[Federal Register: August 15, 2003 (Volume 68, Number 158)]
[Proposed Rules]
[Page 49029-49300]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr15au03-25]
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Part III
Department of Health and Human Services
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Centers for Medicare & Medicaid Services
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42 CFR Parts 410 and 414
Medicare Program; Revisions to Payment Policies Under the Physician Fee
Schedule for Calendar Year 2004; Proposed Rule
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 410 and 414
[CMS-1476-P]
RIN 0938-AL96
Medicare Program; Revisions to Payment Policies Under the
Physician Fee Schedule for Calendar Year 2004
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Proposed rule.
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SUMMARY: This proposed rule would refine the resource-based practice
expense relative value units (RVUs) and make other changes to Medicare
Part B payment policy. The policy changes concern: Medicare Economic
Index, practice expense for professional component services, definition
of diabetes for diabetes self-management training, supplemental survey
data for practice expense, geographic practice cost indices, and
several coding issues.
We are proposing these changes to ensure that our payment systems
are updated to reflect changes in medical practice and the relative
value of services. We solicit comments on these proposed policy
changes.
We also discuss the non-physician work-pool, the 5-year review of
anesthesia services, and outpatient therapy services performed
``incident to'' physician services.
DATES: We will consider comments if we receive them at the address,
provided below, no later than 5 p.m. on October 7, 2003.
ADDRESSES: In commenting, please refer to file code CMS-1476-P. Because
of staff and resource limitations, we cannot accept comments by
facsimile (FAX) transmission or e-mail. Mail written comments (one
original and two copies) to the following address ONLY: Centers for
Medicare & Medicaid Services, Department of Health and Human Services,
Attention: CMS-1476-P, P.O. Box 8013, Baltimore, MD 21244-8013. Please
allow sufficient time for us to receive mailed comments on time in the
event of delivery delays.
If you prefer, you may deliver (by hand or courier) your written
comments (one original and two copies) to one of the following
addresses: Room 445-G, Hubert H. Humphrey Building, 200 Independence
Avenue, SW., Washington, DC 20201, or Room C5-14-03, 7500 Security
Boulevard, Baltimore, MD 21244-1850.
(Because access to the interior of the HHH Building is not readily
available to persons without Federal Government identification,
commenters are encouraged to leave their comments in the CMS drop slots
located in the main lobby of the building. A stamp-in clock is
available for persons wishing to retain a proof of filing by stamping
in and retaining an extra copy of the comments being filed.)
Comments mailed to the addresses indicated as appropriate for hand
or courier delivery may be delayed and could be considered late.
For information on viewing public comments, see the beginning of
the SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT: Gail Addis (410) 786-4522 (for issues
related to repricing of supplies for practice expense inputs.)
Pam West (410) 786-2302 (for issues related to Practice Expense
Advisory Committee (PEAC) recommendations.)
Jim Menas (410) 786-4507 (for issues related to anesthesia).
Rick Ensor (410) 786-5617 (for issues related to Geographic Cost
Price Index (GPCI)).
Mary Stojak (410) 786-6939 (for issues related to the definition of
diabetes for diabetes self-management training (DSMT)).
Shannon Martin (410) 786-7939 (for issues related to rebasing of
the Medicare Economic Index (MEI)).
Dorothy Shannon (410) 786-3396 (for issues related to the
``Incident To'' Therapy Discussion).
Diane Milstead (410) 786-3355, Latesha Walker (410) 786-1101, or
Gaysha Brooks (410) 786-3355 (for all other issues).
SUPPLEMENTARY INFORMATION:
Inspection of Public Comments: Comments received timely will be
available for public inspection as they are processed, generally
beginning approximately 3 weeks after publication of a document, at the
headquarters of the Centers for Medicare & Medicaid Services, 7500
Security Boulevard, Baltimore, Maryland 21244, Monday through Friday of
each week from 8:30 a.m. to 4 p.m. To schedule an appointment to view
public comments, phone (410) 786-7197.
Copies: To order copies of the Federal Register containing this
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and at many other public and academic libraries throughout the country
that receive the Federal Register.
This Federal Register document is also available from the Federal
Register online database through GPO Access, a service of the U.S.
Government Printing Office. The Web site address is: http://www.access.gpo.gov/nara/index.html
.
Information on the physician fee schedule can be found on our
homepage. You can access this data by using the following directions:
1. Go to the CMS homepage (http://www.cms.hhs.gov).
2. Place your cursor over the word ``Professionals'' in the blue
area near the top of the page. Select ``physicians'' from the drop-down
menu.
3. Under ``Policies/Regulations'' select ``Physician Fee
Schedule.''
Or, you can go directly to the Physician Fee Schedule page by
typing the following: http://www.cms.hhs.gov/physicians/pfs.
To assist readers in referencing sections contained in this
preamble, we are providing the following table of contents. Some of the
issues discussed in this preamble affect the payment policies but do
not require changes to the regulations in the Code of Federal
Regulations. Information on the regulation's impact appears throughout
the preamble and is not exclusively in section VII.
Table of Contents
I. Background
A. Legislative History
B. Published Changes to the Fee Schedule
II. Provisions of the Proposed Regulation
A. Resource-Based Practice Expense Relative Value Units
1. Resource-Based Practice Expense Legislation
2. Current Methodology
3. Practice Expense Proposals for Calendar Year 2004
B. Geographic Practice Cost Indices (GPCIs)
C. Coding Issues
III. Other Issues
A. Rebasing of the Medicare Economic Index (MEI)
B. Definition of Diabetes for Diabetes Self-Management Training
(DSMT)
C. Outpatient Therapy Services Performed ``Incident To''
Physicians Services
D. Status of Anesthesia Work and 5-Year Review
E. Payment Policies for Anesthesia Services
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F. Technical Correction
IV. Collection of Information Requirements
V. Response to Comments
VI. Regulatory Impact Analysis
Addendum A--Explanation and Use of Addendum B
Addendum B--2004 Relative Value Units and Related Information Used
in Determining Medicare Payments for 2004.
Addendum C--Codes for Which We Received PEAC Recommendations on
Practice Expense Direct Cost Inputs.
Addendum D--Proposed Changes to Practice Expense Supply Description
and Pricing.
In addition, because of the many organizations and terms to which
we refer by acronym in this proposed rule, we are listing these
acronyms and their corresponding terms in alphabetical order below:
AMA American Medical Association
BBA Balanced Budget Act of 1997
BBRA Balanced Budget Refinement Act of 1999
CF Conversion factor
CFR Code of Federal Regulations
CMS Centers for Medicare & Medicaid Services
CNS Clinical Nurse Specialist
CPT [Physicians'] Current Procedural Terminology [4th Edition, 2002,
copyrighted by the American Medical Association]
CPEP Clinical Practice Expert Panel
CRNA Certified Registered Nurse Anesthetist
E/M Evaluation and management
FMR Fair market rental
GAF Geographic adjustment factor
GPCI Geographic practice cost index
HCPCS Healthcare Common Procedure Coding System
HHA Home health agency
HHS [Department of] Health and Human Services
IDTFs Independent Diagnostic Testing Facilities
MCM Medicare Carrier Manual
MedPAC Medicare Payment Advisory Commission
MEI Medicare Economic Index
MGMA Medical Group Management Association
MPFS Medicare Physician Fee Schedule
MSA Metropolitan Statistical Area
NAMCS National Ambulatory Medical Care Survey
PC Professional component
PEAC Practice Expense Advisory Committee
PPS Prospective payment system
RUC [AMA's Specialty Society] Relative [Value] Update Committee
RVU Relative value unit
SGR Sustainable growth rate
SMS [AMA's] Socioeconomic Monitoring System
SNF Skilled Nursing Facility
TC Technical component
I. Background
A. Legislative History
Since January 1, 1992, Medicare has paid for physicians' services
under section 1848 of the Social Security Act (the Act), ``Payment for
Physicians' Services.'' This section provides for three major elements:
(1) A fee schedule for the payment of physicians' services; (2) limits
on the amounts that nonparticipating physicians can charge
beneficiaries; and (3) a sustainable growth rate for the rates of
increase in Medicare expenditures for physicians' services. The Act
requires that payments under the fee schedule be based on national
uniform relative value units (RVUs) based on the resources used in
furnishing a service. Section 1848(c) of the Act requires that national
RVUs be established for physician work, practice expense, and
malpractice expense. Section 1848(c)(2)(B)(ii)(II) of the Act provides
that adjustments in RVUs may not cause total physician fee schedule
payments to differ by more than $20 million from what they would have
been had the adjustments not been made. If adjustments to RVUs cause
expenditures to change by more than $20 million, we must make
adjustments to ensure that they do not increase or decrease by more
than $20 million.
B. Published Changes to the Fee Schedule
In the July 2000 proposed rule, (65 FR 44177), we listed all of the
final rules published through November 1999. In the August 2001
proposed rule (66 FR 40372) we discussed the November 2000 final rule
relating to the updates to the RVUs and revisions to payment policies
under the physician fee schedule.
In the November 2001 final rule with comment period (66 FR 55246),
we made revisions to resource-based practice expense RVUs; services and
supplies incident to a physician's professional service; anesthesia
base unit variations; recognition of CPT tracking codes; and nurse
practitioners, physician assistants, and clinical nurse specialists
performing screening sigmoidoscopies. We also addressed comments
received on the June 8, 2001 proposed notice (66 FR 31028) for the 5-
year review of work RVUs and finalized these work RVUs. In addition, we
acknowledged comments received in response to a discussion of modifier-
62, which is used to report the work of co-surgeons. The November 2001
final rule also updated the list of services that are subject to the
physician self-referral prohibitions in order to reflect CPT and
Healthcare Common Procedure Coding System (HCPCS) code changes that
were effective January 1, 2002. All these revisions ensure that our
payment systems are updated to reflect changes in medical practice and
the relative value of services. This final rule also conformed our
regulations to reflect statutory provisions of Medicare, Medicaid, and
State Child Health Insurance Program (SCHIP) Benefits Improvement and
Protection Act of 2000 (Pub. L. 106-554) (BIPA) concerning: The
mammography screening benefit; biennial screening pelvic examinations
for certain beneficiaries; expanded coverage for screening
colonoscopies to all beneficiaries; provided for annual glaucoma
screenings for high-risk beneficiaries; established coverage for
medical nutrition therapy services for certain beneficiaries; expanded
payment for telehealth services; required certain Indian Health Service
providers to be paid for some services under the physician fee
schedule; and revised the payment for certain physician pathology
services.
In the December 31, 2002 final rule with comment period (67 FR
79966), we refined resource-based practice expense RVUs and made other
changes to Medicare Part B policy. These included: The pricing of the
technical component for positron emission tomography (PET) scans,
Medicare qualifications for clinical nurse specialists, a process to
add or delete services to the definition of telehealth, the definition
for ZZZ global periods, global period for surface radiation, and
application of endoscopic reduction rules for certain codes. In
addition, this rule: Updated the codes subject to physician self-
referral prohibitions, expanded the definition of a screening fecal-
occult blood test, and modified our regulations to expand coverage for
additional colorectal cancer screening tests through our national
coverage determination process. We also made revisions to the
sustainable growth rate, the anesthesia conversion factor (CF), and the
work values for some gastroenterologic services. We finalized the CY
2002 interim RVUs and assigned interim RVUs for new and revised
procedure codes for calendar year CY 2003, clarified the enrollment of
therapists in private practice and the policy regarding services and
supplies incident to a physician's professional services, and made
technical changes to the definition of outpatient rehabilitation
services.
This final rule also revised the regulations at 42 CFR 485.618 to
allow registered nurses (RNs) to provide
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emergency care in certain critical access hospitals (CAHs) in frontier
areas (an area with fewer than six residents per square mile) or remote
locations (locations designated in a State's rural health plan that we
have approved).
As required by statute this final rule also announced that the
physician fee schedule update for CY 2003 was -4.4 percent, the initial
estimate of the sustainable growth rate (SGR) for CY 2003 was 7.6
percent, and the CF for CY 2003 was $34.5920, effective March 1, 2003.
However, on February 28, 2003 (68 FR 9567), after enactment of the
Consolidated Appropriations Resolution of 2003 (Pub. L. 108-7), we
published a final rule that revised the estimates used to establish the
SGRs for fiscal years 1998 and 1999 and announced a 1.6 percent
increase in the CY 2003 physician fee schedule CF for March 1 to
December 31, 2003. The CF from March 1 to December 31, 2003 is
$36.7856. The anesthesia CF for this period is $17.05. All other
provisions of the December 31, 2002 final rule were unchanged by the
rule published February 28, 2003.
II. Provisions of the Proposed Rule
This proposed rule would affect the regulations set forth at Part
410, Supplementary medical insurance (SMI) benefits and part 414,
Payment for Part B and other health services.
A. Resource-Based Practice Expense Relative Value Units
1. Resource-Based Practice Expense Legislation
Section 121 of the Social Security Act Amendments of 1994 (Pub. L.
103-432), enacted on October 31, 1994, required us to develop a
methodology for a resource-based system for determining practice
expense RVUs for each physician's service beginning in 1998. In
developing the methodology, we were to consider the staff, equipment,
and supplies used in providing medical and surgical services in various
settings. The legislation specifically required that, in implementing
the new system of practice expense RVUs, we apply the same budget-
neutrality provisions that we apply to other adjustments under the
physician fee schedule.
Section 4505(a) of the Balanced Budget Act of 1997 (BBA) (Pub. L.
105-33), enacted on August 5, 1997, amended section 1848(c)(2)(ii) of
the Act and delayed the effective date of the resource-based practice
expense RVU system until January 1, 1999. In addition, section 4505(b)
of the BBA provided for a 4-year transition period from charge-based
practice expense RVUs to resource-based RVUs.
Further legislation affecting resource-based practice expense RVUs
was included in the Medicare, Medicaid and State Child Health Insurance
Program (SCHIP) Balanced Budget Refinement Act of 1999 (BBRA) (Pub. L.
106-113) enacted on November 29, 1999. Section 212 of the BBRA amended
section 1848(c)(2)(ii) of the Act by directing us to establish a
process under which we accept and use, to the maximum extent
practicable and consistent with sound data practices, data collected or
developed by entities and organizations. These data would supplement
the data we normally collect in determining the practice expense
component of the physician fee schedule for payments in CY 2001 and CY
2002. (In the 1999 final rule (64 FR 59380), we extended, for an
additional 2 years, the period during which we would accept
supplementary data.)
2. Current Methodology for Computing the Practice Expense Relative
Value Unit System
Effective with services furnished on or after January 1, 1999, we
established a new methodology for computing resource-based practice
expense RVUs that used the two significant sources of actual practice
expense data we have available--the Clinical Practice Expert Panel
(CPEP) data and the American Medical Association's (AMA) Socioeconomic
Monitoring System (SMS) data. The methodology was based on an
assumption that current aggregate specialty practice costs are a
reasonable way to establish initial estimates of relative resource
costs for physicians' services across specialties. The methodology
allocated these aggregate specialty practice costs to specific
procedures and, thus, can be seen as a ``top-down'' approach.
a. Major Steps
A brief discussion of the major steps involved in the determination
of the practice expense RVUs follows. (Please see the November 1, 2001
final rule (66 FR 55249) for a more detailed explanation of the top-
down methodology.)
[sbull] Step 1--Determine the specialty specific practice expense
per hour of physician direct patient care. We used the AMA's SMS survey
of actual aggregate cost data by specialty to determine the practice
expenses per hour for each specialty. We calculated the practice
expenses per hour for the specialty by dividing the aggregate practice
expenses for the specialty by the total number of hours spent in
patient care activities.
[sbull] Step 2--Create a specialty specific practice expense pool
of practice expense costs for treating Medicare patients. To calculate
the total number of hours spent treating Medicare patients for each
specialty, we used the physician time assigned to each procedure code
and the Medicare utilization data. We then calculated the specialty
specific practice expense pools by multiplying the specialty practice
expenses per hour by the total physician hours.
[sbull] Step 3--Allocate the specialty specific practice expense
pool to the specific services performed by each specialty. For each
specialty, we divided the practice expense pool into two groups based
on whether direct or indirect costs were involved and used a different
allocation basis for each group.
(i) Direct costs--For direct costs (which include clinical labor,
medical supplies, and medical equipment), we used the procedure
specific CPEP data on the staff time, supplies, and equipment as the
allocation basis.
(ii) Indirect costs--To allocate the cost pools for indirect costs,
including administrative labor, office expenses, and all other
expenses, we used the total direct costs combined with the physician
fee schedule work RVUs. We converted the work RVUs to dollars using the
Medicare CF (expressed in 1995 dollars for consistency with the SMS
survey years).
[sbull] Step 4--For procedures performed by more than one
specialty, the final procedure code allocation was a weighted average
of allocations for the specialties that perform the procedure, with the
weights being the frequency with which each specialty performs the
procedure on Medicare patients.
b. Other Methodological Issues
(i) Non-Physician Work Pool
For services with physician work RVUs equal to zero (including the
technical components of radiology services and other diagnostic tests),
we created a separate practice expense pool using the average clinical
staff time from the CPEP data and the ``all physicians'' practice
expense per hour.
We then used the adjusted 1998 practice expense RVUs to allocate
this pool to each service. We have removed services from the non-
physician work pool if the requesting specialty predominates
utilization of the service. Also, for all radiology services that are
assigned physician work RVUs, we used the adjusted 1998 practice
expense RVUs for radiology services as an
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interim measure to allocate the direct practice expense cost pool for
radiology.
(ii) Crosswalks for Specialties Without Practice Expense Survey Data
Since many specialties identified in our claims data did not
correspond exactly to the specialties included in the SMS survey data,
it was necessary to crosswalk these specialties to the most appropriate
SMS specialty.
(iii) Physical Therapy Services
Because we believe that most physical therapy services furnished in
physicians' offices are performed by physical therapists, we
crosswalked all utilization for therapy services in the CPT 97000
series to the physical and occupational therapy practice expense pool.
3. Practice Expense Proposals for Calendar Year 2004
a. Non-Physician Work Pool
The non-physician work pool was created as an interim measure until
we could further analyze the effect of the top-down methodology on the
Medicare payment for services that do not have physician work RVUs (see
the November 1998 final rule (63 FR 58841)).
In the June 28, 2002 proposed rule (67 FR 43849), we discussed
alternatives that we have considered to address the non-physician work
pool issue, including ideas raised by the Lewin Group as well as
recommendations in a 2001 GAO report. While we have not reached a final
resolution on how to best address this issue, we are continuing to
study the alternatives that are available. We also believe that our
proposal extending the deadline for the submission of supplemental
survey data (see following discussion) will provide an opportunity for
specialties whose services are affected by the non-physician work pool
to submit practice expense data that can be used for determining
practice expense RVUs under the physician fee schedule. Any
modifications to the non-physician work pool would be published in
proposed rulemaking.
b. Supplemental Practice Expense Survey Data
As required by the BBRA, we established criteria to evaluate data
collected by organizations to supplement the data normally used in
determining the practice expense component of the physician fee
schedule. Due to the time constraints imposed by the statute for
publication of the physician fee schedule final rule, we have required
supplementary survey data to be submitted by August 1 to be considered
for computing practice expense RVUs for the following year. We are
proposing to change the required submission date to March 1. This would
allow us to publish our decisions regarding survey data in the proposed
rule and would provide an opportunity for public comment on survey
results.
To continue to ensure the maximum opportunity for specialties to
submit supplementary practice expense data, we are again proposing to
extend for an additional 2 years the period for accepting survey data
that meets the criteria set forth in the November 2000 final rule (as
modified in the December 31, 2002 final rule). The deadline for
submission of the supplemental data to be considered in CY 2005 and CY
2006 are March 1, 2004 and March 1, 2005, respectively.
In the December 31, 2002 final rule (67 FR 79979), we responded to
comments expressing concern about the impact of making the technical
component the difference between the global and professional component
practice expense RVUs for services that are not affected by the non-
physician work pool calculations. We agreed to a one-year moratorium on
implementation of the proposed change for pathology services paid under
the physician fee schedule to allow for a supplemental survey of
independent laboratories. Consistent with the change to making the
survey deadline March 1, we are considering whether to extend the
moratorium by one additional year. By extending the moratorium, we can
show the impact of the independent laboratory survey in the 2004
proposed rule and allow public comment on its results prior to making
changes to the practice expense RVUs on January 1, 2005. We welcome
public comment on whether we should adopt the proposed change for 2004
in this year's final rule or extend the moratorium by 1 year.
c. Oncology Survey Data
In the December 31, 2002 final rule (67 FR 79973), we indicated
that the American Society of Clinical Oncology (ASCO) submitted a
supplemental practice expense survey. Our contractor, the Lewin Group,
raised specific concerns to us about the survey results. Consequently,
we did not incorporate the survey into the practice expense methodology
but indicated that we would further examine its results with the Lewin
Group and confer with ASCO about our concerns. We have discussed the
oncology survey together with the Lewin Group and ASCO. These
discussions were useful in providing us with more information upon
which to make a final decision regarding incorporation of the oncology
survey into the practice expense methodology. We expect to make our
decision known in a subsequent proposed rule that will address Medicare
payment for drugs currently paid based on 95 percent of the average
wholesale price.
d. Practice Expense for a Professional Component Service
Since the inception of the resource-based practice expense
methodology, we have assigned all staff equipment and supply costs for
services with professional and technical components (PC and TC) to the
technical portion of the service. We have done this because we believe
that generally all of these direct cost inputs are associated with
obtaining the diagnostic information and there would be no direct costs
associated with the physician interpretation. However, we now believe
that there may be limited exceptions where it is appropriate to assign
direct inputs to a PC service. For instance, the Practice Expense
Advisory Committee (PEAC) recommended that we include clinical staff
time in certain codes that have both a PC and TC component for
activities such as scheduling the procedure and educating the patient
when the procedure is done in the facility setting. We accepted these
recommendations but, because the practice expense methodology currently
does not assign direct inputs to PC services and the TC is not paid in
the facility setting, these procedures were not credited with the
recommended practice expense inputs.
We propose to modify the practice expense methodology to allow
direct inputs to be added to PC services when these inputs are clearly
associated with the professional service, including when the PEAC makes
such recommendations. We are proposing to add the PEAC recommended
staff times to the PC of the following cardiac services: CPT codes
93508, 93510, 93511, 93514, 93524, 93526, 93527, 93528, 93529, 93530,
93531, 93532, 93533 and 93624. The practice expense RVUs for these
codes will increase slightly from this change resulting in minor
reductions in practice expense RVUs for some other services performed
by cardiologists. There will be no impact on the practice expense RVUs
for any other specialty.
e. Utilization Data
We use Medicare utilization data in the development of specialty-
specific practice expense RVUs that are then weight averaged to
determine a single practice expense RVU per code. Prior to
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2003, we used the most recent complete year of utilization data to
determine the practice expense RVUs. For instance, we determined the
2001 practice expense RVUs using Medicare utilization data from 1999
for most procedure codes. However, if a procedure code was new in 2000,
we did not have any 1999 utilization data to determine its 2001
practice expense RVU and could not use specialty-specific data until
2000 utilization data was available to us. In some cases, the new code
was clearly related to an older code or codes and we were able to use
an estimation of the probable specialty utilization for 2001 until
actual specialty-specific utilization was available for 2002. Where we
were not able to determine the probable specialty-specific utilization
we assigned the ``all physician'' average practice expenses to the
service until we obtained specialty-specific utilization. Thus, in this
case, we used the ``all physician average'' to determine the code's
2001 practice expense RVU and specialty-specific utilization to
determine the 2002 practice expense RVU.
In the December 31, 2002 final rule (67 FR 79982), we adopted a
policy of using the 1997 through 2000 Medicare utilization in the
practice expense methodology. For new codes created since 2000, there
are no Medicare utilization data in the 1997 through 2000 period upon
which to determine specialty-specific practice expenses. We are
proposing to follow a similar practice to the one described above and
use specialty-specific Medicare utilization data for codes created
after 2000 at the first opportunity they become available to us.
Therefore, we are proposing to use 1997 through 2000 Medicare
utilization data for all codes that were in existence at that time. If
a code did not exist during the 1997 through 2000 period, we propose
using the first available utilization data for the code in order to
develop the practice expense RVU. Since we will not have any
utilization data at the time we first establish practice expense RVUs
for a new code, we propose that we continue, whenever possible, to make
an assumption about the specialty that will likely provide the service
or to use the ``all physician'' average when we do not have sufficient
information to assign any given specialty. We will make available on
the CMS web site (http://cms.hhs.gov) files containing the data that we
will use in determining the proposed rule practice expense RVUs. We
propose in each year's proposed rule to substitute actual for estimated
utilization once the data become available. For instance, in this
proposed rule, we will substitute actual 2002 utilization data for
estimated 2002 utilization data to determine the 2004 practice expense
RVUs for codes that were new in 2002. Practice expense RVUs may change
as we make updates to the utilization data that we use in the practice
expense methodology. We encourage the AMA's Specialty Society Relative
Value Update Committee (RUC) and other interested parties to provide
information on the specialties that will likely perform a new service
to minimize the potential changes to the practice expense RVUs that
will occur when we substitute actual for estimated utilization.
For the proposed rule, the utilization data from the prior year are
96 percent complete. In the past, we used 100 percent complete data
from a prior year in the proposed rule (for example, we used 2000
utilization data to simulate impacts for the June 28, 2002 proposed
rule) and did not use the preceding year's utilization data until the
final rule (for example, we used 2001 utilization data to simulate
impacts for the December 31, 2002 final rule). Beginning with this
year's proposed rule, we are using the prior year's utilization data
for developing practice expense RVUs and simulating impacts. Because
the utilization file that we are using for the proposed rule is only 96
percent complete, there may be minor changes to the payment impacts and
practice expense RVUs between the proposed rule and the final rule for
which we will use 100 percent complete data from the prior year.
f. Practice Expense Advisory Committee (PEAC)
Recommendations on CPEP Inputs for 2004
The PEAC, a subcommittee of the RUC, has, since 1999, been
providing us with recommendations for refining the direct practice
expense inputs (clinical staff, supplies, and equipment) for existing
CPT codes. In the past, our actions on these PEAC recommendations have
been incorporated into the physician fee schedule final rule and have
been used as interim values for services provided in the following
calendar year. We have accepted comments on these refinements and
addressed them in rulemaking the following year. This year we are
including the PEAC recommendations in the proposed rule, which will
enable specialty groups to assess the impact of these changes on their
services and make comments on the recommendations before the final
rule.
These PEAC recommendations are the result of meetings held in
September of 2002 and January 2003 and account for approximately 772
codes from many specialties. (A list of these codes can be found in
Addendum C.) The PEAC has also submitted recommendations on the
refinements to the clinical staff time for all 90-day global services
(accounting for a further 3,604 CPT codes).
This massive refinement was possible because the PEAC adopted a
standardized approach to the refinement of the clinical staff times for
90-day global codes. The PEAC has recommended that the following
standard clinical staff times be applied to all 90-day codes, except
for those in which the specialty argued for an exception to the
standard:
[sbull] Pre-service time--35 minutes of pre-service clinical staff
time in the office and 60 minutes for services performed in the
facility setting;
[sbull] Discharge day management time--6 minutes of clinical staff
time if the procedure is performed predominantly in the outpatient
facility setting and 12 minutes if performed predominantly in the
inpatient setting. (This standard is also recommended for all of the
10-day global procedures); and
[sbull] Post-service office visit time--equal to the clinical staff
times associated with the evaluation and management visit codes
assigned to each service.
Several specialties, including the neurosurgeons/spine surgeons,
thoracic surgeons and colorectal surgeons requested and received
increased pre-service times for some of their services. There were also
a few services that are usually performed on an emergent basis when the
pre-service time was reduced or omitted altogether. We believe that the
standards recommended by the PEAC are appropriate and that the
exceptions to these standards are also reasonable. Therefore, we are
proposing to use the PEAC's recommendations for the clinical staff time
for these global codes.
In addition, the PEAC convened a workgroup to make recommendations
on the refinement of all the 116 remaining evaluation and management
codes. These are important achievements that have significantly
advanced the pace of the refinement process. A total of 5358 codes have
been refined; these codes represent 87 percent of physician fee
schedule dollars. We greatly appreciate the dedication and hard work of
the specialty societies and the AMA that are helping to ensure that
this refinement process is successful.
[[Page 49035]]
We have reviewed the submitted PEAC recommendations and propose to
accept them. The complete PEAC recommendations and the revised CPEP
database can be found on our web site. (See the Supplementary
Information section of this proposed rule for directions on accessing
our web site.)
g. Repricing of Clinical Practice Expense Inputs--Supplies
We use the practice expense inputs (the clinical staff, supplies,
and equipment assigned to each procedure) to allocate the specialty-
specific practice expense cost pools to the procedures performed by
each specialty. The costs of the original inputs assigned by the CPEP
were determined by our contractor, Abt Associates, based primarily on
1994 and 1995 pricing data from supply catalogs. In addition, for many
items on the equipment and supply list, the associated costs were based
on the recommendations of a CPEP panel member, rather than on actual
catalog prices. Subsequent to the CPEP panels, equipment and supply
items have also been added to the CPEP data, with the costs of the
inputs provided by the relevant specialty society.
In the August 2, 2001 proposed rule (66 FR 40378), we proposed
updates and revisions to the clinical staff salary data which were
finalized in the final rule published November 1, 2001 (66 FR 55255).
In that final rule, we also indicated that in future rulemaking we
would be proposing updates to the supply and equipment inputs that are
used in the CPEP database. We, therefore, contracted with a consultant
to assist us in obtaining the current price for each supply item in our
CPEP database. The consultant has been able to determine the current
prices for most of the supply inputs and has submitted documentation
for the proposed new pricing from vendor catalogs or websites. Whenever
possible, multiple sources were obtained for frequently used supplies
so that a typical price could be determined.
In addition, we asked the consultant to help identify and clarify
those supplies for which the original descriptions in the CPEP database
are too general to price (for example ``laser'' or ``antigen'') or are
otherwise unidentifiable. Our consultant worked closely with the
specialty societies to ensure that accurate information was obtained in
identifying as many of these supplies as possible.
Addendum D contains the proposed new unit prices for supply items
when current pricing was obtained, as well as new descriptions when
needed. A more detailed spreadsheet can be found on our Web site,
(http://www.cms.hhs.gov/physicians/pfs), that contains additional
information regarding the sources used to price each item.
There are items that have either not yet been identified or for
which pricing information has not yet been found. These supply items
are included in Table 1 below. In this table we have identified the
supply code (if assigned), the existing item description, unit and
price, the procedures or specialties associated with the item, as well
as the proposed new description and standardized unit of use. We have
also identified items for deletion from the database. We are requesting
that commenters, particularly the relevant specialty groups, provide us
with the needed pricing information with appropriate documentation.
Whenever possible, multiple sources of documentation should be provided
so that a typical price can be determined. If we are not able to obtain
any verified pricing information for an item, we may eliminate it from
the database.
BILLING CODE 4120-01-P
[[Page 49036]]
[GRAPHIC] [TIFF OMITTED] TP15AU03.005
[[Page 49037]]
[GRAPHIC] [TIFF OMITTED] TP15AU03.006
BILLING CODE 4120-01-C
[[Page 49038]]
In addition to reviewing and updating the cost information for
supplies in the database, our contractor also recommended database
revisions to provide uniformity and consistency in the CPEP supply
database. All of the following recommendations are noted in Addendum D:
[sbull] Assignment of supply categories. In the original CPEP data,
a number was assigned to each supply. The contractor has recommended
that each supply item also be assigned a ``category'' to allow for
easier selection and sorting of items. We agree and are proposing that
supplies be assigned to one of the following 14 categories:
Accessory, Diagnostics;
Accessory, Equipment;
Accessory, Procedure;
Booklets/Forms;
Cutters, Closures/Cautery;
Gown, Drape;
Hypodermic/IV;
Infection Control;
Kit, Pack, Tray;
Lab;
Office, Grocery;
Pharmacy, NonRx;
Pharmacy, Rx; and
Wound Care, Dressings.
These categories could also be used to establish a new numbering
system for supplies. We would assign a letter to each supply category
and use this in conjunction with a number (000 through 999) to identify
each supply. This would enable specialty groups to identify more easily
whether a supply has already been included in the CPEP database and
would help ensure uniformity in the items used for calculating practice
expenses. If we proceed in the final rule with this proposed method for
categorizing supplies, we will assign new identifying numbers to each
supply input item and these will be available on our website.
[sbull] Consolidation/standardization of item descriptions.
When items appear to be duplicative, we are proposing to combine
the items. For example, ``Mayo stand cover'' and ``drape, sterile
Mayo'' have both been changed to ``drape, sterile, for Mayo stand''. We
also have attempted to better describe the supply items in a way that
will make identification easier, using a key first word when possible.
For example, all catheters are described as ``catheter, * * *'', all
needles are described as ``needle * * *.'' In addition, references to
proprietary or trademark names for multisource items have been included
as parenthetical references (for example, ``Polibar TM'' is
renamed barium suspension ``(Polibar TM ).''
[sbull] Standardization of unit descriptions.
The current CPEP database contains over 72 unit descriptions
associated with supplies (for example, item, gram, and cup). To provide
consistency and ensure that inputs in the database accurately reflect
the quantity of an item used, we are proposing to standardize the unit
description of items. If an item is intended for single use, even if it
is not completely used, we propose to identify this by indicating the
item size followed by ``uou'' (unit of use). For example ``soap bath''
has been renamed ``bath soap (one bar uou)'' and ``bacitracin unit dose
pack, 9g'' has been renamed ``bacitracin oint (0.9 gm uou)''.
We welcome any comments on the proposed pricing and all other
proposed revisions. To help us evaluate the information provided,
comments should include documentation such as information from a supply
catalog or website or from a current invoice.
h. Miscellaneous Practice Expense Issues
Hyperbaric Oxygen Services
We have received a request from a freestanding hyperbaric oxygen
center to price the service in the office setting, so that those
providing this service in a nonfacility can receive an appropriate
payment. Therefore, we are proposing to assign on an interim basis the
following practice expense inputs to CPT code 99183, Physician
attendance and supervision of hyperbaric oxygen therapy, per session:
Staff: Respiratory Therapist for 135 minutes (for a 2 hour
treatment).
Supplies: Minimum Visit Supply Package, 180 liters of oxygen, 187
cubic feet of air.
Equipment: Hyperbaric chamber.
We will request that the Practice Expense Advisory Committee review
these inputs at a meeting in the near future.
Maxillofacial Prosthetics PE/hour
In the November 2, 1998 final rule (63 FR 58824), we created a
special practice expense pool for maxillofacial prosthetics (CPT codes
21076 through 21087) using the ``all physician'' practice expense per
hour. Because the practice expense survey submitted in 1998 by the
American Academy of Maxillofacial Prosthetics (AAMP) differed
significantly in format and content from the SMS survey, we were not
able to use the submitted data to calculate a practice expense per hour
for maxillofacial prosthetics. AAMP has contended that the ``all
physician'' rate underestimates the high costs for the staff, supplies
and equipment associated with the provision of maxillofacial prosthetic
services.
We have asked our contractor, The Lewin Group, to analyze the
submitted survey data to determine if the data would or would not
support a change in the crosswalk for this specialty. The Lewin Group's
finding suggests, ``the all-physician average may underestimate the
practice expense per hour for maxillofacial prosthodontists.'' Based on
the Lewin Group's finding, we reviewed the Medicare utilization of the
maxillofacial prosthetics codes. Oral surgeons (specialty code 19) and
maxillofacial surgeons (specialty code 85) overwhelmingly provide these
services. We believe the practice expenses for these practitioners are
likely to be similar to otolaryngologists since these physicians also
provide office procedures affecting the head and face. We are proposing
to eliminate the special practice expense pool for procedure codes
21076 through 21087 and use otolaryngology as the crosswalk for oral
surgeons and maxillofacial surgeons as a more appropriate approximation
of the specialties' practice expense per hour. This proposal will
increase payment for the maxillofacial prosthetics and other services
that are predominantly billed by oral and maxillofacial surgeons. There
will be no impact on payment for services provided by any other
specialty from this change.
Holter Monitoring Codes
A representative of an independent diagnostic testing facility has
communicated to us that their review of the practice expense inputs for
the holter monitoring codes, CPT 93225, 93226, 93231, and 93232 has
revealed the inclusion of items that are not needed to perform these
services. The correspondent suggested the following deletions:
[sbull] For CPT codes 93225 and 93231 delete the ECG electrodes and
laser paper, as well as the electric bed, computer and holter monitor;
and
[sbull] For CPT codes 93226 and 93232 delete the razor, nonsterile
gloves, alcohol swab and tape, as well as the electric bed and exam
table.
We agree that these revisions appear reasonable and will make the
above deletions on an interim basis until the PEAC can review these
codes. It should be noted these codes are currently in the nonphysician
work pool and that the CPEP data is not currently used to calculate
their practice expense RVUs. Therefore, these changes will not at this
time have any effect on the payment for these codes.
[[Page 49039]]
B. Geographic Practice Cost Index Changes
1. Background
The Act requires that payments vary among Medicare physician fee
schedule (MPFS) areas according to the extent that resource costs vary
as measured by the Geographic Practice Cost Indices (GPCIs). In
general, the MPFS areas that existed under the prior reasonable charge
system were retained under the MPFS from calendar years 1992 through
1996. We implemented a comprehensive revision in MPFS payment areas
(localities) in 1997, reducing the number of localities from 210 to 89.
Thirty-four states have a single statewide locality. In contrast, under
the hospital inpatient prospective payment system (IPPS), costs are
adjusted across more than 350 metropolitan statistical areas (MSAs).
A detailed discussion of the MPFS payment localities can be found
in the July 2, 1996 proposed rule (61 FR 34615) and the November 22,
1996 final rule (61 FR 59494).
2. Implication of GPCIs for Rural Areas
The GPCIs do not affect total national payments under the MPFS, but
instead distribute payments among areas according to area cost
differences. In general, the data show that urban areas usually have
higher costs, while rural areas have generally lower costs. Thus, on
average the costs associated with operating a private medical practice,
as measured by factors such as wages and rent, are higher in urban
areas. Alternatively, the average costs associated with the operation
of a private medical practice in a rural area are lower. Since the
costs associated with operating a private medical practice are
measurably different based upon geographic location, varying payments
according to the GPCIs will benefit lower cost areas, usually rural,
since the law provides that only one-quarter of the area cost
difference in physician work, the largest of the three fee schedule
GPCI components, be recognized. We believe this was an attempt by the
Congress to shift payments to rural areas. Thus, about 40 percent of
MPFS payments (.75 x .52) are by statute not adjusted for area cost
differences. Additionally, one component of the practice expense GPCI,
supplies, equipment and other, is also, by statute, not adjusted for
area cost differences. Supplies, equipment and other represent about 13
percent of total physician resource costs. This means that,
effectively, there is a nationwide MPFS for about 53 percent of the
average physician payment (40 percent physician work, 13 percent
supplies, equipment and other). That is, only about 47 percent of
overall physician payment is adjusted for area resource cost
differences. In addition, 34 states are statewide payment localities in
which all physicians, whether urban or rural, are paid the same. All of
these factors shift payments from higher cost, usually urban, areas to
lower cost, usually rural areas.
3. GPCI Composition
Section 1848(e)(1)(C) of the Act requires us to review, and if
necessary, adjust the GPCIs at least every 3 years. This section of the
Act also requires us to phase in the adjustment over 2 years and
implement only one-half of any adjustment if more than 1 year has
elapsed since the last GPCI revision. The GPCIs were first implemented
in 1992. The first review and revision was implemented in 1995, the
second review was implemented in 1998, and the third review was
implemented in 2001. The next GPCI review and revision is scheduled for
implementation in 2004. However, as will be discussed in more detail,
because the work and practice expense GPCIs rely primarily on special
tabulations of U.S. Census data not yet available, review and revision
of only the malpractice GPCI component will be implemented in 2004.
Review and revision of the work and practice expense GPCIs will be
implemented in 2005.
Currently, only one data source is available for the practice
expense GPCI (relative cost of office rent space collected by the
Department of Housing and Urban Development (HUD)). Since we have not
received the primary data upon which practice expense GPCIs are
calculated and since the office rent component of the practice expense
GPCI has proven not to be very substantial in past GPCI updates (it
accounts for approximately 11.0 percent of the total GPCI calculation
and is phased in over a two year period), we have decided not to revise
the practice expense GPCIs for 2004. The work GPCI relies solely on
data collected from the 2000 U.S. Census that is not yet available, so
we are not able to propose updates to the work GPCI in this proposed
rule.
Although there are general discussions of both the background and
composition of all three GPCI components in this proposed rule, a
detailed discussion of only the 2004 revised malpractice GPCI is
included in this proposal while a detailed discussion of the revised
work and practice expense GPCIs will be included in the 2005 proposed
rule.
4. Development of the Geographic Practice Cost Indices
The GPCIs were developed by a joint effort of the Urban Institute
and the Center for Health Economics Research under contract to CMS. The
resource inputs and their weights are obtained from the AMA's
Socioeconomic Characteristics of Medical Practices Survey. Indices were
developed that measured the relative cost differences among areas
compared to the national average in a ``market basket'' of goods. In
this case, the market basket consists of the resources involved in
operating a private medical practice. The resource inputs are physician
work or net income; employee wages; office rents; medical equipment,
supplies, other miscellaneous expenses; and malpractice insurance.
Employee wages, rents, and miscellaneous expenses are combined to
comprise the practice expense component of the GPCI. Table 2 below
illustrates the cost share weights that have been utilized for each
GPCI update:
Table 2.--GPCI (Medicare Economic Index) Cost Share Weights
--------------------------------------------------------------------------------------------------------------------------------------------------------
Expense category 1992-94* 1995-97** 1998-00** 2001-03*** 2004-07****
--------------------------------------------------------------------------------------------------------------------------------------------------------
Physician Earnings....................................... 54.2 54.2 54.2 54.5 52.466
Practice Expenses........................................ 40.2 41.0 41.0 42.3 43.669
Employee Wages....................................... 15.7 16.3 16.3 16.8 18.654
Rents................................................ 11.1 10.3 10.3 11.6 12.209
Equip., Supplies, Other.............................. 13.4 14.4 14.4 13.9 12.807
Malpractice Insurance.................................... 5.6 4.8 4.8 3.2 3.865
--------------------
100.0 100.0 100.0 100.0 100.000
--------------------------------------------------------------------------------------------------------------------------------------------------------
*Weights from 1987 AMA survey.
[[Page 49040]]
**Weights from 1989 AMA survey.
***Weights from 1997 AMA survey
****Weights from Physician Socioeconomic Statistics, 2000-2002 Edition (SMS Survey), Physician Socioeconomic Statistics, 2003 Edition (PCPS Survey),
Center for Health Policy Research, American Medical Association; 2003 Employment Cost Index, U.S. Department of Labor, Bureau of Labor Statistics;
U.S. Department of Commerce, Bureau Economic Analysis 1997 Benchmark Input Output Tables, and U.S. Department of Commerce, Bureau of the Census, 2002
Current Population Survey. (See section III.A. Rebasing and Revising of the Medicare Economic Index.)
The Medicare economic index (MEI) is a measure of the average
increases in the price of inputs used in operating a private medical
practice and is used in the annual update of the MPFS CF. Because the
GPCIs and the MEI use the same resource inputs to measure the costs of
a private medical practice (the GPCIs measure relative costs among
areas while the MEI measures the national average rate of increase in
prices), as in the past, the same weights will be used for both the MEI
and the GPCIs.
Once the components and their weights were determined, we had to
find data sources that were widely and consistently available to
measure costs in all MPFS payment areas. After examining many sources,
the following proxies were selected as the best available sources for
measuring each component of the original 1992 through 1994 GPCIs:
[sbull] Physician work--The median hourly earnings, based on a 20
percent sample of 1980 census data, of workers in six professional
specialty occupation categories (engineers, surveyors, and architects;
natural scientists and mathematicians; teachers, counselors, and
librarians; social scientists, social workers, and lawyers; registered
nurses and pharmacists; writers, artists, and editors) with 5 or more
years of college. Adjustments were made to produce a standard
occupational mix in each area. The actual reported earnings of
physicians were not used to adjust geographical differences in fees
because these fees are, in large part, the determinants of the
earnings. We believe that the earnings of physicians will vary among
areas to the same degree that the earnings of other professionals vary.
[sbull] Employee wages--Median hourly wages of clerical workers,
registered nurses, licensed practical nurses, and health technicians
were also based on a 20 percent sample of 1980 census data.
[sbull] Office rents--Residential apartment rental data produced
annually by the Department of Housing and Urban Development (HUD) were
used because there were insufficient data on commercial rents across
all physician fee schedule areas.
[sbull] Equipment, supplies, other expenses--The Urban Institute
and the Center for Health Economics research assumed that a national
market represents this component and that costs do not vary appreciably
among areas. This component's index is 1.000 for all areas to indicate
no variation from the national average.
[sbull] Malpractice--Premiums in 1985 and 1986 for a mature
``claims made'' policy (a policy that covers malpractice claims made
during the covered period) providing $100,000 to $300,000 of coverage
were used. Adjustments were made to incorporate the costs of $1 million
to $3 million coverage and mandatory patient compensation fund (PCF)
requirements. Some States legally require physicians to join a PCF that
provides coverage for catastrophic claims. Premium data were collected
for physicians in three risk classes: low-risk (general practitioners
who do not perform surgery), moderate risk (general surgeons), and
high-risk (orthopedic surgeons).
The areas selected for measurement purposes were the MSAs. Non-MSA
areas within a State were aggregated into one residual area. Using MSAs
for measurement satisfied our criteria to have (1) areas in which
resource input prices were homogenous, and (2) areas of a large enough
size so that market areas are self-contained to minimize border
crossing; that is, physicians would probably not move their offices a
few miles to secure higher payments and patients who would tend to
receive services within their area.
The Act requires, however, that the GPCIs reflect cost differences
among MPFS payment areas. Thus, it was necessary to map Medicare
localities to the MSA and non-MSA aggregation of GPCI data. Where
localities crossed MSA boundaries, MSA indices were converted to
Medicare locality indices by population weights.
Detailed discussions of the methodology and data sources of the
1992 through 1994 GPCIs can be obtained by requesting studies from the
National Technical Information Service by calling 1-800-553-NTIS, or,
for residents of Springfield, Virginia, (703) 487-4650. The studies are
as follows:
[sbull] The Urban Institute report ``The Geographic Medicare Index:
Alternative Approaches,'' NTIS PB89-216592;
[sbull] The supplement to ``The Geographic Medicare Index:
Alternative Approaches,'' NTIS PB91-113506. This was published in the
Federal Register in the September 4, 1990 notice (55 FR 36238) for the
model fee schedule; and
[sbull] The Urban Institute report, ``Refining the Malpractice
Geographic Practice Cost Index,'' February 1991, NTIS PB91-155218. The
related diskette is NTIS PB91-507491. This is the final version of the
1992 through 1994 GPCIs as published in the Federal Register in the
November 25, 1991 final rule (56 FR 59785).
5. Revised 1995 Through 1997 Geographic Practice Cost Indices
The main criticism of the original GPCIs, that existed from 1992
until 1994, was that they were outdated because they were based on old
data; for example, 1980 census data and 1985 and 1986 malpractice
premium data, was the most recent data available when the GPCIs were
established. The revised 1995 through 1997 GPCIs were based on the most
current data available when they were developed in 1993 and 1994. We
also made some minor changes from the original GPCI methodology in
calculating some of the revised 1995 through 1997 indices.
One methodological change was made that applied across all indices.
As mentioned earlier, under the original GPCIs, where Medicare payment
localities crossed MSA boundaries, MSA indices were converted to
locality indices by population weights. Medicare expenditure weights
were not used because the expenditures under the reasonable charge
system contained large differences unrelated to actual resource cost
differences among areas. In calculating the revised GPCIs, where
payment localities crossed MSA boundaries, locality indices were
calculated by weights based on full MPFS RVUs, which reflect resource
cost differences among areas. Full MPFS RVUs were used rather than
actual 1993 payments because 1993 fee schedule payments still reflected
some reasonable charge payment levels. The advantages of RVU weighting
are (1) the GPCIs will more closely reflect physician practice costs in
the area where the services are provided rather than where the
population lives, and (2) budget neutrality is preserved when we
combine multiple payment localities into larger areas, such as
statewide localities.
[[Page 49041]]
a. Work Geographic Practice Cost Indices
Data from the 20 percent sample of census data of median hourly
earnings for the same six categories of professional specialty
occupations as used in the 1992 through 1994 work GPCIs were used in
calculating the 1995 through 1997 work GPCIs. The 1992 through 1994
work GPCIs were calculated using 1980 census data of earnings for
professionals with 5 or more years of college. That sample was no
longer available with the 1990 census. The 1990 census educational
classifications are by highest degree earned, rather than the 1980
census classification by years of schooling. Thus, it was not possible
to obtain earnings data exactly comparable to the 1980 data.
For 1990, data were available for all-education and advanced-degree
samples, but not for 5 or more years of college. We elected to use the
all-education sample because its larger sample sizes made it more
stable and accurate in the less populous areas. Although it could be
argued that physicians' earnings might more closely approximate the
earnings of professionals with advanced degrees, the differences
between the all-education and advanced-degree indices were negligible
in all but a few of the smallest localities. We believed that the small
sample sizes of advanced-degree occupations in these small localities
would produce inaccurate results.
The 1992 through 1994 work GPCIs used metropolitan-wide median
wages for each county within an MSA. That is, all counties within an
MSA were assigned the MSA-wide median wage even if there were wage
variations within the MSA. We believed that this was appropriate for
all but Consolidated Metropolitan Statistical Areas (CMSAs), the
largest of the MSAs, such as New York. In these CMSAs, we replaced
metropolitan-wide earnings with county-specific earnings. We believed
this change was appropriate because costs were, in fact, higher in
central city areas (for example, Manhattan and San Francisco) than in
the rest of the CMSA. County earnings were a better account of the cost
variation within these large metropolitan areas.
b. Practice Expense Geographic Practice Cost Indices
(1) Employee Wage Indices.
Data from the 20 percent sample of census data of median hourly
earnings for the same categories of medical and clerical occupations
used in the 1992 through 1994 practice expense GPCIs were also used in
the 1995 through 1997 practice expense GPCIs. The 1995 through 1997
practice expense GPCIs used 1990 rather than 1980 census data. As with
the work GPCIs, county level data were used for CMSAs to better reflect
the cost variations within these large metropolitan areas.
(2) Rent Indices.
As with the original rent indices, the HUD fair market rental (FMR)
data for residential rents were again used as the proxy for physician
office rents. The 1995 through 1997 practice expense GPCIs reflect 1994
HUD FMRs. Like the work GPCI and the employee wage index of the
practice expense GPCIs, county level data were used in CMSAs to
recognize the variations within the CMSA.
The major criticism of the rent indices was that residential rather
than commercial rent data were used. As mentioned earlier, for
constructing the GPCIs we needed data that were widely and consistently
available across all physician fee schedule areas.
As with the original GPCIs, we again searched for private sources
of commercial rent data that were widely and consistently available.
The private sources we found were not adequate. None of the sources
collected data for non-metropolitan areas, nor did any collect data for
all metropolitan areas. The sources did not reflect the average
commercial space in the area, but rather the particular type of space
most relevant to the needs of a particular source's clients. In
addition, the sample sizes were small. A comparison of the average
rental for any particular city showed significant variation depending
upon the source. Also, the private commercial rent data tended to be
for very high priced real estate of the type likely to be used by large
institutions such as banks, insurance companies, or financial firms and
not for the type of office space most likely used by physicians.
Among the sources of commercial rent data that were available, the
most promising were data from the Building Owners and Managers
Association, the General Services Administration, and the U.S. Postal
Service. These data were analyzed in depth. We did not use data from
the Building Owners and Managers Association and the General Services
Administration because of poor geographic coverage, especially outside
of large metropolitan areas. That is, data were not widely and
consistently available for all physician fee schedule areas. The U.S.
Postal Service data had much better geographic coverage, but sample
sizes in many areas were unacceptably small and could have led to
erroneous results.
No acceptable national commercial rent data were readily available
for physician office rents. Thus, some proxy needed to be used for this
portion of the index. In addition, commercial rent data were not
available for all areas from published statistical sources. We believed
that the HUD FMR data remained the best available data for constructing
the office rental index. HUD FMR data were available for all areas,
were updated on an annual basis, and were consistent among areas and
from year to year. Moreover, we believed that physicians frequently
locate in areas and office space that are residential rather than
commercial, for example, in apartment complexes and small strip
commercial centers adjacent to residential areas. Residential rents
may, in fact, be a better measure of the differences among areas in the
physician office market than a general commercial rental index.
(3) Medical Equipment, Supplies, and Miscellaneous Expenses.
Consistent with the original 1992 through 1994 update for medical
equipment, supplies, and miscellaneous, this index assumes a national
market in which input prices do not vary among geographic areas. We
were unable to find any data sources that demonstrated price
differences by geographic area. Anecdotal and interview data with
suppliers and manufacturers were inconclusive. While some price
differences may exist, we believed they were more likely to be based on
volume discounts rather than on geographic areas. Generally, it appears
that manufacturers' prices do not vary among areas except for shipping
costs. Since manufacturers and suppliers are located all over the
country, shipping costs do not vary significantly.
c. Malpractice Geographic Practice Cost Indices
Again, malpractice premium data for a $1 million to $3 million
mature ``claims made'' policy were collected, with mandatory Patient
Compensation Funds (PCFs) considered. Some States have legally required
physicians to join PCFs that provide coverage for catastrophic claims.
The PCF charges a premium or surcharge just as any other insurer.
However, more recent and more comprehensive malpractice insurance data
were used in calculating the 1995 through 1997 malpractice GPCIs. The
1995 through 1997 malpractice GPCIs were based on 1990 through 1992
malpractice premium data. Since malpractice premiums may change
[[Page 49042]]
significantly from year to year, we decided to use the most recent 3-
year average available rather than just the most recent single year to
smooth out this volatility and present a more accurate indication of
malpractice premium trends over time.
We collected data on more specialties and from more insurers. We
collected data on 20 specialties, rather than on only 3 as in the 1992
through 1994 malpractice GPCIs. The 1992 through 1994 malpractice GPCI
data were largely drawn from a single nationwide insurer (St. Paul Fire
and Marine) and were supplemented by several State-specific carriers in
States in which St. Paul did not offer coverage. Subsequent analyses
suggest that these data may not be representative of insurers operating
in many States. For the revised malpractice GPCI, data were collected
from insurers that, on average, represented 82 percent of the market in
each State, with the lowest State market share being 60 percent. We
believed that the more recent and much more comprehensive data greatly
improved the accuracy of the malpractice GPCIs for 1995 through 1997.
Detailed discussions of the methodology and data sources of the
1995 through 1997 GPCIs can be obtained by requesting the following
studies from NTIS by calling 1-800-553-NTIS, or (703) 487-4650 in
Springfield, Virginia:
[sbull] ``Updating the Geographic Practice Cost Index: Revised Cost
Shares.'' Debra A. Dayhoff, John E. Schneider, and Gregory C. Pope.
NTIS PB94-161072.
[sbull] ``Updating the Geographic Practice Cost Index: The
Physician Work GPCI.'' Gregory C. Pope and Deborah A. Dayhoff. NTIS
PB94-161080.
[sbull] ``Updating the Geographic Practice Cost Index: The Practice
Expense GPCI.'' Gregory C. Pope, Deborah A. Dayhoff, Angella R.
Merrill, and Killard W. Adamache. NTIS PB94-161098.
``Updating the Geographic Practice Cost Index: The Malpractice
GPCI.'' Stephen Zuckerman and Stephen Norton. NTIS PB94-161106.
6. Revised 1998 Through 2000 Geographic Practice Cost Indices
The same data sources and methodology used for the 1995 through
1997 GPCIs were also used for the revised 1998 through 2000 GPCIs with
a few very minor modifications. No acceptable additional data sources
were found. The cost shares were the same as in the 1995 through 1997
GPCIs because no changes were made in the MEI weights. Indices for fee
schedule areas were based on the indices for the individual counties
within the fee schedule area. Fee schedule RVUs were again used to
weight the county indices (to reflect volumes of services within
counties) when mapping to MPFS payment areas and in constructing the
national average indices. However, we used more recent data, 1994
rather than 1992 RVUs, in the county, locality, and national mapping
for the proposed GPCIs. The payment effect of using more current RVU
weights was negligible in most cases and generally resulted in changes
at the third decimal point if at all.
a. Work Geographic Practice Cost Indices
The work GPCIs were based on the decennial census. The 1992 through
1994 work GPCIs were based on 1980 census data, because 1990 census
data were not yet available. The work GPCIs were revised in 1995 with
new data from the 1990 census. New census data will not be available
again until sometime after the 2000 census is compiled. We searched for
other data that would enable us to update the work GPCIs between the
decennial censuses. No acceptable data sources were found. The most
promising sources of data were the hospital wage data collected by us
to calculate the IPPS hospital wage index and the payroll per worker
data collected by the U.S. Bureau of Labor Statistics from State
unemployment insurance agencies (the ES-202 data).
The IPPS hospital wage data were examined when we constructed the
original GPCIs. They were rejected as a physician fee schedule data
source in favor of census data because of their lack of an occupation
mix adjustment and their unrepresentative occupational composition
(hospital employees rather than professionals or physician office
employees). ES-202 data consist of total payroll divided by counts of
wage and salary workers. The major disadvantage we identified was that
they do not measure hourly earnings, only payroll per employee, and no
occupational detail is available. Also, they did not adjust for part-
time or full-time and hours worked, and the numbers of workers was too
small for certain States, all of which led to unstable estimates of
payroll per worker. We compared the changes by State from 1989 to 1993
in the IPPS wage data and the ES-202 data to see if there was any
correlation between the two series. The correlation between the two was
only moderate, 0.55. The changes indicated by both series were
generally small, for example, a few percentage points. The difference
between the two series by State was in many cases as large as or
greater than the change indicated by either series. The average
difference between the two series (2.1 percent) is as large as the
change indicated by either series. In addition, changes for particular
States were substantially different between the two series. For
example, Indiana relative wages rose by 1.9 percent according to the
IPPS data, but fell 5.7 percent according to the ES-202 data.
Since we were unable to find an acceptable data source for updating
the work GPCIs, we examined the consequences of not updating the work
GPCIs between the decennial censuses. We compared the changes between
the 1992 through 1994 work GPCIs, based on the 1980 census, and the
1995 through 1997 GPCIs, based on the 1990 census. On average, the full
variation in State work GPCIs changed by about 5 percent. This
translates to about a 1.2 percent change in the one-quarter work GPCI
calculation prescribed by law. Since work makes up about one-half of
the GPCI cost shares, this translated into an average payment change
per State of about 0.6 percent from updating the work GPCI based on the
10-year change in relative wages indicated by the census data. Even the
maximum change in the full variation in State work GPCIs from the 1992
through 1994 to the 1995 through 1997 GPCIs of 14 percent translates
into only about a 1.8 percent change in payments. The largest full work
GPCI changes for individual payment areas were from 16 to 20 percent,
or about a 4 to 5 percent change in the one-quarter work GPCI, or about
a 2.4 percent change in payments. However, 80 percent of payment areas
experienced payment changes of less than 1 percent, and 50 percent of
payment localities experienced payment changes of less than 0.5 percent
as a result of changes in the census data from 1980 to 1990.
We, therefore, made no changes in the 1998 through 2000 work GPCIs
from the 1995 through 1997 work GPCIs, other than the generally
negligible changes resulting from using 1994, rather than 1992, RVUs
for this GPCI update because we were unable to find acceptable data for
use between the decennial censuses. We believed it is preferable that
we make no changes rather than make inaccurate changes based on
inappropriate data. We felt that this was a reasonable position given
the generally small magnitude of the changes in payments resulting from
the changes in the work GPCIs from the 1980 to the 1990 census data.
b. Practice Expense Geographic Practice Cost Indices
(1) Employee Wage Indices.
[[Page 49043]]
As with the work GPCIs, the employee wage portion of the practice
expense GPCIs were also based on decennial census data. For the same
reasons discussed above pertaining to the work GPCIs, we made no
changes in the employee wage indices during the 1998 through 2000 GPCI
update. The average change from the 1992 through 1994 to 1995 through
1997 employee wage indices across States was about 6 percent. Since the
employee wage index has a weight of about 16 percent in the GPCI cost
shares, this translates into a 1 percent average change in payments.
The maximum payment change in any payment area resulting from changes
from the 1992 through 1994 to 1995 through 1997 employee wage indices
was about 3.2 percent. Payment changes in over two-thirds of the
payment areas were less than 1 percent.
(2) Rent Indices.
The office rental indices were again based on HUD residential rent
data. The rental indices were based on 1996 HUD data as opposed to 1994
HUD data in the 1995 through 1997 GPCIs. HUD made two small
methodological changes in developing the data. First, HUD used the 40th
percentile of area rents rather than the 45th percentile. This did not
materially affect the GPCIs, which measure relative rents among areas.
Second, HUD established a rental floor for rural counties at the
statewide rural average. This had the effect of raising the office
rental indices slightly in rural areas.
We made one methodological change in the rent indices. HUD
publishes FMRs only for metropolitan areas as a whole. For the 1995
through 1997 GPCIs, HUD used a special tabulation of the 1990 census
data to allocate rents by county within CMSAs. In some metropolitan
areas, this had the effect of reducing the central city index below the
suburban index, probably because of lower unmeasured housing quality in
central cities than in suburbs. We did not feel that this was a
representative indicator of relative physician rents, since the GPCIs
are intended to measure rental costs for offices of similar quality in
different areas. The metropolitan-wide rent was most appropriate for
measuring the cost of space of an average quality across the
metropolitan area, which is why HUD publishes only metropolitan-wide
FMRs. Also, the census county adjustments can be updated only once
every 10 years. For this reason, we believed that the county-specific
adjustment should not be made for all large metropolitan areas but
should be retained only for the New York City Primary Metropolitan
Statistical Area. Available evidence suggests that rents vary
substantially among the boroughs of New York City and that, given the
current locality configuration, the county-specific rental adjustment
appropriately reflects these patterns in the New York City area,
especially the higher rents in Manhattan.
(3) Medical Equipment, Supplies, and Miscellaneous Expenses. As
with the 1992 through 1994 and 1995 through 1997 GPCIs, this component
was given a national value of 1.000, indicating no measurable
difference among areas in costs.
c. Malpractice Geographic Practice Cost Indices.
Again, malpractice premium data were collected for a mature
``claims made'' policy with $1 million to $3 million limits of
coverage, with adjustments made for mandatory patient compensation
funds. As with the 1995 through 1997 GPCIs, data were collected for the
20 largest Medicare-billing physician specialties. The premium data
represent at least 50 percent of the market in each State. Again, we
used an average of the 3 most recent premium years to smooth out the
considerable year-to-year fluctuations that can occur in malpractice
premiums. The revised 1998 through 2000 malpractice indices were based
on 1992 through 1994 premium data, the latest years available when this
revision was being conducted in 1995 through 1996, compared to the 1990
through 1992 data used in the current 1995 through 1997 indices.
Another change from the 1995 through 1997 indices is that the specialty
shares of the 20 specialties were weighted by fee schedule RVUs rather
than allowed charges.
Detailed discussions of the methodology and data sources of the
1998 through 2000 GPCIs may be obtained by requesting the following
study from NTIS by calling 1-800-533-NTIS, or, for residents of
Springfield, Virginia, (703) 487-4650: ``Second Update of the
Geographic Practice Cost Index.'' Gregory C. Pope and Killard W.
Adamache.
7. Revised 2001-2003 Geographic Practice Cost Indices
The same data sources and methodology used for the 1998 through
2000 GPCIs were used for the 2001 through 2003 GPCIs. No acceptable
additional data sources were found. The only changes from the 1998
through 2000 GPCI were in the cost shares and RVU weighting. As shown
in the cost share table in the discussion of the development of the
GPCIs, the cost shares were changed to reflect the revisions in the
MEI. This does not affect the work or malpractice GPCIs since they are
stand-alone indices (not composed of multiple indices). This cost share
revision has a slight effect on the practice expense GPCIs because it
changes slightly the weights among the employee wage, rents and
miscellaneous components of the practice expense index. We used more
recent RVU data, 1998 rather than 1994, in the county, locality, and
national mapping in the proposed GPCIs. The payment effect of this was
generally negligible.
a. Work Geographic Practice Cost Indices.
For the same reasons discussed in the section on the 1998 through
2000 work GPCIs, no changes were proposed in the work GPCIs, other than
the generally negligible changes resulting from the use of 1998 rather
than 1994 RVUs for weighting, because we were unable to find acceptable
data for use between the decennial census.
b. Practice Expense Geographic Practice Cost Indices
(1) Employee Wage Indices.
As with the work GPCIs, the employee wage indices were based on
decennial census data. For the same reasons discussed above pertaining
to the work GPCIs, we proposed no changes in the employee wage indices
during this GPCI update.
(2) Rent Indices.
The office rental indices were again based on HUD residential rent
data. No changes were made in the methodology. The proposed rental
indices were based on 2000 rather than 1994 HUD data.
(3) Medical Equipment, Supplies, and Miscellaneous Expenses. As
with all previous GPCIs, this component is given a national value of
1.000, indicating no measurable differences among areas in costs.
c. Malpractice Geographic Practice Cost Indices
The same methodology described in the 1998 through 2000 malpractice
GPCI section was used in the revision of malpractice GPCIs section for
2001 through 2003, the only difference being the use of more recent
data. The malpractice indices were based on 1996 through 1998
malpractice premium data rather than the 1992 through 1994 malpractice
premium data that was used in the previous GPCI update.
8. Proposed 2004 through 2007 Geographic Practice Cost Indices
The main criticism of the 2001 through 2003 GPCIs was that they
were
[[Page 49044]]
outdated because they were based on old data; for example, 1990
decennial census data and 1996 through 1998 malpractice premiums, the
most recent data available when the GPCIs for 2001 through 2003 were
established. The calculation of the proposed 2004 through 2007 GPCIs
will be based upon the same data sources and methodology, but the 2004
through 2007 GPCIs will utilize more current data: 2000 decennial
census data, 2000 HUD fair market rental (FMR) data for residential
rents, and 1999 through 2003 malpractice premium data. This should
address the criticism of the 2001 through 2003 GPCIs being out of date.
a. Proposed Work Geographic Practice Cost Indices
We have not yet received the 2000 decennial census data that will
be utilized for the revision of the work GPCIs. For this reason,
revisions to the work GPCIs will be included in the proposed rule for
calendar year 2005.
b. Proposed Practice Expense Geographic Practice Cost Indices
We have not yet received the 2000 decennial census data that will
be utilized for the revision of the majority of the practice expense
GPCI. We have obtained 2000 HUD fair market rental (FMR) data for
residential rents that is utilized for a portion of the practice
expense revision. Since we have not received the primary data upon
which practice expense GPCIs are calculated and since the office rent
component of the practice expense GPCI has not proven to be a
substantially variable component in past GPCI updates and accounts for
only approximately 12.0 percent of the total GPCI calculation (phased
in over a two year period), we have decided not to revise the practice
expense GPCIs now based on our limited data. For these reasons,
revisions to the practice expense GPCIs will be included in the
proposed rule for calendar year 2005.
c. Proposed Malpractice Geographic Practice Cost Indices
The malpractice GPCI is the most volatile of the three indexes with
relatively large variations existing between localities. Malpractice
premium data for a $1 million to $3 million mature ``claims made''
policy were collected, with mandatory patient compensation funds
considered. However, due to the recent concerns regarding the
escalating cost of professional liability insurance, especially in 2002
and 2003, we will be collecting more recent malpractice premium data.
We propose using actual 1999 through 2002 malpractice premium data and
projecting the malpractice premium rates for 2003. The methodology for
forecasting 2003 medical malpractice premiums will consist of
calculating the geometric mean rate of growth between 1999 through 2002
and applying that rate to the 2002 premium. We will also obtain a
national aggregate malpractice premium series with which to benchmark
the 2003 forecast. At this point, we are still collecting the 2002
malpractice premium data and are thus unable to project 2003
malpractice premium data in this proposed rule. We are proposing to
base the malpractice GPCIs upon actual 2001 and 2002 malpractice
premium data and projected 2003 malpractice premium data by January 1,
2004. These revised malpractice GPCIs will be published in this year's
final physician fee schedule regulation. They will be considered
interim and subject to public comment.
9. Payment Localities
We are also interested in receiving comments on the composition of
the current Medicare physician payment localities (89 separate payment
localities) to which the GPCIs are applied. For additional information
regarding the composition of the 89 Medicare physician payment
localities please refer to both the July 2, 1996 proposed rule (61 FR
34615) and the November 22, 1996 final rule (61 FR 59494) for the
Medicare physician fee schedule.
C. Coding Issues
1. Payment Policy for CPT Tracking Codes
In the November 1, 2001 final rule (66 FR 55269), we stated that
carriers have discretion for coverage and payment of services described
by CPT tracking codes, also known as CPT Category III codes, unless we
have made a national coverage determination (NCD). (These CPT Category
III codes are distinct from the HCPCS Level III codes used by local
claims processors which are to be discontinued under HIPAA
implementation.) We have received several requests to create national
payment amounts for some CPT tracking codes even if there has been no
NCD with respect to the services. After review of these requests, we
are proposing to change our policy regarding payment for CPT tracking
codes.
We propose to create national payment policy and determine national
payment amounts for CPT tracking codes when there is a significant
programmatic need for us to do so. Such a need could arise, for
example, if we receive requests from carrier medical directors that we
establish a national payment amount because of carrier inability to do
so. This policy change would not change the contractor's discretion
over coverage for the CPT tracking codes, but would establish a payment
level if the contractor finds that coverage is warranted. Carriers do
not need to establish a payment amount for a tracking code until they
receive a claim for the code.
2. Excision of Benign and Malignant Lesions
In the CPT 2003 book, the definitions for excision of benign
lesions (CPT codes 11400 through 11446 inclusive) and excision of
malignant lesions (CPT codes 11600 through 11646 inclusive) were
substantively changed. Starting in 2003, these codes are to be reported
based on the excised diameter (actual skin removed) rather than on the
size of the lesion. We have reviewed the new code descriptors and are
proposing to make the work RVUs the same for removal of all skin
lesions with the same excised diameters that are from the same area of
the body, whether the lesions are benign or malignant For example, the
work RVUs for the removal of benign skin lesions from the trunk, arms
or legs with excised diameter 1.1-2.0 cm, CPT code 11402, would be the
same as the work RVUs for CPT code 11602, which is the removal of
malignant skin lesions from trunk, arms or legs with excised diameter
of 1.1-2.0 cm. Therefore, to retain budget neutrality within each code
pair, the total work RVUs associated with each code pair will be
constant both before and after the work adjustment. We will accomplish
this by dividing the total 2003 work RVUs (2003 work RVUs for a given
code pair multiplied by 2002 utilization) by the total 2002 utilization
for the given code pair. For example:
----------------------------------------------------------------------------------------------------------------
2002 2003 work Total work
CPT code utilization RVU RVUs
----------------------------------------------------------------------------------------------------------------
11400............................................................ 69,041 x 0.85 = 58,685
[[Page 49045]]
11600............................................................ 13,768 x 1.31 = 18,036
------------- ------------- ------------
Total.......................................................... 82,809 .. ........... .. 76,721
----------------------------------------------------------------------------------------------------------------
76,721 divided by 82,809 = 0.93 work RVU
The proposed work RVUs for these codes follow:
[[Page 49046]]
[GRAPHIC] [TIFF OMITTED] TP15AU03.007
[[Page 49047]]
3. Create G Codes for Monitoring Heart Rhythms
Technological advances have made cardiac telemetry equipment,
typically used in hospitals, available in the home setting. It is now
possible to discharge patients with arrhythmias to a home setting and
have them monitored at home in a manner similar to hospital monitoring.
This monitoring can be used to diagnose arrhythmias or to monitor
patients with known arrhythmias to determine, on a real-time basis,
whether the patient is having ongoing arrhythmias. The equipment
consists of patient leads and a home telemetry station that is
connected to a distant monitoring station via the telephone. The
monitoring station is attended twenty-four hours a day, seven days a
week by a technician. Upon receipt of rhythm strips, the technician
records and formats the strips and faxes them to the treating
physician.
This equipment automatically records the patient's heart rhythm and
is not triggered by the patient (for example, his response to
symptoms). The equipment is pre-set with parameters (for example, heart
rate of over 120) that trigger it to transmit the patient's cardiac
rhythm to monitoring station. Additionally, the technician at the
monitoring station can interrogate the home station and have it
transmit rhythm strips upon request even when no arrhythmia has
triggered an automatic transmission. These latter transmissions are at
the discretion of the technician and may or may not be faxed to the
treating physician based on previous orders.
Depending on the clinical need, patients may be monitored by this
equipment for varying lengths of time. Furthermore, the frequency of
transmission of cardiac rhythms varies, as does the amount of material
that must be reviewed by the physician. For example, a patient may have
no cardiac rhythms transmitted for one or more days while on other days
the patient may have several minutes of arrhythmias transmitted for
physician review.
To ensure this technology is available to Medicare beneficiaries
for covered indications (coverage is currently at the discretion of the
local Medicare contractors because there is no national coverage
determination for this service) we are creating several HCPCS G codes
to describe this service and are establishing national payment amounts
for these services. Currently Medicare contractors are requiring both
the PC and TC of this service to be billed under CPT code 93799,
Unlisted cardiovascular procedure or service. This service is covered
under the diagnostic test benefit category at section 1861(s)(3) of the
Act.
Medicare is establishing the following HCPCS codes to describe this
service:
GXXX1--Electrocardiographic monitoring for diagnosis of arrhythmias,
utilizing a home computerized telemetry station and trans-telephonic
transmission, with automatic activation and real time notification of
monitoring station, 24-hour attended monitoring, per 30-day period of
time; includes recording, monitoring, receipt of transmissions,
analysis, and physician review and interpretation. (global)
GXXX2--Electrocardiographic monitoring for diagnosis of arrhythmias,
utilizing a home computerized telemetry station and trans-telephonic
transmission, with automatic activation and real time notification of
monitoring station, 24-hour attended monitoring, per 30-day period of
time; recording (includes hook-up, recording and disconnection)
GXXX3--Electrocardiographic monitoring for diagnosis of arrhythmias,
utilizing a home computerized telemetry station and trans-telephonic
transmission, with automatic activation and real time notification of
monitoring station, 24-hour attended monitoring, per 30-day period of
time; monitoring, receipt of transmissions, and analysis
GXXX4--Electrocardiographic monitoring for diagnosis of arrhythmias,
utilizing a home computerized telemetry station and trans-telephonic
transmission, with automatic activation and real time notification of
monitoring station, 24-hour attended monitoring, per 30-day period of
time; physician review and interpretation.
We are establishing the following payment amounts for these codes:
GXXX1--We are assigning 0.52 physician work RVUs and 0.24 malpractice
RVUs which is equivalent to CPT Code, 93268 Patient demand single or
multiple event recording with presymptom memory loop, 24-hour attended
monitoring, per 30 day period of time; includes transmission physician
review and interpretation. We are also crosswalking the practice
expense inputs from CPT Code 93268.
GXXX2--We are assigning 0.07 malpractice RVUs which is equivalent to
CPT Code 93270, Patient demand single or multiple event recording with
presymptom memory loop, 24-hour attended monitoring, per 30 day period
of time; recording (includes hook-up, recording, and disconnection) and
crosswalking the practice expense inputs from CPT Code 93270.
GXXX3--We are assigning 0.15 malpractice RVUs which is equivalent to
CPT Code 93271, Patient demand single or multiple event recording with
presymptom memory loop, 24-hour attended monitoring, per 30 day period
of time; monitoring, receipt of transmission, and analysis and also are
crosswalking the practice expense inputs from CPT Code 93271.
GXXX4--We are assigning 0.52 physician work RVUs and 0.02 malpractice
RVUs which is equivalent to CPT Code 93272 Patient demand single or
multiple event recording with presymptom memory loop, 24-hour attended
monitoring, per 30 day period of time; physician review and
interpretation only. We are also crosswalking the practice expense
inputs, from CPT Code 93272.
We believe these proposed RVUs and crosswalks are appropriate as
the services provided in the new codes are very similar in terms of
physician work, resource use, and malpractice risk to the existing CPT
Codes.
4. CPT Code 88180 (Flow Cytometry; Each Cell Surface, Cytoplasmic or
Nuclear Marker)
Flow cytometry is a technique to analyze single cell suspensions
from blood, bone marrow, body fluids, lymph nodes, and other tissues.
The technique, currently coded as CPT code 88180, Flow cytometry, each
cell surface, cytoplasmic or nuclear marker, quantifies cell surface,
cytoplasmic, and nuclear antigens. The results are frequently used to
diagnose lymphomas and leukemias. They are also used to monitor
lymphocyte subpopulations in patients with HIV infection or solid organ
transplantation. For example, in patients with HIV infection,
physicians evaluate CD4+ lymphocytes as a measure of the severity of
the infection (some physicians also measure other markers although
their clinical relevance is not as well established). In patients with
solid organ transplantation, physicians measure various lymphocyte
subpopulations to help assess early rejection, identify bone marrow
toxicity during immunosuppressive therapy, and differentiate infections
from transplant rejection. In these cases the treating physician, not
the pathologist, makes the diagnosis. It is inappropriate for the
pathologist to report the professional component (PC) of this service.
In general, flow cytometry results must be utilized along with clinical
data to make
[[Page 49048]]
a diagnosis. Other clinical situations where flow cytometry tests have
some value include stem cell transplantation, paroxysmal nocturnal
hemoglobinuria, immune deficiency disorders, etc.
When flow cytometry is performed to diagnose lymphoma or leukemia,
there is a single interpretation based on the quantification of all
markers tested. There is not an interpretation of each marker
individually.
Moreover, for a given clinical indication (for example, diagnosis
of lymphoma based on lymph node examination) there is variation in the
number of markers performed. The number of markers that are necessary
depends, in part, on the pathologic information available to the
pathologist at the time he/she orders flow cytometry. Therefore, for a
given clinical indication (for example, diagnosis of lymphoma from a
lymph node) a pathologist who chooses to perform flow cytometry before
performing a microscopic examination of the tissue specimen (for
example, a lymph node) may order more markers than a pathologist who
orders flow cytometry after performing a microscopic examination of the
tissue specimen.
The current coding scheme (payment on a per marker basis) may
encourage the performance of more markers than may be medically
necessary because the pathologist determines what markers to perform
and when to perform them.
Our review of flow cytometry reports confirms that markers are
interpreted (and reported) on a panel basis. From our review,
physicians do not typically interpret individual markers. This is
consistent with most of the clinical indications for flow cytometry
that require performance of several markers to make a diagnosis. There
may also be clinical situations where no professional component is
performed although it is appropriate to perform the technical component
(TC) (for example, monitoring of HIV infected patients, monitoring of
solid organ transplantations).
The fact that markers are generally analyzed on a ``panel'' basis,
not an ``individual'' basis, means that the current practice and use of
flow cytometry is not appropriately reflected by the PC of CPT code
88180.
However, we do believe that it is appropriate to pay for the TC of
each marker separately, although at a lower rate of payment (due to
economies of scale) when multiple markers are performed. A coding
scheme that pays per marker for the TC and per panel for the PC would
more accurately reflect the actual practice of flow cytometry.
The laboratory community is aware of our concerns about the coding
of flow cytometery and will review this issue and consider whether
changes should be made to the current coding for the procedure. If no
changes in coding are forthcoming, we would consider creating HCPCS
codes for flow cytometry. We welcome comments and recommendations on
appropriate values for the procedure that we could use in developing
any future proposal.
5. Create G Codes for Dialysis Patient Seeing the Doctor
We have reviewed our current payment policy for the monthly
dialysis capitation, CPT codes 90918 through 90921 in response to
concerns that have been raised over whether our payment policy is
consistent with current medical practice.
Specifically, we understand that physician involvement in dialysis
for end stage renal disease (ESRD) varies based on a patient's
condition, response to dialysis, and comorbidities. A physician
involvement for a single patient may also vary from month to month. It
is our intent to ensure that beneficiaries with ESRD receive the
highest quality dialysis care available and that physician involvement
in dialysis for ESRD patients is appropriate and consistent with the
needs of the patient in any month.
Observers of the quality of care for dialysis patients have noted
that some dialysis patients may benefit from being evaluated by their
physician frequently. A recent international comparison study suggested
that longer physician-patient contact time in hemodialysis facilities
was associated with lower mortality risk.
To align the payment incentives with the frequency of the physician
personally evaluating the dialysis patient, we are proposing to make
CPT codes 90918, 90919, 90920, 90921 invalid for Medicare and to create
G codes. We are proposing to create 3 new G codes in place of each CPT
code with higher payments associated with providing more visits within
each month to an ESRD patient. Under our proposal, there will be
separate codes when the physician provides 1 visit per month, 2-3
visits per month and 4 or more visits per month. The code for 1 visit
per month will have the lowest payment while a higher payment will be
provided for 2 to 3 visits per month and the highest payment for 4 or
more visits per month. Our methodology for determining payment is
described below. These new codes will be reported once per month for
services performed in an outpatient setting and related to the
patient's ESRD. These physician services will continue to include the
establishment of a dialyzing cycle, outpatient evaluation and
management of the dialysis visits, telephone calls, and patient
management, provided during a full month. These codes would not be used
if a hospitalization occurred during the month.
GXXX5--End Stage Renal Disease (ESRD) related services per full month,
for patients under 2 years of age to include monitoring for the
adequacy of nutrition, assessment of growth and development, and
counseling of parents; with 4 or more face-to-face physician visits per
month.
GXXX6--End Stage Renal Disease (ESRD) related services per full month,
for patients under 2 years of age to include monitoring for the
adequacy of nutrition, assessment of growth and development, and
counseling of parents; with 2 or 3 face-to-face physician visits per
month.
GXXX7--End Stage Renal Disease (ESRD) related services per full month,
for patients under 2 years of age to include monitoring for the
adequacy of nutrition, assessment of growth and development, and
counseling of parents; with 1 face-to-face physician visit per month.
GXXX8--End Stage Renal Disease (ESRD) related services per full month,
for patients between 2 and 11 years of age to include monitoring for
the adequacy of nutrition, assessment of growth and development, and
counseling of parents; with 4 or more face-to-face physician visits per
month.
GXXX9--End Stage Renal Disease (ESRD) related services per full month,
for patients between 2 and 11 years of age to include monitoring for
the adequacy of nutrition, assessment of growth and development, and
counseling of parents; with 2 or 3 face-to-face physician visits per
month.
GXX10--End Stage Renal Disease (ESRD) related services per full month,
for patients between 2 and 11 years of age to include monitoring for
the adequacy of nutrition, assessment of growth and development, and
counseling of parents; with 1 face-to-face physician visit per month.
GXX11--End Stage Renal Disease (ESRD) related services per full month,
for patients between 12 and 19 years of age to include monitoring for
the adequacy of nutrition, assessment of growth and development, and
[[Page 49049]]
counseling of parents; with 4 or more face-to-face physician visits per
month.
GXX12--End Stage Renal Disease (ESRD) related services per full month,
for patients between 12 and 19 years of age to include monitoring for
the adequacy of nutrition, assessment of growth and development, and
counseling of parents; with 2 or 3 face-to-face physician visits per
month.
GXX13--End Stage Renal Disease (ESRD) related services per full month,
for patients between 12 and 19 years of age to include monitoring for
the adequacy of nutrition, assessment of growth and development, and
counseling of parents; with 1 face-to-face physician visit per month.
GXX14--End Stage Renal Disease (ESRD) related services per full month,
for patients 20 years of age and over; with 4 or more face-to-face
physician visits per month.
GXX15--End Stage Renal Disease (ESRD) related services per full month,
for patients 20 years of age and over; with 2 or 3 face-to-face
physician visits per month.
GXX16--End Stage Renal Disease (ESRD) related services per full month,
for patients 20 years of age and over; with 1 face-to-face physician
visit per month.
We are assuming that most physicians will provide 4 or more visits
to their ESRD patients and a small proportion will provide 2-3 visits
or only 1 visit per month. Using these assumptions and Medicare
utilization data from 2002, we developed relative value units for the
new G codes that will make the Medicare's aggregate payments for ESRD
related services under the physician fee schedule approximately equal
to current payments that are occurring using procedure codes 90918 to
90921. Relative to our current payments, we are proposing to lower
payment when the physician provides 1 visit per month or 2-3 visits per
month. Since we are proposing to lower payment if the physician
provides fewer than 4 visits per month, in order to maintain the same
aggregate payments for ESRD related services, we are proposing to
increase payment if the physician provides 4 or more visits per month.
Using these assumptions, the proposed work, practice expense and
malpractice RVUs for procedure codes GXXX5 through GXXX16 are shown
below:
Table 4
------------------------------------------------------------------------
Physician Practice
Code work expense Malpractice
------------------------------------------------------------------------
GXXX5................................. 12.92 8.70 0.60
GXXX6................................. 5.19 3.49 0.24
GXXX7................................. 3.39 2.29 0.16
GXXX8................................. 9.91 4.86 0.43
GXXX9................................. 3.55 1.74 0.15
GXX10................................. 2.32 1.14 0.10
GXX11................................. 8.47 4.54 0.35
GXX12................................. 3.14 1.68 0.13
GXX13................................. 2.05 1.10 0.08
GXX14................................. 5.16 2.94 0.22
GXX15................................. 1.94 1.10 0.08
GXX16................................. 1.27 0.73 0.06
------------------------------------------------------------------------
We believe that stratifying payment amounts by physician face-to-
face involvement would be an improvement over the current method, but
still may not be optimal to foster improved outcomes.
Both the Institute of Medicine and Medicare Payment Advisory
Commission (MedPAC) have advocated an increased role for CMS in
encouraging improved quality outcomes. In their June 2003 Report to
Congress (Variation and Innovation in Medicare), MedPAC recommended
``the Secretary should conduct demonstrations to evaluate provider
payment differentials and structures that reward and improve quality.''
We responded to this call by increasing the focus of our Quality
Improvement Organizations (formerly called Peer Review Organizations)
and ESRD Networks on developing quality measures and also performing or
assisting providers with the performance of quality improvement
activities. We have also implemented initiatives to address the quality
of care provided in various settings. These include: The Home Health
Quality Initiative; the Hospital Quality Initiative; the Nursing Home
Quality Initiative; the Home Health Quality Initiative and Doctors
Office Quality Project (see http://cms.hhs.gov/quality/ for more
information).
Additionally, we have developed various demonstration projects that
provide incentives to improve quality. For example, as part of an
ongoing effort to achieve improved patient outcomes, we announced the
ESRD Disease Management Demonstration in the Federal Register on June
4, 2003. The goal of this demonstration is to achieve improved patient
outcomes through disease management services and quality incentives.
This demonstration does not directly involve renal physicians, but we
are considering the use of quality incentives in potential future
payment systems for them as well. Renal physicians play a central role
in leading the interdisciplinary team charged with managing an ESRD
patient's care.
Thus, we are seeking comment on how to further revise our payment
methodology to improve quality of care and outcomes. We are also
interested in information that could help us design future
demonstrations that would incorporate both dimensions of care (quality
and utilization) and help ensure that payment is based on appropriate
patient-specific care that has been shown to lead to improved outcomes
for this complex patient population.
6. Extracorporeal Shock Wave Lithotripsy for Musculoskeletal Conditions
We received several comments on the G codes for extracorporeal
shock wave lithotripsy created in the December 31, 2002 final rule. We
will be responding to those comments as part of this year's final rule,
but we would appreciate any additional information on the physician
work, practice expenses, and duration of treatment and intensity or
energy of the shock waves applied for various conditions at various
anatomic sites.
7. Late RUC recommendations for 2003 CPT codes.
RUC recommendations for RVUs for approximately 20 new CPT codes for
2003 were received too late for incorporation in the December 31, 2002
final rule. We proposed interim RVUs for these codes and, as with all
interim values, these were subject to comment. In their comments on the
December 2002 final rule, the AMA-RUC requested that we consider their
late recommendations for these codes. We will be addressing these, as
well as other comments received on the interim RVUs in the upcoming
final rule.
III. Other Issues
A. Rebasing and Revising of the Medicare Economic Index
1. Background
The Medicare Economic Index (MEI) is required by section 1842(b)(3)
of the Act, which states that prevailing charge levels beginning after
June 30, 1973 may not exceed the level from the previous year except to
the extent that the Secretary finds, on the basis of appropriate
economic index data, that the higher level is justified by year-to-year
economic changes. Beginning July 1, 1975, and continuing through today,
the MEI has met this requirement by reflecting the weighted sum of the
annual price changes of the inputs used
[[Page 49050]]
to produce physicians' services. As such, the MEI attempts to be an
equitable measure of price changes associated with physician time and
operating expenses.
The current form of the MEI was detailed in the November 25, 1992
Federal Register (57 FR 55896) and was based in part on the
recommendations of a Congressionally-mandated meeting of experts held
in March 1987. Since that time, the structure of the MEI has remained
essentially unchanged, with two exceptions. First, the MEI was rebased
in 1998 (63 FR 58845), which moved the cost structure of the index from
1992 data to 1996 data. Second, the methodology for the productivity
adjustment was revised in 2002 (67 FR 80019) to reflect the percentage
change in the 10-year moving average of economy-wide multifactor
productivity.
We are proposing to rebase and revise the MEI for the 2004
physician fee schedule update. The terms ``rebasing'' and ``revising'',
while often used interchangeably, actually denote different activities.
Rebasing means moving the base year for the structure of costs of an
input price index, while revising means changing data sources, cost
categories, or price proxies used in the input price index. As is
always the case with a rebasing and revising exercise, we have
attempted to use the most recently available, relevant, and appropriate
information to develop the MEI cost category weights and price proxies.
We detail below the updated cost weights for the MEI expense
categories, our rationale for selecting the price proxies in the MEI,
and the results of the proposed rebasing and revising of the MEI.
2. Use of More Current Data
The MEI was last rebased and revised in 1998 for the 1999 physician
fee schedule update (63 FR 58845). The current base year for the MEI is
1996, which means that the cost weights in the index reflect
physicians' expenses in 1996. However, we believe it is desirable to
periodically rebase and revise the index so that the expense shares and
proxies reflect more current conditions. For this reason, we propose to
rebase the MEI to reflect physicians' expenses in 2000. In addition, we
are proposing to revise the cost categories in the MEI and to change
three of the proxies we currently use to ensure that the index is
appropriately reflecting price changes. We will continue to adjust the
MEI for economy-wide multifactor productivity.
The expense categories in the proposed MEI were primarily derived
from the 2003 AMA Physician Socioeconomic Characteristics publication
(2003 Patient Care Physician Survey data), which measures physicians'
earnings and overall practice expenses for 2000. The AMA data were used
to determine expenditure weights for total expenses, physicians'
earnings, and malpractice expenses, the only information detailed in
this survey. To further disaggregate into subcategories reflecting more
detailed expenses, we used data from previous AMA surveys, the 1997
Bureau of Economic Analysis Benchmark Input-Output table (I/O), the
2003 Bureau of Labor Statistics (BLS) Employment Cost Index (ECI), and
the 2002 Bureau of the Census Current Population Survey (CPS).
3. Rebasing and Revising Expense Categories in the MEI
a. Developing the Weights For Use in the MEI
Developing a rebased and revised MEI requires selecting a base year
and determining the number and composition of expense categories. We
are proposing to rebase the MEI to CY 2000. CY 2000 was chosen as the
base year for two main reasons: (1) CY 2000 was the most recent year
for which data were available from the AMA, and (2) we believed that
the CY 2000 data were representative of the changing distribution of
physicians' earnings and practice expenses over time.
We determined the number and composition of expense categories
based on the criteria used to develop the current MEI and other CMS
input price index expenditure weights. These criteria are timeliness,
reliability, relevance, and public availability. For more information
on these criteria, see the May 9, 2002 Federal Register (67 FR 31444)
and the detail later in this preamble. Table 5 lists the set of
mutually exclusive and exhaustive cost categories that make up the
proposed rebased and revised MEI.
Table 5.--Proposed Revised Medicare Economic Index Expenditure Categories, Weights, and Price Proxies
----------------------------------------------------------------------------------------------------------------
Proposed 2000--
Expense 1996 Expense
Expense category weights \1\ weights Proposed price proxies
\2\
----------------------------------------------------------------------------------------------------------------
Total............................................ 100.000 100.000
Physician Earnings \3\....................... 52.466 54.460
Wages and Salaries....................... 42.730 44.197 AHE--Private.
Benefits \4\............................. 9.735 10.263 ECI--Ben: Private.
Physician Practice Expenses.................. 47.534 45.540
Nonphysician Employee Compensation....... 18.654 16.812
Employee Wages and Salaries.......... 13.809 12.424
Prof/Tech Wages.................. 5.887 5.662 ECI-W/S: Private P&T.
Managerial Wages................. 3.333 2.410 ECI-W/S: Private Admin.
Clerical Wages................... 3.892 3.830 ECI-W/S: Private Clerical.
Services Wages................... 0.696 0.522 ECI-W/S: Private Service.
Employee Benefits \4\................ 4.845 4.388 ECI-Ben: Priv. White Collar.
Office Expenses.......................... 12.209 11.581 CPI(U)--Housing
Professional Liability Insurance......... 3.865 3.152 CMS--Prof. Liab. Phys.
Premiums.
Medical Equipment........................ 2.055 1.878 PPI--Medical Instruments &
Equip.
Pharmaceuticals and Medical Materials and 4.320 4.516
Supplies.
Medical Materials and Supplies....... 2.011 .............. PPI Surg. Appliances and
Supplies/CPI(U) Med
Supplies.
Pharmaceuticals...................... 2.308 .............. PPI Ethical Prescription
Preparations.
Other Professional Expenses.............. 6.433 7.601 CPI-U All Items Less Food and
Energy.
----------------------------------------------------------------------------------------------------------------
\1\ Due to rounding, weights may not sum to 100.000 percent.
[[Page 49051]]
\2\ Sources: Physician Socioeconomic Statistics, 2000-2002 Edition (SMS Survey), Physician Socioeconomic
Statistics, 2003 Edition (PCPS Survey), Center for Health Policy Research, American Medical Association; 2003
Employment Cost Index, U.S. Department of Labor, Bureau of Labor Statistics; U.S. Department of Commerce,
Bureau of Economic Analysis 1997 Benchmark Input Output Tables, and U.S. Department of Commerce, Bureau of the
Census, 2002 Current Population Survey.
\3\ Includes employee physician payroll.
\4\ Includes paid leave.
To determine the expenditure weights for the proposed rebased and
revised MEI, we used currently available and statistically valid data
sources on physician earnings and practice expenses. While we consulted
numerous data sources, we used five data sources to determine proposed
MEI expenditure weights: (1) The 2003 AMA Physician Socioeconomic
Statistics (2000 survey data) for self-employed physicians, (2) the
2000-2002 AMA Physician Socioeconomic Statistics (1998 data) for self-
employed physicians, (3) the March 2003 BLS Employment Cost Index, (4)
the 2002 Bureau of the Census CPS, and (5) the Bureau of Economic
Analysis (BEA) 1997 Benchmark Input-Output tables (I/O). No one data
source provided all of the information needed to determine expenditure
weights according to our criteria. The development of each of the cost
categories using these sources is described in detail below.
b. Physician Earnings
Like the current MEI, the proposed rebased and revised MEI will use
AMA data on mean physician net income (physician earnings) for self-
employed physicians to develop a weight for physician earnings. The
weight for this expense category was based on AMA data for 2000 and was
calculated as a percentage of total mean expenses (physician earnings
and practice expenses, including malpractice). The physician earnings
expenditure category also includes employee physician compensation.
Currently, physician earnings and overhead expenses generated by
employee physicians are included in the AMA practice expenses category.
However, we believe it is appropriate, for our purposes, to place
employee physician compensation in the MEI cost category of physician
earnings since employee physician compensation represents actual
expenditures made in the delivery of services. In addition, including
employee physician payroll in physician earnings in the MEI is
consistent with the current payment methodologies in accordance with
the physician fee schedule, where the work RVU is computed based on
what service is provided and not on who provides the service. Since
employee physicians perform the same services as self-employed
physicians, employee physician time is reflected in the work RVU. By
including the compensation of employee physicians in the physician
earnings expense category, these expenses will be adjusted by the
appropriate price proxies for a physician's own time.
To obtain further detail for both wages/salaries and benefits, the
ratio between these categories for 1996 (based on current MEI) was
updated to 2000 using the growth in the overall employment cost index
for private employees for wages/salaries and benefits. Alternative data
for determining this split were not readily available from any other
source. The main shortcoming of this method is that any changes in
quantity and intensity (mix of physicians) are not reflected. However,
faced with the lack of alternative data, we deemed this approach to be
the most feasible, and the results appear to be consistent with
anecdotal evidence on this ratio. Its application resulted in a wage-
fringe benefit split of 81.4 and 18.6 percent, respectively, in the
proposed revised and rebased MEI compared with a wage-fringe benefit
split of 81.2 and 18.8 percent, respectively in the 1996-based MEI.
c. Physician Practice Expenses
To determine the remaining individual practice expense weights, we
updated AMA expense data from 1998 to 2000 using the relative price
change in an appropriate price index. After the levels were updated to
2000 values, it was necessary to normalize these levels to equal the
2000 mean total expense data provided by the 2003 AMA survey. The
detailed explanations for the derivation of the individual weights are
listed below.
(i) Nonphysician Employee Compensation
The cost share for nonphysician employee compensation was developed
by updating the 1998 AMA Socioeconomic Survey data on nonphysician
employee compensation costs for self-employed physicians to 2000, using
the current proxy for this category, and dividing the resulting amount
into total expenses (physician earnings plus practice expenses) for
2000 from the AMA survey. We further divided this cost share into
wages/salaries and benefits using BLS Employment Cost Index data. The
ECI survey contains data on the proportion of total compensation
accounted for by wages/salaries and benefits (including paid leave) by
private industry health services occupational category. These
proportions can be used to distribute the total non-physician employee
compensation weight to wages/salaries and benefits for non-physician
employees. We used 2000 data from the March 2003 publication. Although
this survey does not contain data specifically for offices of
physicians, data are available on wage/fringe shares for private
industry health services, which include hospitals, nursing homes,
offices of physicians, and offices of dentists. We believe the data for
health services from the survey do provide a reasonable estimate of the
split between wages and fringe benefits for employees in physicians'
offices. Data for 2000 in the ECI survey for total health services
indicate that wages and fringe benefits are 74.02 percent and 25.98
percent of compensation, respectively.
As in the 1996-based MEI, we are proposing to use CPS data on
earnings by occupation to develop cost shares for wages for
nonphysician occupational groups shown in Table 6. To arrive at a
distribution for these separate categories, we multiplied the overall
share for nonphysician employee wages/salaries by each of the
occupational proportions from the 2000 CPS. The proposed distribution
and the distribution in the current MEI are presented in Table 6.
Table 6.--Percent Distribution of Nonphysician Payroll Expense by
Occupational Group: 2000 and 1996
------------------------------------------------------------------------
2000 1996
BLS Occupational Group Expenditure Expenditure
Shares Shares
------------------------------------------------------------------------
Total......................................... 100.000 100.000
Professional & Technical Workers............ 42.635 45.573
Managers.................................... 24.138 19.398
Clerical Workers............................ 28.187 30.827
Service Workers............................. 5.040 4.202
------------------------------------------------------------------------
Note: Values may not sum to 100 due to rounding.
[[Page 49052]]
(ii) Professional Liability Expense
The weight for professional liability expense was derived from the
2003 AMA survey (2000 data) and was calculated as the mean professional
liability expense expressed as a percentage of total expenses
(physician earnings plus practice expenses). This calculation resulted
in a 3.865 percent share of total costs in 2000 compared to a 3.152
percent share in the 1996-based index. The increase in weight for
professional liability insurance represents the increases in premiums
and increases in the amount of coverage purchased by physicians in 2000
compared to 1996. Since the data do not reflect any changes caused by
increases in these expenses in 2001 and 2002, they do not take into
account the recent acceleration in the growth in premiums that
physicians have experienced and, therefore, the weights will not
reflect these changes. However, the proxy that we currently use in the
1996-based index--and will continue to use in the proposed rebased and
revised index--does reflect the price increases associated with the
recent rise in malpractice costs.
(iii) Office, Medical Equipment, Pharmaceuticals and Medical Materials
and Supplies Expenses, and All Other Expenses
The 2003 AMA survey provides less detail for expenses with respect
to prior years' publications. Therefore, we calculated the share of
each of the above categories by updating the AMA data for 1998 to 2000
using an appropriate price proxy. The primary reason for using the
price proxy was that we lacked other data to develop cost weights for
each of these categories. As stated previously, the main deficiency of
this method is that it does not account for any changes in the quantity
or intensity effects associated with these expenses. Our belief,
however, was that it was important to continue using these detailed
breakouts so that each would be proxied by an appropriate price index
and that the quantity/intensity effects over a short period of time are
not likely to be large. In fact, we have found that even over longer
periods of time, the distribution of costs tends to be relatively
similar.
Office expenses and medical equipment levels were moved to 2000
using the growth from 1998 to 2000 in their respective MEI price
proxies. In the case of office expenses, we used the growth in the CPI-
U Housing; for medical equipment expenses, we used the growth in the
PPI for Medical Instruments and Equipment.
The share for pharmaceuticals (prescription drugs) and medical
materials and supplies was calculated by separating out pharmaceuticals
and other medical materials and supplies using 1997 BEA Benchmark
Input-Output data. First, the sum of all the pharmaceuticals and
medical supplies categories from the Benchmark Input-Output tables for
1997 was calculated. The share of pharmaceuticals and medical supplies
was then calculated as a percentage of this total and applied to the
1997 AMA medical supplies data. These calculated levels were then
inflated to 2000 using the growth in an appropriate price proxy. We
thought it was important and appropriate to account for each of these
categories separately so that differences in relative price growth
between pharmaceuticals (prescription drugs) and other medical
materials and supplies would be more accurately represented. The
resulting 2000 data for the two separate categories were then
aggregated (summed) together to form the overall total for the share
for the pharmaceuticals and medical materials and supplies category in
the rebased and revised MEI. The pharmaceuticals category was inflated
using the Producer Price Index (PPI) for ethical prescription
preparations and the medical materials and supplies category was
updated using the PPI for surgical appliances and supplies.
Finally, the All Other Expense category was calculated as a
residual (total expenses less the percentage of all categories
currently accounted for). The additional detail for transportation
expenses found in the prior MEI was removed because the data were not
readily available for measurement of a cost share for 2000. The effect
on the MEI of removing the detail is negligible.
4. Selection of Price Proxies for Use in the MEI
After the 2000 cost weights for the rebased and revised MEI were
developed, we reviewed the current set of price proxies to determine
whether they were still the most appropriate for each expenditure
category. As was the case in the development of the 1996-based MEI (57
FR 55901), most of the indicators we considered are based on BLS data
and are grouped into one of the following five categories:
Producer Price Indices (PPIs)
PPIs measure price changes for goods sold in other than retail
markets. They are the preferred proxies for physician purchases at the
wholesale level. These fixed-weight indices are a measure of price
change at the producer or at the intermediate stage of production, a
more likely mode of purchase for physicians.
Consumer Price Indices (CPIs)
CPIs measure change in the prices of final goods and services
purchased by consumers. Like the PPIs, they are fixed-weight. Since
they may not represent the price changes faced by producers, CPIs were
used if there were no appropriate PPI or if the expenditure category
was similar to expenditure of retail consumers in general.
Average Hourly Earnings (AHEs)
AHEs are available for production and nonsupervisory workers for
specific industries as well as for the nonfarm business economy. They
are calculated by dividing gross payrolls for wages/salaries by total
hours. The series reflects shifts in employment mix and, thus, is
representative of actual changes in hourly earnings for industries or
for the nonfarm business economy.
ECIs for Wages/Salaries
These ECIs measure the rate of change in employee wage rates per
hour worked. These fixed-weight indices are not affected by shifts in
industry or occupation employment levels and measure only the pure rate
of change in wages.
ECIs for Employee Benefits
These ECIs measure the rate of change in employer costs of employee
benefits, such as the employer's share of Social Security taxes,
pension and other retirement plans, insurance benefits (life, health,
disability, and accident), and paid leave. Like ECIs for wages/
salaries, the ECIs for employee benefits are not affected by changes in
industry output or occupational shifts.
When choosing wage and price proxies for each expense category, we
evaluate the strengths and weaknesses of each proxy variable using four
criteria. The first criterion is relevance. The price variable should
appropriately represent price changes for specific goods or services
within the expense category. Relevance may encompass judgments about
relative efficiency of the market generating the price and wage
increases.
The second criterion is reliability or low sampling variability. If
the proxy wage-price variable has a high sampling variability or
inexplicable erratic patterns over time, its value is greatly
diminished, since it is unlikely to accurately reflect price changes in
its associated expenditure category. Low sampling variability can
conflict with relevance, since the more specifically a price variable
is defined in terms of
[[Page 49053]]
service, commodity, or geographic area, the higher the possibility of
sampling variability. The length of time the time-series data have been
published is also important. A well-established time series is needed
to assess the reasonableness of the series and to provide a solid base
from which to forecast future price changes in the series. We need to
forecast the MEI to make Federal budget and Trustees Report estimates.
The third criterion is timeliness of actual published data. For
this reason, we prefer monthly and quarterly data to annual data.
The fourth criterion is public availability. We prefer to use data
sources that are publicly available for our indices so that the public
may track each of the individual components in the MEI.
The BLS price proxy categories previously described meet the
criteria of relevance, reliability and timeliness, and public
availability. Below we discuss the price-wage proxies for the rebased
and revised MEI (shown in Table 1).
(a) Expense Categories in the MEI
Physician Time
In the proposed revised and rebased MEI, we are using the AHE for
the private nonfarm economy as the proxy for the physician wages/
salaries component; this is the same price measure used in the 1996-
based MEI. In our judgment, this proxy still most closely comports with
Congressional intent as expressed in the Senate Finance Committee's
1972 report (S. Rept. No. 92-1230 at 191 (1972)). AHEs change in
accordance with changes in the type and mix of workers.
As we discussed extensively in the November 2, 1998 final rule (63
FR 58848) and again in the December 31, 2002 final rule (67 FR 80019),
we believe that the current price proxy for physicians' earnings--AHE
in the nonfarm business economy--is the most appropriate proxy to use
in the MEI. The AHE for the nonfarm business economy reflects the
impacts of supply, demand, and economy-wide productivity for the
average worker in the economy. Using this measure as the proxy for
physicians' earnings captures the parity in the rate of change in wages
for the average worker and for physicians. In addition, use of this
proxy is consistent with the original legislative intent that the
change in the physicians' earnings portion of the MEI parallel the
change in general earnings for the economy. Since earnings are
expressed per hour, a constant quantity of labor input per unit of time
is reflected. The use of the AHE data is also consistent with our using
the BLS economy-wide multifactor productivity measures since economy-
wide wage increases reflect economy-wide productivity increases.
Using the ECI for professional and technical workers or other
occupational-specific wage proxies has a major shortcoming; in many
instances, occupations such as engineering, computer science, and
nursing have unique characteristics that are not representative of the
overall economy or the physician market. Specifically, wage changes for
such occupations can be influenced by excess supply or demand for these
types of workers. We believe it would not be appropriate to proxy the
physician earnings portion of the MEI with a wage proxy that reflects
these other occupation's unique characteristics.
The current MEI uses the ECI for fringe benefits for total private
industry as the price proxy for physician fringe benefits. We are
proposing to use the same proxy for the 2000-based MEI. This means that
both the wage and fringe benefit proxies for physician earnings are
derived from the nonfarm private sector and are computed on a per-hour
basis.
Nonphysician Employee Compensation
As in the 1996-based MEI, we are proposing to use Current
Population Survey data on earnings and employment by occupation to
develop labor cost shares for the nonphysician occupational groups
shown in Table 6. BLS maintains an ECI for each occupational group, and
we propose to use these ECIs as price proxies for nonphysician employee
wages in the same manner they are used in the current MEI.
The skill mix shift in employees of physician offices in the last
few years has been towards managerial occupations. While these skill
mix shifts are captured in the expenditure weights, they are
appropriately held constant in a Laspeyres price index such as the MEI.
Skill mix shifts, which may reflect the changing intensity of services
provided in physicians' offices, are accounted for in the payment
system outside of the MEI.
The current MEI uses the ECI for fringe benefits for white collar
employees in the private sector as a proxy for nonphysician benefits.
Since most nonphysician employees in physicians' offices are white-
collar employees, we are again proposing to use the ECI for benefits
for white collar employees in the proposed rebased and revised MEI.
Office Expense
Office expenses include rent or mortgage for office space,
furnishings, insurance, utilities, and telephone. We are proposing the
continued use of the CPI-U for housing because it is a comprehensive
measure of the cost of housing, including rent, owner's equivalent
rent, and the types of goods and services associated with running an
office. This proxy covers about 80 percent of the population.
Pharmaceuticals and Medical Materials and Supplies
This cost category includes drugs, outside laboratory work, x-ray
films, and other related services. There is not one price proxy that
includes this complete mix of materials and supplies. In the absence of
one index, we are proposing to separately account for pharmaceuticals
and medical materials and supplies in the 2000-based MEI.
[sbull] Medical Materials and Supplies
We equally weighted two proxies together (the PPI Surgical
Appliances and Supplies and the CPI-U for Medical Equipment and
Supplies) since one proxy does not accurately measure the price change
associated with these types of products used nor the mode of purchase
used in physicians' offices. While both indexes include such items as
bandages, dressings, catheters, I.V. equipment, syringes, and other
general disposable medical supplies and nonprescription equipment, the
indexes reflect significant differences in the mode of purchase. The
PPI measures actual transaction prices at the wholesale level, the mode
most likely used by physicians, while the CPI measures prices at the
retail level or the final stage of production. The price movements in
these two indexes can be different and we believe that it is
appropriate to combine these indexes into one proxy since physicians
likely use both purchasing methods when obtaining medical supplies.
[sbull] Pharmaceuticals
The PPI for ethical prescription drugs is used to proxy
pharmaceutical prices in other CMS market baskets and reflects the
price change associated with the average mix of pharmaceuticals
purchased economy-wide. We propose to use the PPI for ethical
prescription drugs, rather than the CPI for prescription drugs, because
physicians generally purchase drugs directly from a wholesaler. The
PPIs that we use measure price changes at the final stage of
production.
[[Page 49054]]
Professional Liability Insurance
It is vital that the MEI accurately reflect the price changes
associated with professional liability costs. Accordingly, we continue
to incorporate into the MEI a price proxy that accomplishes this goal
by making the maximum use of available data on professional liability
premiums.
Each year, we solicit professional liability premium data for
physicians from a small sample of commercial carriers. This information
is not collected through a survey form, but instead is requested, on a
voluntary basis, from a few national commercial carriers via letter.
Generally between 5 and 8 carriers volunteer this information. While
the sample size certainly does not cover the entire professional
liability insurance market, we have attempted to maximize the market
share in terms of both national coverage and coverage within States.
As we require for our other price proxies, the professional
liability price proxy should reflect the pure price change associated
with this particular cost category. Thus, it should not capture changes
in the mix or level of liability coverage. To accomplish this result,
we obtain premium information from commercial carriers for a fixed
level of coverage, currently $1 million per occurrence and a $3 million
annual limit. This information is collected for every State by
physician specialty and risk class. Finally, the State-level,
physician-specialty data are aggregated by effective premium date to
compute a national total, using counts of physicians by State and
specialty as provided in the AMA publication, Physician Characteristics
and Distribution in the U.S.
The resulting data provide a quarterly time series, indexed to a
base year consistent with the MEI and reflect the national trend in the
average professional liability premium for a given level of coverage.
From this series, quarterly and annual percent changes in professional
liability insurance are estimated for inclusion in the MEI.
The most comprehensive data on professional liability costs are
held by the State insurance commissioners but these data are available
only with a substantial time lag and, therefore, the data currently
incorporated into the MEI are much more timely. We believe that, given
the limited data available on professional liability premiums, this
methodology adequately reflects the price trends facing physicians.
Medical Equipment
Medical equipment includes depreciation, leases, and rent on
medical equipment. We propose to use the PPI for medical instruments
and equipment as the price proxy for this category, consistent with the
price proxy used in the 1996-based MEI and other CMS input price
indexes.
Other Professional Expenses
This category includes the residual subcategory of other
professional expenses such as accounting services, legal services,
office management services, continuing education, professional
association memberships, journals, professional car expenses, and other
professional expenses. In the absence of one price proxy or even a
group of price proxies that might reflect this heterogeneous mix of
goods and services, we use the CPI-U for all items, less food and
energy, consistent with the price proxy used in the 1996-based MEI. We
also propose to condense the structure used in the previous 1996-based
MEI because we lack the data to develop a representative weight for
transportation, as discussed above. This change would result in only a
negligible effect on the overall MEI over the past 8 years; the average
increase differs by less than a tenth of a percentage point over that
time.
(b) Productivity Adjustment to the MEI
In the December 2002 final rule, we indicated that we were changing
the methodology for adjusting for productivity in the MEI. The MEI used
for the 2003 physician payment update reflected changes in the 10-year
moving average of private nonfarm business (economy-wide) multifactor
productivity applied to the entire index; we had previously used
economy-wide private nonfarm business labor productivity applied to the
labor portions of the index. We will continue to use the method of
adjusting for multifactor productivity applied to the entire index in
the proposed rebased and revised MEI.
As described in the December 31, 2002 final rule, we used
multifactor productivity because: (1) it is theoretically more
appropriate to explicitly reflect the productivity gains associated
with all inputs (both labor and nonlabor); (2) the recent growth rate
in economy-wide multifactor productivity appears to be more consistent
with the current market conditions facing physicians; and (3) the MEI
still uses economy-wide wage changes as a proxy for physician wage
changes. We believe that using a 10-year moving average change in
economy-wide multifactor productivity produces a stable and predictable
adjustment and is consistent with the moving-average methodology used
in the current 1996-based MEI. The adjustment will be based on the
latest available actual historical economy-wide multifactor
productivity data, as measured by BLS.
5. Results of Rebasing
Updating the MEI from a 1996 base year to a 2000 base year resulted
in small changes in expense category weights. Physicians' earnings
dropped slightly, from 54.5 percent of the index in 1996 to 52.5
percent in 2000. The expense shares for non-physician employee
compensation, office expenses, professional liability insurance, and
medical equipment all rose slightly, while expense shares for medical
materials and supplies and all other expenses declined.
The rebased and revised MEI is similar in structure to the current
MEI. Except for two-tenths of a percentage point difference in 2000,
the annual percent change in the rebased and revised MEI was within
one-tenth of a percentage point of the percent change in the 1996-based
MEI each year between 1996 and 2003. Therefore, the revision and
rebasing proposed in this rule, while making the expense shares more
timely, has little impact on the percent changes in the MEI as a whole.
Table 7 below shows the average calendar-year percent change from 1996
to 2003 for both the 1996- and 2000-based MEIs.
Table 7.--Annual Percent Change in the Current and Proposed Revised and
Rebased Medicare Economic Index
------------------------------------------------------------------------
Proposed 2000- Current 1996-
Update year (A) based MEI based MEI
------------------------------------------------------------------------
1996.................................... 1.7 1.8
1997.................................... 1.9 1.9
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1998.................................... 2.4 2.4
1999.................................... 2.7 2.6
2000.................................... 2.9 2.7
2001.................................... 2.8 2.8
2002.................................... 3.3 3.3
2003.................................... 3.1 3.0
Avg Change 1996-2003.................... 2.6 2.6
------------------------------------------------------------------------
(A) Update year based on historical data through the second quarter of
the prior calendar year. For example, the 2003 update is based on
historical data through the second quarter 2002.
The forecast of the proposed rebased and revised MEI for the 2004
Physician Fee Schedule is an increase of 2.5 percent, nearly identical
to the forecasted increase using the previous 1996-based MEI. In the
final rule we will incorporate historical data through the second
quarter of 2003; therefore, the current estimated increase of 2.5
percent for 2004 may differ in the final rule.
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6. Adjustments to RVUs To Match the New MEI Weights
As described in the previous section, we are proposing to rebase
the MEI and establish new weights for physician work, practice expense
and malpractice. Based on 2002 Medicare utilization data, we compared
the proportion of total RVUs attributable to physician work, practice
expense and malpractice to the new MEI weights. We show the proportion
of total RVUs attributable to work, practice expense and malpractice
and their respective proposed new MEI weights across all physicians'
services in the following table:
Table 10
------------------------------------------------------------------------
Proposed
MEI 2002 RVUs
weight
------------------------------------------------------------------------
Physician Work.................................... 52.466% 52.649%
Practice Expense.................................. 43.669% 44.175%
Malpractice....................................... 3.865% 3.176%
------------------------------------------------------------------------
The MEI weights for physician work and practice expense are lower
than the proportion of 2002 aggregate RVUS attributable to these
categories. The malpractice weight within the MEI is higher than its
share of total aggregate 2002 RVUs. (The 2002 shares from the Medicare
utilization do not match the 1996 MEI weights because deviations occur
over time based on changes in the mix of services billed by physicians
and other factors).
We believe there is merit in adjusting the RVUs to match the
revised MEI weights. By giving more weight to malpractice and less
weight to physician work and practice expenses, Medicare's payments
will better reflect each component of physician practice expenses.
Section 1848(c)(2)(B)(ii)(II) of the Act requires that increases or
decreases in RVUs may not cause the amount of expenditures for the year
to differ by more than $20 million from what expenditures would have
been in the absence of these changes. If this threshold is exceeded, we
make across-the-board adjustments to preserve budget neutrality.
Therefore, if we adjust the work, practice expense and malpractice RVUs
to match the new MEI weights, we are required by statute to ensure that
the adjustments do not increase or decrease Medicare expenditures by
more than $20 million. To meet the requirements of the statute and
ensure that aggregate pools of RVUs match the proposed new MEI weights,
we considered two options. We considered making no adjustments to the
physician work RVUs and adjusting only the practice expense and
malpractice RVUs or adjusting all 3 categories of RVUs. We considered
the first option because the medical community, in the past, has
expressed interest in avoiding adjustments to physician work RVUs.
However, we could only meet the requirements of section
1848(c)(2)(B)(ii)(II) if we reduced the physician fee schedule
conversion factor by an additional 0.3 percentage points in addition to
the -4.2 percent reduction we are already forecasting. We believe a
small reduction to the physician work RVUs is preferable to a reducing
the conversion factor by an additional 0.3 percent. For this reason, we
are proposing to reduce the physician work RVUs by 0.35 percent
(0.9965) and the practice expense RVUs by 1.15 percent (0.9885) and
increase the malpractice RVUs by 21.7 percent (1.217) to match the
rebased MEI weights. The effects of these adjustments to the RVUs are
included in the RVUs shown in Addendum B of this proposed rule and, as
explained previously, would not require a compensating adjustment to
the conversion factor.
B. Definition of Diabetes for Diabetes Self-Management Training
Section 4105(a) of the Balanced Budget Act of 1997 (BBA) (Pub. L.
105-33, enacted on August 5, 1997) provides coverage for outpatient
diabetes self-management training in outpatient settings without
limiting this coverage to hospital outpatient departments. The BBA
provided that the services would be provided ``to an individual with
diabetes.'' In the December 29, 2000, final rule entitled, ``Expanded
Coverage for Outpatient Diabetes Self-Management Training and Diabetes
Outcome Measurements'', (65 FR 83129) we established criteria to define
``an individual with diabetes.'' At that time, we did not have a
definition of diabetes that had been widely accepted. Therefore, we
established a set of medical conditions to determine who should receive
the service.
In Sec. 410.141(d), we stated that any beneficiary who has one or
more of the following medical conditions occurring within the 12-month
period before the physician's order for the training would be eligible
for Medicare coverage for training from an approved entity:
[sbull] New onset diabetes.
[sbull] Inadequate glycemic control as evidenced by a glycosylated
hemoglobin (HbA1C) level of 8.5 percent or more on two consecutive
HbA1C determinations 3 or more months apart in the year before the
beneficiary begins receiving training.
[sbull] A change in treatment regimen from no diabetes medications
to any diabetes medication, or from oral diabetes medication to
insulin.
[sbull] High risk for complications based on inadequate glycemic
control (documented acute episodes of severe hyperglycemia or acute
severe hyperglycemia occurring in the past year during which the
beneficiary needed emergency room visits or hospitalization).
[sbull] High risk based on at least one of the following documented
complications:
--Lack of feeling in the foot or other foot complications such as foot
ulcers, deformities, or amputation;
--Pre-proliferative or proliferative retinopathy or prior laser
treatment of the eye; and
--Kidney complications related to diabetes, when manifested by
albuminuria, without other cause, or elevated creatinine.
These requirements have been shown to be burdensome to the public
and to Medicare contractors. Therefore, we are proposing that the
requirements be streamlined to use the definition of diabetes that was
established in a later regulation at Sec. 410.130 and is used to
determine beneficiary eligibility for Medical Nutrition Therapy when
the beneficiary has a diagnosis of diabetes. The definition is:
Diabetes means diabetes mellitus consisting of two types. Type 1 is
an autoimmune disease that destroys the beta cells of the pancreas,
leading to insulin deficiency. Type 2 is familial hyperglycemia that
occurs primarily in adults but can also occur in children
[[Page 49059]]
and adolescents. It is caused by an insulin resistance whose etiology
is multiple and not totally understood. Gestational diabetes is any
degree of glucose intolerance with onset or first recognition during
pregnancy. The diagnostic criterion for a diagnosis of diabetes for a
fasting glucose intolerance test is greater than or equal to 126 mg/dL.
C. Outpatient Therapy Services Performed ``Incident To'' Physicians'
Services--Discussion Only
In almost all settings, our policy provides that outpatient therapy
services can be delivered only by physical therapists, occupational
therapists, physical therapy assistants, occupational therapy
assistants, and speech and language pathologists as defined by our
regulations at Sec. 484.4. While there are currently no national
standards for qualifications of individuals providing outpatient
therapy services incident to physicians' services, we believe that
standards similar to those in Sec. 484.4 are appropriate. Section
1862(a)(20) of the Act requires that any therapy services furnished
incident to a physician's professional services must meet the standards
and conditions that would apply to such therapy services if they were
furnished by a therapist, with the exception of the licensing
requirement.
The OIG conducted a study in March of 1994 (OEI-02-09-00590) which
revealed that 78 percent of ``incident to'' physical therapy services
did represent therapy services covered under Medicare (that is,
reasonable and necessary as defined in section 1862(a)(1)(A) of the
Act). The study also questioned the training of staff providing these
services. Also, in 2002 we contracted for a report on the utilization
of therapy services. The text of that report is available at
www.cms.hhs.gov/medlearn/therapy under Research Tools for Specific
Therapy Topics, DynCorp Report--Outpatient Therapy Utilization
September 2002. The study found that 25 percent of the beneficiaries in
2000 were treated in the offices of physicians and nonphysician
practitioners. There is currently no process to ensure the quality of
the services provided in those settings.
The pending implementation of financial limitations on outpatient
therapy services emphasizes the need to define the qualifications of
those providing therapy services. The limited therapy services covered
by Medicare must be provided by people who meet qualifications needed
to render skilled services.
In order to conform to section 1862(a)(20) of the Act, we are
considering adopting the existing qualification and training standards
(with the exception of licensure) in Sec. 484.4 for individuals
providing therapy services independently and incident to physicians'
services. We are not proposing a change at this time, but are
interested in receiving comments from the public, particularly
physicians and staff who would be affected, on adoption of the existing
standards in Sec. 484.4, to services of independent therapists and
``incident to'' services as well as alternatives that we might use to
ensure that qualified staff are providing ``incident to'' therapy
services. These comments would assist us in the development of any
future proposal concerning this issue.
D. Status of Anesthesia Work and Five-Year Review
In the December 2002 final rule, we modestly increased the work of
anesthesia services. These changes were based on the analysis submitted
by the RUC of its review of the work of 19 high-volume anesthesia
codes. The RUC had provided us with its analysis but did not furnish us
with a definitive recommendation. The increase in anesthesia work
resulted in an increase in the national anesthesia conversion factor.
(We increased the physician work component of the anesthesia conversion
factor by 2.10 percent to reflect a 9.13 percent increase in anesthesia
work applied to 23 percent of anesthesia allowed charges represented by
the 19 codes. We applied a 1.6 percent increase to the anesthesia CF.)
The American Society of Anesthesiologists expressed concerns about
the completeness of the review of anesthesia under the five-year
review, and, in February 2003, we asked the RUC to continue its review
of anesthesia work values; we expected to develop a final
recommendation for a change in the anesthesia CF involving all
anesthesia codes. We asked that the RUC complete this analysis in 2003.
The RUC is considering our request and will respond to us about what
action they plan to take on this issue.
E. Payment Policies for Anesthesia Services
Currently there are different payment policies for teaching
anesthesiologists and teaching certified registered nurse anesthetists
(CRNAs). We are seeking comments on the appropriateness of applying the
CRNA teaching/resident policy to teaching anesthesiologists.
F. Technical Correction
CPT Code 96155 (Health and behavior intervention, each 15 minutes,
face-to-face; family (without the patient present)).
This code describes a visit with a patient's family without the
patient being present and was first included in the November 1, 2001
final rule. It was incorrectly listed as an active code for which
payment could be made under the physician fee schedule. Our
longstanding payment policy is that we do not pay for visits with
family where the patient is not present. Payment for such visits is
included in the pre- and post-service work of a visit where the patient
is present. Consistent with this policy, this code is non-payable under
the physician fee schedule.
IV. Collection of Information Requirements
This document does not impose information collection and
recordkeeping requirements. Consequently, it need not be reviewed by
the Office of Management and Budget under the authority of the
Paperwork Reduction Act of 1995.
V. Response to Comments
Because of the large number of items of correspondence we normally
receive on Federal Register documents published for comment, we are not
able to acknowledge or respond to them individually. We will consider
all comments we receive by the date and time specified in the ``DATES''
section of this preamble, and, if we proceed with a subsequent
document, we will respond to the major comments in the preamble to that
document.
VI. Regulatory Impact Analysis
We have examined the impact of this rule as required by Executive
Order 12866 (September 1993, Regulatory Planning and Review), the
Regulatory Flexibility Act (RFA) (September 16, 1980 Pub. L. 96-354),
section 1102(b) of the Social Security Act, the Unfunded Mandates
Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132.
Executive Order 12866 directs agencies to assess all costs and
benefits of available regulatory alternatives and, when regulation is
necessary, to select regulatory approaches that maximize net benefits
(including potential economic, environmental, public health and safety
effects, distributive impacts, and equity). A regulatory impact
analysis must be prepared for proposed rules with economically
significant effects (that is, a proposed rule that would have an annual
effect on the economy of $100 million or more in any
[[Page 49060]]
1 year, or would adversely affect in a material way the economy, a
sector of the economy, productivity, competition, jobs, the
environment, public health or safety, or State, local, or tribal
governments or communities). We have simulated the effect of the
proposed changes to the practice expense RVUs described earlier. The
net effect of the changes we are proposing will not materially increase
or decrease Medicare expenditures for physicians' services because the
statute requires that changes to RVUs cannot increase or decrease
expenditures more than $20 million. Since increases in payments
resulting from RVU changes must be offset by decreases in payments for
other services, the proposed practice expense changes will result in a
redistribution of payments among physician specialties. The RVU changes
in this proposed rule have an estimated aggregate redistributive effect
of approximately $190 million dollars. (Tables 11 and 12 which appear
later in this section reflect the estimated specialty impacts.)
Therefore, we are considering this proposed rule to be a major rule
because it is economically significant, and, thus, we have prepared a
regulatory impact analysis.
The RFA requires that we analyze regulatory options for small
businesses and other entities. We prepare a Regulatory Flexibility
Analysis unless we certify that a rule would not have a significant
economic impact on a substantial number of small entities. The analysis
must include a justification concerning the reason action is being
taken, the kinds and number of small entities the rule affects, and an
explanation of any meaningful options that achieve the objectives and
less significant adverse economic impact on the small entities.
Section 1102(b) of the Act requires us to prepare a regulatory
impact analysis for any proposed rule that may have a significant
impact on the operations of a substantial number of small rural
hospitals. This analysis must conform to the provisions of section 603
of the RFA. For purposes of section 1102(b) of the Act, we define a
small rural hospital as a hospital that is located outside a
Metropolitan Statistical Area and has fewer than 100 beds.
For purposes of the RFA, physicians, nonphysicians, and suppliers
are considered small businesses if they generate revenues of $6 million
or less. Approximately 95 percent of physicians (except mental health
specialists) are considered to be small entities. There are about
700,000 physicians, other practitioners and medical suppliers that
receive Medicare payment under the physician fee schedule. The analysis
and discussion provided in this section as well as elsewhere in this
proposed rule is intended to comply with the RFA requirements.
Section 202 of the Unfunded Mandates Reform Act of 1995 also
requires that agencies assess anticipated costs and benefits before
issuing any rule that may result in expenditure in any 1 year by State,
local, or tribal governments, in the aggregate, or by the private
sector, of $110 million. This proposed rule would not impose unfunded
mandates on State, local, or tribal governments, or on the private
sector of more than $110 million dollars.
We have examined this proposed rule in accordance with Executive
Order 13132 and have determined that this regulation would not have any
significant impact on the rights, roles, or responsibilities of State,
local, or tribal governments.
We have prepared the following analysis, which together with the
rest of this preamble, meets all assessment requirements. It explains
the rationale for, and purposes of, the rule, details the costs and
benefits of the rule, analyzes alternatives, and presents the measures
we propose to use to minimize the burden on small entities. As
indicated elsewhere in this proposed rule, we propose to make changes
to the Medicare Economic Index, refine resource-based practice based
practice expense RVUs and make a variety of other minor changes to our
regulations, payments or payment policy to ensure that our payment
systems are updated to reflect changes in medical practice and the
relative value of services. We provide information for each of the
proposed policy changes in the relevant sections in this proposed rule.
As discussed elsewhere in this proposed rule, the provisions of this
proposed rule, if adopted, would only change Medicare payment rates for
physician fee schedule services. While this rule would revise the
definition of diabetes for the purposes of outpatient diabetes self-
management training, it does not impose reporting, record-keeping and
other compliance requirements. We are unaware of any relevant Federal
rules that duplicate, overlap or conflict with this proposed rule. The
relevant sections of this proposed rule contain a description of
significant alternatives.
A. Resource-Based Practice Expense Relative Value Units
Under section 1848(c)(2) of the Act, adjustments to RVUs may not
cause the amount of expenditures to differ by more than $20 million
from the amount of expenditures that would have resulted without such
adjustments. We are proposing several changes that would result in a
change of expenditures that would exceed $20 million if we made no
offsetting adjustments to either the conversion factor or RVUs.
With respect to practice expense, our policy has been to meet the
budget neutrality requirements in the statute by incorporating a
rescaling adjustment in the practice expense methodology. That is, we
estimate the aggregate number of practice expense relative values that
will be paid under current and proposed policy in CY 2004. We apply a
uniform adjustment factor to make the aggregate number of proposed
practice expense relative values equal the number estimated that would
be paid under current policy.
Table 11 shows the specialty level impact on payment of changes
being proposed for CY 2004. The payment impacts reflect averages for
each specialty based on Medicare utilization. The payment impact for an
individual physician would be different from the average, based on the
mix of services the physician provides. The average change in total
revenues would be less than the impact displayed here since physicians
furnish services to both Medicare and non-Medicare patients and
specialties may receive substantial Medicare revenues for services that
are not paid under the physician fee schedule. For instance,
independent laboratories receive more than 80 percent of their Medicare
revenues from clinical laboratory services that are not paid under the
physician fee schedules. The table shows only the payment impact on
physician fee schedule services.
We modeled the impact of four changes to the practice expense
methodology and illustrated the effect in table 11 below. The column
labeled ``Utilization Data'' shows the effect of updating the practice
expense methodology to add 2002 utilization data for codes that did not
exist in the 1997-2000 period. In general, updating the methodology
with the latest utilization data will have the largest impact on
payment for a new service where a code was established in 2002. In some
cases, the practice expense RVU will increase (for example, 64561--
Implant Neuroelectrodes and 52001, Cystoscopy Removal of Clots). In
other cases, they will go down (96567--photodynamic treatment skin and
G0249--Providing test materials and equipment for home INR Monitoring,
77418--Radiation Treatment Delivery--Intensity Modulated Radiation).
For most specialties, new codes represent a
[[Page 49061]]
small proportion of the specialties' revenues and updating the practice
expense RVUs with utilization will have little impact on payment across
all of the services the specialty provides. However, updating the
practice expense methodology with the 2002 utilization data will reduce
payment to radiation oncologists by approximately 1 percent. The
payment reduction occurs because the practice expense RVUs for
radiotherapy dose planning and radiation treatment by intensity
modulated radiation are going down. Because this service represents 8
percent of Medicare revenues to radiation oncology in 2002, there is a
somewhat larger impact on this specialty than will generally occur for
most specialties.
The column labeled ``Practice Expense Refinements'' shows the
impact on payment from proposed refinements to the practice expense
RVUs. In general, the largest impact of the refinements is occurring to
surgical procedures with 10 and 90-day global periods. Most of the
impacts on these procedures will occur because of the standardization
of the intra and post period time for clinical staff. There are also
modest impacts on some specialties in the non-facility practice expense
RVUs from the refinements to clinical staff and medical supplies.
Orthopedic surgery and hand surgery will experience an approximate
reduction of 2 percent from the practice expense refinements while
payments to otolaryngology will increase by nearly 2 percent. There
will be more modest payment increases or decreases for all other
specialties from the practice expense refinements.
The column labeled ``Maxillofacial Prosthetics'' shows the impact
on payment from changing the specialty practice expense per hour
crosswalk for oral surgery (specialty 19) and maxillofacial surgery
(specialty 85) to otolaryngology. Payments to these specialties will
increase from this change and there will be virtually no impact on
payment to any other specialty.
As indicated earlier, we are also adding clinical staff time to the
professional component of several cardiac catheterization services
increasing payments for these services by a small amount. The proposed
change will cause minor payment reductions for a few other cardiology
services. All other services are unaffected by this proposal. The
column labeled ``Professional Component of a Diagnostic Test'' shows
the payment impact of the proposed change.
The column labeled ``Total'' in table 11 below shows the payment
impact by specialty of all the changes described above. If we change
any of these proposals following our consideration of comments, these
figures may change.
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The statutory methodology for updating physician fee schedule
conversion factor is specified in section 1848(d)(4) of the Act.
Consistent with the requirements of section 1848(d)(1)(E) of the Act,
we made an estimate of the physician fee schedule update for CY 2004
available to the Medicare Payment Advisory Commission (MedPAC) and the
public in March of this year. Using our point estimate of -4.2 percent,
on table 12, we are showing the estimated change in average payments by
specialty based on provisions of this proposed rule and the estimated
physician fee schedule update. As indicated above, figures will change
if we change any of our proposals following consideration of public
comment. Further, we believe it is highly likely that our estimate of
the 2004 physician fee schedule update will change before we determine
the final figure later this year.
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Table 13 shows the impact on payments for selected high volume
procedures of all of the changes previously discussed. This table shows
the combined impact of the change in the practice expense RVUs and the
estimated physician fee schedule update on total payment for the
procedure. There are separate columns that show the change in the
facility rates and the non-facility rates. For an explanation of
facility and non-facility practice expense refer to Sec.
414.22(b)(5)(i). The table shows the estimated change in payment rates
based on provisions of this proposed rule and the estimated physician
fee schedule update. If we change any of the provisions following the
consideration of public comments, these figures may change. Further,
the payment amounts shown for 2003 will change once we determine the
final figure for the physician fee schedule update.
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B. Geographic Practice Cost Indices
As discussed in section II.B., we are proposing to revise the
malpractice GPCIs based upon actual 2001 and 2002 malpractice premium
data and projected 2003 malpractice premium data. Data collection is
not yet complete therefore we were unable to include the proposed
malpractice GPCIs in this proposed rule. The revised malpractice GPCIs
in the final rule will be subject to public comment. Any changes in the
GPCIs will redistribute payments among geographic areas and will not
increase or decrease Medicare expenditures. Because the malpractice
RVUs only represent 3.9 percent on total payments on average across all
physician fee schedule services, we expect any payment impact to be
modest. We will illustrate the change in the GPCIs from use of the new
malpractice data in the final rule.
C. Tracking Codes
We are proposing a change in policy that will allow CMS to create
national payment policy and determine national payment amounts for CPT
tracking codes regardless of whether a national coverage determination
for a specific service has been made. This proposal will have no effect
on Medicare expenditures but will allow for more flexibility in
determining payment rates for new services.
D. Excision of Lesions
We are proposing to make the work RVUs the same for removal of
benign and malignant skin lesions that have the same excised diameters
that are from similar locations (for example, torso, arms, and legs).
This would result in minor redistribution in payment of these services.
Any impact on payment from this proposal is included in the specialty
and code level impacts shown above.
E. G Codes for Monitoring Heart Rhythms
As discussed earlier, we are creating several HCPCS G codes and
establishing national payment for new technology services that allow
patients with cardiac arrhythmias to be monitored in a home setting.
Currently, Medicare is making payment for these services under CPT code
93799, Unlisted cardiovascular procedure or service. Medicare carriers
make local payment determinations for unlisted procedure codes. Our
proposal will have no impact on Medicare payment for these services
since national payment will replace local carrier payment.
F. G Codes for Managing Dialysis Patients
As we previously discussed in section II.C., we have reviewed our
current payment policy for the monthly dialysis capitation payment in
response to concerns that have been raised over whether our payment
policy is consistent with current medical practice. We are proposing
new G codes for these services that would allow us to align the payment
incentives to match the frequency of the physician personally
evaluating the dialysis patient. We believe that this restructuring of
payment will assist in assuring that beneficiaries with ESRD receive
the highest quality dialysis care available as the proposed codes
provide for reimbursement for physician involvement that is consistent
with the needs of the patient in any specific month. Our proposal will
not increase or decrease Medicare payments for
[[Page 49070]]
treatment of dialysis patients. We are decreasing our current payment
to the physician for providing fewer than four visits per month. If the
physician provides four or more visits per month, we are increasing our
current payment.
G. Rebasing and Revising the MEI
As indicated in section III.A. of this proposed rule, we are
proposing to rebase and revise the MEI for the CY 2004 physician fee
schedule. Substituting the 2000 MEI weights in place of the 1996
weights currently in use will increase the MEI by approximately 0.1
percent for 2004. Based on our current estimates, we expect no impact
from this proposal on any subsequent year MEI.
H. Definition of Diabetes for Diabetes Self-Management Training
We are proposing to revise the definition of diabetes for purposes
of the Outpatient Diabetes Self-Management Training benefit and use the
definition established to determine beneficiary eligibility for Medical
Nutrition Therapy when the beneficiary has a diagnosis of diabetes. The
streamlining of the beneficiary eligibility requirements for Outpatient
Diabetes Self-Management Training will reduce administrative burden for
the referring physician or qualified non-physician practitioner and for
the accredited Outpatient Diabetes Self-Management Training programs by
simplifying documentation requirements and eliminating the need for
reconsiderations and appeals to clarify that the requirements have been
met. As indicated in the February 28, 2003 Federal Register (68 FR
9572), we incorporated an adjustment to the SGR consistent with our
original estimates of expenditures associated with this new benefit.
Our experience is that expenditures have been less than originally
estimated. We expect that simplifying administrative requirements
associated with this new benefit will make it more likely that
expenditures for diabetes self-management training will be consistent
with original estimates and there will be no increase in Medicare
expenditures from making these modifications.
I. Alternatives Considered
This proposed rule contains a range of policies. The preamble
identifies those policies when discretion has been exercised and
presents rationale for our decisions, including a presentation of
nonselected options.
J. Impact on Beneficiaries
Although changes in physicians' payments were large when the
physician fee schedule was implemented in 1992, we detected no problems
with beneficiary access to care. We do not believe that there would be
any problem with access to care as a result of the proposed changes in
this rule. While it has been suggested that the negative update for
2004 may affect beneficiary access to care, we note that the formula to
determine this update is set by statute and this regulation cannot, and
does not, change it. Furthermore, since beginning our transition to a
resource-based practice expense system in CY 1999, we have not found
that there are problems with beneficiary access to care.
In accordance with the provisions of Executive Order 12866, this
regulation was reviewed by the Office of Management and Budget.
List of Subjects
42 CFR Part 410
Health facilities, Health professions, Kidney diseases,
Laboratories, Medicare, Rural areas, X-rays.
42 CFR Part 414
Administrative practice and procedure, Health facilities, Health
professions, Kidney diseases, Medicare, Reporting and recordkeeping
requirements, Rural areas, X-rays.
For the reasons set forth in the preamble, the Centers for Medicare
& Medicaid Services proposes to amend 42 CFR chapter IV as follows:
PART 410--SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS
1. The authority citation for part 410 continues to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
2. Section 410.140 is amended by adding the definition of
``Diabetes'' to read as follows:
Sec. 410.140 Definitions.
* * * * *
Diabetes means diabetes mellitus consisting of two types. Type 1 is
an autoimmune disease that destroys the beta cells of the pancreas,
leading to insulin deficiency. Type 2 is familial hyperglycemia that
occurs primarily in adults but can also occur in children and
adolescents. It is caused by an insulin resistance whose etiology is
multiple and not totally understood. Gestational diabetes is any degree
of glucose intolerance with onset or first recognition during
pregnancy. The diagnostic criterion for a diagnosis of diabetes for a
fasting glucose intolerance test is greater than or equal to 126 mg/dL.
* * * * *
3. Section 410.141 is amended by adding paragraph (f) to read as
follows:
Sec. 410.141 Outpatient diabetes self-management training.
* * * * *
(f) Beneficiaries who may be covered. Medicare Part B covers
outpatient diabetes self-management training for a beneficiary who has
been diagnosed with diabetes.
* * * * *
PART 414--PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES
1. The authority citation for part 414 continues to read as
follows:
Authority: Secs. 1102, 1871, and 1881(b)(1) of the Social
Security Act (42 U.S.C. 1302, 1395hh, and 1395rr(b)(1)).
2. Section 414.22(b)(6)(iii) is revised to read as follows:
Sec. 414.22 Relative value units.
* * * * *
(b) * * *
(6) * * *
(iii) CMS will consider for use in determining practice expense
RVUs for the physician fee schedule survey data and related materials
submitted to CMS by March 1, 2004 to determine CY 2005 practice expense
RVUs.
* * * * *
(Catalog of Federal Domestic Assistance Program No. 93.774,
Medicare--Supplementary Medical Insurance Program)
Dated: June 20, 2003.
Thomas A Scully,
Administrator, Centers for Medicare & Medicaid Services.
Approved: July 22, 2003.
Tommy G. Thompson,
Secretary.
Addendum A--Explanation and Use of Addenda B
The addenda on the following pages provide various data pertaining
to the Medicare fee schedule for physicians' services furnished in
2003. Addendum B contains the RVUs for work, non-facility practice
expense, facility practice expense, and malpractice expense, and other
information for all services included in the physician fee schedule.
In previous years, we have listed many services in Addendum B that
are not paid under the physician fee schedule. To avoid publishing as
many pages of codes for these services, we are not including clinical
laboratory codes
[[Page 49071]]
and most alpha-numeric codes (Healthcare Common Procedure Coding System
(HCPCS) codes not included in CPT) in Addendum B.
Addendum B--2003 Relative Value Units and Related Information Used in
Determining Medicare Payments for 2003
This addendum contains the following information for each CPT code
and alphanumeric HCPCS code, except for alphanumeric codes beginning
with B (enteral and parenteral therapy), E (durable medical equipment),
K (temporary codes for nonphysicians' services or items), or L
(orthotics), and codes for anesthesiology.
1. CPT/HCPCS code. This is the CPT or alphanumeric HCPCS number for
the service. Alphanumeric HCPCS codes are included at the end of this
addendum.
2. Modifier. A modifier is shown if there is a technical component
(modifier TC) and a professional component (PC) (modifier -26) for the
service. If there is a PC and a TC for the service, Addendum B contains
three entries for the code: One for the global values (both
professional and technical); one for modifier -26 (PC); and one for
modifier TC. The global service is not designated by a modifier, and
physicians must bill using the code without a modifier if the physician
furnishes both the PC and the TC of the service.
Modifier -53 is shown for a discontinued procedure. There will be
RVUs for the code (CPT code 45378) with this modifier.
3. Status indicator. This indicator shows whether the CPT/HCPCS
code is in the physician fee schedule and whether it is separately
payable if the service is covered.
A = Active code. These codes are separately payable under the fee
schedule if covered. There will be RVUs for codes with this status. The
presence of an ``A'' indicator does not mean that Medicare has made a
national decision regarding the coverage of the service. Carriers
remain responsible for coverage decisions in the absence of a national
Medicare policy.
B = Bundled code. Payment for covered services is always bundled
into payment for other services not specified. If RVUs are shown, they
are not used for Medicare payment. If these services are covered,
payment for them is subsumed by the payment for the services to which
they are incident. (An example is a telephone call from a hospital
nurse regarding care of a patient.)
C = Carrier-priced code. Carriers will establish RVUs and payment
amounts for these services, generally on a case-by-case basis following
review of documentation, such as an operative report.
D = Deleted code. These codes are deleted effective with the
beginning of the calendar year.
E = Excluded from physician fee schedule by regulation. These codes
are for items or services that we chose to exclude from the physician
fee schedule payment by regulation. No RVUs are shown, and no payment
may be made under the physician fee schedule for these codes. Payment
for them, if they are covered, continues under reasonable charge or
other payment procedures.
F = Deleted/discontinued codes. Code not subject to a 90-day grace
period.
G = Code not valid for Medicare purposes. Medicare does not
recognize codes assigned this status. Medicare uses another code for
reporting of, and payment for, these services.
H = Deleted modifier. Either the TC or PC component shown for the
code has been deleted, and the deleted component is shown in the data
base with the H status indicator. (Code subject to a 90-day grace
period.)
I = Not valid for Medicare purposes. Medicare uses another code for
the reporting of, and the payment for these services. (Code NOT subject
to a 90-day grace period.)
N = Noncovered service. These codes are noncovered services.
Medicare payment may not be made for these codes. If RVUs are shown,
they are not used for Medicare payment.
P = Bundled or excluded code. There are no RVUs for these services.
No separate payment should be made for them under the physician fee
schedule.
-- If the item or service is covered as incident to a physician's
service and is furnished on the same day as a physician's service,
payment for it is bundled into the payment for the physician's service
to which it is incident (an example is an elastic bandage furnished by
a physician incident to a physician's service).
-- If the item or service is covered as other than incident to a
physician's service, it is excluded from the physician fee schedule
(for example, colostomy supplies) and is paid under the other payment
provisions of the Act.
R = Restricted coverage. Special coverage instructions apply. If
the service is covered and no RVUs are shown, it is carrier-priced.
T = Injections. There are RVUs for these services, but they are
only paid if there are no other services payable under the physician
fee schedule billed on the same date by the same provider. If any other
services payable under the physician fee schedule are billed on the
same date by the same provider, these services are bundled into the
service(s) for which payment is made.
X = Exclusion by law. These codes represent an item or service that
is not within the definition of ``physicians' services'' for physician
fee schedule payment purposes. No RVUs are shown for these codes, and
no payment may be made under the physician fee schedule. (Examples are
ambulance services and clinical diagnostic laboratory services.)
4. Description of code. This is an abbreviated version of the
narrative description of the code.
5. Physician work RVUs. These are the RVUs for the physician work
for this service in 2003. Codes that are not used for Medicare payment
are identified with a ``+.''
6. Facility practice expense RVUs. These are the fully implemented
resource-based practice expense RVUs for facility settings.
7. Non-facility practice expense RVUs. These are the fully
implemented resource-based practice expense RVUs for non-facility
settings.
8. Malpractice expense RVUs. These are the RVUs for the malpractice
expense for the service for 2003.
9. Facility total. This is the sum of the work, fully implemented
facility practice expense, and malpractice expense RVUs.
10. Non-facility total. This is the sum of the work, fully
implemented non-facility practice expense, and malpractice expense
RVUs.
11. Global period. This indicator shows the number of days in the
global period for the code (0, 10, or 90 days). An explanation of the
alpha codes follows:
MMM = The code describes a service furnished in uncomplicated
maternity cases including antepartum care, delivery, and postpartum
care. The usual global surgical concept does not apply. See the 1999
Physicians' Current Procedural Terminology for specific definitions.
XXX = The global concept does not apply.
YYY = The global period is to be set by the carrier (for example,
unlisted surgery codes).
ZZZ = Code related to another service that is always included in
the global period of the other service. (Note: Physician work and
practice expense are associated with intra service time and in some
instances the post service time.)
--------------------
\1\ CPT codes and descriptions only are copyright American Medical
Association. All Rights Reserved. Applicable FARS/DFARS Apply.
\2\ Copyright American Dental Association. All rights reserved.
[[Page 49072]]
Addendum B.--Relative Value Units (RVUS) and Related Information
--------------------------------------------------------------------------------------------------------------------------------------------------------
Non- Non-
\1\ CPT/\2\ HCPCS MOD Status Description Physician facility Facility Malpractice facility Facility Global
work RVUs PE RVUs PE RVUs RVUs total total
--------------------------------------------------------------------------------------------------------------------------------------------------------
0001T.............. .............. C Endovas repr abdo ao 0.00 0.00 0.00 0.00 0.00 0.00 XXX
aneurys.
0002T.............. .............. C Endovas repr abdo ao 0.00 0.00 0.00 0.00 0.00 0.00 XXX
aneurys.
0003T.............. .............. C Cervicography....... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0005T.............. .............. C Perc cath stent/ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
brain cv art.
0006T.............. .............. C Perc cath stent/ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
brain cv art.
0007T.............. .............. C Perc cath stent/ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
brain cv art.
0008T.............. .............. C Upper gi endoscopy w/ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
suture.
0009T.............. .............. C Endometrial 0.00 0.00 0.00 0.00 0.00 0.00 XXX
cryoablation.
0010T.............. .............. C Tb test, gamma 0.00 0.00 0.00 0.00 0.00 0.00 XXX
interferon.
0012T.............. .............. C Osteochondral knee 0.00 0.00 0.00 0.00 0.00 0.00 XXX
autograft.
0013T.............. .............. C Osteochondral knee 0.00 0.00 0.00 0.00 0.00 0.00 XXX
allograft.
0014T.............. .............. C Meniscal transplant, 0.00 0.00 0.00 0.00 0.00 0.00 XXX
knee.
0016T.............. .............. C Thermotx choroid 0.00 0.00 0.00 0.00 0.00 0.00 XXX
vasc lesion.
0017T.............. .............. C Photocoagulat 0.00 0.00 0.00 0.00 0.00 0.00 XXX
macular drusen.
0018T.............. .............. C Transcranial 0.00 0.00 0.00 0.00 0.00 0.00 XXX
magnetic stimul.
0019T.............. .............. I Extracorp shock wave 0.00 0.00 0.00 0.00 0.00 0.00 XXX
tx, ms.
0020T.............. .............. C Extracorp shock wave 0.00 0.00 0.00 0.00 0.00 0.00 XXX
tx, ft.
0021T.............. .............. C Fetal oximetry, 0.00 0.00 0.00 0.00 0.00 0.00 XXX
trnsvag/cerv.
0023T.............. .............. C Phenotype drug test, 0.00 0.00 0.00 0.00 0.00 0.00 XXX
hiv 1.
0024T.............. .............. C Transcath cardiac 0.00 0.00 0.00 0.00 0.00 0.00 XXX
reduction.
0025T.............. .............. C Ultrasonic 0.00 0.00 0.00 0.00 0.00 0.00 XXX
pachymetry.
0026T.............. .............. C Measure remnant 0.00 0.00 0.00 0.00 0.00 0.00 XXX
lipoproteins.
0027T.............. .............. C Endoscopic epidural 0.00 0.00 0.00 0.00 0.00 0.00 XXX
lysis.
0028T.............. .............. C Dexa body 0.00 0.00 0.00 0.00 0.00 0.00 XXX
composition study.
0029T.............. .............. C Magnetic tx for 0.00 0.00 0.00 0.00 0.00 0.00 XXX
incontinence.
0030T.............. .............. C Antiprothrombin 0.00 0.00 0.00 0.00 0.00 0.00 XXX
antibody.
0031T.............. .............. C Speculoscopy........ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0032T.............. .............. C Speculoscopy w/ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
direct sample.
0033T.............. .............. C Endovasc taa repr 0.00 0.00 0.00 0.00 0.00 0.00 XXX
incl subcl.
0034T.............. .............. C Endovasc taa repr w/ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
o subcl.
0035T.............. .............. C Insert endovasc 0.00 0.00 0.00 0.00 0.00 0.00 XXX
prosth, taa.
0036T.............. .............. C Endovasc prosth, 0.00 0.00 0.00 0.00 0.00 0.00 XXX
taa, add-on.
0037T.............. .............. C Artery transpose/ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
endovas taa.
0038T.............. .............. C Rad endovasc taa rpr 0.00 0.00 0.00 0.00 0.00 0.00 XXX
w/cover.
0039T.............. .............. C Rad s/i, endovasc 0.00 0.00 0.00 0.00 0.00 0.00 XXX
taa repair.
0040T.............. .............. C Rad s/i, endovasc 0.00 0.00 0.00 0.00 0.00 0.00 XXX
taa prosth.
0041T.............. .............. C Detect ur infect 0.00 0.00 0.00 0.00 0.00 0.00 XXX
agnt w/cpas.
[[Page 49073]]
0042T.............. .............. C Ct perfusion w/ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
contrast, cbf.
0043T.............. .............. C Co expired gas 0.00 0.00 0.00 0.00 0.00 0.00 XXX
analysis.
0044T.............. .............. C Whole body 0.00 0.00 0.00 0.00 0.00 0.00 XXX
photography.
10021.............. .............. A Fna w/o image....... 1.27 2.24 0.55 0.07 3.58 1.89 XXX
10022.............. .............. A Fna w/image......... 1.27 2.67 0.43 0.05 3.99 1.75 XXX
10040.............. .............. A Acne surgery........ 1.18 1.03 0.69 0.05 2.26 1.92 010
10060.............. .............. A Drainage of skin 1.17 0.97 0.48 0.08 2.22 1.73 010
abscess.
10061.............. .............. A Drainage of skin 2.40 1.85 1.54 0.17 4.42 4.11 010
abscess.
10080.............. .............. A Drainage of 1.17 3.11 1.17 0.09 4.37 2.43 010
pilonidal cyst.
10081.............. .............. A Drainage of 2.45 4.08 1.53 0.19 6.72 4.17 010
pilonidal cyst.
10120.............. .............. A Remove foreign body. 1.22 1.50 0.42 0.10 2.82 1.74 010
10121.............. .............. A Remove foreign body. 2.69 3.39 1.91 0.25 6.33 4.85 010
10140.............. .............. A Drainage of hematoma/ 1.53 1.54 0.92 0.15 3.22 2.60 010
fluid.
10160.............. .............. A Puncture drainage of 1.20 0.74 0.47 0.11 2.05 1.78 010
lesion.
10180.............. .............. A Complex drainage, 2.25 3.28 2.10 0.25 5.78 4.60 010
wound.
11000.............. .............. A Debride infected 0.60 0.58 0.22 0.05 1.23 0.87 000
skin.
11001.............. .............. A Debride infected 0.30 0.23 0.11 0.02 0.55 0.43 ZZZ
skin add-on.
11010.............. .............. A Debride skin, fx.... 4.20 6.85 2.37 0.45 11.50 7.02 010
11011.............. .............. A Debride skin/muscle, 4.95 8.17 2.41 0.53 13.65 7.89 000
fx.
11012.............. .............. A Debride skin/muscle/ 6.88 12.07 3.93 0.89 19.84 11.70 000
bone, fx.
11040.............. .............. A Debride skin, 0.50 0.54 0.21 0.05 1.09 0.76 000
partial.
11041.............. .............. A Debride skin, full.. 0.82 0.68 0.33 0.06 1.56 1.21 000
11042.............. .............. A Debride skin/tissue. 1.12 1.01 0.47 0.09 2.22 1.68 000
11043.............. .............. A Debride tissue/ 2.38 3.52 2.64 0.24 6.14 5.26 010
muscle.
11044.............. .............. A Debride tissue/ 3.06 4.64 3.81 0.34 8.04 7.21 010
muscle/bone.
11055.............. .............. R Trim skin lesion.... 0.43 0.58 0.17 0.02 1.03 0.62 000
11056.............. .............. R Trim skin lesions, 2 0.61 0.66 0.24 0.03 1.30 0.88 000
to 4.
11057.............. .............. R Trim skin lesions, 0.79 0.76 0.31 0.04 1.59 1.14 000
over 4.
11100.............. .............. A Biopsy of skin 0.81 1.29 0.37 0.04 2.14 1.22 000
lesion.
11101.............. .............. A Biopsy, skin add-on. 0.41 0.34 0.19 0.02 0.77 0.62 ZZZ
11200.............. .............. A Removal of skin tags 0.77 1.08 0.78 0.04 1.89 1.59 010
11201.............. .............. A Remove skin tags add- 0.29 0.16 0.12 0.02 0.47 0.43 ZZZ
on.
11300.............. .............. A Shave skin lesion... 0.51 1.03 0.22 0.03 1.57 0.76 000
11301.............. .............. A Shave skin lesion... 0.85 1.15 0.39 0.04 2.04 1.28 000
11302.............. .............. A Shave skin lesion... 1.05 1.34 0.47 0.05 2.44 1.57 000
11303.............. .............. A Shave skin lesion... 1.24 1.63 0.53 0.06 2.93 1.83 000
11305.............. .............. A Shave skin lesion... 0.67 0.86 0.27 0.04 1.57 0.98 000
11306.............. .............. A Shave skin lesion... 0.99 1.13 0.43 0.05 2.17 1.47 000
11307.............. .............. A Shave skin lesion... 1.14 1.32 0.50 0.05 2.51 1.69 000
11308.............. .............. A Shave skin lesion... 1.41 1.48 0.61 0.07 2.96 2.09 000
11310.............. .............. A Shave skin lesion... 0.73 1.16 0.33 0.04 1.93 1.10 000
11311.............. .............. A Shave skin lesion... 1.05 1.27 0.50 0.05 2.37 1.60 000
11312.............. .............. A Shave skin lesion... 1.20 1.47 0.57 0.06 2.73 1.83 000
11313.............. .............. A Shave skin lesion... 1.62 1.86 0.73 0.09 3.57 2.44 000
11400.............. .............. A Exc tr-ext b9+marg 0.93 2.10 0.94 0.06 3.09 1.93 010
0.5 < cm.
11401.............. .............. A Exc tr-ext b9+marg 1.44 2.22 1.12 0.09 3.75 2.65 010
0.6-1 cm.
11402.............. .............. A Exc tr-ext b9+marg 1.72 2.39 1.19 0.12 4.23 3.03 010
1.1-2 cm.
11403.............. .............. A Exc tr-ext b9+marg 1.97 2.55 1.42 0.16 4.68 3.55 010
2.1-3 cm.
11404.............. .............. A Exc tr-ext b9+marg 2.21 2.86 1.48 0.18 5.25 3.87 010
3.1-4 cm.
11406.............. .............. A Exc tr-ext b9+marg 3.03 3.27 1.79 0.25 6.55 5.07 010
4.0 cm.
11420.............. .............. A Exc h-f-nk-sp 1.01 1.83 0.96 0.08 2.92 2.05 010
b9+marg 0.5 <.
11421.............. .............. A Exc h-f-nk-sp 1.55 2.19 1.19 0.11 3.85 2.85 010
b9+marg 0.6-1.
[[Page 49074]]
11422.............. .............. A Exc h-f-nk-sp 1.84 2.42 1.45 0.14 4.40 3.43 010
b9+marg 1.1-2.
11423.............. .............. A Exc h-f-nk-sp 2.28 2.78 1.59 0.17 5.23 4.04 010
b9+marg 2.1-3.
11424.............. .............. A Exc h-f-nk-sp 2.72 3.01 1.75 0.21 5.94 4.68 010
b9+marg 3.1-4.
11426.............. .............. A Exc h-f-nk-sp 4.03 3.71 2.24 0.34 8.08 6.61 010
b9+marg
4 cm.
11440.............. .............. A Exc face-mm b9+marg 1.16 2.38 1.40 0.08 3.62 2.64 010
0.5 < cm.
11441.............. .............. A Exc face-mm b9+marg 1.89 2.64 1.72 0.11 4.64 3.72 010
0.6-1 cm.
11442.............. .............. A Exc face-mm b9+marg 2.31 2.92 1.87 0.14 5.37 4.32 010
1.1-2 cm.
11443.............. .............. A Exc face-mm b9+marg 2.86 3.30 2.11 0.18 6.34 5.15 010
2.1-3 cm.
11444.............. .............. A Exc face-mm b9+marg 3.78 3.93 2.52 0.25 7.96 6.55 010
3.1-4 cm.
11446.............. .............. A Exc face-mm b9+marg 5.57 4.70 3.32 0.30 10.57 9.19 010
4 cm.
11450.............. .............. A Removal, sweat gland 2.73 5.22 2.04 0.26 8.21 5.03 090
lesion.
11451.............. .............. A Removal, sweat gland 3.95 6.87 2.57 0.39 11.21 6.91 090
lesion.
11462.............. .............. A Removal, sweat gland 2.51 5.31 2.02 0.23 8.05 4.76 090
lesion.
11463.............. .............. A Removal, sweat gland 3.95 7.12 2.71 0.40 11.47 7.06 090
lesion.
11470.............. .............. A Removal, sweat gland 3.25 5.25 2.28 0.30 8.80 5.83 090
lesion.
11471.............. .............. A Removal, sweat gland 4.41 7.03 2.80 0.40 11.84 7.61 090
lesion.
11600.............. .............. A Exc tr-ext mlg+marg 0.93 2.58 0.84 0.09 3.60 1.86 010
0.5 < cm.
11601.............. .............. A Exc tr-ext mlg+marg 1.44 2.63 1.10 0.12 4.19 2.66 010
0.6-1 cm.
11602.............. .............. A Exc tr-ext mlg+marg 1.72 2.82 1.20 0.13 4.67 3.05 010
1.1-2 cm.
11603.............. .............. A Exc tr-ext mlg+marg 1.97 3.08 1.27 0.16 5.21 3.40 010
2.1-3 cm.
11604.............. .............. A Exc tr-ext mlg+marg 2.21 3.41 1.35 0.18 5.80 3.74 010
3.1-4 cm.
11606.............. .............. A Exc tr-ext mlg+marg 3.03 4.02 1.62 0.28 7.33 4.93 010
4 cm.
11620.............. .............. A Exc h-f-nk-sp 1.01 2.62 0.90 0.09 3.72 2.00 010
mlg+marg 0.5 <.
11621.............. .............. A Exc h-f-nk-sp 1.55 2.70 1.18 0.12 4.37 2.85 010
mlg+marg 0.6-1.
11622.............. .............. A Exc h-f-nk-sp 1.84 2.95 1.31 0.15 4.94 3.30 010
mlg+marg 1.1-2.
11623.............. .............. A Exc h-f-nk-sp 2.28 3.30 1.48 0.20 5.78 3.96 010
mlg+marg 2.1-3.
11624.............. .............. A Exc h-f-nk-sp 2.72 3.72 1.67 0.25 6.69 4.64 010
mlg+marg 3.1-4.
11626.............. .............. A Exc h-f-nk-sp 4.03 4.67 2.33 0.35 9.05 6.71 010
mlg+mar
4 cm.
11640.............. .............. A Exc face-mm 1.16 2.68 1.06 0.10 3.94 2.32 010
malig+marg 0.5 <.
11641.............. .............. A Exc face-mm 1.89 3.01 1.44 0.15 5.05 3.48 010
malig+marg 0.6-1.
11642.............. .............. A Exc face-mm 2.31 3.39 1.63 0.18 5.88 4.12 010
malig+marg 1.1-2.
11643.............. .............. A Exc face-mm 2.86 3.82 1.89 0.24 6.92 4.99 010
malig+marg 2.1-3.
11644.............. .............. A Exc face-mm 3.78 4.72 2.40 0.33 8.83 6.51 010
malig+marg 3.1-4.
[[Page 49075]]
11646.............. .............. A Exc face-mm mlg+marg 5.57 5.76 3.38 0.46 11.79 9.41 010
4 cm.
11719.............. .............. R Trim nail(s)........ 0.17 0.25 0.07 0.01 0.43 0.25 000
11720.............. .............. A Debride nail, 1-5... 0.32 0.34 0.13 0.02 0.68 0.47 000
11721.............. .............. A Debride nail, 6 or 0.54 0.44 0.21 0.04 1.02 0.79 000
more.
11730.............. .............. A Removal of nail 1.13 1.05 0.44 0.09 2.27 1.66 000
plate.
11732.............. .............. A Remove nail plate, 0.57 0.45 0.23 0.05 1.07 0.85 ZZZ
add-on.
11740.............. .............. A Drain blood from 0.37 0.87 0.15 0.03 1.27 0.55 000
under nail.
11750.............. .............. A Removal of nail bed. 1.86 2.18 1.76 0.16 4.20 3.78 010
11752.............. .............. A Remove nail bed/ 2.67 2.50 1.92 0.33 5.50 4.92 010
finger tip.
11755.............. .............. A Biopsy, nail unit... 1.31 1.12 0.56 0.06 2.49 1.93 000
11760.............. .............. A Repair of nail bed.. 1.58 1.88 1.24 0.17 3.63 2.99 010
11762.............. .............. A Reconstruction of 2.89 2.32 1.86 0.32 5.53 5.07 010
nail bed.
11765.............. .............. A Excision of nail 0.69 1.18 0.53 0.05 1.92 1.27 010
fold, toe.
11770.............. .............. A Removal of pilonidal 2.61 3.50 1.53 0.24 6.35 4.38 010
lesion.
11771.............. .............. A Removal of pilonidal 5.74 5.80 3.35 0.56 12.10 9.65 090
lesion.
11772.............. .............. A Removal of pilonidal 6.98 7.34 3.91 0.68 15.00 11.57 090
lesion.
11900.............. .............. A Injection into skin 0.52 0.67 0.22 0.02 1.21 0.76 000
lesions.
11901.............. .............. A Added skin lesions 0.80 0.68 0.36 0.03 1.51 1.19 000
injection.
11920.............. .............. R Correct skin color 1.61 2.03 0.79 0.17 3.81 2.57 000
defects.
11921.............. .............. R Correct skin color 1.93 2.41 1.00 0.21 4.55 3.14 000
defects.
11922.............. .............. R Correct skin color 0.49 0.38 0.25 0.05 0.92 0.79 ZZZ
defects.
11950.............. .............. R Therapy for contour 0.84 1.18 0.42 0.06 2.08 1.32 000
defects.
11951.............. .............. R Therapy for contour 1.19 1.53 0.52 0.10 2.82 1.81 000
defects.
11952.............. .............. R Therapy for contour 1.69 1.90 0.70 0.17 3.76 2.56 000
defects.
11954.............. .............. R Therapy for contour 1.85 2.48 0.92 0.19 4.52 2.96 000
defects.
11960.............. .............. A Insert tissue 9.08 N/A 10.74 0.88 N/A 20.70 090
expander(s).
11970.............. .............. A Replace tissue 7.06 N/A 6.22 0.77 N/A 14.05 090
expander.
11971.............. .............. A Remove tissue 2.13 7.24 4.84 0.21 9.58 7.18 090
expander(s).
11975.............. .............. N Insert contraceptive 1.48 1.50 0.57 0.14 3.12 2.19 XXX
cap.
11976.............. .............. R Removal of 1.78 1.74 0.70 0.17 3.69 2.65 000
contraceptive cap.
11977.............. .............. N Removal/reinsert 3.30 2.42 1.28 0.31 6.03 4.89 XXX
contra cap.
11980.............. .............. A Implant hormone 1.48 1.12 0.56 0.10 2.70 2.14 000
pellet(s).
11981.............. .............. A Insert drug implant 1.48 1.77 0.70 0.14 3.39 2.32 XXX
device.
11982.............. .............. A Remove drug implant 1.78 2.01 0.86 0.17 3.96 2.81 XXX
device.
11983.............. .............. A Remove/insert drug 3.30 2.37 1.50 0.31 5.98 5.11 XXX
implant.
12001.............. .............. A Repair superficial 1.70 2.07 0.50 0.13 3.90 2.33 010
wound(s).
12002.............. .............. A Repair superficial 1.86 2.14 0.95 0.15 4.15 2.96 010
wound(s).
12004.............. .............. A Repair superficial 2.24 2.43 1.06 0.17 4.84 3.47 010
wound(s).
12005.............. .............. A Repair superficial 2.86 2.94 1.25 0.23 6.03 4.34 010
wound(s).
12006.............. .............. A Repair superficial 3.67 3.53 1.57 0.31 7.51 5.55 010
wound(s).
12007.............. .............. A Repair superficial 4.12 3.97 1.87 0.37 8.46 6.36 010
wound(s).
12011.............. .............. A Repair superficial 1.76 2.24 0.51 0.14 4.14 2.41 010
wound(s).
12013.............. .............. A Repair superficial 1.99 2.39 0.99 0.16 4.54 3.14 010
wound(s).
12014.............. .............. A Repair superficial 2.46 2.69 1.11 0.18 5.33 3.75 010
wound(s).
[[Page 49076]]
12015.............. .............. A Repair superficial 3.19 3.28 1.31 0.24 6.71 4.74 010
wound(s).
12016.............. .............. A Repair superficial 3.93 3.70 1.59 0.32 7.95 5.84 010
wound(s).
12017.............. .............. A Repair superficial 4.71 N/A 1.95 0.39 N/A 7.05 010
wound(s).
12018.............. .............. A Repair superficial 5.53 N/A 2.32 0.46 N/A 8.31 010
wound(s).
12020.............. .............. A Closure of split 2.62 2.74 1.77 0.24 5.60 4.63 010
wound.
12021.............. .............. A Closure of split 1.84 1.81 1.43 0.19 3.84 3.46 010
wound.
12031.............. .............. A Layer closure of 2.15 2.36 0.83 0.15 4.66 3.13 010
wound(s).
12032.............. .............. A Layer closure of 2.47 3.88 1.87 0.15 6.50 4.49 010
wound(s).
12034.............. .............. A Layer closure of 2.92 3.24 1.44 0.21 6.37 4.57 010
wound(s).
12035.............. .............. A Layer closure of 3.43 5.27 2.22 0.30 9.00 5.95 010
wound(s).
12036.............. .............. A Layer closure of 4.05 5.53 2.42 0.41 9.99 6.88 010
wound(s).
12037.............. .............. A Layer closure of 4.67 6.62 2.83 0.49 11.78 7.99 010
wound(s).
12041.............. .............. A Layer closure of 2.37 2.53 0.88 0.17 5.07 3.42 010
wound(s).
12042.............. .............. A Layer closure of 2.74 3.28 1.40 0.17 6.19 4.31 010
wound(s).
12044.............. .............. A Layer closure of 3.14 3.28 1.59 0.24 6.66 4.97 010
wound(s).
12045.............. .............. A Layer closure of 3.64 3.79 2.21 0.34 7.77 6.19 010
wound(s).
12046.............. .............. A Layer closure of 4.25 6.61 2.82 0.40 11.26 7.47 010
wound(s).
12047.............. .............. A Layer closure of 4.65 6.50 3.15 0.41 11.56 8.21 010
wound(s).
12051.............. .............. A Layer closure of 2.47 3.30 1.39 0.16 5.93 4.02 010
wound(s).
12052.............. .............. A Layer closure of 2.77 3.24 1.37 0.17 6.18 4.31 010
wound(s).
12053.............. .............. A Layer closure of 3.12 3.29 1.53 0.20 6.61 4.85 010
wound(s).
12054.............. .............. A Layer closure of 3.46 3.63 1.63 0.25 7.34 5.34 010
wound(s).
12055.............. .............. A Layer closure of 4.43 4.63 2.18 0.35 9.41 6.96 010
wound(s).
12056.............. .............. A Layer closure of 5.24 6.92 3.13 0.43 12.59 8.80 010
wound(s).
12057.............. .............. A Layer closure of 5.96 6.27 3.84 0.50 12.73 10.30 010
wound(s).
13100.............. .............. A Repair of wound or 3.12 3.59 1.81 0.21 6.92 5.14 010
lesion.
13101.............. .............. A Repair of wound or 3.92 3.83 2.26 0.22 7.97 6.40 010
lesion.
13102.............. .............. A Repair wound/lesion 1.24 0.75 0.58 0.10 2.09 1.92 ZZZ
add-on.
13120.............. .............. A Repair of wound or 3.30 3.69 1.85 0.23 7.22 5.38 010
lesion.
13121.............. .............. A Repair of wound or 4.33 4.05 2.36 0.25 8.63 6.94 010
lesion.
13122.............. .............. A Repair wound/lesion 1.44 0.88 0.64 0.12 2.44 2.20 ZZZ
add-on.
13131.............. .............. A Repair of wound or 3.79 3.96 2.18 0.25 8.00 6.22 010
lesion.
13132.............. .............. A Repair of wound or 5.95 4.78 3.23 0.32 11.05 9.50 010
lesion.
13133.............. .............. A Repair wound/lesion 2.19 1.22 1.05 0.17 3.58 3.41 ZZZ
add-on.
13150.............. .............. A Repair of wound or 3.81 5.62 2.65 0.29 9.72 6.75 010
lesion.
13151.............. .............. A Repair of wound or 4.45 5.52 3.10 0.28 10.25 7.83 010
lesion.
13152.............. .............. A Repair of wound or 6.33 6.21 4.01 0.38 12.92 10.72 010
lesion.
13153.............. .............. A Repair wound/lesion 2.38 1.37 1.17 0.18 3.93 3.73 ZZZ
add-on.
13160.............. .............. A Late closure of 10.48 N/A 7.24 1.19 N/A 18.91 090
wound.
14000.............. .............. A Skin tissue 5.89 8.69 5.21 0.46 15.04 11.56 090
rearrangement.
14001.............. .............. A Skin tissue 8.47 10.16 6.70 0.65 19.28 15.82 090
rearrangement.
14020.............. .............. A Skin tissue 6.59 9.35 6.10 0.50 16.44 13.19 090
rearrangement.
14021.............. .............. A Skin tissue 10.06 10.67 7.88 0.69 21.42 18.63 090
rearrangement.
14040.............. .............. A Skin tissue 7.87 8.44 7.01 0.55 16.86 15.43 090
rearrangement.
14041.............. .............. A Skin tissue 11.49 10.87 8.87 0.71 23.07 21.07 090
rearrangement.
14060.............. .............. A Skin tissue 8.50 9.27 7.82 0.59 18.36 16.91 090
rearrangement.
14061.............. .............. A Skin tissue 12.29 11.90 9.69 0.75 24.94 22.73 090
rearrangement.
14300.............. .............. A Skin tissue 11.76 11.41 9.32 0.88 24.05 21.96 090
rearrangement.
14350.............. .............. A Skin tissue 9.61 N/A 7.26 1.09 N/A 17.96 090
rearrangement.
15000.............. .............. A Skin graft.......... 4.00 3.89 2.24 0.37 8.26 6.61 000
15001.............. .............. A Skin graft add-on... 1.00 1.39 0.42 0.11 2.50 1.53 ZZZ
15050.............. .............. A Skin pinch graft.... 4.30 6.08 4.81 0.46 10.84 9.57 090
15100.............. .............. A Skin split graft.... 9.05 12.83 7.89 0.94 22.82 17.88 090
15101.............. .............. A Skin split graft add- 1.72 3.89 1.69 0.18 5.79 3.59 ZZZ
on.
15120.............. .............. A Skin split graft.... 9.83 11.04 7.95 0.90 21.77 18.68 090
15121.............. .............. A Skin split graft add- 2.67 4.66 1.91 0.27 7.60 4.85 ZZZ
on.
15200.............. .............. A Skin full graft..... 8.03 10.93 6.11 0.73 19.69 14.87 090
15201.............. .............. A Skin full graft add- 1.32 1.06 0.63 0.14 2.52 2.09 ZZZ
on.
[[Page 49077]]
15220.............. .............. A Skin full graft..... 7.87 10.82 6.55 0.68 19.37 15.10 090
15221.............. .............. A Skin full graft add- 1.19 0.92 0.58 0.12 2.23 1.89 ZZZ
on.
15240.............. .............. A Skin full graft..... 9.04 10.38 7.80 0.80 20.22 17.64 090
15241.............. .............. A Skin full graft add- 1.86 1.48 0.93 0.17 3.51 2.96 ZZZ
on.
15260.............. .............. A Skin full graft..... 10.06 10.10 8.80 0.63 20.79 19.49 090
15261.............. .............. A Skin full graft add- 2.23 2.78 1.45 0.17 5.18 3.85 ZZZ
on.
15342.............. .............. A Cultured skin graft, 1.00 1.84 0.56 0.09 2.93 1.65 010
25 cm.
15343.............. .............. A Culture skn graft 0.25 0.27 0.10 0.02 0.54 0.37 ZZZ
addl 25 cm.
15350.............. .............. A Skin homograft...... 4.00 8.37 4.90 0.42 12.79 9.32 090
15351.............. .............. A Skin homograft add- 1.00 0.95 0.40 0.11 2.06 1.51 ZZZ
on.
15400.............. .............. A Skin heterograft.... 4.00 4.28 4.21 0.40 8.68 8.61 090
15401.............. .............. A Skin heterograft add- 1.00 1.23 0.45 0.11 2.34 1.56 ZZZ
on.
15570.............. .............. A Form skin pedicle 9.21 9.27 6.55 0.96 19.44 16.72 090
flap.
15572.............. .............. A Form skin pedicle 9.27 8.58 6.27 0.93 18.78 16.47 090
flap.
15574.............. .............. A Form skin pedicle 9.88 8.98 7.08 0.92 19.78 17.88 090
flap.
15576.............. .............. A Form skin pedicle 8.69 9.61 6.55 0.72 19.02 15.96 090
flap.
15600.............. .............. A Skin graft.......... 1.91 7.24 2.75 0.19 9.34 4.85 090
15610.............. .............. A Skin graft.......... 2.42 3.83 3.09 0.25 6.50 5.76 090
15620.............. .............. A Skin graft.......... 2.94 7.64 3.75 0.28 10.86 6.97 090
15630.............. .............. A Skin graft.......... 3.27 7.00 4.02 0.28 10.55 7.57 090
15650.............. .............. A Transfer skin 3.97 6.86 4.10 0.36 11.19 8.43 090
pedicle flap.
15732.............. .............. A Muscle-skin graft, 17.84 18.42 12.48 1.50 37.76 31.82 090
head/neck.
15734.............. .............. A Muscle-skin graft, 17.79 18.28 12.55 1.91 37.98 32.25 090
trunk.
15736.............. .............. A Muscle-skin graft, 16.27 18.50 11.43 1.78 36.55 29.48 090
arm.
15738.............. .............. A Muscle-skin graft, 17.92 18.28 11.95 1.95 38.15 31.82 090
leg.
15740.............. .............. A Island pedicle flap 10.25 9.97 7.91 0.62 20.84 18.78 090
graft.
15750.............. .............. A Neurovascular 11.41 N/A 9.16 1.16 N/A 21.73 090
pedicle graft.
15756.............. .............. A Free myo/skin flap 35.23 N/A 21.18 3.11 N/A 59.52 090
microvasc.
15757.............. .............. A Free skin flap, 35.23 N/A 22.24 3.37 N/A 60.84 090
microvasc.
15758.............. .............. A Free fascial flap, 35.10 N/A 22.23 3.52 N/A 60.85 090
microvasc.
15760.............. .............. A Composite skin graft 8.74 9.95 7.16 0.72 19.41 16.62 090
15770.............. .............. A Derma-fat-fascia 7.52 N/A 6.84 0.78 N/A 15.14 090
graft.
15775.............. .............. R Hair transplant 3.96 2.83 1.35 0.43 7.22 5.74 000
punch grafts.
15776.............. .............. R Hair transplant 5.54 5.49 2.87 0.60 11.63 9.01 000
punch grafts.
15780.............. .............. A Abrasion treatment 7.29 7.23 7.23 0.41 14.93 14.93 090
of skin.
15781.............. .............. A Abrasion treatment 4.85 5.46 5.46 0.27 10.58 10.58 090
of skin.
15782.............. .............. A Abrasion treatment 4.32 4.44 4.44 0.21 8.97 8.97 090
of skin.
15783.............. .............. A Abrasion treatment 4.29 5.04 4.26 0.26 9.59 8.81 090
of skin.
15786.............. .............. A Abrasion, lesion, 2.03 1.66 1.30 0.11 3.80 3.44 010
single.
15787.............. .............. A Abrasion, lesions, 0.33 0.32 0.16 0.02 0.67 0.51 ZZZ
add-on.
15788.............. .............. R Chemical peel, face, 2.09 3.39 2.24 0.11 5.59 4.44 090
epiderm.
15789.............. .............. R Chemical peel, face, 4.92 6.54 5.06 0.27 11.73 10.25 090
dermal.
15792.............. .............. R Chemical peel, 1.86 3.22 2.82 0.10 5.18 4.78 090
nonfacial.
15793.............. .............. A Chemical peel, 3.74 N/A 4.25 0.17 N/A 8.16 090
nonfacial.
15810.............. .............. A Salabrasion......... 4.74 3.99 3.99 0.42 9.15 9.15 090
15811.............. .............. A Salabrasion......... 5.39 6.43 5.62 0.52 12.34 11.53 090
15819.............. .............. A Plastic surgery, 9.38 N/A 7.36 0.77 N/A 17.51 090
neck.
15820.............. .............. A Revision of lower 5.15 7.01 5.48 0.30 12.46 10.93 090
eyelid.
15821.............. .............. A Revision of lower 5.72 7.40 5.64 0.31 13.43 11.67 090
eyelid.
15822.............. .............. A Revision of upper 4.45 5.93 4.45 0.22 10.60 9.12 090
eyelid.
15823.............. .............. A Revision of upper 7.05 7.93 6.35 0.32 15.30 13.72 090
eyelid.
15824.............. .............. R Removal of forehead 0.00 0.00 0.00 0.00 0.00 0.00 000
wrinkles.
15825.............. .............. R Removal of neck 0.00 0.00 0.00 0.00 0.00 0.00 000
wrinkles.
15826.............. .............. R Removal of brow 0.00 0.00 0.00 0.00 0.00 0.00 000
wrinkles.
15828.............. .............. R Removal of face 0.00 0.00 0.00 0.00 0.00 0.00 000
wrinkles.
15829.............. .............. R Removal of skin 0.00 0.00 0.00 0.00 0.00 0.00 000
wrinkles.
[[Page 49078]]
15831.............. .............. A Excise excessive 12.40 N/A 8.36 1.30 N/A 22.06 090
skin tissue.
15832.............. .............. A Excise excessive 11.59 N/A 8.52 1.21 N/A 21.32 090
skin tissue.
15833.............. .............. A Excise excessive 10.64 N/A 8.22 1.17 N/A 20.03 090
skin tissue.
15834.............. .............. A Excise excessive 10.85 N/A 7.80 1.18 N/A 19.83 090
skin tissue.
15835.............. .............. A Excise excessive 11.67 11.70 7.76 1.13 24.50 20.56 090
skin tissue.
15836.............. .............. A Excise excessive 9.34 N/A 6.92 0.95 N/A 17.21 090
skin tissue.
15837.............. .............. A Excise excessive 8.43 8.10 7.12 0.78 17.31 16.33 090
skin tissue.
15838.............. .............. A Excise excessive 7.13 N/A 6.23 0.58 N/A 13.94 090
skin tissue.
15839.............. .............. A Excise excessive 9.38 8.02 6.31 0.88 18.28 16.57 090
skin tissue.
15840.............. .............. A Graft for face nerve 13.26 N/A 10.32 1.15 N/A 24.73 090
palsy.
15841.............. .............. A Graft for face nerve 23.26 N/A 15.38 2.65 N/A 41.29 090
palsy.
15842.............. .............. A Flap for face nerve 37.96 N/A 23.49 3.99 N/A 65.44 090
palsy.
15845.............. .............. A Skin and muscle 12.57 N/A 9.34 0.80 N/A 22.71 090
repair, face.
15850.............. .............. B Removal of sutures.. 0.78 1.62 0.30 0.04 2.44 1.12 XXX
15851.............. .............. A Removal of sutures.. 0.86 1.78 0.34 0.05 2.69 1.25 000
15852.............. .............. A Dressing change,not 0.86 1.90 0.36 0.07 2.83 1.29 000
for burn.
15860.............. .............. A Test for blood flow 1.95 1.30 0.80 0.13 3.38 2.88 000
in graft.
15876.............. .............. R Suction assisted 0.00 0.00 0.00 0.00 0.00 0.00 000
lipectomy.
15877.............. .............. R Suction assisted 0.00 0.00 0.00 0.00 0.00 0.00 000
lipectomy.
15878.............. .............. R Suction assisted 0.00 0.00 0.00 0.00 0.00 0.00 000
lipectomy.
15879.............. .............. R Suction assisted 0.00 0.00 0.00 0.00 0.00 0.00 000
lipectomy.
15920.............. .............. A Removal of tail bone 7.95 N/A 5.68 0.83 N/A 14.46 090
ulcer.
15922.............. .............. A Removal of tail bone 9.90 N/A 7.50 1.06 N/A 18.46 090
ulcer.
15931.............. .............. A Remove sacrum 9.24 N/A 5.83 0.95 N/A 16.02 090
pressure sore.
15933.............. .............. A Remove sacrum 10.85 N/A 8.07 1.14 N/A 20.06 090
pressure sore.
15934.............. .............. A Remove sacrum 12.69 N/A 8.35 1.35 N/A 22.39 090
pressure sore.
15935.............. .............. A Remove sacrum 14.57 N/A 10.51 1.56 N/A 26.64 090
pressure sore.
15936.............. .............. A Remove sacrum 12.38 N/A 8.66 1.32 N/A 22.36 090
pressure sore.
15937.............. .............. A Remove sacrum 14.21 N/A 10.23 1.51 N/A 25.95 090
pressure sore.
15940.............. .............. A Remove hip pressure 9.34 N/A 6.33 0.98 N/A 16.65 090
sore.
15941.............. .............. A Remove hip pressure 11.43 N/A 9.75 1.23 N/A 22.41 090
sore.
15944.............. .............. A Remove hip pressure 11.46 N/A 8.87 1.21 N/A 21.54 090
sore.
15945.............. .............. A Remove hip pressure 12.69 N/A 9.92 1.38 N/A 23.99 090
sore.
15946.............. .............. A Remove hip pressure 21.57 N/A 14.86 2.32 N/A 38.75 090
sore.
15950.............. .............. A Remove thigh 7.54 N/A 5.54 0.80 N/A 13.88 090
pressure sore.
15951.............. .............. A Remove thigh 10.72 N/A 8.08 1.14 N/A 19.94 090
pressure sore.
15952.............. .............. A Remove thigh 11.39 N/A 7.81 1.19 N/A 20.39 090
pressure sore.
15953.............. .............. A Remove thigh 12.63 N/A 9.22 1.38 N/A 23.23 090
pressure sore.
15956.............. .............. A Remove thigh 15.52 N/A 10.96 1.64 N/A 28.12 090
pressure sore.
15958.............. .............. A Remove thigh 15.48 N/A 11.24 1.66 N/A 28.38 090
pressure sore.
15999.............. .............. C Removal of pressure 0.00 0.00 0.00 0.00 0.00 0.00 YYY
sore.
16000.............. .............. A Initial treatment of 0.89 0.89 0.27 0.06 1.84 1.22 000
burn(s).
16010.............. .............. A Treatment of burn(s) 0.87 0.68 0.65 0.07 1.62 1.59 000
[[Continued on page 49079]]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
]
[[pp. 49079-49128]] Medicare Program; Revisions to Payment Policies Under the
Physician Fee Schedule for Calendar Year 2004
[[Continued from page 49078]]
[[Page 49079]]
16015.............. .............. A Treatment of burn(s) 2.35 N/A 1.18 0.22 N/A 3.75 000
16020.............. .............. A Treatment of burn(s) 0.80 1.31 0.62 0.06 2.17 1.48 000
16025.............. .............. A Treatment of burn(s) 1.85 1.82 0.99 0.16 3.83 3.00 000
16030.............. .............. A Treatment of burn(s) 2.08 2.24 1.14 0.18 4.50 3.40 000
16035.............. .............. A Incision of burn 3.75 N/A 1.49 0.36 N/A 5.60 090
scab, initi.
16036.............. .............. A Incise burn scab, 1.50 N/A 0.61 0.11 N/A 2.22 ZZZ
addl incis.
17000.............. .............. A Destroy benign/ 0.60 1.00 0.32 0.03 1.63 0.95 010
premlg lesion.
17003.............. .............. A Destroy lesions, 2- 0.15 0.11 0.07 0.01 0.27 0.23 ZZZ
14.
17004.............. .............. A Destroy lesions, 15 2.79 2.37 1.32 0.12 5.28 4.23 010
or more.
17106.............. .............. A Destruction of skin 4.59 5.01 3.29 0.28 9.88 8.16 090
lesions.
17107.............. .............. A Destruction of skin 9.16 7.69 5.45 0.53 17.38 15.14 090
lesions.
17108.............. .............. A Destruction of skin 13.20 9.82 7.72 0.89 23.91 21.81 090
lesions.
17110.............. .............. A Destruct lesion, 1- 0.65 1.68 0.51 0.04 2.37 1.20 010
14.
17111.............. .............. A Destruct lesion, 15 0.92 1.73 0.61 0.04 2.69 1.57 010
or more.
17250.............. .............. A Chemical cautery, 0.50 1.26 0.35 0.04 1.80 0.89 000
tissue.
17260.............. .............. A Destruction of skin 0.91 1.32 0.46 0.04 2.27 1.41 010
lesions.
17261.............. .............. A Destruction of skin 1.17 1.66 0.60 0.05 2.88 1.82 010
lesions.
17262.............. .............. A Destruction of skin 1.58 1.94 0.80 0.07 3.59 2.45 010
lesions.
17263.............. .............. A Destruction of skin 1.79 2.12 0.87 0.08 3.99 2.74 010
lesions.
17264.............. .............. A Destruction of skin 1.94 2.28 0.90 0.08 4.30 2.92 010
lesions.
17266.............. .............. A Destruction of skin 2.34 2.58 1.01 0.11 5.03 3.46 010
lesions.
17270.............. .............. A Destruction of skin 1.32 1.75 0.65 0.06 3.13 2.03 010
lesions.
17271.............. .............. A Destruction of skin 1.49 1.83 0.76 0.06 3.38 2.31 010
lesions.
17272.............. .............. A Destruction of skin 1.77 2.05 0.90 0.07 3.89 2.74 010
lesions.
17273.............. .............. A Destruction of skin 2.05 2.26 1.01 0.09 4.40 3.15 010
lesions.
17274.............. .............. A Destruction of skin 2.59 2.63 1.23 0.11 5.33 3.93 010
lesions.
17276.............. .............. A Destruction of skin 3.20 3.03 1.47 0.15 6.38 4.82 010
lesions.
17280.............. .............. A Destruction of skin 1.17 1.66 0.58 0.05 2.88 1.80 010
lesions.
17281.............. .............. A Destruction of skin 1.72 1.96 0.87 0.07 3.75 2.66 010
lesions.
17282.............. .............. A Destruction of skin 2.04 2.21 1.03 0.09 4.34 3.16 010
lesions.
17283.............. .............. A Destruction of skin 2.64 2.61 1.28 0.11 5.36 4.03 010
lesions.
17284.............. .............. A Destruction of skin 3.21 3.01 1.55 0.14 6.36 4.90 010
lesions.
17286.............. .............. A Destruction of skin 4.44 3.79 2.24 0.22 8.45 6.90 010
lesions.
17304.............. .............. A 1 stage mohs, up to 7.60 8.28 3.65 0.31 16.19 11.56 000
5 spec.
17305.............. .............. A 2 stage mohs, up to 2.85 3.90 1.37 0.12 6.87 4.34 000
5 spec.
17306.............. .............. A 3 stage mohs, up to 2.85 3.92 1.38 0.12 6.89 4.35 000
5 spec.
17307.............. .............. A Mohs addl stage up 2.85 3.87 1.40 0.12 6.84 4.37 000
to 5 spec.
17310.............. .............. A Mohs any stage 5 spec each.
17340.............. .............. A Cryotherapy of skin. 0.76 0.38 0.31 0.04 1.18 1.11 010
17360.............. .............. A Skin peel therapy... 1.43 1.50 0.77 0.06 2.99 2.26 010
17380.............. .............. R Hair removal by 0.00 0.00 0.00 0.00 0.00 0.00 000
electrolysis.
17999.............. .............. C Skin tissue 0.00 0.00 0.00 0.00 0.00 0.00 YYY
procedure.
19000.............. .............. A Drainage of breast 0.84 2.06 0.36 0.07 2.97 1.27 000
lesion.
19001.............. .............. A Drain breast lesion 0.42 0.80 0.14 0.03 1.25 0.59 ZZZ
add-on.
19020.............. .............. A Incision of breast 3.57 6.13 2.84 0.35 10.05 6.76 090
lesion.
19030.............. .............. A Injection for breast 1.53 3.40 0.51 0.07 5.00 2.11 000
x-ray.
19100.............. .............. A Bx breast percut w/o 1.27 2.17 0.43 0.10 3.54 1.80 000
image.
19101.............. .............. A Biopsy of breast, 3.18 4.74 1.71 0.20 8.12 5.09 010
open.
19102.............. .............. A Bx breast percut w/ 2.00 4.02 0.67 0.13 6.15 2.80 000
image.
19103.............. .............. A Bx breast percut w/ 3.70 12.24 1.26 0.16 16.10 5.12 000
device.
19110.............. .............. A Nipple exploration.. 4.30 7.47 3.21 0.44 12.21 7.95 090
19112.............. .............. A Excise breast duct 3.67 7.85 2.74 0.38 11.90 6.79 090
fistula.
19120.............. .............. A Removal of breast 5.56 4.64 3.11 0.56 10.76 9.23 090
lesion.
19125.............. .............. A Excision, breast 6.06 4.88 3.34 0.61 11.55 10.01 090
lesion.
[[Page 49080]]
19126.............. .............. A Excision, addl 2.93 N/A 1.02 0.30 N/A 4.25 ZZZ
breast lesion.
19140.............. .............. A Removal of breast 5.14 7.35 3.44 0.52 13.01 9.10 090
tissue.
19160.............. .............. A Removal of breast 5.99 N/A 3.48 0.61 N/A 10.08 090
tissue.
19162.............. .............. A Remove breast 13.53 N/A 6.46 1.38 N/A 21.37 090
tissue, nodes.
19180.............. .............. A Removal of breast... 8.80 N/A 5.11 0.88 N/A 14.79 090
19182.............. .............. A Removal of breast... 7.73 N/A 4.84 0.79 N/A 13.36 090
19200.............. .............. A Removal of breast... 15.49 N/A 8.12 1.51 N/A 25.12 090
19220.............. .............. A Removal of breast... 15.72 N/A 8.39 1.56 N/A 25.67 090
19240.............. .............. A Removal of breast... 16.00 N/A 8.37 1.62 N/A 25.99 090
19260.............. .............. A Removal of chest 15.44 N/A 11.09 1.64 N/A 28.17 090
wall lesion.
19271.............. .............. A Revision of chest 18.90 N/A 17.48 2.27 N/A 38.65 090
wall.
19272.............. .............. A Extensive chest wall 21.55 N/A 18.27 2.54 N/A 42.36 090
surgery.
19290.............. .............. A Place needle wire, 1.27 3.03 0.43 0.06 4.36 1.76 000
breast.
19291.............. .............. A Place needle wire, 0.63 1.76 0.21 0.03 2.42 0.87 ZZZ
breast.
19295.............. .............. A Place breast clip, 0.00 2.83 N/A 0.01 2.84 N/A ZZZ
percut.
19316.............. .............. A Suspension of breast 10.69 N/A 7.83 1.15 N/A 19.67 090
19318.............. .............. A Reduction of large 15.62 N/A 11.42 1.69 N/A 28.73 090
breast.
19324.............. .............. A Enlarge breast...... 5.85 N/A 5.01 0.63 N/A 11.49 090
19325.............. .............. A Enlarge breast with 8.45 N/A 6.71 0.90 N/A 16.06 090
implant.
19328.............. .............. A Removal of breast 5.68 N/A 5.17 0.61 N/A 11.46 090
implant.
19330.............. .............. A Removal of implant 7.59 N/A 6.09 0.81 N/A 14.49 090
material.
19340.............. .............. A Immediate breast 6.33 N/A 3.18 0.68 N/A 10.19 ZZZ
prosthesis.
19342.............. .............. A Delayed breast 11.20 N/A 8.95 1.21 N/A 21.36 090
prosthesis.
19350.............. .............. A Breast 8.92 14.46 7.25 0.95 24.33 17.12 090
reconstruction.
19355.............. .............. A Correct inverted 7.57 13.06 5.12 0.80 21.43 13.49 090
nipple(s).
19357.............. .............. A Breast 18.16 N/A 14.13 1.96 N/A 34.25 090
reconstruction.
19361.............. .............. A Breast 19.26 N/A 12.01 2.08 N/A 33.35 090
reconstruction.
19364.............. .............. A Breast 41.00 N/A 24.08 3.91 N/A 68.99 090
reconstruction.
19366.............. .............. A Breast 21.28 N/A 11.44 2.27 N/A 34.99 090
reconstruction.
19367.............. .............. A Breast 25.73 N/A 16.89 2.78 N/A 45.40 090
reconstruction.
19368.............. .............. A Breast 32.42 N/A 20.65 3.51 N/A 56.58 090
reconstruction.
19369.............. .............. A Breast 29.82 N/A 20.17 3.24 N/A 53.23 090
reconstruction.
19370.............. .............. A Surgery of breast 8.05 N/A 6.98 0.86 N/A 15.89 090
capsule.
19371.............. .............. A Removal of breast 9.35 N/A 8.02 1.01 N/A 18.38 090
capsule.
19380.............. .............. A Revise breast 9.14 N/A 7.90 0.98 N/A 18.02 090
reconstruction.
19396.............. .............. A Design custom breast 2.17 5.91 1.01 0.23 8.31 3.41 000
implant.
19499.............. .............. C Breast surgery 0.00 0.00 0.00 0.00 0.00 0.00 YYY
procedure.
20000.............. .............. A Incision of abscess. 2.12 2.44 1.63 0.17 4.73 3.92 010
20005.............. .............. A Incision of deep 3.42 3.44 2.15 0.34 7.20 5.91 010
abscess.
20100.............. .............. A Explore wound, neck. 10.08 5.92 4.44 0.99 16.99 15.51 010
20101.............. .............. A Explore wound, chest 3.22 3.02 1.61 0.24 6.48 5.07 010
20102.............. .............. A Explore wound, 3.94 3.57 1.82 0.35 7.86 6.11 010
abdomen.
20103.............. .............. A Explore wound, 5.30 4.25 3.28 0.57 10.12 9.15 010
extremity.
20150.............. .............. A Excise epiphyseal 13.69 N/A 7.37 0.96 N/A 22.02 090
bar.
20200.............. .............. A Muscle biopsy....... 1.46 3.20 0.79 0.17 4.83 2.42 000
20205.............. .............. A Deep muscle biopsy.. 2.35 4.21 1.23 0.23 6.79 3.81 000
20206.............. .............. A Needle biopsy, 0.99 3.23 0.35 0.06 4.28 1.40 000
muscle.
20220.............. .............. A Bone biopsy, trocar/ 1.27 4.83 2.80 0.06 6.16 4.13 000
needle.
20225.............. .............. A Bone biopsy, trocar/ 1.87 4.37 2.95 0.11 6.35 4.93 000
needle.
20240.............. .............. A Bone biopsy, 3.23 N/A 2.56 0.33 N/A 6.12 010
excisional.
20245.............. .............. A Bone biopsy, 7.78 N/A 6.39 0.44 N/A 14.61 010
excisional.
20250.............. .............. A Open bone biopsy.... 5.03 N/A 4.61 0.50 N/A 10.14 010
20251.............. .............. A Open bone biopsy.... 5.56 N/A 5.26 0.79 N/A 11.61 010
20500.............. .............. A Injection of sinus 1.23 6.00 3.86 0.10 7.33 5.19 010
tract.
20501.............. .............. A Inject sinus tract 0.76 3.04 0.25 0.03 3.83 1.04 000
for x-ray.
20520.............. .............. A Removal of foreign 1.85 2.28 1.82 0.17 4.30 3.84 010
body.
20525.............. .............. A Removal of foreign 3.50 3.44 2.68 0.40 7.34 6.58 010
body.
[[Page 49081]]
20526.............. .............. A Ther injection, carp 0.94 0.98 0.52 0.06 1.98 1.52 000
tunnel.
20550.............. .............. A Inj tendon sheath/ 0.75 0.73 0.24 0.06 1.54 1.05 000
ligament.
20551.............. .............. A Inject tendon origin/ 0.75 0.70 0.34 0.06 1.51 1.15 000
insert.
20552.............. .............. A Inject trigger 0.66 0.74 0.21 0.06 1.46 0.93 000
point, 1 or 2.
20553.............. .............. A Inject trigger 0.75 0.85 0.22 0.06 1.66 1.03 000
points, =/ 3.
20600.............. .............. A Drain/inject, joint/ 0.66 0.66 0.36 0.06 1.38 1.08 000
bursa.
20605.............. .............. A Drain/inject, joint/ 0.68 0.77 0.37 0.06 1.51 1.11 000
bursa.
20610.............. .............. A Drain/inject, joint/ 0.79 0.96 0.42 0.08 1.83 1.29 000
bursa.
20612.............. .............. A Aspirate/inj 0.70 0.73 0.34 0.06 1.49 1.10 000
ganglion cyst.
20615.............. .............. A Treatment of bone 2.28 2.59 1.82 0.19 5.06 4.29 010
cyst.
20650.............. .............. A Insert and remove 2.23 2.47 1.97 0.28 4.98 4.48 010
bone pin.
20660.............. .............. A Apply, rem fixation 2.51 3.12 1.74 0.48 6.11 4.73 000
device.
20661.............. .............. A Application of head 4.89 N/A 5.05 0.92 N/A 10.86 090
brace.
20662.............. .............. A Application of 6.07 N/A 5.54 0.81 N/A 12.42 090
pelvis brace.
20663.............. .............. A Application of thigh 5.43 N/A 4.86 0.77 N/A 11.06 090
brace.
20664.............. .............. A Halo brace 8.06 N/A 7.16 1.49 N/A 16.71 090
application.
20665.............. .............. A Removal of fixation 1.31 1.98 1.32 0.17 3.46 2.80 010
device.
20670.............. .............. A Removal of support 1.74 6.83 3.98 0.23 8.80 5.95 010
implant.
20680.............. .............. A Removal of support 3.35 3.44 3.44 0.46 7.25 7.25 090
implant.
20690.............. .............. A Apply bone fixation 3.52 N/A 2.51 0.47 N/A 6.50 090
device.
20692.............. .............. A Apply bone fixation 6.41 N/A 3.80 0.60 N/A 10.81 090
device.
20693.............. .............. A Adjust bone fixation 5.86 N/A 8.43 0.85 N/A 15.14 090
device.
20694.............. .............. A Remove bone fixation 4.16 7.10 4.64 0.57 11.83 9.37 090
device.
20802.............. .............. A Replantation, arm, 41.15 N/A 21.97 5.81 N/A 68.93 090
complete.
20805.............. .............. A Replant forearm, 50.00 N/A 35.96 3.95 N/A 89.91 090
complete.
20808.............. .............. A Replantation hand, 61.65 N/A 44.22 6.49 N/A 112.36 090
complete.
20816.............. .............. A Replantation digit, 30.94 N/A 40.19 3.01 N/A 74.14 090
complete.
20822.............. .............. A Replantation digit, 25.59 N/A 36.64 3.07 N/A 65.30 090
complete.
20824.............. .............. A Replantation thumb, 30.94 N/A 38.92 3.48 N/A 73.34 090
complete.
20827.............. .............. A Replantation thumb, 26.41 N/A 38.68 3.21 N/A 68.30 090
complete.
20838.............. .............. A Replantation foot, 41.41 N/A 22.96 5.85 N/A 70.22 090
complete.
20900.............. .............. A Removal of bone for 5.58 7.43 5.57 0.77 13.78 11.92 090
graft.
20902.............. .............. A Removal of bone for 7.55 N/A 7.06 1.06 N/A 15.67 090
graft.
20910.............. .............. A Remove cartilage for 5.34 7.19 5.51 0.50 13.03 11.35 090
graft.
20912.............. .............. A Remove cartilage for 6.35 N/A 6.21 0.55 N/A 13.11 090
graft.
20920.............. .............. A Removal of fascia 5.31 N/A 4.48 0.54 N/A 10.33 090
for graft.
20922.............. .............. A Removal of fascia 6.61 6.90 5.18 0.88 14.39 12.67 090
for graft.
20924.............. .............. A Removal of tendon 6.48 N/A 6.00 0.82 N/A 13.30 090
for graft.
20926.............. .............. A Removal of tissue 5.53 N/A 5.06 0.73 N/A 11.32 090
for graft.
20931.............. .............. A Spinal bone 1.81 N/A 0.95 0.34 N/A 3.10 ZZZ
allograft.
20937.............. .............. A Spinal bone 2.79 N/A 1.49 0.43 N/A 4.71 ZZZ
autograft.
20938.............. .............. A Spinal bone 3.02 N/A 1.59 0.52 N/A 5.13 ZZZ
autograft.
20950.............. .............. A Fluid pressure, 1.26 1.39 1.02 0.16 2.81 2.44 000
muscle.
20955.............. .............. A Fibula bone graft, 39.21 N/A 25.69 4.35 N/A 69.25 090
microvasc.
20956.............. .............. A Iliac bone graft, 39.27 N/A 25.40 5.77 N/A 70.44 090
microvasc.
20957.............. .............. A Mt bone graft, 40.65 N/A 19.47 5.74 N/A 65.86 090
microvasc.
20962.............. .............. A Other bone graft, 39.27 N/A 26.91 5.19 N/A 71.37 090
microvasc.
20969.............. .............. A Bone/skin graft, 43.92 N/A 28.25 4.34 N/A 76.51 090
microvasc.
20970.............. .............. A Bone/skin graft, 43.06 N/A 26.58 4.64 N/A 74.28 090
iliac crest.
20972.............. .............. A Bone/skin graft, 42.99 21.88 20.34 6.07 70.94 69.40 090
metatarsal.
20973.............. .............. A Bone/skin graft, 45.76 N/A 25.64 4.65 N/A 76.05 090
great toe.
20974.............. .............. A Electrical bone 0.62 0.63 0.56 0.09 1.34 1.27 000
stimulation.
[[Page 49082]]
20975.............. .............. A Electrical bone 2.60 N/A 1.76 0.42 N/A 4.78 000
stimulation.
20979.............. .............. A Us bone stimulation. 0.62 0.78 0.34 0.04 1.44 1.00 000
20999.............. .............. C Musculoskeletal 0.00 0.00 0.00 0.00 0.00 0.00 YYY
surgery.
21010.............. .............. A Incision of jaw 10.14 N/A 7.41 0.54 N/A 18.09 090
joint.
21015.............. .............. A Resection of facial 5.29 N/A 5.73 0.52 N/A 11.54 090
tumor.
21025.............. .............. A Excision of bone, 10.06 10.50 8.40 0.79 21.35 19.25 090
lower jaw.
21026.............. .............. A Excision of facial 4.85 7.20 5.70 0.40 12.45 10.95 090
bone(s).
21029.............. .............. A Contour of face bone 7.71 8.89 6.44 0.74 17.34 14.89 090
lesion.
21030.............. .............. A Excise max/zygoma b9 3.89 5.93 4.17 0.60 10.42 8.66 090
tumor.
21031.............. .............. A Remove exostosis, 3.24 4.74 3.18 0.28 8.26 6.70 090
mandible.
21032.............. .............. A Remove exostosis, 3.24 4.78 3.29 0.27 8.29 6.80 090
maxilla.
21034.............. .............. A Excise max/zygoma 16.17 13.91 11.51 1.37 31.45 29.05 090
mlg tumor.
21040.............. .............. A Excise mandible 3.89 5.79 3.84 0.19 9.87 7.92 090
lesion.
21044.............. .............. A Removal of jaw bone 11.86 N/A 8.95 0.87 N/A 21.68 090
lesion.
21045.............. .............. A Extensive jaw 16.17 N/A 11.75 1.20 N/A 29.12 090
surgery.
21046.............. .............. A Remove mandible cyst 13.00 N/A 13.21 1.01 N/A 27.22 090
complex.
21047.............. .............. A Excise lwr jaw cyst 18.75 N/A 13.84 1.53 N/A 34.12 090
w/repair.
21048.............. .............. A Remove maxilla cyst 13.50 N/A 13.50 1.01 N/A 28.01 090
complex.
21049.............. .............. A Excis uppr jaw cyst 18.00 N/A 13.41 1.01 N/A 32.42 090
w/repair.
21050.............. .............. A Removal of jaw joint 10.77 N/A 10.66 0.84 N/A 22.27 090
21060.............. .............. A Remove jaw joint 10.23 N/A 10.18 1.16 N/A 21.57 090
cartilage.
21070.............. .............. A Remove coronoid 8.20 N/A 7.25 0.67 N/A 16.12 090
process.
21076.............. .............. A Prepare face/oral 13.42 13.19 10.52 1.36 27.97 25.30 010
prosthesis.
21077.............. .............. A Prepare face/oral 33.75 33.45 27.14 3.43 70.63 64.32 090
prosthesis.
21079.............. .............. A Prepare face/oral 22.34 23.11 18.12 1.59 47.04 42.05 090
prosthesis.
21080.............. .............. A Prepare face/oral 25.10 26.21 20.48 2.55 53.86 48.13 090
prosthesis.
21081.............. .............. A Prepare face/oral 22.88 23.87 18.42 1.87 48.62 43.17 090
prosthesis.
21082.............. .............. A Prepare face/oral 20.87 20.66 16.57 1.46 42.99 38.90 090
prosthesis.
21083.............. .............. A Prepare face/oral 19.30 20.13 15.24 1.96 41.39 36.50 090
prosthesis.
21084.............. .............. A Prepare face/oral 22.51 23.94 18.60 1.57 48.02 42.68 090
prosthesis.
21085.............. .............. A Prepare face/oral 9.00 8.84 7.11 0.65 18.49 16.76 010
prosthesis.
21086.............. .............. A Prepare face/oral 24.92 25.25 20.19 1.86 52.03 46.97 090
prosthesis.
21087.............. .............. A Prepare face/oral 24.92 24.82 20.06 2.22 51.96 47.20 090
prosthesis.
21088.............. .............. C Prepare face/oral 0.00 0.00 0.00 0.00 0.00 0.00 090
prosthesis.
21089.............. .............. C Prepare face/oral 0.00 0.00 0.00 0.00 0.00 0.00 090
prosthesis.
21100.............. .............. A Maxillofacial 4.22 5.72 4.67 0.18 10.12 9.07 090
fixation.
21110.............. .............. A Interdental fixation 5.21 7.23 5.78 0.28 12.72 11.27 090
21116.............. .............. A Injection, jaw joint 0.81 5.67 0.34 0.05 6.53 1.20 000
x-ray.
21120.............. .............. A Reconstruction of 4.93 9.00 5.39 0.29 14.22 10.61 090
chin.
21121.............. .............. A Reconstruction of 7.64 10.71 6.82 0.56 18.91 15.02 090
chin.
21122.............. .............. A Reconstruction of 8.52 N/A 7.35 0.59 N/A 16.46 090
chin.
21123.............. .............. A Reconstruction of 11.16 N/A 8.49 1.16 N/A 20.81 090
chin.
[[Page 49083]]
21125.............. .............. A Augmentation, lower 10.62 12.09 8.47 0.72 23.43 19.81 090
jaw bone.
21127.............. .............. A Augmentation, lower 11.12 14.95 9.29 0.76 26.83 21.17 090
jaw bone.
21137.............. .............. A Reduction of 9.82 N/A 7.62 0.53 N/A 17.97 090
forehead.
21138.............. .............. A Reduction of 12.19 N/A 9.53 1.47 N/A 23.19 090
forehead.
21139.............. .............. A Reduction of 14.61 N/A 10.04 1.02 N/A 25.67 090
forehead.
21141.............. .............. A Reconstruct midface, 18.10 N/A 14.30 1.63 N/A 34.03 090
lefort.
21142.............. .............. A Reconstruct midface, 18.81 N/A 13.41 1.16 N/A 33.38 090
lefort.
21143.............. .............. A Reconstruct midface, 19.58 N/A 14.55 0.90 N/A 35.03 090
lefort.
21145.............. .............. A Reconstruct midface, 19.94 N/A 14.57 2.09 N/A 36.60 090
lefort.
21146.............. .............. A Reconstruct midface, 20.71 N/A 16.02 2.13 N/A 38.86 090
lefort.
21147.............. .............. A Reconstruct midface, 21.77 N/A 15.70 1.52 N/A 38.99 090
lefort.
21150.............. .............. A Reconstruct midface, 25.24 N/A 14.42 1.09 N/A 40.75 090
lefort.
21151.............. .............. A Reconstruct midface, 28.30 N/A 17.70 1.98 N/A 47.98 090
lefort.
21154.............. .............. A Reconstruct midface, 30.52 N/A 20.75 4.86 N/A 56.13 090
lefort.
21155.............. .............. A Reconstruct midface, 34.45 N/A 21.92 5.48 N/A 61.85 090
lefort.
21159.............. .............. A Reconstruct midface, 42.38 N/A 25.08 6.74 N/A 74.20 090
lefort.
21160.............. .............. A Reconstruct midface, 46.44 N/A 24.97 4.39 N/A 75.80 090
lefort.
21172.............. .............. A Reconstruct orbit/ 27.80 N/A 14.45 1.91 N/A 44.16 090
forehead.
21175.............. .............. A Reconstruct orbit/ 33.17 N/A 18.80 5.16 N/A 57.13 090
forehead.
21179.............. .............. A Reconstruct entire 22.25 N/A 15.41 2.48 N/A 40.14 090
forehead.
21180.............. .............. A Reconstruct entire 25.19 N/A 16.64 2.15 N/A 43.98 090
forehead.
21181.............. .............. A Contour cranial bone 9.90 N/A 7.69 0.97 N/A 18.56 090
lesion.
21182.............. .............. A Reconstruct cranial 32.19 N/A 20.18 2.53 N/A 54.90 090
bone.
21183.............. .............. A Reconstruct cranial 35.31 N/A 21.89 2.75 N/A 59.95 090
bone.
21184.............. .............. A Reconstruct cranial 38.24 N/A 22.40 4.12 N/A 64.76 090
bone.
21188.............. .............. A Reconstruction of 22.46 N/A 15.69 1.85 N/A 40.00 090
midface.
21193.............. .............. A Reconst lwr jaw w/o 17.15 N/A 13.39 1.53 N/A 32.07 090
graft.
21194.............. .............. A Reconst lwr jaw w/ 19.84 N/A 14.47 1.39 N/A 35.70 090
graft.
21195.............. .............. A Reconst lwr jaw w/o 17.24 N/A 13.70 1.20 N/A 32.14 090
fixation.
21196.............. .............. A Reconst lwr jaw w/ 18.91 N/A 14.31 1.62 N/A 34.84 090
fixation.
21198.............. .............. A Reconstr lwr jaw 14.16 N/A 11.32 1.05 N/A 26.53 090
segment.
21199.............. .............. A Reconstr lwr jaw w/ 16.00 N/A 9.40 1.26 N/A 26.66 090
advance.
21206.............. .............. A Reconstruct upper 14.10 N/A 11.14 1.01 N/A 26.25 090
jaw bone.
21208.............. .............. A Augmentation of 10.23 14.95 9.40 0.92 26.10 20.55 090
facial bones.
21209.............. .............. A Reduction of facial 6.72 12.17 7.28 0.60 19.49 14.60 090
bones.
21210.............. .............. A Face bone graft..... 10.23 14.17 9.66 0.88 25.28 20.77 090
21215.............. .............. A Lower jaw bone graft 10.77 13.96 9.86 1.04 25.77 21.67 090
21230.............. .............. A Rib cartilage graft. 10.77 N/A 8.86 0.96 N/A 20.59 090
21235.............. .............. A Ear cartilage graft. 6.72 11.67 7.25 0.52 18.91 14.49 090
21240.............. .............. A Reconstruction of 14.05 N/A 13.17 1.15 N/A 28.37 090
jaw joint.
21242.............. .............. A Reconstruction of 12.95 N/A 12.63 1.40 N/A 26.98 090
jaw joint.
21243.............. .............. A Reconstruction of 20.79 N/A 18.48 1.85 N/A 41.12 090
jaw joint.
21244.............. .............. A Reconstruction of 11.86 N/A 10.35 0.95 N/A 23.16 090
lower jaw.
21245.............. .............. A Reconstruction of 11.86 16.69 10.05 0.88 29.43 22.79 090
jaw.
21246.............. .............. A Reconstruction of 12.47 15.05 10.13 1.21 28.73 23.81 090
jaw.
21247.............. .............. A Reconstruct lower 22.63 N/A 18.53 2.21 N/A 43.37 090
jaw bone.
21248.............. .............. A Reconstruction of 11.48 13.46 9.59 1.01 25.95 22.08 090
jaw.
21249.............. .............. A Reconstruction of 17.52 17.12 13.05 1.39 36.03 31.96 090
jaw.
21255.............. .............. A Reconstruct lower 16.72 N/A 12.98 1.13 N/A 30.83 090
jaw bone.
21256.............. .............. A Reconstruction of 16.19 N/A 12.47 1.04 N/A 29.70 090
orbit.
21260.............. .............. A Revise eye sockets.. 16.52 N/A 9.13 1.25 N/A 26.90 090
21261.............. .............. A Revise eye sockets.. 31.49 N/A 19.67 2.20 N/A 53.36 090
21263.............. .............. A Revise eye sockets.. 28.42 N/A 13.14 2.16 N/A 43.72 090
21267.............. .............. A Revise eye sockets.. 18.90 N/A 13.58 1.35 N/A 33.83 090
[[Page 49084]]
21268.............. .............. A Revise eye sockets.. 24.48 N/A 15.66 0.79 N/A 40.93 090
21270.............. .............. A Augmentation, cheek 10.23 12.35 8.36 0.73 23.31 19.32 090
bone.
21275.............. .............. A Revision, 11.24 N/A 9.10 1.03 N/A 21.37 090
orbitofacial bones.
21280.............. .............. A Revision of eyelid.. 6.03 N/A 6.18 0.27 N/A 12.48 090
21282.............. .............. A Revision of eyelid.. 3.49 N/A 4.84 0.21 N/A 8.54 090
21295.............. .............. A Revision of jaw 1.53 N/A 3.02 0.13 N/A 4.68 090
muscle/bone.
21296.............. .............. A Revision of jaw 4.25 N/A 4.65 0.30 N/A 9.20 090
muscle/bone.
21299.............. .............. C Cranio/maxillofacial 0.00 0.00 0.00 0.00 0.00 0.00 YYY
surgery.
21300.............. .............. A Treatment of skull 0.72 2.48 0.26 0.09 3.29 1.07 000
fracture.
21310.............. .............. A Treatment of nose 0.58 2.44 0.15 0.05 3.07 0.78 000
fracture.
21315.............. .............. A Treatment of nose 1.51 3.18 1.31 0.12 4.81 2.94 010
fracture.
21320.............. .............. A Treatment of nose 1.85 4.44 1.89 0.15 6.44 3.89 010
fracture.
21325.............. .............. A Treatment of nose 3.77 N/A 3.84 0.31 N/A 7.92 090
fracture.
21330.............. .............. A Treatment of nose 5.38 N/A 5.44 0.48 N/A 11.30 090
fracture.
21335.............. .............. A Treatment of nose 8.61 N/A 7.02 0.64 N/A 16.27 090
fracture.
21336.............. .............. A Treat nasal septal 5.72 N/A 6.18 0.45 N/A 12.35 090
fracture.
21337.............. .............. A Treat nasal septal 2.70 5.27 3.75 0.22 8.19 6.67 090
fracture.
21338.............. .............. A Treat nasoethmoid 6.46 N/A 6.14 0.53 N/A 13.13 090
fracture.
21339.............. .............. A Treat nasoethmoid 8.09 N/A 6.90 0.76 N/A 15.75 090
fracture.
21340.............. .............. A Treatment of nose 10.77 N/A 8.99 0.85 N/A 20.61 090
fracture.
21343.............. .............. A Treatment of sinus 12.95 N/A 10.37 1.06 N/A 24.38 090
fracture.
21344.............. .............. A Treatment of sinus 19.72 N/A 14.00 1.72 N/A 35.44 090
fracture.
21345.............. .............. A Treat nose/jaw 8.16 12.01 8.21 0.60 20.77 16.97 090
fracture.
21346.............. .............. A Treat nose/jaw 10.61 13.67 9.41 0.85 25.13 20.87 090
fracture.
21347.............. .............. A Treat nose/jaw 12.69 N/A 10.02 1.14 N/A 23.85 090
fracture.
21348.............. .............. A Treat nose/jaw 16.69 N/A 11.60 1.50 N/A 29.79 090
fracture.
21355.............. .............. A Treat cheek bone 3.77 4.86 2.43 0.29 8.92 6.49 010
fracture.
21356.............. .............. A Treat cheek bone 4.15 12.21 3.31 0.36 16.72 7.82 010
fracture.
21360.............. .............. A Treat cheek bone 6.46 14.59 6.32 0.52 21.57 13.30 090
fracture.
21365.............. .............. A Treat cheek bone 14.95 N/A 12.08 1.30 N/A 28.33 090
fracture.
21366.............. .............. A Treat cheek bone 17.77 N/A 11.97 1.41 N/A 31.15 090
fracture.
21385.............. .............. A Treat eye socket 9.16 N/A 7.32 0.64 N/A 17.12 090
fracture.
21386.............. .............. A Treat eye socket 9.16 N/A 7.73 0.76 N/A 17.65 090
fracture.
21387.............. .............. A Treat eye socket 9.70 N/A 7.81 0.78 N/A 18.29 090
fracture.
21390.............. .............. A Treat eye socket 10.13 N/A 8.27 0.70 N/A 19.10 090
fracture.
21395.............. .............. A Treat eye socket 12.68 N/A 9.62 1.09 N/A 23.39 090
fracture.
21400.............. .............. A Treat eye socket 1.40 3.80 2.10 0.12 5.32 3.62 090
fracture.
21401.............. .............. A Treat eye socket 3.26 5.11 3.84 0.34 8.71 7.44 090
fracture.
21406.............. .............. A Treat eye socket 7.01 N/A 6.58 0.59 N/A 14.18 090
fracture.
21407.............. .............. A Treat eye socket 8.61 N/A 7.38 0.67 N/A 16.66 090
fracture.
21408.............. .............. A Treat eye socket 12.38 N/A 9.49 1.24 N/A 23.11 090
fracture.
21421.............. .............. A Treat mouth roof 5.14 10.22 6.31 0.42 15.78 11.87 090
fracture.
21422.............. .............. A Treat mouth roof 8.32 11.73 7.38 0.69 20.74 16.39 090
fracture.
21423.............. .............. A Treat mouth roof 10.40 N/A 8.72 0.95 N/A 20.07 090
fracture.
21431.............. .............. A Treat craniofacial 7.05 11.10 7.15 0.58 18.73 14.78 090
fracture.
21432.............. .............. A Treat craniofacial 8.61 N/A 6.53 0.55 N/A 15.69 090
fracture.
21433.............. .............. A Treat craniofacial 25.35 N/A 17.38 2.46 N/A 45.19 090
fracture.
21435.............. .............. A Treat craniofacial 17.25 N/A 13.41 1.66 N/A 32.32 090
fracture.
21436.............. .............. A Treat craniofacial 28.04 N/A 18.94 2.32 N/A 49.30 090
fracture.
21440.............. .............. A Treat dental ridge 2.70 8.32 4.22 0.22 11.24 7.14 090
fracture.
21445.............. .............. A Treat dental ridge 5.38 10.81 6.48 0.55 16.74 12.41 090
fracture.
21450.............. .............. A Treat lower jaw 2.97 11.00 3.86 0.23 14.20 7.06 090
fracture.
21451.............. .............. A Treat lower jaw 4.87 9.15 6.00 0.39 14.41 11.26 090
fracture.
21452.............. .............. A Treat lower jaw 1.98 8.19 3.81 0.14 10.31 5.93 090
fracture.
21453.............. .............. A Treat lower jaw 5.54 10.89 7.07 0.49 16.92 13.10 090
fracture.
21454.............. .............. A Treat lower jaw 6.46 N/A 6.62 0.55 N/A 13.63 090
fracture.
21461.............. .............. A Treat lower jaw 8.09 12.99 8.58 0.73 21.81 17.40 090
fracture.
21462.............. .............. A Treat lower jaw 9.79 14.58 9.31 0.80 25.17 19.90 090
fracture.
[[Page 49085]]
21465.............. .............. A Treat lower jaw 11.91 N/A 10.16 0.84 N/A 22.91 090
fracture.
21470.............. .............. A Treat lower jaw 15.34 N/A 12.41 1.36 N/A 29.11 090
fracture.
21480.............. .............. A Reset dislocated jaw 0.61 2.06 0.19 0.05 2.72 0.85 000
21485.............. .............. A Reset dislocated jaw 3.99 6.15 4.92 0.31 10.45 9.22 090
21490.............. .............. A Repair dislocated 11.86 N/A 10.03 1.31 N/A 23.20 090
jaw.
21493.............. .............. A Treat hyoid bone 1.27 N/A 2.96 0.10 N/A 4.33 090
fracture.
21494.............. .............. A Treat hyoid bone 6.28 N/A 5.91 0.44 N/A 12.63 090
fracture.
21495.............. .............. A Treat hyoid bone 5.69 N/A 6.18 0.41 N/A 12.28 090
fracture.
21497.............. .............. A Interdental wiring.. 3.86 6.77 5.16 0.31 10.94 9.33 090
21499.............. .............. C Head surgery 0.00 0.00 0.00 0.00 0.00 0.00 YYY
procedure.
21501.............. .............. A Drain neck/chest 3.81 4.79 3.95 0.36 8.96 8.12 090
lesion.
21502.............. .............. A Drain chest lesion.. 7.12 N/A 5.71 0.79 N/A 13.62 090
21510.............. .............. A Drainage of bone 5.74 N/A 5.65 0.67 N/A 12.06 090
lesion.
21550.............. .............. A Biopsy of neck/chest 2.06 3.65 1.75 0.13 5.84 3.94 010
21555.............. .............. A Remove lesion, neck/ 4.35 5.15 3.21 0.41 9.91 7.97 090
chest.
21556.............. .............. A Remove lesion, neck/ 5.57 N/A 4.09 0.51 N/A 10.17 090
chest.
21557.............. .............. A Remove tumor, neck/ 8.88 N/A 5.68 0.85 N/A 15.41 090
chest.
21600.............. .............. A Partial removal of 6.89 N/A 5.79 0.81 N/A 13.49 090
rib.
21610.............. .............. A Partial removal of 14.61 N/A 9.25 1.85 N/A 25.71 090
rib.
21615.............. .............. A Removal of rib...... 9.87 N/A 6.63 1.20 N/A 17.70 090
21616.............. .............. A Removal of rib and 12.04 N/A 8.00 1.31 N/A 21.35 090
nerves.
21620.............. .............. A Partial removal of 6.79 N/A 6.09 0.77 N/A 13.65 090
sternum.
21627.............. .............. A Sternal debridement. 6.81 N/A 6.82 0.82 N/A 14.45 090
21630.............. .............. A Extensive sternum 17.38 N/A 11.99 1.95 N/A 31.32 090
surgery.
21632.............. .............. A Extensive sternum 18.14 N/A 10.78 2.16 N/A 31.08 090
surgery.
21700.............. .............. A Revision of neck 6.19 6.23 4.88 0.31 12.73 11.38 090
muscle.
21705.............. .............. A Revision of neck 9.60 N/A 5.79 0.92 N/A 16.31 090
muscle/rib.
21720.............. .............. A Revision of neck 5.68 5.68 4.78 0.80 12.16 11.26 090
muscle.
21725.............. .............. A Revision of neck 6.99 N/A 5.72 0.90 N/A 13.61 090
muscle.
21740.............. .............. A Reconstruction of 16.50 N/A 8.67 2.03 N/A 27.20 090
sternum.
21742.............. .............. C Repair stern/nuss w/ 0.00 0.00 0.00 0.00 0.00 0.00 090
o scope.
21743.............. .............. C Repair sternum/nuss 0.00 0.00 0.00 0.00 0.00 0.00 090
w/scope.
21750.............. .............. A Repair of sternum 10.77 N/A 6.16 1.35 N/A 18.28 090
separation.
21800.............. .............. A Treatment of rib 0.96 2.15 1.43 0.09 3.20 2.48 090
fracture.
21805.............. .............. A Treatment of rib 2.75 N/A 3.31 0.29 N/A 6.35 090
fracture.
21810.............. .............. A Treatment of rib 6.86 N/A 5.04 0.60 N/A 12.50 090
fracture(s).
21820.............. .............. A Treat sternum 1.28 2.68 1.85 0.15 4.11 3.28 090
fracture.
21825.............. .............. A Treat sternum 7.41 N/A 6.48 0.84 N/A 14.73 090
fracture.
21899.............. .............. C Neck/chest surgery 0.00 0.00 0.00 0.00 0.00 0.00 YYY
procedure.
21920.............. .............. A Biopsy soft tissue 2.06 3.27 1.50 0.12 5.45 3.68 010
of back.
21925.............. .............. A Biopsy soft tissue 4.49 9.16 3.44 0.44 14.09 8.37 090
of back.
21930.............. .............. A Remove lesion, back 5.00 5.49 3.42 0.49 10.98 8.91 090
or flank.
21935.............. .............. A Remove tumor, back.. 17.96 N/A 10.50 1.87 N/A 30.33 090
22100.............. .............. A Remove part of neck 9.73 N/A 7.82 1.55 N/A 19.10 090
vertebra.
22101.............. .............. A Remove part, thorax 9.81 N/A 8.04 1.51 N/A 19.36 090
vertebra.
22102.............. .............. A Remove part, lumbar 9.81 N/A 8.30 1.46 N/A 19.57 090
vertebra.
22103.............. .............. A Remove extra spine 2.34 N/A 1.24 0.37 N/A 3.95 ZZZ
segment.
22110.............. .............. A Remove part of neck 12.74 N/A 9.54 2.20 N/A 24.48 090
vertebra.
22112.............. .............. A Remove part, thorax 12.81 N/A 9.56 1.96 N/A 24.33 090
vertebra.
22114.............. .............. A Remove part, lumbar 12.81 N/A 9.58 1.98 N/A 24.37 090
vertebra.
22116.............. .............. A Remove extra spine 2.32 N/A 1.19 0.40 N/A 3.91 ZZZ
segment.
22210.............. .............. A Revision of neck 23.82 N/A 15.88 4.23 N/A 43.93 090
spine.
[[Page 49086]]
22212.............. .............. A Revision of thorax 19.42 N/A 13.57 2.78 N/A 35.77 090
spine.
22214.............. .............. A Revision of lumbar 19.45 N/A 14.04 2.78 N/A 36.27 090
spine.
22216.............. .............. A Revise, extra spine 6.04 N/A 3.20 0.98 N/A 10.22 ZZZ
segment.
22220.............. .............. A Revision of neck 21.37 N/A 14.10 3.65 N/A 39.12 090
spine.
22222.............. .............. A Revision of thorax 21.52 N/A 11.93 3.08 N/A 36.53 090
spine.
22224.............. .............. A Revision of lumbar 21.52 N/A 14.60 3.20 N/A 39.32 090
spine.
22226.............. .............. A Revise, extra spine 6.04 N/A 3.16 1.01 N/A 10.21 ZZZ
segment.
22305.............. .............. A Treat spine process 2.05 3.25 2.43 0.29 5.59 4.77 090
fracture.
22310.............. .............. A Treat spine fracture 2.61 4.98 4.20 0.37 7.96 7.18 090
22315.............. .............. A Treat spine fracture 8.84 18.69 7.74 1.37 28.90 17.95 090
22318.............. .............. A Treat odontoid fx w/ 21.50 N/A 13.81 4.26 N/A 39.57 090
o graft.
22319.............. .............. A Treat odontoid fx w/ 24.00 N/A 15.33 4.76 N/A 44.09 090
graft.
22325.............. .............. A Treat spine fracture 18.30 N/A 12.41 2.61 N/A 33.32 090
22326.............. .............. A Treat neck spine 19.59 N/A 13.20 3.54 N/A 36.33 090
fracture.
22327.............. .............. A Treat thorax spine 19.20 N/A 12.71 2.75 N/A 34.66 090
fracture.
22328.............. .............. A Treat each add spine 4.61 N/A 2.32 0.66 N/A 7.59 ZZZ
fx.
22505.............. .............. A Manipulation of 1.87 N/A 0.95 0.27 N/A 3.09 010
spine.
22520.............. .............. A Percut 8.91 104.96 4.40 0.99 114.86 14.30 010
vertebroplasty thor.
22521.............. .............. A Percut 8.34 93.70 4.24 0.93 102.97 13.51 010
vertebroplasty lumb.
22522.............. .............. A Percut 4.31 N/A 1.72 0.33 N/A 6.36 ZZZ
vertebroplasty addl.
22548.............. .............. A Neck spine fusion... 25.82 N/A 16.15 4.98 N/A 46.95 090
22554.............. .............. A Neck spine fusion... 18.62 N/A 12.57 3.51 N/A 34.70 090
22556.............. .............. A Thorax spine fusion. 23.46 N/A 14.91 3.78 N/A 42.15 090
22558.............. .............. A Lumbar spine fusion. 22.28 N/A 13.45 3.18 N/A 38.91 090
22585.............. .............. A Additional spinal 5.53 N/A 2.86 0.98 N/A 9.37 ZZZ
fusion.
22590.............. .............. A Spine & skull spinal 20.51 N/A 13.57 3.81 N/A 37.89 090
fusion.
22595.............. .............. A Neck spinal fusion.. 19.39 N/A 13.06 3.62 N/A 36.07 090
22600.............. .............. A Neck spine fusion... 16.14 N/A 11.37 2.89 N/A 30.40 090
22610.............. .............. A Thorax spine fusion. 16.02 N/A 11.55 2.66 N/A 30.23 090
22612.............. .............. A Lumbar spine fusion. 21.00 N/A 14.36 3.28 N/A 38.64 090
22614.............. .............. A Spine fusion, extra 6.44 N/A 3.43 1.04 N/A 10.91 ZZZ
segment.
22630.............. .............. A Lumbar spine fusion. 20.84 N/A 13.82 3.79 N/A 38.45 090
22632.............. .............. A Spine fusion, extra 5.23 N/A 2.73 0.90 N/A 8.86 ZZZ
segment.
22800.............. .............. A Fusion of spine..... 18.25 N/A 12.88 2.71 N/A 33.84 090
22802.............. .............. A Fusion of spine..... 30.88 N/A 19.84 4.42 N/A 55.14 090
22804.............. .............. A Fusion of spine..... 36.27 N/A 23.00 5.23 N/A 64.50 090
22808.............. .............. A Fusion of spine..... 26.27 N/A 16.55 4.36 N/A 47.18 090
22810.............. .............. A Fusion of spine..... 30.27 N/A 18.61 4.49 N/A 53.37 090
22812.............. .............. A Fusion of spine..... 32.70 N/A 20.21 4.67 N/A 57.58 090
22818.............. .............. A Kyphectomy, 1-2 31.83 N/A 19.30 5.01 N/A 56.14 090
segments.
22819.............. .............. A Kyphectomy, 3 or 36.44 N/A 20.38 5.20 N/A 62.02 090
more.
22830.............. .............. A Exploration of 10.85 N/A 8.13 1.73 N/A 20.71 090
spinal fusion.
22840.............. .............. A Insert spine 12.54 N/A 6.64 2.03 N/A 21.21 ZZZ
fixation device.
22842.............. .............. A Insert spine 12.58 N/A 6.66 2.04 N/A 21.28 ZZZ
fixation device.
22843.............. .............. A Insert spine 13.46 N/A 6.75 2.10 N/A 22.31 ZZZ
fixation device.
22844.............. .............. A Insert spine 16.44 N/A 8.95 2.42 N/A 27.81 ZZZ
fixation device.
22845.............. .............. A Insert spine 11.96 N/A 6.22 2.22 N/A 20.40 ZZZ
fixation device.
22846.............. .............. A Insert spine 12.42 N/A 6.48 2.26 N/A 21.16 ZZZ
fixation device.
22847.............. .............. A Insert spine 13.80 N/A 7.19 2.36 N/A 23.35 ZZZ
fixation device.
22848.............. .............. A Insert pelv fixation 6.00 N/A 3.26 0.88 N/A 10.14 ZZZ
device.
22849.............. .............. A Reinsert spinal 18.51 N/A 12.17 2.87 N/A 33.55 090
fixation.
22850.............. .............. A Remove spine 9.52 N/A 7.28 1.51 N/A 18.31 090
fixation device.
22851.............. .............. A Apply spine prosth 6.71 N/A 3.44 1.11 N/A 11.26 ZZZ
device.
22852.............. .............. A Remove spine 9.01 N/A 7.06 1.40 N/A 17.47 090
fixation device.
22855.............. .............. A Remove spine 15.13 N/A 10.02 2.74 N/A 27.89 090
fixation device.
22899.............. .............. C Spine surgery 0.00 0.00 0.00 0.00 0.00 0.00 YYY
procedure.
[[Page 49087]]
22900.............. .............. A Remove abdominal 5.80 N/A 3.32 0.58 N/A 9.70 090
wall lesion.
22999.............. .............. C Abdomen surgery 0.00 0.00 0.00 0.00 0.00 0.00 YYY
procedure.
23000.............. .............. A Removal of calcium 4.36 5.59 4.74 0.50 10.45 9.60 090
deposits.
23020.............. .............. A Release shoulder 8.93 N/A 7.82 1.23 N/A 17.98 090
joint.
23030.............. .............. A Drain shoulder 3.43 3.07 2.97 0.42 6.92 6.82 010
lesion.
23031.............. .............. A Drain shoulder bursa 2.74 2.73 2.73 0.33 5.80 5.80 010
23035.............. .............. A Drain shoulder bone 8.61 N/A 9.12 1.19 N/A 18.92 090
lesion.
23040.............. .............. A Exploratory shoulder 9.20 N/A 8.20 1.28 N/A 18.68 090
surgery.
23044.............. .............. A Exploratory shoulder 7.12 N/A 6.80 0.97 N/A 14.89 090
surgery.
23065.............. .............. A Biopsy shoulder 2.27 2.88 1.55 0.14 5.29 3.96 010
tissues.
23066.............. .............. A Biopsy shoulder 4.16 5.19 4.18 0.50 9.85 8.84 090
tissues.
23075.............. .............. A Removal of shoulder 2.39 2.27 1.82 0.25 4.91 4.46 010
lesion.
23076.............. .............. A Removal of shoulder 7.63 N/A 5.88 0.87 N/A 14.38 090
lesion.
23077.............. .............. A Remove tumor of 16.09 N/A 11.03 1.81 N/A 28.93 090
shoulder.
23100.............. .............. A Biopsy of shoulder 6.03 N/A 5.89 0.81 N/A 12.73 090
joint.
23101.............. .............. A Shoulder joint 5.58 N/A 5.68 0.77 N/A 12.03 090
surgery.
23105.............. .............. A Remove shoulder 8.23 N/A 7.41 1.13 N/A 16.77 090
joint lining.
23106.............. .............. A Incision of 5.96 N/A 5.93 0.82 N/A 12.71 090
collarbone joint.
23107.............. .............. A Explore treat 8.62 N/A 7.63 1.19 N/A 17.44 090
shoulder joint.
23120.............. .............. A Partial removal, 7.11 N/A 6.70 0.99 N/A 14.80 090
collar bone.
23125.............. .............. A Removal of collar 9.39 N/A 7.85 1.27 N/A 18.51 090
bone.
23130.............. .............. A Remove shoulder 7.55 N/A 7.23 1.06 N/A 15.84 090
bone, part.
23140.............. .............. A Removal of bone 6.89 N/A 5.56 0.82 N/A 13.27 090
lesion.
23145.............. .............. A Removal of bone 9.09 N/A 7.92 1.24 N/A 18.25 090
lesion.
23146.............. .............. A Removal of bone 7.83 N/A 7.39 1.11 N/A 16.33 090
lesion.
23150.............. .............. A Removal of humerus 8.48 N/A 7.19 1.14 N/A 16.81 090
lesion.
23155.............. .............. A Removal of humerus 10.35 N/A 8.64 1.20 N/A 20.19 090
lesion.
23156.............. .............. A Removal of humerus 8.68 N/A 7.63 1.18 N/A 17.49 090
lesion.
23170.............. .............. A Remove collar bone 6.86 N/A 6.60 0.84 N/A 14.30 090
lesion.
23172.............. .............. A Remove shoulder 6.90 N/A 6.70 0.95 N/A 14.55 090
blade lesion.
23174.............. .............. A Remove humerus 9.51 N/A 8.63 1.30 N/A 19.44 090
lesion.
23180.............. .............. A Remove collar bone 8.53 N/A 9.76 1.18 N/A 19.47 090
lesion.
23182.............. .............. A Remove shoulder 8.15 N/A 9.36 1.08 N/A 18.59 090
blade lesion.
23184.............. .............. A Remove humerus 9.38 N/A 10.12 1.24 N/A 20.74 090
lesion.
23190.............. .............. A Partial removal of 7.24 N/A 6.34 0.97 N/A 14.55 090
scapula.
23195.............. .............. A Removal of head of 9.81 N/A 8.00 1.38 N/A 19.19 090
humerus.
23200.............. .............. A Removal of collar 12.08 N/A 9.24 1.48 N/A 22.80 090
bone.
23210.............. .............. A Removal of shoulder 12.49 N/A 9.61 1.61 N/A 23.71 090
blade.
23220.............. .............. A Partial removal of 14.56 N/A 11.28 2.03 N/A 27.87 090
humerus.
23221.............. .............. A Partial removal of 17.74 N/A 12.23 2.51 N/A 32.48 090
humerus.
23222.............. .............. A Partial removal of 23.92 N/A 16.44 3.37 N/A 43.73 090
humerus.
23330.............. .............. A Remove shoulder 1.85 2.08 1.89 0.18 4.11 3.92 010
foreign body.
23331.............. .............. A Remove shoulder 7.38 N/A 7.02 1.02 N/A 15.42 090
foreign body.
23332.............. .............. A Remove shoulder 11.62 N/A 9.49 1.62 N/A 22.73 090
foreign body.
[[Page 49088]]
23350.............. .............. A Injection for 1.00 3.88 0.34 0.05 4.93 1.39 000
shoulder x-ray.
23395.............. .............. A Muscle 16.85 N/A 12.87 2.29 N/A 32.01 090
transfer,shoulder/
arm.
23397.............. .............. A Muscle transfers.... 16.13 N/A 11.59 2.24 N/A 29.96 090
23400.............. .............. A Fixation of shoulder 13.54 N/A 10.42 1.91 N/A 25.87 090
blade.
23405.............. .............. A Incision of tendon & 8.37 N/A 7.08 1.12 N/A 16.57 090
muscle.
23406.............. .............. A Incise tendon(s) & 10.79 N/A 8.66 1.48 N/A 20.93 090
muscle(s).
23410.............. .............. A Repair rotator cuff, 12.45 N/A 9.69 1.72 N/A 23.86 090
acute.
23412.............. .............. A Repair rotator cuff, 13.31 N/A 10.19 1.86 N/A 25.36 090
chronic.
23415.............. .............. A Release of shoulder 9.97 N/A 8.12 1.39 N/A 19.48 090
ligament.
23420.............. .............. A Repair of shoulder.. 13.30 N/A 11.08 1.86 N/A 26.24 090
23430.............. .............. A Repair biceps tendon 9.98 N/A 8.36 1.40 N/A 19.74 090
23440.............. .............. A Remove/transplant 10.48 N/A 8.55 1.47 N/A 20.50 090
tendon.
23450.............. .............. A Repair shoulder 13.40 N/A 10.16 1.86 N/A 25.42 090
capsule.
23455.............. .............. A Repair shoulder 14.37 N/A 10.75 2.01 N/A 27.13 090
capsule.
23460.............. .............. A Repair shoulder 15.37 N/A 11.58 2.17 N/A 29.12 090
capsule.
23462.............. .............. A Repair shoulder 15.30 N/A 11.08 2.16 N/A 28.54 090
capsule.
23465.............. .............. A Repair shoulder 15.85 N/A 11.52 1.61 N/A 28.98 090
capsule.
23466.............. .............. A Repair shoulder 14.22 N/A 11.48 2.00 N/A 27.70 090
capsule.
23470.............. .............. A Reconstruct shoulder 17.15 N/A 12.30 2.40 N/A 31.85 090
joint.
23472.............. .............. A Reconstruct shoulder 21.10 N/A 14.54 2.37 N/A 38.01 090
joint.
23480.............. .............. A Revision of collar 11.18 N/A 9.04 1.56 N/A 21.78 090
bone.
23485.............. .............. A Revision of collar 13.43 N/A 10.19 1.84 N/A 25.46 090
bone.
23490.............. .............. A Reinforce clavicle.. 11.86 N/A 8.96 1.11 N/A 21.93 090
23491.............. .............. A Reinforce shoulder 14.21 N/A 10.90 2.00 N/A 27.11 090
bones.
23500.............. .............. A Treat clavicle 2.08 3.73 2.61 0.26 6.07 4.95 090
fracture.
23505.............. .............. A Treat clavicle 3.69 5.52 3.92 0.50 9.71 8.11 090
fracture.
23515.............. .............. A Treat clavicle 7.41 N/A 6.65 1.03 N/A 15.09 090
fracture.
23520.............. .............. A Treat clavicle 2.16 3.73 2.76 0.26 6.15 5.18 090
dislocation.
23525.............. .............. A Treat clavicle 3.60 5.35 3.95 0.44 9.39 7.99 090
dislocation.
23530.............. .............. A Treat clavicle 7.31 N/A 6.08 0.85 N/A 14.24 090
dislocation.
23532.............. .............. A Treat clavicle 8.01 N/A 7.05 1.13 N/A 16.19 090
dislocation.
23540.............. .............. A Treat clavicle 2.23 4.34 2.51 0.24 6.81 4.98 090
dislocation.
23545.............. .............. A Treat clavicle 3.25 4.59 3.45 0.39 8.23 7.09 090
dislocation.
23550.............. .............. A Treat clavicle 7.24 N/A 6.51 0.94 N/A 14.69 090
dislocation.
23552.............. .............. A Treat clavicle 8.45 N/A 7.40 1.18 N/A 17.03 090
dislocation.
23570.............. .............. A Treat shoulder blade 2.23 3.74 2.92 0.29 6.26 5.44 090
fx.
23575.............. .............. A Treat shoulder blade 4.06 5.87 4.33 0.53 10.46 8.92 090
fx.
23585.............. .............. A Treat scapula 8.96 N/A 7.74 1.25 N/A 17.95 090
fracture.
23600.............. .............. A Treat humerus 2.93 5.73 3.80 0.39 9.05 7.12 090
fracture.
23605.............. .............. A Treat humerus 4.87 7.03 5.36 0.67 12.57 10.90 090
fracture.
23615.............. .............. A Treat humerus 9.35 N/A 8.86 1.31 N/A 19.52 090
fracture.
23616.............. .............. A Treat humerus 21.27 N/A 14.39 2.98 N/A 38.64 090
fracture.
23620.............. .............. A Treat humerus 2.40 5.29 3.29 0.32 8.01 6.01 090
fracture.
23625.............. .............. A Treat humerus 3.93 6.54 4.74 0.53 11.00 9.20 090
fracture.
23630.............. .............. A Treat humerus 7.35 N/A 6.71 1.03 N/A 15.09 090
fracture.
23650.............. .............. A Treat shoulder 3.39 4.87 2.99 0.31 8.57 6.69 090
dislocation.
23655.............. .............. A Treat shoulder 4.57 N/A 4.17 0.52 N/A 9.26 090
dislocation.
23660.............. .............. A Treat shoulder 7.49 N/A 6.48 1.01 N/A 14.98 090
dislocation.
23665.............. .............. A Treat dislocation/ 4.47 6.81 5.13 0.60 11.88 10.20 090
fracture.
23670.............. .............. A Treat dislocation/ 7.90 N/A 6.95 1.10 N/A 15.95 090
fracture.
23675.............. .............. A Treat dislocation/ 6.05 7.70 6.17 0.83 14.58 13.05 090
fracture.
23680.............. .............. A Treat dislocation/ 10.06 N/A 8.24 1.39 N/A 19.69 090
fracture.
23700.............. .............. A Fixation of shoulder 2.52 N/A 2.39 0.35 N/A 5.26 010
23800.............. .............. A Fusion of shoulder 14.16 N/A 10.76 1.97 N/A 26.89 090
joint.
23802.............. .............. A Fusion of shoulder 16.60 N/A 10.49 2.34 N/A 29.43 090
joint.
23900.............. .............. A Amputation of arm & 19.72 N/A 12.21 2.47 N/A 34.40 090
girdle.
23920.............. .............. A Amputation at 14.61 N/A 10.45 1.92 N/A 26.98 090
shoulder joint.
23921.............. .............. A Amputation follow-up 5.49 5.32 5.32 0.78 11.59 11.59 090
surgery.
23929.............. .............. C Shoulder surgery 0.00 0.00 0.00 0.00 0.00 0.00 YYY
procedure.
[[Page 49089]]
23930.............. .............. A Drainage of arm 2.94 3.07 2.50 0.32 6.33 5.76 010
lesion.
23931.............. .............. A Drainage of arm 1.79 2.76 2.31 0.21 4.76 4.31 010
bursa.
23935.............. .............. A Drain arm/elbow bone 6.09 N/A 6.74 0.84 N/A 13.67 090
lesion.
24000.............. .............. A Exploratory elbow 5.82 N/A 5.56 0.77 N/A 12.15 090
surgery.
24006.............. .............. A Release elbow joint. 9.31 N/A 7.93 1.27 N/A 18.51 090
24065.............. .............. A Biopsy arm/elbow 2.08 2.45 1.94 0.14 4.67 4.16 010
soft tissue.
24066.............. .............. A Biopsy arm/elbow 5.21 5.90 4.41 0.61 11.72 10.23 090
soft tissue.
24075.............. .............. A Remove arm/elbow 3.92 5.18 3.79 0.43 9.53 8.14 090
lesion.
24076.............. .............. A Remove arm/elbow 6.30 N/A 5.17 0.70 N/A 12.17 090
lesion.
24077.............. .............. A Remove tumor of arm/ 11.76 N/A 8.97 1.32 N/A 22.05 090
elbow.
24100.............. .............. A Biopsy elbow joint 4.93 N/A 4.72 0.62 N/A 10.27 090
lining.
24101.............. .............. A Explore/treat elbow 6.13 N/A 6.07 0.84 N/A 13.04 090
joint.
24102.............. .............. A Remove elbow joint 8.03 N/A 7.05 1.09 N/A 16.17 090
lining.
24105.............. .............. A Removal of elbow 3.61 N/A 4.53 0.49 N/A 8.63 090
bursa.
24110.............. .............. A Remove humerus 7.39 N/A 6.93 0.99 N/A 15.31 090
lesion.
24115.............. .............. A Remove/graft bone 9.63 N/A 7.58 1.15 N/A 18.36 090
lesion.
24116.............. .............. A Remove/graft bone 11.81 N/A 9.34 1.66 N/A 22.81 090
lesion.
24120.............. .............. A Remove elbow lesion. 6.65 N/A 6.08 0.87 N/A 13.60 090
24125.............. .............. A Remove/graft bone 7.89 N/A 6.38 0.88 N/A 15.15 090
lesion.
24126.............. .............. A Remove/graft bone 8.31 N/A 7.19 0.90 N/A 16.40 090
lesion.
24130.............. .............. A Removal of head of 6.25 N/A 6.16 0.87 N/A 13.28 090
radius.
24134.............. .............. A Removal of arm bone 9.73 N/A 9.79 1.31 N/A 20.83 090
lesion.
24136.............. .............. A Remove radius bone 7.99 N/A 7.66 0.85 N/A 16.50 090
lesion.
24138.............. .............. A Remove elbow bone 8.05 N/A 7.71 1.12 N/A 16.88 090
lesion.
24140.............. .............. A Partial removal of 9.18 N/A 10.17 1.23 N/A 20.58 090
arm bone.
24145.............. .............. A Partial removal of 7.58 N/A 8.80 1.01 N/A 17.39 090
radius.
24147.............. .............. A Partial removal of 7.54 N/A 9.19 1.04 N/A 17.77 090
elbow.
24149.............. .............. A Radical resection of 14.20 N/A 11.53 1.90 N/A 27.63 090
elbow.
24150.............. .............. A Extensive humerus 13.27 N/A 10.47 1.81 N/A 25.55 090
surgery.
24151.............. .............. A Extensive humerus 15.58 N/A 12.08 2.19 N/A 29.85 090
surgery.
24152.............. .............. A Extensive radius 10.06 N/A 8.27 1.19 N/A 19.52 090
surgery.
24153.............. .............. A Extensive radius 11.54 N/A 6.08 0.64 N/A 18.26 090
surgery.
24155.............. .............. A Removal of elbow 11.73 N/A 8.62 1.42 N/A 21.77 090
joint.
24160.............. .............. A Remove elbow joint 7.83 N/A 6.85 1.07 N/A 15.75 090
implant.
24164.............. .............. A Remove radius head 6.23 N/A 5.77 0.84 N/A 12.84 090
implant.
24200.............. .............. A Removal of arm 1.76 2.38 1.82 0.15 4.29 3.73 010
foreign body.
24201.............. .............. A Removal of arm 4.56 5.84 4.46 0.56 10.96 9.58 090
foreign body.
24220.............. .............. A Injection for elbow 1.31 7.42 0.45 0.07 8.80 1.83 000
x-ray.
24300.............. .............. A Manipulate elbow w/ 3.75 N/A 5.70 0.49 N/A 9.94 090
anesth.
24301.............. .............. A Muscle/tendon 10.20 N/A 8.40 1.30 N/A 19.90 090
transfer.
24305.............. .............. A Arm tendon 7.45 N/A 6.87 0.98 N/A 15.30 090
lengthening.
24310.............. .............. A Revision of arm 5.98 N/A 5.90 0.74 N/A 12.62 090
tendon.
24320.............. .............. A Repair of arm tendon 10.56 N/A 7.95 1.00 N/A 19.51 090
24330.............. .............. A Revision of arm 9.60 N/A 8.09 1.21 N/A 18.90 090
muscles.
24331.............. .............. A Revision of arm 10.65 N/A 8.75 1.41 N/A 20.81 090
muscles.
24332.............. .............. A Tenolysis, triceps.. 7.45 N/A 6.76 0.77 N/A 14.98 090
24340.............. .............. A Repair of biceps 7.89 N/A 7.11 1.08 N/A 16.08 090
tendon.
24341.............. .............. A Repair arm tendon/ 7.90 N/A 7.86 1.08 N/A 16.84 090
muscle.
24342.............. .............. A Repair of ruptured 10.62 N/A 8.68 1.48 N/A 20.78 090
tendon.
24343.............. .............. A Repr elbow lat 8.65 N/A 8.21 1.13 N/A 17.99 090
ligmnt w/tiss.
[[Page 49090]]
24344.............. .............. A Reconstruct elbow 14.00 N/A 11.53 1.83 N/A 27.36 090
lat ligmnt.
24345.............. .............. A Repr elbw med ligmnt 8.65 N/A 8.11 1.13 N/A 17.89 090
w/tissu.
24346.............. .............. A Reconstruct elbow 14.00 N/A 11.38 1.83 N/A 27.21 090
med ligmnt.
24350.............. .............. A Repair of tennis 5.25 N/A 5.68 0.72 N/A 11.65 090
elbow.
24351.............. .............. A Repair of tennis 5.91 N/A 6.04 0.82 N/A 12.77 090
elbow.
24352.............. .............. A Repair of tennis 6.43 N/A 6.30 0.90 N/A 13.63 090
elbow.
24354.............. .............. A Repair of tennis 6.48 N/A 6.26 0.88 N/A 13.62 090
elbow.
24356.............. .............. A Revision of tennis 6.68 N/A 6.44 0.90 N/A 14.02 090
elbow.
24360.............. .............. A Reconstruct elbow 12.34 N/A 9.48 1.69 N/A 23.51 090
joint.
24361.............. .............. A Reconstruct elbow 14.08 N/A 10.56 1.95 N/A 26.59 090
joint.
24362.............. .............. A Reconstruct elbow 14.99 N/A 10.12 1.92 N/A 27.03 090
joint.
24363.............. .............. A Replace elbow joint. 18.49 N/A 13.78 2.52 N/A 34.79 090
24365.............. .............. A Reconstruct head of 8.39 N/A 7.16 1.11 N/A 16.66 090
radius.
24366.............. .............. A Reconstruct head of 9.13 N/A 7.51 1.28 N/A 17.92 090
radius.
24400.............. .............. A Revision of humerus. 11.06 N/A 9.14 1.53 N/A 21.73 090
24410.............. .............. A Revision of humerus. 14.82 N/A 10.69 1.89 N/A 27.40 090
24420.............. .............. A Revision of humerus. 13.44 N/A 11.04 1.82 N/A 26.30 090
24430.............. .............. A Repair of humerus... 12.81 N/A 10.01 1.80 N/A 24.62 090
24435.............. .............. A Repair humerus with 13.17 N/A 11.10 1.84 N/A 26.11 090
graft.
24470.............. .............. A Revision of elbow 8.74 N/A 7.83 1.23 N/A 17.80 090
joint.
24495.............. .............. A Decompression of 8.12 N/A 9.09 0.92 N/A 18.13 090
forearm.
24498.............. .............. A Reinforce humerus... 11.92 N/A 9.52 1.67 N/A 23.11 090
24500.............. .............. A Treat humerus 3.21 5.40 3.59 0.41 9.02 7.21 090
fracture.
24505.............. .............. A Treat humerus 5.17 7.64 5.58 0.72 13.53 11.47 090
fracture.
24515.............. .............. A Treat humerus 11.65 N/A 9.48 1.63 N/A 22.76 090
fracture.
24516.............. .............. A Treat humerus 11.65 N/A 9.45 1.63 N/A 22.73 090
fracture.
24530.............. .............. A Treat humerus 3.50 5.59 4.11 0.47 9.56 8.08 090
fracture.
24535.............. .............. A Treat humerus 6.87 8.54 6.53 0.96 16.37 14.36 090
fracture.
24538.............. .............. A Treat humerus 9.43 N/A 8.85 1.25 N/A 19.53 090
fracture.
24545.............. .............. A Treat humerus 10.46 N/A 8.55 1.47 N/A 20.48 090
fracture.
24546.............. .............. A Treat humerus 15.69 N/A 11.63 2.18 N/A 29.50 090
fracture.
24560.............. .............. A Treat humerus 2.80 5.07 3.19 0.35 8.22 6.34 090
fracture.
24565.............. .............. A Treat humerus 5.56 7.42 5.50 0.74 13.72 11.80 090
fracture.
24566.............. .............. A Treat humerus 7.79 N/A 8.36 1.10 N/A 17.25 090
fracture.
24575.............. .............. A Treat humerus 10.66 N/A 8.42 1.44 N/A 20.52 090
fracture.
24576.............. .............. A Treat humerus 2.86 4.94 3.57 0.38 8.18 6.81 090
fracture.
24577.............. .............. A Treat humerus 5.79 7.70 5.80 0.81 14.30 12.40 090
fracture.
24579.............. .............. A Treat humerus 11.60 N/A 9.10 1.62 N/A 22.32 090
fracture.
24582.............. .............. A Treat humerus 8.55 N/A 9.17 1.20 N/A 18.92 090
fracture.
24586.............. .............. A Treat elbow fracture 15.21 N/A 11.19 2.12 N/A 28.52 090
24587.............. .............. A Treat elbow fracture 15.16 N/A 11.00 2.14 N/A 28.30 090
24600.............. .............. A Treat elbow 4.23 5.86 3.74 0.49 10.58 8.46 090
dislocation.
24605.............. .............. A Treat elbow 5.42 N/A 5.16 0.72 N/A 11.30 090
dislocation.
24615.............. .............. A Treat elbow 9.42 N/A 7.84 1.31 N/A 18.57 090
dislocation.
24620.............. .............. A Treat elbow fracture 6.98 N/A 6.23 0.90 N/A 14.11 090
24635.............. .............. A Treat elbow fracture 13.19 N/A 14.76 1.84 N/A 29.79 090
24640.............. .............. A Treat elbow 1.20 2.06 0.91 0.11 3.37 2.22 010
dislocation.
24650.............. .............. A Treat radius 2.16 4.64 2.79 0.28 7.08 5.23 090
fracture.
24655.............. .............. A Treat radius 4.40 6.89 4.78 0.58 11.87 9.76 090
fracture.
24665.............. .............. A Treat radius 8.14 N/A 7.62 1.13 N/A 16.89 090
fracture.
24666.............. .............. A Treat radius 9.49 N/A 8.30 1.32 N/A 19.11 090
fracture.
24670.............. .............. A Treat ulnar fracture 2.54 4.52 3.07 0.33 7.39 5.94 090
24675.............. .............. A Treat ulnar fracture 4.72 6.94 5.01 0.65 12.31 10.38 090
24685.............. .............. A Treat ulnar fracture 8.80 N/A 7.77 1.23 N/A 17.80 090
24800.............. .............. A Fusion of elbow 11.20 N/A 8.95 1.41 N/A 21.56 090
joint.
24802.............. .............. A Fusion/graft of 13.69 N/A 10.59 1.89 N/A 26.17 090
elbow joint.
24900.............. .............. A Amputation of upper 9.60 N/A 7.53 1.18 N/A 18.31 090
arm.
24920.............. .............. A Amputation of upper 9.54 N/A 7.88 1.22 N/A 18.64 090
arm.
24925.............. .............. A Amputation follow-up 7.07 N/A 6.45 0.95 N/A 14.47 090
surgery.
[[Page 49091]]
24930.............. .............. A Amputation follow-up 10.25 N/A 7.78 1.23 N/A 19.26 090
surgery.
24931.............. .............. A Amputate upper arm & 12.72 N/A 6.31 1.56 N/A 20.59 090
implant.
24935.............. .............. A Revision of 15.56 N/A 8.64 1.58 N/A 25.78 090
amputation.
24940.............. .............. C Revision of upper 0.00 0.00 0.00 0.00 0.00 0.00 090
arm.
24999.............. .............. C Upper arm/elbow 0.00 0.00 0.00 0.00 0.00 0.00 YYY
surgery.
25000.............. .............. A Incision of tendon 3.38 N/A 6.95 0.45 N/A 10.78 090
sheath.
25001.............. .............. A Incise flexor carpi 3.38 N/A 4.29 0.45 N/A 8.12 090
radialis.
25020.............. .............. A Decompress forearm 1 5.92 N/A 10.24 0.76 N/A 16.92 090
space.
25023.............. .............. A Decompress forearm 1 12.96 N/A 15.71 1.52 N/A 30.19 090
space.
25024.............. .............. A Decompress forearm 2 9.50 N/A 7.63 1.24 N/A 18.37 090
spaces.
25025.............. .............. A Decompress forarm 2 16.54 N/A 10.25 2.18 N/A 28.97 090
spaces.
25028.............. .............. A Drainage of forearm 5.25 N/A 8.79 0.61 N/A 14.65 090
lesion.
25031.............. .............. A Drainage of forearm 4.14 N/A 8.65 0.50 N/A 13.29 090
bursa.
25035.............. .............. A Treat forearm bone 7.36 N/A 14.64 0.98 N/A 22.98 090
lesion.
25040.............. .............. A Explore/treat wrist 7.18 N/A 7.68 0.96 N/A 15.82 090
joint.
25065.............. .............. A Biopsy forearm soft 1.99 2.89 2.89 0.12 5.00 5.00 010
tissues.
25066.............. .............. A Biopsy forearm soft 4.13 N/A 7.43 0.49 N/A 12.05 090
tissues.
25075.............. .............. A Removel forearm 3.74 N/A 6.28 0.40 N/A 10.42 090
lesion subcu.
25076.............. .............. A Removel forearm 4.92 N/A 10.35 0.59 N/A 15.86 090
lesion deep.
25077.............. .............. A Remove tumor, 9.76 N/A 12.98 1.10 N/A 23.84 090
forearm/wrist.
25085.............. .............. A Incision of wrist 5.50 N/A 7.81 0.71 N/A 14.02 090
capsule.
25100.............. .............. A Biopsy of wrist 3.90 N/A 5.67 0.50 N/A 10.07 090
joint.
25101.............. .............. A Explore/treat wrist 4.69 N/A 6.25 0.60 N/A 11.54 090
joint.
25105.............. .............. A Remove wrist joint 5.85 N/A 7.88 0.77 N/A 14.50 090
lining.
25107.............. .............. A Remove wrist joint 6.43 N/A 8.83 0.82 N/A 16.08 090
cartilage.
25110.............. .............. A Remove wrist tendon 3.92 N/A 7.46 0.48 N/A 11.86 090
lesion.
25111.............. .............. A Remove wrist tendon 3.39 N/A 5.08 0.42 N/A 8.89 090
lesion.
25112.............. .............. A Reremove wrist 4.53 N/A 5.69 0.54 N/A 10.76 090
tendon lesion.
25115.............. .............. A Remove wrist/forearm 8.82 N/A 14.84 1.11 N/A 24.77 090
lesion.
25116.............. .............. A Remove wrist/forearm 7.11 N/A 13.82 0.90 N/A 21.83 090
lesion.
25118.............. .............. A Excise wrist tendon 4.37 N/A 6.17 0.55 N/A 11.09 090
sheath.
25119.............. .............. A Partial removal of 6.04 N/A 8.17 0.80 N/A 15.01 090
ulna.
25120.............. .............. A Removal of forearm 6.10 N/A 12.83 0.81 N/A 19.74 090
lesion.
25125.............. .............. A Remove/graft forearm 7.48 N/A 13.61 1.02 N/A 22.11 090
lesion.
25126.............. .............. A Remove/graft forearm 7.55 N/A 13.69 1.00 N/A 22.24 090
lesion.
25130.............. .............. A Removal of wrist 5.26 N/A 6.72 0.66 N/A 12.64 090
lesion.
25135.............. .............. A Remove & graft wrist 6.89 N/A 7.75 0.89 N/A 15.53 090
lesion.
25136.............. .............. A Remove & graft wrist 5.97 N/A 6.87 0.58 N/A 13.42 090
lesion.
25145.............. .............. A Remove forearm bone 6.37 N/A 12.84 0.82 N/A 20.03 090
lesion.
25150.............. .............. A Partial removal of 7.09 N/A 8.85 0.96 N/A 16.90 090
ulna.
25151.............. .............. A Partial removal of 7.39 N/A 13.46 0.93 N/A 21.78 090
radius.
25170.............. .............. A Extensive forearm 11.09 N/A 15.81 1.52 N/A 28.42 090
surgery.
25210.............. .............. A Removal of wrist 5.95 N/A 7.10 0.73 N/A 13.78 090
bone.
25215.............. .............. A Removal of wrist 7.89 N/A 9.32 1.02 N/A 18.23 090
bones.
[[Page 49092]]
25230.............. .............. A Partial removal of 5.23 N/A 6.51 0.66 N/A 12.40 090
radius.
25240.............. .............. A Partial removal of 5.17 N/A 7.59 0.69 N/A 13.45 090
ulna.
25246.............. .............. A Injection for wrist 1.45 7.16 0.49 0.07 8.68 2.01 000
x-ray.
25248.............. .............. A Remove forearm 5.14 N/A 9.00 0.54 N/A 14.68 090
foreign body.
25250.............. .............. A Removal of wrist 6.60 N/A 6.06 0.84 N/A 13.50 090
prosthesis.
25251.............. .............. A Removal of wrist 9.57 N/A 7.95 1.15 N/A 18.67 090
prosthesis.
25259.............. .............. A Manipulate wrist w/ 3.75 N/A 5.70 0.50 N/A 9.95 090
anesthes.
25260.............. .............. A Repair forearm 7.80 N/A 14.22 0.97 N/A 22.99 090
tendon/muscle.
25263.............. .............. A Repair forearm 7.82 N/A 14.09 0.94 N/A 22.85 090
tendon/muscle.
25265.............. .............. A Repair forearm 9.88 N/A 14.98 1.19 N/A 26.05 090
tendon/muscle.
25270.............. .............. A Repair forearm 6.00 N/A 12.99 0.76 N/A 19.75 090
tendon/muscle.
25272.............. .............. A Repair forearm 7.04 N/A 13.70 0.89 N/A 21.63 090
tendon/muscle.
25274.............. .............. A Repair forearm 8.75 N/A 14.41 1.14 N/A 24.30 090
tendon/muscle.
25275.............. .............. A Repair forearm 8.50 N/A 7.72 1.13 N/A 17.35 090
tendon sheath.
25280.............. .............. A Revise wrist/forearm 7.22 N/A 13.39 0.91 N/A 21.52 090
tendon.
25290.............. .............. A Incise wrist/forearm 5.29 N/A 16.39 0.66 N/A 22.34 090
tendon.
25295.............. .............. A Release wrist/ 6.55 N/A 12.95 0.86 N/A 20.36 090
forearm tendon.
25300.............. .............. A Fusion of tendons at 8.80 N/A 8.66 1.07 N/A 18.53 090
wrist.
25301.............. .............. A Fusion of tendons at 8.40 N/A 8.38 1.08 N/A 17.86 090
wrist.
25310.............. .............. A Transplant forearm 8.14 N/A 13.81 1.01 N/A 22.96 090
tendon.
25312.............. .............. A Transplant forearm 9.57 N/A 14.72 1.22 N/A 25.51 090
tendon.
25315.............. .............. A Revise palsy hand 10.20 N/A 15.32 1.26 N/A 26.78 090
tendon(s).
25316.............. .............. A Revise palsy hand 12.33 N/A 16.98 1.74 N/A 31.05 090
tendon(s).
25320.............. .............. A Repair/revise wrist 10.77 N/A 11.40 1.32 N/A 23.49 090
joint.
25332.............. .............. A Revise wrist joint.. 11.41 N/A 9.18 1.46 N/A 22.05 090
25335.............. .............. A Realignment of hand. 12.88 N/A 11.90 1.66 N/A 26.44 090
25337.............. .............. A Reconstruct ulna/ 10.17 N/A 11.55 1.31 N/A 23.03 090
radioulnar.
25350.............. .............. A Revision of radius.. 8.78 N/A 14.68 1.17 N/A 24.63 090
25355.............. .............. A Revision of radius.. 10.17 N/A 15.36 1.44 N/A 26.97 090
25360.............. .............. A Revision of ulna.... 8.43 N/A 14.59 1.17 N/A 24.19 090
25365.............. .............. A Revise radius & ulna 12.40 N/A 16.32 1.67 N/A 30.39 090
25370.............. .............. A Revise radius or 13.36 N/A 16.54 1.88 N/A 31.78 090
ulna.
25375.............. .............. A Revise radius & ulna 13.04 N/A 17.15 1.84 N/A 32.03 090
25390.............. .............. A Shorten radius or 10.40 N/A 15.34 1.38 N/A 27.12 090
ulna.
25391.............. .............. A Lengthen radius or 13.65 N/A 17.22 1.73 N/A 32.60 090
ulna.
25392.............. .............. A Shorten radius & 13.95 N/A 16.31 1.73 N/A 31.99 090
ulna.
25393.............. .............. A Lengthen radius & 15.87 N/A 18.23 1.87 N/A 35.97 090
ulna.
25394.............. .............. A Repair carpal bone, 10.40 N/A 8.53 1.40 N/A 20.33 090
shorten.
25400.............. .............. A Repair radius or 10.92 N/A 15.93 1.50 N/A 28.35 090
ulna.
25405.............. .............. A Repair/graft radius 14.38 N/A 17.96 1.95 N/A 34.29 090
or ulna.
25415.............. .............. A Repair radius & ulna 13.35 N/A 17.20 1.87 N/A 32.42 090
25420.............. .............. A Repair/graft radius 16.33 N/A 18.97 2.20 N/A 37.50 090
& ulna.
25425.............. .............. A Repair/graft radius 13.21 N/A 23.02 1.61 N/A 37.84 090
or ulna.
25426.............. .............. A Repair/graft radius 15.82 N/A 17.55 2.23 N/A 35.60 090
& ulna.
25430.............. .............. A Vasc graft into 9.25 N/A 7.54 1.07 N/A 17.86 090
carpal bone.
25431.............. .............. A Repair nonunion 10.44 N/A 8.52 0.56 N/A 19.52 090
carpal bone.
[[Page 49093]]
25440.............. .............. A Repair/graft wrist 10.44 N/A 9.69 1.41 N/A 21.54 090
bone.
25441.............. .............. A Reconstruct wrist 12.90 N/A 10.01 1.83 N/A 24.74 090
joint.
25442.............. .............. A Reconstruct wrist 10.85 N/A 8.88 1.24 N/A 20.97 090
joint.
25443.............. .............. A Reconstruct wrist 10.39 N/A 8.76 1.30 N/A 20.45 090
joint.
25444.............. .............. A Reconstruct wrist 11.15 N/A 9.07 1.43 N/A 21.65 090
joint.
25445.............. .............. A Reconstruct wrist 9.69 N/A 8.02 1.26 N/A 18.97 090
joint.
25446.............. .............. A Wrist replacement... 16.55 N/A 11.98 2.20 N/A 30.73 090
25447.............. .............. A Repair wrist 10.37 N/A 8.64 1.34 N/A 20.35 090
joint(s).
25449.............. .............. A Remove wrist joint 14.49 N/A 10.72 1.77 N/A 26.98 090
implant.
25450.............. .............. A Revision of wrist 7.87 N/A 10.71 0.88 N/A 19.46 090
joint.
25455.............. .............. A Revision of wrist 9.49 N/A 11.66 1.07 N/A 22.22 090
joint.
25490.............. .............. A Reinforce radius.... 9.54 N/A 14.46 1.19 N/A 25.19 090
25491.............. .............. A Reinforce ulna...... 9.96 N/A 15.21 1.41 N/A 26.58 090
25492.............. .............. A Reinforce radius and 12.33 N/A 15.97 1.62 N/A 29.92 090
ulna.
25500.............. .............. A Treat fracture of 2.45 4.06 2.77 0.28 6.79 5.50 090
radius.
25505.............. .............. A Treat fracture of 5.21 7.36 5.34 0.69 13.26 11.24 090
radius.
25515.............. .............. A Treat fracture of 9.18 N/A 7.70 1.22 N/A 18.10 090
radius.
25520.............. .............. A Treat fracture of 6.26 7.58 5.98 0.85 14.69 13.09 090
radius.
25525.............. .............. A Treat fracture of 12.24 N/A 10.12 1.68 N/A 24.04 090
radius.
25526.............. .............. A Treat fracture of 12.98 N/A 13.93 1.80 N/A 28.71 090
radius.
25530.............. .............. A Treat fracture of 2.09 4.22 2.85 0.27 6.58 5.21 090
ulna.
25535.............. .............. A Treat fracture of 5.14 6.98 5.27 0.68 12.80 11.09 090
ulna.
25545.............. .............. A Treat fracture of 8.90 N/A 7.90 1.23 N/A 18.03 090
ulna.
25560.............. .............. A Treat fracture 2.44 4.12 2.70 0.27 6.83 5.41 090
radius & ulna.
25565.............. .............. A Treat fracture 5.63 7.49 5.41 0.76 13.88 11.80 090
radius & ulna.
25574.............. .............. A Treat fracture 7.01 N/A 7.26 0.96 N/A 15.23 090
radius & ulna.
25575.............. .............. A Treat fracture 10.45 N/A 9.57 1.46 N/A 21.48 090
radius/ulna.
25600.............. .............. A Treat fracture 2.63 4.56 3.00 0.34 7.53 5.97 090
radius/ulna.
25605.............. .............. A Treat fracture 5.81 8.18 6.13 0.81 14.80 12.75 090
radius/ulna.
25611.............. .............. A Treat fracture 7.77 N/A 8.90 1.08 N/A 17.75 090
radius/ulna.
25620.............. .............. A Treat fracture 8.55 N/A 7.51 1.17 N/A 17.23 090
radius/ulna.
25622.............. .............. A Treat wrist bone 2.61 4.63 3.10 0.33 7.57 6.04 090
fracture.
25624.............. .............. A Treat wrist bone 4.53 7.10 5.00 0.61 12.24 10.14 090
fracture.
25628.............. .............. A Treat wrist bone 8.43 N/A 8.05 1.14 N/A 17.62 090
fracture.
25630.............. .............. A Treat wrist bone 2.88 4.65 3.00 0.37 7.90 6.25 090
fracture.
25635.............. .............. A Treat wrist bone 4.39 6.87 3.96 0.39 11.65 8.74 090
fracture.
25645.............. .............. A Treat wrist bone 7.25 N/A 7.01 0.93 N/A 15.19 090
fracture.
25650.............. .............. A Treat wrist bone 3.05 4.82 3.21 0.37 8.24 6.63 090
fracture.
25651.............. .............. A Pin ulnar styloid 5.36 N/A 5.62 0.72 N/A 11.70 090
fracture.
25652.............. .............. A Treat fracture ulnar 7.60 N/A 7.11 1.02 N/A 15.73 090
styloid.
25660.............. .............. A Treat wrist 4.76 N/A 4.75 0.59 N/A 10.10 090
dislocation.
25670.............. .............. A Treat wrist 7.92 N/A 7.31 1.07 N/A 16.30 090
dislocation.
25671.............. .............. A Pin radioulnar 6.00 N/A 6.23 0.81 N/A 13.04 090
dislocation.
25675.............. .............. A Treat wrist 4.67 6.62 4.69 0.57 11.86 9.93 090
dislocation.
25676.............. .............. A Treat wrist 8.04 N/A 7.56 1.10 N/A 16.70 090
dislocation.
25680.............. .............. A Treat wrist fracture 5.99 N/A 4.99 0.61 N/A 11.59 090
25685.............. .............. A Treat wrist fracture 9.78 N/A 8.12 1.25 N/A 19.15 090
25690.............. .............. A Treat wrist 5.50 N/A 5.69 0.78 N/A 11.97 090
dislocation.
25695.............. .............. A Treat wrist 8.34 N/A 7.43 1.07 N/A 16.84 090
dislocation.
25800.............. .............. A Fusion of wrist 9.76 N/A 9.35 1.30 N/A 20.41 090
joint.
25805.............. .............. A Fusion/graft of 11.28 N/A 10.42 1.51 N/A 23.21 090
wrist joint.
25810.............. .............. A Fusion/graft of 10.57 N/A 10.15 1.37 N/A 22.09 090
wrist joint.
25820.............. .............. A Fusion of hand bones 7.45 N/A 8.10 0.96 N/A 16.51 090
25825.............. .............. A Fuse hand bones with 9.27 N/A 9.37 1.20 N/A 19.84 090
graft.
25830.............. .............. A Fusion, radioulnar 10.06 N/A 15.11 1.27 N/A 26.44 090
jnt/ulna.
25900.............. .............. A Amputation of 9.01 N/A 13.06 1.08 N/A 23.15 090
forearm.
25905.............. .............. A Amputation of 9.12 N/A 13.13 1.06 N/A 23.31 090
forearm.
25907.............. .............. A Amputation follow-up 7.80 N/A 12.59 1.01 N/A 21.40 090
surgery.
25909.............. .............. A Amputation follow-up 8.96 N/A 13.10 1.07 N/A 23.13 090
surgery.
25915.............. .............. A Amputation of 17.08 N/A 20.05 2.41 N/A 39.54 090
forearm.
[[Page 49094]]
25920.............. .............. A Amputate hand at 8.68 N/A 8.22 1.06 N/A 17.96 090
wrist.
25922.............. .............. A Amputate hand at 7.42 N/A 7.25 0.93 N/A 15.60 090
wrist.
25924.............. .............. A Amputation follow-up 8.46 N/A 8.46 1.07 N/A 17.99 090
surgery.
25927.............. .............. A Amputation of hand.. 8.80 N/A 12.40 1.02 N/A 22.22 090
25929.............. .............. A Amputation follow-up 7.59 N/A 6.13 0.89 N/A 14.61 090
surgery.
25931.............. .............. A Amputation follow-up 7.81 N/A 12.40 0.88 N/A 21.09 090
surgery.
25999.............. .............. C Forearm or wrist 0.00 0.00 0.00 0.00 0.00 0.00 YYY
surgery.
26010.............. .............. A Drainage of finger 1.54 5.85 1.70 0.14 7.53 3.38 010
abscess.
26011.............. .............. A Drainage of finger 2.19 9.22 2.35 0.25 11.66 4.79 010
abscess.
26020.............. .............. A Drain hand tendon 4.67 N/A 5.61 0.59 N/A 10.87 090
sheath.
26025.............. .............. A Drainage of palm 4.82 N/A 5.45 0.60 N/A 10.87 090
bursa.
26030.............. .............. A Drainage of palm 5.93 N/A 6.11 0.72 N/A 12.76 090
bursa(s).
26034.............. .............. A Treat hand bone 6.23 N/A 6.33 0.79 N/A 13.35 090
lesion.
26035.............. .............. A Decompress fingers/ 9.51 N/A 8.21 1.12 N/A 18.84 090
hand.
26037.............. .............. A Decompress fingers/ 7.25 N/A 6.72 0.87 N/A 14.84 090
hand.
26040.............. .............. A Release palm 3.33 N/A 4.00 0.45 N/A 7.78 090
contracture.
26045.............. .............. A Release palm 5.56 N/A 5.60 0.74 N/A 11.90 090
contracture.
26055.............. .............. A Incise finger tendon 2.69 14.74 3.86 0.36 17.79 6.91 090
sheath.
26060.............. .............. A Incision of finger 2.81 N/A 3.52 0.35 N/A 6.68 090
tendon.
26070.............. .............. A Explore/treat hand 3.69 N/A 3.39 0.35 N/A 7.43 090
joint.
26075.............. .............. A Explore/treat finger 3.79 N/A 3.80 0.40 N/A 7.99 090
joint.
26080.............. .............. A Explore/treat finger 4.24 N/A 4.82 0.52 N/A 9.58 090
joint.
26100.............. .............. A Biopsy hand joint 3.67 N/A 4.12 0.45 N/A 8.24 090
lining.
26105.............. .............. A Biopsy finger joint 3.71 N/A 4.20 0.45 N/A 8.36 090
lining.
26110.............. .............. A Biopsy finger joint 3.53 N/A 4.00 0.44 N/A 7.97 090
lining.
26115.............. .............. A Removel hand lesion 3.86 13.55 4.71 0.48 17.89 9.05 090
subcut.
26116.............. .............. A Removel hand lesion, 5.53 N/A 5.98 0.69 N/A 12.20 090
deep.
26117.............. .............. A Remove tumor, hand/ 8.55 N/A 7.15 1.01 N/A 16.71 090
finger.
26121.............. .............. A Release palm 7.54 N/A 7.02 0.94 N/A 15.50 090
contracture.
26123.............. .............. A Release palm 9.29 N/A 8.90 1.17 N/A 19.36 090
contracture.
26125.............. .............. A Release palm 4.61 N/A 2.50 0.57 N/A 7.68 ZZZ
contracture.
26130.............. .............. A Remove wrist joint 5.42 N/A 5.35 0.65 N/A 11.42 090
lining.
26135.............. .............. A Revise finger joint, 6.96 N/A 6.47 0.87 N/A 14.30 090
each.
26140.............. .............. A Revise finger joint, 6.17 N/A 6.03 0.76 N/A 12.96 090
each.
26145.............. .............. A Tendon excision, 6.32 N/A 6.04 0.77 N/A 13.13 090
palm/finger.
26160.............. .............. A Remove tendon sheath 3.15 12.95 4.11 0.39 16.49 7.65 090
lesion.
26170.............. .............. A Removal of palm 4.77 N/A 4.97 0.60 N/A 10.34 090
tendon, each.
26180.............. .............. A Removal of finger 5.18 N/A 5.40 0.64 N/A 11.22 090
tendon.
26185.............. .............. A Remove finger bone.. 5.25 N/A 6.01 0.67 N/A 11.93 090
26200.............. .............. A Remove hand bone 5.51 N/A 5.39 0.71 N/A 11.61 090
lesion.
26205.............. .............. A Remove/graft bone 7.70 N/A 6.91 0.95 N/A 15.56 090
lesion.
26210.............. .............. A Removal of finger 5.15 N/A 5.41 0.64 N/A 11.20 090
lesion.
26215.............. .............. A Remove/graft finger 7.10 N/A 6.31 0.77 N/A 14.18 090
lesion.
26230.............. .............. A Partial removal of 6.33 N/A 5.96 0.84 N/A 13.13 090
hand bone.
26235.............. .............. A Partial removal, 6.19 N/A 5.85 0.78 N/A 12.82 090
finger bone.
26236.............. .............. A Partial removal, 5.32 N/A 5.37 0.66 N/A 11.35 090
finger bone.
26250.............. .............. A Extensive hand 7.55 N/A 6.46 0.92 N/A 14.93 090
surgery.
26255.............. .............. A Extensive hand 12.43 N/A 9.49 1.05 N/A 22.97 090
surgery.
26260.............. .............. A Extensive finger 7.03 N/A 6.20 0.83 N/A 14.06 090
surgery.
26261.............. .............. A Extensive finger 9.09 N/A 6.35 0.84 N/A 16.28 090
surgery.
26262.............. .............. A Partial removal of 5.67 N/A 5.39 0.70 N/A 11.76 090
finger.
26320.............. .............. A Removal of implant 3.98 N/A 4.28 0.49 N/A 8.75 090
from hand.
[[Page 49095]]
26340.............. .............. A Manipulate finger w/ 2.50 N/A 4.95 0.30 N/A 7.75 090
anesth.
26350.............. .............. A Repair finger/hand 5.99 N/A 16.02 0.73 N/A 22.74 090
tendon.
26352.............. .............. A Repair/graft hand 7.68 N/A 16.69 0.93 N/A 25.30 090
tendon.
26356.............. .............. A Repair finger/hand 8.07 N/A 19.20 0.99 N/A 28.26 090
tendon.
26357.............. .............. A Repair finger/hand 8.58 N/A 17.14 1.02 N/A 26.74 090
tendon.
26358.............. .............. A Repair/graft hand 9.14 N/A 17.96 1.07 N/A 28.17 090
tendon.
26370.............. .............. A Repair finger/hand 7.11 N/A 16.57 0.90 N/A 24.58 090
tendon.
26372.............. .............. A Repair/graft hand 8.76 N/A 17.97 1.06 N/A 27.79 090
tendon.
26373.............. .............. A Repair finger/hand 8.16 N/A 17.54 0.98 N/A 26.68 090
tendon.
26390.............. .............. A Revise hand/finger 9.19 N/A 14.34 1.09 N/A 24.62 090
tendon.
26392.............. .............. A Repair/graft hand 10.26 N/A 18.34 1.26 N/A 29.86 090
tendon.
26410.............. .............. A Repair hand tendon.. 4.63 N/A 13.17 0.57 N/A 18.37 090
26412.............. .............. A Repair/graft hand 6.31 N/A 14.43 0.80 N/A 21.54 090
tendon.
26415.............. .............. A Excision, hand/ 8.34 N/A 12.79 0.77 N/A 21.90 090
finger tendon.
26416.............. .............. A Graft hand or finger 9.37 N/A 15.71 1.20 N/A 26.28 090
tendon.
26418.............. .............. A Repair finger tendon 4.25 N/A 13.34 0.50 N/A 18.09 090
26420.............. .............. A Repair/graft finger 6.77 N/A 14.78 0.83 N/A 22.38 090
tendon.
26426.............. .............. A Repair finger/hand 6.15 N/A 14.25 0.77 N/A 21.17 090
tendon.
26428.............. .............. A Repair/graft finger 7.21 N/A 15.06 0.84 N/A 23.11 090
tendon.
26432.............. .............. A Repair finger tendon 4.02 N/A 11.13 0.48 N/A 15.63 090
26433.............. .............. A Repair finger tendon 4.56 N/A 11.83 0.56 N/A 16.95 090
26434.............. .............. A Repair/graft finger 6.09 N/A 12.43 0.71 N/A 19.23 090
tendon.
26437.............. .............. A Realignment of 5.82 N/A 12.34 0.74 N/A 18.90 090
tendons.
26440.............. .............. A Release palm/finger 5.02 N/A 14.83 0.62 N/A 20.47 090
tendon.
26442.............. .............. A Release palm & 8.16 N/A 17.10 0.94 N/A 26.20 090
finger tendon.
26445.............. .............. A Release hand/finger 4.31 N/A 14.59 0.54 N/A 19.44 090
tendon.
26449.............. .............. A Release forearm/hand 7.00 N/A 16.90 0.84 N/A 24.74 090
tendon.
26450.............. .............. A Incision of palm 3.67 N/A 7.79 0.46 N/A 11.92 090
tendon.
26455.............. .............. A Incision of finger 3.64 N/A 7.71 0.47 N/A 11.82 090
tendon.
26460.............. .............. A Incise hand/finger 3.46 N/A 7.52 0.44 N/A 11.42 090
tendon.
26471.............. .............. A Fusion of finger 5.73 N/A 12.00 0.73 N/A 18.46 090
tendons.
26474.............. .............. A Fusion of finger 5.32 N/A 12.20 0.69 N/A 18.21 090
tendons.
26476.............. .............. A Tendon lengthening.. 5.18 N/A 11.71 0.62 N/A 17.51 090
26477.............. .............. A Tendon shortening... 5.15 N/A 11.87 0.60 N/A 17.62 090
26478.............. .............. A Lengthening of hand 5.80 N/A 12.62 0.77 N/A 19.19 090
tendon.
26479.............. .............. A Shortening of hand 5.74 N/A 12.45 0.76 N/A 18.95 090
tendon.
26480.............. .............. A Transplant hand 6.69 N/A 16.27 0.84 N/A 23.80 090
tendon.
26483.............. .............. A Transplant/graft 8.29 N/A 16.72 1.03 N/A 26.04 090
hand tendon.
26485.............. .............. A Transplant palm 7.70 N/A 16.60 0.94 N/A 25.24 090
tendon.
26489.............. .............. A Transplant/graft 9.55 N/A 13.02 0.98 N/A 23.55 090
palm tendon.
26490.............. .............. A Revise thumb tendon. 8.41 N/A 13.55 1.05 N/A 23.01 090
26492.............. .............. A Tendon transfer with 9.62 N/A 14.30 1.19 N/A 25.11 090
graft.
26494.............. .............. A Hand tendon/muscle 8.47 N/A 13.78 1.13 N/A 23.38 090
transfer.
26496.............. .............. A Revise thumb tendon. 9.59 N/A 13.97 1.17 N/A 24.73 090
26497.............. .............. A Finger tendon 9.57 N/A 14.36 1.17 N/A 25.10 090
transfer.
26498.............. .............. A Finger tendon 14.00 N/A 16.90 1.74 N/A 32.64 090
transfer.
26499.............. .............. A Revision of finger.. 8.98 N/A 13.90 0.94 N/A 23.82 090
26500.............. .............. A Hand tendon 5.96 N/A 12.48 0.66 N/A 19.10 090
reconstruction.
26502.............. .............. A Hand tendon 7.14 N/A 12.95 0.87 N/A 20.96 090
reconstruction.
26504.............. .............. A Hand tendon 7.47 N/A 13.06 0.84 N/A 21.37 090
reconstruction.
26508.............. .............. A Release thumb 6.01 N/A 12.48 0.76 N/A 19.25 090
contracture.
26510.............. .............. A Thumb tendon 5.43 N/A 12.16 0.71 N/A 18.30 090
transfer.
[[Page 49096]]
26516.............. .............. A Fusion of knuckle 7.15 N/A 13.02 0.90 N/A 21.07 090
joint.
26517.............. .............. A Fusion of knuckle 8.83 N/A 14.37 0.96 N/A 24.16 090
joints.
26518.............. .............. A Fusion of knuckle 9.02 N/A 14.19 1.13 N/A 24.34 090
joints.
26520.............. .............. A Release knuckle 5.30 N/A 15.21 0.65 N/A 21.16 090
contracture.
26525.............. .............. A Release finger 5.33 N/A 15.33 0.66 N/A 21.32 090
contracture.
26530.............. .............. A Revise knuckle joint 6.69 N/A 6.13 0.86 N/A 13.68 090
26531.............. .............. A Revise knuckle with 7.91 N/A 7.07 1.01 N/A 15.99 090
implant.
26535.............. .............. A Revise finger joint. 5.24 N/A 3.76 0.66 N/A 9.66 090
26536.............. .............. A Revise/implant 6.37 N/A 10.06 0.80 N/A 17.23 090
finger joint.
26540.............. .............. A Repair hand joint... 6.43 N/A 12.73 0.81 N/A 19.97 090
26541.............. .............. A Repair hand joint 8.62 N/A 14.25 1.12 N/A 23.99 090
with graft.
26542.............. .............. A Repair hand joint 6.78 N/A 12.78 0.87 N/A 20.43 090
with graft.
26545.............. .............. A Reconstruct finger 6.92 N/A 13.16 0.79 N/A 20.87 090
joint.
26546.............. .............. A Repair nonunion hand 8.92 N/A 15.44 1.14 N/A 25.50 090
26548.............. .............. A Reconstruct finger 8.03 N/A 13.81 0.98 N/A 22.82 090
joint.
26550.............. .............. A Construct thumb 21.24 N/A 18.80 1.80 N/A 41.84 090
replacement.
26551.............. .............. A Great toe-hand 46.58 N/A 32.79 6.57 N/A 85.94 090
transfer.
26553.............. .............. A Single transfer, toe- 46.27 N/A 23.66 1.99 N/A 71.92 090
hand.
26554.............. .............. A Double transfer, toe- 54.95 N/A 35.88 7.76 N/A 98.59 090
hand.
26555.............. .............. A Positional change of 16.63 N/A 19.12 2.13 N/A 37.88 090
finger.
26556.............. .............. A Toe joint transfer.. 47.26 N/A 30.96 6.67 N/A 84.89 090
26560.............. .............. A Repair of web finger 5.38 N/A 10.71 0.60 N/A 16.69 090
26561.............. .............. A Repair of web finger 10.92 N/A 13.30 0.69 N/A 24.91 090
26562.............. .............. A Repair of web finger 15.00 N/A 17.99 0.98 N/A 33.97 090
26565.............. .............. A Correct metacarpal 6.74 N/A 12.83 0.84 N/A 20.41 090
flaw.
26567.............. .............. A Correct finger 6.82 N/A 12.76 0.84 N/A 20.42 090
deformity.
26568.............. .............. A Lengthen metacarpal/ 9.08 N/A 16.65 1.10 N/A 26.83 090
finger.
26580.............. .............. A Repair hand 18.18 N/A 14.08 1.46 N/A 33.72 090
deformity.
26587.............. .............. A Reconstruct extra 14.05 N/A 9.30 1.12 N/A 24.47 090
finger.
26590.............. .............. A Repair finger 17.96 N/A 14.84 1.32 N/A 34.12 090
deformity.
26591.............. .............. A Repair muscles of 3.25 N/A 10.88 0.37 N/A 14.50 090
hand.
26593.............. .............. A Release muscles of 5.31 N/A 11.84 0.64 N/A 17.79 090
hand.
26596.............. .............. A Excision 8.95 N/A 9.20 0.87 N/A 19.02 090
constricting tissue.
26600.............. .............. A Treat metacarpal 1.96 4.15 2.69 0.25 6.36 4.90 090
fracture.
26605.............. .............. A Treat metacarpal 2.85 5.45 3.74 0.38 8.68 6.97 090
fracture.
26607.............. .............. A Treat metacarpal 5.36 N/A 6.65 0.70 N/A 12.71 090
fracture.
26608.............. .............. A Treat metacarpal 5.36 N/A 6.56 0.73 N/A 12.65 090
fracture.
26615.............. .............. A Treat metacarpal 5.33 N/A 5.83 0.70 N/A 11.86 090
fracture.
26641.............. .............. A Treat thumb 3.94 5.59 3.72 0.42 9.95 8.08 090
dislocation.
26645.............. .............. A Treat thumb fracture 4.41 6.31 4.34 0.54 11.26 9.29 090
26650.............. .............. A Treat thumb fracture 5.72 N/A 6.88 0.77 N/A 13.37 090
26665.............. .............. A Treat thumb fracture 7.60 N/A 7.02 0.97 N/A 15.59 090
26670.............. .............. A Treat hand 3.69 5.17 3.21 0.36 9.22 7.26 090
dislocation.
26675.............. .............. A Treat hand 4.64 6.26 4.41 0.56 11.46 9.61 090
dislocation.
26676.............. .............. A Pin hand dislocation 5.52 N/A 6.92 0.76 N/A 13.20 090
26685.............. .............. A Treat hand 6.98 N/A 6.57 0.95 N/A 14.50 090
dislocation.
26686.............. .............. A Treat hand 7.94 N/A 7.26 1.05 N/A 16.25 090
dislocation.
26700.............. .............. A Treat knuckle 3.69 4.74 3.02 0.35 8.78 7.06 090
dislocation.
26705.............. .............. A Treat knuckle 4.19 6.05 4.24 0.50 10.74 8.93 090
dislocation.
26706.............. .............. A Pin knuckle 5.12 N/A 5.19 0.64 N/A 10.95 090
dislocation.
26715.............. .............. A Treat knuckle 5.74 N/A 6.02 0.75 N/A 12.51 090
dislocation.
26720.............. .............. A Treat finger 1.66 3.97 2.65 0.20 5.83 4.51 090
fracture, each.
26725.............. .............. A Treat finger 3.33 6.20 4.11 0.43 9.96 7.87 090
fracture, each.
26727.............. .............. A Treat finger 5.23 N/A 6.62 0.69 N/A 12.54 090
fracture, each.
26735.............. .............. A Treat finger 5.98 N/A 6.17 0.77 N/A 12.92 090
fracture, each.
26740.............. .............. A Treat finger 1.94 3.63 2.74 0.24 5.81 4.92 090
fracture, each.
26742.............. .............. A Treat finger 3.85 6.11 4.11 0.49 10.45 8.45 090
fracture, each.
26746.............. .............. A Treat finger 5.81 N/A 6.22 0.74 N/A 12.77 090
fracture, each.
26750.............. .............. A Treat finger 1.70 3.29 2.19 0.19 5.18 4.08 090
fracture, each.
26755.............. .............. A Treat finger 3.10 4.89 3.11 0.37 8.36 6.58 090
fracture, each.
[[Page 49097]]
26756.............. .............. A Pin finger fracture, 4.39 N/A 6.24 0.56 N/A 11.19 090
each.
26765.............. .............. A Treat finger 4.17 N/A 5.05 0.51 N/A 9.73 090
fracture, each.
26770.............. .............. A Treat finger 3.02 4.49 2.60 0.27 7.78 5.89 090
dislocation.
26775.............. .............. A Treat finger 3.71 5.87 3.82 0.43 10.01 7.96 090
dislocation.
26776.............. .............. A Pin finger 4.80 N/A 6.41 0.63 N/A 11.84 090
dislocation.
26785.............. .............. A Treat finger 4.21 N/A 5.09 0.54 N/A 9.84 090
dislocation.
26820.............. .............. A Thumb fusion with 8.26 N/A 14.03 1.11 N/A 23.40 090
graft.
26841.............. .............. A Fusion of thumb..... 7.13 N/A 13.84 0.97 N/A 21.94 090
26842.............. .............. A Thumb fusion with 8.24 N/A 14.11 1.10 N/A 23.45 090
graft.
26843.............. .............. A Fusion of hand joint 7.61 N/A 13.01 0.99 N/A 21.61 090
26844.............. .............. A Fusion/graft of hand 8.73 N/A 14.07 1.12 N/A 23.92 090
joint.
26850.............. .............. A Fusion of knuckle... 6.97 N/A 12.93 0.89 N/A 20.79 090
26852.............. .............. A Fusion of knuckle 8.46 N/A 13.62 1.05 N/A 23.13 090
with graft.
26860.............. .............. A Fusion of finger 4.69 N/A 11.90 0.60 N/A 17.19 090
joint.
26861.............. .............. A Fusion of finger 1.74 N/A 0.95 0.22 N/A 2.91 ZZZ
jnt, add-on.
26862.............. .............. A Fusion/graft of 7.37 N/A 13.10 0.92 N/A 21.39 090
finger joint.
26863.............. .............. A Fuse/graft added 3.90 N/A 2.16 0.51 N/A 6.57 ZZZ
joint.
26910.............. .............. A Amputate metacarpal 7.60 N/A 12.03 0.90 N/A 20.53 090
bone.
26951.............. .............. A Amputation of finger/ 4.59 N/A 10.94 0.56 N/A 16.09 090
thumb.
26952.............. .............. A Amputation of finger/ 6.31 N/A 12.51 0.74 N/A 19.56 090
thumb.
26989.............. .............. C Hand/finger surgery. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
26990.............. .............. A Drainage of pelvis 7.48 N/A 8.16 0.92 N/A 16.56 090
lesion.
26991.............. .............. A Drainage of pelvis 6.68 7.77 6.24 0.85 15.30 13.77 090
bursa.
26992.............. .............. A Drainage of bone 13.02 N/A 11.57 1.75 N/A 26.34 090
lesion.
27000.............. .............. A Incision of hip 5.62 N/A 5.49 0.76 N/A 11.87 090
tendon.
27001.............. .............. A Incision of hip 6.94 N/A 6.36 0.95 N/A 14.25 090
tendon.
27003.............. .............. A Incision of hip 7.34 N/A 6.77 0.93 N/A 15.04 090
tendon.
27005.............. .............. A Incision of hip 9.66 N/A 8.09 1.36 N/A 19.11 090
tendon.
27006.............. .............. A Incision of hip 9.68 N/A 8.25 1.33 N/A 19.26 090
tendons.
27025.............. .............. A Incision of hip/ 11.16 N/A 8.73 1.38 N/A 21.27 090
thigh fascia.
27030.............. .............. A Drainage of hip 13.01 N/A 9.94 1.81 N/A 24.76 090
joint.
27033.............. .............. A Exploration of hip 13.39 N/A 10.21 1.87 N/A 25.47 090
joint.
27035.............. .............. A Denervation of hip 16.69 N/A 12.66 1.70 N/A 31.05 090
joint.
27036.............. .............. A Excision of hip 12.88 N/A 10.41 1.80 N/A 25.09 090
joint/muscle.
27040.............. .............. A Biopsy of soft 2.87 2.92 2.20 0.21 6.00 5.28 010
tissues.
27041.............. .............. A Biopsy of soft 9.89 N/A 6.83 1.01 N/A 17.73 090
tissues.
27047.............. .............. A Remove hip/pelvis 7.45 6.66 5.07 0.79 14.90 13.31 090
lesion.
27048.............. .............. A Remove hip/pelvis 6.25 N/A 5.19 0.73 N/A 12.17 090
lesion.
27049.............. .............. A Remove tumor, hip/ 13.66 N/A 9.20 1.60 N/A 24.46 090
pelvis.
27050.............. .............. A Biopsy of sacroiliac 4.36 N/A 4.64 0.53 N/A 9.53 090
joint.
27052.............. .............. A Biopsy of hip joint. 6.23 N/A 6.19 0.85 N/A 13.27 090
27054.............. .............. A Removal of hip joint 8.54 N/A 7.71 1.17 N/A 17.42 090
lining.
27060.............. .............. A Removal of ischial 5.43 N/A 4.99 0.60 N/A 11.02 090
bursa.
27062.............. .............. A Remove femur lesion/ 5.37 N/A 5.42 0.74 N/A 11.53 090
bursa.
27065.............. .............. A Removal of hip bone 5.90 N/A 5.73 0.76 N/A 12.39 090
lesion.
27066.............. .............. A Removal of hip bone 10.33 N/A 8.76 1.42 N/A 20.51 090
lesion.
27067.............. .............. A Remove/graft hip 13.83 N/A 10.97 1.95 N/A 26.75 090
bone lesion.
27070.............. .............. A Partial removal of 10.72 N/A 10.40 1.36 N/A 22.48 090
hip bone.
27071.............. .............. A Partial removal of 11.46 N/A 11.32 1.51 N/A 24.29 090
hip bone.
27075.............. .............. A Extensive hip 35.00 N/A 20.42 2.22 N/A 57.64 090
surgery.
27076.............. .............. A Extensive hip 22.12 N/A 15.35 2.86 N/A 40.33 090
surgery.
27077.............. .............. A Extensive hip 40.00 N/A 23.94 3.18 N/A 67.12 090
surgery.
27078.............. .............. A Extensive hip 13.44 N/A 10.81 1.67 N/A 25.92 090
surgery.
27079.............. .............. A Extensive hip 13.75 N/A 10.45 1.86 N/A 26.06 090
surgery.
[[Page 49098]]
27080.............. .............. A Removal of tail bone 6.39 N/A 5.24 0.80 N/A 12.43 090
27086.............. .............. A Remove hip foreign 1.87 2.33 2.03 0.17 4.37 4.07 010
body.
27087.............. .............. A Remove hip foreign 8.54 N/A 6.84 1.09 N/A 16.47 090
body.
27090.............. .............. A Removal of hip 11.15 N/A 8.81 1.55 N/A 21.51 090
prosthesis.
27091.............. .............. A Removal of hip 22.14 N/A 14.12 3.11 N/A 39.37 090
prosthesis.
27093.............. .............. A Injection for hip x- 1.30 8.65 0.49 0.09 10.04 1.88 000
ray.
27095.............. .............. A Injection for hip x- 1.50 7.80 0.53 0.10 9.40 2.13 000
ray.
27096.............. .............. A Inject sacroiliac 1.40 6.89 0.33 0.08 8.37 1.81 000
joint.
27097.............. .............. A Revision of hip 8.80 N/A 6.65 1.22 N/A 16.67 090
tendon.
27098.............. .............. A Transfer tendon to 8.83 N/A 7.28 1.24 N/A 17.35 090
pelvis.
27100.............. .............. A Transfer of 11.08 N/A 8.97 1.57 N/A 21.62 090
abdominal muscle.
27105.............. .............. A Transfer of spinal 11.77 N/A 9.45 1.66 N/A 22.88 090
muscle.
27110.............. .............. A Transfer of 13.26 N/A 9.66 1.38 N/A 24.30 090
iliopsoas muscle.
27111.............. .............. A Transfer of 12.15 N/A 9.31 1.48 N/A 22.94 090
iliopsoas muscle.
27120.............. .............. A Reconstruction of 18.01 N/A 11.96 2.45 N/A 32.42 090
hip socket.
27122.............. .............. A Reconstruction of 14.98 N/A 11.06 2.08 N/A 28.12 090
hip socket.
27125.............. .............. A Partial hip 14.69 N/A 10.63 2.05 N/A 27.37 090
replacement.
27130.............. .............. A Total hip 20.12 N/A 13.41 2.82 N/A 36.35 090
arthroplasty.
27132.............. .............. A Total hip 23.30 N/A 15.78 3.26 N/A 42.34 090
arthroplasty.
27134.............. .............. A Revise hip joint 28.52 N/A 18.03 3.97 N/A 50.52 090
replacement.
27137.............. .............. A Revise hip joint 21.17 N/A 14.08 2.97 N/A 38.22 090
replacement.
27138.............. .............. A Revise hip joint 22.17 N/A 14.55 3.11 N/A 39.83 090
replacement.
27140.............. .............. A Transplant femur 12.24 N/A 9.66 1.67 N/A 23.57 090
ridge.
27146.............. .............. A Incision of hip bone 17.43 N/A 12.65 2.27 N/A 32.35 090
27147.............. .............. A Revision of hip bone 20.58 N/A 13.76 2.61 N/A 36.95 090
27151.............. .............. A Incision of hip 22.51 N/A 8.40 3.12 N/A 34.03 090
bones.
27156.............. .............. A Revision of hip 24.63 N/A 16.52 3.48 N/A 44.63 090
bones.
27158.............. .............. A Revision of pelvis.. 19.74 N/A 11.58 2.60 N/A 33.92 090
27161.............. .............. A Incision of neck of 16.71 N/A 12.28 2.32 N/A 31.31 090
femur.
27165.............. .............. A Incision/fixation of 17.91 N/A 13.07 2.51 N/A 33.49 090
femur.
27170.............. .............. A Repair/graft femur 16.07 N/A 11.68 2.20 N/A 29.95 090
head/neck.
27175.............. .............. A Treat slipped 8.46 N/A 6.70 1.19 N/A 16.35 090
epiphysis.
27176.............. .............. A Treat slipped 12.05 N/A 9.03 1.68 N/A 22.76 090
epiphysis.
27177.............. .............. A Treat slipped 15.08 N/A 10.90 2.11 N/A 28.09 090
epiphysis.
27178.............. .............. A Treat slipped 11.99 N/A 8.45 1.68 N/A 22.12 090
epiphysis.
27179.............. .............. A Revise head/neck of 12.98 N/A 9.84 1.84 N/A 24.66 090
femur.
27181.............. .............. A Treat slipped 14.68 N/A 10.31 1.74 N/A 26.73 090
epiphysis.
27185.............. .............. A Revision of femur 9.18 N/A 7.81 1.29 N/A 18.28 090
epiphysis.
27187.............. .............. A Reinforce hip bones. 13.54 N/A 10.60 1.89 N/A 26.03 090
27193.............. .............. A Treat pelvic ring 5.56 6.99 5.41 0.77 13.32 11.74 090
fracture.
27194.............. .............. A Treat pelvic ring 9.65 8.92 7.65 1.32 19.89 18.62 090
fracture.
27200.............. .............. A Treat tail bone 1.84 3.09 2.22 0.22 5.15 4.28 090
fracture.
27202.............. .............. A Treat tail bone 7.04 N/A 18.09 0.69 N/A 25.82 090
fracture.
27215.............. .............. A Treat pelvic 10.05 N/A 7.46 1.37 N/A 18.88 090
fracture(s).
27216.............. .............. A Treat pelvic ring 15.19 N/A 10.14 2.15 N/A 27.48 090
fracture.
27217.............. .............. A Treat pelvic ring 14.11 N/A 10.42 1.95 N/A 26.48 090
fracture.
27218.............. .............. A Treat pelvic ring 20.15 N/A 11.78 2.85 N/A 34.78 090
fracture.
27220.............. .............. A Treat hip socket 6.18 7.18 5.62 0.85 14.21 12.65 090
fracture.
27222.............. .............. A Treat hip socket 12.70 N/A 9.82 1.77 N/A 24.29 090
fracture.
27226.............. .............. A Treat hip wall 14.91 N/A 8.11 2.07 N/A 25.09 090
fracture.
27227.............. .............. A Treat hip 23.45 N/A 15.72 3.24 N/A 42.41 090
fracture(s).
27228.............. .............. A Treat hip 27.16 N/A 17.99 3.77 N/A 48.92 090
fracture(s).
27230.............. .............. A Treat thigh fracture 5.50 6.64 5.14 0.73 12.87 11.37 090
27232.............. .............. A Treat thigh fracture 10.68 N/A 7.53 1.45 N/A 19.66 090
27235.............. .............. A Treat thigh fracture 12.16 N/A 9.54 1.71 N/A 23.41 090
27236.............. .............. A Treat thigh fracture 15.60 N/A 11.14 2.18 N/A 28.92 090
[[Page 49099]]
27238.............. .............. A Treat thigh fracture 5.52 N/A 5.19 0.76 N/A 11.47 090
27240.............. .............. A Treat thigh fracture 12.50 N/A 9.45 1.69 N/A 23.64 090
27244.............. .............. A Treat thigh fracture 15.94 N/A 11.44 2.23 N/A 29.61 090
27245.............. .............. A Treat thigh fracture 20.31 N/A 13.92 2.85 N/A 37.08 090
27246.............. .............. A Treat thigh fracture 4.71 5.87 4.60 0.66 11.24 9.97 090
27248.............. .............. A Treat thigh fracture 10.45 N/A 8.31 1.45 N/A 20.21 090
27250.............. .............. A Treat hip 6.95 N/A 4.79 0.68 N/A 12.42 090
dislocation.
27252.............. .............. A Treat hip 10.39 N/A 7.53 1.37 N/A 19.29 090
dislocation.
27253.............. .............. A Treat hip 12.92 N/A 9.87 1.81 N/A 24.60 090
dislocation.
27254.............. .............. A Treat hip 18.26 N/A 12.23 2.52 N/A 33.01 090
dislocation.
27256.............. .............. A Treat hip 4.12 3.50 2.13 0.49 8.11 6.74 010
dislocation.
27257.............. .............. A Treat hip 5.22 N/A 3.02 0.56 N/A 8.80 010
dislocation.
27258.............. .............. A Treat hip 15.43 N/A 11.19 2.06 N/A 28.68 090
dislocation.
27259.............. .............. A Treat hip 21.55 N/A 14.53 2.99 N/A 39.07 090
dislocation.
27265.............. .............. A Treat hip 5.05 N/A 4.85 0.65 N/A 10.55 090
dislocation.
27266.............. .............. A Treat hip 7.49 N/A 6.39 1.04 N/A 14.92 090
dislocation.
27275.............. .............. A Manipulation of hip 2.27 N/A 2.25 0.31 N/A 4.83 010
joint.
27280.............. .............. A Fusion of sacroiliac 13.39 N/A 10.56 1.98 N/A 25.93 090
joint.
27282.............. .............. A Fusion of pubic 11.34 N/A 8.44 1.14 N/A 20.92 090
bones.
27284.............. .............. A Fusion of hip joint. 23.45 N/A 15.39 2.36 N/A 41.20 090
27286.............. .............. A Fusion of hip joint. 23.45 N/A 16.28 2.37 N/A 42.10 090
27290.............. .............. A Amputation of leg at 23.28 N/A 14.30 2.94 N/A 40.52 090
hip.
27295.............. .............. A Amputation of leg at 18.65 N/A 11.79 2.35 N/A 32.79 090
hip.
27299.............. .............. C Pelvis/hip joint 0.00 0.00 0.00 0.00 0.00 0.00 YYY
surgery.
27301.............. .............. A Drain thigh/knee 6.49 7.81 6.33 0.80 15.10 13.62 090
lesion.
27303.............. .............. A Drainage of bone 8.28 N/A 7.85 1.14 N/A 17.27 090
lesion.
27305.............. .............. A Incise thigh tendon 5.92 N/A 5.58 0.77 N/A 12.27 090
& fascia.
27306.............. .............. A Incision of thigh 4.62 N/A 4.96 0.62 N/A 10.20 090
tendon.
27307.............. .............. A Incision of thigh 5.80 N/A 5.69 0.78 N/A 12.27 090
tendons.
27310.............. .............. A Exploration of knee 9.27 N/A 8.10 1.29 N/A 18.66 090
joint.
27315.............. .............. A Partial removal, 6.97 N/A 4.81 0.79 N/A 12.57 090
thigh nerve.
27320.............. .............. A Partial removal, 6.30 N/A 5.12 0.78 N/A 12.20 090
thigh nerve.
27323.............. .............. A Biopsy, thigh soft 2.28 2.54 2.07 0.17 4.99 4.52 010
tissues.
27324.............. .............. A Biopsy, thigh soft 4.90 N/A 4.50 0.59 N/A 9.99 090
tissues.
27327.............. .............. A Removal of thigh 4.47 5.47 4.03 0.50 10.44 9.00 090
lesion.
27328.............. .............. A Removal of thigh 5.57 N/A 4.71 0.66 N/A 10.94 090
lesion.
27329.............. .............. A Remove tumor, thigh/ 14.14 N/A 9.91 1.68 N/A 25.73 090
knee.
27330.............. .............. A Biopsy, knee joint 4.97 N/A 4.82 0.66 N/A 10.45 090
lining.
27331.............. .............. A Explore/treat knee 5.88 N/A 5.81 0.81 N/A 12.50 090
joint.
27332.............. .............. A Removal of knee 8.27 N/A 7.30 1.15 N/A 16.72 090
cartilage.
27333.............. .............. A Removal of knee 7.30 N/A 6.83 1.03 N/A 15.16 090
cartilage.
27334.............. .............. A Remove knee joint 8.70 N/A 7.72 1.21 N/A 17.63 090
lining.
27335.............. .............. A Remove knee joint 10.00 N/A 8.54 1.41 N/A 19.95 090
lining.
27340.............. .............. A Removal of kneecap 4.18 N/A 4.71 0.58 N/A 9.47 090
bursa.
27345.............. .............. A Removal of knee cyst 5.92 N/A 5.80 0.81 N/A 12.53 090
27347.............. .............. A Remove knee cyst.... 5.78 N/A 5.70 0.76 N/A 12.24 090
27350.............. .............. A Removal of kneecap.. 8.17 N/A 7.43 1.15 N/A 16.75 090
27355.............. .............. A Remove femur lesion. 7.65 N/A 7.03 1.07 N/A 15.75 090
27356.............. .............. A Remove femur lesion/ 9.48 N/A 8.13 1.29 N/A 18.90 090
graft.
27357.............. .............. A Remove femur lesion/ 10.53 N/A 8.87 1.48 N/A 20.88 090
graft.
27358.............. .............. A Remove femur lesion/ 4.74 N/A 2.58 0.67 N/A 7.99 ZZZ
fixation.
27360.............. .............. A Partial removal, leg 10.50 N/A 10.59 1.42 N/A 22.51 090
bone(s).
27365.............. .............. A Extensive leg 16.27 N/A 12.20 2.26 N/A 30.73 090
surgery.
27370.............. .............. A Injection for knee x- 0.96 8.43 0.33 0.06 9.45 1.35 000
ray.
27372.............. .............. A Removal of foreign 5.07 6.19 4.84 0.62 11.88 10.53 090
body.
27380.............. .............. A Repair of kneecap 7.16 N/A 7.38 1.00 N/A 15.54 090
tendon.
27381.............. .............. A Repair/graft kneecap 10.34 N/A 9.21 1.44 N/A 20.99 090
tendon.
27385.............. .............. A Repair of thigh 7.76 N/A 7.73 1.09 N/A 16.58 090
muscle.
27386.............. .............. A Repair/graft of 10.56 N/A 9.64 1.49 N/A 21.69 090
thigh muscle.
[[Page 49100]]
27390.............. .............. A Incision of thigh 5.33 N/A 5.32 0.69 N/A 11.34 090
tendon.
27391.............. .............. A Incision of thigh 7.20 N/A 6.62 0.99 N/A 14.81 090
tendons.
27392.............. .............. A Incision of thigh 9.20 N/A 7.83 1.23 N/A 18.26 090
tendons.
27393.............. .............. A Lengthening of thigh 6.39 N/A 5.93 0.90 N/A 13.22 090
tendon.
27394.............. .............. A Lengthening of thigh 8.50 N/A 7.38 1.17 N/A 17.05 090
tendons.
27395.............. .............. A Lengthening of thigh 11.73 N/A 9.53 1.63 N/A 22.89 090
tendons.
27396.............. .............. A Transplant of thigh 7.86 N/A 7.26 1.11 N/A 16.23 090
tendon.
27397.............. .............. A Transplants of thigh 11.28 N/A 9.27 1.58 N/A 22.13 090
tendons.
27400.............. .............. A Revise thigh muscles/ 9.02 N/A 7.54 1.18 N/A 17.74 090
tendons.
27403.............. .............. A Repair of knee 8.33 N/A 7.32 1.16 N/A 16.81 090
cartilage.
27405.............. .............. A Repair of knee 8.65 N/A 7.77 1.21 N/A 17.63 090
ligament.
27407.............. .............. A Repair of knee 10.28 N/A 8.53 1.38 N/A 20.19 090
ligament.
27409.............. .............. A Repair of knee 12.90 N/A 10.16 1.75 N/A 24.81 090
ligaments.
27418.............. .............. A Repair degenerated 10.85 N/A 9.09 1.51 N/A 21.45 090
kneecap.
27420.............. .............. A Revision of unstable 9.83 N/A 8.27 1.38 N/A 19.48 090
kneecap.
27422.............. .............. A Revision of unstable 9.78 N/A 8.29 1.37 N/A 19.44 090
kneecap.
27424.............. .............. A Revision/removal of 9.81 N/A 8.26 1.38 N/A 19.45 090
kneecap.
27425.............. .............. A Lat retinacular 5.22 N/A 5.62 0.73 N/A 11.57 090
release open.
27427.............. .............. A Reconstruction, knee 9.36 N/A 7.94 1.29 N/A 18.59 090
27428.............. .............. A Reconstruction, knee 14.00 N/A 11.36 1.95 N/A 27.31 090
27429.............. .............. A Reconstruction, knee 15.52 N/A 12.54 2.18 N/A 30.24 090
27430.............. .............. A Revision of thigh 9.67 N/A 8.18 1.35 N/A 19.20 090
muscles.
27435.............. .............. A Incision of knee 9.49 N/A 8.55 1.33 N/A 19.37 090
joint.
27437.............. .............. A Revise kneecap...... 8.46 N/A 7.20 1.18 N/A 16.84 090
27438.............. .............. A Revise kneecap with 11.23 N/A 8.58 1.56 N/A 21.37 090
implant.
27440.............. .............. A Revision of knee 10.43 N/A 6.08 1.42 N/A 17.93 090
joint.
27441.............. .............. A Revision of knee 10.82 N/A 6.77 1.49 N/A 19.08 090
joint.
27442.............. .............. A Revision of knee 11.89 N/A 8.97 1.68 N/A 22.54 090
joint.
27443.............. .............. A Revision of knee 10.93 N/A 8.75 1.52 N/A 21.20 090
joint.
27445.............. .............. A Revision of knee 17.68 N/A 12.41 2.49 N/A 32.58 090
joint.
27446.............. .............. A Revision of knee 15.84 N/A 11.36 2.22 N/A 29.42 090
joint.
27447.............. .............. A Total knee 21.48 N/A 14.72 3.00 N/A 39.20 090
arthroplasty.
27448.............. .............. A Incision of thigh... 11.06 N/A 8.88 1.51 N/A 21.45 090
27450.............. .............. A Incision of thigh... 13.98 N/A 10.76 1.96 N/A 26.70 090
27454.............. .............. A Realignment of thigh 17.56 N/A 12.80 2.46 N/A 32.82 090
bone.
27455.............. .............. A Realignment of knee. 12.82 N/A 9.94 1.78 N/A 24.54 090
27457.............. .............. A Realignment of knee. 13.45 N/A 9.91 1.88 N/A 25.24 090
27465.............. .............. A Shortening of thigh 13.87 N/A 10.50 1.86 N/A 26.23 090
bone.
27466.............. .............. A Lengthening of thigh 16.33 N/A 12.17 1.92 N/A 30.42 090
bone.
27468.............. .............. A Shorten/lengthen 18.97 N/A 12.59 2.68 N/A 34.24 090
thighs.
27470.............. .............. A Repair of thigh..... 16.07 N/A 12.13 2.24 N/A 30.44 090
27472.............. .............. A Repair/graft of 17.72 N/A 13.04 2.49 N/A 33.25 090
thigh.
27475.............. .............. A Surgery to stop leg 8.64 N/A 7.43 1.13 N/A 17.20 090
growth.
27477.............. .............. A Surgery to stop leg 9.85 N/A 7.95 1.31 N/A 19.11 090
growth.
27479.............. .............. A Surgery to stop leg 12.80 N/A 10.12 1.81 N/A 24.73 090
growth.
27485.............. .............. A Surgery to stop leg 8.84 N/A 7.59 1.24 N/A 17.67 090
growth.
27486.............. .............. A Revise/replace knee 19.27 N/A 13.59 2.70 N/A 35.56 090
joint.
27487.............. .............. A Revise/replace knee 25.27 N/A 16.72 3.54 N/A 45.53 090
joint.
27488.............. .............. A Removal of knee 15.74 N/A 11.76 2.21 N/A 29.71 090
prosthesis.
27495.............. .............. A Reinforce thigh..... 15.55 N/A 11.75 2.18 N/A 29.48 090
27496.............. .............. A Decompression of 6.11 N/A 5.77 0.77 N/A 12.65 090
thigh/knee.
27497.............. .............. A Decompression of 7.17 N/A 5.80 0.84 N/A 13.81 090
thigh/knee.
[[Page 49101]]
27498.............. .............. A Decompression of 7.99 N/A 6.15 0.97 N/A 15.11 090
thigh/knee.
27499.............. .............. A Decompression of 9.00 N/A 7.07 1.18 N/A 17.25 090
thigh/knee.
27500.............. .............. A Treatment of thigh 5.92 7.24 5.18 0.80 13.96 11.90 090
fracture.
27501.............. .............. A Treatment of thigh 5.92 7.82 5.87 0.83 14.57 12.62 090
fracture.
27502.............. .............. A Treatment of thigh 10.58 N/A 8.36 1.49 N/A 20.43 090
fracture.
27503.............. .............. A Treatment of thigh 10.58 N/A 8.52 1.49 N/A 20.59 090
fracture.
27506.............. .............. A Treatment of thigh 17.45 N/A 12.81 2.33 N/A 32.59 090
fracture.
27507.............. .............. A Treatment of thigh 13.99 N/A 10.13 1.95 N/A 26.07 090
fracture.
27508.............. .............. A Treatment of thigh 5.83 7.10 5.42 0.80 13.73 12.05 090
fracture.
27509.............. .............. A Treatment of thigh 7.71 N/A 8.04 1.08 N/A 16.83 090
fracture.
27510.............. .............. A Treatment of thigh 9.13 N/A 7.31 1.26 N/A 17.70 090
fracture.
27511.............. .............. A Treatment of thigh 13.64 N/A 11.39 1.91 N/A 26.94 090
fracture.
27513.............. .............. A Treatment of thigh 17.92 N/A 14.08 2.51 N/A 34.51 090
fracture.
27514.............. .............. A Treatment of thigh 17.30 N/A 13.44 2.41 N/A 33.15 090
fracture.
27516.............. .............. A Treat thigh fx 5.37 7.41 5.48 0.74 13.52 11.59 090
growth plate.
27517.............. .............. A Treat thigh fx 8.78 9.06 7.49 1.22 19.06 17.49 090
growth plate.
27519.............. .............. A Treat thigh fx 15.02 N/A 11.83 2.09 N/A 28.94 090
growth plate.
27520.............. .............. A Treat kneecap 2.86 5.32 3.48 0.38 8.56 6.72 090
fracture.
27524.............. .............. A Treat kneecap 10.00 N/A 8.29 1.40 N/A 19.69 090
fracture.
27530.............. .............. A Treat knee fracture. 3.78 5.99 4.35 0.51 10.28 8.64 090
27532.............. .............. A Treat knee fracture. 7.30 7.86 6.27 1.02 16.18 14.59 090
27535.............. .............. A Treat knee fracture. 11.50 N/A 10.27 1.61 N/A 23.38 090
27536.............. .............. A Treat knee fracture. 15.65 N/A 11.70 2.19 N/A 29.54 090
27538.............. .............. A Treat knee 4.87 7.20 5.17 0.67 12.74 10.71 090
fracture(s).
27540.............. .............. A Treat knee fracture. 13.10 N/A 9.64 1.80 N/A 24.54 090
27550.............. .............. A Treat knee 5.76 6.71 5.02 0.68 13.15 11.46 090
dislocation.
27552.............. .............. A Treat knee 7.90 N/A 6.99 1.10 N/A 15.99 090
dislocation.
27556.............. .............. A Treat knee 14.41 N/A 12.07 2.01 N/A 28.49 090
dislocation.
27557.............. .............. A Treat knee 16.77 N/A 13.47 2.37 N/A 32.61 090
dislocation.
27558.............. .............. A Treat knee 17.72 N/A 13.52 2.51 N/A 33.75 090
dislocation.
27560.............. .............. A Treat kneecap 3.82 5.68 3.35 0.40 9.90 7.57 090
dislocation.
27562.............. .............. A Treat kneecap 5.79 N/A 4.87 0.69 N/A 11.35 090
dislocation.
27566.............. .............. A Treat kneecap 12.23 N/A 9.43 1.73 N/A 23.39 090
dislocation.
27570.............. .............. A Fixation of knee 1.74 N/A 1.91 0.24 N/A 3.89 010
joint.
27580.............. .............. A Fusion of knee...... 19.37 N/A 15.13 2.70 N/A 37.20 090
27590.............. .............. A Amputate leg at 12.03 N/A 7.33 1.35 N/A 20.71 090
thigh.
27591.............. .............. A Amputate leg at 12.68 N/A 9.27 1.63 N/A 23.58 090
thigh.
27592.............. .............. A Amputate leg at 10.02 N/A 6.84 1.17 N/A 18.03 090
thigh.
27594.............. .............. A Amputation follow-up 6.92 N/A 5.56 0.82