4122 Dermacell X 9 XXX $ - $ -
Q4123 Alloskin X 9 XXX $ - $ -
Q4124 Oasis tri-layer wound matrix X 9 XXX $ - $ -
Q4125 Arthroflex X 9 XXX $ - $ -
Q4126 Memoderm X 9 XXX $ - $ -
Q4127 Talymed X 9 XXX $ - $ -
Q4128 Flexhd or allopatch hd X 9 XXX $ - $ -
Q4129 Unite biomatrix X 9 XXX $ - $ -
Q4130 Strattice TM X 9 XXX $ - $ -
Q5001 Hospice in patient home X 9 XXX $ - $ -
Q5002 Hospice in assisted living X 9 XXX $ - $ -
Q5003 Hospice in LT/non-skilled NF X 9 XXX $ - $ -
Q5004 Hospice in SNF X 9 XXX $ - $ -
Q5005 Hospice, inpatient hospital X 9 XXX $ - $ -
Q5006 Hospice in hospice facility X 9 XXX $ - $ -
Q5007 Hospice in LTCH X 9 XXX $ - $ -
Q5008 Hospice in inpatient psych X 9 XXX $ - $ -
Q5009 Hospice care, NOS X 9 XXX $ - $ -
Q5010 Hospice home care in hospice X 9 XXX $ - $ -
Q9951 LOCM >= 400 mg/ml iodine,1ml X 9 XXX $ - $ -
Q9953 Inj Fe-based MR contrast,1ml X 9 XXX $ - $ -
Q9954 Oral MR contrast, 100 ml X 9 XXX $ - $ -
Q9955 Inj perflexane lip micros,ml X 9 XXX $ - $ -
Q9956 Inj octafluoropropane mic,ml X 9 XXX $ - $ -
Q9957 Inj perflutren lip micros,ml X 9 XXX $ - $ -
Q9958 HOCM <=149 mg/ml iodine, 1ml X 9 XXX $ - $ -
Q9959 HOCM 150-199mg/ml iodine,1ml X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012

Q9964 HOCM>= 400mg/ml iodine, 1ml X 9 XXX $ - $ -
Q9965 LOCM 100-199mg/ml iodine,1ml X 9 XXX $ - $ -
Q9968 Visualization adjunct X 9 XXX $ - $ -
R0070 Transport portable x-ray C 3 XXX $ - $ -
R0075 Transport port x-ray multipl C 3 XXX $ - $ -
R0076 Transport portable EKG B 9 XXX $ - $ -
S0012 Butorphanol tartrate, nasal X 9 XXX $ - $ -
S0014 Tacrine hydrochloride, 10 mg X 9 XXX $ - $ -
S0017 Injection, aminocaproic acid X 9 XXX $ - $ -
S0020 Injection, bupivicaine hydro X 9 XXX $ - $ -
S0021 Injection, cefoperazone sod X 9 XXX $ - $ -
S0023 Injection, cimetidine hydroc X 9 XXX $ - $ -
S0028 Injection, famotidine, 20 mg X 9 XXX $ - $ -
S0030 Injection, metronidazole X 9 XXX $ - $ -
S0032 Injection, nafcillin sodium X 9 XXX $ - $ -
S0034 Injection, ofloxacin, 400 mg X 9 XXX $ - $ -
S0039 Injection, sulfamethoxazole X 9 XXX $ - $ -
S0040 Injection, ticarcillin disod X 9 XXX $ - $ -
S0073 Injection, aztreonam, 500 mg X 9 XXX $ - $ -
S0074 Injection, cefotetan disodiu X 9 XXX $ - $ -
S0077 Injection, clindamycin phosp X 9 XXX $ - $ -
S0078 Injection, fosphenytoin sodi X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
S0080 Injection, pentamidine iseth X 9 XXX $ - $ -

S0081 Injection, piperacillin sodi X 9 XXX $ - $ -
S0088 Imatinib 100 mg X 9 XXX $ - $ -
S0090 Sildenafil citrate, 25 mg X 9 XXX $ - $ -
S0091 Granisetron 1mg X 9 XXX $ - $ -
S0092 Hydromorphone 250 mg X 9 XXX $ - $ -
S0093 Morphine 500 mg X 9 XXX $ - $ -
S0104 Zidovudine, oral, 100 mg X 9 XXX $ - $ -
S0106 Bupropion HCL SR 60 tablets X 9 XXX $ - $ -
S0108 Mercaptopurine 50 mg X 9 XXX $ - $ -
S0109 Methadone oral 5mg X 9 XXX $ - $ -
S0117 Tretinoin topical 5 g X 9 XXX $ - $ -
S0119 Ondansetron 4 mg X 9 XXX $ - $ -
S0122 Inj menotropins 75 iu X 9 XXX $ - $ -
S0126 Inj follitropin alfa 75 iu X 9 XXX $ - $ -
S0128 Inj follitropin beta 75 iu X 9 XXX $ - $ -
S0132 Inj ganirelix acetat 250 mcg X 9 XXX $ - $ -
S0136 Clozapine, 25 mg X 9 XXX $ - $ -
S0137 Didanosine, 25 mg X 9 XXX $ - $ -
S0138 Finasteride, 5 mg X 9 XXX $ - $ -
S0139 Minoxidil, 10 mg X 9 XXX $ - $ -
S0140 Saquinavir, 200 mg X 9 XXX $ - $ -
S0142 Colistimethate inh sol mg X 9 XXX $ - $ -
S0145 Peg interferon alfa-2A/180 X 9 XXX $ - $ -
S0148 Peg interferon alfa-2b/10 X 9 XXX $ - $ -
S0155 Epoprostenol dilutant X 9 XXX $ - $ -
S0156 Exemestane, 25 mg X 9 XXX $ - $ -
S0157 Becaplermin gel 1%, 0.5 gm X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
S0160 Dextroamphetamine X 9 XXX $ - $ -

S0164 Injection pantroprazole X 9 XXX $ - $ -
S0166 Inj olanzapine 2.5mg X 9 XXX $ - $ -
S0169 Calcitrol X 9 XXX $ - $ -
S0170 Anastrozole 1 mg X 9 XXX $ - $ -
S0171 Bumetanide 0.5 mg X 9 XXX $ - $ -
S0172 Chlorambucil 2 mg X 9 XXX $ - $ -
S0174 Dolasetron 50 mg X 9 XXX $ - $ -
S0175 Flutamide 125 mg X 9 XXX $ - $ -
S0176 Hydroxyurea 500 mg X 9 XXX $ - $ -
S0177 Levamisole 50 mg X 9 XXX $ - $ -
S0178 Lomustine 10 mg X 9 XXX $ - $ -
S0179 Megestrol 20 mg X 9 XXX $ - $ -
S0182 Procarbazine 5 mg X 9 XXX $ - $ -
S0183 Prochlorperazine 5 mg X 9 XXX $ - $ -
S0187 Tamoxifen 10 mg X 9 XXX $ - $ -
S0189 Testosterone pellet 75 mg X 9 XXX $ - $ -
S0190 Mifepristone, oral, 200 mg X 9 XXX $ - $ -
S0191 Misoprostol, oral, 200 mcg X 9 XXX $ - $ -
S0194 Vitamin suppl 100 caps X 9 XXX $ - $ -
S0195 Pneumo vaccine 5-9 yrs X 9 XXX $ - $ -
S0197 Prenatal vitamins 30 day X 9 XXX $ - $ -
S0199 Med abortion inc all ex drug X 9 XXX $ - $ -
S0201 Partial hospitalization serv X 9 XXX $ - $ -
S0207 Paramedicintercep nonhospals X 9 XXX $ - $ -
S0208 Paramed intrcept nonvol X 9 XXX $ - $ -
S0209 WC van mileage per mi X 9 XXX $ - $ -
S0215 Nonemerg transp mileage X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
S0220 Medical conference by physic X 9 XXX $ - $ -

S0221 Medical conference, 60 min X 9 XXX $ - $ -
S0250 Comp geriatr assmt team X 9 XXX $ - $ -
S0255 Hospice refer visit nonmd X 9 XXX $ - $ -
S0257 End of life counseling X 9 XXX $ - $ -
S0260 H&P for surgery X 9 XXX $ - $ -
S0265 Genetic counsel 15 mins X 9 XXX $ - $ -
S0270 Home std case rate 30 days X 9 XXX $ - $ -
S0271 Home hospice case 30 days X 9 XXX $ - $ -
S0272 Home episodic case 30 days X 9 XXX $ - $ -
S0273 MD home visit outside cap X 9 XXX $ - $ -
S0274 Nurse practr visit outs cap X 9 XXX $ - $ -
S0280 Medical home, initial plan X 9 XXX $ - $ -
S0281 Medical home, maintenance X 9 XXX $ - $ -
S0302 Completed EPSDT X 9 XXX $ - $ -
S0310 Hospitalist visit X 9 XXX $ - $ -
S0315 Disease management program X 9 XXX $ - $ -
S0316 Follow-up/reassessment X 9 XXX $ - $ -
S0317 Disease mgmt per diem X 9 XXX $ - $ -
S0320 RN telephone calls to DMP X 9 XXX $ - $ -
S0340 Lifestyle mod 1st stage X 9 XXX $ - $ -
S0341 Lifestyle mod 2 or 3 stage X 9 XXX $ - $ -
S0342 Lifestyle mod 4th stage X 9 XXX $ - $ -
S0390 Rout foot care per visit X 9 XXX $ - $ -
S0395 Impression casting ft X 9 XXX $ - $ -
S0400 Global eswl kidney X 9 XXX $ - $ -
S0500 Dispos cont lens X 9 XXX $ - $ -
S0504 Singl prscrp lens X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
S0506 Bifoc prscp lens X 9 XXX $ - $ -

S0508 Trifoc prscrp lens X 9 XXX $ - $ -
S0510 Non-prscrp lens X 9 XXX $ - $ -
S0512 Daily cont lens X 9 XXX $ - $ -
S0514 Color cont lens X 9 XXX $ - $ -
S0515 Scleral lens liquid bandage X 9 XXX $ - $ -
S0516 Safety frames X 9 XXX $ - $ -
S0518 Sunglass frames X 9 XXX $ - $ -
S0580 Polycarb lens X 9 XXX $ - $ -
S0581 Nonstnd lens X 9 XXX $ - $ -
S0590 Misc integral lens serv X 9 XXX $ - $ -
S0592 Comp cont lens eval X 9 XXX $ - $ -
S0595 New lenses in pts old frame X 9 XXX $ - $ -
S0601 Screening proctoscopy X 9 XXX $ - $ -
S0610 Annual gynecological examina X 9 XXX $ - $ -
S0612 Annual gynecological examina X 9 XXX $ - $ -
S0613 Ann breast exam X 9 XXX $ - $ -
S0618 Audiometry for hearing aid X 9 XXX $ - $ -
S0620 Routine ophthalmological exa X 9 XXX $ - $ -
S0621 Routine ophthalmological exa X 9 XXX $ - $ -
S0622 Phys exam for college X 9 XXX $ - $ -
S0630 Removal of sutures X 9 XXX $ - $ -
S0800 Laser in situ keratomileusis X 9 XXX $ - $ -
S0810 Photorefractive keratectomy X 9 XXX $ - $ -
S0812 Phototherap keratect X 9 XXX $ - $ -
S1001 Deluxe item X 9 XXX $ - $ -
S1002 Custom item X 9 XXX $ - $ -
S1015 IV tubing extension set X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
S1016 Non-pvc intravenous administ X 9 XXX $ - $ -

S1030 Gluc monitor purchase X 9 XXX $ - $ -
S1031 Gluc monitor rental X 9 XXX $ - $ -
S1040 Cranial remolding orthosis X 9 XXX $ - $ -
S2053 Transplantation of small int X 9 XXX $ - $ -
S2054 Transplantation of multivisc X 9 XXX $ - $ -
S2055 Harvesting of donor multivis X 9 XXX $ - $ -
S2060 Lobar lung transplantation X 9 XXX $ - $ -
S2061 Donor lobectomy (lung) X 9 XXX $ - $ -
S2065 Simult panc kidn trans X 9 XXX $ - $ -
S2066 Breast GAP flap reconst X 9 XXX $ - $ -
S2067 Breast "stacked" DIEP/GAP X 9 XXX $ - $ -
S2068 Breast DIEP or SIEA flap X 9 XXX $ - $ -
S2070 Cysto laser tx ureteral calc X 9 XXX $ - $ -
S2079 Lap esophagomyotomy X 9 XXX $ - $ -
S2080 Laup X 9 XXX $ - $ -
S2083 Adjustment gastric band X 9 XXX $ - $ -
S2095 Transcath emboliz microspher X 9 XXX $ - $ -
S2102 Islet cell tissue transplant X 9 XXX $ - $ -
S2103 Adrenal tissue transplant X 9 XXX $ - $ -
S2107 Adoptive immunotherapy X 9 XXX $ - $ -
S2112 Knee arthroscp harv X 9 XXX $ - $ -
S2115 Periacetabular osteotomy X 9 XXX $ - $ -
S2117 Arthroereisis, subtalar X 9 XXX $ - $ -
S2118 Total hip resurfacing X 9 XXX $ - $ -
S2120 Low density lipoprotein(LDL) X 9 XXX $ - $ -
S2140 Cord blood harvesting X 9 XXX $ - $ -
S2142 Cord blood-derived stem-cell X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
S2150 BMT harv/transpl 28d pkg X 9 XXX $ - $ -

S2152 Solid organ transpl pkg X 9 XXX $ - $ -
S2202 Echosclerotherapy X 9 XXX $ - $ -
S2205 Minimally invasive direct co X 9 XXX $ - $ -
S2225 Myringotomy laser-assist X 9 XXX $ - $ -
S2230 Implant semi-imp hear X 9 XXX $ - $ -
S2235 Implant auditory brain imp X 9 XXX $ - $ -
S2260 Induced abortion 17-24 weeks X 9 XXX $ - $ -
S2265 Induced abortion 25-28 wks X 9 XXX $ - $ -
S2266 Induced abortion 29-31 wks X 9 XXX $ - $ -
S2267 Induced abortion 32 or more X 9 XXX $ - $ -
S2300 Arthroscopy, shoulder, surgi X 9 XXX $ - $ -
S2325 Hip core decompression X 9 XXX $ - $ -
S2340 Chemodenervation of abductor X 9 XXX $ - $ -
S2341 Chemodenerv adduct vocal X 9 XXX $ - $ -
S2342 Nasal endoscop po debrid X 9 XXX $ - $ -
S2348 Decompress disc RF lumbar X 9 XXX $ - $ -
S2350 Diskectomy, anterior, with d X 9 XXX $ - $ -
S2351 Diskectomy, anterior, with d X 9 XXX $ - $ -
S2360 Vertebroplast cerv 1st X 9 XXX $ - $ -
S2361 Vertebroplast cerv addl X 9 XXX $ - $ -
S2400 Fetal surg congen hernia X 9 XXX $ - $ -
S2401 Fetal surg urin trac obstr X 9 XXX $ - $ -
S2402 Fetal surg cong cyst malf X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
S2403 Fetal surg pulmon sequest X 9 XXX $ - $ -

S2404 Fetal surg myelomeningo X 9 XXX $ - $ -
S2405 Fetal surg sacrococ teratoma X 9 XXX $ - $ -
S2409 Fetal surg noc X 9 XXX $ - $ -
S2411 Fetoscop laser ther TTTS X 9 XXX $ - $ -
S2900 Robotic surgical system X 9 XXX $ - $ -
S3000 Bilat dil retinal exam X 9 XXX $ - $ -
S3005 Eval self-assess depression X 9 XXX $ - $ -
S3600 Stat lab X 9 XXX $ - $ -
S3601 Stat lab home/nf X 9 XXX $ - $ -
S3620 Newborn metabolic screening X 9 XXX $ - $ -
S3625 Maternal triple screen test X 9 XXX $ - $ -
S3626 Maternal serum quad screen X 9 XXX $ - $ -
S3630 Eosinophil blood count X 9 XXX $ - $ -
S3645 HIV-1 antibody testing of or X 9 XXX $ - $ -
S3650 Saliva test, hormone level; X 9 XXX $ - $ -
S3652 Saliva test, hormone level; X 9 XXX $ - $ -
S3655 Antisperm antibodies test X 9 XXX $ - $ -
S3708 Gastrointestinal fat absorpt X 9 XXX $ - $ -
S3711 Circulating tumor cell test X 9 XXX $ - $ -
S3713 KRAS mutation analysis X 9 XXX $ - $ -
S3722 Dose optimization AUC - 5FU X 9 XXX $ - $ -
S3800 Genetic testing ALS X 9 XXX $ - $ -
S3818 BRCA1 gene anal X 9 XXX $ - $ -
S3819 BRCA2 gene anal X 9 XXX $ - $ -
S3820 Comp BRCA1/BRCA2 X 9 XXX $ - $ -
S3822 Sing mutation brst/ovar X 9 XXX $ - $ -
S3823 3 mutation brst/ovar X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
S3828 Comp MLH1 gene X 9 XXX $ - $ -

S3829 Comp MSH2 gene X 9 XXX $ - $ -
S3830 Gene test HNPCC comp X 9 XXX $ - $ -
S3831 Gene test HNPCC single X 9 XXX $ - $ -
S3833 Comp APC sequence X 9 XXX $ - $ -
S3834 Sing mutation APC X 9 XXX $ - $ -
S3835 Gene test cystic fibrosis X 9 XXX $ - $ -
S3837 Gene test hemochromato X 9 XXX $ - $ -
S3840 DNA analysis RET-oncogene X 9 XXX $ - $ -
S3841 Gene test retinoblastoma X 9 XXX $ - $ -
S3842 Gene test Hippel-Lindau X 9 XXX $ - $ -
S3843 DNA analysis factor v X 9 XXX $ - $ -
S3844 DNA analysis deafness X 9 XXX $ - $ -
S3845 Gene test alpha-thalassemia X 9 XXX $ - $ -
S3846 Gene test beta-thalassemia X 9 XXX $ - $ -
S3847 Gene test Tay-Sachs X 9 XXX $ - $ -
S3848 Gene test Gaucher X 9 XXX $ - $ -
S3849 Gene test Niemann-Pick X 9 XXX $ - $ -
S3850 Gene test sickle cell X 9 XXX $ - $ -
S3851 Gene test canavan X 9 XXX $ - $ -
S3852 DNA analysis APOE alzheimer X 9 XXX $ - $ -
S3853 Gene test myo musclr dyst X 9 XXX $ - $ -
S3854 Gene profile panel breast X 9 XXX $ - $ -
S3855 Gene test presenilin-1 gene X 9 XXX $ - $ -
S3860 Genet test cardiac ion-comp X 9 XXX $ - $ -
S3861 Genetic test brugada X 9 XXX $ - $ -
S3862 Genet test cardiac ion-spec X 9 XXX $ - $ -
S3865 Comp genet test hyp cardiomy X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
S3866 Spec gene test hyp cardiomy X 9 XXX $ - $ -

S3870 CGH test developmental delay X 9 XXX $ - $ -
S3890 Fecal DNA analysis X 9 XXX $ - $ -
S3900 Surface EMG X 9 XXX $ - $ -
S3902 Ballistocardiogram X 9 XXX $ - $ -
S3904 Masters two step X 9 XXX $ - $ -
S4005 Interim labor facility globa X 9 XXX $ - $ -
S4011 IVF package X 9 XXX $ - $ -
S4013 Compl GIFT case rate X 9 XXX $ - $ -
S4014 Compl ZIFT case rate X 9 XXX $ - $ -
S4015 Complete IVF nos case rate X 9 XXX $ - $ -
S4016 Frozen IVF case rate X 9 XXX $ - $ -
S4017 IVF canc a stim case rate X 9 XXX $ - $ -
S4018 F EMB trns canc case rate X 9 XXX $ - $ -
S4020 IVF canc a aspir case rate X 9 XXX $ - $ -
S4021 IVF canc p aspir case rate X 9 XXX $ - $ -
S4022 Asst oocyte fert case rate X 9 XXX $ - $ -
S4023 Incompl donor egg case rate X 9 XXX $ - $ -
S4025 Donor serv IVF case rate X 9 XXX $ - $ -
S4026 Procure donor sperm X 9 XXX $ - $ -
S4027 Store prev froz embryos X 9 XXX $ - $ -
S4028 Microsurg epi sperm asp X 9 XXX $ - $ -
S4030 Sperm procure init visit X 9 XXX $ - $ -
S4031 Sperm procure subs visit X 9 XXX $ - $ -
S4035 Stimulated IUI case rate X 9 XXX $ - $ -
S4037 Cryo embryo transf case rate X 9 XXX $ - $ -
S4040 Monit store cryo embryo 30 d X 9 XXX $ - $ -
S4042 Ovulation mgmt per cycle X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
S4981 Insert levonorgestrel ius X 9 XXX $ - $ -

S4989 Contracept IUD X 9 XXX $ - $ -
S4990 Nicotine patch legend X 9 XXX $ - $ -
S4991 Nicotine patch nonlegend X 9 XXX $ - $ -
S4993 Contraceptive pills for bc X 9 XXX $ - $ -
S4995 Smoking cessation gum X 9 XXX $ - $ -
S5000 Prescription drug, generic X 9 XXX $ - $ -
S5001 Prescription drug,brand name X 9 XXX $ - $ -
S5010 5% dextrose and 0.45% saline X 9 XXX $ - $ -
S5011 5% dextrose in lactated ring X 9 XXX $ - $ -
S5012 5% dextrose with potassium X 9 XXX $ - $ -
S5013 5%dextrose/0.45%saline1000ml X 9 XXX $ - $ -
S5014 D5W/0.45NS w KCl and MGS04 X 9 XXX $ - $ -
S5035 HIT routine device maint X 9 XXX $ - $ -
S5036 HIT device repair X 9 XXX $ - $ -
S5100 Adult daycare services 15min X 9 XXX $ - $ -
S5101 Adult day care per half day X 9 XXX $ - $ -
S5102 Adult day care per diem X 9 XXX $ - $ -
S5105 Centerbased day care perdiem X 9 XXX $ - $ -
S5108 Homecare train pt 15 min X 9 XXX $ - $ -
S5109 Homecare train pt session X 9 XXX $ - $ -
S5110 Family homecare training 15m X 9 XXX $ - $ -
S5111 Family homecare train/sessio X 9 XXX $ - $ -
S5115 Nonfamily homecare train/15m X 9 XXX $ - $ -
S5116 Nonfamily HC train/session X 9 XXX $ - $ -
S5120 Chore services per 15 min X 9 XXX $ - $ -
S5121 Chore services per diem X 9 XXX $ - $ -
S5125 Attendant care service /15m X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
S5126 Attendant care service /diem X 9 XXX $ - $ -

S5130 Homaker service nos per 15m X 9 XXX $ - $ -
S5131 Homemaker service nos /diem X 9 XXX $ - $ -
S5135 Adult companioncare per 15m X 9 XXX $ - $ -
S5136 Adult companioncare per diem X 9 XXX $ - $ -
S5140 Adult foster care per diem X 9 XXX $ - $ -
S5141 Adult foster care per month X 9 XXX $ - $ -
S5145 Child fostercare th per diem X 9 XXX $ - $ -
S5146 Ther fostercare child /month X 9 XXX $ - $ -
S5150 Unskilled respite care /15m X 9 XXX $ - $ -
S5151 Unskilled respitecare /diem X 9 XXX $ - $ -
S5160 Emer response sys instal&tst X 9 XXX $ - $ -
S5161 Emer rspns sys serv permonth X 9 XXX $ - $ -
S5162 Emer rspns system purchase X 9 XXX $ - $ -
S5165 Home modifications per serv X 9 XXX $ - $ -
S5170 Homedelivered prepared meal X 9 XXX $ - $ -
S5175 Laundry serv,ext,prof,/order X 9 XXX $ - $ -
S5180 HH respiratory thrpy in eval X 9 XXX $ - $ -
S5181 HH respiratory thrpy nos/day X 9 XXX $ - $ -
S5185 Med reminder serv per month X 9 XXX $ - $ -
S5190 Wellness assessment by nonph X 9 XXX $ - $ -
S5199 Personal care item nos each X 9 XXX $ - $ -
S5497 HIT cath care noc X 9 XXX $ - $ -
S5498 HIT simple cath care X 9 XXX $ - $ -
S5501 HIT complex cath care X 9 XXX $ - $ -
S5502 HIT interim cath care X 9 XXX $ - $ -
S5517 HIT declotting kit X 9 XXX $ - $ -
S5518 HIT cath repair kit X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
S5520 HIT picc insert kit X 9 XXX $ - $ -

S5521 HIT midline cath insert kit X 9 XXX $ - $ -
S5522 HIT picc insert no supp X 9 XXX $ - $ -
S5523 HIP midline cath insert kit X 9 XXX $ - $ -
S5550 Insulin rapid 5 u X 9 XXX $ - $ -
S5551 Insulin most rapid 5 u X 9 XXX $ - $ -
S5552 Insulin intermed 5 u X 9 XXX $ - $ -
S5553 Insulin long acting 5 u X 9 XXX $ - $ -
S5560 Insulin reuse pen 1.5 ml X 9 XXX $ - $ -
S5561 Insulin reuse pen 3 ml X 9 XXX $ - $ -
S5565 Insulin cartridge 150 u X 9 XXX $ - $ -
S5566 Insulin cartridge 300 u X 9 XXX $ - $ -
S5570 Insulin dispos pen 1.5 ml X 9 XXX $ - $ -
S5571 Insulin dispos pen 3 ml X 9 XXX $ - $ -
S8030 Tantalum ring application X 9 XXX $ - $ -
S8035 Magnetic source imaging X 9 XXX $ - $ -
S8037 mrcp X 9 XXX $ - $ -
S8040 Topographic brain mapping X 9 XXX $ - $ -
S8042 MRI low field X 9 XXX $ - $ -
S8049 Intraoperative radiation the X 9 XXX $ - $ -
S8055 Us guidance fetal reduct X 9 XXX $ - $ -
S8080 Scintimammography X 9 XXX $ - $ -
S8085 Fluorine-18 fluorodeoxygluco X 9 XXX $ - $ -
S8092 Electron beam computed tomog X 9 XXX $ - $ -
S8096 Portable peak flow meter X 9 XXX $ - $ -
S8097 Asthma kit X 9 XXX $ - $ -
S8100 Spacer without mask X 9 XXX $ - $ -
S8101 Spacer with mask X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
S8110 Peak expiratory flow rate (p X 9 XXX $ - $ -

S8120 O2 contents gas cubic ft X 9 XXX $ - $ -
S8121 O2 contents liquid lb X 9 XXX $ - $ -
S8130 Interferential stim 2 chan X 9 XXX $ - $ -
S8131 Interferential stim 4 chan X 9 XXX $ - $ -
S8185 Flutter device X 9 XXX $ - $ -
S8186 Swivel adaptor X 9 XXX $ - $ -
S8189 Trach supply noc X 9 XXX $ - $ -
S8210 Mucus trap X 9 XXX $ - $ -
S8262 Mandib ortho repos device X 9 XXX $ - $ -
S8265 Haberman feeder X 9 XXX $ - $ -
S8270 Enuresis alarm X 9 XXX $ - $ -
S8301 Infect control supplies NOS X 9 XXX $ - $ -
S8415 Supplies for home delivery X 9 XXX $ - $ -
S8420 Custom gradient sleev/glov X 9 XXX $ - $ -
S8421 Ready gradient sleev/glov X 9 XXX $ - $ -
S8422 Custom grad sleeve med X 9 XXX $ - $ -
S8423 Custom grad sleeve heavy X 9 XXX $ - $ -
S8424 Ready gradient sleeve X 9 XXX $ - $ -
S8425 Custom grad glove med X 9 XXX $ - $ -
S8426 Custom grad glove heavy X 9 XXX $ - $ -
S8427 Ready gradient glove X 9 XXX $ - $ -
S8428 Ready gradient gauntlet X 9 XXX $ - $ -
S8429 Gradient pressure wrap X 9 XXX $ - $ -
S8430 Padding for comprssn bdg X 9 XXX $ - $ -
S8431 Compression bandage X 9 XXX $ - $ -
S8450 Splint digit X 9 XXX $ - $ -
S8451 Splint wrist or ankle X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
S8452 Splint elbow X 9 XXX $ - $ -

S8460 Camisole post-mast X 9 XXX $ - $ -
S8490 100 insulin syringes X 9 XXX $ - $ -
S8940 Hippotherapy per session X 9 XXX $ - $ -
S8948 Low-level laser trmt 15 min X 9 XXX $ - $ -
S8950 Complex lymphedema therapy, X 9 XXX $ - $ -
S8990 Pt or manip for maint X 9 XXX $ - $ -
S8999 Resuscitation bag X 9 XXX $ - $ -
S9001 Home uterine monitor with or X 9 XXX $ - $ -
S9007 Ultrafiltration monitor X 9 XXX $ - $ -
S9015 Automated EEG monitoring X 9 XXX $ - $ -
S9024 Paranasal sinus ultrasound X 9 XXX $ - $ -
S9025 Omnicardiogram/cardiointegra X 9 XXX $ - $ -
S9034 ESWL for gallstones X 9 XXX $ - $ -
S9055 Procuren or other growth fac X 9 XXX $ - $ -
S9056 Coma stimulation per diem X 9 XXX $ - $ -
S9061 Medical supplies and equipme X 9 XXX $ - $ -
S9083 Urgent care center global X 9 XXX $ - $ -
S9088 Services provided in urgent X 9 XXX $ - $ -
S9090 Vertebral axial decompressio X 9 XXX $ - $ -
S9097 Home visit wound care X 9 XXX $ - $ -
S9098 Home phototherapy visit X 9 XXX $ - $ -
S9109 CHF telemonitoring month X 9 XXX $ - $ -
S9117 Back school visit X 9 XXX $ - $ -
S9122 Home health aide or certifie X 9 XXX $ - $ -
S9123 Nursing care in home RN X 9 XXX $ - $ -
S9124 Nursing care, in the home; b X 9 XXX $ - $ -
S9125 Respite care, in the home, p X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
S9126 Hospice care, in the home, p X 9 XXX $ - $ -

S9127 Social work visit, in the ho X 9 XXX $ - $ -
S9128 Speech therapy, in the home, X 9 XXX $ - $ -
S9129 Occupational therapy, in the X 9 XXX $ - $ -
S9131 PT in the home per diem X 9 XXX $ - $ -
S9140 Diabetic Management Program, X 9 XXX $ - $ -
S9145 Insulin pump initiation X 9 XXX $ - $ -
S9150 Evaluation by ocularist X 9 XXX $ - $ -
S9152 Speech therapy, re-eval X 9 XXX $ - $ -
S9208 Home mgmt preterm labor X 9 XXX $ - $ -
S9209 Home mgmt PPROM X 9 XXX $ - $ -
S9211 Home mgmt gest hypertension X 9 XXX $ - $ -
S9212 Hm postpar hyper per diem X 9 XXX $ - $ -
S9213 Hm preeclamp per diem X 9 XXX $ - $ -
S9214 Hm gest dm per diem X 9 XXX $ - $ -
S9325 HIT pain mgmt per diem X 9 XXX $ - $ -
S9326 HIT cont pain per diem X 9 XXX $ - $ -
S9327 HIT int pain per diem X 9 XXX $ - $ -
S9328 HIT pain imp pump diem X 9 XXX $ - $ -
S9329 HIT chemo per diem X 9 XXX $ - $ -
S9330 HIT cont chem diem X 9 XXX $ - $ -
S9331 HIT intermit chemo diem X 9 XXX $ - $ -
S9335 HT hemodialysis diem X 9 XXX $ - $ -
S9336 HIT cont anticoag diem X 9 XXX $ - $ -
S9338 HIT immunotherapy diem X 9 XXX $ - $ -
S9339 HIT periton dialysis diem X 9 XXX $ - $ -
S9340 HIT enteral per diem X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
S9341 HIT enteral grav diem X 9 XXX $ - $ -

S9342 HIT enteral pump diem X 9 XXX $ - $ -
S9343 HIT enteral bolus nurs X 9 XXX $ - $ -
S9345 HIT anti-hemophil diem X 9 XXX $ - $ -
S9346 HIT alpha-1-proteinas diem X 9 XXX $ - $ -
S9347 HIT longterm infusion diem X 9 XXX $ - $ -
S9348 HIT sympathomim diem X 9 XXX $ - $ -
S9349 HIT tocolysis diem X 9 XXX $ - $ -
S9351 HIT cont antiemetic diem X 9 XXX $ - $ -
S9353 HIT cont insulin diem X 9 XXX $ - $ -
S9355 HIT chelation diem X 9 XXX $ - $ -
S9357 HIT enzyme replace diem X 9 XXX $ - $ -
S9359 HIT anti-tnf per diem X 9 XXX $ - $ -
S9361 HIT diuretic infus diem X 9 XXX $ - $ -
S9363 HIT anti-spasmotic diem X 9 XXX $ - $ -
S9364 HIT tpn total diem X 9 XXX $ - $ -
S9365 HIT tpn 1 liter diem X 9 XXX $ - $ -
S9368 HIT tpn over 3l diem X 9 XXX $ - $ -
S9370 HT inj antiemetic diem X 9 XXX $ - $ -
S9372 HT inj anticoag diem X 9 XXX $ - $ -
S9373 HIT hydra total diem X 9 XXX $ - $ -
S9374 HIT hydra 1 liter diem X 9 XXX $ - $ -
S9377 HIT hydra over 3l diem X 9 XXX $ - $ -
S9379 HIT noc per diem X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
S9381 HIT high risk/escort X 9 XXX $ - $ -

S9401 Anticoag clinic per session X 9 XXX $ - $ -
S9430 Pharmacy comp/disp serv X 9 XXX $ - $ -
S9433 Medical food oral 100% nutr X 9 XXX $ - $ -
S9434 Mod solid food suppl X 9 XXX $ - $ -
S9435 Medical foods for inborn err X 9 XXX $ - $ -
S9436 Lamaze class X 9 XXX $ - $ -
S9437 Childbirth refresher class X 9 XXX $ - $ -
S9438 Cesarean birth class X 9 XXX $ - $ -
S9439 VBAC class X 9 XXX $ - $ -
S9441 Asthma education X 9 XXX $ - $ -
S9442 Birthing class X 9 XXX $ - $ -
S9443 Lactation class X 9 XXX $ - $ -
S9444 Parenting class X 9 XXX $ - $ -
S9445 PT education noc individ X 9 XXX $ - $ -
S9446 PT education noc group X 9 XXX $ - $ -
S9447 Infant safety class X 9 XXX $ - $ -
S9449 Weight mgmt class X 9 XXX $ - $ -
S9451 Exercise class X 9 XXX $ - $ -
S9452 Nutrition class X 9 XXX $ - $ -
S9453 Smoking cessation class X 9 XXX $ - $ -
S9454 Stress mgmt class X 9 XXX $ - $ -
S9470 Nutritional counseling, diet X 9 XXX $ - $ -
S9472 Cardiac rehabilitation progr X 9 XXX $ - $ -
S9473 Pulmonary rehabilitation pro X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
S9474 Enterostomal therapy by a re X 9 XXX $ - $ -

S9475 Ambulatory setting substance X 9 XXX $ - $ -
S9476 Vestibular rehab per diem X 9 XXX $ - $ -
S9480 Intensive outpatient psychia X 9 XXX $ - $ -
S9482 Family stabilization 15 min X 9 XXX $ - $ -
S9484 Crisis intervention per hour X 9 XXX $ - $ -
S9485 Crisis intervention mental h X 9 XXX $ - $ -
S9490 HIT corticosteroid/diem X 9 XXX $ - $ -
S9494 HIT antibiotic total diem X 9 XXX $ - $ -
S9497 HIT antibiotic q3h diem X 9 XXX $ - $ -
S9529 Venipuncture home/snf X 9 XXX $ - $ -
S9537 HT hem horm inj diem X 9 XXX $ - $ -
S9538 HIT blood products diem X 9 XXX $ - $ -
S9542 HT inj noc per diem X 9 XXX $ - $ -
S9558 HT inj growth horm diem X 9 XXX $ - $ -
S9559 HIT inj interferon diem X 9 XXX $ - $ -
S9560 HT inj hormone diem X 9 XXX $ - $ -
S9562 HT inj palivizumab diem X 9 XXX $ - $ -
S9590 HT irrigation diem X 9 XXX $ - $ -
S9810 HT pharm per hour X 9 XXX $ - $ -
S9900 Christian Sci Pract visit X 9 XXX $ - $ -
S9970 Health club membership yr X 9 XXX $ - $ -
S9975 Transplant related per diem X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
S9976 Lodging per diem X 9 XXX $ - $ -

S9977 Meals per diem X 9 XXX $ - $ -
S9981 Med record copy admin X 9 XXX $ - $ -
S9982 Med record copy per page X 9 XXX $ - $ -
S9986 Not medically necessary svc X 9 XXX $ - $ -
S9988 Serv part of phase I trial X 9 XXX $ - $ -
S9989 Services outside US X 9 XXX $ - $ -
S9990 Services provided as part of X 9 XXX $ - $ -
S9991 Services provided as part of X 9 XXX $ - $ -
S9992 Transportation costs to and X 9 XXX $ - $ -
S9994 Lodging costs (e.g. hotel ch X 9 XXX $ - $ -
S9996 Meals for clinical trial par X 9 XXX $ - $ -
S9999 Sales tax X 9 XXX $ - $ -
T1000 Private duty/independent nsg X 9 XXX $ - $ -
T1001 Nursing assessment/evaluatn X 9 XXX $ - $ -
T1002 RN services up to 15 minutes X 9 XXX $ - $ -
T1003 LPN/LVN services up to 15min X 9 XXX $ - $ -
T1004 Nsg aide service up to 15min X 9 XXX $ - $ -
T1005 Respite care service 15 min X 9 XXX $ - $ -
T1006 Family/Couple Counseling X 9 XXX $ - $ -
T1007 Treatment Plan Development X 9 XXX $ - $ -
T1009 Child Sitting Services X 9 XXX $ - $ -
T1010 Meals when Receive Services X 9 XXX $ - $ -
T1012 Alcohol/Substance Abuse Skil X 9 XXX $ - $ -
T1013 Sign Lang/Oral Interpreter X 9 XXX $ - $ -
T1014 Telehealth transmit, per min X 9 XXX $ - $ -
T1015 Clinic service X 9 XXX $ - $ -
T1016 Case management X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
T1017 Targeted case management X 9 XXX $ - $ -

T1018 School-based IEP ser bundled X 9 XXX $ - $ -
T1019 Personal care ser per 15 min X 9 XXX $ - $ -
T1020 Personal care ser per diem X 9 XXX $ - $ -
T1021 HH Aide or cn aide per visit X 9 XXX $ - $ -
T1022 Contracted services per day X 9 XXX $ - $ -
T1023 Program intake assessment X 9 XXX $ - $ -
T1024 Team evaluation & management X 9 XXX $ - $ -
T1025 Ped compr care pkg, per diem X 9 XXX $ - $ -
T1026 Ped compr care pkg, per hour X 9 XXX $ - $ -
T1027 Family training & counseling X 9 XXX $ - $ -
T1028 Home environment assessment X 9 XXX $ - $ -
T1029 Dwelling lead investigation X 9 XXX $ - $ -
T1030 RN home care per diem X 9 XXX $ - $ -
T1031 LPN home care per diem X 9 XXX $ - $ -
T1502 Medication admin visit X 9 XXX $ - $ -
T1503 Med admin, not oral/inject X 9 XXX $ - $ -
T1505 Elec med comp dev, noc X 9 XXX $ - $ -
T1999 NOC retail items andsupplies X 9 XXX $ - $ -
T2001 N-et; patient attend/escort X 9 XXX $ - $ -
T2002 N-et; per diem X 9 XXX $ - $ -
T2003 N-et; encounter/trip X 9 XXX $ - $ -
T2004 N-et; commerc carrier pass X 9 XXX $ - $ -
T2005 N-et; stretcher van X 9 XXX $ - $ -
T2007 Non-emer transport wait time X 9 XXX $ - $ -
T2010 PASRR Level I X 9 XXX $ - $ -
T2011 PASRR Level II X 9 XXX $ - $ -
T2012 Habil ed waiver, per diem X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
T2013 Habil ed waiver per hour X 9 XXX $ - $ -

T2014 Habil prevoc waiver, per d X 9 XXX $ - $ -
T2015 Habil prevoc waiver per hr X 9 XXX $ - $ -
T2016 Habil res waiver per diem X 9 XXX $ - $ -
T2017 Habil res waiver 15 min X 9 XXX $ - $ -
T2018 Habil sup empl waiver/diem X 9 XXX $ - $ -
T2019 Habil sup empl waiver 15min X 9 XXX $ - $ -
T2020 Day habil waiver per diem X 9 XXX $ - $ -
T2021 Day habil waiver per 15 min X 9 XXX $ - $ -
T2022 Case management, per month X 9 XXX $ - $ -
T2023 Targeted case mgmt per month X 9 XXX $ - $ -
T2024 Serv asmnt/care plan waiver X 9 XXX $ - $ -
T2025 Waiver service, nos X 9 XXX $ - $ -
T2026 Special childcare waiver/d X 9 XXX $ - $ -
T2027 Spec childcare waiver 15 min X 9 XXX $ - $ -
T2028 Special supply, nos waiver X 9 XXX $ - $ -
T2029 Special med equip, noswaiver X 9 XXX $ - $ -
T2030 Assist living waiver/month X 9 XXX $ - $ -
T2031 Assist living waiver/diem X 9 XXX $ - $ -
T2032 Res care, nos waiver/month X 9 XXX $ - $ -
T2033 Res, nos waiver per diem X 9 XXX $ - $ -
T2034 Crisis interven waiver/diem X 9 XXX $ - $ -
T2035 Utility services waiver X 9 XXX $ - $ -
T2036 Camp overnite waiver/session X 9 XXX $ - $ -
T2037 Camp day waiver/session X 9 XXX $ - $ -
T2038 Comm trans waiver/service X 9 XXX $ - $ -
T2039 Vehicle mod waiver/service X 9 XXX $ - $ -
T2040 Financial mgt waiver/15min X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
T2041 Support broker waiver/15 min X 9 XXX $ - $ -

T2042 Hospice routine home care X 9 XXX $ - $ -
T2043 Hospice continuous home care X 9 XXX $ - $ -
T2044 Hospice respite care X 9 XXX $ - $ -
T2045 Hospice general care X 9 XXX $ - $ -
T2046 Hospice long term care, r&b X 9 XXX $ - $ -
T2048 Bh ltc res r&b, per diem X 9 XXX $ - $ -
T2049 N-ET; stretcher van, mileage X 9 XXX $ - $ -
T2101 Breast milk proc/store/dist X 9 XXX $ - $ -
T4521 Adult size brief/diaper sm N 9 XXX $ - $ -
T4522 Adult size brief/diaper med N 9 XXX $ - $ -
T4523 Adult size brief/diaper lg N 9 XXX $ - $ -
T4524 Adult size brief/diaper xl N 9 XXX $ - $ -
T4525 Adult size pull-on sm N 9 XXX $ - $ -
T4526 Adult size pull-on med N 9 XXX $ - $ -
T4527 Adult size pull-on lg N 9 XXX $ - $ -
T4528 Adult size pull-on xl N 9 XXX $ - $ -
T4529 Ped size brief/diaper sm/med N 9 XXX $ - $ -
T4530 Ped size brief/diaper lg N 9 XXX $ - $ -
T4531 Ped size pull-on sm/med N 9 XXX $ - $ -
T4532 Ped size pull-on lg N 9 XXX $ - $ -
T4533 Youth size brief/diaper N 9 XXX $ - $ -
T4534 Youth size pull-on N 9 XXX $ - $ -
T4535 Disposable liner/shield/pad N 9 XXX $ - $ -
T4536 Reusable pull-on any size N 9 XXX $ - $ -
T4537 Reusable underpad bed size N 9 XXX $ - $ -
T4538 Diaper serv reusable diaper N 9 XXX $ - $ -
T4539 Reuse diaper/brief any size N 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
T4540 Reusable underpad chair size N 9 XXX $ - $ -

T4541 Large disposable underpad N 9 XXX $ - $ -
T4542 Small disposable underpad N 9 XXX $ - $ -
T4543 Disp bariatric brief/diaper N 9 XXX $ - $ -
T5001 Position seat spec orth need N 9 XXX $ - $ -
T5999 Supply, nos N 9 XXX $ - $ -
V2020 Vision svcs frames purchases X 9 XXX $ - $ -
V2025 Eyeglasses delux frames N 9 XXX $ - $ -
V2100 Lens spher single plano 4.00 X 9 XXX $ - $ -
V2101 Single visn sphere 4.12-7.00 X 9 XXX $ - $ -
V2102 Singl visn sphere 7.12-20.00 X 9 XXX $ - $ -
V2103 Spherocylindr 4.00d/12-2.00d X 9 XXX $ - $ -
V2104 Spherocylindr 4.00d/2.12-4d X 9 XXX $ - $ -
V2105 Spherocylinder 4.00d/4.25-6d X 9 XXX $ - $ -
V2106 Spherocylinder 4.00d/>6.00d X 9 XXX $ - $ -
V2107 Spherocylinder 4.25d/12-2d X 9 XXX $ - $ -
V2110 Spherocylinder 4.25d/over 6d X 9 XXX $ - $ -
V2111 Spherocylindr 7.25d/.25-2.25 X 9 XXX $ - $ -
V2114 Spherocylinder over 12.00d X 9 XXX $ - $ -
V2115 Lens lenticular bifocal X 9 XXX $ - $ -
V2118 Lens aniseikonic single X 9 XXX $ - $ -
V2121 Lenticular lens, single X 9 XXX $ - $ -
V2199 Lens single vision not oth c X 9 XXX $ - $ -
V2200 Lens spher bifoc plano 4.00d X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
V2201 Lens sphere bifocal 4.12-7.0 X 9 XXX $ - $ -

V2202 Lens sphere bifocal 7.12-20. X 9 XXX $ - $ -
V2203 Lens sphcyl bifocal 4.00d/.1 X 9 XXX $ - $ -
V2204 Lens sphcy bifocal 4.00d/2.1 X 9 XXX $ - $ -
V2205 Lens sphcy bifocal 4.00d/4.2 X 9 XXX $ - $ -
V2206 Lens sphcy bifocal 4.00d/ove X 9 XXX $ - $ -
V2207 Lens sphcy bifocal 4.25-7d/. X 9 XXX $ - $ -
V2208 Lens sphcy bifocal 4.25-7/2. X 9 XXX $ - $ -
V2209 Lens sphcy bifocal 4.25-7/4. X 9 XXX $ - $ -
V2210 Lens sphcy bifocal 4.25-7/ov X 9 XXX $ - $ -
V2211 Lens sphcy bifo 7.25-12/.25- X 9 XXX $ - $ -
V2212 Lens sphcyl bifo 7.25-12/2.2 X 9 XXX $ - $ -
V2213 Lens sphcyl bifo 7.25-12/4.2 X 9 XXX $ - $ -
V2214 Lens sphcyl bifocal over 12. X 9 XXX $ - $ -
V2215 Lens lenticular bifocal X 9 XXX $ - $ -
V2218 Lens aniseikonic bifocal X 9 XXX $ - $ -
V2219 Lens bifocal seg width over X 9 XXX $ - $ -
V2220 Lens bifocal add over 3.25d X 9 XXX $ - $ -
V2221 Lenticular lens, bifocal X 9 XXX $ - $ -
V2299 Lens bifocal speciality X 9 XXX $ - $ -
V2300 Lens sphere trifocal 4.00d X 9 XXX $ - $ -
V2301 Lens sphere trifocal 4.12-7. X 9 XXX $ - $ -
V2302 Lens sphere trifocal 7.12-20 X 9 XXX $ - $ -
V2303 Lens sphcy trifocal 4.0/.12- X 9 XXX $ - $ -
V2304 Lens sphcy trifocal 4.0/2.25 X 9 XXX $ - $ -
V2305 Lens sphcy trifocal 4.0/4.25 X 9 XXX $ - $ -
V2306 Lens sphcyl trifocal 4.00/>6 X 9 XXX $ - $ -
V2307 Lens sphcy trifocal 4.25-7/. X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
V2308 Lens sphc trifocal 4.25-7/2. X 9 XXX $ - $ -

V2309 Lens sphc trifocal 4.25-7/4. X 9 XXX $ - $ -
V2310 Lens sphc trifocal 4.25-7/>6 X 9 XXX $ - $ -
V2311 Lens sphc trifo 7.25-12/.25- X 9 XXX $ - $ -
V2312 Lens sphc trifo 7.25-12/2.25 X 9 XXX $ - $ -
V2313 Lens sphc trifo 7.25-12/4.25 X 9 XXX $ - $ -
V2314 Lens sphcyl trifocal over 12 X 9 XXX $ - $ -
V2315 Lens lenticular trifocal X 9 XXX $ - $ -
V2318 Lens aniseikonic trifocal X 9 XXX $ - $ -
V2319 Lens trifocal seg width > 28 X 9 XXX $ - $ -
V2320 Lens trifocal add over 3.25d X 9 XXX $ - $ -
V2321 Lenticular lens, trifocal X 9 XXX $ - $ -
V2399 Lens trifocal speciality X 9 XXX $ - $ -
V2410 Lens variab asphericity sing X 9 XXX $ - $ -
V2430 Lens variable asphericity bi X 9 XXX $ - $ -
V2499 Variable asphericity lens X 9 XXX $ - $ -
V2500 Contact lens pmma spherical X 9 XXX $ - $ -
V2501 Cntct lens pmma-toric/prism X 9 XXX $ - $ -
V2502 Contact lens pmma bifocal X 9 XXX $ - $ -
V2503 Cntct lens pmma color vision X 9 XXX $ - $ -
V2510 Cntct gas permeable sphericl X 9 XXX $ - $ -
V2511 Cntct toric prism ballast X 9 XXX $ - $ -
V2512 Cntct lens gas permbl bifocl X 9 XXX $ - $ -
V2513 Contact lens extended wear X 9 XXX $ - $ -
V2520 Contact lens hydrophilic X 9 XXX $ - $ -
V2521 Cntct lens hydrophilic toric X 9 XXX $ - $ -
V2522 Cntct lens hydrophil bifocl X 9 XXX $ - $ -
V2523 Cntct lens hydrophil extend X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
V2530 Contact lens gas impermeable X 9 XXX $ - $ -

V2531 Contact lens gas permeable X 9 XXX $ - $ -
V2599 Contact lens/es other type X 9 XXX $ - $ -
V2600 Hand held low vision aids X 9 XXX $ - $ -
V2610 Single lens spectacle mount X 9 XXX $ - $ -
V2615 Telescop/othr compound lens X 9 XXX $ - $ -
V2623 Plastic eye prosth custom X 9 XXX $ - $ -
V2624 Polishing artifical eye X 9 XXX $ - $ -
V2625 Enlargemnt of eye prosthesis X 9 XXX $ - $ -
V2626 Reduction of eye prosthesis X 9 XXX $ - $ -
V2627 Scleral cover shell X 9 XXX $ - $ -
V2628 Fabrication & fitting X 9 XXX $ - $ -
V2629 Prosthetic eye other type X 9 XXX $ - $ -
V2630 Anter chamber intraocul lens X 9 XXX $ - $ -
V2631 Iris support intraoclr lens X 9 XXX $ - $ -
V2632 Post chmbr intraocular lens X 9 XXX $ - $ -
V2700 Balance lens X 9 XXX $ - $ -
V2702 Deluxe lens feature N 9 XXX $ - $ -
V2710 Glass/plastic slab off prism X 9 XXX $ - $ -
V2715 Prism lens/es X 9 XXX $ - $ -
V2718 Fresnell prism press-on lens X 9 XXX $ - $ -
V2730 Special base curve X 9 XXX $ - $ -
V2744 Tint photochromatic lens/es X 9 XXX $ - $ -
V2745 Tint, any color/solid/grad X 9 XXX $ - $ -
V2750 Anti-reflective coating X 9 XXX $ - $ -
V2755 UV lens/es X 9 XXX $ - $ -
V2756 Eye glass case X 9 XXX $ - $ -
V2760 Scratch resistant coating X 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
V2761 Mirror coating X 9 XXX $ - $ -

V2762 Polarization, any lens X 9 XXX $ - $ -
V2770 Occluder lens/es X 9 XXX $ - $ -
V2780 Oversize lens/es X 9 XXX $ - $ -
V2781 Progressive lens per lens X 9 XXX $ - $ -
V2782 Lens, 1.54-1.65 p/1.60-1.79g X 9 XXX $ - $ -
V2783 Lens, >= 1.66 p/>=1.80 g X 9 XXX $ - $ -
V2784 Lens polycarb or equal X 9 XXX $ - $ -
V2785 Corneal tissue processing X 9 XXX $ - $ -
V2786 Occupational multifocal lens X 9 XXX $ - $ -
V2787 Astigmatism-correct function N 9 XXX $ - $ -
V2788 Presbyopia-correct function N 9 XXX $ - $ -
V2790 Amniotic membrane X 9 XXX $ - $ -
V2797 Vis item/svc in other code X 9 XXX $ - $ -
V2799 Miscellaneous vision service X 9 XXX $ - $ -
V5008 Hearing screening N 9 XXX $ - $ -
V5010 Assessment for hearing aid N 9 XXX $ - $ -
V5011 Hearing aid fitting/checking N 9 XXX $ - $ -
V5014 Hearing aid repair/modifying N 9 XXX $ - $ -
V5020 Conformity evaluation N 9 XXX $ - $ -
V5030 Body-worn hearing aid air N 9 XXX $ - $ -
V5040 Body-worn hearing aid bone N 9 XXX $ - $ -
V5050 Hearing aid monaural in ear N 9 XXX $ - $ -
V5060 Behind ear hearing aid N 9 XXX $ - $ -
V5070 Glasses air conduction N 9 XXX $ - $ -
V5080 Glasses bone conduction N 9 XXX $ - $ -
V5090 Hearing aid dispensing fee N 9 XXX $ - $ -
V5095 Implant mid ear hearing pros N 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
V5100 Body-worn bilat hearing aid N 9 XXX $ - $ -

V5110 Hearing aid dispensing fee N 9 XXX $ - $ -
V5120 Body-worn binaur hearing aid N 9 XXX $ - $ -
V5130 In ear binaural hearing aid N 9 XXX $ - $ -
V5140 Behind ear binaur hearing ai N 9 XXX $ - $ -
V5150 Glasses binaural hearing aid N 9 XXX $ - $ -
V5160 Dispensing fee binaural N 9 XXX $ - $ -
V5170 Within ear cros hearing aid N 9 XXX $ - $ -
V5180 Behind ear cros hearing aid N 9 XXX $ - $ -
V5190 Glasses cros hearing aid N 9 XXX $ - $ -
V5200 Cros hearing aid dispens fee N 9 XXX $ - $ -
V5210 In ear bicros hearing aid N 9 XXX $ - $ -
V5220 Behind ear bicros hearing ai N 9 XXX $ - $ -
V5230 Glasses bicros hearing aid N 9 XXX $ - $ -
V5240 Dispensing fee bicros N 9 XXX $ - $ -
V5241 Dispensing fee, monaural N 9 XXX $ - $ -
V5242 Hearing aid, monaural, cic N 9 XXX $ - $ -
V5243 Hearing aid, monaural, itc N 9 XXX $ - $ -
V5244 Hearing aid, prog, mon, cic N 9 XXX $ - $ -
V5245 Hearing aid, prog, mon, itc N 9 XXX $ - $ -
V5246 Hearing aid, prog, mon, ite N 9 XXX $ - $ -
V5247 Hearing aid, prog, mon, bte N 9 XXX $ - $ -
V5248 Hearing aid, binaural, cic N 9 XXX $ - $ -
V5249 Hearing aid, binaural, itc N 9 XXX $ - $ -
V5250 Hearing aid, prog, bin, cic N 9 XXX $ - $ -
V5251 Hearing aid, prog, bin, itc N 9 XXX $ - $ -
V5252 Hearing aid, prog, bin, ite N 9 XXX $ - $ -
V5253 Hearing aid, prog, bin, bte N 9 XXX $ - $ -

$ 35.15
RELEASED 11/1/2011
CY 2012 CY 2012 CY2012
V5254 Hearing id, digit, mon, cic N 9 XXX $ - $ -

V5255 Hearing aid, digit, mon, itc N 9 XXX $ - $ -
V5256 Hearing aid, digit, mon, ite N 9 XXX $ - $ -
V5257 Hearing aid, digit, mon, bte N 9 XXX $ - $ -
V5258 Hearing aid, digit, bin, cic N 9 XXX $ - $ -
V5259 Hearing aid, digit, bin, itc N 9 XXX $ - $ -
V5260 Hearing aid, digit, bin, ite N 9 XXX $ - $ -
V5261 Hearing aid, digit, bin, bte N 9 XXX $ - $ -
V5262 Hearing aid, disp, monaural N 9 XXX $ - $ -
V5263 Hearing aid, disp, binaural N 9 XXX $ - $ -
V5264 Ear mold/insert N 9 XXX $ - $ -
V5265 Ear mold/insert, disp N 9 XXX $ - $ -
V5266 Battery for hearing device N 9 XXX $ - $ -
V5267 Hearing aid supply/accessory N 9 XXX $ - $ -
V5268 ALD Telephone Amplifier N 9 XXX $ - $ -
V5269 Alerting device, any type N 9 XXX $ - $ -
V5270 ALD, TV amplifier, any type N 9 XXX $ - $ -
V5271 ALD, TV caption decoder N 9 XXX $ - $ -
V5272 Tdd N 9 XXX $ - $ -
V5273 ALD for cochlear implant N 9 XXX $ - $ -
V5274 ALD unspecified N 9 XXX $ - $ -
V5275 Ear impression N 9 XXX $ - $ -
V5298 Hearing aid noc N 9 XXX $ - $ -
V5299 Hearing service X 0 XXX $ - $ -
V5336 Repair communication device N 9 XXX $ - $ -
V5362 Speech screening N 9 XXX $ - $ -
V5363 Language screening N 9 XXX $ - $ -
V5364 Dysphagia screening N 9 XXX $ - $ -

RBRVS Fee Schedule 7-1-12

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RBRVS Fee Schedule 7-1-12

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2012 Physician Fee Schedule RVU File Effective March 1, 2012

000F Heart failure composite X 9 XXX $ - $ -

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

00210 Anesth cranial surg nos X 9 XXX $ - $ -

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

0048T Implant ventricular device C 0 XXX $ - $ -

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

00566 Anesth cabg w/o pump X 9 XXX $ - $ -

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

0075T Perq stent/chest vert art C 1 XXX $ - $ -

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

00848 Anesth pelvic organ surg X 9 XXX $ - $ -

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

00928 Anesth removal of testis X 9 XXX $ - $ -

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

01130 Anesth body cast procedure X 9 XXX $ - $ -

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

01360 Anesth knee area surgery X 9 XXX $ - $ -

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

0159T Cad breast mri N 1 ZZZ $ - $ -

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

01732 Anesth dx elbow arthroscopy X 9 XXX $ - $ -

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

01842 Anesth lwr arm embolectomy X 9 XXX $ - $ -

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

01958 Anesth antepartum manipul X 9 XXX $ - $ -

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

0210T Speech audiometry threshold C 3 XXX $ - $ -

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

0238T Trluml perip athrc iliac art C 0 YYY $ - $ -

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

0255T 26 Evasc rpr iliac art bifr s&i C 1 YYY $ - $ -

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

0282T Periph field stimul trial C 0 XXX Y $ - $ -

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

0514F Care plan hgb docd esa pt X 9 XXX $ - $ -

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

10060 Drainage of skin abscess A 0 010 Y $ 96.05 $ 111.71

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

1039F Intermittent asthma M 9 XXX $ - $ -

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

11046 Deb musc/fascia add-on A 0 ZZZ $ 67.16 $ 81.08

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

11308 Shave skin lesion A 0 000 Y $ 81.08 $ 123.54

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

11450 Removal sweat gland lesion A 0 090 Y $ 280.84 $ 386.28

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

11642 Exc f/e/e/n/l mal+mrg 1.1-2 A 0 010 Y $ 203.58 $ 275.96

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

11921 Correct skin color defects R 0 000 Y $ 157.64 $ 213.32

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

12020 Closure of split wound A 0 010 Y $ 207.06 $ 280.84

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

13122 Repair wound/lesion add-on A 0 ZZZ $ 102.31 $ 130.50

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

1494F Cognit assessed and reviewed M 9 XXX $ - $ -

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012

15221 Skin full graft add-on A 0 ZZZ $ 87.35 $ 143.03

Myers and Stauffer LC RBRVS_Fee_Schedule_7-1-12 [RVUs] 7/24/2012