[Federal Register: January 7, 2004 (Volume 69, Number 4)]
[Rules and Regulations]
[Page 1083-1267]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr07ja04-18]
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Part IX
Department of Health and Human Services
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Centers for Medicare & Medicaid Services
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42 CFR Parts 405 and 414
Medicare Program; Changes to Medicare Payment for Drugs and Physician
Fee Schedule Payments for Calendar Year 2004; Interim Final Rule
[[Page 1084]]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 405 and 414
[CMS-1372-IFC]
RIN 0938-AM97
Medicare Program; Changes to Medicare Payment for Drugs and
Physician Fee Schedule Payments for Calendar Year 2004
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Interim final rule with comment period.
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SUMMARY: This interim final rule implements the provisions of the
Medicare Prescription Drug, Improvement, and Modernization Act (MPDIMA)
of 2003, Pub. L. 108-173, which are applicable in 2004 to Medicare
payment for covered drugs and physician fee schedule services. These
provisions revise the current payment methodology for Part B covered
drugs and biologicals that are not paid on a cost or prospective
payment basis; make changes to Medicare payment for furnishing or
administering drugs and biologicals; revise the geographic practice
cost indices and change the physician fee schedule conversion factor.
The 2004 physician fee schedule conversion factor will be $37.3374. The
2004 national anesthesia conversion factor (prior to making adjustment
for the geographic practice cost indices) will be $17.4969. The
information contained in this final rule related to payment under the
physician fee schedule supercedes the information contained in the
November 7, 2003, final rule to the extent that the two are
inconsistent. All other provisions of the November 7, 2003, final rule
are unchanged unless otherwise noted. This rule also extends the ``opt-
out'' provisions of 1802(b)(5)(3) of the Social Security Act to
dentists, podiatrists, and optometrists.
DATES: Effective date: These regulations are effective on January 1,
2004.
Comment date: We will consider comments if we receive them at the
appropriate address, as provided in the addresses section, no later
than 5 p.m. on March 8, 2004.
ADDRESSES: In commenting, please refer to file code CMS-1372-FC.
Because of staff and resource limitations, we cannot accept comments by
facsimile (FAX) transmission.
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-1372-FC, 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 21244-8013.
(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 if you wish to retain 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: Jennifer Fan, (410) 786-0548 regarding
Medicare payment for Part B covered drugs and biologicals.
Rick Ensor, (410) 786-5617 regarding provisions related to
geographic practice cost indices.
Diane Milstead, (410) 786-3355 for provisions related to the
physician fee schedule.
Gaysha Brooks, (410) 786-9649 for questions related to obtaining
Medicare physician fee schedule information from the CMS Web site.
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
document, send your request to: New Orders, Superintendent of
Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. Specify the date
of the issue requested and enclose a check or money order payable to
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number and expiration date. Credit card orders can also be placed by
calling the order desk at (202) 512-1800 or by faxing to (202) 512-
2250. The cost for each copy is $10. As an alternative, you can view
and photocopy the Federal Register document at most libraries
designated as Federal Depository Libraries and at many other public and
academic libraries throughout the country that receive the Federal
Register.
This Federal Register document is also available from the Federal
Register online database through GPO Access, a service of the U.S.
Government Printing Office. The Web site address is http://www.access.gpo.gov/nara/index.html
.
Accessing Physician Fee Schedule Web Site and Pricing Information
Information on the physician fee schedule and pricing files can be
found on our home page. You can access this data at the following Web
site: http://cms.hhs.gov/physicians/pfs or you can access this data by
using the following directions:
1. Go to the CMS home page (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. Scroll down and under ``Payment/Billing'' select ``Physician Fee
Schedule''.
The Physician Fee Schedule pricing information is contained in two
public use files.
(1) National Physician Fee Schedule Relative Value File--This file
contains all CPT/HCPCS (excluding codes beginning with B, E, L, K, and
0), their short descriptions and a status indicator, which denotes
whether or not the service is priced under the physician fee schedule.
The file also contains the components used in the calculation of the
annual pricing amount (that is, the RVUs, GPCIs, and conversion
factor), anesthesia conversion factors, and the payment policy
indicators used to price the claims with surgical modifiers. This file
does not contain the calculated pricing amounts.
(2) Physician Fee Schedule Payment Amount File National/Carrier--
This file contains the CPT code and the Medicare price for all services
priced under the Physician Fee Schedule. These data can be downloaded
for the entire country, or for a selected carrier (in most cases
[[Page 1085]]
carriers correlate with States). There is no option of requesting data
for selected HCPCS codes. The zip file, which is downloaded, contains a
file named ``PF04pc'', which explains the data contained in each
column. This file also contains a description of pricing localities
used in the Physician Fee Schedule. Due to the size of the national
file (as well as many of the carrier-specific files), these data are
provided in a comma-delimited format, which can be used to populate
database applications. Generally speaking, these data are too large for
Excel, however if a carrier specific file has 3 or fewer localities,
Excel can be used.
Another file that may prove useful is the Zip Code to Carrier
Locality file. This file will map ZIP Codes to CMS carriers and
localities and map Zip Codes to their State and determine whether the
ZIP Code has a rural designation as determined by CMS. You can access
this file at the following Web site: http://cms.hhs.gov/providers/pufdownload/default.asp#alphanu
or you can access this data by using
the following directions:
1. Go to the CMS home page (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. Scroll down and under ``Payment/Billing'' select ``Medicare
Payment Systems.''
4. Scroll down and under Coding Files select ``Zip Code to Carrier
Locality File.''
Table of Contents
I. Background
A. Medicare Payment for Part B Covered Drugs and the Furnishing
or Administration of Drugs
B. Geographic Practice Cost Indices and Physician Fee Schedule
Conversion Factor
II. Provisions of the Final Rule
A. Application of Market-Based Systems of Medicare Payment for
Part B Drugs
B. Payment for Inhalation Drugs
C. Pharmacy Supplying Fee for Certain Drugs and Biologicals
D. Physician Fee Schedule Provisions Related to the
Administration of Drugs
1. Provisions Related to Budget Neutrality
2. Adjustments in Practice Expense Relative Value Units for
Certain Drug Administration Services beginning with 2004
3. Pricing of Clinical Oncology Nurses in the Practice Expense
Methodology
4. Work Relative Value Units for Certain Drug Administration
Services
5. Adjustments in the Practice Expense Relative Value Units for
Certain Drug Administration Services Beginning with 2005
6. Provisions for Appropriate Reporting and Billing for
Physicians' Services Associated with the Administration of Covered
Outpatient Drugs and Biologicals
7. Treatment of Other Services Currently in the Nonphysician
Work Pool
8. Payment for Multiple Chemotherapy Agents Furnished on a
Single Day through the Push Technique
9. Transitional Adjustment to Medicare Payment for Certain Drug
Administration Services
E. Geographic Practice Cost Indices
F. Adjustments to the Work, Practice Expense and Malpractice
Relative Value Units
G. Anesthesia and Physician Fee Schedule Conversion Factors for
2004
H. Publication of Addenda
III. Private Contracting with Medicare Beneficiaries
IV. Waiver of Proposed Rulemaking and Delay in Effective Date
V. Collection of Information Requirements
VI. Response to Comments
VII. Regulatory Impact Analysis
Addendum A--Explanation and Use of Addendum B
Addendum B--Relative Value Units and Related Information Used in
Determining Medicare Payments for 2004
Addendum C--Codes with Interim Relative Value Units
Addendum D--2004 Geographic Practice Cost Indices by Medicare
Carrier and Locality
Addendum E--2005 Geographic Practice Cost Indices by Medicare
Carrier and Locality
Addendum F--List of Medicare Covered Part B Drugs Under Payment
Reform
I. Background
A. Medicare Payment for Part B Covered Drugs and the Furnishing or
Administration of Drugs
Medicare Part B covers a limited number of prescription drugs and
biologicals. For the purposes of this final rule, the term ``drugs''
will hereafter refer to both drugs and biologicals. Currently, covered
Medicare drugs generally fall into three categories: drugs furnished
incident to a physician's service, durable medical equipment (DME)
drugs, and drugs specifically covered by statute (for example, oral
immunosuppressive drugs). Prior to January 1, 2004, drugs not paid on a
cost or prospective payment basis are paid based on the lower of the
actual charge or 95 percent of the average wholesale price (AWP)
(section 1842(o)(1) of the Social Security Act (the Act), as added by
section 4556 of the Balanced Budget Act of 1997 (Pub. L. 105-33)). In
December 2000, the Congress passed the Medicare, Medicaid, and SCHIP
Benefits Improvement and Protection Act (BIPA). Section 429(a) of BIPA
required the GAO to conduct a study of the current payment methodology.
Section 429(b) of BIPA requires the Secretary, notwithstanding any
other provision of law, to revise the Medicare payment methodology for
drugs based on the GAO study. In September 2001, the GAO presented its
study to the Congress in a report titled, ``Medicare: Payments for
Covered Outpatient Drugs Exceed Providers' Costs'' (GAO-01-1118).
Consistent with the recommendations in the report, we published four
options for revising the current drug payment system in a proposed rule
published August 20, 2003 (68 FR 50428), in the Federal Register. This
proposed rule also discussed changes to Medicare payment under the
physician fee schedule for furnishing or administering certain drugs
and biologicals. However, as discussed in the November 7, 2003, final
rule (68 FR 63196), ``Revisions to Payment Policies Under the Physician
Fee Schedule for Calendar Year 2004'', since the Congress was
considering legislation to address these issues, we were reluctant to
proceed with finalizing the proposals contained in the August 20, 2003,
proposed rule. On November 25, 2003, the Congress enacted the Medicare
Prescription Drug, Improvement, and Modernization Act (MPDIMA) of 2003,
Pub L. 108-173. The President signed Pub. L. 108-173 into law on
December 8, 2003. Sections 303 through 305 of MPDIMA make revisions to
payment methodology for Part B covered drugs that are not paid on a
cost or prospective payment basis. Sections 303 and 304 also require
the Secretary of Health and Human Services to revise Medicare payments
for the administration of drugs made using the physician fee schedule.
We are using this final rule to implement those sections of MPDIMA that
are effective January 1, 2004, and prior to January 1, 2006, and affect
Medicare payment for covered Part B drugs and their administration.
B. Geographic Practice Cost Indices (GPCIs) and Physician Fee Schedule
Conversion Factor
Section 1848(e) of the Act requires that payments vary among
Medicare physician fee schedule areas according to the extent resource
costs vary, as measured by Geographic Practice Cost Indices (GPCIs) for
each of the three fee schedule components--work, practice expense and
malpractice. As explained later in this document, for services provided
on or after January 1, 2004, and prior to January 1, 2007, section 412
of MPDIMA requires that the work GPCI cannot be less than 1.00. Section
602 of MPDIMA requires that work, practice
[[Page 1086]]
expense and malpractice GPCIs otherwise calculated cannot be less than
1.67 for services furnished in Alaska on or after January 1, 2004, or
prior to January 1, 2006.
Sections 1848(d) and (f) of the Act establish a formula for
determining the physician fee schedule update and conversion factor
(CF). As indicated in the November 7, 2003, final rule (68 FR 63239),
the application of the formula in the statute resulted in a 2004
physician fee CF of $35.1339, a reduction of 4.5 percent. However,
section 601 of MPDIMA requires that the update to the physician fee
schedule CF for 2004 cannot be less than 1.5 percent. We are using this
final rule to announce the CF and GPCIs that will be used to determine
physician fee schedule rates in 2004.
II. Provisions of the Final Rule
A. Application of Market-Based Systems of Medicare Payment for Part B
Drugs
1. General Rule
Subject to the other provisions of MPDIMA, section 303(b) of MPDIMA
specifies that drugs not paid on a cost or prospective payment basis
will be paid at 85 percent of the average wholesale price (AWP)
determined as of April 1, 2003.
2. Specific Provisions
Section 303(b)(1) of MPDIMA specifies that for CY 2004 the
following drugs will be paid at 95 percent of the AWP:
[sbull] Blood clotting factors;
[sbull] A drug or biological furnished during 2004 that was not
available for Medicare payment as of April 1, 2003;
[sbull] Pneumococcal and influenza vaccines as well as hepatitis B
vaccine that is furnished to individuals at high or intermediate risk
of contracting hepatitis B (as determined by the Secretary); and
[sbull] A drug or biological furnished during 2004 in connection
with the furnishing of renal dialysis services if separately billed by
renal dialysis facilities.
Section 303(b)(1) of MPDIMA also specifies that infusion drugs will
be paid at 95 percent of the AWP in effect on October 1, 2003, when
furnished through a covered item of durable medical equipment.
Section 303(b)(2) of MPDIMA specifies that the payment for a drug
contained in the table entitled ``Table 3--Medicare Part B Drugs in the
Most Recent GAO and OIG Studies'' published in the August 20, 2003,
proposed rule (68 FR 50445) will be the percentage of the AWP indicated
in the column entitled ``Average of the GAO and OIG data (percent)''.
This percentage will be applied to the AWP determined as of April 1,
2003. However, in the event that the percentage from Table 3 is less
than 80 percent, the percentage applied to the AWP determined as of
April 1, 2003, will be 80 percent. Table 1 below is a reprint of Table
3 from the August 20, 2003, proposed rule. Table 2 highlights the
relevant column from the August 20, 2003, proposed rule table and
applies the 80 percent limit where applicable.
We note that there was a typographical error in Table 3 as
published on August 20, 2003, for J1642 ``Heparin Sodium Lock Flush''.
The percentage in the column specified in MPDIMA is missing for J1642.
Given that this column is calculated as the average of the values in
the preceding two columns for the drugs in this table, we will treat
the missing value as the average of the values in the prior two columns
for J1642, namely 66 percent. This is the percentage that would have
been in that column in the table in the absence of the typographical
error. We believe that this correction is consistent with Congress'
intent to revise the percentage based on the average of accurate GAO
and OIG data. This percentage will be subject to the 80 percent
limitation described above.
We also note that there was another typographical error in Table 3
as published on August 20, 2003, for J9390 ``Vinorelbine Tartrate
(Navelbine).'' The percentage listed under the column titled ``GAO
Average Widely Available Price as a Percent of AWP (2001)'' for J9390
in Table 3 is incorrect and should not have been listed at all since
GAO did not include this drug in its study. The percentage under the
column titled ``OIG Median Catalogue Price as a Percent of AWP (2000)''
is correct. Since the column specified in MPDIMA is calculated as the
average of the values in the preceding two columns for the drugs in
this table, the correct percentage listed for J9390 under this column
will be 81 percent based on the data from OIG. We believe that this
correction is also consistent with Congress' intent to revise rates
based on the average of accurate GAO and OIG data. This is the
percentage that would have been in that column in the table in the
absence of the typographical error.
BILLING CODE 4120-01-P
[[Page 1087]]
[GRAPHIC] [TIFF OMITTED] TR06JA04.000
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[GRAPHIC] [TIFF OMITTED] TR06JA04.001
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[GRAPHIC] [TIFF OMITTED] TR06JA04.002
[[Page 1090]]
[GRAPHIC] [TIFF OMITTED] TR06JA04.003
BILLING CODE 4120-01-C
[[Page 1091]]
Section 303(b)(2) of MPDIMA also provides an opportunity for the
manufacturer of a drug to submit data and information requesting a
different percentage from the percentage indicated in Table 1A or the
85 percent general rule. The Secretary may adjust the percentage based
on this data and information beginning April 1, 2004. Section 303(b) of
MPDIMA specifies that this data and information can be submitted after
October 15, 2003, and before January 1, 2004. As required by the
statute, manufacturers need to submit this data and information before
January 1, 2004. Manufacturers may supplement this data and
information; however, any additional supplemental information should be
received by CMS before 5 p.m. e.s.t. on January 16, 2004. We will use
the supplemental information to help us evaluate the initial submission
of data and information.
We expect that the data and information submitted by a manufacturer
would include the manufacturer's average sales price for the drug for
the most recent quarter available. For the purposes of the exceptions
process, the manufacturer's average sales price is calculated as the
manufacturer's sales to all purchasers in the United States (excluding
sales exempted below) for the quarter divided by the total number of
units of such drug or biological sold by the manufacturer in that
quarter. The submission should also specify the units used in the
calculation (for example, micrograms).
In the calculation of the manufacturer's average sales price, a
manufacturer should include volume discounts, prompt pay discounts,
cash discounts, free goods that are contingent on any purchase
requirement, chargebacks, and rebates (other than rebates under the
Medicaid program). To the extent that there is a lag in the
availability of this information applicable to the quarter, the
manufacturer should apply a methodology based on the most recent 12-
month period available to estimate costs attributable to these price
concessions. The manufacturer should submit a description of the
methodology used to estimate these costs.
In the calculation of the manufacturer's average sales price, a
manufacturer should exclude the following sales as defined for the
Medicaid best price calculation under section 1827(c)(1)(C)(i) of the
Act:
1. Sales to the Indian Health Service, the Department of Veterans
Affairs, a state home as defined for the purposes of the Medicaid best
price calculation, the Department of Defense, the Public Health Service
and entities described in section 340(B)(a)(4) of the Public Health
Act;
2. Sales under the Federal Supply Schedule of the General Services
Administration;
3. Sales under a State pharmaceutical assistance program; and
4. Any depot sales and single award contract sales as defined for
the purposes of the Medicaid best price calculation.
A manufacturer should also exclude sales at a nominal charge. Sales
at a nominal charge are defined as sales below 10 percent of the
average calculated as described above. In other words, after following
the methodology described above, sales below 10 percent of the
resulting average should be excluded and the average recalculated. The
result of this final calculation is the manufacturer's average sales
price for the purpose of the exceptions process.
Note that we would base any changes to the percentage indicated in
Table 1 or the 85 percent general rule only on data that we could make
available to the public.
Section 303(b)(2) of MPDIMA also specifies that we may adjust the
percentage effective January 1, 2004, based on data and information
that a manufacturer submitted by October 15, 2003. We accepted data
from the manufacturer of two biologicals: imiglucerase and alglucerase.
The data and information submitted by the manufacturer indicated that
the manufacturer's average sales price was 94 percent of the average
wholesale price. Based on this data, we will pay for these two
biologicals when furnished in 2004 at 94 percent of the average
wholesale price determined as of April 1, 2003.
B. Payment for Inhalation Drugs
Section 305(a) of MPDIMA specifies that inhalation drugs furnished
through durable medical equipment covered under 1861(n) of the Act will
be paid in accordance with section 1842(o)(4) of the Act, as added by
section 303(b)(2) of MPDIMA. The methodology for determining the
payment for a drug under section 303(b)(2) of MPDIMA is described above
in section II.A.2 of this rule.
C. Pharmacy Supplying Fee for Certain Drugs and Biologicals
Section 303(e)(2) of MPDIMA provides that the Secretary shall pay a
pharmacy supplying fee, less applicable deductible and coinsurance, for
immunosuppressive drugs described in section 1861(s)(2)(J) and oral
anti-cancer and anti-nausea drugs described in subparagraph (Q) and (T)
of the same section as determined appropriate by the Secretary. We
believe that the payment of this fee should be bundled into the current
payment for these drugs and the 2004 payment amounts specified in
section 303(b) of MPDIMA. We do not have data indicating that the 85%
figure is insufficient to cover the cost of supplying these drugs.
However, for 2005, we will re-examine this issue in light of the
average sales price (ASP) data that will be submitted by manufacturers.
D. Physician Fee Schedule Provisions Related to the Administration of
Drugs
As indicated above, sections 303 and 304 of MPDIMA amend section
1848 of the Act for physician fee schedule payments made beginning
January 1, 2004. We are describing our implementation of the parts of
sections 303 and 304 which have a January 1, 2004, effective date.
1. Provisions Related to Budget Neutrality
Section 303(a)(1) of MPDIMA amends section 1848(c) of the Act to
require changes to the practice expense and physician work relative
value units (RVUs) used to determine payment for drug administration
services. In general, section 1848(c)(2)(B)(ii)(II) provides that the
Secretary shall review and may make adjustments to the RVUs if the
changes do not cause the amount of expenditures to increase or decrease
by more than $20 million. Section 303(a) of MPDIMA amends section
1848(c)(2)(B) of the Act to add a new clause (iv) that exempts from
this limitation, any additional expenditures in 2004 attributable to:
(1) The increase in practice expense RVUs for drug administration
services resulting from the use of a practice expense survey meeting
specific criteria described in the statute;
(2) The increase in practice expense RVUs resulting from using
survey data on the compensation of clinical oncology nurses; and
(3) New physician work RVUs that we are adding to the drug
administration services consistent with the new statutory provisions.
In addition, section 303(a)(1) of MPDIMA also modifies section
1848(c)(2)(B) of the Act to provide an exemption from the budget
neutrality requirements in 2005 or 2006 for further increases in
practice expense RVUs for drug administration services that may result
from using additional survey data from physician specialties meeting
specific criteria that we will discuss in
[[Page 1092]]
more detail later in this document. Furthermore, any increase in
spending associated with any coding or policy changes resulting from
the Secretary's review of existing drug administration codes is also
exempted from budget neutrality requirements of section 1848 (c)(2)(B)
by section 303 of MPDIMA. Section 303(a)(3) also requires the Secretary
to review the policy in effect for the administration of more than one
drug administered by the push technique. This change is also exempt
from budget neutrality.
In general, we have met the budget neutrality requirements in the
statute by either applying an adjustment to the physician fee schedule
CF or to the RVUs themselves. However, section 303(a) of MPDIMA
specifically amends the statute to exempt the additional expenditures
that result from changes to the RVUs for drug administration services
from the budget neutrality requirements. Therefore, we will make no
changes to the physician fee schedule CF or physician work RVUs to
account for physician work RVUs being added to drug administration
services. We will add the additional expenditures as a result of these
provisions to the expenditure base in applying our practice expense
methodology.
2. Adjustments in Practice Expense Relative Value Units for Certain
Drug Administration Services Beginning with 2004
Section 303(a)(1)(B) of MPDIMA amends section 1848(c)(2) of the Act
by adding new subparagraph (H), ``Adjustments in Practice Expense
Relative Value Units for Certain Drug Administration Services beginning
in 2004''. Subparagraph (H)(i) requires the Secretary to determine the
practice expense RVUs for 2004 using practice expense surveys submitted
to the Secretary as of January 1, 2003, by a physician specialty
organization in accordance with section 212 of the Medicare, Medicaid,
and SCHIP Balanced Budget Refinement Act (BBRA) of 1999 if the survey:
(1) Covers practice expenses for oncology drug administration services;
and (2) meets criteria established by the Secretary for acceptance of
such surveys.
Section 212 of the BBRA directed the Secretary to establish a
process under which we would accept and use, to the maximum extent
practicable and consistent with sound data practices, data collected or
developed by entities and organizations. In an interim final rule with
comment published in the Federal Register on May 3, 2000 (65 FR 25664),
we established the criteria under which we would accept supplemental
data for use in computing the practice expense RVUs. We subsequently
modified those criteria in the November 1, 2000, physician fee schedule
final rule (65 FR 65383) and the December 31, 2002, final rule (67 FR
79971).
The American Society of Clinical Oncology (ASCO) provided us with a
supplemental survey prior to January 1, 2003, that includes expenses
associated with the administration of chemotherapy drugs. While the
survey meets the criteria we established, we initially decided not to
use the information because of concerns about the data (for more
information, see the December 31, 2003, final rule (67 FR 79973)). In a
proposed rule published in the Federal Register on August 20, 2003 (68
FR 50437), we described subsequent discussions held with ASCO that
resolved our concerns about the data.
Consistent with section 1848(c)(2)(H)(i) of the Act, we are using
the ASCO survey to determine the practice expense RVUs for physician
fee schedule services furnished on or after January 1, 2004, because
it: (1) Was submitted prior to January 1, 2003; (2) includes expenses
for drug administration services; and (3) meets criteria we have
established for use of surveys.
Section 303(j) of MPDIMA applies the amendments made by section 303
for payments for drugs or biologicals and drug administrative services
to physicians in the specialties of hematology, hematology/oncology and
medical oncology. Section 304 indicates that: ``Notwithstanding section
303(j), the amendments made by section 303 shall also apply to payments
for drugs or biologicals and drug administration services furnished by
physicians in specialties other than the specialties of hematology,
hematology/oncology and medical oncology.''
Because the section 303 (a)(1) provisions apply to hematology,
hematology/oncology and medical oncology, we will use the supplemental
survey submitted by ASCO for CMS specialty codes 82 (hematology), 83
(hematology/oncology) and 90 (medical oncology).
The Conference Report indicates that section 304 requires the
Secretary to disregard the (section 303) exemption and apply the
adjustments in section 303 to these other specialties. The Conference
report further indicates the intent in drafting the provisions in this
fashion: ``The intent in drafting the two sections in this manner is to
segregate the savings achieved from adjustments to payments to
oncologists from savings derived from other physician specialties. The
specialties to which the provisions apply are the specialties as used
by the carriers in administering Medicare.''
The purpose of the separation is only to display the budget scoring
effects separately for oncologists from other physician specialties.
There is no substantive policy effect at all from the enactment of the
amendments in this manner. The combined effect of the amendments made
by both section 303(j) and section 304 is that the substantive changes
in both payments for drugs and biologicals as well as drug
administration services apply to physicians of all specialties.
When we use supplemental survey data, we have generally blended the
supplemental survey data with prior survey data from the American
Medical Association's Socioeconomic Monitoring Survey (SMS). However,
section 1848(c)(2)(H)(i) of the Act indicates that the Secretary should
use survey data that meets the specific criteria specified in the
statute. We are using the ASCO survey data and are not blending it with
the prior SMS data.
Because we are not blending the ASCO survey with the SMS data, we
are adopting a consistent policy in 2004 for survey data received in
1999 from the Society for Thoracic Surgery (STS). That is, we will use
the STS supplemental survey data without blending it with the SMS data.
However, we have not made a final decision and will continue to
consider the issue of whether to blend supplemental survey with prior
SMS data or to use specialty submitted supplemental surveys without
blending. At this time, we are not using the ASCO and STS cases as
precedent for our consideration of future survey data. While some may
argue that the inclusion of newer, more specific survey data will
improve the precision of the data underlying the calculation of the
practice expense resource based RVUs, and lead to more stability in the
practice expense methodology, it can also be argued that a specialty
society would only undertake a survey (arguing that existing SMS data
were not sufficiently representative of the specialty's practice
expenses) if it believed that higher practice expense payments for that
specialty could be achieved by submitting additional data. We do not
believe that it would be prudent for the program to commit to the use
of supplemental survey data without blending it with the SMS data for
any and all future supplementary surveys. We will continue to consider
this issue in 2004 when we make proposals for the 2005 physician fee
schedule. At this time, we suggest that supplemental
[[Page 1093]]
survey data should be used without blending only under certain
conditions that would be specified in a future rule. (Note that this
issue does not affect specialties that are not included in the SMS
sample, and for which we have no other previous survey data. In such
cases there would obviously be no SMS survey data to blend.)
We invite comments on this issue and on appropriate criteria for
determining when to employ specialty submitted supplemental surveys
without blending.
Table 2 shows the revised practice expense per hour for each cost
pool for the specialties of cardiac and thoracic surgery and oncology,
hematology/oncology and hematology.
Table 2
----------------------------------------------------------------------------------------------------------------
Clin Admin. Office Med. Med.
Specialty Staff Staff Expense Supplies Equip Other Total
----------------------------------------------------------------------------------------------------------------
Cardiac/Thoracic Surgery........... 19.5 18.0 17.2 2.1 2.1 14.2 73.1
Oncology........................... 53.4 34.7 34.4 16.9 7.4 42.2 189.0
----------------------------------------------------------------------------------------------------------------
3. Pricing of Clinical Oncology Nurses in the Practice Expense
Methodology
Section 1848(c)(2)(H)(ii) of the Act (as added by section 303(a)(1)
of MPDIMA) specifies that if a survey meets the criteria described
above (that is, the survey that is submitted prior to January 1, 2003,
meets criteria established by the Secretary, etc.) and includes data on
wages, salaries and compensation of clinical oncology nurses, the
Secretary will use the data in the methodology for determining the
practice expense RVUs. The ASCO survey meets the criteria specified in
the statute and also includes data on oncology nursing compensation.
For this reason, we are using information from the survey to determine
the wage rate per minute for oncology certified nurses (OCN). The OCN
is included as a practice expense input for the nonchemotherapy
infusion codes (90780 through 90781) and the chemotherapy
administration codes (96400 through 96549). Using information from the
ASCO survey, we determined a wage rate of 0.79 per minute (increase
from the 0.56 per minute we are currently using) for the OCN. We used
this revised wage rate to determine the practice expense RVUs for the
drug administration services shown in Addendum B.
4. Work Relative Value Units for Certain Drug Administration Services
For services furnished on or after January 1, 2004, section
1848(c)(2)(H)(iii) of the Act (as added by section 303(a)(1) of MPDIMA)
requires the Secretary to establish work RVUs for drug administration
services equal to the work RVUs for a level 1 office medical visit for
an established patient (CPT code 99211). Section 1848(c)(2)(H)(iv) of
the Act defines drug administration services as those classified as of
October 1, 2003, within any of the following groups: therapeutic or
diagnostic infusions (excluding chemotherapy); chemotherapy
administration services; and therapeutic, prophylactic, or diagnostic
injections for which there are no work RVUs assigned and for which
national RVUs have been assigned.
CPT code 99211 is a level 1 established patient office visit with
physician work RVUs of 0.17. Consistent with the statute we are adding
physician work RVUs of 0.17 to the following drug administration
services: CPT codes 90780 through 90781, 90782 through 90788, 96400,
96408 through 96425, 96520, and 96530.
Currently, section 15010 of the Medicare Carriers Manual (MCM) does
not allow payment for CPT codes 90782, 90783, 90784 and 90788 unless
these are the only physician fee schedule services provided on that
day. We do pay separately for cancer chemotherapy injections (CPT codes
96400-96549) in addition to an office visit (CPT codes 99211-99215)
furnished on the same day by the same physician. CPT code 99211 does
not require a face-to-face encounter between the physician and the
patient like other office visit services (CPT codes 99212-99215) and
can be used be physicians supervising a nurse performing chemotherapy
administration. Currently, physicians typically bill for CPT code 99211
approximately 34 percent of the time that they are also providing a
drug administration service. We believe that adding physician work to
the drug administration services will subsume the supervision that
physicians billing for a 99211 on the same day are typically providing.
Therefore, we will no longer allow for 99211 to be billed on the same
day as a chemotherapy administration service.
Although less common than CPT 99211, physicians also bill for other
office visit (CPT codes 99212-99215) provided on the same day as
chemotherapy administration. We will continue to allow other office
visits to be billed on the same day as a drug administration service
with modifier 25 indicating that a separately identifiable evaluation
and management service was provided. This policy will make our practice
with chemotherapy administration consistent with all other physician
fee schedule services where we require use of modifier 25 if a
separately identifiable evaluation and management service is provided
on the day as a procedure. Section 15400(D) of the Medicare Carrier
Manual (MCM) describes Medicare payment policy with respect to
chemotherapy administration and ``incident to'' services provided on
the same day. We will be revising section 15400 of the MCM (in addition
to section 15010 that describes ``bundled services'') to reflect that
CPT code 99211 and a chemotherapy administration service cannot be
billed for the same patient on a single day.
5. Adjustments in the Practice Expense Relative Value Units for Certain
Drug Administration Services Beginning with 2005
Section 303(a)(1) of MPDIMA also modifies section 1848(c)(2)(B) of
the Act to provide an exemption from the budget neutrality requirements
in 2005 or 2006 for further increases in practice expense RVUs for drug
administration services that may result from using additional survey
data from physician specialties meeting specific criteria. Section
1848(c)(2)(I) of the Act specifies that the exemption from budget
neutrality will apply for any survey (other than the ASCO survey that
meets the exemption requirement specified by another provision of the
statute) submitted by a specialty group where 40 percent or more of its
payments for Part B services are attributable to the administration of
drugs in 2002 as determined by the Secretary. The statute indicates
that the survey must include expenses for the administration of drugs
and must be received by the Secretary prior to March 1, 2004, to
determine the 2005 practice expense RVUs and prior to March 1, 2005, to
determine the 2006 practice expense RVUs.
[[Page 1094]]
We have reviewed Medicare allowed charge data for 2002. Based on
the 2002 data, we found that the specialties of gynecology/oncology
(specialty code 98) rheumatology (specialty code 66) and urology
(specialty code 30) received more than 40 percent of total Part B
revenues from drugs. We will apply the exemption from budget neutrality
specified in section 1848(c)(2)(I) of the Act for additional
expenditures that result from the increases in drug administration
practice expense RVUs in 2005 or 2006 resulting from use of a survey
that is submitted timely by any of these specialties and otherwise
meets criteria we have established for use of supplemental surveys.
Hematology (specialty 82), hematology/oncology (specialty 83) and
medical oncology (specialty 90) also receive more than 40 percent of
their Medicare revenues from drugs. However, we are already using the
ASCO survey for these specialties and the increase in payment for drug
administration is exempt from budget neutrality by another provision of
the statute.
6. Provisions for Appropriate Reporting and Billing for Physicians'
Services Associated with the Administration of Covered Outpatient Drugs
Section 1848(c)(2)(J) of the Act requires the Secretary to promptly
evaluate existing drug administration codes for physicians' services to
ensure accurate reporting and billing for such services, taking into
account levels of complexity of the administration and resource
consumption. The statute further specifies that the Secretary will use
existing processes for the consideration of coding changes and, to the
extent changes are made, will use the processes to establish relative
values for these services. The Secretary is also required to consult
with physician specialties affected by the provisions that change
Medicare payments for drugs.
We expect to review this issue in the context of all the payment
changes being made by the statute to Medicare payment for drug
administration in order to assure accurate reporting and billing for
such services taking into account levels of complexity of the
administration and resource consumption. The existing processes we plan
to use include review by our Physician's Regulatory Issues Team (PRIT)
and consultation with the AMA's CPT Editorial Committee and physician
specialties affected by changes in payment for drugs and drug
administration. The PRIT, an internal CMS group that is working to
eliminate unnecessary regulations, is reviewing the issue of coding for
drug administration services including section 15400 of the Medicare
Carriers Manual (MCM) that currently governs Medicare policy with
respect to use of CPT codes in the 96400 through 96549 series for
chemotherapy administration.
7. Treatment of Other Services Currently in the Nonphysician Work Pool
The nonphysician work pool is a special interim methodology that we
use to determine practice expense RVUs for many services that do not
have physician work RVUs. The drug administration codes listed above
are currently valued using the nonphysician work pool methodology.
Because we are now assigning work RVUs to these drug administration
codes, they will no longer be included in the nonphysician work pool.
Practice expense RVUs for these services will be computed using the
standard practice expense methodology that applies to all other
physicians' services.
Section 303(a)(2) of MPDIMA requires the Secretary to make
adjustments to the nonphysician work pool methodology for the
determination of practice expense RVUs under the physician fee schedule
so that the practice expense RVUs for services determined under such
methodology are not affected relative to the practice expense RVUs of
services not determined under such methodology as a result of the
amendments made by section 303(a)(2) of MPDIMA. If we made no other
changes, removing drug administration codes from the nonphysician work
pool would result in a reduction to the practice expense RVUs for
services remaining in the nonphysician work pool. Consistent with
section 303(a)(1) of MPDIMA, we are making two changes to the
nonphysician work pool methodology so that the practice expense RVUs
for nonphysician work pool services are not affected relative to other
services.
First, we are changing the practice expense per hour assigned to
the nonphysician work pool. In place of the ``all physician'' average,
we are using a weighted average practice expense per hour of the
specialties that perform the services affected by its calculations.
Specifically, we will use the following revised data in the practice
expense methodology for services remaining in the nonphysician work
pool:
Table 3
----------------------------------------------------------------------------------------------------------------
Clin Admin. Office Med. Med.
Specialty Staff Staff Expense Supplies Equip Other Total
----------------------------------------------------------------------------------------------------------------
Nonphysician Work pool............. 15.8 17.4 21.5 7.9 4.9 15.0 82.6
----------------------------------------------------------------------------------------------------------------
Second, we are adjusting the clinical staff times used in the
creation of the pool. By definition, nonphysician work pool services do
not involve the physician and have no physician time. To create the
nonphysician work pool, we have used clinical staff time per procedure
in the computation. We will now use the total staff time rather than
the previously utilized maximum staff time for developing the 2004
physician fee schedule. Consistent with section 303(a)(2) of MPDIMA,
the change to the practice expense per hour and staff time will result
in no reduction to the practice expense RVUs for the services remaining
in the nonphysician work pool once drug administration services are
removed. By using the maximum staff time, we are assuming that clinical
staff are working concurrently. However, it is possible that clinical
staff are working sequentially and it would be appropriate to use the
total staff time for each service. We are proposing to use the total
staff in place of the maximum staff for developing the 2004 physician
fee schedule since each are equally likely to address staff time
arrangements for non-physician work pool services and the latter
approach will assist in meeting the statutory directive that payment
for non-physician work pool services not be affected by the changes we
are making to drug administration services.
8. Payment for Multiple Chemotherapy Agents Furnished on a Single Day
Through the Push Technique
Section 303(a)(3) of MPDIMA requires the Secretary to review the
policy as in effect October 1, 2003, for section 1848 of the Act for
the administration of more than one drug or biological to an individual
on a single day through the push technique. Subsequent to that review,
the Secretary will modify the
[[Page 1095]]
payment policy as determined to be appropriate. Section 303(a)(3)(C) of
MPDIMA indicates that any change in policy resulting from this review
will be treated as additional expenditures attributable to section
1848(c)(2)(H). (This section relates to the additional expenditures
that result from use of survey data that includes expenses for drug
administration and clinical oncology nurses and requires that we
establish work RVUs equal to a level 1 office visit for drug
administration services. Currently, a level 1 office has 0.17 work
RVUs)
In the November 25, 1991, Federal Register (56 FR 59541), we
specified that Medicare will allow CPT code 96408 (Chemotherapy
administration, intravenous; push technique) to be reported only once
per day even if the physician administers multiple drugs and this
policy is contained in Section 15400 of MCM. In the August 20, 2003,
proposed rule (68 FR 50439) concerning payment reform for part B drugs
under Medicare, we had proposed revising this policy to allow for CPT
code 96408 to be reported once per day for each drug administered. This
revision was supported by commenters.
Upon review of this issue and in acknowledgement that there are
additional resources involved in administering each subsequent drug
which should be considered in a resource-based payment system, we are
changing our policy and will allow for CPT code 96408 to be reported
once per day for each drug administered. The effective date for this
change is for services furnished on or after January 1, 2004. We will
modify section 15400 of the manual consistent with this change. In
addition, as previously mentioned, the PRIT will be reviewing the issue
of use of the chemotherapy administration codes in the 96400 CPT code
series and Medicare's manual provisions on their use.
9. Transitional Adjustment to Medicare Payment for Certain Drug
Administration Services
Section 303(a)(4) of MPDIMA provides for a transitional adjustment
to Medicare payment for drug administration services to reflect
implementation of the amendments made by section 303 of MPDIMA
affecting Medicare's payments for drugs. Specifically, section
303(a)(4) of MPDIMA requires Medicare to increase the physician fee
schedule amounts otherwise determined by 32 percent for 2004 and 3
percent for 2005. Thus, we will determine the payment for CPT codes
90780 through 90781, 90782 through 90788, 96400, 96408 through 96425,
96520, and 96530 based on the work, practice expense and malpractice
RVUs shown in Addendum B and the 2004 CF of $37.3374. Consistent with
section 303(a)(4) of MPDIMA, we will increase the physician fee
schedule amount by an additional 32 percent for 2004. (The physician
fee schedule amounts applicable in 2005 will be increased by 3
percent.)
C. Geographic Practice Cost Indices (GPCIs)
The Act requires that payments vary among physician fee schedule
areas according to the extent that resource costs vary as measured by
the Geographic Practice Cost Indices (GPCIs) for each of the three fee
schedule components: work, practice expense, and malpractice.
Section 412 of MPDIMA amended section 1848(e)(1) of the Act and
establishes a floor of 1.0 for the work geographic index for any
locality to be used for purposes of payment for services furnished on
or after January 1, 2004, and before January 1, 2007. In addition,
section 602 of MPDIMA further amended section 1848(e)(1) of the Act for
purposes of payment for services furnished in Alaska under the
physician fee schedule on or after January 1, 2004, and before January
1, 2006, and sets the practice expense, malpractice and work indices at
1.67 if the index would otherwise be less than 1.67.
Based on these changes to the Act, we are revising the addenda
published in the November 7, 2003, final rule concerning the
transitional 2004 and full 2005 GPCIs (Addendum D and Addendum E,
respectively). No locality will have a work GPCI of less than 1.00 and
the work, practice expense and malpractice GPCIs for Alaska are set at
1.67. Addendum D in the November 7, 2003, final rule listed 58
localities having work GPCIs of less than 1.00. Of these, the range was
from 0.881 for Puerto Rico to 0.998 for ``Rest of New York'' and New
Orleans, Louisiana. Addendum D and E that are included in this final
rule will replace the addenda previously published November 7, 2003.
D. Adjustments to the Work, Practice Expense and Malpractice Relative
Value Units
In the August 15, 2003, proposed rule (68 FR 49058), we proposed to
adjust the work, practice expense and malpractice RVUs to match the
rebased MEI weights. In the November 7, 2003, final rule (68 FR 63245),
we responded to public comments and applied adjustments of -0.57
percent (0.9943) to the physician work RVUs, -0.77 percent (0.9923) to
the practice expense RVUs and 19.86 percent (1.1986) to the malpractice
RVUs. These adjustments were intended to make the aggregate work,
practice expense and malpractice RVUs used to determine payments in
2004 consistent with their respective weights in the rebased MEI.
However, the changes required by MPDIMA change the 2004 work,
practice expense and malpractice RVUs. Provisions that require changes
to the work and practice expense RVUs and exempt them from budget
neutrality will increase the number of work and practice expense RVUs.
As we indicated in the November 7, 2003, final rule, we believe
Medicare payment policy will be improved by adjusting the work,
practice expense and malpractice RVUs to match the revised MEI weights.
By matching the aggregate pools of RVUs to the rebased MEI weights,
Medicare's payments for physician work, practice expense and
malpractice will more closely match the proportion of expenses incurred
by physicians in these categories. Therefore, we are revising the
adjustments applied to the RVUs in the November 7, 2003, final rule
consistent with our goal of making the work, practice expense and
malpractice RVUs match the rebased MEI weights. The revised adjustments
are -0.15 percent (0.9985) for physician work, -1.320 percent (0.9868)
for practice expense, and 20.61 percent (1.2061) for malpractice. We
have incorporated these adjustments into the RVUs shown in Addenda B
and C of this final rule.
E. Anesthesia and Physician Fee Schedule Conversion Factors for 2004
The physician fee schedule update is determined under a methodology
specified by statute. In the November 7, 2003, final rule (68 FR
63251), we used the formula specified in section 1848(d)(4) of the Act
to determine a 4.5 percent reduction to the physician fee schedule CF.
However, section 601 of MPDIMA amended section 1848(d) of the Act to
specify that the update to the single CF for 2004 and 2005 will not be
less than 1.5 percent. Because the statutory formula will yield a 4.5
percent reduction to the physician fee schedule CF and the amendments
to the statute indicate that the update for 2004 cannot be less than
1.5 percent, we will increase the physician fee schedule CF by 1.5
percent for 2004.
The specific calculations to determine the physician fee schedule
and anesthesia CFs for 2004 are explained below.
[[Page 1096]]
[sbull] Physician Fee Schedule Conversion Factor
Under section 1848(d)(1)(A) of the Act, the physician fee schedule
CF is equal to the CF for the previous year multiplied by the update
determined under section 1848(d)(4) of the Act.
We illustrate the calculation for the 2004 physician fee schedule
CF in table 4:
Table 4
------------------------------------------------------------------------
------------------------------------------------------------------------
2003 Conversion Factor.................................. $36.7856
2004 Update............................................. 1.5% (1.015)
2004 Conversion Factor.................................. $37.3374
------------------------------------------------------------------------
[sbull] Anesthesia Fee Schedule Conversion Factor
As described in the November 7, 2003, final rule (68 FR 63252),
anesthesia services do not have RVUs like other physician fee schedule
services. For this reason, we are accounting for the adjustments to
match the revised MEI weights and changes to anesthesia work and
practice expenses through a 1.09 percent 1.0109 adjustment to the
anesthesia fee schedule CF. The 1.09 percent increase reflects a 0.15
percent reduction on the work portion (79 percent), a 2.0 percent
reduction on the practice expense portion (13.7 percent) and a 20.61
percent increase on the malpractice portion (7.2 percent) of the
anesthesia conversion factor. (The adjustment to the practice expense
portion is comprised of 1.3 percent for the MEI weights and 0.7 percent
for the revisions in the practice expense methodology). To determine
the anesthesia fee schedule CF for 2004, we used the following figures:
Table 5
------------------------------------------------------------------------
------------------------------------------------------------------------
2003 Conversion Factor............................... $17.0522
Adjustments for Work and Practice Expense............ 1.09% (1.0109)
2004 Update.......................................... 1.5% (1.0150)
2004 Conversion Factor............................... $17.4969
------------------------------------------------------------------------
F. Publication of Addenda
The addenda included in this final rule concerning RVUs and Related
Information Used in Determining Medicare Payments for 2004 (Addenda A,
B and C) and GPCIs by Medicare Carrier and Locality (Addenda D and E)
replace the addenda published November 7, 2003 (68 FR 63261). The
revised addenda reflect changes required by MPDIMA as well as
corrections to minor errors contained in the addenda published November
7, 2003.
III. Private Contracting With Medicare Beneficiaries
Section 4507 of the Balanced Budget Act of 1997 added section
1802(b) to the Act. This section provides that physicians and certain
nonphysician practitioners may opt out of Medicare and enter into
private contracts with Medicare beneficiaries. Under these contracts,
no limits apply to what physicians or nonphysician practitioners can
charge beneficiaries. Physicians opting out of Medicare file an
affidavit with the Medicare carrier in which they agree to opt out of
Medicare for a period of 2 years and to meet certain other criteria. In
general, the statute requires that during that two-year period,
physicians and nonphysician practitioners who have filed affidavits
opting out of Medicare have private contracts with all Medicare
beneficiaries to whom they furnish Medicare covered services. These
contracts may not be entered into at a time when a beneficiary needs
emergency or urgent care services.
Moreover, the statute requires that the private contract be in
writing and be signed by the Medicare beneficiary before any item or
service is provided in accordance with the contract and that:
[sbull] The beneficiary agrees not to submit a claim (or to request
that the physician or practitioner submit a claim) with Medicare for
Medicare covered services.
[sbull] The beneficiary agrees to be responsible, whether through
insurance or otherwise, for services furnished under a private
contract.
[sbull] The beneficiary acknowledges that no limits (including the
limits under section 1848(g) of the Social Security Act) apply to
amounts that are charged under the private contract.
[sbull] The beneficiary acknowledges that no payment will be made
under a Medigap plan, and other insurers may elect not to make payment
for services furnished under the private contract.
[sbull] The beneficiary acknowledges that Medicare may make payment
for covered services if the service was received from a physician or
non-physician practitioner with whom the beneficiary has not signed a
private contract.
Prior to enactment of MPDIMA, section 1802(b)(5)(B) of the Act
limited the types of physicians who could choose to opt out of Medicare
to doctors of medicine and doctors of osteopathy. Section 603 of MPDIMA
amends section 1802(b)(5)(B) of the Act to include dentists,
podiatrists, and optometrists, in certain circumstances, in the
definition of physicians who may opt out of Medicare. We are making
conforming changes to our regulations to reflect this change in the
statute.
IV. Waiver of Proposed Rulemaking and Delay in Effective Date
We ordinarily publish a notice of proposed rulemaking in the
Federal Register and invite public comment on a proposed rule. The
notice of proposed rulemaking includes a reference to the legal
authority under which the rule is proposed, and the terms and substance
of the proposed rule or a description of the subjects and issues
involved. This procedure can be waived, however, if an agency finds
good cause that notice-and-comment procedure is impracticable,
unnecessary, or contrary to the public interest and incorporates a
statement of the finding and its reasons in the rule issued. In
addition, the Administrative Procedure Act (APA) normally requires a
30-day delay in the effective date of a final rule. Furthermore, the
Congressional Review Act (CRA) generally requires an agency to delay
the effective date of a major rule by 60-days in order to allow for
congressional review of the agency action.
Section 1871 of the Act provides for publication of a notice of
proposed rulemaking and opportunity for public comment before CMS
issues a final rule. However, section 1871(b)(2)(B) provides an
exception when a law establishes a specific deadline for implementation
of a provision and the deadline is less than 150 days after the law's
date of enactment. MPDIMA was enacted by Congress on November 25, 2003,
and signed into law by the President on December 8, 2003. The
provisions of this rule that amend the physician fee schedule and drug
payment rate are required to be implemented January 1, 2004. Therefore,
these provisions are subject to waiver of proposed rulemaking and
public comment in accordance with section 1871(b)(2)(B) of the Act.
Even if section 1871(b)(2)(B) of the Act were not directly
applicable here, we would find good cause to waive the requirement for
publication of an notice of proposed rulemaking and public comment on
the grounds that it is impracticable, unnecessary, and contrary to the
public interest. This final rule, with the exception of implementation
of billing for a level 1 office visit and pharmacy supplying fee and
the technical correction of minor errors in the November rule, merely
sets out the non-discretionary provisions of MPDIMA with respect to
payment under the physician fee schedule and drug AWP methodology.
Because the rule is generally ministerial, we believe that pursuing
notice and comment is
[[Page 1097]]
unnecessary. Moreover, because such process would prevent
congressionally-mandated revisions, updates, and increases in payment
under the physician fee schedule for 2004, we find that pursuing such
process would be both impracticable and contrary to the public
interest.
For these same reasons, we are waiving the 30-day delay in
effective date contained in 5 U.S.C. section 553(d).
With respect to the requirement of a 60-day delay in the effective
date of any final rule pursuant to the CRA, see 5 U.S.C. section 801,
the CRA provides that the 60-day delayed effective date shall not apply
to any rule ``which an agency for good cause finds . . . that notice
and public procedure thereon are impracticable, unnecessary, or
contrary to the public interest'' (5 U.S.C. section 808(2)). For the
reasons set forth above, we believe that additional notice-and-comment
rulemaking on this subject would be impracticable, unnecessary, or
contrary to the public interest. Therefore, we do not believe that the
CRA requires a 60-day delay in the effective date of this final rule.
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. Collection of Information Requirements
Under the Paperwork Reduction Act (PRA) of 1995, we are required to
provide 60-day notice in the Federal Register and solicit public
comment before a collection of information requirement is submitted to
the Office of Management and Budget (OMB) for review and approval. In
order to fairly evaluate whether an information collection should be
approved by OMB, section 3506(c)(2)(A) of the PRA of 1995 requires that
we solicit comment on the following issues:
The need for the information collection and its usefulness in
carrying out the proper functions of our agency.
[sbull] The accuracy of our estimate of the information collection
burden.
[sbull] The quality, utility, and clarity of the information to be
collected.
[sbull] Recommendations to minimize the information collection
burden on the affected public, including automated collection
techniques.
Therefore, we are soliciting public comments on each of these
issues for the information collection requirement discussed below.
The following information collection requirement and associated
burden are subject to the PRA.
Sec. 414.707 Basis of payment
Under paragraph (a)(7) of this section, a manufacturer requesting a
drug payment exception to the default 85 percent used in the general
rule or the percentage specified in Table 1 will have to submit data
and information including the manufacturer's average sales price for
the drug. The burden associated with this requirement is the time
involved in providing us the information for the submission due before
January 1, 2004, and the optional supplemental submission due by
January 16, 2004. We believe that it would take an average of one hour
to submit the request and the necessary data and information. Given the
universe of approximately 450 Medicare drug codes and assuming an
average of 10 manufacturers per drug code, the maximum aggregate burden
associated with this activity would be 4500 hours.
We are soliciting public comment on this requirement in conjunction
with a request for emergency approval of this information collection so
that manufacturers may submit their requests during the statutorily
prescribed timeframe. These requirements were submitted to OMB for
review and are approved by OMB under OMB control number 0938-0913.
If you comment on any of these information collection and record
keeping requirements, please mail copies directly to the following:
Centers for Medicare & Medicaid Services, Office of Strategic
Operations and Regulatory Affairs, Regulations Development and
Issuances Group, Attn: Julie Brown, CMS-1372-FC, Room C5-16-03, 7500
Security Boulevard, Baltimore, MD 21244-1850; and Office of Information
and Regulatory Affairs, Office of Management and Budget, Room 10235,
New Executive Office Building, Washington, DC 20503, Attn: Brenda
Aguilar, CMS Desk Officer.
Comments submitted to OMB may also be emailed to the following
address: email: baguilar@omb.eop.gov; or faxed to OMB at (202) 395-
6974.
VII. 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 final rules with economically significant effects (that
is, a final rule that would have an annual effect on the economy of
$100 million or more in any 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 estimate that the
combined effect of the physician fee schedule update and GPCI
provisions included in this final rule will increase Medicare spending
by $1.0 billion in FY 2004. We have simulated the effect of both the
drug payment and physician fee schedule changes that we are adopting in
this final rule. We are making several changes to the physician fee
schedule RVUs in this final rule. In general, section
1848(c)(2)(B)(ii)(II) of the Act requires that changes to RVUs cannot
increase or decrease expenditures more than $20 million from the amount
of expenditures that would have resulted with such adjustments.
However, section 303(a)(1) of the MPDIMA specifically exempts the
changes we are making to the RVUs in this final rule from the budget
neutrality requirements of section 1848(c)(2)(B)(ii)(II) of the Act.
Thus, the changes that we are making to the physician fee schedule RVUs
will increase aggregate spending for Medicare physician fee schedule
services. Because the changes in this final rule will increase Medicare
spending by more than $1.0 billion in FY 2004, we are considering this
final rule to be economically significant. Therefore, this final rule
is a major rule and we have prepared a regulatory impact analysis. The
table 6 below shows our estimates of the fiscal year 2004 impact of
specific MPDIMA provisions we are implementing in this final rule
(rounded to the nearest $0.1 billion).
[[Page 1098]]
Table 6
------------------------------------------------------------------------
FY 2004
Section Description impact ($ in
billions)
------------------------------------------------------------------------
303............................ Competitive Acquisition $0.0
of Covered Outpatient
Drugs.
304............................ Application to Certain -0.1
Specialties.
305............................ Payment for Inhalation -0.1
Drugs.
412............................ Work GPCI Floor for 0.2
Physicians.
601............................ Update Revisions....... 0.8
602............................ Services in Alaska..... 0.0
------------------------------------------------------------------------
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, non-physician practitioners,
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 875,000 physicians, other practitioners and medical suppliers
that receive Medicare payment under the physician fee schedule. There
are in excess of 20,000 physicians and other practitioners that receive
Medicare payment for drugs. These physicians are concentrated in the
specialties of oncology, urology and rheumatology. Of the physicians in
these specialties, approximately 40 percent are in oncology and 45
percent in urology.
For purposes of the RFA, approximately 98 percent of suppliers of
DME and prosthetic devices are considered small businesses according to
the Small Business Administration's (SBA) size standards. We estimate
that 106,000 entities bill Medicare for DME, prosthetics, orthotics,
surgical dressings, and other equipment and supplies each year. Total
Medicare expenditures for DME are approximately $7.7 billion per year,
of which approximately $1.4 billion are for DME drugs.
The analysis and discussion provided in this section as well as
elsewhere in this final rule complies 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 final rule would not impose unfunded mandates on State,
local, or tribal governments, or on the private sector of more than
$110 million.
We have examined this final 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. This final
rule changes Medicare payment rates for drugs and their administration
as well as other physician fee schedule services. We are providing
information for each of the policy changes in the relevant sections of
this final rule. We are unaware of any relevant Federal rules that
duplicate, overlap or conflict with this final rule. The relevant
sections of this final rule contain a description of significant
alternatives if applicable.
A. Application of Market-Based Systems of Medicare Payment for Part B
Drugs
As described in more detail earlier in this final rule, effective
January 1, 2004, with some exceptions, section 303(b) of MPDIMA
specifies that drugs not paid on a cost or prospective payment basis
will be paid at 85 percent of the average wholesale price determined as
of April 1, 2003. Section 303(a) directs the Secretary to make changes
to the physician fee schedule that will increase Medicare spending for
physicians' services. Section 303 applies only to oncology payments
while section 304 indicates that identical provisions to those in
section 303 apply to other physicians. We have estimated that section
303 of MPDIMA would have no cost in FY 2004 and that section 304 would
save $0.1 billion in FY 2004.
B. Payment for Inhalation Drugs
Section 305(a) of MPDIMA specifies that inhalation drugs furnished
through durable medical equipment covered under 1861(n) of the Act will
be paid at 80 percent of the average wholesale price determined as of
April 1, 2003. We estimated savings associated with implementing
section 305(a) of the MPDIMA is $0.1 billion in FY 2004.
C. Pharmacy Supplying Fee for Certain Drugs and Biologicals
Section 303(e)(2) provides for payment of a pharmacy supplying fee,
less applicable deductible and coinsurance, for immunosuppressive drugs
described in subparagraph (J) of section 1861(s)(2) and oral anti-
cancer and anti-nausea drugs described in subparagraphs (Q) and (T) of
such section. The payment of this fee is bundled into the current
payment for these drugs and the 2004 payment amounts specified in
section 303(b). This provision has no impact on Medicare expenditures
in 2004.
D. Physician Fee Schedule Provisions Related to the Administration of
Drugs
As indicated above, we are making changes to the work and practice
expense RVUs under the provisions of section 1848(c)(2) of the Act as
amended by section 303 of MPDIMA. In general, 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
[[Page 1099]]
resulted without such adjustments. However, section 303(a)(1) of the
MPDIMA specifically exempts the changes we are making to the RVUs in
this final rule from the budget neutrality requirements of section
1848(c)(2)(B)(ii)(II). As described above, consistent with section
303(a)(1), we are making several changes to the physician fee schedule
work and practice expense RVUs.
Table 6A shows the specialty level impact on payment of changes
being made 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,
oncologists receive approximately 20 percent of their Medicare revenues
from physician fee schedule services and approximately 77 percent of
their Medicare revenues from drugs. Table 6A shows only the payment
impact on physician fee schedule services. Table 11 below shows the
combined impact of the physician fee schedule and drug payment changes
for selected specialties and suppliers that receive a high percentage
of their Medicare revenues from drugs.
We modeled the impact of all changes to the relative value units
and illustrated their effect in table 6A. The column labeled ``Impact
11/7/2003 Final Rule Pre-MEI Weight Adjustments'' shows the combined
effect of all of the relative value unit changes contained in the
August 15, 2003, proposed rule and the November 7, 2003, final rule
other than the adjustments to make the aggregate work, practice expense
and malpractice RVUs match the MEI weights. (For a description of the
impact of the provisions of the August 15, 2003, proposed rule see 68
FR 49060-49065. For a description of the impact of additional impacts
resulting from the November 7, 2003, final rule, see 68 FR 63252-
63253). As described below, we have revised the MEI weight adjustments
and will illustrate their impact once we show the effect of all other
provisions that change RVUs.
The column labeled ``Section 303 and 304 Changes without Transition
Payments'' shows the impact of changes made in this final rule
implementing section 303 and 304 of MPDIMA other than section 303(a)(4)
that requires a ``transitional adjustment'' that increases payments for
specific drug administration services by an additional 32 percent in
2004. This column shows the effect of increases in payments for drug
administration services resulting from the higher work and practice
expense RVUs required by section 303 and 304 of MPDIMA as well allowing
oncologists to bill for multiple drug administrations by the ``push''
technique on a single day. In addition, because there will be no same
day billing of a level 1 office visit and a drug administration
service, the impacts shown include the effect of fewer office visit
billings by the minority of oncologists who billed for such services.
Taken together, these provisions will increase payments to oncologists
by an estimated 27 percent. We estimate that payments to other
physicians that provide drug administration services (rheumatology,
infectious disease, obstetrics/gynecology) will increase by 1 to 2
percent. The revision to the practice expense per hour for cardiac and
thoracic surgeons will increase their payments by an estimated 1
percent. All of the other increases shown in the table are a result of
changes that we are making to the non-physician work pool. These
changes will increase payments to physicians, practitioners and
suppliers (Allergy/Immunology, Radiation Oncology, Radiology,
Audiology, Diagnostic Testing Facility and Portable X-Ray suppliers)
that provide services affected by the non-physician work pool
calculations by approximately 1 percent. There will be little or no
change in payments for all other specialties from the changes we are
making in this interim final rule because the changes to the RVUs
resulting from MPDIMA are exempt from the budget neutrality
requirements of section 1848(c)(2)(ii)(II) of the Act.
The column labeled ``Transition Payments'' shows the impact on
payment from the 32 percent increase in payment for drug administration
services required by section 303(a)(4) of MPDIMA. This provision will
have an effect on only those specialties that provide drug
administration services and is estimated to increase payments to
oncologists by an additional 14 percent. We estimate that payments to
other physicians that provide drug administration services (infectious
disease, obstetrics/gynecology rheumatology and urology) will increase
by 1 to 2 percent.
We also modeled the effect of adjusting the RVUs to match the new
MEI weights. Because we are increasing the malpractice RVUs by more
than 20 percent, adjusting the RVUs to match the new MEI weights will
result in an increase in payment for those specialties that perform
services with high malpractice RVUs. Payments to anesthesiology,
cardiac surgery, emergency medicine, neurosurgery, orthopedic surgery,
thoracic surgery and vascular surgery will increase by approximately 1
percent. There will be a small impact on payment to all other
physicians, practitioners and suppliers from the adjustments that
reduce physician work and practice expense RVUs to match the new MEI
weights. The total change in payment from provisions of the November 7,
2003, final rule and this final rule are shown in the total column.
BILLING CODE 4120-01-P
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In general, the statutory methodology for updating the physician
fee schedule conversion factor is specified in section 1848(d)(4) of
the Act. However, section 1848(d)(5) specifies that the update to the
conversion factor for 2004 and 2005 shall not be less than 1.5 percent.
Application of the statutory methodology of section 1848(d)(4) of the
Act would reduce the physician fee schedule conversion factor by 4.5
percent. However, because section 1848(d)(5) of the Act indicates that
the update can be no less than 1.5 percent, we are increasing the 2004
physician fee schedule conversion factor by 1.5 percent. In table 7, we
are showing the estimated change in average payments by specialty based
on provisions of this final rule and the estimated physician fee
schedule update.
[[Page 1102]]
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[[Page 1103]]
[GRAPHIC] [TIFF OMITTED] TR06JA04.007
In the November 7, 2003, final rule, we showed the impact of all
RVUs changes and a 4.5 percent reduction in the physician fee schedule
conversion factor. In the table below, we are showing the effect of
MPDIMA on payment for physician fee schedule services relative to the
changes that would have occurred in 2004 under current law had MPDIMA
not been enacted. That is, because the physician fee schedule
conversion factor would have been reduced by 4.5 percent to $35.1339
and MPDIMA requires that it be increased by 1.5 percent to $37.3374,
MPDIMA provisions affecting the update increased average physician fee
schedule rates by 6.3 percent ($37.3374/$35.339 - 1 = 1.063 or 6.3
percent). Furthermore, MPDIMA required changes to relative value units
that also resulted in further average increases in Medicare payment for
physician fee schedule services. The following table also includes the
impact of the GPCI provision that does not allow a work GPCI to be less
than 1.0 and another one that increases the Alaska GPCI to 1.67.
However, the impact on any specific physician, practitioner or supplier
will be different than the average depending upon on whether the
individual is located in Alaska or an area that would have had a GPCI
that is less than 1.0.
The column labeled ``Impact 11/7/2003'' final rule shows the
impacts from table 27 of the November 7, 2003, final rule (68 FR
63256). The next column shows the impacts from table 7 and an estimate
of the increase in payments due to the GPCI provisions. The percentage
difference between these columns isolates the impact of the MPDIMA
provisions we are adopting in this final rule and are shown in the last
column.
[[Page 1104]]
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[[Page 1105]]
[GRAPHIC] [TIFF OMITTED] TR06JA04.009
Table 9 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 work, practice expense and
malpractice 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 figures in tables 9 and 10 show the impact
of the RVU changes and the physician fee schedule update but do not
include the impact of the GPCI changes.
[[Page 1106]]
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[[Page 1107]]
[GRAPHIC] [TIFF OMITTED] TR06JA04.012
[[Page 1108]]
The next table shows the change in payments from 2003 to 2004 for
selected high volume drug administration services. This table shows the
impact of the increases in the physician work and practice expense
RVUs, the 1.5 percent increase in the physician fee schedule conversion
factor and the additional 32 percent ``transition adjustment'' required
by section 303(a)(4) of MPDIMA in 2004.
[GRAPHIC] [TIFF OMITTED] TR06JA04.013
Table 11 shows the combined impact of changes we are making to
Medicare drug and physician fee schedule payments on selected
specialties/medical suppliers that receive a significant portion of
their total Medicare revenues from drugs. These figures do not include
the impact of the legislated increases in the GPCI. The table shows the
amount and proportion of total Medicare revenues received from drugs
and physician fee schedule services (DME fee schedule services for DME/
Other Medical Suppliers). We note that these impacts and percentages
represent averages for each specialty or supplier. The percentages and
impacts for any individual physician or DME supplier are dependent on
the mix of drugs and physician fee schedule services they provide to
Medicare beneficiaries. These tables are intended to illustrate the
combined payment impact in a single year across all of the services
that these specialties or suppliers perform using the most recent data
available to us. The first two columns of table 11 list the specialty
and its combined Medicare revenues from all sources. The next three
columns show estimated total Medicare drug revenues, the proportion of
total revenues represented by drugs and the percent change in Medicare
drug payments estimated in the first year. The revenue reduction shown
includes the effect of limiting decreases in drug payments to 15
percent, the maximum reduction allowed in 2004 consistent with section
1842(o)(4)(D) of the Act (as added by section 303(b) of MPDIMA). The
following three columns show analogous information for physician fee
schedule services. The last column shows the combined percentage change
across all Medicare revenues. For example, as indicated in the table,
approximately 77 percent of total Medicare revenues for oncologists are
attributed to drugs. As indicated in the next column, we estimate that
Medicare revenues from drugs will decline by approximately 12 percent
for oncologists as a result of policies adopted in this interim final
rule or about $510 million. We are increasing oncology physician fee
schedule payments by 47 percent in this interim final rule or about
$510 million. We estimated that the one-year decrease in drug payments
and increase in physician fee schedule payments resulting from this
final rule will produce virtually no net change in total Medicare
payments for oncologists.
For DME/Other Medical Suppliers, 42 and 58 percent of Medicare
revenues respectively are received from drugs and DME fee schedule
services. These suppliers will receive an approximate reduction of 13
percent in their Medicare drug revenues the first year. The total
reduction in payment in one year across all of the services they
provide will be approximately 6 percent.
In general, the other physician specialties receive a smaller share
of their total Medicare revenues from drugs than oncologists. However,
they are also less affected by the payment increases for drug
administration services. Taken together, we estimate a net change in
revenues from the drug and drug administration payment changes for
urology (-4 percent), rheumatology (-2 percent), obstetrics/gynecology
(+1 percent) and infectious disease (+4 percent).
[[Page 1109]]
[GRAPHIC] [TIFF OMITTED] TR06JA04.014
[[Page 1110]]
C. Geographic Practice Cost Indices (GPCIs) Changes
Section 412 of MPDIMA amended section 1848(e)(1) of the Act and
establishes a floor of 1.0 for the work geographic index for any
locality to be used for purposes of payment for services furnished on
or after January 1, 2004, and before January 1, 2007. In addition,
section 602 of MPDIMA further amended 1848 (e)(1) of the Act for
purposes of payment for services furnished in Alaska under the
physician fee schedule on or after January 1, 2004, and before January
1, 2006, and sets the practice expense, malpractice and work indices at
1.67 if such index would otherwise be less than 1.67. The impact of the
MPDIMA provisions on the work GPCI is illustrated in Table 12.
An impact of these legislative changes to the GPCI can also be
demonstrated by a comparison of area geographic adjustment factors
(GAFs). The GAFs are a weighted composite of each area's work, practice
expense, and malpractice expense GPCIs using the national GPCI cost
share weights. While we do not actually use the GAFs in computing the
fee schedule payment for a specific service, they are useful in
comparing overall area costs and payments. The actual effect on payment
for any specific service will deviate from the GAF to the extent that
the service's proportions of work, practice expenses, and malpractice
expense RVUs differ from those of the GAF. Table 13 shows the effects
of the legislative revisions to the GPCIs on area GAFs for 2004. As
directed by the legislation no locality will have a work GPCI of less
than 1.00 and the work, practice expense and malpractice GPCIs for
Alaska are set at 1.67. Tables 12 and 13 are sorted by decreasing
percent change in work GPCI and GAF respectively.
[[Page 1111]]
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[[Page 1112]]
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[[Page 1113]]
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[[Page 1114]]
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[[Page 1115]]
[GRAPHIC] [TIFF OMITTED] TR06JA04.019
BILLING CODE 4120-01-C
We estimate the cost of the provisions affecting the GPCI will
increase Medicare spending by 0.2 billion in FY 2004.
E. Alternatives Considered
For the most part, this interim final implements prescriptive
provisions of MPDIMA and the statute does not permit us to exercise our
discretion. Nevertheless, the preamble identifies ancillary policies
and rationale for our decisions.
For instance, the statutory provisions requiring changes to
Medicare's payments for drugs were prescriptive. We did not consider
any alternatives because of the clear direction in the statute to
determine Medicare prices for drugs in 2004. Similarly, the provisions
of the statute with respect to the GPCI were also prescriptive and did
not allow for us to consider any alternatives. While we considered
using the formula contained in section 1848(d)(4) of the Act to update
the physician fee schedule conversion factor, its application would
result in a reduction of 4.5 percent and would be inconsistent with the
MPDIMA provision requiring an update to the physician fee schedule
conversion factor for 2004 of not less than 1.5 percent. With respect
to the provisions of this final rule that require changes to Medicare
payments for the administration of drugs, we generally did not find
that the statute permitted discretion. Nevertheless, earlier in the
preamble of this final rule, we provided detailed descriptions of the
statutory provisions and its requirements and, where possible, of the
alternatives we considered.
F. 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 changes in this
rule. For the most part, we are increasing payments for physicians fee
schedule services that otherwise would be reduced. We don't believe the
drug payment changes will have an impact on beneficiary access to
services but we will continue to monitor this issue.
We estimate that beneficiary liability will increase in CY 2004 by
$1.0 billion for the physician fee schedule provisions relative to
current law. Payment changes we are making in this final rule for drug
administration will increase beneficiary liability. However, we
estimate that the provisions that change Medicare's drug payments to
oncologists (section 303 of MPDIMA), other physicians (section 304 of
MPDIMA) and inhalation drugs (section 305 of MPDIMA) will offset the
additional beneficiary liability for drug administration. We estimate
that the net effect of changes to payment for drugs and drug
administration will result in savings to beneficiaries of approximately
$100 million in CY 2004.
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 405
Administrative practice and procedure, Health facilities, Health
professions, Kidney diseases, Medical devices, Medicare, Reporting and
recordkeeping requirements, 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.
(Catalog of Federal Domestic Assistance Program No. 93.774,
Medicare--Supplementary Medical Insurance Program.)
[[Page 1116]]
Dated: December 15, 2003.
Thomas A Scully,
Administrator, Centers for Medicare & Medicaid Services.
Approved: December 24, 2003.
Tommy G. Thompson,
Secretary.
For the reasons set forth in the preamble, the Centers for Medicare
& Medicaid Services amends 42 CFR chapter IV as follows:
PART 405--FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED
0
1. The authority citation for part 405 continues to read as follows:
Authority: Secs. 1102, 1802, and 1871 of the Social Security Act
(42 U.S.C. 1302, 1395a, and 1395hh).
0
2. Section 405.400 is amended by revising the definition of
``physician'' to read as follows:
Sec. 405.400 Definitions.
* * * * *
Physician means a doctor of medicine; doctor of osteopathy; doctor
of dental surgery or of dental medicine; doctor of podiatric medicine;
or doctor of optometry who is legally authorized to practice medicine,
osteopathy, dental surgery, dental medicine, podiatric medicine, or
optometry by the State in which he performs such function and who is
acting within the scope of his license when he performs such functions.
* * * * *
0
3. Section 405.517 is amended by--
0
A. Redesignating the text of paragraph (a) as paragraph (a)(1) and
adding a heading;
0
B. Adding a new paragraph (a)(2).
Sec. 405.517 Payment for drugs and biologicals that are not paid on a
cost or prospective payment basis.
(a) Applicability. (1) Payment for drugs and biologicals before
January 1, 2004. * * *
(2) Payment for drugs and biologicals on or after January 1, 2004.
Effective January 1, 2004, payment for drugs and biologicals that are
not paid on a cost or prospective payment basis are paid in accordance
with Part 414, subpart I of this chapter.
* * * * *
PART 414--PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES
0
4. 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)).
0
5. The list in Sec. 414.1 is amended by adding a new entry in
numerical order as follows:
Sec. 414.1 Basis and scope.
* * * * *
1842(o)--Rules for payment of certain drugs and biologicals.
* * * * *
0
6. A new subpart I is added to read as follows:
Subpart I--Payment for Drugs and Biologicals
Sec.
414.701 Purpose.
414.704 Definitions.
414.707 Basis of payment.
Sec. 414.701 Purpose.
This subpart implements section 1842(o) of the Social Security Act
by specifying the methodology for determining the payment allowance
limit for drugs and biologicals covered under Part B of Title XVIII of
the Act (hereafter in this subpart referred to as the ``program'') that
are not paid on a cost or prospective payment system basis. Examples of
drugs that are subject to the rules contained in this subpart are:
drugs furnished incident to a physician's service; durable medical
equipment (DME) drugs; separately billable drugs at independent
dialysis facilities not under the ESRD composite rate; statutorily
covered drugs, for example, influenza, pneumococcal and hepatitis
vaccines, antigens, hemophilia blood clotting factor, immunosuppressive
drugs and certain oral anti-cancer drugs.
Sec. 414.704 Definitions.
As used in this subpart, the following definition applies. Drug
refers to both drugs and biologicals.
Sec. 414.707 Basis of payment.
(a) Method of payment. (1) Payment for a drug in calendar year 2004
is based on the lesser of--
(i) The actual charge on the claim for program benefits; or
(ii) 85 percent of the average wholesale price determined as of
April 1, 2003, subject to the exceptions as specified in paragraphs
(a)(2) through (a)(8) of this section.
(2) The payment limits for the following drugs are calculated using
95 percent of the average wholesale price:
(i) Blood clotting factors.
(ii) A drug or biological furnished during 2004 that was not
available for Medicare payment as of April 1, 2003.
(iii) Pneumococcal and influenza vaccines as well as hepatitis B
vaccine that is furnished to individuals at high or intermediate risk
of contracting hepatitis B (as determined by the Secretary).
(iv) A drug or biological furnished during 2004 in connection with
the furnishing of renal dialysis services if separately billed by renal
dialysis facilities.
(3) The payment limits for infusion drugs furnished through a
covered item of durable medical equipment are calculated using 95
percent of the average wholesale price in effect on October 1, 2003.
(4) The payments limits for drugs contained in the following table
are calculated based on the percentages of the average wholesale price
determined as of April 1, 2003 that are specified in the table.
------------------------------------------------------------------------
Percentage
used to
calculate
Drug 2004
payment
limit
------------------------------------------------------------------------
EPOETIN ALFA............................................... 87
LEUPROLIDE ACETATE......................................... 81
GOSERELIN ACETATE.......................................... 80
RITUXIMAB.................................................. 81
PACLITAXEL................................................. 81
DOCETAXEL.................................................. 80
CARBOPLATIN................................................ 81
IRINOTECAN................................................. 80
GEMCITABINE HCL............................................ 80
PAMIDRONATE DISODIUM....................................... 85
DOLASETRON MESYLATE........................................ 80
FILGRASTIM................................................. 81
HYLAN G-F 20............................................... 82
MYCOPHENOLATE MOFETIL...................................... 86
GRANISETRON HCL............................................ 80
ONDANSETRON................................................ 87
VINORELBINE TARTATE........................................ 81
SARGRAMOSTIM............................................... 80
TOPOTECAN.................................................. 84
IPRATROPIUM BROMIDE........................................ 80
ALBUTEROL SULFATE.......................................... 80
IMMUNE GLOBULIN............................................ 80
LEUCOVORIN CALCIUM......................................... 80
DOXORUBICIN HCL............................................ 80
DEXAMETHOSONE SODIUM PHOSPHATE............................. 86
HEPARIN SODIUM LOCK-FLUSH.................................. 80
CROMOLYN SODIUM............................................ 80
ACETYLCYSTEINE............................................. 80
------------------------------------------------------------------------
(5) The payment limits for imiglucerase and alglucerase are
calculated using 94 percent of the average wholesale price determined
as of April 1, 2003.
(6) Exception. The payment limit for a drug otherwise subject to
paragraph (a)(1)(ii) or paragraph (a)(4) of this section may be
calculated using the percentage of the average wholesale price as the
Secretary deems appropriate based on data and information submitted by
the drug manufacturer.
(i) The manufacturer must submit data after October 15, 2003 and
before January 1, 2004.
(ii) The percentage only applies for drugs furnished on or after
April 1, 2004.
[[Page 1117]]
(7) In the case of blood and blood products (other than blood
clotting factors), the payment limits shall be determined in the same
manner as such payment limit was determined on October 1, 2003.
(b) Mandatory assignment. Effective with services furnished on or
after February 1, 2001, payment for any drug covered under Part B of
Medicare may be made on an assignment-related basis only. All billers
must accept the program allowed charge as payment in full and may not
bill nor collect from the beneficiary any amount other than the unmet
Part B deductible and Part B coinsurance amounts, if applicable.
Violations of this requirement may subject the supplier to sanctions,
as provided by the statute (See Sec. 402 of this chapter).
Note: These addenda will not appear in the Code of Federal
Regulations.
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 2004. 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 and most alpha-numeric codes
(Healthcare Common Procedure Coding System (HCPCS) codes not
included in CPT) in Addendum B.
Addendum B--2004 Relative Value Units and Related Information Used in
Determining Medicare Payments for 2004
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.
[sbull] 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).
[sbull] 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. Non-facility practice expense RVUs. These are the fully
implemented resource-based practice expense RVUs for non-facility
settings.
7. Facility practice expense RVUs. These are the fully
implemented resource-based practice expense RVUs for facility
settings.
8. Malpractice expense RVUs. These are the RVUs for the
malpractice expense for the service for 2004.
9. Non-facility total. This is the sum of the work, fully
implemented non-facility practice expense, and malpractice expense
RVUs.
10. Facility total. This is the sum of the work, fully
implemented 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 2003 American Medical
Association. All Rights Reserved. Applicable FARS/DFARS Apply.
\2\ Copyright 2003 American Dental Association. All rights reserved.
\3\ + Indicates RVUs are not used for Medicare payment.
[[Page 1118]]
Addendum B.--Relative Value Units (RVUS) and Related Information
--------------------------------------------------------------------------------------------------------------------------------------------------------
Physician Non- Mal- Non-
CPT\1\ HCPCS\2\ MOD Status Description work facility Facility practice facility Facility Global
RVUs\3\ PE RVUs PE RVUs RVUs total total
--------------------------------------------------------------------------------------------------------------------------------------------------------
0001F............... .............. I Blood pressure, 0.00 0.00 0.00 0.00 0.00 0.00 XXX
measured.
0001T............... .............. C Endovas repr abdo ao 0.00 0.00 0.00 0.00 0.00 0.00 XXX
aneurys.
0002F............... .............. I Tobacco use, smoking, 0.00 0.00 0.00 0.00 0.00 0.00 XXX
assess.
0002T............... .............. D endo repair abd aa 0.00 0.00 0.00 0.00 0.00 0.00 XXX
aorto uni.
0003F............... .............. I Tobacco use, non- 0.00 0.00 0.00 0.00 0.00 0.00 XXX
smoking.
0003T............... .............. C Cervicography........ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0004F............... .............. I Tobacco use txmnt 0.00 0.00 0.00 0.00 0.00 0.00 XXX
counseling.
0005F............... .............. I Tobacco use txmnt, 0.00 0.00 0.00 0.00 0.00 0.00 XXX
pharmacol.
0005T............... .............. C Perc cath stent/brain 0.00 0.00 0.00 0.00 0.00 0.00 XXX
cv art.
0006F............... .............. I Statin therapy, 0.00 0.00 0.00 0.00 0.00 0.00 XXX
prescribed.
0006T............... .............. C Perc cath stent/brain 0.00 0.00 0.00 0.00 0.00 0.00 XXX
cv art.
0007F............... .............. I Beta-blocker thx 0.00 0.00 0.00 0.00 0.00 0.00 XXX
prescribed.
0007T............... .............. C Perc cath stent/brain 0.00 0.00 0.00 0.00 0.00 0.00 XXX
cv art.
0008F............... .............. I Ace inhibitor thx 0.00 0.00 0.00 0.00 0.00 0.00 XXX
prescribed.
0008T............... .............. C Upper gi endoscopy w/ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
suture.
0009F............... .............. I Assess anginal 0.00 0.00 0.00 0.00 0.00 0.00 XXX
symptom/level.
0009T............... .............. C Endometrial 0.00 0.00 0.00 0.00 0.00 0.00 XXX
cryoablation.
0010F............... .............. I Assess anginal 0.00 0.00 0.00 0.00 0.00 0.00 XXX
symptom/level.
0010T............... .............. C Tb test, gamma 0.00 0.00 0.00 0.00 0.00 0.00 XXX
interferon.
0011F............... .............. I Oral antiplat thx 0.00 0.00 0.00 0.00 0.00 0.00 XXX
prescribed.
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 vasc 0.00 0.00 0.00 0.00 0.00 0.00 XXX
lesion.
0017T............... .............. C Photocoagulat macular 0.00 0.00 0.00 0.00 0.00 0.00 XXX
drusen.
0018T............... .............. C Transcranial magnetic 0.00 0.00 0.00 0.00 0.00 0.00 XXX
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............... .............. D Ultrasonic pachymetry 0.00 0.00 0.00 0.00 0.00 0.00 XXX
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 composition 0.00 0.00 0.00 0.00 0.00 0.00 XXX
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/direct 0.00 0.00 0.00 0.00 0.00 0.00 XXX
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/o 0.00 0.00 0.00 0.00 0.00 0.00 XXX
subcl.
0035T............... .............. C Insert endovasc 0.00 0.00 0.00 0.00 0.00 0.00 XXX
prosth, taa.
0036T............... .............. C Endovasc prosth, taa, 0.00 0.00 0.00 0.00 0.00 0.00 XXX
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 taa 0.00 0.00 0.00 0.00 0.00 0.00 XXX
repair.
0040T............... .............. C Rad s/i, endovasc taa 0.00 0.00 0.00 0.00 0.00 0.00 XXX
prosth.
0041T............... .............. C Detect ur infect agnt 0.00 0.00 0.00 0.00 0.00 0.00 XXX
w/cpas.
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.
0045T............... .............. C Whole body 0.00 0.00 0.00 0.00 0.00 0.00 XXX
photography.
0046T............... .............. C Cath lavage, mammary 0.00 0.00 0.00 0.00 0.00 0.00 XXX
duct(s.
0047T............... .............. C Cath lavage, mammary 0.00 0.00 0.00 0.00 0.00 0.00 XXX
duct(s).
0048T............... .............. C Implant ventricular 0.00 0.00 0.00 0.00 0.00 0.00 XXX
device.
0049T............... .............. C External circulation 0.00 0.00 0.00 0.00 0.00 0.00 XXX
assist.
0050T............... .............. C Removal circulation 0.00 0.00 0.00 0.00 0.00 0.00 XXX
assist.
0051T............... .............. C Implant total heart 0.00 0.00 0.00 0.00 0.00 0.00 XXX
system.
0052T............... .............. C Replace component 0.00 0.00 0.00 0.00 0.00 0.00 XXX
heart syst.
0053T............... .............. C Replace component 0.00 0.00 0.00 0.00 0.00 0.00 XXX
heart syst.
0054T............... .............. C Bone surgery using 0.00 0.00 0.00 0.00 0.00 0.00 XXX
computer.
0055T............... .............. C Bone surgery using 0.00 0.00 0.00 0.00 0.00 0.00 XXX
computer.
0056T............... .............. C Bone surgery using 0.00 0.00 0.00 0.00 0.00 0.00 XXX
computer.
0057T............... .............. C Uppr gi scope w/ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
thrml txmnt.
0058T............... .............. C Cryopreservation, 0.00 0.00 0.00 0.00 0.00 0.00 XXX
ovary tiss.
0059T............... .............. C Cryopreservation, 0.00 0.00 0.00 0.00 0.00 0.00 XXX
oocyte.
0060T............... .............. C Electrical impedance 0.00 0.00 0.00 0.00 0.00 0.00 XXX
scan.
0061T............... .............. C Destruction of tumor, 0.00 0.00 0.00 0.00 0.00 0.00 XXX
breast.
10021............... .............. A Fna w/o image........ 1.27 2.20 0.54 0.08 3.55 1.89 XXX
10022............... .............. A Fna w/image.......... 1.27 2.61 0.42 0.06 3.94 1.75 XXX
10040............... .............. A Acne surgery......... 1.18 1.02 0.68 0.06 2.26 1.92 010
10060............... .............. A Drainage of skin 1.17 1.20 0.94 0.10 2.47 2.21 010
abscess.
10061............... .............. A Drainage of skin 2.40 1.81 1.51 0.21 4.42 4.12 010
abscess.
10080............... .............. A Drainage of pilonidal 1.17 3.13 1.14 0.11 4.41 2.42 010
cyst.
10081............... .............. A Drainage of pilonidal 2.45 4.11 1.51 0.23 6.79 4.19 010
cyst.
[[Page 1119]]
10120............... .............. A Remove foreign body.. 1.22 1.46 0.41 0.12 2.80 1.75 010
10121............... .............. A Remove foreign body.. 2.69 3.33 1.88 0.30 6.32 4.87 010
10140............... .............. A Drainage of hematoma/ 1.53 1.51 0.91 0.18 3.22 2.62 010
fluid.
10160............... .............. A Puncture drainage of 1.20 0.73 0.46 0.13 2.06 1.79 010
lesion.
10180............... .............. A Complex drainage, 2.25 3.25 2.08 0.30 5.80 4.63 010
wound.
11000............... .............. A Debride infected skin 0.60 0.57 0.22 0.06 1.23 0.88 000
11001............... .............. A Debride infected skin 0.30 0.23 0.11 0.02 0.55 0.43 ZZZ
add-on.
11010............... .............. A Debride skin, fx..... 4.19 6.74 2.33 0.54 11.47 7.06 010
11011............... .............. A Debride skin/muscle, 4.94 8.03 2.37 0.64 13.61 7.95 000
fx.
11012............... .............. A Debride skin/muscle/ 6.87 12.01 3.86 1.07 19.95 11.80 000
bone, fx.
11040............... .............. A Debride skin, partial 0.50 0.51 0.21 0.06 1.07 0.77 000
11041............... .............. A Debride skin, full... 0.82 0.65 0.33 0.07 1.54 1.22 000
11042............... .............. A Debride skin/tissue.. 1.12 0.97 0.45 0.11 2.20 1.68 000
11043............... .............. A Debride tissue/muscle 2.38 3.41 2.61 0.29 6.08 5.28 010
11044............... .............. A Debride tissue/muscle/ 3.06 4.50 3.77 0.41 7.97 7.24 010
bone.
11055............... .............. R Trim skin lesion..... 0.43 0.55 0.17 0.02 1.00 0.62 000
11056............... .............. R Trim skin lesions, 2 0.61 0.63 0.24 0.04 1.28 0.89 000
to 4.
11057............... .............. R Trim skin lesions, 0.79 0.73 0.31 0.05 1.57 1.15 000
over 4.
11100............... .............. A Biopsy, skin lesion.. 0.81 1.26 0.37 0.05 2.12 1.23 000
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 1.06 0.77 0.05 1.88 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 1.00 0.22 0.04 1.55 0.77 000
11301............... .............. A Shave skin lesion.... 0.85 1.12 0.37 0.05 2.02 1.27 000
11302............... .............. A Shave skin lesion.... 1.05 1.31 0.46 0.06 2.42 1.57 000
11303............... .............. A Shave skin lesion.... 1.24 1.59 0.52 0.07 2.90 1.83 000
11305............... .............. A Shave skin lesion.... 0.67 0.84 0.27 0.05 1.56 0.99 000
11306............... .............. A Shave skin lesion.... 0.99 1.11 0.41 0.06 2.16 1.46 000
11307............... .............. A Shave skin lesion.... 1.14 1.29 0.49 0.06 2.49 1.69 000
11308............... .............. A Shave skin lesion.... 1.41 1.45 0.59 0.08 2.94 2.08 000
11310............... .............. A Shave skin lesion.... 0.73 1.12 0.33 0.05 1.90 1.11 000
11311............... .............. A Shave skin lesion.... 1.05 1.24 0.48 0.06 2.35 1.59 000
11312............... .............. A Shave skin lesion.... 1.20 1.44 0.55 0.07 2.71 1.82 000
11313............... .............. A Shave skin lesion.... 1.62 1.82 0.72 0.11 3.55 2.45 000
11400............... .............. A Exc tr-ext b9+marg 0.85 2.00 0.89 0.07 2.92 1.81 010
0.5 < cm.
11401............... .............. A Exc tr-ext b9+marg 1.23 2.07 1.03 0.11 3.41 2.37 010
0.6-1 cm.
11402............... .............. A Exc tr-ext b9+marg 1.51 2.25 1.10 0.14 3.90 2.75 010
1.1-2 cm.
11403............... .............. A Exc tr-ext b9+marg 1.79 2.42 1.33 0.19 4.40 3.31 010
2.1-3 cm.
11404............... .............. A Exc tr-ext b9+marg 2.06 2.73 1.41 0.22 5.01 3.69 010
3.1-4 cm.
11406............... .............. A Exc tr-ext b9+marg 2.76 3.10 1.67 0.30 6.16 4.73 010
4.0 cm.
11420............... .............. A Exc h-f-nk-sp b9+marg 0.98 1.77 0.94 0.10 2.85 2.02 010
0.5 <.
11421............... .............. A Exc h-f-nk-sp b9+marg 1.42 2.08 1.12 0.13 3.63 2.67 010
0.6-1.
11422............... .............. A Exc h-f-nk-sp b9+marg 1.63 2.27 1.34 0.17 4.07 3.14 010
1.1-2.
11423............... .............. A Exc h-f-nk-sp b9+marg 2.01 2.61 1.46 0.21 4.83 3.68 010
2.1-3.
11424............... .............. A Exc h-f-nk-sp b9+marg 2.43 2.82 1.61 0.25 5.50 4.29 010
3.1-4.
11426............... .............. A Exc h-f-nk-sp b9+marg 3.77 3.52 2.11 0.41 7.70 6.29 010
4 cm.
11440............... .............. A Exc face-mm b9+marg 1.06 2.28 1.33 0.10 3.44 2.49 010
0.5 < cm.
11441............... .............. A Exc face-mm b9+marg 1.48 2.40 1.51 0.13 4.01 3.12 010
0.6-1 cm.
11442............... .............. A Exc face-mm b9+marg 1.72 2.59 1.58 0.17 4.48 3.47 010
1.1-2 cm.
11443............... .............. A Exc face-mm b9+marg 2.29 2.97 1.83 0.22 5.48 4.34 010
2.1-3 cm.
11444............... .............. A Exc face-mm b9+marg 3.14 3.54 2.19 0.30 6.98 5.63 010
3.1-4 cm.
11446............... .............. A Exc face-mm b9+marg 4.48 4.11 2.78 0.36 8.95 7.62 010
4 cm.
11450............... .............. A Removal, sweat gland 2.73 5.11 2.03 0.31 8.15 5.07 090
lesion.
11451............... .............. A Removal, sweat gland 3.94 6.74 2.56 0.47 11.15 6.97 090
lesion.
11462............... .............. A Removal, sweat gland 2.51 5.20 2.02 0.28 7.99 4.81 090
lesion.
11463............... .............. A Removal, sweat gland 3.94 6.96 2.69 0.48 11.38 7.11 090
lesion.
11470............... .............. A Removal, sweat gland 3.25 5.14 2.27 0.36 8.75 5.88 090
lesion.
11471............... .............. A Removal, sweat gland 4.40 6.85 2.78 0.48 11.73 7.66 090
lesion.
11600............... .............. A Exc tr-ext mlg+marg 1.31 2.65 0.98 0.11 4.07 2.40 010
0.5 < cm.
11601............... .............. A Exc tr-ext mlg+marg 1.80 2.72 1.23 0.14 4.66 3.17 010
0.6-1 cm.
11602............... .............. A Exc tr-ext mlg+marg 1.95 2.86 1.27 0.16 4.97 3.38 010
1.1-2 cm.
11603............... .............. A Exc tr-ext mlg+marg 2.19 3.11 1.33 0.19 5.49 3.71 010
2.1-3 cm.
11604............... .............. A Exc tr-ext mlg+marg 2.40 3.41 1.40 0.22 6.03 4.02 010
3.1-4 cm.
11606............... .............. A Exc tr-ext mlg+marg 3.42 4.11 1.75 0.34 7.87 5.51 010
4 cm.
11620............... .............. A Exc h-f-nk-sp 1.19 2.62 0.96 0.11 3.92 2.26 010
mlg+marg 0.5 <.
11621............... .............. A Exc h-f-nk-sp 1.76 2.73 1.25 0.14 4.63 3.15 010
mlg+marg 0.6-1.
11622............... .............. A Exc h-f-nk-sp 2.09 3.00 1.39 0.18 5.27 3.66 010
mlg+marg 1.1-2.
11623............... .............. A Exc h-f-nk-sp 2.61 3.36 1.59 0.24 6.21 4.44 010
mlg+marg 2.1-3.
11624............... .............. A Exc h-f-nk-sp 3.06 3.79 1.78 0.30 7.15 5.14 010
mlg+marg 3.1-4.
11626............... .............. A Exc h-f-nk-sp mlg+mar 4.29 4.70 2.40 0.42 9.41 7.11 010
4 cm.
11640............... .............. A Exc face-mm 1.35 2.69 1.12 0.12 4.16 2.59 010
malig+marg 0.5 <.
11641............... .............. A Exc face-mm 2.16 3.06 1.54 0.18 5.40 3.88 010
malig+marg 0.6-1.
11642............... .............. A Exc face-mm 2.59 3.44 1.73 0.22 6.25 4.54 010
malig+marg 1.1-2.
11643............... .............. A Exc face-mm 3.10 3.85 1.96 0.29 7.24 5.35 010
malig+marg 2.1-3.
11644............... .............. A Exc face-mm 4.02 4.74 2.47 0.40 9.16 6.89 010
malig+marg 3.1-4.
[[Page 1120]]
11646............... .............. A Exc face-mm mlg+marg 5.94 5.81 3.49 0.55 12.30 9.98 010
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 0.43 0.21 0.05 1.02 0.80 000
more.
11730............... .............. A Removal of nail plate 1.13 1.02 0.43 0.11 2.26 1.67 000
11732............... .............. A Remove nail plate, 0.57 0.43 0.22 0.06 1.06 0.85 ZZZ
add-on.
11740............... .............. A Drain blood from 0.37 0.85 0.14 0.04 1.26 0.55 000
under nail.
11750............... .............. A Removal of nail bed.. 1.86 2.13 1.72 0.19 4.18 3.77 010
11752............... .............. A Remove nail bed/ 2.67 2.95 2.95 0.40 6.02 6.02 010
finger tip.
11755............... .............. A Biopsy, nail unit.... 1.31 1.10 0.54 0.07 2.48 1.92 000
11760............... .............. A Repair of nail bed... 1.58 1.84 1.21 0.21 3.63 3.00 010
11762............... .............. A Reconstruction of 2.89 2.27 1.83 0.39 5.55 5.11 010
nail bed.
11765............... .............. A Excision of nail 0.69 1.14 0.52 0.06 1.89 1.27 010
fold, toe.
11770............... .............. A Removal of pilonidal 2.61 3.52 1.51 0.29 6.42 4.41 010
lesion.
11771............... .............. A Removal of pilonidal 5.73 5.70 3.33 0.68 12.11 9.74 090
lesion.
11772............... .............. A Removal of pilonidal 6.97 7.17 3.87 0.82 14.96 11.66 090
lesion.
11900............... .............. A Injection into skin 0.52 0.65 0.22 0.02 1.19 0.76 000
lesions.
11901............... .............. A Added skin lesions 0.80 0.66 0.36 0.04 1.50 1.20 000
injection.
11920............... .............. R Correct skin color 1.61 1.99 0.78 0.21 3.81 2.60 000
defects.
11921............... .............. R Correct skin color 1.93 2.36 0.98 0.25 4.54 3.16 000
defects.
11922............... .............. R Correct skin color 0.49 0.37 0.25 0.06 0.92 0.80 ZZZ
defects.
11950............... .............. R Therapy for contour 0.84 1.15 0.40 0.07 2.06 1.31 000
defects.
11951............... .............. R Therapy for contour 1.19 1.50 0.51 0.12 2.81 1.82 000
defects.
11952............... .............. R Therapy for contour 1.69 1.87 0.68 0.21 3.77 2.58 000
defects.
11954............... .............. R Therapy for contour 1.85 2.44 0.91 0.23 4.52 2.99 000
defects.
11960............... .............. A Insert tissue 9.07 NA 10.52 1.06 NA 20.65 090
expander(s).
11970............... .............. A Replace tissue 7.05 NA 6.10 0.93 NA 14.08 090
expander.
11971............... .............. A Remove tissue 2.13 7.10 4.76 0.25 9.48 7.14 090
expander(s).
11975............... .............. N Insert contraceptive +1.48 1.42 0.57 0.17 3.07 2.22 XXX
cap.
11976............... .............. R Removal of 1.78 1.70 0.68 0.21 3.69 2.67 000
contraceptive cap.
11977............... .............. N Removal/reinsert +3.30 2.27 1.26 0.37 5.94 4.93 XXX
contra cap.
11980............... .............. A Implant hormone 1.48 1.10 0.54 0.12 2.70 2.14 000
pellet(s).
11981............... .............. A Insert drug implant 1.48 1.74 0.68 0.17 3.39 2.33 XXX
device.
11982............... .............. A Remove drug implant 1.78 1.97 0.84 0.21 3.96 2.83 XXX
device.
11983............... .............. A Remove/insert drug 3.30 2.32 1.47 0.37 5.99 5.14 XXX
implant.
12001............... .............. A Repair superficial 1.70 2.00 0.49 0.16 3.86 2.35 010
wound(s).
12002............... .............. A Repair superficial 1.86 2.06 0.93 0.18 4.10 2.97 010
wound(s).
12004............... .............. A Repair superficial 2.24 2.36 1.05 0.21 4.81 3.50 010
wound(s).
12005............... .............. A Repair superficial 2.86 2.85 1.23 0.28 5.99 4.37 010
wound(s).
12006............... .............. A Repair superficial 3.66 3.43 1.54 0.37 7.46 5.57 010
wound(s).
12007............... .............. A Repair superficial 4.11 3.86 1.84 0.45 8.42 6.40 010
wound(s).
12011............... .............. A Repair superficial 1.76 2.16 0.50 0.17 4.09 2.43 010
wound(s).
12013............... .............. A Repair superficial 1.99 2.31 0.97 0.19 4.49 3.15 010
wound(s).
12014............... .............. A Repair superficial 2.46 2.61 1.09 0.22 5.29 3.77 010
wound(s).
12015............... .............. A Repair superficial 3.19 3.19 1.28 0.29 6.67 4.76 010
wound(s).
12016............... .............. A Repair superficial 3.92 3.60 1.56 0.39 7.91 5.87 010
wound(s).
12017............... .............. A Repair superficial 4.70 NA 1.91 0.47 NA 7.08 010
wound(s).
12018............... .............. A Repair superficial 5.52 NA 2.27 0.55 NA 8.34 010
wound(s).
12020............... .............. A Closure of split 2.62 2.65 1.75 0.29 5.56 4.66 010
wound.
12021............... .............. A Closure of split 1.84 1.74 1.41 0.23 3.81 3.48 010
wound.
12031............... .............. A Layer closure of 2.15 2.31 0.81 0.18 4.64 3.14 010
wound(s).
12032............... .............. A Layer closure of 2.47 3.88 1.84 0.18 6.53 4.49 010
wound(s).
12034............... .............. A Layer closure of 2.92 3.17 1.41 0.25 6.34 4.58 010
wound(s).
12035............... .............. A Layer closure of 3.42 5.26 2.18 0.36 9.04 5.96 010
wound(s).
12036............... .............. A Layer closure of 4.04 5.36 2.38 0.49 9.89 6.91 010
wound(s).
12037............... .............. A Layer closure of 4.66 6.41 2.78 0.59 11.66 8.03 010
wound(s).
12041............... .............. A Layer closure of 2.37 2.47 0.87 0.21 5.05 3.45 010
wound(s).
12042............... .............. A Layer closure of 2.74 3.21 1.37 0.21 6.16 4.32 010
wound(s).
12044............... .............. A Layer closure of 3.14 3.20 1.56 0.29 6.63 4.99 010
wound(s).
12045............... .............. A Layer closure of 3.63 3.67 2.17 0.41 7.71 6.21 010
wound(s).
12046............... .............. A Layer closure of 4.24 6.57 2.76 0.48 11.29 7.48 010
wound(s).
12047............... .............. A Layer closure of 4.64 6.42 3.10 0.49 11.55 8.23 010
wound(s).
12051............... .............. A Layer closure of 2.47 3.23 1.36 0.19 5.89 4.02 010
wound(s).
12052............... .............. A Layer closure of 2.77 3.17 1.34 0.21 6.15 4.32 010
wound(s).
12053............... .............. A Layer closure of 3.12 3.22 1.50 0.24 6.58 4.86 010
wound(s).
12054............... .............. A Layer closure of 3.45 3.54 1.60 0.30 7.29 5.35 010
wound(s).
12055............... .............. A Layer closure of 4.42 4.54 2.14 0.42 9.38 6.98 010
wound(s).
12056............... .............. A Layer closure of 5.23 6.76 3.07 0.52 12.51 8.82 010
wound(s).
12057............... .............. A Layer closure of 5.95 6.10 3.76 0.60 12.65 10.31 010
wound(s).
13100............... .............. A Repair of wound or 3.12 3.51 1.78 0.25 6.88 5.15 010
lesion.
13101............... .............. A Repair of wound or 3.91 3.75 2.22 0.27 7.93 6.40 010
lesion.
13102............... .............. A Repair wound/lesion 1.24 0.74 0.57 0.12 2.10 1.93 ZZZ
add-on.
13120............... .............. A Repair of wound or 3.30 3.61 1.82 0.28 7.19 5.40 010
lesion.
13121............... .............. A Repair of wound or 4.32 3.97 2.32 0.30 8.59 6.94 010
lesion.
13122............... .............. A Repair wound/lesion 1.44 0.87 0.63 0.14 2.45 2.21 ZZZ
add-on.
[[Page 1121]]
13131............... .............. A Repair of wound or 3.78 3.88 2.14 0.30 7.96 6.22 010
lesion.
13132............... .............. A Repair of wound or 5.94 4.68 3.17 0.39 11.01 9.50 010
lesion.
13133............... .............. A Repair wound/lesion 2.19 1.19 1.03 0.21 3.59 3.43 ZZZ
add-on.
13150............... .............. A Repair of wound or 3.80 5.50 2.61 0.35 9.65 6.76 010
lesion.
13151............... .............. A Repair of wound or 4.44 5.40 3.03 0.34 10.18 7.81 010
lesion.
13152............... .............. A Repair of wound or 6.32 6.08 3.93 0.46 12.86 10.71 010
lesion.
13153............... .............. A Repair wound/lesion 2.38 1.34 1.14 0.22 3.94 3.74 ZZZ
add-on.
13160............... .............. A Late closure of wound 10.46 NA 7.14 1.44 NA 19.04 090
14000............... .............. A Skin tissue 5.88 8.52 5.12 0.55 14.95 11.55 090
rearrangement.
14001............... .............. A Skin tissue 8.46 9.94 6.59 0.78 19.18 15.83 090
rearrangement.
14020............... .............. A Skin tissue 6.58 9.17 5.99 0.60 16.35 13.17 090
rearrangement.
14021............... .............. A Skin tissue 10.04 10.45 7.74 0.83 21.32 18.61 090
rearrangement.
14040............... .............. A Skin tissue 7.86 8.25 6.86 0.66 16.77 15.38 090
rearrangement.
14041............... .............. A Skin tissue 11.47 10.64 8.68 0.86 22.97 21.01 090
rearrangement.
14060............... .............. A Skin tissue 8.49 9.08 7.69 0.71 18.28 16.89 090
rearrangement.
14061............... .............. A Skin tissue 12.27 11.66 9.51 0.90 24.83 22.68 090
rearrangement.
14300............... .............. A Skin tissue 11.74 11.19 9.17 1.06 23.99 21.97 090
rearrangement.
14350............... .............. A Skin tissue 9.60 NA 7.12 1.31 NA 18.03 090
rearrangement.
15000............... .............. A Skin graft........... 3.99 3.81 2.20 0.45 8.25 6.64 000
15001............... .............. A Skin graft add-on.... 1.00 1.36 0.41 0.13 2.49 1.54 ZZZ
15050............... .............. A Skin pinch graft..... 4.29 5.97 4.74 0.55 10.81 9.58 090
15100............... .............. A Skin split graft..... 9.04 12.63 7.80 1.13 22.80 17.97 090
15101............... .............. A Skin split graft add- 1.72 3.83 1.66 0.22 5.77 3.60 ZZZ
on.
15120............... .............. A Skin split graft..... 9.82 10.78 7.77 1.09 21.69 18.68 090
15121............... .............. A Skin split graft add- 2.67 4.58 1.87 0.33 7.58 4.87 ZZZ
on.
15200............... .............. A Skin full graft...... 8.02 10.71 6.00 0.88 19.61 14.90 090
15201............... .............. A Skin full graft add- 1.32 1.04 0.62 0.17 2.53 2.11 ZZZ
on.
15220............... .............. A Skin full graft...... 7.86 10.59 6.43 0.82 19.27 15.11 090
15221............... .............. A Skin full graft add- 1.19 0.91 0.56 0.14 2.24 1.89 ZZZ
on.
15240............... .............. A Skin full graft...... 9.03 10.15 7.65 0.96 20.14 17.64 090
15241............... .............. A Skin full graft add- 1.86 1.45 0.92 0.21 3.52 2.99 ZZZ
on.
15260............... .............. A Skin full graft...... 10.04 9.88 8.60 0.76 20.68 19.40 090
15261............... .............. A Skin full graft add- 2.23 2.72 1.42 0.21 5.16 3.86 ZZZ
on.
15342............... .............. A Cultured skin graft, 1.00 1.83 0.55 0.11 2.94 1.66 010
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....... 3.99 8.22 4.83 0.51 12.72 9.33 090
15351............... .............. A Skin homograft add-on 1.00 0.94 0.39 0.13 2.07 1.52 ZZZ
15400............... .............. A Skin heterograft..... 3.99 4.18 4.10 0.48 8.65 8.57 090
15401............... .............. A Skin heterograft add- 1.00 1.22 0.44 0.13 2.35 1.57 ZZZ
on.
15570............... .............. A Form skin pedicle 9.20 9.17 6.68 1.16 19.53 17.04 090
flap.
15572............... .............. A Form skin pedicle 9.26 8.38 6.25 1.12 18.76 16.63 090
flap.
15574............... .............. A Form skin pedicle 9.87 8.79 6.95 1.11 19.77 17.93 090
flap.
15576............... .............. A Form skin pedicle 8.68 9.39 6.42 0.87 18.94 15.97 090
flap.
15600............... .............. A Skin graft........... 1.91 7.04 2.70 0.23 9.18 4.84 090
15610............... .............. A Skin graft........... 2.42 3.73 3.03 0.30 6.45 5.75 090
15620............... .............. A Skin graft........... 2.94 7.46 3.67 0.34 10.74 6.95 090
15630............... .............. A Skin graft........... 3.27 6.84 3.93 0.34 10.45 7.54 090
15650............... .............. A Transfer skin pedicle 3.96 6.70 4.02 0.43 11.09 8.41 090
flap.
15732............... .............. A Muscle-skin graft, 17.81 18.05 12.22 1.81 37.67 31.84 090
head/neck.
15734............... .............. A Muscle-skin graft, 17.76 17.84 12.34 2.30 37.90 32.40 090
trunk.
15736............... .............. A Muscle-skin graft, 16.25 18.16 11.22 2.15 36.56 29.62 090
arm.
15738............... .............. A Muscle-skin graft, 17.89 17.93 11.74 2.35 38.17 31.98 090
leg.
15740............... .............. A Island pedicle flap 10.23 9.81 7.88 0.75 20.79 18.86 090
graft.
15750............... .............. A Neurovascular pedicle 11.39 NA 9.04 1.40 NA 21.83 090
graft.
15756............... .............. A Free myo/skin flap 35.18 NA 20.69 3.75 NA 59.62 090
microvasc.
15757............... .............. A Free skin flap, 35.18 NA 21.73 4.06 NA 60.97 090
microvasc.
15758............... .............. A Free fascial flap, 35.05 NA 21.72 4.25 NA 61.02 090
microvasc.
15760............... .............. A Composite skin graft. 8.73 9.71 7.02 0.87 19.31 16.62 090
15770............... .............. A Derma-fat-fascia 7.51 NA 6.69 0.94 NA 15.14 090
graft.
15775............... .............. R Hair transplant punch 3.95 2.78 1.32 0.52 7.25 5.79 000
grafts.
15776............... .............. R Hair transplant punch 5.53 5.39 2.81 0.72 11.64 9.06 000
grafts.
15780............... .............. A Abrasion treatment of 7.28 7.07 7.07 0.49 14.84 14.84 090
skin.
15781............... .............. A Abrasion treatment of 4.84 5.35 5.35 0.33 10.52 10.52 090
skin.
15782............... .............. A Abrasion treatment of 4.31 4.30 4.30 0.25 8.86 8.86 090
skin.
15783............... .............. A Abrasion treatment of 4.28 4.92 4.17 0.31 9.51 8.76 090
skin.
15786............... .............. A Abrasion, lesion, 2.03 1.63 1.27 0.13 3.79 3.43 010
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 3.34 2.27 0.13 5.56 4.49 090
epiderm.
15789............... .............. R Chemical peel, face, 4.91 6.39 4.91 0.33 11.63 10.15 090
dermal.
15792............... .............. R Chemical peel, 1.86 3.16 2.76 0.12 5.14 4.74 090
nonfacial.
15793............... .............. A Chemical peel, 3.73 NA 4.14 0.21 NA 8.08 090
nonfacial.
15810............... .............. A Salabrasion.......... 4.73 3.87 3.87 0.51 9.11 9.11 090
15811............... .............. A Salabrasion.......... 5.38 6.31 5.52 0.63 12.32 11.53 090
15819............... .............. A Plastic surgery, neck 9.37 NA 7.20 0.93 NA 17.50 090
15820............... .............. A Revision of lower 5.14 6.85 5.34 0.36 12.35 10.84 090
eyelid.
[[Page 1122]]
15821............... .............. A Revision of lower 5.71 7.23 5.52 0.37 13.31 11.60 090
eyelid.
15822............... .............. A Revision of upper 4.44 5.80 4.36 0.27 10.51 9.07 090
eyelid.
15823............... .............. A Revision of upper 7.04 7.79 6.24 0.39 15.22 13.67 090
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.
15831............... .............. A Excise excessive skin 12.38 NA 8.22 1.57 NA 22.17 090
tissue.
15832............... .............. A Excise excessive skin 11.57 NA 8.38 1.46 NA 21.41 090
tissue.
15833............... .............. A Excise excessive skin 10.62 NA 8.24 1.41 NA 20.27 090
tissue.
15834............... .............. A Excise excessive skin 10.83 NA 7.71 1.42 NA 19.96 090
tissue.
15835............... .............. A Excise excessive skin 11.65 11.40 7.63 1.36 24.41 20.64 090
tissue.
15836............... .............. A Excise excessive skin 9.33 NA 6.81 1.15 NA 17.29 090
tissue.
15837............... .............. A Excise excessive skin 8.42 7.90 7.00 0.94 17.26 16.36 090
tissue.
15838............... .............. A Excise excessive skin 7.12 NA 6.09 0.70 NA 13.91 090
tissue.
15839............... .............. A Excise excessive skin 9.37 7.84 6.21 1.06 18.27 16.64 090
tissue.
15840............... .............. A Graft for face nerve 13.24 NA 10.05 1.39 NA 24.68 090
palsy.
15841............... .............. A Graft for face nerve 23.23 NA 15.08 3.20 NA 41.51 090
palsy.
15842............... .............. A Flap for face nerve 37.90 NA 23.01 4.81 NA 65.72 090
palsy.
15845............... .............. A Skin and muscle 12.55 NA 9.36 0.96 NA 22.87 090
repair, face.
15850............... .............. B Removal of sutures... +0.78 1.58 0.30 0.05 2.41 1.13 XXX
15851............... .............. A Removal of sutures... 0.86 1.72 0.34 0.06 2.64 1.26 000
15852............... .............. A Dressing change not 0.86 1.87 0.36 0.08 2.81 1.30 000
for burn.
15860............... .............. A Test for blood flow 1.95 1.28 0.79 0.16 3.39 2.90 000
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 7.94 NA 5.61 1.00 NA 14.55 090
ulcer.
15922............... .............. A Removal of tail bone 9.89 NA 7.31 1.28 NA 18.48 090
ulcer.
15931............... .............. A Remove sacrum 9.23 NA 5.75 1.15 NA 16.13 090
pressure sore.
15933............... .............. A Remove sacrum 10.83 NA 7.94 1.37 NA 20.14 090
pressure sore.
15934............... .............. A Remove sacrum 12.67 NA 8.15 1.63 NA 22.45 090
pressure sore.
15935............... .............. A Remove sacrum 14.55 NA 10.40 1.88 NA 26.83 090
pressure sore.
15936............... .............. A Remove sacrum 12.36 NA 8.36 1.59 NA 22.31 090
pressure sore.
15937............... .............. A Remove sacrum 14.19 NA 9.96 1.82 NA 25.97 090
pressure sore.
15940............... .............. A Remove hip pressure 9.33 NA 6.23 1.18 NA 16.74 090
sore.
15941............... .............. A Remove hip pressure 11.41 NA 9.58 1.48 NA 22.47 090
sore.
15944............... .............. A Remove hip pressure 11.44 NA 8.70 1.46 NA 21.60 090
sore.
15945............... .............. A Remove hip pressure 12.67 NA 9.74 1.66 NA 24.07 090
sore.
15946............... .............. A Remove hip pressure 21.54 NA 14.41 2.80 NA 38.75 090
sore.
15950............... .............. A Remove thigh pressure 7.53 NA 5.47 0.96 NA 13.96 090
sore.
15951............... .............. A Remove thigh pressure 10.70 NA 7.95 1.37 NA 20.02 090
sore.
15952............... .............. A Remove thigh pressure 11.37 NA 7.83 1.44 NA 20.64 090
sore.
15953............... .............. A Remove thigh pressure 12.61 NA 9.07 1.66 NA 23.34 090
sore.
15956............... .............. A Remove thigh pressure 15.50 NA 10.85 1.98 NA 28.33 090
sore.
15958............... .............. A Remove thigh pressure 15.46 NA 11.13 2.00 NA 28.59 090
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 0.86 0.27 0.07 1.82 1.23 000
burn(s).
16010............... .............. A Treatment of burn(s). 0.87 0.66 0.63 0.08 1.61 1.58 000
16015............... .............. A Treatment of burn(s). 2.35 NA 1.15 0.27 NA 3.77 000
16020............... .............. A Treatment of burn(s). 0.80 1.31 0.61 0.07 2.18 1.48 000
16025............... .............. A Treatment of burn(s). 1.85 1.79 0.97 0.19 3.83 3.01 000
16030............... .............. A Treatment of burn(s). 2.08 2.20 1.12 0.22 4.50 3.42 000
16035............... .............. A Incision of burn 3.74 NA 1.47 0.43 NA 5.64 090
scab, initi.
16036............... .............. A Escharotomy; add'l 1.50 NA 0.60 0.13 NA 2.23 ZZZ
incision.
17000............... .............. A Destroy benign/premlg 0.60 0.98 0.32 0.04 1.62 0.96 010
lesion.
17003............... .............. A Destroy lesions, 2-14 0.15 0.11 0.07 0.01 0.27 0.23 ZZZ
17004............... .............. A Destroy lesions, 15 2.79 2.32 1.29 0.14 5.25 4.22 010
or more.
17106............... .............. A Destruction of skin 4.58 4.87 3.34 0.34 9.79 8.26 090
lesions.
17107............... .............. A Destruction of skin 9.15 7.52 5.45 0.64 17.31 15.24 090
lesions.
17108............... .............. A Destruction of skin 13.18 9.68 7.68 1.07 23.93 21.93 090
lesions.
17110............... .............. A Destruct lesion, 1-14 0.65 1.63 0.49 0.05 2.33 1.19 010
17111............... .............. A Destruct lesion, 15 0.92 1.68 0.59 0.05 2.65 1.56 010
or more.
17250............... .............. A Chemical cautery, 0.50 1.23 0.35 0.05 1.78 0.90 000
tissue.
17260............... .............. A Destruction of skin 0.91 1.28 0.44 0.05 2.24 1.40 010
lesions.
17261............... .............. A Destruction of skin 1.17 1.62 0.59 0.06 2.85 1.82 010
lesions.
17262............... .............. A Destruction of skin 1.58 1.89 0.78 0.08 3.55 2.44 010
lesions.
17263............... .............. A Destruction of skin 1.79 2.07 0.86 0.10 3.96 2.75 010
lesions.
17264............... .............. A Destruction of skin 1.94 2.23 0.89 0.10 4.27 2.93 010
lesions.
17266............... .............. A Destruction of skin 2.34 2.53 0.99 0.13 5.00 3.46 010
lesions.
17270............... .............. A Destruction of skin 1.32 1.71 0.64 0.07 3.10 2.03 010
lesions.
17271............... .............. A Destruction of skin 1.49 1.79 0.74 0.07 3.35 2.30 010
lesions.
17272............... .............. A Destruction of skin 1.77 2.00 0.88 0.08 3.85 2.73 010
lesions.
[[Page 1123]]
17273............... .............. A Destruction of skin 2.05 2.21 0.99 0.11 4.37 3.15 010
lesions.
17274............... .............. A Destruction of skin 2.59 2.58 1.20 0.13 5.30 3.92 010
lesions.
17276............... .............. A Destruction of skin 3.20 2.97 1.44 0.18 6.35 4.82 010
lesions.
17280............... .............. A Destruction of skin 1.17 1.62 0.57 0.06 2.85 1.80 010
lesions.
17281............... .............. A Destruction of skin 1.72 1.91 0.86 0.08 3.71 2.66 010
lesions.
17282............... .............. A Destruction of skin 2.04 2.17 1.01 0.11 4.32 3.16 010
lesions.
17283............... .............. A Destruction of skin 2.64 2.56 1.25 0.13 5.33 4.02 010
lesions.
17284............... .............. A Destruction of skin 3.21 2.94 1.52 0.17 6.32 4.90 010
lesions.
17286............... .............. A Destruction of skin 4.43 3.71 2.19 0.27 8.41 6.89 010
lesions.
17304............... .............. A 1 stage mohs, up to 5 7.59 8.09 3.57 0.37 16.05 11.53 000
spec.
17305............... .............. A 2 stage mohs, up to 5 2.85 3.81 1.34 0.14 6.80 4.33 000
spec.
17306............... .............. A 3 stage mohs, up to 5 2.85 3.83 1.35 0.14 6.82 4.34 000
spec.
17307............... .............. A Mohs addl stage up to 2.85 3.78 1.37 0.14 6.77 4.36 000
5 spec.
17310............... .............. A Mohs any stage 5 spec each.
17340............... .............. A Cryotherapy of skin.. 0.76 0.37 0.31 0.05 1.18 1.12 010
17360............... .............. A Skin peel therapy.... 1.43 1.46 0.75 0.07 2.96 2.25 010
17380............... .............. R Hair removal by 0.00 0.00 0.00 0.00 0.00 0.00 000
electrolysis.
17999............... .............. C Skin tissue procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY
19000............... .............. A Drainage of breast 0.84 2.03 0.36 0.08 2.95 1.28 000
lesion.
19001............... .............. A Drain breast lesion 0.42 0.79 0.14 0.04 1.25 0.60 ZZZ
add-on.
19020............... .............. A Incision of breast 3.56 6.00 2.77 0.42 9.98 6.75 090
lesion.
19030............... .............. A Injection for breast 1.53 3.37 0.50 0.08 4.98 2.11 000
x-ray.
19100............... .............. A Bx breast percut w/o 1.27 2.15 0.42 0.12 3.54 1.81 000
image.
19101............... .............. A Biopsy of breast, 3.18 4.69 1.68 0.24 8.11 5.10 010
open.
19102............... .............. A Bx breast percut w/ 2.00 3.98 0.66 0.16 6.14 2.82 000
image.
19103............... .............. A Bx breast percut w/ 3.69 12.07 1.23 0.19 15.95 5.11 000
device.
19110............... .............. A Nipple exploration... 4.29 5.82 3.06 0.53 10.64 7.88 090
19112............... .............. A Excise breast duct 3.66 5.80 2.68 0.46 9.92 6.80 090
fistula.
19120............... .............. A Removal of breast 5.55 4.58 3.08 0.68 10.81 9.31 090
lesion.
19125............... .............. A Excision, breast 6.05 4.83 3.30 0.74 11.62 10.09 090
lesion.
19126............... .............. A Excision, addl breast 2.93 NA 1.01 0.36 NA 4.30 ZZZ
lesion.
19140............... .............. A Removal of breast 5.13 7.29 3.42 0.63 13.05 9.18 090
tissue.
19160............... .............. A Removal of breast 5.98 NA 3.45 0.74 NA 10.17 090
tissue.
19162............... .............. A Remove breast tissue, 13.51 NA 6.38 1.66 NA 21.55 090
nodes.
19180............... .............. A Removal of breast.... 8.79 NA 5.06 1.06 NA 14.91 090
19182............... .............. A Removal of breast.... 7.72 NA 4.81 0.95 NA 13.48 090
19200............... .............. A Removal of breast.... 15.47 NA 8.04 1.82 NA 25.33 090
19220............... .............. A Removal of breast.... 15.70 NA 8.30 1.88 NA 25.88 090
19240............... .............. A Removal of breast.... 15.98 NA 8.28 1.95 NA 26.21 090
19260............... .............. A Removal of chest wall 15.42 NA 11.30 1.98 NA 28.70 090
lesion.
19271............... .............. A Revision of chest 18.87 NA 18.23 2.74 NA 39.84 090
wall.
19272............... .............. A Extensive chest wall 21.52 NA 19.18 3.06 NA 43.76 090
surgery.
19290............... .............. A Place needle wire, 1.27 3.01 0.41 0.07 4.35 1.75 000
breast.
19291............... .............. A Place needle wire, 0.63 1.75 0.21 0.04 2.42 0.88 ZZZ
breast.
19295............... .............. A Place breast clip, 0.00 2.77 NA 0.01 2.78 NA ZZZ
percut.
19316............... .............. A Suspension of breast. 10.67 NA 7.59 1.39 NA 19.65 090
19318............... .............. A Reduction of large 15.60 NA 11.20 2.04 NA 28.84 090
breast.
19324............... .............. A Enlarge breast....... 5.84 NA 4.92 0.76 NA 11.52 090
19325............... .............. A Enlarge breast with 8.44 NA 6.59 1.09 NA 16.12 090
implant.
19328............... .............. A Removal of breast 5.67 NA 5.07 0.74 NA 11.48 090
implant.
19330............... .............. A Removal of implant 7.58 NA 6.07 0.98 NA 14.63 090
material.
19340............... .............. A Immediate breast 6.32 NA 3.12 0.82 NA 10.26 ZZZ
prosthesis.
19342............... .............. A Delayed breast 11.18 NA 8.97 1.46 NA 21.61 090
prosthesis.
19350............... .............. A Breast reconstruction 8.91 14.20 7.11 1.15 24.26 17.17 090
19355............... .............. A Correct inverted 7.56 12.80 5.00 0.96 21.32 13.52 090
nipple(s).
19357............... .............. A Breast reconstruction 18.13 NA 13.85 2.36 NA 34.34 090
19361............... .............. A Breast reconstruction 19.23 NA 11.78 2.51 NA 33.52 090
19364............... .............. A Breast reconstruction 40.94 NA 23.64 4.72 NA 69.30 090
19366............... .............. A Breast reconstruction 21.25 NA 11.23 2.74 NA 35.22 090
19367............... .............. A Breast reconstruction 25.69 NA 16.57 3.35 NA 45.61 090
19368............... .............. A Breast reconstruction 32.37 NA 20.26 4.23 NA 56.86 090
19369............... .............. A Breast reconstruction 29.78 NA 19.79 3.91 NA 53.48 090
19370............... .............. A Surgery of breast 8.04 NA 6.95 1.04 NA 16.03 090
capsule.
19371............... .............. A Removal of breast 9.34 NA 7.87 1.22 NA 18.43 090
capsule.
19380............... .............. A Revise breast 9.13 NA 7.76 1.18 NA 18.07 090
reconstruction.
19396............... .............. A Design custom breast 2.17 5.78 0.99 0.28 8.23 3.44 000
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 2.36 1.61 0.21 4.69 3.94 010
20005............... .............. A Incision of deep 3.41 3.34 2.12 0.41 7.16 5.94 010
abscess.
20100............... .............. A Explore wound, neck.. 10.06 5.79 4.38 1.19 17.04 15.63 010
20101............... .............. A Explore wound, chest. 3.22 2.96 1.61 0.29 6.47 5.12 010
20102............... .............. A Explore wound, 3.93 3.51 1.80 0.42 7.86 6.15 010
abdomen.
20103............... .............. A Explore wound, 5.29 4.14 3.23 0.69 10.12 9.21 010
extremity.
20150............... .............. A Excise epiphyseal bar 13.67 NA 7.21 1.16 NA 22.04 090
20200............... .............. A Muscle biopsy........ 1.46 3.19 0.78 0.21 4.86 2.45 000
[[Page 1124]]
20205............... .............. A Deep muscle biopsy... 2.35 4.14 1.21 0.28 6.77 3.84 000
20206............... .............. A Needle biopsy, muscle 0.99 3.17 0.35 0.07 4.23 1.41 000
20220............... .............. A Bone biopsy, trocar/ 1.27 4.73 2.69 0.07 6.07 4.03 000
needle.
20225............... .............. A Bone biopsy, trocar/ 1.87 4.92 2.96 0.13 6.92 4.96 000
needle.
20240............... .............. A Bone biopsy, 3.23 NA 2.60 0.40 NA 6.23 010
excisional.
20245............... .............. A Bone biopsy, 7.77 NA 6.36 0.53 NA 14.66 010
excisional.
20250............... .............. A Open bone biopsy..... 5.02 NA 4.54 0.60 NA 10.16 010
20251............... .............. A Open bone biopsy..... 5.55 NA 5.17 0.95 NA 11.67 010
20500............... .............. A Injection of sinus 1.23 5.88 3.89 0.12 7.23 5.24 010
tract.
20501............... .............. A Inject sinus tract 0.76 3.03 0.25 0.04 3.83 1.05 000
for x-ray.
20520............... .............. A Removal of foreign 1.85 2.25 1.81 0.21 4.31 3.87 010
body.
20525............... .............. A Removal of foreign 3.49 3.43 2.66 0.48 7.40 6.63 010
body.
20526............... .............. A Ther injection, carp 0.94 0.97 0.51 0.07 1.98 1.52 000
tunnel.
20550............... .............. A Inj tendon sheath/ 0.75 0.71 0.24 0.07 1.53 1.06 000
ligament.
20551............... .............. A Inj tendon origin/ 0.75 0.68 0.34 0.07 1.50 1.16 000
insertion.
20552............... .............. A Inj trigger point, 1/ 0.66 0.73 0.21 0.07 1.46 0.94 000
2 muscl.
20553............... .............. A Inject trigger 0.75 0.84 0.23 0.07 1.66 1.05 000
points, =/ 3.
20600............... .............. A Drain/inject, joint/ 0.66 0.64 0.36 0.07 1.37 1.09 000
bursa.
20605............... .............. A Drain/inject, joint/ 0.68 0.75 0.37 0.07 1.50 1.12 000
bursa.
20610............... .............. A Drain/inject, joint/ 0.79 0.94 0.41 0.10 1.83 1.30 000
bursa.
20612............... .............. A Aspirate/inj ganglion 0.70 0.71 0.34 0.07 1.48 1.11 000
cyst.
20615............... .............. A Treatment of bone 2.28 2.54 1.83 0.23 5.05 4.34 010
cyst.
20650............... .............. A Insert and remove 2.23 2.42 1.94 0.34 4.99 4.51 010
bone pin.
20660............... .............. A Apply, rem fixation 2.51 3.07 1.70 0.58 6.16 4.79 000
device.
20661............... .............. A Application of head 4.88 NA 4.95 1.11 NA 10.94 090
brace.
20662............... .............. A Application of pelvis 6.06 NA 5.43 0.98 NA 12.47 090
brace.
20663............... .............. A Application of thigh 5.42 NA 4.76 0.93 NA 11.11 090
brace.
20664............... .............. A Halo brace 8.05 NA 7.03 1.80 NA 16.88 090
application.
20665............... .............. A Removal of fixation 1.31 2.05 1.30 0.21 3.57 2.82 010
device.
20670............... .............. A Removal of support 1.74 6.69 3.93 0.28 8.71 5.95 010
implant.
20680............... .............. A Removal of support 3.34 3.22 3.22 0.55 7.11 7.11 090
implant.
20690............... .............. A Apply bone fixation 3.51 NA 2.47 0.57 NA 6.55 090
device.
20692............... .............. A Apply bone fixation 6.40 NA 3.73 0.72 NA 10.85 090
device.
20693............... .............. A Adjust bone fixation 5.85 NA 5.54 1.03 NA 12.42 090
device.
20694............... .............. A Remove bone fixation 4.15 6.86 4.49 0.69 11.70 9.33 090
device.
20802............... .............. A Replantation, arm, 41.09 NA 21.40 7.01 NA 69.50 090
complete.
20805............... .............. A Replant forearm, 49.93 NA 35.06 4.76 NA 89.75 090
complete.
20808............... .............. A Replantation hand, 61.56 NA 43.43 7.83 NA 112.82 090
complete.
20816............... .............. A Replantation digit, 30.89 NA 39.17 3.63 NA 73.69 090
complete.
20822............... .............. A Replantation digit, 25.55 NA 35.90 3.70 NA 65.15 090
complete.
20824............... .............. A Replantation thumb, 30.89 NA 38.12 4.20 NA 73.21 090
complete.
20827............... .............. A Replantation thumb, 26.37 NA 37.95 3.87 NA 68.19 090
complete.
20838............... .............. A Replantation foot, 41.35 NA 22.70 7.06 NA 71.11 090
complete.
20900............... .............. A Removal of bone for 5.57 7.31 5.79 0.93 13.81 12.29 090
graft.
20902............... .............. A Removal of bone for 7.54 NA 6.86 1.28 NA 15.68 090
graft.
20910............... .............. A Remove cartilage for 5.33 7.11 5.44 0.60 13.04 11.37 090
graft.
20912............... .............. A Remove cartilage for 6.34 NA 6.09 0.66 NA 13.09 090
graft.
20920............... .............. A Removal of fascia for 5.30 NA 4.37 0.65 NA 10.32 090
graft.
20922............... .............. A Removal of fascia for 6.60 6.73 5.06 1.06 14.39 12.72 090
graft.
20924............... .............. A Removal of tendon for 6.47 NA 5.92 0.99 NA 13.38 090
graft.
20926............... .............. A Removal of tissue for 5.52 NA 4.93 0.88 NA 11.33 090
graft.
20930............... .............. B Spinal bone allograft 0.00 0.00 0.00 0.00 0.00 0.00 XXX
20931............... .............. A Spinal bone allograft 1.81 NA 0.93 0.41 NA 3.15 ZZZ
20936............... .............. B Spinal bone autograft 0.00 0.00 0.00 0.00 0.00 0.00 XXX
20937............... .............. A Spinal bone autograft 2.79 NA 1.46 0.52 NA 4.77 ZZZ
20938............... .............. A Spinal bone autograft 3.02 NA 1.56 0.63 NA 5.21 ZZZ
20950............... .............. A Fluid pressure, 1.26 1.36 1.01 0.19 2.81 2.46 000
muscle.
20955............... .............. A Fibula bone graft, 39.15 NA 25.01 5.25 NA 69.41 090
microvasc.
20956............... .............. A Iliac bone graft, 39.21 NA 24.86 6.96 NA 71.03 090
microvasc.
20957............... .............. A Mt bone graft, 40.59 NA 19.08 6.92 NA 66.59 090
microvasc.
20962............... .............. A Other bone graft, 39.21 NA 26.41 6.26 NA 71.88 090
microvasc.
20969............... .............. A Bone/skin graft, 43.85 NA 27.48 5.23 NA 76.56 090
microvasc.
20970............... .............. A Bone/skin graft, 43.00 NA 25.84 5.60 NA 74.44 090
iliac crest.
20972............... .............. A Bone/skin graft, 42.93 21.79 20.14 7.32 72.04 70.39 090
metatarsal.
20973............... .............. A Bone/skin graft, 45.69 NA 25.29 5.61 NA 76.59 090
great toe.
20974............... .............. A Electrical bone 0.62 0.62 0.55 0.11 1.35 1.28 000
stimulation.
20975............... .............. A Electrical bone 2.60 NA 1.73 0.51 NA 4.84 000
stimulation.
20979............... .............. A Us bone stimulation.. 0.62 0.77 0.34 0.05 1.44 1.01 000
20982............... .............. A Ablate, bone tumor(s) 7.27 105.35 2.99 0.69 113.31 10.95 000
perq.
20999............... .............. C Musculoskeletal 0.00 0.00 0.00 0.00 0.00 0.00 YYY
surgery.
21010............... .............. A Incision of jaw joint 10.12 NA 7.25 0.65 NA 18.02 090
21015............... .............. A Resection of facial 5.28 NA 5.53 0.63 NA 11.44 090
tumor.
21025............... .............. A Excision of bone, 10.04 10.20 8.21 0.95 21.19 19.20 090
lower jaw.
21026............... .............. A Excision of facial 4.84 6.94 5.53 0.48 12.26 10.85 090
bone(s).
21029............... .............. A Contour of face bone 7.70 8.60 6.27 0.89 17.19 14.86 090
lesion.
[[Page 1125]]
21030............... .............. A Excise max/zygoma b9 4.49 6.84 4.31 0.72 12.05 9.52 090
tumor.
21031............... .............. A Remove exostosis, 3.24 4.58 3.14 0.34 8.16 6.72 090
mandible.
21032............... .............. A Remove exostosis, 3.24 4.63 3.25 0.33 8.20 6.82 090
maxilla.
21034............... .............. A Excise max/zygoma mlg 16.15 13.56 11.32 1.65 31.36 29.12 090
tumor.
21040............... .............. A Excise mandible 4.49 6.87 4.14 0.23 11.59 8.86 090
lesion.
21044............... .............. A Removal of jaw bone 11.84 NA 8.68 1.05 NA 21.57 090
lesion.
21045............... .............. A Extensive jaw surgery 16.15 NA 11.43 1.45 NA 29.03 090
21046............... .............. A Remove mandible cyst 12.98 NA 12.69 1.22 NA 26.89 090
complex.
21047............... .............. A Excise lwr jaw cyst w/ 18.72 NA 13.44 1.85 NA 34.01 090
repair.
21048............... .............. A Remove maxilla cyst 13.48 NA 12.97 1.22 NA 27.67 090
complex.
21049............... .............. A Excis uppr jaw cyst w/ 17.97 NA 13.03 1.22 NA 32.22 090
repair.
21050............... .............. A Removal of jaw joint. 10.75 NA 10.26 1.01 NA 22.02 090
21060............... .............. A Remove jaw joint 10.21 NA 9.80 1.40 NA 21.41 090
cartilage.
21070............... .............. A Remove coronoid 8.19 NA 7.03 0.81 NA 16.03 090
process.
21076............... .............. A Prepare face/oral 13.40 12.71 10.17 1.64 27.75 25.21 010
prosthesis.
21077............... .............. A Prepare face/oral 33.70 32.20 26.20 4.14 70.04 64.04 090
prosthesis.
21079............... .............. A Prepare face/oral 22.31 22.21 17.49 1.92 46.44 41.72 090
prosthesis.
21080............... .............. A Prepare face/oral 25.06 25.22 19.77 3.08 53.36 47.91 090
prosthesis.
21081............... .............. A Prepare face/oral 22.85 22.95 17.79 2.26 48.06 42.90 090
prosthesis.
21082............... .............. A Prepare face/oral 20.84 19.88 15.99 1.76 42.48 38.59 090
prosthesis.
21083............... .............. A Prepare face/oral 19.27 19.35 14.73 2.36 40.98 36.36 090
prosthesis.
21084............... .............. A Prepare face/oral 22.48 22.71 17.68 1.89 47.08 42.05 090
prosthesis.
21085............... .............. A Prepare face/oral 8.99 8.52 6.88 0.78 18.29 16.65 010
prosthesis.
21086............... .............. A Prepare face/oral 24.88 24.30 19.60 2.24 51.42 46.72 090
prosthesis.
21087............... .............. A Prepare face/oral 24.88 23.89 19.41 2.68 51.45 46.97 090
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 4.21 5.62 4.62 0.22 10.05 9.05 090
fixation.
21110............... .............. A Interdental fixation. 5.20 7.02 5.66 0.34 12.56 11.20 090
21116............... .............. A Injection, jaw joint 0.81 7.32 0.34 0.06 8.19 1.21 000
x-ray.
21120............... .............. A Reconstruction of 4.92 8.83 5.30 0.35 14.10 10.57 090
chin.
21121............... .............. A Reconstruction of 7.63 10.43 6.65 0.68 18.74 14.96 090
chin.
21122............... .............. A Reconstruction of 8.51 NA 7.08 0.71 NA 16.30 090
chin.
21123............... .............. A Reconstruction of 11.14 NA 8.26 1.40 NA 20.80 090
chin.
21125............... .............. A Augmentation, lower 10.60 11.82 8.28 0.87 23.29 19.75 090
jaw bone.
21127............... .............. A Augmentation, lower 11.10 14.52 9.11 0.92 26.54 21.13 090
jaw bone.
21137............... .............. A Reduction of forehead 9.81 NA 7.44 0.64 NA 17.89 090
21138............... .............. A Reduction of forehead 12.17 NA 9.31 1.77 NA 23.25 090
21139............... .............. A Reduction of forehead 14.59 NA 9.78 1.23 NA 25.60 090
21141............... .............. A Reconstruct midface, 18.07 NA 13.88 1.97 NA 33.92 090
lefort.
21142............... .............. A Reconstruct midface, 18.78 NA 13.08 1.40 NA 33.26 090
lefort.
21143............... .............. A Reconstruct midface, 19.55 NA 14.09 1.09 NA 34.73 090
lefort.
21145............... .............. A Reconstruct midface, 19.91 NA 14.15 2.52 NA 36.58 090
lefort.
21146............... .............. A Reconstruct midface, 20.68 NA 15.59 2.57 NA 38.84 090
lefort.
21147............... .............. A Reconstruct midface, 21.74 NA 15.29 1.83 NA 38.86 090
lefort.
21150............... .............. A Reconstruct midface, 25.20 NA 14.12 1.31 NA 40.63 090
lefort.
21151............... .............. A Reconstruct midface, 28.26 NA 17.92 2.39 NA 48.57 090
lefort.
21154............... .............. A Reconstruct midface, 30.47 NA 20.18 5.86 NA 56.51 090
lefort.
21155............... .............. A Reconstruct midface, 34.40 NA 22.30 6.61 NA 63.31 090
lefort.
21159............... .............. A Reconstruct midface, 42.32 NA 24.47 8.13 NA 74.92 090
lefort.
21160............... .............. A Reconstruct midface, 46.37 NA 24.41 5.29 NA 76.07 090
lefort.
21172............... .............. A Reconstruct orbit/ 27.76 NA 14.07 2.30 NA 44.13 090
forehead.
21175............... .............. A Reconstruct orbit/ 33.12 NA 18.31 6.22 NA 57.65 090
forehead.
21179............... .............. A Reconstruct entire 22.22 NA 14.86 2.99 NA 40.07 090
forehead.
21180............... .............. A Reconstruct entire 25.15 NA 16.07 2.59 NA 43.81 090
forehead.
21181............... .............. A Contour cranial bone 9.89 NA 7.81 1.17 NA 18.87 090
lesion.
21182............... .............. A Reconstruct cranial 32.14 NA 19.66 3.05 NA 54.85 090
bone.
21183............... .............. A Reconstruct cranial 35.26 NA 21.36 3.32 NA 59.94 090
bone.
21184............... .............. A Reconstruct cranial 38.18 NA 22.55 4.97 NA 65.70 090
bone.
21188............... .............. A Reconstruction of 22.43 NA 15.18 2.23 NA 39.84 090
midface.
21193............... .............. A Reconst lwr jaw w/o 17.12 NA 12.97 1.85 NA 31.94 090
graft.
21194............... .............. A Reconst lwr jaw w/ 19.81 NA 14.06 1.68 NA 35.55 090
graft.
21195............... .............. A Reconst lwr jaw w/o 17.21 NA 13.26 1.45 NA 31.92 090
fixation.
21196............... .............. A Reconst lwr jaw w/ 18.88 NA 13.88 1.95 NA 34.71 090
fixation.
21198............... .............. A Reconstr lwr jaw 14.14 NA 10.90 1.27 NA 26.31 090
segment.
21199............... .............. A Reconstr lwr jaw w/ 15.98 NA 9.19 1.52 NA 26.69 090
advance.
21206............... .............. A Reconstruct upper jaw 14.08 NA 10.81 1.22 NA 26.11 090
bone.
21208............... .............. A Augmentation of 10.21 14.49 9.28 1.11 25.81 20.60 090
facial bones.
21209............... .............. A Reduction of facial 6.71 11.89 7.23 0.72 19.32 14.66 090
bones.
21210............... .............. A Face bone graft...... 10.21 13.69 9.41 1.06 24.96 20.68 090
21215............... .............. A Lower jaw bone graft. 10.75 13.48 9.61 1.25 25.48 21.61 090
21230............... .............. A Rib cartilage graft.. 10.75 NA 8.57 1.16 NA 20.48 090
21235............... .............. A Ear cartilage graft.. 6.71 11.37 7.10 0.63 18.71 14.44 090
21240............... .............. A Reconstruction of jaw 14.03 NA 12.70 1.39 NA 28.12 090
joint.
21242............... .............. A Reconstruction of jaw 12.93 NA 12.21 1.69 NA 26.83 090
joint.
[[Page 1126]]
21243............... .............. A Reconstruction of jaw 20.76 NA 17.87 2.23 NA 40.86 090
joint.
21244............... .............. A Reconstruction of 11.84 NA 10.06 1.15 NA 23.05 090
lower jaw.
21245............... .............. A Reconstruction of jaw 11.84 16.10 9.73 1.06 29.00 22.63 090
21246............... .............. A Reconstruction of jaw 12.45 14.55 9.85 1.46 28.46 23.76 090
21247............... .............. A Reconstruct lower jaw 22.60 NA 17.93 2.67 NA 43.20 090
bone.
21248............... .............. A Reconstruction of jaw 11.46 13.02 9.31 1.22 25.70 21.99 090
21249............... .............. A Reconstruction of jaw 17.49 16.58 12.66 1.68 35.75 31.83 090
21255............... .............. A Reconstruct lower jaw 16.69 NA 12.78 1.36 NA 30.83 090
bone.
21256............... .............. A Reconstruction of 16.17 NA 12.17 1.25 NA 29.59 090
orbit.
21260............... .............. A Revise eye sockets... 16.50 NA 8.96 1.51 NA 26.97 090
21261............... .............. A Revise eye sockets... 31.44 NA 19.21 2.65 NA 53.30 090
21263............... .............. A Revise eye sockets... 28.38 NA 12.86 2.61 NA 43.85 090
21267............... .............. A Revise eye sockets... 18.87 NA 13.22 1.63 NA 33.72 090
21268............... .............. A Revise eye sockets... 24.44 NA 15.32 0.95 NA 40.71 090
21270............... .............. A Augmentation, cheek 10.21 11.90 8.10 0.88 22.99 19.19 090
bone.
21275............... .............. A Revision, 11.22 NA 8.74 1.24 NA 21.20 090
orbitofacial bones.
21280............... .............. A Revision of eyelid... 6.02 NA 6.07 0.33 NA 12.42 090
21282............... .............. A Revision of eyelid... 3.48 NA 4.68 0.25 NA 8.41 090
21295............... .............. A Revision of jaw 1.53 NA 2.82 0.16 NA 4.51 090
muscle/bone.
21296............... .............. A Revision of jaw 4.24 NA 4.43 0.36 NA 9.03 090
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 2.38 0.26 0.11 3.21 1.09 000
fracture.
21310............... .............. A Treatment of nose 0.58 2.34 0.15 0.06 2.98 0.79 000
fracture.
21315............... .............. A Treatment of nose 1.51 3.03 1.27 0.14 4.68 2.92 010
fracture.
21320............... .............. A Treatment of nose 1.85 4.25 1.84 0.18 6.28 3.87 010
fracture.
21325............... .............. A Treatment of nose 3.76 NA 3.75 0.37 NA 7.88 090
fracture.
21330............... .............. A Treatment of nose 5.37 NA 5.28 0.58 NA 11.23 090
fracture.
21335............... .............. A Treatment of nose 8.60 NA 6.81 0.77 NA 16.18 090
fracture.
21336............... .............. A Treat nasal septal 5.71 NA 6.07 0.54 NA 12.32 090
fracture.
21337............... .............. A Treat nasal septal 2.70 5.11 3.69 0.27 8.08 6.66 090
fracture.
21338............... .............. A Treat nasoethmoid 6.45 NA 5.99 0.64 NA 13.08 090
fracture.
21339............... .............. A Treat nasoethmoid 8.08 NA 6.75 0.92 NA 15.75 090
fracture.
21340............... .............. A Treatment of nose 10.75 NA 8.70 1.03 NA 20.48 090
fracture.
21343............... .............. A Treatment of sinus 12.93 NA 10.14 1.28 NA 24.35 090
fracture.
21344............... .............. A Treatment of sinus 19.69 NA 13.71 2.07 NA 35.47 090
fracture.
21345............... .............. A Treat nose/jaw 8.15 11.54 7.90 0.72 20.41 16.77 090
fracture.
21346............... .............. A Treat nose/jaw 10.59 13.18 9.03 1.03 24.80 20.65 090
fracture.
21347............... .............. A Treat nose/jaw 12.67 NA 9.77 1.37 NA 23.81 090
fracture.
21348............... .............. A Treat nose/jaw 16.66 NA 11.31 1.81 NA 29.78 090
fracture.
21355............... .............. A Treat cheek bone 3.76 4.70 2.37 0.35 8.81 6.48 010
fracture.
21356............... .............. A Treat cheek bone 4.14 11.67 3.22 0.43 16.24 7.79 010
fracture.
21360............... .............. A Treat cheek bone 6.45 13.89 6.19 0.63 20.97 13.27 090
fracture.
21365............... .............. A Treat cheek bone 14.93 NA 11.77 1.57 NA 28.27 090
fracture.
21366............... .............. A Treat cheek bone 17.74 NA 11.64 1.70 NA 31.08 090
fracture.
21385............... .............. A Treat eye socket 9.15 NA 7.07 0.77 NA 16.99 090
fracture.
21386............... .............. A Treat eye socket 9.15 NA 7.48 0.92 NA 17.55 090
fracture.
21387............... .............. A Treat eye socket 9.69 NA 7.54 0.94 NA 18.17 090
fracture.
21390............... .............. A Treat eye socket 10.11 NA 8.01 0.84 NA 18.96 090
fracture.
21395............... .............. A Treat eye socket 12.66 NA 9.32 1.31 NA 23.29 090
fracture.
21400............... .............. A Treat eye socket 1.40 3.72 2.10 0.14 5.26 3.64 090
fracture.
21401............... .............. A Treat eye socket 3.26 5.05 3.87 0.41 8.72 7.54 090
fracture.
21406............... .............. A Treat eye socket 7.00 NA 6.35 0.71 NA 14.06 090
fracture.
21407............... .............. A Treat eye socket 8.60 NA 7.14 0.81 NA 16.55 090
fracture.
21408............... .............. A Treat eye socket 12.36 NA 9.21 1.50 NA 23.07 090
fracture.
21421............... .............. A Treat mouth roof 5.13 9.92 6.16 0.51 15.56 11.80 090
fracture.
21422............... .............. A Treat mouth roof 8.31 11.28 7.10 0.83 20.42 16.24 090
fracture.
21423............... .............. A Treat mouth roof 10.38 NA 8.49 1.15 NA 20.02 090
fracture.
21431............... .............. A Treat craniofacial 7.04 10.66 6.84 0.70 18.40 14.58 090
fracture.
21432............... .............. A Treat craniofacial 8.60 NA 6.19 0.66 NA 15.45 090
fracture.
21433............... .............. A Treat craniofacial 25.31 NA 16.83 2.97 NA 45.11 090
fracture.
21435............... .............. A Treat craniofacial 17.22 NA 12.96 2.00 NA 32.18 090
fracture.
21436............... .............. A Treat craniofacial 28.00 NA 18.42 2.80 NA 49.22 090
fracture.
21440............... .............. A Treat dental ridge 2.70 8.05 4.11 0.27 11.02 7.08 090
fracture.
21445............... .............. A Treat dental ridge 5.37 10.45 6.28 0.66 16.48 12.31 090
fracture.
21450............... .............. A Treat lower jaw 2.97 10.65 3.76 0.28 13.90 7.01 090
fracture.
21451............... .............. A Treat lower jaw 4.86 8.77 5.76 0.47 14.10 11.09 090
fracture.
21452............... .............. A Treat lower jaw 1.98 7.85 3.56 0.17 10.00 5.71 090
fracture.
21453............... .............. A Treat lower jaw 5.53 10.50 6.83 0.59 16.62 12.95 090
fracture.
21454............... .............. A Treat lower jaw 6.45 NA 6.54 0.66 NA 13.65 090
fracture.
21461............... .............. A Treat lower jaw 8.08 12.52 8.30 0.88 21.48 17.26 090
fracture.
21462............... .............. A Treat lower jaw 9.78 14.06 9.02 0.96 24.80 19.76 090
fracture.
21465............... .............. A Treat lower jaw 11.89 NA 10.05 1.01 NA 22.95 090
fracture.
21470............... .............. A Treat lower jaw 15.32 NA 12.24 1.64 NA 29.20 090
fracture.
21480............... .............. A Reset dislocated jaw. 0.61 1.95 0.19 0.06 2.62 0.86 000
21485............... .............. A Reset dislocated jaw. 3.98 5.94 4.80 0.37 10.29 9.15 090
[[Page 1127]]
21490............... .............. A Repair dislocated jaw 11.84 NA 9.90 1.58 NA 23.32 090
21493............... .............. A Treat hyoid bone 1.27 NA 2.84 0.12 NA 4.23 090
fracture.
21494............... .............. A Treat hyoid bone 6.27 NA 5.70 0.53 NA 12.50 090
fracture.
21495............... .............. A Treat hyoid bone 5.68 NA 5.99 0.49 NA 12.16 090
fracture.
21497............... .............. A Interdental wiring... 3.85 6.54 5.01 0.37 10.76 9.23 090
21499............... .............. C Head surgery 0.00 0.00 0.00 0.00 0.00 0.00 YYY
procedure.
21501............... .............. A Drain neck/chest 3.80 4.70 3.95 0.43 8.93 8.18 090
lesion.
21502............... .............. A Drain chest lesion... 7.11 NA 5.70 0.95 NA 13.76 090
21510............... .............. A Drainage of bone 5.73 NA 5.72 0.81 NA 12.26 090
lesion.
21550............... .............. A Biopsy of neck/chest. 2.06 3.64 1.74 0.16 5.86 3.96 010
21555............... .............. A Remove lesion, neck/ 4.34 5.06 3.17 0.49 9.89 8.00 090
chest.
21556............... .............. A Remove lesion, neck/ 5.56 NA 4.11 0.62 NA 10.29 090
chest.
21557............... .............. A Remove tumor, neck/ 8.87 NA 5.44 1.03 NA 15.34 090
chest.
21600............... .............. A Partial removal of 6.88 NA 5.80 0.98 NA 13.66 090
rib.
21610............... .............. A Partial removal of 14.59 NA 9.04 2.23 NA 25.86 090
rib.
21615............... .............. A Removal of rib....... 9.86 NA 6.73 1.45 NA 18.04 090
21616............... .............. A Removal of rib and 12.02 NA 8.05 1.58 NA 21.65 090
nerves.
21620............... .............. A Partial removal of 6.78 NA 6.07 0.93 NA 13.78 090
sternum.
21627............... .............. A Sternal debridement.. 6.80 NA 6.46 0.99 NA 14.25 090
21630............... .............. A Extensive sternum 17.35 NA 11.99 2.35 NA 31.69 090
surgery.
21632............... .............. A Extensive sternum 18.11 NA 11.18 2.61 NA 31.90 090
surgery.
21685............... .............. A Hyoid myotomy & 12.98 NA 10.09 1.52 NA 24.59 090
suspension.
21700............... .............. A Revision of neck 6.18 6.08 4.86 0.37 12.63 11.41 090
muscle.
21705............... .............. A Revision of neck 9.59 NA 5.63 1.11 NA 16.33 090
muscle/rib.
21720............... .............. A Revision of neck 5.67 5.47 4.64 0.96 12.10 11.27 090
muscle.
21725............... .............. A Revision of neck 6.98 NA 5.52 1.09 NA 13.59 090
muscle.
21740............... .............. A Reconstruction of 16.48 NA 8.60 2.45 NA 27.53 090
sternum.
21742............... .............. C Repair stern/nuss w/o 0.00 0.00 0.00 0.00 0.00 0.00 090
scope.
21743............... .............. C Repair sternum/nuss w/ 0.00 0.00 0.00 0.00 0.00 0.00 090
scope.
21750............... .............. A Repair of sternum 10.75 NA 6.14 1.63 NA 18.52 090
separation.
21800............... .............. A Treatment of rib 0.96 2.10 1.40 0.11 3.17 2.47 090
fracture.
21805............... .............. A Treatment of rib 2.75 NA 3.35 0.35 NA 6.45 090
fracture.
21810............... .............. A Treatment of rib 6.85 NA 5.03 0.72 NA 12.60 090
fracture(s).
21820............... .............. A Treat sternum 1.28 2.63 1.83 0.18 4.09 3.29 090
fracture.
21825............... .............. A Treat sternum 7.40 NA 6.69 1.01 NA 15.10 090
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 of 2.06 3.28 1.49 0.14 5.48 3.69 010
back.
21925............... .............. A Biopsy soft tissue of 4.48 6.63 3.35 0.53 11.64 8.36 090
back.
21930............... .............. A Remove lesion, back 4.99 5.48 3.46 0.59 11.06 9.04 090
or flank.
21935............... .............. A Remove tumor, back... 17.93 NA 10.20 2.26 NA 30.39 090
22100............... .............. A Remove part of neck 9.72 NA 7.63 1.87 NA 19.22 090
vertebra.
22101............... .............. A Remove part, thorax 9.80 NA 7.87 1.82 NA 19.49 090
vertebra.
22102............... .............. A Remove part, lumbar 9.80 NA 8.08 1.76 NA 19.64 090
vertebra.
22103............... .............. A Remove extra spine 2.34 NA 1.21 0.45 NA 4.00 ZZZ
segment.
22110............... .............. A Remove part of neck 12.72 NA 9.27 2.65 NA 24.64 090
vertebra.
22112............... .............. A Remove part, thorax 12.79 NA 9.33 2.36 NA 24.48 090
vertebra.
22114............... .............. A Remove part, lumbar 12.79 NA 9.31 2.39 NA 24.49 090
vertebra.
22116............... .............. A Remove extra spine 2.32 NA 1.17 0.48 NA 3.97 ZZZ
segment.
22210............... .............. A Revision of neck 23.78 NA 15.51 5.10 NA 44.39 090
spine.
22212............... .............. A Revision of thorax 19.39 NA 13.27 3.35 NA 36.01 090
spine.
22214............... .............. A Revision of lumbar 19.42 NA 13.78 3.35 NA 36.55 090
spine.
22216............... .............. A Revise, extra spine 6.03 NA 3.14 1.18 NA 10.35 ZZZ
segment.
22220............... .............. A Revision of neck 21.34 NA 13.79 4.40 NA 39.53 090
spine.
22222............... .............. A Revision of thorax 21.49 NA 11.61 3.71 NA 36.81 090
spine.
22224............... .............. A Revision of lumbar 21.49 NA 14.24 3.86 NA 39.59 090
spine.
22226............... .............. A Revise, extra spine 6.03 NA 3.11 1.22 NA 10.36 ZZZ
segment.
22305............... .............. A Treat spine process 2.05 3.19 2.39 0.35 5.59 4.79 090
fracture.
22310............... .............. A Treat spine fracture. 2.61 4.88 4.11 0.45 7.94 7.17 090
22315............... .............. A Treat spine fracture. 8.83 13.42 7.53 1.65 23.90 18.01 090
22318............... .............. A Treat odontoid fx w/o 21.47 NA 13.52 5.14 NA 40.13 090
graft.
22319............... .............. A Treat odontoid fx w/ 23.96 NA 14.90 5.74 NA 44.60 090
graft.
22325............... .............. A Treat spine fracture. 18.27 NA 12.15 3.15 NA 33.57 090
22326............... .............. A Treat neck spine 19.56 NA 12.83 4.27 NA 36.66 090
fracture.
22327............... .............. A Treat thorax spine 19.17 NA 12.44 3.32 NA 34.93 090
fracture.
22328............... .............. A Treat each add spine 4.60 NA 2.28 0.80 NA 7.68 ZZZ
fx.
22505............... .............. A Manipulation of spine 1.87 NA 0.94 0.33 NA 3.14 010
22520............... .............. A Percut vertebroplasty 8.90 101.62 4.34 1.19 111.71 14.43 010
thor.
22521............... .............. A Percut vertebroplasty 8.33 89.47 4.18 1.12 98.92 13.63 010
lumb.
22522............... .............. A Percut vertebroplasty 4.30 NA 1.69 0.40 NA 6.39 ZZZ
add'l.
22532............... .............. A Lat thorax spine 23.96 NA 14.82 4.56 NA 43.34 090
fusion.
22533............... .............. A Lat lumbar spine 23.09 NA 13.48 3.84 NA 40.41 090
fusion.
22534............... .............. A Lat thor/lumb, add'l 5.99 NA 3.04 1.18 NA 10.21 ZZZ
seg.
22548............... .............. A Neck spine fusion.... 25.78 NA 15.83 6.01 NA 47.62 090
22554............... .............. A Neck spine fusion.... 18.59 NA 12.32 4.23 NA 35.14 090
22556............... .............. A Thorax spine fusion.. 23.42 NA 14.68 4.56 NA 42.66 090
[[Page 1128]]
22558............... .............. A Lumbar spine fusion.. 22.25 NA 13.24 3.84 NA 39.33 090
22585............... .............. A Additional spinal 5.52 NA 2.80 1.18 NA 9.50 ZZZ
fusion.
22590............... .............. A Spine & skull spinal 20.48 NA 13.29 4.60 NA 38.37 090
fusion.
22595............... .............. A Neck spinal fusion... 19.36 NA 12.80 4.37 NA 36.53 090
22600............... .............. A Neck spine fusion.... 16.12 NA 11.14 3.49 NA 30.75 090
22610............... .............. A Thorax spine fusion.. 16.00 NA 11.32 3.21 NA 30.53 090
22612............... .............. A Lumbar spine fusion.. 20.97 NA 14.09 3.96 NA 39.02 090
22614............... .............. A Spine fusion, extra 6.43 NA 3.36 1.25 NA 11.04 ZZZ
segment.
22630............... .............. A Lumbar spine fusion.. 20.81 NA 13.55 4.57 NA 38.93 090
22632............... .............. A Spine fusion, extra 5.22 NA 2.67 1.09 NA 8.98 ZZZ
segment.
22800............... .............. A Fusion of spine...... 18.22 NA 12.64 3.27 NA 34.13 090
22802............... .............. A Fusion of spine...... 30.83 NA 19.48 5.33 NA 55.64 090
22804............... .............. A Fusion of spine...... 36.22 NA 22.58 6.31 NA 65.11 090
22808............... .............. A Fusion of spine...... 26.23 NA 16.25 5.26 NA 47.74 090
22810............... .............. A Fusion of spine...... 30.22 NA 18.29 5.42 NA 53.93 090
22812............... .............. A Fusion of spine...... 32.65 NA 19.95 5.63 NA 58.23 090
22818............... .............. A Kyphectomy, 1-2 31.78 NA 18.86 6.04 NA 56.68 090
segments.
22819............... .............. A Kyphectomy, 3 or more 36.39 NA 20.03 6.27 NA 62.69 090
22830............... .............. A Exploration of spinal 10.83 NA 7.89 2.09 NA 20.81 090
fusion.
22840............... .............. A Insert spine fixation 12.52 NA 6.51 2.45 NA 21.48 ZZZ
device.
22841............... .............. B Insert spine fixation 0.00 0.00 0.00 0.00 0.00 0.00 XXX
device.
22842............... .............. A Insert spine fixation 12.56 NA 6.53 2.46 NA 21.55 ZZZ
device.
22843............... .............. A Insert spine fixation 13.44 NA 6.63 2.53 NA 22.60 ZZZ
device.
22844............... .............. A Insert spine fixation 16.42 NA 8.78 2.92 NA 28.12 ZZZ
device.
22845............... .............. A Insert spine fixation 11.94 NA 6.11 2.68 NA 20.73 ZZZ
device.
22846............... .............. A Insert spine fixation 12.40 NA 6.36 2.73 NA 21.49 ZZZ
device.
22847............... .............. A Insert spine fixation 13.78 NA 7.06 2.85 NA 23.69 ZZZ
device.
22848............... .............. A Insert pelv fixation 5.99 NA 3.20 1.06 NA 10.25 ZZZ
device.
22849............... .............. A Reinsert spinal 18.48 NA 11.76 3.46 NA 33.70 090
fixation.
22850............... .............. A Remove spine fixation 9.51 NA 7.00 1.82 NA 18.33 090
device.
22851............... .............. A Apply spine prosth 6.70 NA 3.37 1.34 NA 11.41 ZZZ
device.
22852............... .............. A Remove spine fixation 9.00 NA 6.79 1.69 NA 17.48 090
device.
22855............... .............. A Remove spine fixation 15.11 NA 9.72 3.30 NA 28.13 090
device.
22899............... .............. C Spine surgery 0.00 0.00 0.00 0.00 0.00 0.00 YYY
procedure.
22900............... .............. A Remove abdominal wall 5.79 NA 3.28 0.70 NA 9.77 090
lesion.
22999............... .............. C Abdomen surgery 0.00 0.00 0.00 0.00 0.00 0.00 YYY
procedure.
23000............... .............. A Removal of calcium 4.35 5.18 4.16 0.60 10.13 9.11 090
deposits.
23020............... .............. A Release shoulder 8.92 NA 7.58 1.48 NA 17.98 090
joint.
23030............... .............. A Drain shoulder lesion 3.42 3.01 2.93 0.51 6.94 6.86 010
23031............... .............. A Drain shoulder bursa. 2.74 2.69 2.69 0.40 5.83 5.83 010
23035............... .............. A Drain shoulder bone 8.60 NA 8.51 1.44 NA 18.55 090
lesion.
23040............... .............. A Exploratory shoulder 9.19 NA 7.85 1.54 NA 18.58 090
surgery.
23044............... .............. A Exploratory shoulder 7.11 NA 6.50 1.17 NA 14.78 090
surgery.
23065............... .............. A Biopsy shoulder 2.27 2.81 1.54 0.17 5.25 3.98 010
tissues.
23066............... .............. A Biopsy shoulder 4.15 5.10 4.07 0.60 9.85 8.82 090
tissues.
23075............... .............. A Removal of shoulder 2.39 2.24 1.82 0.30 4.93 4.51 010
lesion.
23076............... .............. A Removal of shoulder 7.62 NA 5.78 1.05 NA 14.45 090
lesion.
23077............... .............. A Remove tumor of 16.07 NA 10.76 2.18 NA 29.01 090
shoulder.
23100............... .............. A Biopsy of shoulder 6.02 NA 5.69 0.98 NA 12.69 090
joint.
23101............... .............. A Shoulder joint 5.57 NA 5.39 0.93 NA 11.89 090
surgery.
23105............... .............. A Remove shoulder joint 8.22 NA 7.17 1.36 NA 16.75 090
lining.
23106............... .............. A Incision of 5.95 NA 5.77 0.99 NA 12.71 090
collarbone joint.
23107............... .............. A Explore treat 8.61 NA 7.39 1.44 NA 17.44 090
shoulder joint.
23120............... .............. A Partial removal, 7.10 NA 6.48 1.19 NA 14.77 090
collar bone.
23125............... .............. A Removal of collar 9.38 NA 7.63 1.53 NA 18.54 090
bone.
23130............... .............. A Remove shoulder bone, 7.54 NA 7.10 1.28 NA 15.92 090
part.
23140............... .............. A Removal of bone 6.88 NA 5.41 0.99 NA 13.28 090
lesion.
23145............... .............. A Removal of bone 9.08 NA 7.58 1.50 NA 18.16 090
lesion.
23146............... .............. A Removal of bone 7.82 NA 7.13 1.34 NA 16.29 090
lesion.
23150............... .............. A Removal of humerus 8.47 NA 6.97 1.37 NA 16.81 090
lesion.
23155............... .............. A Removal of humerus 10.33 NA 8.46 1.45 NA 20.24 090
lesion.
23156............... .............. A Removal of humerus 8.67 NA 7.38 1.42 NA 17.47 090
lesion.
23170............... .............. A Remove collar bone 6.85 NA 6.36 1.01 NA 14.22 090
lesion.
23172............... .............. A Remove shoulder blade 6.89 NA 6.41 1.15 NA 14.45 090
lesion.
23174............... .............. A Remove humerus lesion 9.50 NA 8.37 1.57 NA 19.44 090
23180............... .............. A Remove collar bone 8.52 NA 9.21 1.42 NA 19.15 090
lesion.
23182............... .............. A Remove shoulder blade 8.14 NA 8.89 1.30 NA 18.33 090
lesion.
23184............... .............. A Remove humerus lesion 9.37 NA 9.54 1.50 NA 20.41 090
23190............... .............. A Partial removal of 7.23 NA 6.23 1.17 NA 14.63 090
scapula.
23195............... .............. A Removal of head of 9.80 NA 7.76 1.66 NA 19.22 090
humerus.
23200............... .............. A Removal of collar 12.06 NA 8.97 1.79 NA 22.82 090
bone.
23210............... .............. A Removal of shoulder 12.47 NA 9.30 1.94 NA 23.71 090
blade.
23220............... .............. A Partial removal of 14.54 NA 10.87 2.45 NA 27.86 090
humerus.
23221............... .............. A Partial removal of 17.71 NA 11.84 3.03 NA 32.58 090
humerus.
23222............... .............. A Partial removal of 23.88 NA 15.85 4.06 NA 43.79 090
humerus.
[[Page 1129]]
23330............... .............. A Remove shoulder 1.85 1.98 1.91 0.22 4.05 3.98 010
foreign body.
23331............... .............. A Remove shoulder 7.37 NA 6.79 1.23 NA 15.39 090
foreign body.
23332............... .............. A Remove shoulder 11.60 NA 9.31 1.95 NA 22.86 090
foreign body.
23350............... .............. A Injection for 1.00 3.85 0.33 0.06 4.91 1.39 000
shoulder x-ray.
23395............... .............. A Muscle 16.82 NA 12.74 2.76 NA 32.32 090
transfer,shoulder/
arm.
23397............... .............. A Muscle transfers..... 16.11 NA 11.40 2.70 NA 30.21 090
23400............... .............. A Fixation of shoulder 13.52 NA 10.16 2.30 NA 25.98 090
blade.
23405............... .............. A Incision of tendon & 8.36 NA 7.01 1.35 NA 16.72 090
muscle.
23406............... .............. A Incise tendon(s) & 10.77 NA 8.41 1.79 NA 20.97 090
muscle(s).
23410............... .............. A Repair rotator cuff, 12.43 NA 9.40 2.07 NA 23.90 090
acute.
23412............... .............. A Repair rotator cuff, 13.29 NA 9.90 2.24 NA 25.43 090
chronic.
23415............... .............. A Release of shoulder 9.96 NA 7.97 1.68 NA 19.61 090
ligament.
23420............... .............. A Repair of shoulder... 13.28 NA 10.78 2.24 NA 26.30 090
23430............... .............. A Repair biceps tendon. 9.97 NA 8.11 1.69 NA 19.77 090
23440............... .............. A Remove/transplant 10.46 NA 8.29 1.77 NA 20.52 090
tendon.
23450............... .............. A Repair shoulder 13.38 NA 9.87 2.24 NA 25.49 090
capsule.
23455............... .............. A Repair shoulder 14.35 NA 10.45 2.42 NA 27.22 090
capsule.
23460............... .............. A Repair shoulder 15.35 NA 11.37 2.62 NA 29.34 090
capsule.
23462............... .............. A Repair shoulder 15.28 NA 10.78 2.61 NA 28.67 090
capsule.
23465............... .............. A Repair shoulder 15.83 NA 11.30 1.94 NA 29.07 090
capsule.
23466............... .............. A Repair shoulder 14.20 NA 11.27 2.41 NA 27.88 090
capsule.
23470............... .............. A Reconstruct shoulder 17.12 NA 12.13 2.89 NA 32.14 090
joint.
23472............... .............. A Reconstruct shoulder 21.07 NA 14.27 2.86 NA 38.20 090
joint.
23480............... .............. A Revision of collar 11.16 NA 8.77 1.88 NA 21.81 090
bone.
23485............... .............. A Revision of collar 13.41 NA 9.91 2.22 NA 25.54 090
bone.
23490............... .............. A Reinforce clavicle... 11.84 NA 8.81 1.34 NA 21.99 090
23491............... .............. A Reinforce shoulder 14.19 NA 10.70 2.41 NA 27.30 090
bones.
23500............... .............. A Treat clavicle 2.08 3.66 2.57 0.31 6.05 4.96 090
fracture.
23505............... .............. A Treat clavicle 3.68 5.33 3.76 0.60 9.61 8.04 090
fracture.
23515............... .............. A Treat clavicle 7.40 NA 6.52 1.24 NA 15.16 090
fracture.
23520............... .............. A Treat clavicle 2.16 3.65 2.71 0.31 6.12 5.18 090
dislocation.
23525............... .............. A Treat clavicle 3.59 5.27 3.88 0.53 9.39 8.00 090
dislocation.
23530............... .............. A Treat clavicle 7.30 NA 6.03 1.03 NA 14.36 090
dislocation.
23532............... .............. A Treat clavicle 8.00 NA 6.92 1.36 NA 16.28 090
dislocation.
23540............... .............. A Treat clavicle 2.23 4.26 2.46 0.29 6.78 4.98 090
dislocation.
23545............... .............. A Treat clavicle 3.25 4.50 3.38 0.47 8.22 7.10 090
dislocation.
23550............... .............. A Treat clavicle 7.23 NA 6.38 1.13 NA 14.74 090
dislocation.
23552............... .............. A Treat clavicle 8.44 NA 7.26 1.42 NA 17.12 090
dislocation.
23570............... .............. A Treat shoulder blade 2.23 3.67 2.87 0.35 6.25 5.45 090
fx.
23575............... .............. A Treat shoulder blade 4.05 5.76 4.24 0.64 10.45 8.93 090
fx.
23585............... .............. A Treat scapula 8.95 NA 7.60 1.51 NA 18.06 090
fracture.
23600............... .............. A Treat humerus 2.93 5.73 3.82 0.47 9.13 7.22 090
fracture.
23605............... .............. A Treat humerus 4.86 6.59 4.96 0.81 12.26 10.63 090
fracture.
23615............... .............. A Treat humerus 9.34 NA 8.69 1.58 NA 19.61 090
fracture.
23616............... .............. A Treat humerus 21.24 NA 14.13 3.59 NA 38.96 090
fracture.
23620............... .............. A Treat humerus 2.40 5.20 3.23 0.39 7.99 6.02 090
fracture.
23625............... .............. A Treat humerus 3.92 6.33 4.56 0.64 10.89 9.12 090
fracture.
23630............... .............. A Treat humerus 7.34 NA 6.59 1.24 NA 15.17 090
fracture.
23650............... .............. A Treat shoulder 3.38 4.69 2.88 0.37 8.44 6.63 090
dislocation.
23655............... .............. A Treat shoulder 4.56 NA 4.16 0.63 NA 9.35 090
dislocation.
23660............... .............. A Treat shoulder 7.48 NA 6.36 1.22 NA 15.06 090
dislocation.
23665............... .............. A Treat islocation/ 4.46 6.58 4.93 0.72 11.76 10.11 090
fracture.
23670............... .............. A Treat dislocation/ 7.89 NA 6.82 1.33 NA 16.04 090
fracture.
23675............... .............. A Treat dislocation/ 6.04 7.56 6.06 1.00 14.60 13.10 090
fracture.
23680............... .............. A Treat dislocation/ 10.04 NA 8.09 1.68 NA 19.81 090
fracture.
23700............... .............. A Fixation of shoulder. 2.52 NA 2.30 0.42 NA 5.24 010
23800............... .............. A Fusion of shoulder 14.14 NA 10.46 2.38 NA 26.98 090
joint.
23802............... .............. A Fusion of shoulder 16.58 NA 10.23 2.82 NA 29.63 090
joint.
23900............... .............. A Amputation of arm & 19.69 NA 11.91 2.98 NA 34.58 090
girdle.
23920............... .............. A Amputation at 14.59 NA 10.09 2.32 NA 27.00 090
shoulder joint.
23921............... .............. A Amputation follow-up 5.48 5.16 5.16 0.94 11.58 11.58 090
surgery.
23929............... .............. C Shoulder surgery 0.00 0.00 0.00 0.00 0.00 0.00 YYY
procedure.
23930............... .............. A Drainage of arm 2.94 2.71 2.35 0.39 6.04 5.68 010
lesion.
23931............... .............. A Drainage of arm bursa 1.79 2.43 2.19 0.25 4.47 4.23 010
23935............... .............. A Drain arm/elbow bone 6.08 NA 6.13 1.01 NA 13.22 090
lesion.
24000............... .............. A Exploratory elbow 5.81 NA 5.36 0.93 NA 12.10 090
surgery.
24006............... .............. A Release elbow joint.. 9.30 NA 7.69 1.53 NA 18.52 090
24065............... .............. A Biopsy arm/elbow soft 2.08 2.10 1.78 0.17 4.35 4.03 010
tissue.
24066............... .............. A Biopsy arm/elbow soft 5.20 5.76 4.27 0.74 11.70 10.21 090
tissue.
24075............... .............. A Remove arm/elbow 3.91 5.05 3.67 0.52 9.48 8.10 090
lesion.
24076............... .............. A Remove arm/elbow 6.29 NA 5.09 0.84 NA 12.22 090
lesion.
24077............... .............. A Remove tumor of arm/ 11.74 NA 8.65 1.59 NA 21.98 090
elbow.
24100............... .............. A Biopsy elbow joint 4.92 NA 4.49 0.75 NA 10.16 090
lining.
24101............... .............. A Explore/treat elbow 6.12 NA 5.86 1.01 NA 12.99 090
joint.
24102............... .............. A Remove elbow joint 8.02 NA 6.83 1.31 NA 16.16 090
lining.
[[Page 1130]]
24105............... .............. A Removal of elbow 3.60 NA 4.35 0.59 NA 8.54 090
bursa.
24110............... .............. A Remove humerus lesion 7.38 NA 6.71 1.19 NA 15.28 090
24115............... .............. A Remove/graft bone 9.62 NA 7.35 1.39 NA 18.36 090
lesion.
24116............... .............. A Remove/graft bone 11.79 NA 9.11 2.00 NA 22.90 090
lesion.
24120............... .............. A Remove elbow lesion.. 6.64 NA 5.88 1.05 NA 13.57 090
24125............... .............. A Remove/graft bone 7.88 NA 6.18 1.06 NA 15.12 090
lesion.
24126............... .............. A Remove/graft bone 8.30 NA 6.97 1.09 NA 16.36 090
lesion.
24130............... .............. A Removal of head of 6.24 NA 5.95 1.05 NA 13.24 090
radius.
24134............... .............. A Removal of arm bone 9.72 NA 9.18 1.58 NA 20.48 090
lesion.
24136............... .............. A Remove radius bone 7.98 NA 7.41 1.03 NA 16.42 090
lesion.
24138............... .............. A Remove elbow bone 8.04 NA 7.67 1.35 NA 17.06 090
lesion.
24140............... .............. A Partial removal of 9.17 NA 9.49 1.48 NA 20.14 090
arm bone.
24145............... .............. A Partial removal of 7.57 NA 8.15 1.22 NA 16.94 090
radius.
24147............... .............. A Partial removal of 7.53 NA 8.64 1.25 NA 17.42 090
elbow.
24149............... .............. A Radical resection of 14.18 NA 11.41 2.29 NA 27.88 090
elbow.
24150............... .............. A Extensive humerus 13.25 NA 10.10 2.18 NA 25.53 090
surgery.
24151............... .............. A Extensive humerus 15.56 NA 11.67 2.64 NA 29.87 090
surgery.
24152............... .............. A Extensive radius 10.04 NA 7.85 1.44 NA 19.33 090
surgery.
24153............... .............. A Extensive radius 11.52 NA 5.83 0.77 NA 18.12 090
surgery.
24155............... .............. A Removal of elbow 11.71 NA 8.41 1.71 NA 21.83 090
joint.
24160............... .............. A Remove elbow joint 7.82 NA 6.77 1.29 NA 15.88 090
implant.
24164............... .............. A Remove radius head 6.22 NA 5.66 1.01 NA 12.89 090
implant.
24200............... .............. A Removal of arm 1.76 1.97 1.67 0.18 3.91 3.61 010
foreign body.
24201............... .............. A Removal of arm 4.55 5.68 4.34 0.68 10.91 9.57 090
foreign body.
24220............... .............. A Injection for elbow x- 1.31 10.32 0.44 0.08 11.71 1.83 000
ray.
24300............... .............. A Manipulate elbow w/ 3.74 NA 5.48 0.59 NA 9.81 090
anesth.
24301............... .............. A Muscle/tendon 10.18 NA 8.18 1.57 NA 19.93 090
transfer.
24305............... .............. A Arm tendon 7.44 NA 6.68 1.18 NA 15.30 090
lengthening.
24310............... .............. A Revision of arm 5.97 NA 5.72 0.89 NA 12.58 090
tendon.
24320............... .............. A Repair of arm tendon. 10.54 NA 7.74 1.21 NA 19.49 090
24330............... .............. A Revision of arm 9.59 NA 7.86 1.46 NA 18.91 090
muscles.
24331............... .............. A Revision of arm 10.63 NA 8.60 1.70 NA 20.93 090
muscles.
24332............... .............. A Tenolysis, triceps... 7.44 NA 6.58 0.93 NA 14.95 090
24340............... .............. A Repair of biceps 7.88 NA 6.91 1.30 NA 16.09 090
tendon.
24341............... .............. A Repair arm tendon/ 7.89 NA 7.75 1.30 NA 16.94 090
muscle.
24342............... .............. A Repair of ruptured 10.60 NA 8.46 1.79 NA 20.85 090
tendon.
24343............... .............. A Repr elbow lat ligmnt 8.64 NA 7.93 1.36 NA 17.93 090
w/tiss.
24344............... .............. A Reconstruct elbow lat 13.98 NA 11.31 2.21 NA 27.50 090
ligmnt.
24345............... .............. A Repr elbw med ligmnt 8.64 NA 7.83 1.36 NA 17.83 090
w/tissu.
24346............... .............. A Reconstruct elbow med 13.98 NA 11.17 2.21 NA 27.36 090
ligmnt.
24350............... .............. A Repair of tennis 5.24 NA 5.52 0.87 NA 11.63 090
elbow.
24351............... .............. A Repair of tennis 5.90 NA 5.86 0.99 NA 12.75 090
elbow.
24352............... .............. A Repair of tennis 6.42 NA 6.12 1.09 NA 13.63 090
elbow.
24354............... .............. A Repair of tennis 6.47 NA 6.08 1.06 NA 13.61 090
elbow.
24356............... .............. A Revision of tennis 6.67 NA 6.26 1.09 NA 14.02 090
elbow.
24360............... .............. A Reconstruct elbow 12.32 NA 9.35 2.04 NA 23.71 090
joint.
24361............... .............. A Reconstruct elbow 14.06 NA 10.44 2.35 NA 26.85 090
joint.
24362............... .............. A Reconstruct elbow 14.97 NA 9.97 2.32 NA 27.26 090
joint.
24363............... .............. A Replace elbow joint.. 18.46 NA 13.53 3.04 NA 35.03 090
24365............... .............. A Reconstruct head of 8.38 NA 7.09 1.34 NA 16.81 090
radius.
24366............... .............. A Reconstruct head of 9.12 NA 7.43 1.54 NA 18.09 090
radius.
24400............... .............. A Revision of humerus.. 11.04 NA 8.91 1.85 NA 21.80 090
24410............... .............. A Revision of humerus.. 14.80 NA 10.43 2.28 NA 27.51 090
24420............... .............. A Revision of humerus.. 13.42 NA 10.66 2.20 NA 26.28 090
24430............... .............. A Repair of humerus.... 12.79 NA 9.75 2.17 NA 24.71 090
24435............... .............. A Repair humerus with 13.15 NA 10.83 2.22 NA 26.20 090
graft.
24470............... .............. A Revision of elbow 8.73 NA 7.62 1.48 NA 17.83 090
joint.
24495............... .............. A Decompression of 8.11 NA 9.05 1.11 NA 18.27 090
forearm.
24498............... .............. A Reinforce humerus.... 11.90 NA 9.28 2.01 NA 23.19 090
24500............... .............. A Treat humerus 3.21 5.40 3.61 0.49 9.10 7.31 090
fracture.
24505............... .............. A Treat humerus 5.16 7.29 5.28 0.87 13.32 11.31 090
fracture.
24515............... .............. A Treat humerus 11.63 NA 9.34 1.97 NA 22.94 090
fracture.
24516............... .............. A Treat humerus 11.63 NA 9.11 1.97 NA 22.71 090
fracture.
24530............... .............. A Treat humerus 3.49 5.39 3.94 0.57 9.45 8.00 090
fracture.
24535............... .............. A Treat humerus 6.86 8.39 6.40 1.16 16.41 14.42 090
fracture.
24538............... .............. A Treat humerus 9.42 NA 8.69 1.51 NA 19.62 090
fracture.
24545............... .............. A Treat humerus 10.44 NA 8.42 1.77 NA 20.63 090
fracture.
24546............... .............. A Treat humerus 15.67 NA 11.31 2.63 NA 29.61 090
fracture.
24560............... .............. A Treat humerus 2.80 5.07 3.21 0.42 8.29 6.43 090
fracture.
24565............... .............. A Treat humerus 5.55 7.28 5.40 0.89 13.72 11.84 090
fracture.
24566............... .............. A Treat humerus 7.78 NA 8.11 1.33 NA 17.22 090
fracture.
24575............... .............. A Treat humerus 10.64 NA 8.30 1.74 NA 20.68 090
fracture.
24576............... .............. A Treat humerus 2.86 4.94 3.59 0.46 8.26 6.91 090
fracture.
24577............... .............. A Treat humerus 5.78 7.56 5.69 0.98 14.32 12.45 090
fracture.
24579............... .............. A Treat humerus 11.58 NA 8.83 1.95 NA 22.36 090
fracture.
[[Page 1131]]
24582............... .............. A Treat humerus 8.54 NA 9.01 1.45 NA 19.00 090
fracture.
24586............... .............. A Treat elbow fracture. 15.19 NA 11.11 2.56 NA 28.86 090
24587............... .............. A Treat elbow fracture. 15.14 NA 10.91 2.58 NA 28.63 090
24600............... .............. A Treat elbow 4.22 5.57 3.52 0.59 10.38 8.33 090
dislocation.
24605............... .............. A Treat elbow 5.41 NA 5.25 0.87 NA 11.53 090
dislocation.
24615............... .............. A Treat elbow 9.41 NA 7.73 1.58 NA 18.72 090
dislocation.
24620............... .............. A Treat elbow fracture. 6.97 NA 6.11 1.09 NA 14.17 090
24635............... .............. A Treat elbow fracture. 13.17 NA 14.21 2.22 NA 29.60 090
24640............... .............. A Treat elbow 1.20 1.93 0.87 0.13 3.26 2.20 010
dislocation.
24650............... .............. A Treat radius fracture 2.16 4.55 2.73 0.34 7.05 5.23 090
24655............... .............. A Treat radius fracture 4.39 6.76 4.69 0.70 11.85 9.78 090
24665............... .............. A Treat radius fracture 8.13 NA 7.48 1.36 NA 16.97 090
24666............... .............. A Treat radius fracture 9.48 NA 8.05 1.59 NA 19.12 090
24670............... .............. A Treat ulnar fracture. 2.54 4.44 3.01 0.40 7.38 5.95 090
24675............... .............. A Treat ulnar fracture. 4.71 6.72 4.82 0.78 12.21 10.31 090
24685............... .............. A Treat ulnar fracture. 8.79 NA 7.52 1.48 NA 17.79 090
24800............... .............. A Fusion of elbow joint 11.18 NA 8.71 1.70 NA 21.59 090
24802............... .............. A Fusion/graft of elbow 13.67 NA 10.32 2.28 NA 26.27 090
joint.
24900............... .............. A Amputation of upper 9.59 NA 7.35 1.42 NA 18.36 090
arm.
24920............... .............. A Amputation of upper 9.53 NA 7.52 1.47 NA 18.52 090
arm.
24925............... .............. A Amputation follow-up 7.06 NA 6.27 1.15 NA 14.48 090
surgery.
24930............... .............. A Amputation follow-up 10.23 NA 7.52 1.48 NA 19.23 090
surgery.
24931............... .............. A Amputate upper arm & 12.70 NA 6.11 1.88 NA 20.69 090
implant.
24935............... .............. A Revision of 15.54 NA 8.42 1.91 NA 25.87 090
amputation.
24940............... .............. C Revision of upper arm 0.00 0.00 0.00 0.00 0.00 0.00 090
24999............... .............. C Upper arm/elbow 0.00 0.00 0.00 0.00 0.00 0.00 YYY
surgery.
25000............... .............. A Incision of tendon 3.37 NA 6.95 0.54 NA 10.86 090
sheath.
25001............... .............. A Incise flexor carpi 3.37 NA 4.09 0.54 NA 8.00 090
radialis.
25020............... .............. A Decompress forearm 1 5.91 NA 9.94 0.92 NA 16.77 090
space.
25023............... .............. A Decompress forearm 1 12.94 NA 15.45 1.83 NA 30.22 090
space.
25024............... .............. A Decompress forearm 2 9.49 NA 7.52 1.50 NA 18.51 090
spaces.
25025............... .............. A Decompress forearm 2 16.52 NA 10.00 2.63 NA 29.15 090
spaces.
25028............... .............. A Drainage of forearm 5.24 NA 8.48 0.74 NA 14.46 090
lesion.
25031............... .............. A Drainage of forearm 4.13 NA 8.25 0.60 NA 12.98 090
bursa.
25035............... .............. A Treat forearm bone 7.35 NA 14.03 1.18 NA 22.56 090
lesion.
25040............... .............. A Explore/treat wrist 7.17 NA 7.34 1.16 NA 15.67 090
joint.
25065............... .............. A Biopsy forearm soft 1.99 2.79 2.79 0.14 4.92 4.92 010
tissues.
25066............... .............. A Biopsy forearm soft 4.12 NA 7.24 0.59 NA 11.95 090
tissues.
25075............... .............. A Removel forearm 3.73 NA 6.13 0.48 NA 10.34 090
lesion subcu.
25076............... .............. A Removel forearm 4.91 NA 9.98 0.71 NA 15.60 090
lesion deep.
25077............... .............. A Remove tumor, forearm/ 9.75 NA 12.68 1.33 NA 23.76 090
wrist.
25085............... .............. A Incision of wrist 5.49 NA 7.30 0.86 NA 13.65 090
capsule.
25100............... .............. A Biopsy of wrist joint 3.89 NA 5.41 0.60 NA 9.90 090
25101............... .............. A Explore/treat wrist 4.68 NA 5.96 0.72 NA 11.36 090
joint.
25105............... .............. A Remove wrist joint 5.84 NA 7.48 0.93 NA 14.25 090
lining.
25107............... .............. A Remove wrist joint 6.42 NA 8.41 0.99 NA 15.82 090
cartilage.
25110............... .............. A Remove wrist tendon 3.91 NA 7.26 0.58 NA 11.75 090
lesion.
25111............... .............. A Remove wrist tendon 3.38 NA 4.83 0.51 NA 8.72 090
lesion.
25112............... .............. A Reremove wrist tendon 4.52 NA 5.43 0.65 NA 10.60 090
lesion.
25115............... .............. A Remove wrist/forearm 8.81 NA 14.44 1.34 NA 24.59 090
lesion.
25116............... .............. A Remove wrist/forearm 7.10 NA 13.53 1.09 NA 21.72 090
lesion.
25118............... .............. A Excise wrist tendon 4.36 NA 5.88 0.66 NA 10.90 090
sheath.
25119............... .............. A Partial removal of 6.03 NA 7.77 0.96 NA 14.76 090
ulna.
25120............... .............. A Removal of forearm 6.09 NA 12.44 0.98 NA 19.51 090
lesion.
25125............... .............. A Remove/graft forearm 7.47 NA 13.21 1.23 NA 21.91 090
lesion.
25126............... .............. A Remove/graft forearm 7.54 NA 13.31 1.21 NA 22.06 090
lesion.
25130............... .............. A Removal of wrist 5.25 NA 6.51 0.80 NA 12.56 090
lesion.
25135............... .............. A Remove & graft wrist 6.88 NA 7.53 1.07 NA 15.48 090
lesion.
25136............... .............. A Remove & graft wrist 5.96 NA 6.68 0.70 NA 13.34 090
lesion.
25145............... .............. A Remove forearm bone 6.36 NA 12.47 0.99 NA 19.82 090
lesion.
25150............... .............. A Partial removal of 7.08 NA 8.41 1.16 NA 16.65 090
ulna.
25151............... .............. A Partial removal of 7.38 NA 13.08 1.12 NA 21.58 090
radius.
25170............... .............. A Extensive forearm 11.07 NA 15.46 1.83 NA 28.36 090
surgery.
25210............... .............. A Removal of wrist bone 5.94 NA 6.90 0.88 NA 13.72 090
25215............... .............. A Removal of wrist 7.88 NA 8.89 1.23 NA 18.00 090
bones.
25230............... .............. A Partial removal of 5.22 NA 6.22 0.80 NA 12.24 090
radius.
25240............... .............. A Partial removal of 5.16 NA 7.09 0.83 NA 13.08 090
ulna.
25246............... .............. A Injection for wrist x- 1.45 10.05 0.48 0.08 11.58 2.01 000
ray.
25248............... .............. A Remove forearm 5.13 NA 8.75 0.65 NA 14.53 090
foreign body.
25250............... .............. A Removal of wrist 6.59 NA 6.00 1.01 NA 13.60 090
prosthesis.
25251............... .............. A Removal of wrist 9.56 NA 7.82 1.39 NA 18.77 090
prosthesis.
25259............... .............. A Manipulate wrist w/ 3.74 NA 5.48 0.60 NA 9.82 090
anesthes.
25260............... .............. A Repair forearm tendon/ 7.79 NA 13.90 1.17 NA 22.86 090
muscle.
25263............... .............. A Repair forearm tendon/ 7.81 NA 13.81 1.13 NA 22.75 090
muscle.
25265............... .............. A Repair forearm tendon/ 9.87 NA 14.70 1.44 NA 26.01 090
muscle.
[[Page 1132]]
25270............... .............. A Repair forearm tendon/ 5.99 NA 12.60 0.92 NA 19.51 090
muscle.
25272............... .............. A Repair forearm tendon/ 7.03 NA 13.30 1.07 NA 21.40 090
muscle.
25274............... .............. A Repair forearm tendon/ 8.74 NA 14.02 1.37 NA 24.13 090
muscle.
25275............... .............. A Repair forearm tendon 8.49 NA 7.47 1.36 NA 17.32 090
sheath.
25280............... .............. A Revise wrist/forearm 7.21 NA 13.03 1.10 NA 21.34 090
tendon.
25290............... .............. A Incise wrist/forearm 5.28 NA 15.53 0.80 NA 21.61 090
tendon.
25295............... .............. A Release wrist/forearm 6.54 NA 12.59 1.04 NA 20.17 090
tendon.
25300............... .............. A Fusion of tendons at 8.79 NA 8.52 1.29 NA 18.60 090
wrist.
25301............... .............. A Fusion of tendons at 8.39 NA 8.16 1.30 NA 17.85 090
wrist.
25310............... .............. A Transplant forearm 8.13 NA 13.44 1.22 NA 22.79 090
tendon.
25312............... .............. A Transplant forearm 9.56 NA 14.32 1.47 NA 25.35 090
tendon.
25315............... .............. A Revise palsy hand 10.18 NA 14.89 1.52 NA 26.59 090
tendon(s).
25316............... .............. A Revise palsy hand 12.31 NA 16.66 2.10 NA 31.07 090
tendon(s).
25320............... .............. A Repair/revise wrist 10.75 NA 11.21 1.59 NA 23.55 090
joint.
25332............... .............. A Revise wrist joint... 11.39 NA 9.06 1.76 NA 22.21 090
25335............... .............. A Realignment of hand.. 12.86 NA 11.72 2.00 NA 26.58 090
25337............... .............. A Reconstruct ulna/ 10.15 NA 11.07 1.58 NA 22.80 090
radioulnar.
25350............... .............. A Revision of radius... 8.77 NA 14.28 1.41 NA 24.46 090
25355............... .............. A Revision of radius... 10.15 NA 14.90 1.74 NA 26.79 090
25360............... .............. A Revision of ulna..... 8.42 NA 14.17 1.41 NA 24.00 090
25365............... .............. A Revise radius & ulna. 12.38 NA 15.93 2.01 NA 30.32 090
25370............... .............. A Revise radius or ulna 13.34 NA 16.30 2.27 NA 31.91 090
25375............... .............. A Revise radius & ulna. 13.02 NA 16.72 2.22 NA 31.96 090
25390............... .............. A Shorten radius or 10.38 NA 14.91 1.66 NA 26.95 090
ulna.
25391............... .............. A Lengthen radius or 13.63 NA 16.87 2.09 NA 32.59 090
ulna.
25392............... .............. A Shorten radius & ulna 13.93 NA 16.24 2.09 NA 32.26 090
25393............... .............. A Lengthen radius & 15.85 NA 17.88 2.26 NA 35.99 090
ulna.
25394............... .............. A Repair carpal bone, 10.38 NA 8.23 1.69 NA 20.30 090
shorten.
25400............... .............. A Repair radius or ulna 10.90 NA 15.49 1.81 NA 28.20 090
25405............... .............. A Repair/graft radius 14.36 NA 17.58 2.35 NA 34.29 090
or ulna.
25415............... .............. A Repair radius & ulna. 13.33 NA 16.81 2.26 NA 32.40 090
25420............... .............. A Repair/graft radius & 16.31 NA 18.56 2.65 NA 37.52 090
ulna.
25425............... .............. A Repair/graft radius 13.19 NA 22.08 1.94 NA 37.21 090
or ulna.
25426............... .............. A Repair/graft radius & 15.80 NA 17.29 2.69 NA 35.78 090
ulna.
25430............... .............. A Vasc graft into 9.24 NA 7.28 1.29 NA 17.81 090
carpal bone.
25431............... .............. A Repair nonunion 10.42 NA 8.23 0.68 NA 19.33 090
carpal bone.
25440............... .............. A Repair/graft wrist 10.42 NA 9.41 1.70 NA 21.53 090
bone.
25441............... .............. A Reconstruct wrist 12.88 NA 9.88 2.21 NA 24.97 090
joint.
25442............... .............. A Reconstruct wrist 10.83 NA 8.77 1.50 NA 21.10 090
joint.
25443............... .............. A Reconstruct wrist 10.37 NA 8.65 1.57 NA 20.59 090
joint.
25444............... .............. A Reconstruct wrist 11.13 NA 9.07 1.72 NA 21.92 090
joint.
25445............... .............. A Reconstruct wrist 9.68 NA 7.87 1.52 NA 19.07 090
joint.
25446............... .............. A Wrist replacement.... 16.53 NA 11.81 2.65 NA 30.99 090
25447............... .............. A Repair wrist joint(s) 10.35 NA 8.54 1.62 NA 20.51 090
25449............... .............. A Remove wrist joint 14.47 NA 10.57 2.13 NA 27.17 090
implant.
25450............... .............. A Revision of wrist 7.86 NA 10.41 1.06 NA 19.33 090
joint.
25455............... .............. A Revision of wrist 9.48 NA 11.33 1.29 NA 22.10 090
joint.
25490............... .............. A Reinforce radius..... 9.53 NA 14.03 1.44 NA 25.00 090
25491............... .............. A Reinforce ulna....... 9.95 NA 14.79 1.70 NA 26.44 090
25492............... .............. A Reinforce radius and 12.31 NA 15.58 1.95 NA 29.84 090
ulna.
25500............... .............. A Treat fracture of 2.45 3.99 2.71 0.34 6.78 5.50 090
radius.
25505............... .............. A Treat fracture of 5.20 7.22 5.25 0.83 13.25 11.28 090
radius.
25515............... .............. A Treat fracture of 9.17 NA 7.47 1.47 NA 18.11 090
radius.
25520............... .............. A Treat fracture of 6.25 7.44 5.87 1.03 14.72 13.15 090
radius.
25525............... .............. A Treat fracture of 12.22 NA 9.94 2.03 NA 24.19 090
radius.
25526............... .............. A Treat fracture of 12.96 NA 13.59 2.17 NA 28.72 090
radius.
25530............... .............. A Treat fracture of 2.09 4.14 2.80 0.33 6.56 5.22 090
ulna.
25535............... .............. A Treat fracture of 5.13 6.85 5.17 0.82 12.80 11.12 090
ulna.
25545............... .............. A Treat fracture of 8.89 NA 7.65 1.48 NA 18.02 090
ulna.
25560............... .............. A Treat fracture radius 2.44 4.04 2.64 0.33 6.81 5.41 090
& ulna.
25565............... .............. A Treat fracture radius 5.62 7.35 5.32 0.92 13.89 11.86 090
& ulna.
25574............... .............. A Treat fracture radius 7.00 NA 7.13 1.16 NA 15.29 090
& ulna.
25575............... .............. A Treat fracture radius/ 10.43 NA 9.39 1.76 NA 21.58 090
ulna.
25600............... .............. A Treat fracture radius/ 2.63 4.47 2.94 0.41 7.51 5.98 090
ulna.
25605............... .............. A Treat fracture radius/ 5.80 8.03 6.01 0.98 14.81 12.79 090
ulna.
25611............... .............. A Treat fracture radius/ 7.76 NA 8.84 1.30 NA 17.90 090
ulna.
25620............... .............. A Treat fracture radius/ 8.54 NA 7.28 1.41 NA 17.23 090
ulna.
25622............... .............. A Treat wrist bone 2.61 4.64 3.12 0.40 7.65 6.13 090
fracture.
25624............... .............. A Treat wrist bone 4.52 6.98 4.90 0.74 12.24 10.16 090
fracture.
25628............... .............. A Treat wrist bone 8.42 NA 7.81 1.37 NA 17.60 090
fracture.
25630............... .............. A Treat wrist bone 2.88 4.57 2.94 0.45 7.90 6.27 090
fracture.
25635............... .............. A Treat wrist bone 4.38 6.75 3.89 0.47 11.60 8.74 090
fracture.
25645............... .............. A Treat wrist bone 7.24 NA 6.79 1.12 NA 15.15 090
fracture.
25650............... .............. A Treat wrist bone 3.05 4.83 3.22 0.45 8.33 6.72 090
fracture.
25651............... .............. A Pin ulnar styloid 5.35 NA 5.39 0.87 NA 11.61 090
fracture.
[[Continued on page 1133]]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
]
[[pp. 1133-1182]] Medicare Program; Changes to Medicare Payment for Drugs and
Physician Fee Schedule Payments for Calendar Year 2004
[[Continued from page 1132]]
[[Page 1133]]
25652............... .............. A Treat fracture ulnar 7.59 NA 6.85 1.23 NA 15.67 090
styloid.
25660............... .............. A Treat wrist 4.75 NA 4.66 0.71 NA 10.12 090
dislocation.
25670............... .............. A Treat wrist 7.91 NA 7.08 1.29 NA 16.28 090
dislocation.
25671............... .............. A Pin radioulnar 5.99 NA 5.98 0.98 NA 12.95 090
dislocation.
25675............... .............. A Treat wrist 4.66 6.49 4.61 0.69 11.84 9.96 090
dislocation.
25676............... .............. A Treat wrist 8.03 NA 7.32 1.33 NA 16.68 090
dislocation.
25680............... .............. A Treat wrist fracture. 5.98 NA 4.75 0.74 NA 11.47 090
25685............... .............. A Treat wrist fracture. 9.77 NA 7.87 1.51 NA 19.15 090
25690............... .............. A Treat wrist 5.49 NA 5.39 0.94 NA 11.82 090
dislocation.
25695............... .............. A Treat wrist 8.33 NA 7.19 1.29 NA 16.81 090
dislocation.
25800............... .............. A Fusion of wrist joint 9.75 NA 9.10 1.57 NA 20.42 090
25805............... .............. A Fusion/graft of wrist 11.26 NA 10.24 1.82 NA 23.32 090
joint.
25810............... .............. A Fusion/graft of wrist 10.55 NA 9.88 1.65 NA 22.08 090
joint.
25820............... .............. A Fusion of hand bones. 7.44 NA 7.88 1.16 NA 16.48 090
25825............... .............. A Fuse hand bones with 9.26 NA 9.22 1.45 NA 19.93 090
graft.
25830............... .............. A Fusion, radioulnar 10.04 NA 14.69 1.53 NA 26.26 090
jnt/ulna.
25900............... .............. A Amputation of forearm 9.00 NA 12.89 1.30 NA 23.19 090
25905............... .............. A Amputation of forearm 9.11 NA 12.82 1.28 NA 23.21 090
25907............... .............. A Amputation follow-up 7.79 NA 12.21 1.22 NA 21.22 090
surgery.
25909............... .............. A Amputation follow-up 8.95 NA 12.76 1.29 NA 23.00 090
surgery.
25915............... .............. A Amputation of forearm 17.05 NA 19.51 2.91 NA 39.47 090
25920............... .............. A Amputate hand at 8.67 NA 8.00 1.28 NA 17.95 090
wrist.
25922............... .............. A Amputate hand at 7.41 NA 7.25 1.12 NA 15.78 090
wrist.
25924............... .............. A Amputation follow-up 8.45 NA 8.22 1.29 NA 17.96 090
surgery.
25927............... .............. A Amputation of hand... 8.79 NA 12.15 1.23 NA 22.17 090
25929............... .............. A Amputation follow-up 7.58 NA 6.06 1.07 NA 14.71 090
surgery.
25931............... .............. A Amputation follow-up 7.80 NA 12.06 1.06 NA 20.92 090
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 5.67 1.66 0.17 7.38 3.37 010
abscess.
26011............... .............. A Drainage of finger 2.19 9.08 2.31 0.30 11.57 4.80 010
abscess.
26020............... .............. A Drain hand tendon 4.66 NA 5.57 0.71 NA 10.94 090
sheath.
26025............... .............. A Drainage of palm 4.81 NA 5.36 0.72 NA 10.89 090
bursa.
26030............... .............. A Drainage of palm 5.92 NA 6.00 0.87 NA 12.79 090
bursa(s).
26034............... .............. A Treat hand bone 6.22 NA 6.27 0.95 NA 13.44 090
lesion.
26035............... .............. A Decompress fingers/ 9.50 NA 8.10 1.35 NA 18.95 090
hand.
26037............... .............. A Decompress fingers/ 7.24 NA 6.60 1.05 NA 14.89 090
hand.
26040............... .............. A Release palm 3.33 NA 3.99 0.54 NA 7.86 090
contracture.
26045............... .............. A Release palm 5.55 NA 5.56 0.89 NA 12.00 090
contracture.
26055............... .............. A Incise finger tendon 2.69 14.54 3.85 0.43 17.66 6.97 090
sheath.
26060............... .............. A Incision of finger 2.81 NA 3.45 0.42 NA 6.68 090
tendon.
26070............... .............. A Explore/treat hand 3.68 NA 3.36 0.42 NA 7.46 090
joint.
26075............... .............. A Explore/treat finger 3.78 NA 3.76 0.48 NA 8.02 090
joint.
26080............... .............. A Explore/treat finger 4.23 NA 4.78 0.63 NA 9.64 090
joint.
26100............... .............. A Biopsy hand joint 3.66 NA 4.10 0.54 NA 8.30 090
lining.
26105............... .............. A Biopsy finger joint 3.70 NA 4.17 0.54 NA 8.41 090
lining.
26110............... .............. A Biopsy finger joint 3.52 NA 3.98 0.53 NA 8.03 090
lining.
26115............... .............. A Removel hand lesion 3.85 13.33 4.67 0.58 17.76 9.10 090
subcut.
26116............... .............. A Removel hand lesion, 5.52 NA 5.92 0.83 NA 12.27 090
deep.
26117............... .............. A Remove tumor, hand/ 8.54 NA 7.03 1.22 NA 16.79 090
finger.
26121............... .............. A Release palm 7.53 NA 6.90 1.13 NA 15.56 090
contracture.
26123............... .............. A Release palm 9.28 NA 8.74 1.41 NA 19.43 090
contracture.
26125............... .............. A Release palm 4.60 NA 2.46 0.69 NA 7.75 ZZZ
contracture.
26130............... .............. A Remove wrist joint 5.41 NA 5.30 0.78 NA 11.49 090
lining.
26135............... .............. A Revise finger joint, 6.95 NA 6.39 1.05 NA 14.39 090
each.
26140............... .............. A Revise finger joint, 6.16 NA 5.97 0.92 NA 13.05 090
each.
26145............... .............. A Tendon excision, palm/ 6.31 NA 5.98 0.93 NA 13.22 090
finger.
26160............... .............. A Remove tendon sheath 3.15 12.69 4.04 0.47 16.31 7.66 090
lesion.
26170............... .............. A Removal of palm 4.76 NA 4.88 0.72 NA 10.36 090
tendon, each.
26180............... .............. A Removal of finger 5.17 NA 5.35 0.77 NA 11.29 090
tendon.
26185............... .............. A Remove finger bone... 5.24 NA 5.91 0.81 NA 11.96 090
26200............... .............. A Remove hand bone 5.50 NA 5.29 0.86 NA 11.65 090
lesion.
26205............... .............. A Remove/graft bone 7.69 NA 6.84 1.15 NA 15.68 090
lesion.
26210............... .............. A Removal of finger 5.14 NA 5.36 0.77 NA 11.27 090
lesion.
26215............... .............. A Remove/graft finger 7.09 NA 6.26 0.93 NA 14.28 090
lesion.
26230............... .............. A Partial removal of 6.32 NA 5.85 1.01 NA 13.18 090
hand bone.
26235............... .............. A Partial removal, 6.18 NA 5.75 0.94 NA 12.87 090
finger bone.
26236............... .............. A Partial removal, 5.31 NA 5.28 0.80 NA 11.39 090
finger bone.
26250............... .............. A Extensive hand 7.54 NA 6.38 1.11 NA 15.03 090
surgery.
26255............... .............. A Extensive hand 12.41 NA 9.35 1.27 NA 23.03 090
surgery.
26260............... .............. A Extensive finger 7.02 NA 6.14 1.00 NA 14.16 090
surgery.
26261............... .............. A Extensive finger 9.08 NA 6.23 1.01 NA 16.32 090
surgery.
26262............... .............. A Partial removal of 5.66 NA 5.29 0.84 NA 11.79 090
finger.
26320............... .............. A Removal of implant 3.97 NA 4.25 0.59 NA 8.81 090
from hand.
26340............... .............. A Manipulate finger w/ 2.50 NA 4.74 0.36 NA 7.60 090
anesth.
26350............... .............. A Repair finger/hand 5.98 NA 15.49 0.88 NA 22.35 090
tendon.
[[Page 1134]]
26352............... .............. A Repair/graft hand 7.67 NA 16.08 1.12 NA 24.87 090
tendon.
26356............... .............. A Repair finger/hand 8.06 NA 18.91 1.19 NA 28.16 090
tendon.
26357............... .............. A Repair finger/hand 8.57 NA 16.53 1.23 NA 26.33 090
tendon.
26358............... .............. A Repair/graft hand 9.13 NA 17.43 1.29 NA 27.85 090
tendon.
26370............... .............. A Repair finger/hand 7.10 NA 15.95 1.09 NA 24.14 090
tendon.
26372............... .............. A Repair/graft hand 8.75 NA 17.32 1.28 NA 27.35 090
tendon.
26373............... .............. A Repair finger/hand 8.15 NA 16.87 1.18 NA 26.20 090
tendon.
26390............... .............. A Revise hand/finger 9.18 NA 13.92 1.31 NA 24.41 090
tendon.
26392............... .............. A Repair/graft hand 10.24 NA 17.66 1.52 NA 29.42 090
tendon.
26410............... .............. A Repair hand tendon... 4.62 NA 12.59 0.69 NA 17.90 090
26412............... .............. A Repair/graft hand 6.30 NA 13.92 0.96 NA 21.18 090
tendon.
26415............... .............. A Excision, hand/finger 8.33 NA 12.28 0.93 NA 21.54 090
tendon.
26416............... .............. A Graft hand or finger 9.36 NA 15.21 1.45 NA 26.02 090
tendon.
26418............... .............. A Repair finger tendon. 4.24 NA 12.95 0.60 NA 17.79 090
26420............... .............. A Repair/graft finger 6.76 NA 14.26 1.00 NA 22.02 090
tendon.
26426............... .............. A Repair finger/hand 6.14 NA 13.78 0.93 NA 20.85 090
tendon.
26428............... .............. A Repair/graft finger 7.20 NA 14.58 1.01 NA 22.79 090
tendon.
26432............... .............. A Repair finger tendon. 4.01 NA 10.69 0.58 NA 15.28 090
26433............... .............. A Repair finger tendon. 4.55 NA 11.37 0.68 NA 16.60 090
26434............... .............. A Repair/graft finger 6.08 NA 12.06 0.86 NA 19.00 090
tendon.
26437............... .............. A Realignment of 5.81 NA 11.98 0.89 NA 18.68 090
tendons.
26440............... .............. A Release palm/finger 5.01 NA 14.18 0.75 NA 19.94 090
tendon.
26442............... .............. A Release palm & finger 8.15 NA 16.61 1.13 NA 25.89 090
tendon.
26445............... .............. A Release hand/finger 4.30 NA 13.93 0.65 NA 18.88 090
tendon.
26449............... .............. A Release forearm/hand 6.99 NA 16.39 1.01 NA 24.39 090
tendon.
26450............... .............. A Incision of palm 3.66 NA 7.58 0.55 NA 11.79 090
tendon.
26455............... .............. A Incision of finger 3.63 NA 7.50 0.57 NA 11.70 090
tendon.
26460............... .............. A Incise hand/finger 3.45 NA 7.32 0.53 NA 11.30 090
tendon.
26471............... .............. A Fusion of finger 5.72 NA 11.65 0.88 NA 18.25 090
tendons.
26474............... .............. A Fusion of finger 5.31 NA 11.84 0.83 NA 17.98 090
tendons.
26476............... .............. A Tendon lengthening... 5.17 NA 11.37 0.75 NA 17.29 090
26477............... .............. A Tendon shortening.... 5.14 NA 11.54 0.72 NA 17.40 090
26478............... .............. A Lengthening of hand 5.79 NA 12.24 0.93 NA 18.96 090
tendon.
26479............... .............. A Shortening of hand 5.73 NA 12.08 0.92 NA 18.73 090
tendon.
26480............... .............. A Transplant hand 6.68 NA 15.68 1.01 NA 23.37 090
tendon.
26483............... .............. A Transplant/graft hand 8.28 NA 16.12 1.24 NA 25.64 090
tendon.
26485............... .............. A Transplant palm 7.69 NA 16.01 1.13 NA 24.83 090
tendon.
26489............... .............. A Transplant/graft palm 9.54 NA 12.54 1.18 NA 23.26 090
tendon.
26490............... .............. A Revise thumb tendon.. 8.40 NA 13.16 1.27 NA 22.83 090
26492............... .............. A Tendon transfer with 9.61 NA 13.97 1.44 NA 25.02 090
graft.
26494............... .............. A Hand tendon/muscle 8.46 NA 13.61 1.36 NA 23.43 090
transfer.
26496............... .............. A Revise thumb tendon.. 9.58 NA 13.61 1.41 NA 24.60 090
26497............... .............. A Finger tendon 9.56 NA 13.96 1.41 NA 24.93 090
transfer.
26498............... .............. A Finger tendon 13.98 NA 16.55 2.10 NA 32.63 090
transfer.
26499............... .............. A Revision of finger... 8.97 NA 13.50 1.13 NA 23.60 090
26500............... .............. A Hand tendon 5.95 NA 12.12 0.80 NA 18.87 090
reconstruction.
26502............... .............. A Hand tendon 7.13 NA 12.58 1.05 NA 20.76 090
reconstruction.
26504............... .............. A Hand tendon 7.46 NA 13.01 1.01 NA 21.48 090
reconstruction.
26508............... .............. A Release thumb 6.00 NA 12.11 0.92 NA 19.03 090
contracture.
26510............... .............. A Thumb tendon transfer 5.42 NA 11.79 0.86 NA 18.07 090
26516............... .............. A Fusion of knuckle 7.14 NA 12.65 1.09 NA 20.88 090
joint.
26517............... .............. A Fusion of knuckle 8.82 NA 13.96 1.16 NA 23.94 090
joints.
26518............... .............. A Fusion of knuckle 9.01 NA 13.77 1.36 NA 24.14 090
joints.
26520............... .............. A Release knuckle 5.29 NA 14.63 0.78 NA 20.70 090
contracture.
26525............... .............. A Release finger 5.32 NA 14.74 0.80 NA 20.86 090
contracture.
26530............... .............. A Revise knuckle joint. 6.68 NA 6.02 1.04 NA 13.74 090
26531............... .............. A Revise knuckle with 7.90 NA 6.99 1.22 NA 16.11 090
implant.
26535............... .............. A Revise finger joint.. 5.23 NA 3.69 0.80 NA 9.72 090
26536............... .............. A Revise/implant finger 6.36 NA 9.74 0.96 NA 17.06 090
joint.
26540............... .............. A Repair hand joint.... 6.42 NA 12.35 0.98 NA 19.75 090
26541............... .............. A Repair hand joint 8.61 NA 13.83 1.35 NA 23.79 090
with graft.
26542............... .............. A Repair hand joint 6.77 NA 12.39 1.05 NA 20.21 090
with graft.
26545............... .............. A Reconstruct finger 6.91 NA 12.79 0.95 NA 20.65 090
joint.
26546............... .............. A Repair nonunion hand. 8.91 NA 15.20 1.37 NA 25.48 090
26548............... .............. A Reconstruct finger 8.02 NA 13.39 1.18 NA 22.59 090
joint.
26550............... .............. A Construct thumb 21.21 NA 18.16 2.17 NA 41.54 090
replacement.
26551............... .............. A Great toe-hand 46.51 NA 33.71 7.92 NA 88.14 090
transfer.
26553............... .............. A Single transfer, toe- 46.20 NA 23.22 2.40 NA 71.82 090
hand.
26554............... .............. A Double transfer, toe- 54.87 NA 38.02 9.36 NA 102.25 090
hand.
26555............... .............. A Positional change of 16.61 NA 18.67 2.57 NA 37.85 090
finger.
26556............... .............. A Toe joint transfer... 47.19 NA 34.50 8.04 NA 89.73 090
26560............... .............. A Repair of web finger. 5.37 NA 10.28 0.72 NA 16.37 090
26561............... .............. A Repair of web finger. 10.90 NA 12.93 0.83 NA 24.66 090
26562............... .............. A Repair of web finger. 14.98 NA 17.59 1.18 NA 33.75 090
26565............... .............. A Correct metacarpal 6.73 NA 12.46 1.01 NA 20.20 090
flaw.
[[Page 1135]]
26567............... .............. A Correct finger 6.81 NA 12.39 1.01 NA 20.21 090
deformity.
26568............... .............. A Lengthen metacarpal/ 9.07 NA 16.09 1.33 NA 26.49 090
finger.
26580............... .............. A Repair hand deformity 18.15 NA 13.98 1.76 NA 33.89 090
26587............... .............. A Reconstruct extra 14.03 NA 9.05 1.35 NA 24.43 090
finger.
26590............... .............. A Repair finger 17.93 NA 14.40 1.59 NA 33.92 090
deformity.
26591............... .............. A Repair muscles of 3.25 NA 10.44 0.45 NA 14.14 090
hand.
26593............... .............. A Release muscles of 5.30 NA 11.51 0.77 NA 17.58 090
hand.
26596............... .............. A Excision constricting 8.94 NA 9.01 1.05 NA 19.00 090
tissue.
26600............... .............. A Treat metacarpal 1.96 4.08 2.64 0.30 6.34 4.90 090
fracture.
26605............... .............. A Treat metacarpal 2.85 5.25 3.58 0.46 8.56 6.89 090
fracture.
26607............... .............. A Treat metacarpal 5.35 NA 6.35 0.84 NA 12.54 090
fracture.
26608............... .............. A Treat metacarpal 5.35 NA 6.35 0.88 NA 12.58 090
fracture.
26615............... .............. A Treat metacarpal 5.32 NA 5.53 0.84 NA 11.69 090
fracture.
26641............... .............. A Treat thumb 3.93 5.40 3.58 0.51 9.84 8.02 090
dislocation.
26645............... .............. A Treat thumb fracture. 4.40 6.10 4.17 0.65 11.15 9.22 090
26650............... .............. A Treat thumb fracture. 5.71 NA 6.76 0.93 NA 13.40 090
26665............... .............. A Treat thumb fracture. 7.59 NA 6.80 1.17 NA 15.56 090
26670............... .............. A Treat hand 3.68 4.89 3.03 0.43 9.00 7.14 090
dislocation.
26675............... .............. A Treat hand 4.63 6.23 4.41 0.68 11.54 9.72 090
dislocation.
26676............... .............. A Pin hand dislocation. 5.51 NA 6.79 0.92 NA 13.22 090
26685............... .............. A Treat hand 6.97 NA 6.26 1.15 NA 14.38 090
dislocation.
26686............... .............. A Treat hand 7.93 NA 7.03 1.27 NA 16.23 090
dislocation.
26700............... .............. A Treat knuckle 3.68 4.65 2.96 0.42 8.75 7.06 090
dislocation.
26705............... .............. A Treat knuckle 4.18 6.03 4.24 0.60 10.81 9.02 090
dislocation.
26706............... .............. A Pin knuckle 5.11 NA 5.09 0.77 NA 10.97 090
dislocation.
26715............... .............. A Treat knuckle 5.73 NA 5.71 0.90 NA 12.34 090
dislocation.
26720............... .............. A Treat finger 1.66 3.89 2.60 0.24 5.79 4.50 090
fracture, each.
26725............... .............. A Treat finger 3.33 6.09 4.04 0.52 9.94 7.89 090
fracture, each.
26727............... .............. A Treat finger 5.22 NA 6.40 0.83 NA 12.45 090
fracture, each.
26735............... .............. A Treat finger 5.97 NA 5.86 0.93 NA 12.76 090
fracture, each.
26740............... .............. A Treat finger 1.94 3.56 2.69 0.29 5.79 4.92 090
fracture, each.
26742............... .............. A Treat finger 3.84 5.81 3.85 0.59 10.24 8.28 090
fracture, each.
26746............... .............. A Treat finger 5.80 NA 5.91 0.89 NA 12.60 090
fracture, each.
26750............... .............. A Treat finger 1.70 3.14 2.08 0.23 5.07 4.01 090
fracture, each.
26755............... .............. A Treat finger 3.10 4.81 3.05 0.45 8.36 6.60 090
fracture, each.
26756............... .............. A Pin finger fracture, 4.38 NA 6.04 0.68 NA 11.10 090
each.
26765............... .............. A Treat finger 4.16 NA 4.78 0.62 NA 9.56 090
fracture, each.
26770............... .............. A Treat finger 3.02 4.40 2.55 0.33 7.75 5.90 090
dislocation.
26775............... .............. A Treat finger 3.70 5.85 3.82 0.52 10.07 8.04 090
dislocation.
26776............... .............. A Pin finger 4.79 NA 6.21 0.76 NA 11.76 090
dislocation.
26785............... .............. A Treat finger 4.20 NA 4.81 0.65 NA 9.66 090
dislocation.
26820............... .............. A Thumb fusion with 8.25 NA 13.63 1.34 NA 23.22 090
graft.
26841............... .............. A Fusion of thumb...... 7.12 NA 13.53 1.17 NA 21.82 090
26842............... .............. A Thumb fusion with 8.23 NA 13.71 1.33 NA 23.27 090
graft.
26843............... .............. A Fusion of hand joint. 7.60 NA 12.68 1.19 NA 21.47 090
26844............... .............. A Fusion/graft of hand 8.72 NA 13.68 1.35 NA 23.75 090
joint.
26850............... .............. A Fusion of knuckle.... 6.96 NA 12.56 1.07 NA 20.59 090
26852............... .............. A Fusion of knuckle 8.45 NA 13.25 1.27 NA 22.97 090
with graft.
26860............... .............. A Fusion of finger 4.68 NA 11.55 0.72 NA 16.95 090
joint.
26861............... .............. A Fusion of finger jnt, 1.74 NA 0.93 0.27 NA 2.94 ZZZ
add-on.
26862............... .............. A Fusion/graft of 7.36 NA 12.75 1.11 NA 21.22 090
finger joint.
26863............... .............. A Fuse/graft added 3.89 NA 2.12 0.62 NA 6.63 ZZZ
joint.
26910............... .............. A Amputate metacarpal 7.59 NA 11.70 1.09 NA 20.38 090
bone.
26951............... .............. A Amputation of finger/ 4.58 NA 10.62 0.68 NA 15.88 090
thumb.
26952............... .............. A Amputation of finger/ 6.30 NA 12.23 0.89 NA 19.42 090
thumb.
26989............... .............. C Hand/finger surgery.. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
26990............... .............. A Drainage of pelvis 7.47 NA 7.63 1.11 NA 16.21 090
lesion.
26991............... .............. A Drainage of pelvis 6.67 7.47 5.94 1.03 15.17 13.64 090
bursa.
26992............... .............. A Drainage of bone 13.00 NA 10.86 2.11 NA 25.97 090
lesion.
27000............... .............. A Incision of hip 5.61 NA 5.29 0.92 NA 11.82 090
tendon.
27001............... .............. A Incision of hip 6.93 NA 6.15 1.15 NA 14.23 090
tendon.
27003............... .............. A Incision of hip 7.33 NA 6.55 1.12 NA 15.00 090
tendon.
27005............... .............. A Incision of hip 9.65 NA 7.85 1.64 NA 19.14 090
tendon.
27006............... .............. A Incision of hip 9.67 NA 7.99 1.60 NA 19.26 090
tendons.
27025............... .............. A Incision of hip/thigh 11.14 NA 8.60 1.66 NA 21.40 090
fascia.
27030............... .............. A Drainage of hip joint 12.99 NA 9.66 2.18 NA 24.83 090
27033............... .............. A Exploration of hip 13.37 NA 9.93 2.26 NA 25.56 090
joint.
27035............... .............. A Denervation of hip 16.66 NA 12.33 2.05 NA 31.04 090
joint.
27036............... .............. A Excision of hip joint/ 12.86 NA 10.03 2.17 NA 25.06 090
muscle.
27040............... .............. A Biopsy of soft 2.87 2.62 2.05 0.25 5.74 5.17 010
tissues.
27041............... .............. A Biopsy of soft 9.88 NA 6.73 1.22 NA 17.83 090
tissues.
27047............... .............. A Remove hip/pelvis 7.44 6.55 4.99 0.95 14.94 13.38 090
lesion.
27048............... .............. A Remove hip/pelvis 6.24 NA 5.04 0.88 NA 12.16 090
lesion.
27049............... .............. A Remove tumor, hip/ 13.64 NA 8.81 1.93 NA 24.38 090
pelvis.
27050............... .............. A Biopsy of sacroiliac 4.35 NA 4.48 0.64 NA 9.47 090
joint.
[[Page 1136]]
27052............... .............. A Biopsy of hip joint.. 6.22 NA 5.89 1.03 NA 13.14 090
27054............... .............. A Removal of hip joint 8.53 NA 7.36 1.41 NA 17.30 090
lining.
27060............... .............. A Removal of ischial 5.42 NA 4.84 0.72 NA 10.98 090
bursa.
27062............... .............. A Remove femur lesion/ 5.36 NA 5.22 0.89 NA 11.47 090
bursa.
27065............... .............. A Removal of hip bone 5.89 NA 5.54 0.92 NA 12.35 090
lesion.
27066............... .............. A Removal of hip bone 10.31 NA 8.51 1.71 NA 20.53 090
lesion.
27067............... .............. A Remove/graft hip bone 13.81 NA 10.67 2.35 NA 26.83 090
lesion.
27070............... .............. A Partial removal of 10.70 NA 9.78 1.64 NA 22.12 090
hip bone.
27071............... .............. A Partial removal of 11.44 NA 10.75 1.82 NA 24.01 090
hip bone.
27075............... .............. A Extensive hip surgery 34.95 NA 19.68 2.68 NA 57.31 090
27076............... .............. A Extensive hip surgery 22.09 NA 14.79 3.45 NA 40.33 090
27077............... .............. A Extensive hip surgery 39.94 NA 23.10 3.84 NA 66.88 090
27078............... .............. A Extensive hip surgery 13.42 NA 10.43 2.01 NA 25.86 090
27079............... .............. A Extensive hip surgery 13.73 NA 10.09 2.24 NA 26.06 090
27080............... .............. A Removal of tail bone. 6.38 NA 5.08 0.96 NA 12.42 090
27086............... .............. A Remove hip foreign 1.87 2.01 1.87 0.21 4.09 3.95 010
body.
27087............... .............. A Remove hip foreign 8.53 NA 6.71 1.31 NA 16.55 090
body.
27090............... .............. A Removal of hip 11.13 NA 8.65 1.87 NA 21.65 090
prosthesis.
27091............... .............. A Removal of hip 22.11 NA 13.86 3.75 NA 39.72 090
prosthesis.
27093............... .............. A Injection for hip x- 1.30 12.21 0.48 0.11 13.62 1.89 000
ray.
27095............... .............. A Injection for hip x- 1.50 10.76 0.52 0.12 12.38 2.14 000
ray.
27096............... .............. A Inject sacroiliac 1.40 9.35 0.33 0.10 10.85 1.83 000
joint.
27097............... .............. A Revision of hip 8.79 NA 6.47 1.47 NA 16.73 090
tendon.
27098............... .............. A Transfer tendon to 8.82 NA 7.10 1.50 NA 17.42 090
pelvis.
27100............... .............. A Transfer of abdominal 11.06 NA 8.73 1.89 NA 21.68 090
muscle.
27105............... .............. A Transfer of spinal 11.75 NA 9.20 2.00 NA 22.95 090
muscle.
27110............... .............. A Transfer of iliopsoas 13.24 NA 9.33 1.66 NA 24.23 090
muscle.
27111............... .............. A Transfer of iliopsoas 12.13 NA 9.18 1.79 NA 23.10 090
muscle.
27120............... .............. A Reconstruction of hip 17.98 NA 11.74 2.95 NA 32.67 090
socket.
27122............... .............. A Reconstruction of hip 14.96 NA 10.91 2.51 NA 28.38 090
socket.
27125............... .............. A Partial hip 14.67 NA 10.49 2.47 NA 27.63 090
replacement.
27130............... .............. A Total hip 20.09 NA 13.21 3.40 NA 36.70 090
arthroplasty.
27132............... .............. A Total hip 23.27 NA 15.48 3.93 NA 42.68 090
arthroplasty.
27134............... .............. A Revise hip joint 28.48 NA 17.69 4.79 NA 50.96 090
replacement.
27137............... .............. A Revise hip joint 21.14 NA 13.82 3.58 NA 38.54 090
replacement.
27138............... .............. A Revise hip joint 22.14 NA 14.28 3.75 NA 40.17 090
replacement.
27140............... .............. A Transplant femur 12.22 NA 9.41 2.01 NA 23.64 090
ridge.
27146............... .............. A Incision of hip bone. 17.40 NA 12.27 2.74 NA 32.41 090
27147............... .............. A Revision of hip bone. 20.55 NA 13.34 3.15 NA 37.04 090
27151............... .............. A Incision of hip bones 22.48 NA 8.21 3.76 NA 34.45 090
27156............... .............. A Revision of hip bones 24.59 NA 16.10 4.20 NA 44.89 090
27158............... .............. A Revision of pelvis... 19.71 NA 11.24 3.14 NA 34.09 090
27161............... .............. A Incision of neck of 16.68 NA 12.09 2.80 NA 31.57 090
femur.
27165............... .............. A Incision/fixation of 17.88 NA 12.85 3.03 NA 33.76 090
femur.
27170............... .............. A Repair/graft femur 16.05 NA 11.30 2.65 NA 30.00 090
head/neck.
27175............... .............. A Treat slipped 8.45 NA 6.58 1.44 NA 16.47 090
epiphysis.
27176............... .............. A Treat slipped 12.03 NA 8.98 2.03 NA 23.04 090
epiphysis.
27177............... .............. A Treat slipped 15.06 NA 10.83 2.54 NA 28.43 090
epiphysis.
27178............... .............. A Treat slipped 11.97 NA 8.40 2.03 NA 22.40 090
epiphysis.
27179............... .............. A Revise head/neck of 12.96 NA 9.92 2.22 NA 25.10 090
femur.
27181............... .............. A Treat slipped 14.66 NA 10.15 2.10 NA 26.91 090
epiphysis.
27185............... .............. A Revision of femur 9.17 NA 7.58 1.56 NA 18.31 090
epiphysis.
27187............... .............. A Reinforce hip bones.. 13.52 NA 10.33 2.28 NA 26.13 090
27193............... .............. A Treat pelvic ring 5.55 7.10 5.74 0.93 13.58 12.22 090
fracture.
27194............... .............. A Treat pelvic ring 9.64 8.75 7.50 1.59 19.98 18.73 090
fracture.
27200............... .............. A Treat tail bone 1.84 3.04 2.17 0.27 5.15 4.28 090
fracture.
27202............... .............. A Treat tail bone 7.03 NA 17.65 0.83 NA 25.51 090
fracture.
27215............... .............. A Treat pelvic 10.03 NA 7.17 1.65 NA 18.85 090
fracture(s).
27216............... .............. A Treat pelvic ring 15.17 NA 9.72 2.59 NA 27.48 090
fracture.
27217............... .............. A Treat pelvic ring 14.09 NA 10.15 2.35 NA 26.59 090
fracture.
27218............... .............. A Treat pelvic ring 20.12 NA 11.50 3.44 NA 35.06 090
fracture.
27220............... .............. A Treat hip socket 6.17 7.06 5.51 1.03 14.26 12.71 090
fracture.
27222............... .............. A Treat hip socket 12.68 NA 9.88 2.13 NA 24.69 090
fracture.
27226............... .............. A Treat hip wall 14.89 NA 7.92 2.50 NA 25.31 090
fracture.
27227............... .............. A Treat hip fracture(s) 23.41 NA 15.35 3.91 NA 42.67 090
27228............... .............. A Treat hip fracture(s) 27.12 NA 17.57 4.55 NA 49.24 090
27230............... .............. A Treat thigh fracture. 5.49 6.51 5.04 0.88 12.88 11.41 090
27232............... .............. A Treat thigh fracture. 10.66 NA 7.18 1.75 NA 19.59 090
27235............... .............. A Treat thigh fracture. 12.14 NA 9.39 2.06 NA 23.59 090
27236............... .............. A Treat thigh fracture. 15.58 NA 10.93 2.63 NA 29.14 090
27238............... .............. A Treat thigh fracture. 5.51 NA 5.09 0.92 NA 11.52 090
27240............... .............. A Treat thigh fracture. 12.48 NA 9.37 2.04 NA 23.89 090
27244............... .............. A Treat thigh fracture. 15.92 NA 11.26 2.69 NA 29.87 090
27245............... .............. A Treat thigh fracture. 20.28 NA 13.70 3.44 NA 37.42 090
27246............... .............. A Treat thigh fracture. 4.70 5.66 4.41 0.80 11.16 9.91 090
[[Page 1137]]
27248............... .............. A Treat thigh fracture. 10.43 NA 8.19 1.75 NA 20.37 090
27250............... .............. A Treat hip dislocation 6.94 NA 4.77 0.82 NA 12.53 090
27252............... .............. A Treat hip dislocation 10.37 NA 7.39 1.65 NA 19.41 090
27253............... .............. A Treat hip dislocation 12.90 NA 9.72 2.18 NA 24.80 090
27254............... .............. A Treat hip dislocation 18.23 NA 12.03 3.04 NA 33.30 090
27256............... .............. A Treat hip dislocation 4.11 3.43 2.09 0.59 8.13 6.79 010
27257............... .............. A Treat hip dislocation 5.21 NA 2.88 0.68 NA 8.77 010
27258............... .............. A Treat hip dislocation 15.41 NA 10.91 2.48 NA 28.80 090
27259............... .............. A Treat hip dislocation 21.52 NA 14.16 3.61 NA 39.29 090
27265............... .............. A Treat hip dislocation 5.04 NA 4.76 0.78 NA 10.58 090
27266............... .............. A Treat hip dislocation 7.48 NA 6.27 1.25 NA 15.00 090
27275............... .............. A Manipulation of hip 2.27 NA 2.13 0.37 NA 4.77 010
joint.
27280............... .............. A Fusion of sacroiliac 13.37 NA 10.30 2.39 NA 26.06 090
joint.
27282............... .............. A Fusion of pubic bones 11.32 NA 8.23 1.37 NA 20.92 090
27284............... .............. A Fusion of hip joint.. 23.41 NA 14.83 2.85 NA 41.09 090
27286............... .............. A Fusion of hip joint.. 23.41 NA 15.81 2.86 NA 42.08 090
27290............... .............. A Amputation of leg at 23.25 NA 14.16 3.55 NA 40.96 090
hip.
27295............... .............. A Amputation of leg at 18.62 NA 11.54 2.83 NA 32.99 090
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 6.48 7.34 5.88 0.96 14.78 13.32 090
lesion.
27303............... .............. A Drainage of bone 8.27 NA 7.24 1.37 NA 16.88 090
lesion.
27305............... .............. A Incise thigh tendon & 5.91 NA 5.36 0.93 NA 12.20 090
fascia.
27306............... .............. A Incision of thigh 4.61 NA 4.80 0.75 NA 10.16 090
tendon.
27307............... .............. A Incision of thigh 5.79 NA 5.52 0.94 NA 12.25 090
tendons.
27310............... .............. A Exploration of knee 9.26 NA 7.54 1.56 NA 18.36 090
joint.
27315............... .............. A Partial removal, 6.96 NA 4.83 0.95 NA 12.74 090
thigh nerve.
27320............... .............. A Partial removal, 6.29 NA 5.12 0.94 NA 12.35 090
thigh nerve.
27323............... .............. A Biopsy, thigh soft 2.28 2.19 1.92 0.21 4.68 4.41 010
tissues.
27324............... .............. A Biopsy, thigh soft 4.89 NA 4.35 0.71 NA 9.95 090
tissues.
27327............... .............. A Removal of thigh 4.46 5.34 3.91 0.60 10.40 8.97 090
lesion.
27328............... .............. A Removal of thigh 5.56 NA 4.57 0.80 NA 10.93 090
lesion.
27329............... .............. A Remove tumor, thigh/ 14.12 NA 9.51 2.03 NA 25.66 090
knee.
27330............... .............. A Biopsy, knee joint 4.96 NA 4.61 0.80 NA 10.37 090
lining.
27331............... .............. A Explore/treat knee 5.87 NA 5.51 0.98 NA 12.36 090
joint.
27332............... .............. A Removal of knee 8.26 NA 7.08 1.39 NA 16.73 090
cartilage.
27333............... .............. A Removal of knee 7.29 NA 6.60 1.24 NA 15.13 090
cartilage.
27334............... .............. A Remove knee joint 8.69 NA 7.38 1.46 NA 17.53 090
lining.
27335............... .............. A Remove knee joint 9.99 NA 8.18 1.70 NA 19.87 090
lining.
27340............... .............. A Removal of kneecap 4.17 NA 4.53 0.70 NA 9.40 090
bursa.
27345............... .............. A Removal of knee cyst. 5.91 NA 5.61 0.98 NA 12.50 090
27347............... .............. A Remove knee cyst..... 5.77 NA 5.42 0.92 NA 12.11 090
27350............... .............. A Removal of kneecap... 8.16 NA 7.19 1.39 NA 16.74 090
27355............... .............. A Remove femur lesion.. 7.64 NA 6.81 1.29 NA 15.74 090
27356............... .............. A Remove femur lesion/ 9.47 NA 7.88 1.56 NA 18.91 090
graft.
27357............... .............. A Remove femur lesion/ 10.51 NA 8.70 1.79 NA 21.00 090
graft.
27358............... .............. A Remove femur lesion/ 4.73 NA 2.54 0.81 NA 8.08 ZZZ
fixation.
27360............... .............. A Partial removal, leg 10.48 NA 9.95 1.71 NA 22.14 090
bone(s).
27365............... .............. A Extensive leg surgery 16.25 NA 11.67 2.73 NA 30.65 090
27370............... .............. A Injection for knee x- 0.96 12.01 0.32 0.07 13.04 1.35 000
ray.
27372............... .............. A Removal of foreign 5.06 6.00 4.69 0.75 11.81 10.50 090
body.
27380............... .............. A Repair of kneecap 7.15 NA 7.25 1.21 NA 15.61 090
tendon.
27381............... .............. A Repair/graft kneecap 10.32 NA 9.05 1.74 NA 21.11 090
tendon.
27385............... .............. A Repair of thigh 7.75 NA 7.59 1.31 NA 16.65 090
muscle.
27386............... .............. A Repair/graft of thigh 10.54 NA 9.46 1.80 NA 21.80 090
muscle.
27390............... .............. A Incision of thigh 5.32 NA 5.26 0.83 NA 11.41 090
tendon.
27391............... .............. A Incision of thigh 7.19 NA 6.63 1.19 NA 15.01 090
tendons.
27392............... .............. A Incision of thigh 9.19 NA 7.72 1.48 NA 18.39 090
tendons.
27393............... .............. A Lengthening of thigh 6.38 NA 5.85 1.09 NA 13.32 090
tendon.
27394............... .............. A Lengthening of thigh 8.49 NA 7.28 1.41 NA 17.18 090
tendons.
27395............... .............. A Lengthening of thigh 11.71 NA 9.38 1.97 NA 23.06 090
tendons.
27396............... .............. A Transplant of thigh 7.85 NA 7.07 1.34 NA 16.26 090
tendon.
27397............... .............. A Transplants of thigh 11.26 NA 9.03 1.91 NA 22.20 090
tendons.
27400............... .............. A Revise thigh muscles/ 9.01 NA 7.34 1.42 NA 17.77 090
tendons.
27403............... .............. A Repair of knee 8.32 NA 7.14 1.40 NA 16.86 090
cartilage.
27405............... .............. A Repair of knee 8.64 NA 7.46 1.46 NA 17.56 090
ligament.
27407............... .............. A Repair of knee 10.26 NA 8.30 1.66 NA 20.22 090
ligament.
27409............... .............. A Repair of knee 12.88 NA 9.91 2.11 NA 24.90 090
ligaments.
27418............... .............. A Repair degenerated 10.83 NA 8.85 1.82 NA 21.50 090
kneecap.
27420............... .............. A Revision of unstable 9.82 NA 8.05 1.66 NA 19.53 090
kneecap.
27422............... .............. A Revision of unstable 9.77 NA 8.07 1.65 NA 19.49 090
kneecap.
27424............... .............. A Revision/removal of 9.80 NA 8.04 1.66 NA 19.50 090
kneecap.
27425............... .............. A Lat retinacular 5.21 NA 5.49 0.88 NA 11.58 090
release open.
27427............... .............. A Reconstruction, knee. 9.35 NA 7.74 1.56 NA 18.65 090
27428............... .............. A Reconstruction, knee. 13.98 NA 11.10 2.35 NA 27.43 090
27429............... .............. A Reconstruction, knee. 15.50 NA 12.34 2.63 NA 30.47 090
[[Page 1138]]
27430............... .............. A Revision of thigh 9.66 NA 7.96 1.63 NA 19.25 090
muscles.
27435............... .............. A Incision of knee 9.48 NA 8.36 1.60 NA 19.44 090
joint.
27437............... .............. A Revise kneecap....... 8.45 NA 7.11 1.42 NA 16.98 090
27438............... .............. A Revise kneecap with 11.21 NA 8.43 1.88 NA 21.52 090
implant.
27440............... .............. A Revision of knee 10.41 NA 5.97 1.71 NA 18.09 090
joint.
27441............... .............. A Revision of knee 10.80 NA 6.65 1.80 NA 19.25 090
joint.
27442............... .............. A Revision of knee 11.87 NA 8.80 2.03 NA 22.70 090
joint.
27443............... .............. A Revision of knee 10.91 NA 8.59 1.83 NA 21.33 090
joint.
27445............... .............. A Revision of knee 17.65 NA 12.23 3.00 NA 32.88 090
joint.
27446............... .............. A Revision of knee 15.82 NA 11.15 2.68 NA 29.65 090
joint.
27447............... .............. A Total knee 21.45 NA 14.46 3.62 NA 39.53 090
arthroplasty.
27448............... .............. A Incision of thigh.... 11.04 NA 8.65 1.82 NA 21.51 090
27450............... .............. A Incision of thigh.... 13.96 NA 10.59 2.36 NA 26.91 090
27454............... .............. A Realignment of thigh 17.53 NA 12.50 2.97 NA 33.00 090
bone.
27455............... .............. A Realignment of knee.. 12.80 NA 9.87 2.15 NA 24.82 090
27457............... .............. A Realignment of knee.. 13.43 NA 9.91 2.27 NA 25.61 090
27465............... .............. A Shortening of thigh 13.85 NA 10.34 2.24 NA 26.43 090
bone.
27466............... .............. A Lengthening of thigh 16.31 NA 11.87 2.32 NA 30.50 090
bone.
27468............... .............. A Shorten/lengthen 18.94 NA 12.45 3.23 NA 34.62 090
thighs.
27470............... .............. A Repair of thigh...... 16.05 NA 11.83 2.70 NA 30.58 090
27472............... .............. A Repair/graft of thigh 17.69 NA 12.72 3.00 NA 33.41 090
27475............... .............. A Surgery to stop leg 8.63 NA 7.22 1.36 NA 17.21 090
growth.
27477............... .............. A Surgery to stop leg 9.84 NA 7.73 1.58 NA 19.15 090
growth.
27479............... .............. A Surgery to stop leg 12.78 NA 9.86 2.18 NA 24.82 090
growth.
27485............... .............. A Surgery to stop leg 8.83 NA 7.38 1.50 NA 17.71 090
growth.
27486............... .............. A Revise/replace knee 19.24 NA 13.34 3.26 NA 35.84 090
joint.
27487............... .............. A Revise/replace knee 25.23 NA 16.41 4.27 NA 45.91 090
joint.
27488............... .............. A Removal of knee 15.72 NA 11.54 2.67 NA 29.93 090
prosthesis.
27495............... .............. A Reinforce thigh...... 15.53 NA 11.47 2.63 NA 29.63 090
27496............... .............. A Decompression of 6.10 NA 5.72 0.93 NA 12.75 090
thigh/knee.
27497............... .............. A Decompression of 7.16 NA 5.66 1.01 NA 13.83 090
thigh/knee.
27498............... .............. A Decompression of 7.98 NA 6.11 1.17 NA 15.26 090
thigh/knee.
27499............... .............. A Decompression of 8.99 NA 6.99 1.42 NA 17.40 090
thigh/knee.
27500............... .............. A Treatment of thigh 5.91 7.01 4.99 0.96 13.88 11.86 090
fracture.
27501............... .............. A Treatment of thigh 5.91 7.57 5.66 1.00 14.48 12.57 090
fracture.
27502............... .............. A Treatment of thigh 10.56 NA 8.10 1.80 NA 20.46 090
fracture.
27503............... .............. A Treatment of thigh 10.56 NA 8.26 1.80 NA 20.62 090
fracture.
27506............... .............. A Treatment of thigh 17.42 NA 12.70 2.81 NA 32.93 090
fracture.
27507............... .............. A Treatment of thigh 13.97 NA 9.88 2.35 NA 26.20 090
fracture.
27508............... .............. A Treatment of thigh 5.82 6.97 5.32 0.96 13.75 12.10 090
fracture.
27509............... .............. A Treatment of thigh 7.70 NA 7.90 1.30 NA 16.90 090
fracture.
27510............... .............. A Treatment of thigh 9.12 NA 7.17 1.52 NA 17.81 090
fracture.
27511............... .............. A Treatment of thigh 13.62 NA 11.19 2.30 NA 27.11 090
fracture.
27513............... .............. A Treatment of thigh 17.89 NA 13.83 3.03 NA 34.75 090
fracture.
27514............... .............. A Treatment of thigh 17.27 NA 13.29 2.91 NA 33.47 090
fracture.
27516............... .............. A Treat thigh fx growth 5.36 7.27 5.38 0.89 13.52 11.63 090
plate.
27517............... .............. A Treat thigh fx growth 8.77 8.89 7.35 1.47 19.13 17.59 090
plate.
27519............... .............. A Treat thigh fx growth 15.00 NA 11.61 2.52 NA 29.13 090
plate.
27520............... .............. A Treat kneecap 2.86 5.22 3.41 0.46 8.54 6.73 090
fracture.
27524............... .............. A Treat kneecap 9.99 NA 8.14 1.69 NA 19.82 090
fracture.
27530............... .............. A Treat knee fracture.. 3.77 5.88 4.26 0.62 10.27 8.65 090
27532............... .............. A Treat knee fracture.. 7.29 7.82 6.26 1.23 16.34 14.78 090
27535............... .............. A Treat knee fracture.. 11.48 NA 10.09 1.94 NA 23.51 090
27536............... .............. A Treat knee fracture.. 15.63 NA 11.48 2.64 NA 29.75 090
27538............... .............. A Treat knee 4.86 7.07 5.08 0.81 12.74 10.75 090
fracture(s).
27540............... .............. A Treat knee fracture.. 13.08 NA 9.46 2.17 NA 24.71 090
27550............... .............. A Treat knee 5.75 6.57 4.92 0.82 13.14 11.49 090
dislocation.
27552............... .............. A Treat knee 7.89 NA 6.86 1.33 NA 16.08 090
dislocation.
27556............... .............. A Treat knee 14.39 NA 11.66 2.42 NA 28.47 090
dislocation.
27557............... .............. A Treat knee 16.74 NA 13.12 2.86 NA 32.72 090
dislocation.
27558............... .............. A Treat knee 17.69 NA 13.08 3.03 NA 33.80 090
dislocation.
27560............... .............. A Treat kneecap 3.81 5.58 3.29 0.48 9.87 7.58 090
dislocation.
27562............... .............. A Treat kneecap 5.78 NA 4.79 0.83 NA 11.40 090
dislocation.
27566............... .............. A Treat kneecap 12.21 NA 9.26 2.09 NA 23.56 090
dislocation.
27570............... .............. A Fixation of knee 1.74 NA 1.81 0.29 NA 3.84 010
joint.
27580............... .............. A Fusion of knee....... 19.34 NA 14.75 3.26 NA 37.35 090
27590............... .............. A Amputate leg at thigh 12.01 NA 7.10 1.63 NA 20.74 090
27591............... .............. A Amputate leg at thigh 12.66 NA 8.87 1.97 NA 23.50 090
27592............... .............. A Amputate leg at thigh 10.00 NA 6.59 1.41 NA 18.00 090
27594............... .............. A Amputation follow-up 6.91 NA 5.45 0.99 NA 13.35 090
surgery.
27596............... .............. A Amputation follow-up 10.58 NA 7.22 1.50 NA 19.30 090
surgery.
27598............... .............. A Amputate lower leg at 10.51 NA 7.32 1.50 NA 19.33 090
knee.
27599............... .............. C Leg surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY
27600............... .............. A Decompression of 5.64 NA 4.75 0.82 NA 11.21 090
lower leg.
27601............... .............. A Decompression of 5.63 NA 5.04 0.83 NA 11.50 090
lower leg.
[[Page 1139]]
27602............... .............. A Decompression of 7.34 NA 5.33 1.03 NA 13.70 090
lower leg.
27603............... .............. A Drain lower leg 4.93 10.64 4.85 0.68 16.25 10.46 090
lesion.
27604............... .............. A Drain lower leg bursa 4.46 8.58 4.53 0.65 13.69 9.64 090
27605............... .............. A Incision of achilles 2.87 8.80 2.34 0.46 12.13 5.67 010
tendon.
27606............... .............. A Incision of achilles 4.13 10.03 3.40 0.69 14.85 8.22 010
tendon.
27607............... .............. A Treat lower leg bone 7.96 NA 6.58 1.30 NA 15.84 090
lesion.
27610............... .............. A Explore/treat ankle 8.33 NA 7.06 1.39 NA 16.78 090
joint.
27612............... .............. A Exploration of ankle 7.32 NA 6.12 1.22 NA 14.66 090
joint.
27613............... .............. A Biopsy lower leg soft 2.17 3.77 1.76 0.19 6.13 4.12 010
tissue.
27614............... .............. A Biopsy lower leg soft 5.65 8.78 4.63 0.75 15.18 11.03 090
tissue.
27615............... .............. A Remove tumor, lower 12.54 NA 10.56 1.68 NA 24.78 090
leg.
27618............... .............. A Remove lower leg 5.08 9.10 4.21 0.65 14.83 9.94 090
lesion.
27619............... .............. A Remove lower leg 8.39 10.62 6.17 1.22 20.23 15.78 090
lesion.
27620............... .............. A Explore/treat ankle 5.97 NA 5.50 1.00 NA 12.47 090
joint.
27625............... .............. A Remove ankle joint 8.29 NA 6.54 1.40 NA 16.23 090
lining.
27626............... .............. A Remove ankle joint 8.90 NA 7.00 1.48 NA 17.38 090
lining.
27630............... .............. A Removal of tendon 4.79 8.99 4.46 0.72 14.50 9.97 090
lesion.
27635............... .............. A Remove lower leg bone 7.77 NA 6.84 1.28 NA 15.89 090
lesion.
27637............... .............. A Remove/graft leg bone 9.84 NA 8.35 1.66 NA 19.85 090
lesion.
27638............... .............. A Remove/graft leg bone 10.55 NA 8.39 1.77 NA 20.71 090
lesion.
27640............... .............. A Partial removal of 11.35 NA 10.81 1.86 NA 24.02 090
tibia.
27641............... .............. A Partial removal of 9.23 NA 8.83 1.47 NA 19.53 090
fibula.
27645............... .............. A Extensive lower leg 14.15 NA 12.34 2.39 NA 28.88 090
surgery.
27646............... .............. A Extensive lower leg 12.64 NA 11.34 1.87 NA 25.85 090
surgery.
27647............... .............. A Extensive ankle/heel 12.22 NA 7.85 1.98 NA 22.05 090
surgery.
27648............... .............. A Injection for ankle x- 0.96 9.45 0.33 0.06 10.47 1.35 000
ray.
27650............... .............. A Repair achilles 9.68 NA 7.51 1.63 NA 18.82 090
tendon.
27652............... .............. A Repair/graft achilles 10.31 NA 8.01 1.75 NA 20.07 090
tendon.
27654............... .............. A Repair of achilles 10.00 NA 7.23 1.70 NA 18.93 090
tendon.
27656............... .............. A Repair leg fascia 4.56 9.93 4.01 0.58 15.07 9.15 090
defect.
27658............... .............. A Repair of leg tendon, 4.97 9.18 4.77 0.82 14.97 10.56 090
each.
27659............... .............. A Repair of leg tendon, 6.80 11.30 5.80 1.16 19.26 13.76 090
each.
27664............... .............. A Repair of leg tendon, 4.58 11.26 4.74 0.76 16.60 10.08 090
each.
27665............... .............. A Repair of leg tendon, 5.39 11.05 5.18 0.90 17.34 11.47 090
each.
27675............... .............. A Repair lower leg 7.17 NA 5.79 1.22 NA 14.18 090
tendons.
27676............... .............. A Repair lower leg 8.41 NA 6.77 1.39 NA 16.57 090
tendons.
27680............... .............. A Release of lower leg 5.73 NA 5.19 0.96 NA 11.88 090
tendon.
27681............... .............. A Release of lower leg 6.81 NA 5.96 1.11 NA 13.88 090
tendons.
27685............... .............. A Revision of lower leg 6.49 8.11 5.51 1.10 15.70 13.10 090
tendon.
27686............... .............. A Revise lower leg 7.45 12.57 6.59 1.27 21.29 15.31 090
tendons.
27687............... .............. A Revision of calf 6.23 NA 5.42 1.06 NA 12.71 090
tendon.
27690............... .............. A Revise lower leg 8.70 NA 6.45 1.47 NA 16.62 090
tendon.
27691............... .............. A Revise lower leg 9.95 NA 7.81 1.69 NA 19.45 090
tendon.
27692............... .............. A Revise additional leg 1.87 NA 0.93 0.31 NA 3.11 ZZZ
tendon.
27695............... .............. A Repair of ankle 6.50 NA 5.92 1.09 NA 13.51 090
ligament.
27696............... .............. A Repair of ankle 8.26 NA 6.50 1.40 NA 16.16 090
ligaments.
27698............... .............. A Repair of ankle 9.35 NA 6.98 1.58 NA 17.91 090
ligament.
27700............... .............. A Revision of ankle 9.28 NA 5.62 1.50 NA 16.40 090
joint.
27702............... .............. A Reconstruct ankle 13.65 NA 10.32 2.32 NA 26.29 090
joint.
27703............... .............. A Reconstruction, ankle 15.85 NA 11.09 2.70 NA 29.64 090
joint.
27704............... .............. A Removal of ankle 7.61 NA 5.52 0.74 NA 13.87 090
implant.
27705............... .............. A Incision of tibia.... 10.36 NA 8.23 1.74 NA 20.33 090
27707............... .............. A Incision of fibula... 4.36 NA 5.01 0.72 NA 10.09 090
27709............... .............. A Incision of tibia & 9.94 NA 8.16 1.68 NA 19.78 090
fibula.
27712............... .............. A Realignment of lower 14.23 NA 10.72 2.41 NA 27.36 090
leg.
27715............... .............. A Revision of lower leg 14.37 NA 10.84 2.41 NA 27.62 090
27720............... .............. A Repair of tibia...... 11.77 NA 9.45 2.00 NA 23.22 090
27722............... .............. A Repair/graft of tibia 11.80 NA 9.21 1.99 NA 23.00 090
27724............... .............. A Repair/graft of tibia 18.17 NA 12.45 2.53 NA 33.15 090
27725............... .............. A Repair of lower leg.. 15.57 NA 11.88 2.65 NA 30.10 090
27727............... .............. A Repair of lower leg.. 13.99 NA 10.41 2.22 NA 26.62 090
27730............... .............. A Repair of tibia 7.40 17.74 6.45 0.90 26.04 14.75 090
epiphysis.
27732............... .............. A Repair of fibula 5.31 11.60 5.00 0.76 17.67 11.07 090
epiphysis.
27734............... .............. A Repair lower leg 8.47 NA 6.42 1.03 NA 15.92 090
epiphyses.
27740............... .............. A Repair of leg 9.29 20.61 7.93 1.58 31.48 18.80 090
epiphyses.
27742............... .............. A Repair of leg 10.28 12.50 7.26 1.87 24.65 19.41 090
epiphyses.
27745............... .............. A Reinforce tibia...... 10.05 NA 8.21 1.66 NA 19.92 090
27750............... .............. A Treatment of tibia 3.19 5.37 3.77 0.52 9.08 7.48 090
fracture.
27752............... .............. A Treatment of tibia 5.83 7.38 5.49 0.99 14.20 12.31 090
fracture.
27756............... .............. A Treatment of tibia 6.77 NA 6.52 1.13 NA 14.42 090
fracture.
27758............... .............. A Treatment of tibia 11.65 NA 9.19 1.83 NA 22.67 090
fracture.
27759............... .............. A Treatment of tibia 13.74 NA 10.32 2.33 NA 26.39 090
fracture.
27760............... .............. A Treatment of ankle 3.01 5.25 3.53 0.47 8.73 7.01 090
fracture.
27762............... .............. A Treatment of ankle 5.24 7.12 5.16 0.86 13.22 11.26 090
fracture.
27766............... .............. A Treatment of ankle 8.35 NA 7.16 1.41 NA 16.92 090
fracture.
[[Page 1140]]
27780............... .............. A Treatment of fibula 2.65 4.92 3.21 0.40 7.97 6.26 090
fracture.
27781............... .............. A Treatment of fibula 4.39 6.35 4.49 0.69 11.43 9.57 090
fracture.
27784............... .............. A Treatment of fibula 7.10 NA 6.45 1.18 NA 14.73 090
fracture.
27786............... .............. A Treatment of ankle 2.84 5.09 3.33 0.45 8.38 6.62 090
fracture.
27788............... .............. A Treatment of ankle 4.44 6.46 4.50 0.74 11.64 9.68 090
fracture.
27792............... .............. A Treatment of ankle 7.65 NA 6.90 1.29 NA 15.84 090
fracture.
27808............... .............. A Treatment of ankle 2.83 5.68 3.60 0.46 8.97 6.89 090
fracture.
27810............... .............. A Treatment of ankle 5.12 6.95 4.99 0.86 12.93 10.97 090
fracture.
27814............... .............. A Treatment of ankle 10.66 NA 8.55 1.81 NA 21.02 090
fracture.
27816............... .............. A Treatment of ankle 2.89 4.99 3.40 0.45 8.33 6.74 090
fracture.
27818............... .............. A Treatment of ankle 5.49 7.06 5.04 0.89 13.44 11.42 090
fracture.
27822............... .............. A Treatment of ankle 10.98 NA 10.63 1.56 NA 23.17 090
fracture.
27823............... .............. A Treatment of ankle 12.98 NA 11.49 1.99 NA 26.46 090
fracture.
27824............... .............. A Treat lower leg 2.89 5.56 3.74 0.47 8.92 7.10 090
fracture.
27825............... .............. A Treat lower leg 6.18 8.19 5.86 1.03 15.40 13.07 090
fracture.
27826............... .............. A Treat lower leg 8.53 NA 8.87 1.44 NA 18.84 090
fracture.
27827............... .............. A Treat lower leg 14.04 NA 12.71 2.36 NA 29.11 090
fracture.
27828............... .............. A Treat lower leg 16.21 NA 13.85 2.74 NA 32.80 090
fracture.
27829............... .............. A Treat lower leg joint 5.48 NA 6.77 0.93 NA 13.18 090
27830............... .............. A Treat lower leg 3.78 5.12 3.83 0.53 9.43 8.14 090
dislocation.
27831............... .............. A Treat lower leg 4.55 NA 4.43 0.74 NA 9.72 090
dislocation.
27832............... .............. A Treat lower leg 6.48 NA 6.16 1.10 NA 13.74 090
dislocation.
27840............... .............. A Treat ankle 4.57 NA 3.89 0.57 NA 9.03 090
dislocation.
27842............... .............. A Treat ankle 6.20 NA 5.08 0.92 NA 12.20 090
dislocation.
27846............... .............. A Treat ankle 9.78 NA 7.91 1.64 NA 19.33 090
dislocation.
27848............... .............. A Treat ankle 11.18 NA 9.71 1.87 NA 22.76 090
dislocation.
27860............... .............. A Fixation of ankle 2.34 NA 2.01 0.37 NA 4.72 010
joint.
27870............... .............. A Fusion of ankle 13.89 NA 10.50 2.35 NA 26.74 090
joint, open.
27871............... .............. A Fusion of 9.16 NA 7.62 1.56 NA 18.34 090
tibiofibular joint.
27880............... .............. A Amputation of lower 11.83 NA 7.46 1.66 NA 20.95 090
leg.
27881............... .............. A Amputation of lower 12.32 NA 9.01 1.92 NA 23.25 090
leg.
27882............... .............. A Amputation of lower 8.93 NA 6.93 1.24 NA 17.10 090
leg.
27884............... .............. A Amputation follow-up 8.20 NA 6.10 1.15 NA 15.45 090
surgery.
27886............... .............. A Amputation follow-up 9.31 NA 6.82 1.36 NA 17.49 090
surgery.
27888............... .............. A Amputation of foot at 9.66 NA 7.60 1.52 NA 18.78 090
ankle.
27889............... .............. A Amputation of foot at 9.97 NA 6.74 1.44 NA 18.15 090
ankle.
27892............... .............. A Decompression of leg. 7.38 NA 5.85 1.04 NA 14.27 090
27893............... .............. A Decompression of leg. 7.34 NA 5.74 1.09 NA 14.17 090
27894............... .............. A Decompression of leg. 10.47 NA 7.93 1.51 NA 19.91 090
27899............... .............. C Leg/ankle surgery 0.00 0.00 0.00 0.00 0.00 0.00 YYY
procedure.
28001............... .............. A Drainage of bursa of 2.73 5.82 3.51 0.37 8.92 6.61 010
foot.
28002............... .............. A Treatment of foot 4.61 7.22 4.64 0.68 12.51 9.93 010
infection.
28003............... .............. A Treatment of foot 8.40 7.68 6.04 1.24 17.32 15.68 090
infection.
28005............... .............. A Treat foot bone 8.67 NA 6.36 1.37 NA 16.40 090
lesion.
28008............... .............. A Incision of foot 4.44 5.68 3.55 0.68 10.80 8.67 090
fascia.
28010............... .............. A Incision of toe 2.84 5.53 2.91 0.47 8.84 6.22 090
tendon.
28011............... .............. A Incision of toe 4.13 7.42 4.24 0.70 12.25 9.07 090
tendons.
28020............... .............. A Exploration of foot 5.00 7.07 4.20 0.77 12.84 9.97 090
joint.
28022............... .............. A Exploration of foot 4.66 6.09 3.93 0.75 11.50 9.34 090
joint.
28024............... .............. A Exploration of toe 4.37 6.20 3.99 0.60 11.17 8.96 090
joint.
28030............... .............. A Removal of foot nerve 6.14 NA 3.58 1.03 NA 10.75 090
28035............... .............. A Decompression of 5.08 5.54 4.03 0.86 11.48 9.97 090
tibia nerve.
28043............... .............. A Excision of foot 3.53 5.79 3.28 0.54 9.86 7.35 090
lesion.
28045............... .............. A Excision of foot 4.71 6.12 3.71 0.75 11.58 9.17 090
lesion.
28046............... .............. A Resection of tumor, 10.16 9.42 7.34 1.36 20.94 18.86 090
foot.
28050............... .............. A Biopsy of foot joint 4.24 5.78 3.66 0.66 10.68 8.56 090
lining.
28052............... .............. A Biopsy of foot joint 3.93 5.97 3.56 0.62 10.52 8.11 090
lining.
28054............... .............. A Biopsy of toe joint 3.44 5.82 3.36 0.54 9.80 7.34 090
lining.
28060............... .............. A Partial removal, foot 5.22 6.39 4.03 0.83 12.44 10.08 090
fascia.
28062............... .............. A Removal of foot 6.51 7.13 4.19 1.03 14.67 11.73 090
fascia.
28070............... .............. A Removal of foot joint 5.09 5.96 3.89 0.82 11.87 9.80 090
lining.
28072............... .............. A Removal of foot joint 4.57 6.43 4.32 0.77 11.77 9.66 090
lining.
28080............... .............. A Removal of foot 3.57 5.93 3.70 0.60 10.10 7.87 090
lesion.
28086............... .............. A Excise foot tendon 4.77 9.50 4.69 0.80 15.07 10.26 090
sheath.
28088............... .............. A Excise foot tendon 3.85 7.04 4.00 0.63 11.52 8.48 090
sheath.
28090............... .............. A Removal of foot 4.40 6.02 3.55 0.69 11.11 8.64 090
lesion.
28092............... .............. A Removal of toe 3.63 6.33 3.61 0.55 10.51 7.79 090
lesions.
28100............... .............. A Removal of ankle/heel 5.65 9.21 4.81 0.92 15.78 11.38 090
lesion.
28102............... .............. A Remove/graft foot 7.72 NA 6.05 1.17 NA 14.94 090
lesion.
28103............... .............. A Remove/graft foot 6.49 8.41 4.76 1.07 15.97 12.32 090
lesion.
28104............... .............. A Removal of foot 5.11 6.35 4.05 0.83 12.29 9.99 090
lesion.
28106............... .............. A Remove/graft foot 7.15 NA 4.59 1.22 NA 12.96 090
lesion.
28107............... .............. A Remove/graft foot 5.55 7.24 4.32 0.89 13.68 10.76 090
lesion.
28108............... .............. A Removal of toe 4.15 5.44 3.36 0.63 10.22 8.14 090
lesions.
28110............... .............. A Part removal of 4.07 6.03 3.68 0.59 10.69 8.34 090
metatarsal.
[[Page 1141]]
28111............... .............. A Part removal of 5.00 7.18 4.18 0.76 12.94 9.94 090
metatarsal.
28112............... .............. A Part removal of 4.48 6.69 4.06 0.72 11.89 9.26 090
metatarsal.
28113............... .............. A Part removal of 4.78 6.81 4.66 0.76 12.35 10.20 090
metatarsal.
28114............... .............. A Removal of metatarsal 9.78 11.93 8.52 1.64 23.35 19.94 090
heads.
28116............... .............. A Revision of foot..... 7.74 7.20 5.22 1.24 16.18 14.20 090
28118............... .............. A Removal of heel bone. 5.95 7.13 4.53 0.95 14.03 11.43 090
28119............... .............. A Removal of heel spur. 5.38 6.21 3.87 0.89 12.48 10.14 090
28120............... .............. A Part removal of ankle/ 5.39 8.67 5.07 0.83 14.89 11.29 090
heel.
28122............... .............. A Partial removal of 7.28 7.89 5.69 1.16 16.33 14.13 090
foot bone.
28124............... .............. A Partial removal of 4.80 6.08 4.06 0.78 11.66 9.64 090
toe.
28126............... .............. A Partial removal of 3.51 5.34 3.51 0.59 9.44 7.61 090
toe.
28130............... .............. A Removal of ankle bone 8.10 NA 6.70 1.34 NA 16.14 090
28140............... .............. A Removal of metatarsal 6.90 8.26 5.00 1.01 16.17 12.91 090
28150............... .............. A Removal of toe....... 4.08 5.98 3.78 0.63 10.69 8.49 090
28153............... .............. A Partial removal of 3.65 5.40 3.08 0.59 9.64 7.32 090
toe.
28160............... .............. A Partial removal of 3.73 5.68 3.83 0.62 10.03 8.18 090
toe.
28171............... .............. A Extensive foot 9.59 NA 5.69 1.36 NA 16.64 090
surgery.
28173............... .............. A Extensive foot 8.79 8.26 5.64 1.25 18.30 15.68 090
surgery.
28175............... .............. A Extensive foot 6.04 6.68 4.10 0.90 13.62 11.04 090
surgery.
28190............... .............. A Removal of foot 1.96 6.51 3.47 0.19 8.66 5.62 010
foreign body.
28192............... .............. A Removal of foot 4.63 6.43 3.72 0.63 11.69 8.98 090
foreign body.
28193............... .............. A Removal of foot 5.72 6.35 4.11 0.76 12.83 10.59 090
foreign body.
28200............... .............. A Repair of foot tendon 4.59 5.94 3.71 0.71 11.24 9.01 090
28202............... .............. A Repair/graft of foot 6.83 8.16 4.63 1.04 16.03 12.50 090
tendon.
28208............... .............. A Repair of foot tendon 4.36 5.72 3.46 0.71 10.79 8.53 090
28210............... .............. A Repair/graft of foot 6.34 7.12 4.19 0.93 14.39 11.46 090
tendon.
28220............... .............. A Release of foot 4.52 5.56 3.56 0.76 10.84 8.84 090
tendon.
28222............... .............. A Release of foot 5.61 5.95 4.23 0.93 12.49 10.77 090
tendons.
28225............... .............. A Release of foot 3.65 5.26 3.07 0.60 9.51 7.32 090
tendon.
28226............... .............. A Release of foot 4.52 5.61 3.85 0.75 10.88 9.12 090
tendons.
28230............... .............. A Incision of foot 4.23 5.62 3.81 0.71 10.56 8.75 090
tendon(s).
28232............... .............. A Incision of toe 3.38 5.66 3.44 0.58 9.62 7.40 090
tendon.
28234............... .............. A Incision of foot 3.36 5.81 3.47 0.55 9.72 7.38 090
tendon.
28238............... .............. A Revision of foot 7.72 7.97 5.07 1.30 16.99 14.09 090
tendon.
28240............... .............. A Release of big toe... 4.35 5.59 3.63 0.74 10.68 8.72 090
28250............... .............. A Revision of foot 5.91 6.53 4.25 0.98 13.42 11.14 090
fascia.
28260............... .............. A Release of midfoot 7.95 7.09 5.14 1.30 16.34 14.39 090
joint.
28261............... .............. A Revision of foot 11.71 8.91 7.34 2.00 22.62 21.05 090
tendon.
28262............... .............. A Revision of foot and 15.81 14.32 11.44 2.68 32.81 29.93 090
ankle.
28264............... .............. A Release of midfoot 10.33 8.51 7.82 1.76 20.60 19.91 090
joint.
28270............... .............. A Release of foot 4.75 5.90 4.19 0.81 11.46 9.75 090
contracture.
28272............... .............. A Release of toe joint, 3.79 5.14 3.04 0.63 9.56 7.46 090
each.
28280............... .............. A Fusion of toes....... 5.18 7.25 4.52 0.87 13.30 10.57 090
28285............... .............. A Repair of hammertoe.. 4.58 5.96 3.85 0.77 11.31 9.20 090
28286............... .............. A Repair of hammertoe.. 4.55 5.74 3.67 0.77 11.06 8.99 090
28288............... .............. A Partial removal of 4.73 6.69 5.30 0.78 12.20 10.81 090
foot bone.
28289............... .............. A Repair hallux rigidus 7.03 8.97 6.21 1.16 17.16 14.40 090
28290............... .............. A Correction of bunion. 5.65 7.02 5.28 0.95 13.62 11.88 090
28292............... .............. A Correction of bunion. 7.03 7.80 5.75 1.18 16.01 13.96 090
28293............... .............. A Correction of bunion. 9.14 10.84 6.01 1.54 21.52 16.69 090
28294............... .............. A Correction of bunion. 8.55 7.64 5.08 1.40 17.59 15.03 090
28296............... .............. A Correction of bunion. 9.17 8.14 5.80 1.54 18.85 16.51 090
28297............... .............. A Correction of bunion. 9.17 9.11 6.74 1.58 19.86 17.49 090
28298............... .............. A Correction of bunion. 7.93 7.31 5.40 1.35 16.59 14.68 090
28299............... .............. A Correction of bunion. 10.56 8.71 6.41 1.50 20.77 18.47 090
28300............... .............. A Incision of heel bone 9.53 13.10 7.07 1.58 24.21 18.18 090
28302............... .............. A Incision of ankle 9.54 13.11 6.95 1.39 24.04 17.88 090
bone.
28304............... .............. A Incision of midfoot 9.15 8.16 5.80 1.21 18.52 16.16 090
bones.
28305............... .............. A Incise/graft midfoot 10.48 10.90 6.80 0.66 22.04 17.94 090
bones.
28306............... .............. A Incision of 5.85 7.19 4.25 0.98 14.02 11.08 090
metatarsal.
28307............... .............. A Incision of 6.32 11.59 5.33 0.86 18.77 12.51 090
metatarsal.
28308............... .............. A Incision of 5.28 6.07 3.76 0.89 12.24 9.93 090
metatarsal.
28309............... .............. A Incision of 12.76 NA 8.05 1.98 NA 22.79 090
metatarsals.
28310............... .............. A Revision of big toe.. 5.42 6.24 3.96 0.92 12.58 10.30 090
28312............... .............. A Revision of toe...... 4.54 5.98 4.11 0.75 11.27 9.40 090
28313............... .............. A Repair deformity of 5.00 6.43 5.45 0.82 12.25 11.27 090
toe.
28315............... .............. A Removal of sesamoid 4.85 5.82 3.67 0.80 11.47 9.32 090
bone.
28320............... .............. A Repair of foot bones. 9.17 NA 6.76 1.53 NA 17.46 090
28322............... .............. A Repair of metatarsals 8.33 10.13 6.33 1.41 19.87 16.07 090
28340............... .............. A Resect enlarged toe 6.97 7.06 4.41 1.18 15.21 12.56 090
tissue.
28341............... .............. A Resect enlarged toe.. 8.40 7.23 4.95 1.42 17.05 14.77 090
28344............... .............. A Repair extra toe(s).. 4.25 6.78 3.69 0.72 11.75 8.66 090
28345............... .............. A Repair webbed toe(s). 5.91 6.99 4.79 1.01 13.91 11.71 090
28360............... .............. A Reconstruct cleft 13.32 NA 10.50 2.27 NA 26.09 090
foot.
28400............... .............. A Treatment of heel 2.16 4.28 2.98 0.35 6.79 5.49 090
fracture.
[[Page 1142]]
28405............... .............. A Treatment of heel 4.56 5.51 4.53 0.76 10.83 9.85 090
fracture.
28406............... .............. A Treatment of heel 6.30 NA 6.80 1.05 NA 14.15 090
fracture.
28415............... .............. A Treat heel fracture.. 15.95 NA 13.24 2.70 NA 31.89 090
28420............... .............. A Treat/graft heel 16.62 NA 12.97 2.76 NA 32.35 090
fracture.
28430............... .............. A Treatment of ankle 2.09 4.07 2.61 0.33 6.49 5.03 090
fracture.
28435............... .............. A Treatment of ankle 3.39 4.49 3.63 0.57 8.45 7.59 090
fracture.
28436............... .............. A Treatment of ankle 4.70 NA 5.90 0.80 NA 11.40 090
fracture.
28445............... .............. A Treat ankle fracture. 15.60 NA 11.02 1.56 NA 28.18 090
28450............... .............. A Treat midfoot 1.90 4.07 2.52 0.30 6.27 4.72 090
fracture, each.
28455............... .............. A Treat midfoot 3.09 3.97 3.41 0.52 7.58 7.02 090
fracture, each.
28456............... .............. A Treat midfoot 2.68 NA 4.21 0.43 NA 7.32 090
fracture.
28465............... .............. A Treat midfoot 7.00 NA 6.37 1.05 NA 14.42 090
fracture, each.
28470............... .............. A Treat metatarsal 1.99 3.87 2.48 0.31 6.17 4.78 090
fracture.
28475............... .............. A Treat metatarsal 2.97 4.05 3.19 0.49 7.51 6.65 090
fracture.
28476............... .............. A Treat metatarsal 3.37 NA 4.99 0.55 NA 8.91 090
fracture.
28485............... .............. A Treat metatarsal 5.70 NA 5.55 0.96 NA 12.21 090
fracture.
28490............... .............. A Treat big toe 1.09 2.21 1.73 0.16 3.46 2.98 090
fracture.
28495............... .............. A Treat big toe 1.58 2.50 2.06 0.23 4.31 3.87 090
fracture.
28496............... .............. A Treat big toe 2.33 9.72 3.63 0.39 12.44 6.35 090
fracture.
28505............... .............. A Treat big toe 3.80 9.71 4.70 0.60 14.11 9.10 090
fracture.
28510............... .............. A Treatment of toe 1.09 1.98 1.69 0.16 3.23 2.94 090
fracture.
28515............... .............. A Treatment of toe 1.46 2.33 1.99 0.21 4.00 3.66 090
fracture.
28525............... .............. A Treat toe fracture... 3.32 9.30 4.25 0.53 13.15 8.10 090
28530............... .............. A Treat sesamoid bone 1.06 2.08 1.46 0.16 3.30 2.68 090
fracture.
28531............... .............. A Treat sesamoid bone 2.35 8.98 2.51 0.40 11.73 5.26 090
fracture.
28540............... .............. A Treat foot 2.04 2.87 2.67 0.29 5.20 5.00 090
dislocation.
28545............... .............. A Treat foot 2.45 2.86 2.86 0.40 5.71 5.71 090
dislocation.
28546............... .............. A Treat foot 3.20 7.89 4.84 0.55 11.64 8.59 090
dislocation.
28555............... .............. A Repair foot 6.29 11.49 6.54 1.06 18.84 13.89 090
dislocation.
28570............... .............. A Treat foot 1.66 2.89 2.29 0.27 4.82 4.22 090
dislocation.
28575............... .............. A Treat foot 3.31 4.37 4.03 0.54 8.22 7.88 090
dislocation.
28576............... .............. A Treat foot 4.16 10.15 5.51 0.68 14.99 10.35 090
dislocation.
28585............... .............. A Repair foot 7.98 8.14 6.53 1.36 17.48 15.87 090
dislocation.
28600............... .............. A Treat foot 1.89 3.29 2.66 0.29 5.47 4.84 090
dislocation.
28605............... .............. A Treat foot 2.71 3.74 3.61 0.42 6.87 6.74 090
dislocation.
28606............... .............. A Treat foot 4.89 16.02 6.01 0.82 21.73 11.72 090
dislocation.
28615............... .............. A Repair foot 7.76 NA 7.98 1.31 NA 17.05 090
dislocation.
28630............... .............. A Treat toe dislocation 1.70 1.22 1.12 0.21 3.13 3.03 010
28635............... .............. A Treat toe dislocation 1.91 1.66 1.49 0.29 3.86 3.69 010
28636............... .............. A Treat toe dislocation 2.77 6.14 3.07 0.47 9.38 6.31 010
28645............... .............. A Repair toe 4.21 5.66 3.50 0.70 10.57 8.41 090
dislocation.
28660............... .............. A Treat toe dislocation 1.23 1.61 1.16 0.13 2.97 2.52 010
28665............... .............. A Treat toe dislocation 1.92 1.65 1.63 0.29 3.86 3.84 010
28666............... .............. A Treat toe dislocation 2.66 5.93 2.24 0.46 9.05 5.36 010
28675............... .............. A Repair of toe 2.92 8.81 3.77 0.49 12.22 7.18 090
dislocation.
28705............... .............. A Fusion of foot bones. 18.77 NA 12.43 2.57 NA 33.77 090
28715............... .............. A Fusion of foot bones. 13.08 NA 9.74 2.22 NA 25.04 090
28725............... .............. A Fusion of foot bones. 11.59 NA 8.30 1.97 NA 21.86 090
28730............... .............. A Fusion of foot bones. 10.74 NA 8.47 1.82 NA 21.03 090
28735............... .............. A Fusion of foot bones. 10.83 NA 7.86 1.82 NA 20.51 090
28737............... .............. A Revision of foot 9.63 NA 6.87 1.64 NA 18.14 090
bones.
28740............... .............. A Fusion of foot bones. 8.01 11.59 6.43 1.36 20.96 15.80 090
28750............... .............. A Fusion of big toe 7.29 12.97 6.59 1.24 21.50 15.12 090
joint.
28755............... .............. A Fusion of big toe 4.73 6.83 3.86 0.80 12.36 9.39 090
joint.
28760............... .............. A Fusion of big toe 7.74 8.04 5.62 1.29 17.07 14.65 090
joint.
28800............... .............. A Amputation of midfoot 8.20 NA 6.04 1.18 NA 15.42 090
28805............... .............. A Amputation thru 8.38 NA 5.90 1.17 NA 15.45 090
metatarsal.
28810............... .............. A Amputation toe & 6.20 NA 4.76 0.84 NA 11.80 090
metatarsal.
28820............... .............. A Amputation of toe.... 4.40 8.50 4.10 0.62 13.52 9.12 090
28825............... .............. A Partial amputation of 3.58 7.91 3.79 0.52 12.01 7.89 090
toe.
28899............... .............. C Foot/toes surgery 0.00 0.00 0.00 0.00 0.00 0.00 YYY
procedure.
29000............... .............. A Application of body 2.25 3.09 1.72 0.36 5.70 4.33 000
cast.
29010............... .............. A Application of body 2.06 3.30 1.73 0.33 5.69 4.12 000
cast.
29015............... .............. A Application of body 2.41 3.01 1.58 0.25 5.67 4.24 000
cast.
29020............... .............. A Application of body 2.11 3.30 1.41 0.19 5.60 3.71 000
cast.
29025............... .............. A Application of body 2.40 3.22 1.83 0.31 5.93 4.54 000
cast.
29035............... .............. A Application of body 1.77 3.45 1.54 0.29 5.51 3.60 000
cast.
29040............... .............. A Application of body 2.22 2.57 1.51 0.42 5.21 4.15 000
cast.
29044............... .............. A Application of body 2.12 3.80 1.85 0.35 6.27 4.32 000
cast.
29046............... .............. A Application of body 2.41 3.27 2.02 0.41 6.09 4.84 000
cast.
29049............... .............. A Application of figure 0.89 1.24 0.54 0.14 2.27 1.57 000
eight.
29055............... .............. A Application of 1.78 2.81 1.43 0.29 4.88 3.50 000
shoulder cast.
29058............... .............. A Application of 1.31 1.50 0.73 0.17 2.98 2.21 000
shoulder cast.
29065............... .............. A Application of long 0.87 1.26 0.74 0.14 2.27 1.75 000
arm cast.
29075............... .............. A Application of 0.77 1.20 0.67 0.13 2.10 1.57 000
forearm cast.
[[Page 1143]]
29085............... .............. A Apply hand/wrist cast 0.87 1.23 0.63 0.13 2.23 1.63 000
29086............... .............. A Apply finger cast.... 0.62 0.93 0.51 0.07 1.62 1.20 000
29105............... .............. A Apply long arm splint 0.87 1.18 0.52 0.13 2.18 1.52 000
29125............... .............. A Apply forearm splint. 0.59 0.99 0.40 0.07 1.65 1.06 000
29126............... .............. A Apply forearm splint. 0.77 1.19 0.46 0.07 2.03 1.30 000
29130............... .............. A Application of finger 0.50 0.45 0.17 0.06 1.01 0.73 000
splint.
29131............... .............. A Application of finger 0.55 0.73 0.24 0.04 1.32 0.83 000
splint.
29200............... .............. A Strapping of chest... 0.65 0.75 0.36 0.05 1.45 1.06 000
29220............... .............. A Strapping of low back 0.64 0.72 0.39 0.08 1.44 1.11 000
29240............... .............. A Strapping of shoulder 0.71 0.86 0.37 0.06 1.63 1.14 000
29260............... .............. A Strapping of elbow or 0.55 0.75 0.34 0.05 1.35 0.94 000
wrist.
29280............... .............. A Strapping of hand or 0.51 0.81 0.34 0.05 1.37 0.90 000
finger.
29305............... .............. A Application of hip 2.03 3.19 1.71 0.35 5.57 4.09 000
cast.
29325............... .............. A Application of hip 2.32 3.37 1.89 0.37 6.06 4.58 000
casts.
29345............... .............. A Application of long 1.40 1.69 1.04 0.23 3.32 2.67 000
leg cast.
29355............... .............. A Application of long 1.53 1.65 1.10 0.24 3.42 2.87 000
leg cast.
29358............... .............. A Apply long leg cast 1.43 1.96 1.07 0.23 3.62 2.73 000
brace.
29365............... .............. A Application of long 1.18 1.58 0.93 0.21 2.97 2.32 000
leg cast.
29405............... .............. A Apply short leg cast. 0.86 1.17 0.70 0.14 2.17 1.70 000
29425............... .............. A Apply short leg cast. 1.01 1.18 0.72 0.17 2.36 1.90 000
29435............... .............. A Apply short leg cast. 1.18 1.49 0.91 0.21 2.88 2.30 000
29440............... .............. A Addition of walker to 0.57 0.67 0.28 0.08 1.32 0.93 000
cast.
29445............... .............. A Apply rigid leg cast. 1.78 1.75 0.96 0.29 3.82 3.03 000
29450............... .............. A Application of leg 2.08 1.45 1.10 0.16 3.69 3.34 000
cast.
29505............... .............. A Application, long leg 0.69 1.15 0.46 0.07 1.91 1.22 000
splint.
29515............... .............. A Application lower leg 0.73 0.85 0.47 0.08 1.66 1.28 000
splint.
29520............... .............. A Strapping of hip..... 0.54 0.87 0.45 0.02 1.43 1.01 000
29530............... .............. A Strapping of knee.... 0.57 0.80 0.35 0.05 1.42 0.97 000
29540............... .............. A Strapping of ankle 0.51 0.41 0.32 0.05 0.97 0.88 000
and/or ft.
29550............... .............. A Strapping of toes.... 0.47 0.41 0.28 0.06 0.94 0.81 000
29580............... .............. A Application of paste 0.57 0.65 0.36 0.06 1.28 0.99 000
boot.
29590............... .............. A Application of foot 0.76 0.50 0.30 0.07 1.33 1.13 000
splint.
29700............... .............. A Removal/revision of 0.57 0.88 0.28 0.08 1.53 0.93 000
cast.
29705............... .............. A Removal/revision of 0.76 0.79 0.38 0.12 1.67 1.26 000
cast.
29710............... .............. A Removal/revision of 1.34 1.49 0.70 0.21 3.04 2.25 000
cast.
29715............... .............. A Removal/revision of 0.94 1.14 0.40 0.10 2.18 1.44 000
cast.
29720............... .............. A Repair of body cast.. 0.68 1.10 0.38 0.12 1.90 1.18 000
29730............... .............. A Windowing of cast.... 0.75 0.78 0.36 0.12 1.65 1.23 000
29740............... .............. A Wedging of cast...... 1.12 1.12 0.49 0.18 2.42 1.79 000
29750............... .............. A Wedging of clubfoot 1.26 1.04 0.58 0.19 2.49 2.03 000
cast.
29799............... .............. C Casting/strapping 0.00 0.00 0.00 0.00 0.00 0.00 YYY
procedure.
29800............... .............. A Jaw arthroscopy/ 6.42 NA 7.12 1.01 NA 14.55 090
surgery.
29804............... .............. A Jaw arthroscopy/ 8.13 NA 8.41 0.80 NA 17.34 090
surgery.
29805............... .............. A Shoulder arthroscopy, 5.88 NA 5.65 1.01 NA 12.54 090
dx.
29806............... .............. A Shoulder arthroscopy/ 14.35 NA 10.94 2.41 NA 27.70 090
surgery.
29807............... .............. A Shoulder arthroscopy/ 13.88 NA 10.78 2.34 NA 27.00 090
surgery.
29819............... .............. A Shoulder arthroscopy/ 7.61 NA 6.66 1.29 NA 15.56 090
surgery.
29820............... .............. A Shoulder arthroscopy/ 7.06 NA 6.12 1.19 NA 14.37 090
surgery.
29821............... .............. A Shoulder arthroscopy/ 7.71 NA 6.68 1.30 NA 15.69 090
surgery.
29822............... .............. A Shoulder arthroscopy/ 7.42 NA 6.56 1.25 NA 15.23 090
surgery.
29823............... .............. A Shoulder arthroscopy/ 8.16 NA 7.09 1.39 NA 16.64 090
surgery.
29824............... .............. A Shoulder arthroscopy/ 8.24 NA 7.33 1.39 NA 16.96 090
surgery.
29825............... .............. A Shoulder arthroscopy/ 7.61 NA 6.64 1.28 NA 15.53 090
surgery.
29826............... .............. A Shoulder arthroscopy/ 8.98 NA 7.41 1.52 NA 17.91 090
surgery.
29827............... .............. A Arthroscop rotator 15.34 NA 11.32 2.24 NA 28.90 090
cuff repr.
29830............... .............. A Elbow arthroscopy.... 5.75 NA 5.25 0.95 NA 11.95 090
29834............... .............. A Elbow arthroscopy/ 6.27 NA 5.72 1.04 NA 13.03 090
surgery.
29835............... .............. A Elbow arthroscopy/ 6.47 NA 5.77 1.06 NA 13.30 090
surgery.
29836............... .............. A Elbow arthroscopy/ 7.54 NA 6.66 1.28 NA 15.48 090
surgery.
29837............... .............. A Elbow arthroscopy/ 6.86 NA 6.02 1.16 NA 14.04 090
surgery.
29838............... .............. A Elbow arthroscopy/ 7.70 NA 6.76 1.29 NA 15.75 090
surgery.
29840............... .............. A Wrist arthroscopy.... 5.53 NA 5.24 0.83 NA 11.60 090
29843............... .............. A Wrist arthroscopy/ 6.00 NA 5.54 0.99 NA 12.53 090
surgery.
29844............... .............. A Wrist arthroscopy/ 6.36 NA 5.71 1.04 NA 13.11 090
surgery.
29845............... .............. A Wrist arthroscopy/ 7.51 NA 6.38 1.01 NA 14.90 090
surgery.
29846............... .............. A Wrist arthroscopy/ 6.74 NA 5.95 1.07 NA 13.76 090
surgery.
29847............... .............. A Wrist arthroscopy/ 7.07 NA 6.10 1.10 NA 14.27 090
surgery.
29848............... .............. A Wrist endoscopy/ 5.43 NA 5.49 0.87 NA 11.79 090
surgery.
29850............... .............. A Knee arthroscopy/ 8.18 NA 5.04 0.89 NA 14.11 090
surgery.
29851............... .............. A Knee arthroscopy/ 13.08 NA 9.66 2.18 NA 24.92 090
surgery.
29855............... .............. A Tibial arthroscopy/ 10.60 NA 8.60 1.81 NA 21.01 090
surgery.
29856............... .............. A Tibial arthroscopy/ 14.12 NA 10.51 2.41 NA 27.04 090
surgery.
29860............... .............. A Hip arthroscopy, dx.. 8.04 NA 6.82 1.37 NA 16.23 090
29861............... .............. A Hip arthroscopy/ 9.14 NA 7.22 1.56 NA 17.92 090
surgery.
29862............... .............. A Hip arthroscopy/ 9.89 NA 8.39 1.68 NA 19.96 090
surgery.
[[Page 1144]]
29863............... .............. A Hip arthroscopy/ 9.89 NA 8.34 1.69 NA 19.92 090
surgery.
29870............... .............. A Knee arthroscopy, dx. 5.06 NA 4.80 0.81 NA 10.67 090
29871............... .............. A Knee arthroscopy/ 6.54 NA 5.76 1.06 NA 13.36 090
drainage.
29873............... .............. A Knee arthroscopy/ 5.99 NA 6.37 0.88 NA 13.24 090
surgery.
29874............... .............. A Knee arthroscopy/ 7.04 NA 5.97 1.05 NA 14.06 090
surgery.
29875............... .............. A Knee arthroscopy/ 6.30 NA 5.74 1.06 NA 13.10 090
surgery.
29876............... .............. A Knee arthroscopy/ 7.91 NA 6.88 1.34 NA 16.13 090
surgery.
29877............... .............. A Knee arthroscopy/ 7.34 NA 6.59 1.24 NA 15.17 090
surgery.
29879............... .............. A Knee arthroscopy/ 8.03 NA 6.97 1.36 NA 16.36 090
surgery.
29880............... .............. A Knee arthroscopy/ 8.49 NA 7.21 1.44 NA 17.14 090
surgery.
29881............... .............. A