[Federal Register: August 26, 2005 (Volume 70, Number 165)]
[Proposed Rules]
[Page 50679-50886]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr26au05-42]
[[Page 50679]]
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Part III
Book 2 of 2 Books
Pages 50679-50948
Department of Health and Human Services
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Centers for Medicare & Medicaid Services
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42 CFR Parts 419 and 485
Medicare Program; Proposed Changes to the Hospital Outpatient
Prospective Payment System and Calendar Year 2006 Payment Rates;
Correction; Proposed Rule
[[Page 50680]]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 419 and 485
[CMS-1501-CN]
RIN 0938-AN46
Medicare Program; Proposed Changes to the Hospital Outpatient
Prospective Payment System and Calendar Year 2006 Payment Rates;
Correction
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Proposed rule; correction.
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SUMMARY: This document corrects technical errors that appeared in the
proposed rule published in the Federal Register on July 25, 2005
entitled ``Medicare Program; Proposed Changes to the Hospital
Outpatient Prospective Payment System and Calendar Year 2006 Payment
Rates; Proposed Rule.''
FOR FURTHER INFORMATION CONTACT: Rebecca Kane, (410) 786-0378.
SUPPLEMENTARY INFORMATION:
I. Background
FR Doc. 05-14448 contains our proposed rule to update the Medicare
Outpatient Prospective Payment System for calendar year (CY) 2006. We
have identified a number of technical errors in the ``Summary of
Errors'' section and are correcting them in the ``Correction of
Errors'' section below.
II. Summary of Errors
A. Corrections Related to the Rural Adjustment Calculation
The calendar year (CY) 2006 Outpatient Prospective Payment System
(OPPS) proposed rule that we published in the Federal Register on July
25, 2005 included a proposed 6.6 percent adjustment for rural sole
community hospitals. The calculations used to develop the conversion
factor and budget neutrality scalar inadvertently incorporated this
adjustment as 6.4 percent. The rural adjustment is used in calculations
that determine the scalar and conversion factor, and therefore affects
the payment rates and copayment amounts published in the proposed rule.
The corrected scalar is 1.003753831, and the corrected conversion
factor is $59.343. The various changes to the preamble are specified
under section III. of this correction notice. In addition to preamble
text changes, we are correcting specific tables and addenda which also
reflected the inadvertent use of a 6.4 percent rural adjustment factor,
which we have described below.
On page 42709, we published Table 11. We are correcting the last
column of this table to present the corrected proposed CY 2006 payment
amounts. In section III. of this notice, we republish Table 11 as
corrected.
On pages 42761-42762, we published Table 33. In section III. of
this notice, we republish Table 33 as corrected.
On pages 42764-42775, we published Addendum A, which provides the
payment rates and copayment amounts for Ambulatory Payment
Classification (APC) groups used for payment purposes under the OPPS. A
corrected Addendum A is posted on the OPPS Web site at http://www.cms.hhs.gov
/providers /hopps/2006p/1501p.asp.
On pages 42776-42965, we published Addendum B, which provides the
payment rates and copayment amounts for services payable under OPPS. A
corrected Addendum B, including additional technical errors affecting
HCPCS codes 78814, 78815, 78816, 91035, and 95950 is posted on the OPPS
Web site at http://www.cms.hhs.gov /providers /hopps/2006p/1501p.asp.
We are posting the corrected Addendum A and Addendum B on our Web
site rather than publishing them in this notice because of the large
volume of data included in these addenda. Hard copies of these tables
are available by contacting the CMS staff member identified above.
We note that as soon as we discovered these inadvertent errors that
affected the payment rates noted in the proposed rule, we posted the
corrections on the CMS Web site at: http://www.cms.hhs.gov /providers /
hopps/2006p/1501p.asp.
B. Other Corrections
We also noted other typographical, formatting, and other technical
errors in the proposed rule.
On page 42714, we published Table 15. The proposed ``unadjusted''
and ``adjusted'' CY 2006 APC median cost for APC 0085 Level II
Electrophysiologic Evaluation contained a typographical error and
should read $2,123.38. We are correcting this under section III. of
this notice.
On page 42761, column 2 includes a comparison that discusses the
differences in copayments from CY 2005 to CY 2006. While the analysis
of this example is correct, the example incorrectly identifies the
comparison as being the ``minimum unadjusted copayment'' rather than
the ``national unadjusted copayment''. We are making this correction
under section III. of this notice to refer to the ``national unadjusted
copayment''.
On page 42737, we published Table 26, which inadvertently excluded
C2636 (Brachytherapy linear source, Palladium -103, per 1 mm) which was
accurately described in the text of page 42736 as a proposed separately
payable brachytherapy source. In section III. of the notice we append
the excluded row to correct table 26 as published.
The other technical, typographical, formatting, and other errors
that appeared on various other pages of the Federal Register are
corrected as noted in section III. of this notice.
III. Correction of Errors
In FR Doc. 05-14448 of July 25, 2005 (70 FR 42674), make the
following corrections:
1. On page 42690, in column 3, in the last paragraph, in line 20,
the figure ``0.999207669'' is corrected to read ``1.003753831''.
2. On page 42691, in column 1, in the second full paragraph, line
8, the year ``2006'' is corrected to read ``2007''.
3. On page 42694,
a. In column 1, in the second full paragraph, in line 8, the figure
``$240.51'' is corrected to read ``$241.57''.
b. In column 1, in the second full paragraph, in line 8, the figure
``$48.10'' is corrected to read ``$48.31''.
c. In column 3, in the third full paragraph, in line 8, the figure
``1.002015212'' is corrected to read ``1.002023412''.
d. In column 3, in the third full paragraph, in line 18, the figure
``0.99652023'' is corrected to read ``0.99639633''.
e. In column 3, in the last partial paragraph, in line 5, the
figure ``1.002015212'' is corrected to read ``1.002023412''.
4. On page 42695,
a. In column 1, in the first partial paragraph, in line 5, the
figure ``0.99652023'' is corrected to read ``0.99639633''.
b. In column 1, in the first partial paragraph, in line 7, the
figure ``$59.350'' is corrected to read ``$59.343''.
5. On page 42703,
a. In column 1, in the second full paragraph, in line 5, the figure
``$9.95'' is corrected to read ``$7.00''.
b. In column 1, in the second full paragraph, in line 5, the figure
``40'' is corrected to read ``28''.
c. In column 1, in the second full paragraph, in line 6, the figure
``$24.89'' is corrected to read ``$25.00''.
6. On page 42709,
[[Page 50681]]
a. In column 1, in the first full paragraph, in line 22, the figure
``$1,297'' is corrected to read ``$1,274''.
b. In column 1, in the first full paragraph, in line 23, the figure
``$1,366'' is corrected to read ``$1,244''.
c. In column 1, in the first full paragraph, in line 25, the figure
``$1,100'' is corrected to read ``$1,025''.
d. Table 11 is corrected to read as follows:
Table 11.--Proposed APC Reassignment of New Technology Procedures Into Clinical APCs for CY 2006
----------------------------------------------------------------------------------------------------------------
Proposed
CY 2005 CY 2005 status Proposed Proposed CY 2006 CY 2005 CY 2006
HCPCS Descriptor APC indicator CY 2006 status payment payment
APC indicator amount amount
----------------------------------------------------------------------------------------------------------------
0027T.......... Endoscopic 1547 T 0220 T $850 $1,030.11
epidural lysis.
33225.......... L ventric pacing 1525 S 0418 T 3,750 6,486.45
lead add-on.
61623.......... Endovasc tempory 1555 T 0081 T 1,650 2,044.21
vessel occl.
92974.......... Cath place, cardio 1559 T 0103 T 2,250 873.18
brachytx.
93580.......... Transcath closure 1559 T 0434 T 2,250 5,387.61
of asd.
93581.......... Transcath closure 1559 T 0434 T 2,250 5,387.61
of vsd.
95965.......... Meg, spontaneous.. 1528 S 0430 T 5,250 676.75
95966.......... Meg, evoked, 1516 S 0430 T 1,450 676.75
single.
95967.......... Meg, evoked, each 1511 S 0430 T 950 676.75
add'l.
C9713.......... Non-contact laser 1525 S 0429 T 3,750 2,511.08
vap prosta.
----------------------------------------------------------------------------------------------------------------
7. On page 42710, in column 2, in the first full paragraph, in line
19, the figure ``$93.71'' is corrected to read ``$93.37''.
8. On page 42714, Table 15, APC 0085, in columns 5 and 7, in row 7,
both occurrences of the figure ``$2,123.46'' are corrected to read
``$2,123.38''.
9. On page 42737, Table 26, ``Proposed Separately payable
Brachytherapy Sources for CY 2006'' is appended with the following row:
----------------------------------------------------------------------------------------------------------------
New status
HCPCS Long descriptor APC APC title indicator
----------------------------------------------------------------------------------------------------------------
C2636........ Brachytherapy 2636 Brachytx linear source, P-103....................... H
linear source,
Palladium-103,
per 1mm.
----------------------------------------------------------------------------------------------------------------
10. On page 42756, in column 1, in the first partial paragraph, in
line 5, the figure ``1.8'' is corrected to read ``1.7''.
11. On page 42758, in column 2, in the third full paragraph, in
line 13, the figure ``$59.35'' is corrected to read ``$59.34''.
12. On page 42759,
a. In column 1, in the first partial paragraph, in line 21, the
figure ``5.8'' is corrected to read ``5.6''.
b. In column 1, in the first partial paragraph, in line 31, the
figure ``1.2'' is corrected to read ``1.3''.
c. In column 1, in the first partial paragraph, in line 31, the
figure ``1.8'' is corrected to read ``1.7''.
d. In column 1, in the first partial paragraph, in line 36, the
figure ``2.6'' is corrected to read ``2.5''.
e. In column 1, in the second partial paragraph, in line 22, the
figure ``2.9'' is corrected to read ``2.7''.
f. In column 1, in the second partial paragraph, in line 25, the
figure ``0.7'' is corrected to read ``0.6''.
g. In column 1, in the second partial paragraph, in line 30, the
text ``West South Central'' is corrected to read ``New England''.
h. In column 2, in the first partial paragraph, in line 2, the
figure ``1.9'' is corrected to read ``1.7''.
i. In column 2, in the first partial paragraph, in line 2, the
figure ``1.8'' is corrected to read ``1.6''.
j. In column 2, in the first full paragraph, in line 4, the figure
``0.4'' is corrected to read ``0.3''.
k. In column 2, in the first full paragraph, in line 5, the figure
``0.5'' is corrected to read ``0.3''.
l. In column 2, in the first full paragraph, in line 9, the figure
``0.9'' is corrected to read ``1.6''.
m. In column 2, in the first full paragraph, in line 10, the figure
``1.4'' is corrected to read ``2.2''.
n. In column 2, in the first full paragraph, in line 21, the
sentence portion ``1.3 percent and voluntary and government hospitals
will gain at least 0.1 percent.'' is corrected to read ``1.1 percent,
voluntary hospitals would gain 0.2 percent, and government hospitals
will see no changes as a result of changes to APC structure.''
o. In column 3, in the second full paragraph, in line 7, the figure
``0.997'' is corrected to read ``0.996''.
p. In column 3, in the second full paragraph, in line 10, the
figure ``0.3'' is corrected to read ``0.4''.
q. In column 3, in the second full paragraph, in line 13, the
figure ``5.2'' is corrected to read ``5.4''.
13. On page 42760,
a. In column 1, in the first partial paragraph, in line 6, the
figure ``0.3'' is corrected to read ``0.4''.
b. In column 1, in the first full paragraph, in line 19, the figure
``5.8'' is corrected to read ``5.6''.
c. In column 1, in the first full paragraph, in line 24, the figure
``-2.8'' is corrected to read ``-2.4''.
d. In column 1, in the first full paragraph, in line 32, the figure
``1.2'' is corrected to read ``1.3''.
e. In column 1, in the first full paragraph, in line 35, the figure
``0.3'' is corrected to read ``0.4''.
f. In column 1, in the first full paragraph, in line 37, the figure
``1.5'' is corrected to read ``1.4''.
g. In column 1, in the last paragraph, in line 7, the figure
``8.6'' is corrected to read ``8.7''.
h. In column 1, in the third partial paragraph, in line 12, the
figure ``5.0'' is corrected to read ``4.7''.
i. In column 3, in the first partial paragraph, in line 6, the
figure ``2.6'' is corrected to read ``2.5''.
j. In column 3, in the first partial paragraph, in line 12, the
figure ``2.1'' is corrected to read ``1.8''.
k. In column 3, in the first partial paragraph, in line 32, the
figure ``3.7'' is corrected to read ``3.6''.
[[Page 50682]]
l. In column 3, in the first full paragraph, in line 11, the figure
``3.4'' is corrected to read ``3.5''.
m. In column 3, in the first full paragraph, in line 13, the figure
``6.4'' is corrected to read ``6.5''.
n. In column 3, in the first full paragraph, in line 30, the text
``greater than'' is corrected to read ``of at least''.
o. In column 3, in the first full paragraph, in lines 33 and 34,
the figure ``only 1.0'' is corrected to read ``1.4'' and the text ``and
0.8 percent, respectively.'' is appended to the end of the sentence.
14. On page 42761
a. In column 1, in the first partial paragraph, in line 3, the
figure ``1.9'' is corrected to read ``2.6''.
b. In column 1, in the first partial paragraph, in line 6, the
figure ``2.6'' is corrected to read ``3.4''.
c. In column 1, in the first partial paragraph, in line 11, the
figure ``0.8'' is corrected to read ``0.6''.
d. In column 1, in line 12, the designation for the heading
``Estimated Impacts of This Proposed Rule on Beneficiaries'' is
corrected from ``G'' to read ``F''.
e. In column 1, in the second partial paragraph, in line 12, the
figure ``$11.86'' is corrected to read ``$11.91''.
f. In column 2, in the first partial paragraph, in lines 4 and 6,
the term ``minimum'' is corrected to read ``national''.
g. In column 2, in the first partial paragraph, in line 8, the
figure ``$223.91'' is corrected to read ``$224.91''.
h. Table 33 is corrected to read as follows:
Table 33.--Impact of Proposed Changes for CY 2006 Hospital Outpatient Prospective Payment System
----------------------------------------------------------------------------------------------------------------
Cumulative
New adj (Cols
Number of New for rural 2,3,4)
Hospital category APC wage sole with All
hospitals changes index community market changes
hospitals basket
update
(1) (2) (3) (4) (5) (6)
----------------------------------------------------
ALL HOSPITALS...................................... 4212 0.0 0.0 0.0 3.2 1.9
URBAN HOSPITALS.................................... 2949 0.0 0.0 -0.4 2.8 1.6
LARGE URBAN.................................... 1624 -0.8 0.0 -0.4 2.0 0.8
OTHER URBAN.................................... 1325 1.0 0.0 -0.4 3.8 2.5
RURAL HOSPITALS.................................... 1263 -0.1 0.1 1.8 5.0 3.5
SOLE COMMUNITY................................. 478 -0.1 0.0 5.4 8.7 6.5
OTHER RURAL.................................... 785 -0.1 0.1 -0.4 2.8 1.6
BEDS (URBAN):
0-99 BEDS...................................... 917 0.0 0.2 -0.4 3.0 2.1
100-199 BEDS................................... 964 -0.4 0.0 -0.4 2.5 1.5
200-299 BEDS................................... 503 0.2 0.1 -0.4 3.2 2.4
300-499 BEDS................................... 402 -0.1 -0.1 -0.4 2.6 1.5
500 + BEDS..................................... 163 0.3 0.0 -0.4 3.1 1.0
BEDS (RURAL):
0-49 BEDS...................................... 551 -0.9 0.2 2.1 4.6 3.1
50-100 BEDS.................................... 419 -0.8 0.2 2.3 4.8 3.0
101-149 BEDS................................... 180 1.4 0.0 1.1 5.8 4.7
150-199 BEDS................................... 62 -0.2 -0.2 1.8 4.7 3.7
200 + BEDS..................................... 51 0.1 0.0 1.7 5.1 3.1
VOLUME (URBAN):
LT 5,000 claim lines........................... 600 -5.6 0.5 -0.4 -2.4 -1.8
5,000-10,999................................... 180 -2.4 0.2 -0.4 0.5 0.6
11,000-20,999.................................. 299 -0.6 0.2 -0.4 2.4 2.5
21,000-42,999.................................. 575 -0.6 0.1 -0.4 2.3 1.9
GT 42,999...................................... 1295 0.2 0.0 -0.4 3.0 1.6
VOLUME (RURAL):
LT 5,000 claim lines........................... 119 -2.7 0.0 1.4 1.7 1.4
5,000-10,999................................... 195 -1.9 0.0 2.1 3.4 2.4
11,000-20,999.................................. 325 -0.9 -0.1 2.0 4.3 3.4
21,000-42,999.................................. 364 -0.9 0.2 1.9 4.5 3.0
GT 42,999...................................... 260 0.6 0.0 1.7 5.7 3.8
REGION (URBAN):
NEW ENGLAND.................................... 166 -1.3 -0.1 -0.4 1.4 -0.2
MIDDLE ATLANTIC................................ 393 0.6 -0.1 -0.4 3.4 2.1
SOUTH ATLANTIC................................. 453 -0.4 -0.4 -0.4 2.0 1.0
EAST NORTH CENT................................ 466 0.4 -0.1 -0.4 3.2 1.7
EAST SOUTH CENT................................ 197 1.5 0.0 -0.4 4.4 3.4
WEST NORTH CENT................................ 184 2.5 -0.3 -0.4 5.1 3.6
WEST SOUTH CENT................................ 445 -0.3 -0.1 -0.4 2.5 1.3
MOUNTAIN....................................... 163 -0.1 -0.2 -0.4 2.5 1.3
PACIFIC........................................ 431 -1.7 1.1 -0.4 2.2 1.4
PUERTO RICO.................................... 51 0.4 -0.3 -0.4 2.9 2.2
REGION (RURAL):
NEW ENGLAND.................................... 37 -1.1 0.9 1.2 4.2 0.8
MIDDLE ATLANTIC................................ 78 1.7 -0.4 1.4 6.0 4.1
SOUTH ATLANTIC................................. 189 -0.4 -0.2 1.7 4.4 3.3
EAST NORTH CENT................................ 171 -0.6 0.1 1.4 4.1 2.2
EAST SOUTH CENT................................ 202 -0.7 0.5 0.5 3.5 3.0
WEST NORTH CENT................................ 188 1.6 -0.3 2.6 7.2 4.7
[[Page 50683]]
WEST SOUTH CENT................................ 242 -0.9 -0.2 2.2 4.4 3.7
MOUNTAIN....................................... 95 -1.0 0.1 4.6 7.0 5.2
PACIFIC........................................ 61 -0.7 1.8 2.7 7.2 5.3
TEACHING STATUS:
NON-TEACHING................................... 3115 -0.3 0.1 0.3 3.2 2.3
MINOR.......................................... 769 0.3 0.0 -0.2 3.3 2.3
MAJOR.......................................... 328 0.3 -0.2 -0.3 3.0 0.6
DSH PATIENT PERCENT:
0.............................................. 16 0.3 0.0 -0.4 3.1 3.1
GT 0-0.10...................................... 386 0.1 -0.2 -0.3 2.8 1.7
0.10-0.16...................................... 555 0.0 0.1 0.2 3.5 2.4
0.16-0.23...................................... 802 0.1 0.0 0.1 3.5 2.3
0.23-0.35...................................... 977 0.1 -0.1 0.0 3.2 1.9
GE 0.35........................................ 792 -0.3 0.1 -0.1 3.0 1.8
TEFRA: DSH NOT AVAIL 1......................... 684 -1.6 0.0 -0.4 1.2 -2.6
URBAN TEACHING/DSH:
TEACHING & DSH................................. 944 0.4 -0.1 -0.4 3.1 1.7
NO TEACHING/DSH................................ 1401 -0.3 0.1 -0.4 2.5 1.8
NO TEACHING/NO DSH............................. 16 0.3 0.0 -0.4 3.1 3.1
TEFRA: DSH NOT AVAIL 1......................... 588 -2.2 0.1 -0.4 0.7 -3.4
TYPE OF OWNERSHIP:
VOLUNTARY...................................... 2397 0.2 0.0 0.0 3.3 2.0
PROPRIETARY.................................... 1091 -1.1 0.0 0.0 2.1 1.6
GOVERNMENT..................................... 724 0.0 0.1 0.2 3.6 1.7
----------------------------------------------------------------------------------------------------------------
Col (1) Total Hospitals in 2006.
Col (2) This column shows the impact of changes resulting from the reclassification of HCPCS codes among APC
groups and from the addition of multiple procedure discounting for radiology procedures (budget neutral
overall).
Col (3) This column shows the adjustment for updating the wage index (budget neutral overall).
Col (4) This column shows the adjustment for rural sole community hospitals (budget neutral overall).
Col (5) This column shows the cumulative impact of cols 2 through 4 and the addition of the market basket
update.
Col (6) The column shows the impact of the change in MMA dollars in 2006 (drugs and 508) and outlier changes.
1 Complete DSH numbers are not available for hospitals that are not paid under IPPS.
15. On pages 42764-42775, Addendum A is corrected to read as
follows:
[[Page 50684]]
Addendum A.--List of Ambulatory Payment Classifications (APCs) with Status Indicators, Relative Weights, Payment
Rates, and Copayment Amounts Calendar Year 2006
----------------------------------------------------------------------------------------------------------------
National Minimum
APC Group title SI Relative Payment unadjusted unadjusted
weight rate copayment copayment
----------------------------------------------------------------------------------------------------------------
0001........... Level I Photochemotherapy S............... 0.4213 $25.00 $7.00 $5.00
0002........... Level I Fine Needle T............... 0.9559 $56.73 ........... $11.35
Biopsy/Aspiration.
0003........... Bone Marrow Biopsy/ T............... 2.6530 $157.44 ........... $31.49
Aspiration.
0004........... Level I Needle Biopsy/ T............... 1.7646 $104.72 $22.36 $20.94
Aspiration Except Bone
Marrow.
0005........... Level II Needle Biopsy/ T............... 3.5994 $213.60 $71.59 $42.72
Aspiration Except Bone
Marrow.
0006........... Level I Incision & T............... 1.5500 $91.98 $22.28 $18.40
Drainage.
0007........... Level II Incision & T............... 11.4501 $679.48 ........... $135.90
Drainage.
0008........... Level III Incision and T............... 16.4989 $979.09 ........... $195.82
Drainage.
0009........... Nail Procedures.......... T............... 0.6680 $39.64 $8.34 $7.93
0010........... Level I Destruction of T............... 0.5719 $33.94 $9.65 $6.79
Lesion.
0011........... Level II Destruction of T............... 2.0839 $123.66 $25.17 $24.73
Lesion.
0012........... Level I Debridement & T............... 0.8497 $50.42 $11.18 $10.08
Destruction.
0013........... Level II Debridement & T............... 1.1078 $65.74 $14.20 $13.15
Destruction.
0015........... Level III Debridement & T............... 1.6514 $98.00 $20.29 $19.60
Destruction.
0016........... Level IV Debridement & T............... 2.5834 $153.31 $33.57 $30.66
Destruction.
0017........... Level VI Debridement & T............... 18.4211 $1,093.16 $227.84 $218.63
Destruction.
0018........... Biopsy of Skin/Puncture T............... 1.1726 $69.59 $16.04 $13.92
of Lesion.
0019........... Level I Excision/ Biopsy. T............... 4.0547 $240.62 $71.87 $48.12
0020........... Level II Excision/ Biopsy T............... 6.9433 $412.04 $107.40 $82.41
0021........... Level III Excision/ T............... 14.9776 $888.82 $219.48 $177.76
Biopsy.
0022........... Level IV Excision/ Biopsy T............... 19.6472 $1,165.92 $354.45 $233.18
0023........... Exploration Penetrating T............... 4.7775 $283.51 ........... $56.70
Wound.
0024........... Level I Skin Repair...... T............... 1.6084 $95.45 $31.25 $19.09
0025........... Level II Skin Repair..... T............... 5.4938 $326.02 $101.85 $65.20
0027........... Level IV Skin Repair..... T............... 18.4182 $1,092.99 $329.72 $218.60
0028........... Level I Breast Surgery... T............... 19.5801 $1,161.94 $303.74 $232.39
0029........... Level II Breast Surgery.. T............... 32.0476 $1,901.80 $632.64 $380.36
0030........... Level III Breast Surgery. T............... 40.0825 $2,378.62 $763.55 $475.72
0033........... Partial Hospitalization.. P............... 4.0708 $241.57 ........... $48.31
0035........... Venous Cutdown........... T............... 0.7158 $42.48 ........... $8.50
0036........... Level II Fine Needle T............... 2.1773 $129.21 ........... $25.84
Biopsy/Aspiration.
0037........... Level IV Needle Biopsy/ T............... 9.4751 $562.28 $224.91 $112.46
Aspiration Except Bone
Marrow.
0039........... Level I Implantation of S............... 181.4000 $10,764.82 ........... $2,152.96
Neurostimulator.
0040........... Level I Implantation of S............... 55.3297 $3,283.43 ........... $656.69
Neurostimulator
Electrodes.
0041........... Level I Arthroscopy...... T............... 28.1318 $1,669.43 ........... $333.89
0042........... Level II Arthroscopy..... T............... 43.9753 $2,609.63 $804.74 $521.93
0043........... Closed Treatment Fracture T............... 1.7694 $105.00 ........... $21.00
Finger/Toe/Trunk.
0045........... Bone/Joint Manipulation T............... 14.4945 $860.15 $268.47 $172.03
Under Anesthesia.
0046........... Open/Percutaneous T............... 37.7023 $2,237.37 $535.76 $447.47
Treatment Fracture or
Dislocation.
0047........... Arthroplasty without T............... 31.6107 $1,875.87 $537.03 $375.17
Prosthesis.
0048........... Level I Arthroplasty with T............... 43.1288 $2,559.39 $570.30 $511.88
Prosthesis.
0049........... Level I Musculoskeletal T............... 20.3707 $1,208.86 ........... $241.77
Procedures Except Hand
and Foot.
0050........... Level II Musculoskeletal T............... 23.9081 $1,418.78 ........... $283.76
Procedures Except Hand
and Foot.
0051........... Level III Musculoskeletal T............... 36.5271 $2,167.63 ........... $433.53
Procedures Except Hand
and Foot.
0052........... Level IV Musculoskeletal T............... 43.9378 $2,607.40 ........... $521.48
Procedures Except Hand
and Foot.
0053........... Level I Hand T............... 15.6795 $930.47 $253.49 $186.09
Musculoskeletal
Procedures.
0054........... Level II Hand T............... 25.3711 $1,505.60 ........... $301.12
Musculoskeletal
Procedures.
0055........... Level I Foot T............... 20.0692 $1,190.97 $355.34 $238.19
Musculoskeletal
Procedures.
0056........... Level II Foot T............... 40.2957 $2,391.27 ........... $478.25
Musculoskeletal
Procedures.
0057........... Bunion Procedures........ T............... 27.5493 $1,634.86 $475.91 $326.97
0058........... Level I Strapping and S............... 1.0934 $64.89 ........... $12.98
Cast Application.
0060........... Manipulation Therapy..... S............... 0.4935 $29.29 ........... $5.86
0068........... CPAP Initiation.......... S............... 1.2293 $72.95 $29.18 $14.59
0069........... Thoracoscopy............. T............... 30.6775 $1,820.49 $591.64 $364.10
0070........... Thoracentesis/Lavage T............... 3.2101 $190.50 ........... $38.10
Procedures.
0071........... Level I Endoscopy Upper T............... 0.7915 $46.97 $11.31 $9.39
Airway.
0072........... Level II Endoscopy Upper T............... 1.4361 $85.22 $21.27 $17.04
Airway.
0074........... Level IV Endoscopy Upper T............... 15.7757 $936.18 $295.70 $187.24
Airway.
0075........... Level V Endoscopy Upper T............... 21.3426 $1,266.53 $445.92 $253.31
Airway.
0076........... Level I Endoscopy Lower T............... 9.4592 $561.34 $189.82 $112.27
Airway.
0077........... Level I Pulmonary S............... 0.3444 $20.44 $7.74 $4.09
Treatment.
0078........... Level II Pulmonary S............... 1.0236 $60.74 $14.55 $12.15
Treatment.
0079........... Ventilation Initiation S............... 2.3482 $139.35 ........... $27.87
and Management.
0080........... Diagnostic Cardiac T............... 37.1361 $2,203.77 $838.92 $440.75
Catheterization.
0081........... Non-Coronary Angioplasty T............... 34.4473 $2,044.21 ........... $408.84
or Atherectomy.
0082........... Coronary Atherectomy..... T............... 85.0126 $5,044.90 $1,085.20 $1,008.98
0083........... Coronary Angioplasty and T............... 50.8925 $3,020.11 ........... $604.02
Percutaneous
Valvuloplasty.
0084........... Level I S............... 10.0205 $594.65 ........... $118.93
Electrophysiologic
Evaluation.
0085........... Level II T............... 35.1882 $2,088.17 $426.25 $417.63
Electrophysiologic
Evaluation.
[[Page 50685]]
0086........... Ablate Heart Dysrhythm T............... 44.2596 $2,626.50 $833.33 $525.30
Focus.
0087........... Cardiac T............... 30.7101 $1,822.43 ........... $364.49
Electrophysiologic
Recording/Mapping.
0088........... Thrombectomy............. T............... 36.5617 $2,169.68 $655.22 $433.94
0089........... Insertion/Replacement of T............... 105.6143 $6,267.47 $1,682.28 $1,253.49
Permanent Pacemaker and
Electrodes.
0090........... Insertion/Replacement of T............... 89.1574 $5,290.87 $1,612.80 $1,058.17
Pacemaker Pulse
Generator.
0091........... Level II Vascular T............... 28.9999 $1,720.94 $348.23 $344.19
Ligation.
0092........... Level I Vascular Ligation T............... 23.4516 $1,391.69 ........... $278.34
0093........... Vascular Reconstruction/ ................ ........... ........... ........... ...........
Fistula Repair without
Device.
0094........... Level I Resuscitation and S............... 2.5363 $150.51 $47.62 $30.10
Cardioversion.
0095........... Cardiac Rehabilitation... S............... 0.5885 $34.92 $13.96 $6.98
0096........... Non-Invasive Vascular S............... 1.6307 $96.77 $38.70 $19.35
Studies.
0097........... Cardiac and Ambulatory X............... 1.0223 $60.67 $23.79 $12.13
Blood Pressure
Monitoring.
0098........... Injection of Sclerosing T............... 1.1346 $67.33 ........... $13.47
Solution.
0099........... Electrocardiograms....... S............... 0.3821 $22.67 ........... $4.53
0100........... Cardiac Stress Tests..... X............... 2.4968 $148.17 $41.44 $29.63
0101........... Tilt Table Evaluation.... S............... 4.2787 $253.91 $101.56 $50.78
0103........... Miscellaneous Vascular T............... 14.7142 $873.18 $223.63 $174.64
Procedures.
0104........... Transcatheter Placement T............... 79.0094 $4,688.65 ........... $937.73
of Intracoronary Stents.
0105........... Revision/Removal of T............... 22.3685 $1,327.41 $370.40 $265.48
Pacemakers, AICD, or
Vascular.
0106........... Insertion/Replacement/ T............... 45.4851 $2,699.22 ........... $539.84
Repair of Pacemaker and/
or Electrodes.
0107........... Insertion of Cardioverter- T............... 260.0295 $15,430.93 $3,103.22 $3,086.19
Defibrillator.
0108........... Insertion/Replacement/ T............... 349.1681 $20,720.68 ........... $4,144.14
Repair of Cardioverter-
Defibrillator Leads.
0109........... Removal of Implanted T............... 11.0433 $655.34 $131.49 $131.07
Devices.
0110........... Transfusion.............. S............... 3.6594 $217.16 ........... $43.43
0111........... Blood Product Exchange... S............... 12.3956 $735.59 $200.18 $147.12
0112........... Apheresis, Photopheresis, S............... 26.7948 $1,590.08 $438.94 $318.02
and Plasmapheresis.
0113........... Excision Lymphatic System T............... 21.4653 $1,273.82 ........... $254.76
0114........... Thyroid/Lymphadenectomy T............... 40.7652 $2,419.13 $485.91 $483.83
Procedures.
0115........... Cannula/Access Device T............... 31.4727 $1,867.68 $459.35 $373.54
Procedures.
0116........... Chemotherapy S............... 1.1453 $67.97 ........... $13.59
Administration by Other
Technique Except
Infusion.
0117........... Chemotherapy S............... 3.2378 $192.14 $42.54 $38.43
Administration by
Infusion Only.
0120........... Infusion Therapy Except S............... 2.0193 $119.83 $28.21 $23.97
Chemotherapy.
0121........... Level I Tube changes and T............... 2.2766 $135.10 $43.80 $27.02
Repositioning.
0122........... Level II Tube changes and T............... 6.9721 $413.75 $84.85 $82.75
Repositioning.
0123........... Bone Marrow Harvesting S............... 22.9902 $1,364.31 ........... $272.86
and Bone Marrow/Stem
Cell Transplant.
0125........... Refilling of Infusion T............... 1.9331 $114.72 ........... $22.94
Pump.
0130........... Level I Laparoscopy...... T............... 31.9271 $1,894.65 $659.53 $378.93
0131........... Level II Laparoscopy..... T............... 43.3389 $2,571.86 $1,001.89 $514.37
0132........... Level III Laparoscopy.... T............... 62.9914 $3,738.10 $1,239.22 $747.62
0140........... Esophageal Dilation T............... 5.4737 $324.83 $94.18 $64.97
without Endoscopy.
0141........... Level I Upper GI T............... 8.1835 $485.63 $143.38 $97.13
Procedures.
0142........... Small Intestine Endoscopy T............... 9.3487 $554.78 $152.78 $110.96
0143........... Lower GI Endoscopy....... T............... 8.6869 $515.51 $186.06 $103.10
0146........... Level I Sigmoidoscopy and T............... 4.6374 $275.20 $64.40 $55.04
Anoscopy.
0147........... Level II Sigmoidoscopy T............... 7.9679 $472.84 ........... $94.57
and Anoscopy.
0148........... Level I Anal/Rectal T............... 3.7383 $221.84 $57.21 $44.37
Procedures.
0149........... Level III Anal/Rectal T............... 18.0726 $1,072.48 $293.06 $214.50
Procedures.
0150........... Level IV Anal/Rectal T............... 23.8654 $1,416.24 $437.12 $283.25
Procedures.
0151........... Endoscopic Retrograde T............... 18.7338 $1,111.72 $245.46 $222.34
Cholangio-
Pancreatography (ERCP).
0152........... Level I Percutaneous T............... 12.2833 $728.93 ........... $145.79
Abdominal and Biliary
Procedures.
0153........... Peritoneal and Abdominal T............... 21.6961 $1,287.51 $382.75 $257.50
Procedures.
0154........... Hernia/Hydrocele T............... 28.7847 $1,708.17 $464.85 $341.63
Procedures.
0155........... Level II Anal/Rectal T............... 16.2546 $964.60 ........... $192.92
Procedures.
0156........... Level II Urinary and Anal T............... 2.5751 $152.81 $40.52 $30.56
Procedures.
0157........... Colorectal Cancer S............... 2.2904 $135.92 ........... $27.18
Screening: Barium Enema.
0158........... Colorectal Cancer T............... 7.6588 $454.50 ........... $113.63
Screening: Colonoscopy.
0159........... Colorectal Cancer S............... 3.1455 $186.66 ........... $46.67
Screening: Flexible
Sigmoidoscopy.
0160........... Level I Cystourethroscopy T............... 6.6753 $396.13 $105.06 $79.23
and other Genitourinary
Procedures.
0161........... Level II T............... 18.5576 $1,101.26 $249.36 $220.25
Cystourethroscopy and
other Genitourinary
Procedures.
0162........... Level III T............... 23.3918 $1,388.14 ........... $277.63
Cystourethroscopy and
other Genitourinary
Procedures.
0163........... Level IV T............... 33.7354 $2,001.96 ........... $400.39
Cystourethroscopy and
other Genitourinary
Procedures.
0164........... Level I Urinary and Anal T............... 1.1855 $70.35 $17.29 $14.07
Procedures.
[[Page 50686]]
0165........... Level III Urinary and T............... 16.6689 $989.18 ........... $197.84
Anal Procedures.
0166........... Level I Urethral T............... 17.6743 $1,048.85 $218.73 $209.77
Procedures.
0168........... Level II Urethral T............... 28.2685 $1,677.54 $388.03 $335.51
Procedures.
0169........... Lithotripsy.............. T............... 43.0133 $2,552.54 $1,021.01 $510.51
0170........... Dialysis................. S............... 5.8994 $350.09 ........... $70.02
0180........... Circumcision............. T............... 19.8827 $1,179.90 $304.87 $235.98
0181........... Penile Procedures........ T............... 30.8663 $1,831.70 $621.82 $366.34
0183........... Testes/Epididymis T............... 23.6415 $1,402.96 ........... $280.59
Procedures.
0184........... Prostate Biopsy.......... T............... 4.3566 $258.53 $96.27 $51.71
0188........... Level II Female T............... 1.1400 $67.65 ........... $13.53
Reproductive Proc.
0189........... Level III Female T............... 2.3710 $140.70 ........... $28.14
Reproductive Proc.
0190........... Level I Hysteroscopy..... T............... 21.0653 $1,250.08 $424.28 $250.02
0191........... Level I Female T............... 0.1670 $9.91 $2.78 $1.98
Reproductive Proc.
0192........... Level IV Female T............... 4.3082 $255.66 ........... $51.13
Reproductive Proc.
0193........... Level V Female T............... 14.5843 $865.48 ........... $173.10
Reproductive Proc.
0194........... Level VIII Female T............... 20.7525 $1,231.52 $397.84 $246.30
Reproductive Proc.
0195........... Level IX Female T............... 26.6791 $1,583.22 $483.80 $316.64
Reproductive Proc.
0196........... Dilation and Curettage... T............... 17.0974 $1,014.61 $338.23 $202.92
0197........... Infertility Procedures... T............... 2.3572 $139.88 ........... $27.98
0198........... Pregnancy and Neonatal T............... 1.3683 $81.20 $32.19 $16.24
Care Procedures.
0200........... Level VII Female T............... 17.8728 $1,060.63 $263.69 $212.13
Reproductive Proc.
0201........... Level VI Female T............... 17.6047 $1,044.72 $329.65 $208.94
Reproductive Proc.
0202........... Level X Female T............... 40.3866 $2,396.66 $958.66 $479.33
Reproductive Proc.
0203........... Level IV Nerve Injections T............... 10.4015 $617.26 $246.90 $123.45
0204........... Level I Nerve Injections. T............... 2.1910 $130.02 $40.13 $26.00
0206........... Level II Nerve Injections T............... 5.4920 $325.91 $75.55 $65.18
0207........... Level III Nerve T............... 6.0109 $356.70 $86.92 $71.34
Injections.
0208........... Laminotomies and T............... 42.3409 $2,512.64 ........... $502.53
Laminectomies.
0209........... Extended EEG Studies and S............... 11.5713 $686.68 $274.67 $137.34
Sleep Studies, Level II.
0212........... Nervous System Injections T............... 2.9740 $176.49 $70.59 $35.30
0213........... Extended EEG Studies and S............... 2.2932 $136.09 $54.43 $27.22
Sleep Studies, Level I.
0214........... Electroencephalogram..... S............... 1.1353 $67.37 $26.94 $13.47
0215........... Level I Nerve and Muscle S............... 0.6115 $36.29 $14.51 $7.26
Tests.
0216........... Level III Nerve and S............... 2.6720 $158.56 ........... $31.71
Muscle Tests.
0218........... Level II Nerve and Muscle S............... 1.1408 $67.70 ........... $13.54
Tests.
0220........... Level I Nerve Procedures. T............... 17.3586 $1,030.11 ........... $206.02
0221........... Level II Nerve Procedures T............... 29.9209 $1,775.60 $463.62 $355.12
0222........... Implantation of T............... 179.0982 $10,628.22 ........... $2,125.64
Neurological Device.
0223........... Implantation or Revision T............... 28.1230 $1,668.90 ........... $333.78
of Pain Management
Catheter.
0224........... Implantation of Reservoir/ T............... 40.6455 $2,412.03 ........... $482.41
Pump/Shunt.
0225........... Level II Implantation of S............... 234.6925 $13,927.36 ........... $2,785.47
Neurostimulator
Electrodes.
0226........... Implantation of Drug T............... 138.8695 $8,240.93 ........... $1,648.19
Infusion Reservoir.
0227........... Implantation of Drug T............... 136.4922 $8,099.86 ........... $1,619.97
Infusion Device.
0228........... Creation of Lumbar T............... 51.7258 $3,069.56 ........... $613.91
Subarachnoid Shunt.
0229........... Transcatherter Placement T............... 64.4545 $3,824.92 $771.23 $764.98
of Intravascular Shunts.
0230........... Level I Eye Tests & S............... 0.7858 $46.63 $14.97 $9.33
Treatments.
0231........... Level III Eye Tests & S............... 1.9278 $114.40 $44.61 $22.88
Treatments.
0232........... Level I Anterior Segment T............... 6.6732 $396.01 $103.17 $79.20
Eye Procedures.
0233........... Level II Anterior Segment T............... 14.9673 $888.20 $266.33 $177.64
Eye Procedures.
0234........... Level III Anterior T............... 21.9741 $1,304.01 $511.31 $260.80
Segment Eye Procedures.
0235........... Level I Posterior Segment T............... 4.6593 $276.50 $67.40 $55.30
Eye Procedures.
0236........... Level II Posterior T............... 17.0229 $1,010.19 ........... $202.04
Segment Eye Procedures.
0237........... Level III Posterior T............... 28.9401 $1,717.39 ........... $343.48
Segment Eye Procedures.
0238........... Level I Repair and T............... 2.5933 $153.89 ........... $30.78
Plastic Eye Procedures.
0239........... Level II Repair and T............... 6.9097 $410.04 ........... $82.01
Plastic Eye Procedures.
0240........... Level III Repair and T............... 18.1508 $1,077.12 $315.31 $215.42
Plastic Eye Procedures.
0241........... Level IV Repair and T............... 23.3036 $1,382.91 $384.47 $276.58
Plastic Eye Procedures.
0242........... Level V Repair and T............... 30.5464 $1,812.72 $597.36 $362.54
Plastic Eye Procedures.
0243........... Strabismus/Muscle T............... 22.1671 $1,315.46 $431.39 $263.09
Procedures.
0244........... Corneal Transplant....... T............... 38.3723 $2,277.13 $803.26 $455.43
0245........... Level I Cataract T............... 13.3625 $792.97 $221.89 $158.59
Procedures without IOL
Insert.
0246........... Cataract Procedures with T............... 23.4597 $1,392.17 $495.96 $278.43
IOL Insert.
0247........... Laser Eye Procedures T............... 5.0330 $298.67 $104.31 $59.73
Except Retinal.
0248........... Laser Retinal Procedures. T............... 4.6769 $277.54 $93.98 $55.51
0249........... Level II Cataract T............... 27.9369 $1,657.86 $524.67 $331.57
Procedures without IOL
Insert.
0250........... Nasal Cauterization/ T............... 1.2896 $76.53 $26.79 $15.31
Packing.
0251........... Level I ENT Procedures... T............... 2.0101 $119.29 ........... $23.86
0252........... Level II ENT Procedures.. T............... 7.8673 $466.87 $113.41 $93.37
0253........... Level III ENT Procedures. T............... 16.1357 $957.54 $282.29 $191.51
[[Page 50687]]
0254........... Level IV ENT Procedures.. T............... 23.4040 $1,388.86 $321.35 $277.77
0256........... Level V ENT Procedures... T............... 37.3204 $2,214.70 ........... $442.94
0258........... Tonsil and Adenoid T............... 22.2466 $1,320.18 $437.25 $264.04
Procedures.
0259........... Level VI ENT Procedures.. T............... 366.3317 $21,739.22 $8,070.21 $4,347.84
0260........... Level I Plain Film Except X............... 0.7555 $44.83 $17.93 $8.97
Teeth.
0261........... Level II Plain Film X............... 1.2901 $76.56 ........... $15.31
Except Teeth Including
Bone Density Measurement.
0262........... Plain Film of Teeth...... X............... 0.9228 $54.76 ........... $10.95
0263........... Level I Miscellaneous X............... 1.7476 $103.71 $24.40 $20.74
Radiology Procedures.
0264........... Level II Miscellaneous X............... 3.5240 $209.12 $79.41 $41.82
Radiology Procedures.
0265........... Level I Diagnostic S............... 1.0213 $60.61 $24.24 $12.12
Ultrasound.
0266........... Level II Diagnostic S............... 1.6393 $97.28 $38.91 $19.46
Ultrasound.
0267........... Level III Diagnostic S............... 2.6327 $156.23 $62.18 $31.25
Ultrasound.
0268........... Ultrasound Guidance S............... 1.0610 $62.96 ........... $12.59
Procedures.
0269........... Level III Echocardiogram S............... 3.2437 $192.49 $76.99 $38.50
Except Transesophageal.
0270........... Transesophageal S............... 6.0192 $357.20 $142.88 $71.44
Echocardiogram.
0272........... Level I Fluoroscopy...... X............... 1.3801 $81.90 $32.76 $16.38
0274........... Myelography.............. S............... 3.0413 $180.48 $72.19 $36.10
0275........... Arthrography............. S............... 3.5779 $212.32 $69.09 $42.46
0276........... Level I Digestive S............... 1.5319 $90.91 $36.36 $18.18
Radiology.
0277........... Level II Digestive S............... 2.3852 $141.54 $56.61 $28.31
Radiology.
0278........... Diagnostic Urography..... S............... 2.6434 $156.87 $62.74 $31.37
0279........... Level II Angiography and S............... 8.9319 $530.05 $150.03 $106.01
Venography except
Extremity.
0280........... Level III Angiography and S............... 20.7902 $1,233.75 $353.85 $246.75
Venography except
Extremity.
0282........... Miscellaneous S............... 1.6542 $98.17 $39.26 $19.63
Computerized Axial
Tomography.
0283........... Computerized Axial S............... 4.4253 $262.61 $105.04 $52.52
Tomography with Contrast
Material.
0284........... Magnetic Resonance S............... 6.4201 $380.99 $152.39 $76.20
Imaging and Magnetic
Resonance Angiography
with Contras.
0285........... Myocardial Positron S............... 17.1798 $1,019.50 $318.72 $203.90
Emission Tomography
(PET).
0288........... Bone Density: Axial S............... 1.2568 $74.58 ........... $14.92
Skeleton.
0296........... Level I Therapeutic S............... 2.2452 $133.24 $53.29 $26.65
Radiologic Procedures.
0297........... Level II Therapeutic S............... 5.2530 $311.73 $122.13 $62.35
Radiologic Procedures.
0299........... Miscellaneous Radiation S............... 5.8482 $347.05 ........... $69.41
Treatment.
0300........... Level I Radiation Therapy S............... 1.5198 $90.19 ........... $18.04
0301........... Level II Radiation S............... 2.2195 $131.71 ........... $26.34
Therapy.
0302........... Level III Radiation S............... 4.6145 $273.84 $103.74 $54.77
Therapy.
0303........... Treatment Device X............... 2.8356 $168.27 $66.95 $33.65
Construction.
0304........... Level I Therapeutic X............... 1.7738 $105.26 $41.52 $21.05
Radiation Treatment
Preparation.
0305........... Level II Therapeutic X............... 4.0036 $237.59 $91.38 $47.52
Radiation Treatment
Preparation.
0310........... Level III Therapeutic X............... 13.9490 $827.78 $325.27 $165.56
Radiation Treatment
Preparation.
0312........... Radioelement Applications S............... 5.0032 $296.90 ........... $59.38
0313........... Brachytherapy............ S............... 12.8655 $763.48 ........... $152.70
0314........... Hyperthermic Therapies... S............... 5.9945 $355.73 $98.36 $71.15
0315........... Level II Implantation of T............... 290.6470 $17,247.86 ........... $3,449.57
Neurostimulator.
0320........... Electroconvulsive Therapy S............... 5.3765 $319.06 $80.06 $63.81
0321........... Biofeedback and Other S............... 1.3579 $80.58 $21.71 $16.12
Training.
0322........... Brief Individual S............... 1.2319 $73.10 ........... $14.62
Psychotherapy.
0323........... Extended Individual S............... 1.6227 $96.30 $20.08 $19.26
Psychotherapy.
0324........... Family Psychotherapy..... S............... 2.0997 $124.60 ........... $24.92
0325........... Group Psychotherapy...... S............... 1.3189 $78.27 $17.10 $15.65
0330........... Dental Procedures........ S............... 7.1756 $425.82 ........... $85.16
0332........... Computerized Axial S............... 3.2694 $194.02 $77.60 $38.80
Tomography and
Computerized Angiography
without Contras.
0333........... Computerized Axial S............... 5.2836 $313.54 $125.41 $62.71
Tomography and
Computerized Angio w/o
Contrast Material.
0335........... Magnetic Resonance S............... 5.1581 $306.10 $122.43 $61.22
Imaging, Miscellaneous.
0336........... Magnetic Resonance S............... 6.0742 $360.46 $144.18 $72.09
Imaging and Magnetic
Resonance Angiography
without Cont.
0337........... MRI and Magnetic S............... 8.7945 $521.89 $208.75 $104.38
Resonance Angiography
without Contrast
Material followed.
0339........... Observation.............. S............... 7.1403 $423.73 ........... $84.75
0340........... Minor Ancillary X............... 0.6384 $37.88 ........... $7.58
Procedures.
0341........... Skin Tests............... X............... 0.1112 $6.60 $2.62 $1.32
0342........... Level I Pathology........ X............... 0.1560 $9.26 $3.70 $1.85
0343........... Level III Pathology...... X............... 0.4786 $28.40 $11.10 $5.68
0344........... Level IV Pathology....... X............... 0.7996 $47.45 $15.66 $9.49
0345........... Level I Transfusion X............... 0.2277 $13.51 $3.01 $2.70
Laboratory Procedures.
0346........... Level II Transfusion X............... 0.3434 $20.38 $4.54 $4.08
Laboratory Procedures.
0347........... Level III Transfusion X............... 0.8434 $50.05 $12.35 $10.01
Laboratory Procedures.
[[Page 50688]]
0348........... Fertility Laboratory X............... 0.7927 $47.04 ........... $9.41
Procedures.
0350........... Administration of flu and X............... 0.3954 $23.46 $0.00 $0.00
PPV vaccines.
0352........... Level I Injections....... X............... 0.1413 $8.39 ........... $1.68
0353........... Level II Injections...... X............... 0.3954 $23.46 ........... $4.69
0359........... Level III Injections..... X............... 0.8312 $49.33 ........... $9.87
0360........... Level I Alimentary Tests. X............... 1.4739 $87.47 $34.98 $17.49
0361........... Level II Alimentary Tests X............... 3.6216 $214.92 $83.23 $42.98
0362........... Contact Lens and X............... 2.6607 $157.89 ........... $31.58
Spectacle Services.
0363........... Level I X............... 0.9128 $54.17 $17.44 $10.83
Otorhinolaryngologic
Function Tests.
0364........... Level I Audiometry....... X............... 0.4708 $27.94 $9.06 $5.59
0365........... Level II Audiometry...... X............... 1.2356 $73.32 $18.95 $14.66
0366........... Level III Audiometry..... X............... 1.7743 $105.29 $30.04 $21.06
0367........... Level I Pulmonary Test... X............... 0.6659 $39.52 $14.80 $7.90
0368........... Level II Pulmonary Tests. X............... 0.9761 $57.92 $23.16 $11.58
0369........... Level III Pulmonary Tests X............... 2.7519 $163.31 $44.18 $32.66
0370........... Allergy Tests............ X............... 1.1232 $66.65 ........... $13.33
0372........... Therapeutic Phlebotomy... X............... 0.5700 $33.83 $10.09 $6.77
0373........... Neuropsychological X............... 2.1926 $130.12 ........... $26.02
Testing.
0374........... Monitoring Psychiatric X............... 1.0414 $61.80 ........... $12.36
Drugs.
0375........... Ancillary Outpatient T............... 42.5900 $2,527.42 ........... $505.48
Services When Patient
Expires.
0376........... Level II Cardiac Imaging. S............... 5.1975 $308.44 $121.42 $61.69
0377........... Level III Cardiac Imaging S............... 6.8344 $405.57 $162.22 $81.11
0378........... Level II Pulmonary S............... 5.4997 $326.37 $130.54 $65.27
Imaging.
0379........... Injection adenosine...... K............... ........... $33.45 ........... $6.69
0381........... Single Allergy Tests..... X............... 0.1884 $11.18 $2.35 $2.24
0384........... GI Procedures with Stents T............... 22.3392 $1,325.68 $287.93 $265.14
0385........... Level I Prosthetic S............... 75.6446 $4,488.98 ........... $897.80
Urological Procedures.
0386........... Level II Prosthetic S............... 120.1694 $7,131.21 ........... $1,426.24
Urological Procedures.
0387........... Level II Hysteroscopy.... T............... 32.5445 $1,931.29 $655.55 $386.26
0388........... Discography.............. S............... 12.3294 $731.66 $292.66 $146.33
0389........... Non-imaging Nuclear S............... 1.4976 $88.87 $35.54 $17.77
Medicine.
0390........... Level I Endocrine Imaging S............... 2.5562 $151.69 $60.67 $30.34
0391........... Level II Endocrine S............... 2.8774 $170.75 $68.30 $34.15
Imaging.
0393........... Red Cell/Plasma Studies.. S............... 3.4438 $204.37 $81.74 $40.87
0394........... Hepatobiliary Imaging.... S............... 4.4630 $264.85 $105.93 $52.97
0395........... GI Tract Imaging......... S............... 3.8699 $229.65 $91.86 $45.93
0396........... Bone Imaging............. S............... 4.1426 $245.83 $98.33 $49.17
0397........... Vascular Imaging......... S............... 2.2646 $134.39 $53.75 $26.88
0398........... Level I Cardiac Imaging.. S............... 4.3093 $255.73 $102.29 $51.15
0399........... Nuclear Medicine Add-on S............... 1.5192 $90.15 $36.06 $18.03
Imaging.
0400........... Hematopoietic Imaging.... S............... 4.1335 $245.29 $98.11 $49.06
0401........... Level I Pulmonary Imaging S............... 3.4150 $202.66 $81.06 $40.53
0402........... Brain Imaging............ S............... 5.1847 $307.68 $123.07 $61.54
0403........... CSF Imaging.............. S............... 3.6138 $214.45 $85.78 $42.89
0404........... Renal and Genitourinary S............... 3.8559 $228.82 $91.52 $45.76
Studies Level I.
0405........... Renal and Genitourinary S............... 4.2674 $253.24 $101.29 $50.65
Studies Level II.
0406........... Tumor/Infection Imaging.. S............... 4.3035 $255.38 $102.15 $51.08
0407........... Radionuclide Therapy..... S............... 3.9839 $236.42 $94.56 $47.28
0409........... Red Blood Cell Tests..... X............... 0.1258 $7.47 $2.22 $1.49
0411........... Respiratory Procedures... S............... 0.3869 $22.96 ........... $4.59
0412........... IMRT Treatment Delivery.. S............... 5.3643 $318.33 ........... $63.67
0415........... Level II Endoscopy Lower T............... 22.0955 $1,311.21 $459.92 $262.24
Airway.
0416........... Level I Intravascular and S............... 19.5542 $1,160.40 ........... $232.08
Intracardiac Ultrasound
and Flow Reserve.
0417........... Computerized S............... 4.0750 $241.82 ........... $48.36
Reconstruction.
0418........... Insertion of Left T............... 109.3043 $6,486.45 ........... $1,297.29
Ventricular Pacing Elect.
0421........... Prolonged Physiologic X............... 1.6600 $98.51 ........... $19.70
Monitoring.
0422........... Level II Upper GI T............... 22.9647 $1,362.79 $448.81 $272.56
Procedures.
0423........... Level II Percutaneous T............... 40.2866 $2,390.73 ........... $478.15
Abdominal and Biliary
Procedures.
0425........... Level II Arthroplasty T............... 100.2058 $5,946.51 $1,378.01 $1,189.30
with Prosthesis.
0426........... Level II Strapping and S............... 2.1243 $126.06 ........... $25.21
Cast Application.
0427........... Level III Tube Changes T............... 10.1977 $605.16 $124.11 $121.03
and Repositioning.
0428........... Level III Sigmoidoscopy T............... 19.9022 $1,181.06 ........... $236.21
and Anoscopy.
0429........... Level V Cystourethroscopy T............... 42.3147 $2,511.08 ........... $502.22
and other Genitourinary
Procedures.
0430........... Level IV Nerve and Muscle T............... 11.4040 $676.75 ........... $135.35
Tests.
0432........... Health and Behavior S............... 0.6949 $41.24 ........... $8.25
Services.
0433........... Level II Pathology....... X............... 0.2581 $15.32 $6.12 $3.06
0434........... Cardiac Defect Repair.... T............... 90.7877 $5,387.61 ........... $1,077.52
[[Page 50689]]
0600........... Low Level Clinic Visits.. V............... 0.8688 $51.56 ........... $10.31
0601........... Mid Level Clinic Visits.. V............... 1.0038 $59.57 ........... $11.91
0602........... High Level Clinic Visits. V............... 1.4284 $84.77 ........... $16.95
0610........... Low Level Emergency V............... 1.2947 $76.83 $19.48 $15.37
Visits.
0611........... Mid Level Emergency V............... 2.2718 $134.82 $35.76 $26.96
Visits.
0612........... High Level Emergency V............... 3.9853 $236.50 $54.12 $47.30
Visits.
0620........... Critical Care............ S............... 8.2996 $492.52 $135.68 $98.50
0621........... Level I Vascular Access T............... 8.2986 $492.46 ........... $98.49
Procedures.
0622........... Level II Vascular Access T............... 21.2671 $1,262.05 ........... $252.41
Procedures.
0623........... Level III Vascular Access T............... 27.1105 $1,608.82 ........... $321.76
Procedures.
0648........... Breast Reconstruction T............... 50.4459 $2,993.61 ........... $598.72
with Prosthesis.
0651........... Complex Interstitial S............... 12.1448 $720.71 ........... $144.14
Radiation Source
Application.
0652........... Insertion of T............... 28.8948 $1,714.70 ........... $342.94
Intraperitoneal
Catheters.
0653........... Vascular Reconstruction/ T............... 30.5339 $1,811.97 ........... $362.39
Fistula Repair with
Device.
0654........... Insertion/Replacement of T............... 100.9294 $5,989.45 ........... $1,197.89
a permanent dual chamber
pacemaker.
0655........... Insertion/Replacement/ T............... 133.7768 $7,938.72 ........... $1,587.74
Conversion of a
permanent dual chamber
pacemaker.
0656........... Transcatheter Placement T............... 109.9237 $6,523.20 ........... $1,304.64
of Intracoronary Drug-
Eluting Stents.
0657........... Placement of Tissue Clips S............... 1.7092 $101.43 ........... $20.29
0658........... Percutaneous Breast T............... 6.1049 $362.28 ........... $72.46
Biopsies.
0659........... Hyperbaric Oxygen........ S............... 1.5473 $91.82 ........... $18.36
0660........... Level II X............... 1.6419 $97.44 $30.66 $19.49
Otorhinolaryngologic
Function Tests.
0661........... Level V Pathology........ X............... 3.3775 $200.43 $80.17 $40.09
0662........... CT Angiography........... S............... 5.1621 $306.33 $122.53 $61.27
0664........... Level I Proton Beam S............... 12.9439 $768.13 ........... $153.63
Radiation Therapy.
0665........... Bone Density: S............... 0.6464 $38.36 ........... $7.67
AppendicularSkeleton.
0667........... Level II Proton Beam S............... 15.4857 $918.97 ........... $183.79
Radiation Therapy.
0668........... Level I Angiography and S............... 6.5024 $385.87 $114.67 $77.17
Venography except
Extremity.
0670........... Level II Intravascular S............... 25.4131 $1,508.09 $472.46 $301.62
and Intracardiac
Ultrasound and Flow
Reserve.
0671........... Level II Echocardiogram S............... 1.7028 $101.05 $40.42 $20.21
Except Transesophageal.
0672........... Level IV Posterior T............... 36.9284 $2,191.44 ........... $438.29
Segment Eye Procedures.
0673........... Level IV Anterior Segment T............... 29.2582 $1,736.27 $649.56 $347.25
Eye Procedures.
0674........... Prostate Cryoablation.... T............... 95.7856 $5,684.20 ........... $1,136.84
0675........... Prostatic Thermotherapy.. T............... 43.7329 $2,595.24 ........... $519.05
0676........... Thrombolysis and T............... 2.4105 $143.05 ........... $28.61
Thrombectomy.
0678........... External Counterpulsation T............... 1.7276 $102.52 ........... $20.50
0679........... Level II Resuscitation S............... 5.5774 $330.98 $95.30 $66.20
and Cardioversion.
0680........... Insertion of Patient S............... 62.9082 $3,733.16 ........... $746.63
Activated Event
Recorders.
0681........... Knee Arthroplasty........ T............... 137.1630 $8,139.66 $2,081.48 $1,627.93
0682........... Level V Debridement & T............... 6.9107 $410.10 $162.42 $82.02
Destruction.
0683........... Level II S............... 1.9006 $112.79 $25.34 $22.56
Photochemotherapy.
0685........... Level III Needle Biopsy/ T............... 6.0174 $357.09 $115.47 $71.42
Aspiration Except Bone
Marrow.
0686........... Level III Skin Repair.... T............... 13.8287 $820.64 ........... $164.13
0687........... Revision/Removal of T............... 19.2347 $1,141.44 $456.57 $228.29
Neurostimulator
Electrodes.
0688........... Revision/Removal of T............... 43.0444 $2,554.38 $1,021.75 $510.88
Neurostimulator Pulse
Generator Receiver.
0689........... Electronic Analysis of S............... 0.5735 $34.03 ........... $6.81
Cardioverter-
defibrillators.
0690........... Electronic Analysis of S............... 0.3755 $22.28 $8.91 $4.46
Pacemakers and other
Cardiac Devices.
0691........... Electronic Analysis of S............... 2.5252 $149.85 $59.94 $29.97
Programmable Shunts/
Pumps.
0692........... Electronic Analysis of S............... 2.0111 $119.34 $30.16 $23.87
Neurostimulator Pulse
Generators.
0693........... Level II Breast T............... 42.2254 $2,505.78 $798.17 $501.16
Reconstruction.
0694........... Mohs Surgery............. T............... 3.8452 $228.19 $61.86 $45.64
0695........... Level VII Debridement & T............... 20.3164 $1,205.64 $266.59 $241.13
Destruction.
0697........... Level I Echocardiogram S............... 1.5357 $91.13 $36.45 $18.23
Except Transesophageal.
0698........... Level II Eye Tests & S............... 1.2438 $73.81 $16.55 $14.76
Treatments.
0699........... Level IV Eye Tests & T............... 10.0177 $594.48 ........... $118.90
Treatments.
0700........... Antepartum Manipulation.. T............... 5.3614 $318.16 ........... $63.63
0701........... SR 89 chloride, per mCi.. H............... ........... ........... ........... ...........
0702........... SM 153 lexidronam........ H............... ........... ........... ........... ...........
0704........... IN 111 Satumomab H............... ........... ........... ........... ...........
pendetide per dose.
0705........... Technetium TC99M H............... ........... ........... ........... ...........
tetrofosmin.
0726........... Dexrazoxane hcl injection K............... ........... $216.39 ........... $43.28
0728........... Filgrastim injection..... K............... ........... $178.39 ........... $35.68
0730........... Pamidronate disodium..... K............... ........... $58.42 ........... $11.68
0731........... Sargramostim injection... K............... ........... $21.11 ........... $4.22
0732........... Mesna injection.......... K............... ........... $13.68 ........... $2.74
0733........... Non esrd epoetin alpha K............... ........... $9.99 ........... $2.00
inj.
[[Page 50690]]
0734........... Injection, darbepoetin K............... ........... $3.28 ........... $0.66
alfa (for non-ESRD).
0735........... Ampho b cholesteryl K............... ........... $12.24 ........... $2.45
sulfate.
0736........... Amphotericin b liposome K............... ........... $21.91 ........... $4.38
inj.
0737........... Ammonia N-13, per dose... H............... ........... ........... ........... ...........
0738........... Rasburicase.............. G............... ........... $109.18 ........... $21.84
0750........... Dolasetron mesylate...... K............... ........... $6.55 ........... $1.31
0763........... Dolasetron mesylate oral. K............... ........... $48.54 ........... $9.71
0764........... Granisetron HCl injection K............... ........... $7.24 ........... $1.45
0765........... Granisetron HCl oral..... K............... ........... $33.51 ........... $6.70
0768........... Ondansetron hcl injection K............... ........... $3.80 ........... $0.76
0769........... Ondansetron hcl oral..... K............... ........... $32.02 ........... $6.40
0800........... Leuprolide acetate....... K............... ........... $441.78 ........... $88.36
0802........... Etoposide oral........... K............... ........... $41.12 ........... $8.22
0807........... Aldesleukin/single use K............... ........... $701.76 ........... $140.35
vial.
0809........... Bcg live intravesical vac K............... ........... $121.74 ........... $24.35
0810........... Goserelin acetate implant K............... ........... $196.25 ........... $39.25
0811........... Carboplatin injection.... K............... ........... $77.16 ........... $15.43
0812........... Carmus bischl nitro inj.. K............... ........... $141.29 ........... $28.26
0814........... Asparaginase injection... K............... ........... $55.42 ........... $11.08
0819........... Dacarbazine inj.......... K............... ........... $6.20 ........... $1.24
0820........... Daunorubicin............. K............... ........... $35.28 ........... $7.06
0821........... Daunorubicin citrate K............... ........... $57.56 ........... $11.51
liposom.
0823........... Docetaxel................ K............... ........... $301.17 ........... $60.23
0827........... Floxuridine injection.... K............... ........... $60.17 ........... $12.03
0828........... Gemcitabine HCL.......... K............... ........... $117.45 ........... $23.49
0830........... Irinotecan injection..... K............... ........... $129.08 ........... $25.82
0831........... Ifosfomide injection..... K............... ........... $53.54 ........... $10.71
0832........... Idarubicin hcl injection. K............... ........... $314.00 ........... $62.80
0834........... Interferon alfa-2a inj... K............... ........... $31.75 ........... $6.35
0835........... Inj cosyntropin.......... K............... ........... $69.27 ........... $13.85
0836........... Interferon alfa-2b inj K............... ........... $13.22 ........... $2.64
recombinant, 1 million.
0838........... Interferon gamma 1-b inj. K............... ........... $277.79 ........... $55.56
0840........... Melphalan hydrochl....... K............... ........... $523.22 ........... $104.64
0842........... Fludarabine phosphate inj K............... ........... $262.41 ........... $52.48
0843........... Pegaspargase............. K............... ........... $1,528.80 ........... $305.76
0844........... Pentostatin injection.... K............... ........... $1,868.91 ........... $373.78
0849........... Rituximab................ K............... ........... $447.97 ........... $89.59
0850........... Streptozocin injection... K............... ........... $153.33 ........... $30.67
0851........... Thiotepa injection....... K............... ........... $44.55 ........... $8.91
0852........... Topotecan................ K............... ........... $755.51 ........... $151.10
0855........... Vinorelbine tartrate..... K............... ........... $62.85 ........... $12.57
0856........... Porfimer sodium.......... K............... ........... $2,457.97 ........... $491.59
0857........... Bleomycin sulfate K............... ........... $54.18 ........... $10.84
injection.
0858........... Cladribine............... K............... ........... $39.37 ........... $7.87
0860........... Plicamycin (mithramycin) K............... ........... $80.54 ........... $16.11
inj.
0861........... Leuprolide acetate K............... ........... $10.96 ........... $2.19
injection.
0862........... Mitomycin................ K............... ........... $26.36 ........... $5.27
0863........... Paclitaxel injection..... K............... ........... $19.11 ........... $3.82
0864........... Mitoxantrone hcl......... K............... ........... $329.69 ........... $65.94
0865........... Interferon alfa-n3 inj, K............... ........... $8.77 ........... $1.75
human leukocyte derived,
2.
0868........... Oral aprepitant.......... G............... ........... $4.75 ........... $0.95
0869........... IVIG lyophil 1g.......... K............... ........... $39.46 ........... $7.89
0870........... IVIG lyophil 10 mg....... K............... ........... $0.40 ........... $0.08
0871........... IVIG non-lyophil 1g...... K............... ........... $57.26 ........... $11.45
0872........... IVIG non-lyophil 10 mg... K............... ........... $0.57 ........... $0.11
0876........... Caffeine citrate K............... ........... $3.34 ........... $0.67
injection.
0880........... Penicillin g benzathine K............... ........... $72.26 ........... $14.45
inj.
0884........... Rho d immune globulin inj K............... ........... $113.91 ........... $22.78
0887........... Azathioprine parenteral.. K............... ........... $47.40 ........... $9.48
0888........... Cyclosporine oral........ K............... ........... $3.94 ........... $0.79
0890........... Lymphocyte immune K............... ........... $290.30 ........... $58.06
globulin.
0891........... Tacrolimus oral.......... K............... ........... $3.37 ........... $0.67
0892........... Edetate calcium disodium K............... ........... $40.34 ........... $8.07
inj.
0893........... Calcitonin salmon K............... ........... $35.68 ........... $7.14
injection.
0895........... Deferoxamine mesylate inj K............... ........... $14.91 ........... $2.98
0900........... Alglucerase injection.... K............... ........... $39.94 ........... $7.99
0901........... Alpha 1 proteinase K............... ........... $3.30 ........... $0.66
inhibitor.
0902........... Botulinum toxin a, per K............... ........... $4.80 ........... $0.96
unit.
0903........... Cytomegalovirus imm IV/ K............... ........... $683.07 ........... $136.61
vial.
[[Page 50691]]
0906........... RSV-ivig................. K............... ........... $15.56 ........... $3.11
0910........... Interferon beta-1b....... K............... ........... $81.95 ........... $16.39
0911........... Streptokinase............ K............... ........... $83.36 ........... $16.67
0912........... Interferon alfacon-1..... K............... ........... $3.91 ........... $0.78
0913........... Ganciclovir long act K............... ........... $4,318.68 ........... $863.74
implant.
0916........... Injection imiglucerase / K............... ........... $3.98 ........... $0.80
unit.
0917........... Adenosine injection...... K............... ........... $71.53 ........... $14.31
0925........... Factor viii.............. K............... ........... $0.51 ........... $0.10
0926........... Factor VIII (porcine).... K............... ........... $1.75 ........... $0.35
0927........... Factor viii recombinant.. K............... ........... $0.94 ........... $0.19
0928........... Factor ix complex........ K............... ........... $0.52 ........... $0.10
0929........... Anti-inhibitor per iu.... K............... ........... $1.12 ........... $0.22
0931........... Factor IX non-recombinant K............... ........... $0.75 ........... $0.15
0932........... Factor IX recombinant.... K............... ........... $0.86 ........... $0.17
0935........... Clonidine hydrochloride.. K............... ........... $57.47 ........... $11.49
0949........... Plasma, Pooled Multiple K............... 1.1956 $70.95 ........... $14.19
Donor, Solvent/Detergent
T.
0950........... Blood (Whole) For K............... 2.0123 $119.42 ........... $23.88
Transfusion.
0952........... Cryoprecipitate.......... K............... 0.7395 $43.88 ........... $8.78
0954........... RBC leukocytes reduced... K............... 2.7370 $162.42 ........... $32.48
0955........... Plasma, Fresh Frozen..... K............... 1.2934 $76.75 ........... $15.35
0956........... Plasma Protein Fraction.. K............... 1.1226 $66.62 ........... $13.32
0957........... Platelet Concentrate..... K............... 0.8317 $49.36 ........... $9.87
0958........... Platelet Rich Plasma..... K............... 5.1815 $307.49 ........... $61.50
0959........... Red Blood Cells.......... K............... 2.0301 $120.47 ........... $24.09
0960........... Washed Red Blood Cells... K............... 2.9707 $176.29 ........... $35.26
0961........... Infusion, Albumin (Human) K............... 0.5119 $30.38 ........... $6.08
5%, 50 ml.
0963........... Albumin (human), 5%...... K............... 1.3869 $82.30 ........... $16.46
0964........... Albumin (human), 25%..... K............... 0.4878 $28.95 ........... $5.79
0965........... Albumin (human), 25%..... K............... 1.1117 $65.97 ........... $13.19
0966........... Plasmaprotein fract, 5%.. K............... 4.9564 $294.13 ........... $58.83
0967........... Split unit of blood...... K............... 1.2698 $75.35 ........... $15.07
0968........... Platelets leukocyte K............... 2.3639 $140.28 ........... $28.06
reduced irradiated.
0969........... Red blood cell leukocyte K............... 3.6451 $216.31 ........... $43.26
reduced irradiated.
1009........... Cryoprecip reduced plasma K............... 1.3062 $77.51 ........... $15.50
1010........... Blood, L/R, CMV-neg...... K............... 2.9692 $176.20 ........... $35.24
1011........... Platelets, HLA-m, L/R, K............... 10.9690 $650.93 ........... $130.19
unit.
1013........... Platelet concentrate, L/ K............... 1.6023 $95.09 ........... $19.02
R, unit.
1016........... Blood, L/R, froz/ K............... 5.2631 $312.33 ........... $62.47
deglycerol/washed.
1017........... Platelets, aph/pher, L/R, K............... 8.5998 $510.34 ........... $102.07
CMV-neg, unit.
1018........... Blood, L/R, irradiated... K............... 2.8004 $166.18 ........... $33.24
1019........... Platelets, aph/pher, L/R, K............... 9.5131 $564.54 ........... $112.91
irradiated, unit.
1020........... Pit, pher, L/R, CMV, K............... 10.1551 $602.63 ........... $120.53
irrad.
1021........... RBC, frz/deg/wsh, L/R, K............... 4.8787 $289.52 ........... $57.90
irrad.
1022........... RBC, L/R, CMV neg, irrad. K............... 4.2901 $254.59 ........... $50.92
1045........... Iobenguane sulfate I-131. H............... ........... ........... ........... ...........
1052........... Injection, Voriconazole.. K............... ........... $4.63 ........... $0.93
1064........... I-131 sodium iodide H............... ........... ........... ........... ...........
capsule.
1065........... I-131 sodium iodide H............... ........... ........... ........... ...........
solution.
1080........... I-131 tositumomab, dx.... H............... ........... ........... ........... ...........
1081........... I-131 tositumomab, tx.... H............... ........... ........... ........... ...........
1082........... Treprostinil............. K............... ........... $55.02 ........... $11.00
1083........... Injection, Adalimumab.... K............... ........... $300.10 ........... $60.02
1084........... Denileukin diftitox...... K............... ........... $1,235.33 ........... $247.07
1085........... Injection, Gallium K............... ........... $1.30 ........... $0.26
Nitrate.
1086........... Temozolomide,oral........ K............... ........... $7.28 ........... $1.46
1088........... Dx I131 so iodide cap H............... ........... ........... ........... ...........
millic.
1091........... IN 111 Oxyquinoline...... H............... ........... ........... ........... ...........
1092........... IN 111 Pentetate......... H............... ........... ........... ........... ...........
1093........... TC99M fanolesomab........ H............... ........... ........... ........... ...........
1096........... TC 99M Exametazime, per H............... ........... ........... ........... ...........
dose.
1150........... Th I131 so iodide sol H............... ........... ........... ........... ...........
millic.
1166........... Cytarabine liposome...... K............... ........... $366.43 ........... $73.29
1167........... Epirubicin hcl........... K............... ........... $25.15 ........... $5.03
1178........... Busulfan IV.............. K............... 0.2851 $16.92 ........... $3.38
1201........... TC 99M SUCCIMER, PER Vial H............... ........... ........... ........... ...........
1203........... Verteporfin for injection K............... ........... $9.16 ........... $1.83
1207........... Octreotide injection, K............... ........... $87.40 ........... $17.48
depot.
1210........... Inj dihydroergotamine K............... ........... $27.82 ........... $5.56
mesylt.
1280........... Corticotropin injection.. K............... ........... $95.44 ........... $19.09
[[Page 50692]]
1305........... Apligraf................. K............... 12.9222 $766.84 ........... $153.37
1330........... Ergonovine maleate K............... 0.5263 $31.23 ........... $6.25
injection.
1409........... Factor viia recombinant.. K............... ........... $1,080.11 ........... $216.02
1436........... Etidronate disodium inj.. K............... ........... $68.69 ........... $13.74
1491........... New Technology--Level I S............... ........... $5.00 ........... $1.00
($0-$10).
1492........... New Technology--Level I S............... ........... $15.00 ........... $3.00
($10-$20).
1493........... New Technology--Level I S............... ........... $25.00 ........... $5.00
($20-$30).
1494........... New Technology--Level I S............... ........... $35.00 ........... $7.00
($30-$40).
1495........... New Technology--Level I S............... ........... $45.00 ........... $9.00
($40-$50).
1496........... New Technology--Level I T............... ........... $5.00 ........... $1.00
($0-$10).
1497........... New Technology--Level I T............... ........... $15.00 ........... $3.00
($10-$20).
1498........... New Technology--Level I T............... ........... $25.00 ........... $5.00
($20-$30).
1499........... New Technology--Level I T............... ........... $35.00 ........... $7.00
($30-$40).
1500........... New Technology--Level I T............... ........... $45.00 ........... $9.00
($40-$50).
1502........... New Technology--Level II S............... ........... $75.00 ........... $15.00
($50-$100).
1503........... New Technology--Level III S............... ........... $150.00 ........... $30.00
($100-$200).
1504........... New Technology--Level IV S............... ........... $250.00 ........... $50.00
($200-$300).
1505........... New Technology--Level V S............... ........... $350.00 ........... $70.00
($300-$400).
1506........... New Technology--Level VI S............... ........... $450.00 ........... $90.00
($400-$500).
1507........... New Technology--Level VII S............... ........... $550.00 ........... $110.00
($500-$600).
1508........... New Technology--Level S............... ........... $650.00 ........... $130.00
VIII ($600-$700).
1509........... New Technology--Level IX S............... ........... $750.00 ........... $150.00
($700-$800).
1510........... New Technology--Level X S............... ........... $850.00 ........... $170.00
($800-$900).
1511........... New Technology--Level XI S............... ........... $950.00 ........... $190.00
($900-$1000).
1512........... New Technology--Level XII S............... ........... $1,050.00 ........... $210.00
($1000-$1100).
1513........... New Technology--Level S............... ........... $1,150.00 ........... $230.00
XIII ($1100-$1200).
1514........... New Technology--Level XIV S............... ........... $1,250.00 ........... $250.00
($1200-$1300).
1515........... New Technology--Level XV S............... ........... $1,350.00 ........... $270.00
($1300-$1400).
1516........... New Technology--Level XVI S............... ........... $1,450.00 ........... $290.00
($1400-$1500).
1517........... New Technology--Level S............... ........... $1,550.00 ........... $310.00
XVII ($1500-$1600).
1518........... New Technology--Level S............... ........... $1,650.00 ........... $330.00
XVIII ($1600-$1700).
1519........... New Technology--Level IXX S............... ........... $1,750.00 ........... $350.00
($1700-$1800).
1520........... New Technology--Level XX S............... ........... $1,850.00 ........... $370.00
($1800-$1900).
1521........... New Technology--Level XXI S............... ........... $1,950.00 ........... $390.00
($1900-$2000).
1522........... New Technology--Level S............... ........... $2,250.00 ........... $450.00
XXII ($2000-$2500).
1523........... New Technology--Level S............... ........... $2,750.00 ........... $550.00
XXIII ($2500-$3000).
1524........... New Technology--Level XIV S............... ........... $3,250.00 ........... $650.00
($3000-$3500).
1525........... New Technology--Level XXV S............... ........... $3,750.00 ........... $750.00
($3500-$4000).
1526........... New Technology--Level S............... ........... $4,250.00 ........... $850.00
XXVI ($4000-$4500).
1527........... New Technology--Level S............... ........... $4,750.00 ........... $950.00
XXVII ($4500-$5000).
1528........... New Technology--Level S............... ........... $5,250.00 ........... $1,050.00
XXVIII ($5000-$5500).
1529........... New Technology--Level S............... ........... $5,750.00 ........... $1,150.00
XXIX ($5500-$6000).
1530........... New Technology--Level XXX S............... ........... $6,250.00 ........... $1,250.00
($6000-$6500).
1531........... New Technology--Level S............... ........... $6,750.00 ........... $1,350.00
XXXI ($6500-$7000).
1532........... New Technology--Level S............... ........... $7,250.00 ........... $1,450.00
XXXII ($7000-$7500).
1533........... New Technology--Level S............... ........... $7,750.00 ........... $1,550.00
XXXIII ($7500-$8000).
1534........... New Technology--Level S............... ........... $8,250.00 ........... $1,650.00
XXXIV ($8000-$8500).
1535........... New Technology--Level S............... ........... $8,750.00 ........... $1,750.00
XXXV ($8500-$9000).
1536........... New Technology--Level S............... ........... $9,250.00 ........... $1,850.00
XXXVI ($9000-$9500).
1537........... New Technology--Level S............... ........... $9,750.00 ........... $1,950.00
XXXVII ($9500-$10000).
1539........... New Technology--Level II T............... ........... $75.00 ........... $15.00
($50-$100).
1540........... New Technology--Level III T............... ........... $150.00 ........... $30.00
($100-$200).
1541........... New Technology--Level IV T............... ........... $250.00 ........... $50.00
($200-$300).
1542........... New Technology--Level V T............... ........... $350.00 ........... $70.00
($300-$400).
1543........... New Technology--Level VI T............... ........... $450.00 ........... $90.00
($400-$500).
1544........... New Technology--Level VII T............... ........... $550.00 ........... $110.00
($500-$600).
1545........... New Technology--Level T............... ........... $650.00 ........... $130.00
VIII ($600-$700).
1546........... New Technology--Level IX T............... ........... $750.00 ........... $150.00
($700-$800).
1547........... New Technology--Level X T............... ........... $850.00 ........... $170.00
($800-$900).
1548........... New Technology--Level XI T............... ........... $950.00 ........... $190.00
($900-$1000).
1549........... New Technology--Level XII T............... ........... $1,050.00 ........... $210.00
($1000-$1100).
1550........... New Technology--Level T............... ........... $1,150.00 ........... $230.00
XIII ($1100-$1200).
1551........... New Technology--Level XIV T............... ........... $1,250.00 ........... $250.00
($1200- $1300).
1552........... New Technology--Level XV T............... ........... $1,350.00 ........... $270.00
($1300-$1400).
1553........... New Technology--Level XVI T............... ........... $1,450.00 ........... $290.00
($1400-$1500).
1554........... New Technology--Level T............... ........... $1,550.00 ........... $310.00
XVII ($1500-$1600).
1555........... New Technology--Level T............... ........... $1,650.00 ........... $330.00
XVIII ($1600-$1700).
1556........... New Technology--Level XIX T............... ........... $1,750.00 ........... $350.00
($1700-$1800).
1557........... New Technology--Level XX T............... ........... $1,850.00 ........... $370.00
($1800-$1900).
[[Page 50693]]
1558........... New Technology--Level XXI T............... ........... $1,950.00 ........... $390.00
($1900-$2000).
1559........... New Technology--Level T............... ........... $2,250.00 ........... $450.00
XXII ($2000-$2500).
1560........... New Technology--Level T............... ........... $2,750.00 ........... $550.00
XXIII ($2500-$3000).
1561........... New Technology--Level T............... ........... $3,250.00 ........... $650.00
XXIV ($3000-$3500).
1562........... New Technology--Level XXV T............... ........... $3,750.00 ........... $750.00
($3500-$4000).
1563........... New Technology--Level T............... ........... $4,250.00 ........... $850.00
XXVI ($4000-$4500).
1564........... New Technology--Level T............... ........... $4,750.00 ........... $950.00
XXVII ($4500-$5000).
1565........... New Technology--Level T............... ........... $5,250.00 ........... $1,050.00
XXVIII ($5000-$5500).
1566........... New Technology--Level T............... ........... $5,750.00 ........... $1,150.00
XXIX ($5500-$6000).
1567........... New Technology--Level XXX T............... ........... $6,250.00 ........... $1,250.00
($6000-$6500).
1568........... New Technology--Level T............... ........... $6,750.00 ........... $1,350.00
XXXI ($6500-$7000).
1569........... New Technology--Level T............... ........... $7,250.00 ........... $1,450.00
XXXII ($7000-$7500).
1570........... New Technology--Level T............... ........... $7,750.00 ........... $1,550.00
XXXIII ($7500-$8000).
1571........... New Technology--Level T............... ........... $8,250.00 ........... $1,650.00
XXXIV ($8000-$8500).
1572........... New Technology--Level T............... ........... $8,750.00 ........... $1,750.00
XXXV ($8500-$9000).
1573........... New Technology--Level T............... ........... $9,250.00 ........... $1,850.00
XXXVI ($9000-$9500).
1574........... New Technology--Level T............... ........... $9,750.00 ........... $1,950.00
XXXVII ($9500-$10000).
1600........... Technetium TC 99m H............... ........... ........... ........... ...........
sestamibi.
1603........... Thallous chloride TL 201. H............... ........... ........... ........... ...........
1604........... IN 111 capromab H............... ........... ........... ........... ...........
pendetide, per dose.
1605........... Abciximab injection...... K............... ........... $450.60 ........... $90.12
1607........... Eptifibatide injection... K............... ........... $12.73 ........... $2.55
1608........... Etanercept injection..... K............... ........... $152.11 ........... $30.42
1609........... Rho(D) immune globulin h, K............... ........... $12.04 ........... $2.41
sd.
1611........... Hylan G-F 20 injection... K............... ........... $203.15 ........... $40.63
1612........... Daclizumab, parenteral... K............... ........... $381.48 ........... $76.30
1613........... Trastuzumab.............. K............... ........... $53.98 ........... $10.80
1615........... Basiliximab.............. K............... ........... $1,473.57 ........... $294.71
1618........... Vonwillebrandfactrcmplx, K............... ........... $0.74 ........... $0.15
per iu.
1619........... Gallium ga 67............ H............... ........... ........... ........... ...........
1620........... Technetium tc99m bicisate H............... ........... ........... ........... ...........
1622........... Technetium tc99m H............... ........... ........... ........... ...........
mertiatide.
1624........... Sodium phosphate p32..... H............... ........... ........... ........... ...........
1625........... Indium 111-in H............... ........... ........... ........... ...........
pentetreotide.
1628........... Chromic phosphate p32.... H............... ........... ........... ........... ...........
1655........... Tinzaparin sodium K............... ........... $2.53 ........... $0.51
injection.
1670........... Tetanus immune globulin K............... ........... $76.90 ........... $15.38
inj.
1716........... Brachytx source, Gold 198 H............... ........... ........... ........... ...........
1717........... Brachytx source, HDR Ir- H............... ........... ........... ........... ...........
192.
1718........... Brachytx source, Iodine H............... ........... ........... ........... ...........
125.
1719........... Brachytx sour, Non-HDR Ir- H............... ........... ........... ........... ...........
192.
1720........... Brachytx sour, Palladium H............... ........... ........... ........... ...........
103.
1740........... Diazoxide injection...... K............... ........... $113.86 ........... $22.77
1775........... FDG, per dose (4-40 mCi/ H............... ........... ........... ........... ...........
ml).
2210........... Methyldopate hcl K............... ........... $9.58 ........... $1.92
injection.
2616........... Brachytx source, Yttrium- H............... ........... ........... ........... ...........
90.
2632........... Brachytx sol, I-125, per H............... ........... ........... ........... ...........
mCi.
2633........... Brachytx source, Cesium- H............... ........... ........... ........... ...........
131.
2634........... Brachytx source, HA, I- H............... ........... ........... ........... ...........
125.
2635........... Brachytx source, HA, P- H............... ........... ........... ........... ...........
103.
2636........... Brachytx linear source, P- H............... ........... ........... ........... ...........
103.
2730........... Pralidoxime chloride inj. K............... ........... $76.68 ........... $15.34
2770........... Quinupristin/dalfopristin K............... ........... $105.48 ........... $21.10
2940........... Somatrem injection....... K............... ........... $43.14 ........... $8.63
3030........... Sumatriptan succinate.... K............... ........... $51.03 ........... $10.21
7000........... Amifostine............... K............... ........... $436.01 ........... $87.20
7005........... Gonadorelin hydroch...... K............... ........... $173.44 ........... $34.69
7011........... Oprelvekin injection..... K............... ........... $249.06 ........... $49.81
7015........... Busulfan, oral........... K............... ........... $1.98 ........... $0.40
7019........... Aprotinin................ K............... ........... $2.20 ........... $0.44
7024........... Corticorelin ovine K............... ........... $386.53 ........... $77.31
triflutat.
7025........... Digoxin immune FAB K............... ........... $552.18 ........... $110.44
(ovine).
7026........... Ethanolamine oleate...... K............... ........... $64.53 ........... $12.91
7027........... Fomepizole............... K............... ........... $12.31 ........... $2.46
7028........... Fosphenytoin............. K............... ........... $5.19 ........... $1.04
7030........... Hemin.................... K............... ........... $6.51 ........... $1.30
7034........... Somatropin injection..... K............... ........... $42.93 ........... $8.59
7035........... Teniposide............... K............... ........... $266.23 ........... $53.25
7036........... Urokinase inj............ K............... ........... $415.69 ........... $83.14
[[Page 50694]]
7037........... Urofollitropin........... K............... ........... $44.74 ........... $8.95
7038........... Monoclonal antibodies.... K............... ........... $885.36 ........... $177.07
7040........... Pentastarch 10% solution. K............... ........... $12.45 ........... $2.49
7041........... Tirofiban hcl............ K............... ........... $7.89 ........... $1.58
7042........... Capecitabine, oral....... K............... ........... $3.30 ........... $0.66
7043........... Infliximab injection..... K............... ........... $54.20 ........... $10.84
7045........... Trimetrexate glucoronate. K............... ........... $139.85 ........... $27.97
7046........... Doxorubicin hcl liposome K............... ........... $365.64 ........... $73.13
inj.
7048........... Alteplase recombinant.... K............... ........... $30.65 ........... $6.13
7049........... Filgrastim injection..... K............... ........... $282.29 ........... $56.46
7051........... Leuprolide acetate K............... ........... $2,262.19 ........... $452.44
implant.
7308........... Aminolevulinic acid hcl K............... ........... $96.79 ........... $19.36
top.
7316........... Sodium hyaluronate K............... ........... $110.65 ........... $22.13
injection.
7515........... Cyclosporine oral........ K............... ........... $1.00 ........... $0.20
9001........... Linezolid injection...... K............... ........... $24.15 ........... $4.83
9002........... Tenecteplase............. K............... ........... $2,052.77 ........... $410.55
9003........... Palivizumab.............. K............... 4.1491 $246.22 ........... $49.24
9004........... Gemtuzumab ozogamicin.... K............... ........... $2,245.04 ........... $449.01
9005........... Reteplase injection...... K............... ........... $898.81 ........... $179.76
9006........... Tacrolimus injection..... K............... ........... $126.61 ........... $25.32
9008........... Baclofen Refill Kit- K............... 0.2447 $14.52 ........... $2.90
500mcg.
9009........... Baclofen refill kit--per K............... 0.7209 $42.78 ........... $8.56
2000 mcg.
9012........... Arsenic Trioxide......... K............... ........... $33.76 ........... $6.75
9015........... Mycophenolate mofetil K............... ........... $2.50 ........... $0.50
oral.
9018........... Botulinum toxin B........ K............... ........... $7.89 ........... $1.58
9019........... Caspofungin acetate...... K............... ........... $32.35 ........... $6.47
9020........... Sirolimus tablet......... K............... ........... $6.85 ........... $1.37
9022........... IM inj interferon beta 1- K............... ........... $89.10 ........... $17.82
a.
9023........... Rho d immune globulin.... K............... ........... $25.08 ........... $5.02
9024........... Amphotericin b lipid K............... ........... $11.95 ........... $2.39
complex.
9025........... Rubidium-Rb-82........... H............... ........... ........... ........... ...........
9030........... Amphotericin B........... K............... ........... $30.70 ........... $6.14
9031........... Arbutamine HCl injection. K............... ........... $163.15 ........... $32.63
9032........... Baclofen 10 MG injection. K............... ........... $188.01 ........... $37.60
9033........... Cidofovir injection...... K............... ........... $782.98 ........... $156.60
9038........... Inj estrogen conjugate... K............... ........... $57.77 ........... $11.55
9040........... Intraocular Fomivirsen na K............... ........... $203.93 ........... $40.79
9042........... Glucagon hydrochloride... K............... ........... $62.16 ........... $12.43
9044........... Ibutilide fumarate K............... ........... $243.34 ........... $48.67
injection.
9045........... Iron dextran............. K............... ........... $11.43 ........... $2.29
9046........... Iron sucrose injection... K............... ........... $0.38 ........... $0.08
9047........... Itraconazole injection... K............... ........... $36.93 ........... $7.39
9051........... Urea injection........... K............... 1.0454 $62.04 ........... $12.41
9054........... Metabolically active K............... ........... $15.69 ........... $3.14
tissue.
9055........... Injectable human tissue.. K............... ........... $3.54 ........... $0.71
9057........... Lepirudin................ K............... ........... $128.17 ........... $25.63
9100........... Iodinated I-131 H............... ........... ........... ........... ...........
serumalbumin, per 5uci.
9104........... Anti-thymocycte globulin K............... ........... $299.47 ........... $59.89
rabbit.
9105........... Hep B imm glob........... K............... 1.8813 $111.64 ........... $22.33
9108........... Thyrotropin alfa......... K............... ........... $712.58 ........... $142.52
9110........... Alemtuzumab injection.... K............... ........... $516.87 ........... $103.37
9112........... Inj Perflutren lipid K............... ........... $63.51 ........... $12.70
micros, ml.
9114........... Nesiritide............... K............... ........... $75.19 ........... $15.04
9115........... Inj, zoledronic acid..... K............... ........... $202.41 ........... $40.48
9117........... Yttrium 90 ibritumomab H............... ........... ........... ........... ...........
tiuxetan.
9118........... In-111 ibritumomab H............... ........... ........... ........... ...........
tiuxetan.
9119........... Pegfilgrastim............ K............... ........... $2,178.28 ........... $435.66
9120........... Inj, Fulvestrant......... K............... ........... $82.90 ........... $16.58
9121........... Inj, Argatroban.......... K............... 0.1897 $11.26 ........... $2.25
9122........... Triptorelin pamoate...... K............... ........... $369.98 ........... $74.00
9123........... Transcyte................ K............... ........... $719.41 ........... $143.88
9124........... Injection, daptomycin.... G............... ........... $0.30 ........... $0.06
9125........... Risperidone, long acting. G............... ........... $4.71 ........... $0.94
9126........... Injection, natalizumab... G............... ........... $6.51 ........... $1.30
9127........... Paclitaxel protein pr.... K............... ........... $8.59 ........... $1.72
9128........... Inj pegaptanib sodium.... K............... ........... $1,074.27 ........... $214.85
9130........... Na chromateCr51, per H............... ........... ........... ........... ...........
0.25mCi.
9132........... 51 Na Chromate, 50mCi.... H............... ........... ........... ........... ...........
9133........... Rabies ig, im/sc......... K............... ........... $64.56 ........... $12.91
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9134........... Rabies ig, heat treated.. K............... ........... $69.79 ........... $13.96
9135........... Varicella-zoster ig, im.. K............... ........... $96.58 ........... $19.32
9136........... Adenovirus vaccine, type K............... 0.9499 $56.37 ........... $11.27
4.
9137........... Bcg vaccine, percut...... K............... ........... $124.54 ........... $24.91
9138........... Hep a/hep b vacc, adult K............... 0.9674 $57.41 ........... $11.48
im.
9139........... Rabies vaccine, im....... K............... ........... $128.04 ........... $25.61
9140........... Rabies vaccine, id....... K............... 1.4959 $88.77 ........... $17.75
9141........... Measles-rubella vaccine, K............... 0.9467 $56.18 ........... $11.24
sc.
9142........... Chicken pox vaccine, sc.. K............... ........... $64.29 ........... $12.86
9143........... Meni