101 cmr: executive office of health and human … · otherwise update codes or modifiers, and to...

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Final Adoption March 9, 2018 101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES 101 CMR 316.00 SURGERY AND ANESTHESIA 1 Section 316.01: General Provisions 316.02: General Definitions 316.03: General Rate Provisions 316.04: Maximum Allowable Fees - Anesthesia Services 316.05: Maximum Allowable Fees - Surgical Services 316.06: Severability 316.01: General Provisions (1) Scope, Purpose, and Effective Date. (a) 101 CMR 316.00 governs the payment rates used by all governmental units for surgery and anesthesia services provided to publicly aided patients. Rates under 101 CMR 316.00 are effective on and after March 1, 2018, unless otherwise indicated. Rates for services provided to individuals covered by the Workers’ Compensation Act, M.G.L. c. 152, are not set forth in 101 CMR 316.00, but are at 114.3 CMR 40.00: Rates For Services Under M.G.L. c. 152, Workers Compensation Act. (b) The following laboratory services have a professional and technical component: 83020, 84165, 84166, 84181, 84182, 85390, 85576, 86153, 86255, 86256, 86320, 86325, 86327, 86334, 86335, 87164, 87207, 88371, 88372, and 89060. Payment rates for the professional component are contained herein. Payment rates for the technical component for these codes are contained in 101 CMR 320.00: Clinical Laboratory Services. (2) Coverage. (a) Payment rates in 101 CMR 316.00 are used to pay for surgical and anesthesia services rendered to patients in a private medical office, freestanding ambulatory surgical center, licensed clinic, hospital or other inpatient or outpatient facility or department, or other appropriate setting by an individual eligible provider, when an eligible provider bills for the medical services rendered and no other payment method applies. (b) The rates of payment under 101 CMR 316.00 are full compensation for patient care rendered to publicly aided patients as well as for any related administrative or supervisory duties in connection with patient care. The rates of payment also reimburse all overhead expenses associated with the service provided, without regard to where the care is rendered. (3) Disclaimer of Authorization of Services. 101 CMR 316.00 is not authorization for or approval of the procedures for which rates are determined pursuant to 101 CMR 316.00. Governmental units that purchase care are responsible for the definition, authorization, coverage policies, and approval of care and services provided to publicly aided patients. (4) Coding Updates and Corrections. EOHHS may publish procedure code updates and corrections in the form of an Administrative Bulletin. Updates may reference coding systems including but not limited to the American Medical Association’s Current Procedural Terminology (CPT). (a) The publication of such updates and corrections will list

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Page 1: 101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN … · otherwise update codes or modifiers, and to clarify its policy on and understanding of substantive provisions of 101 CMR 316.00

Final Adoption

March 9, 2018

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00 SURGERY AND ANESTHESIA

1

Section

316.01: General Provisions

316.02: General Definitions

316.03: General Rate Provisions

316.04: Maximum Allowable Fees - Anesthesia Services

316.05: Maximum Allowable Fees - Surgical Services

316.06: Severability

316.01: General Provisions

(1) Scope, Purpose, and Effective Date.

(a) 101 CMR 316.00 governs the payment rates used by all governmental units for surgery

and anesthesia services provided to publicly aided patients. Rates under 101 CMR 316.00 are

effective on and after March 1, 2018, unless otherwise indicated. Rates for services provided

to individuals covered by the Workers’ Compensation Act, M.G.L. c. 152, are not set forth in

101 CMR 316.00, but are at 114.3 CMR 40.00: Rates For Services Under M.G.L. c. 152,

Worker’s Compensation Act.

(b) The following laboratory services have a professional and technical component: 83020,

84165, 84166, 84181, 84182, 85390, 85576, 86153, 86255, 86256, 86320, 86325, 86327,

86334, 86335, 87164, 87207, 88371, 88372, and 89060. Payment rates for the professional

component are contained herein. Payment rates for the technical component for these codes

are contained in 101 CMR 320.00: Clinical Laboratory Services.

(2) Coverage.

(a) Payment rates in 101 CMR 316.00 are used to pay for surgical and anesthesia services

rendered to patients in a private medical office, freestanding ambulatory surgical center,

licensed clinic, hospital or other inpatient or outpatient facility or department, or other

appropriate setting by an individual eligible provider, when an eligible provider bills for the

medical services rendered and no other payment method applies.

(b) The rates of payment under 101 CMR 316.00 are full compensation for patient care

rendered to publicly aided patients as well as for any related administrative or supervisory

duties in connection with patient care. The rates of payment also reimburse all overhead

expenses associated with the service provided, without regard to where the care is rendered.

(3) Disclaimer of Authorization of Services. 101 CMR 316.00 is not authorization for or

approval of the procedures for which rates are determined pursuant to 101 CMR 316.00.

Governmental units that purchase care are responsible for the definition, authorization, coverage

policies, and approval of care and services provided to publicly aided patients.

(4) Coding Updates and Corrections. EOHHS may publish procedure code updates and

corrections in the form of an Administrative Bulletin. Updates may reference coding systems

including but not limited to the American Medical Association’s Current Procedural Terminology

(CPT).

(a) The publication of such updates and corrections will list

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101 CMR 316.00 SURGERY AND ANESTHESIA

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1. codes for which the code numbers change, with the corresponding cross references

between the new codes and the codes being replaced. Rates for such updated codes are set at

the rate of the code that is being replaced;

2. deleted codes for which there are no corresponding new codes; and

3. codes for entirely new services that require pricing. EOHHS will list these codes and

apply individual consideration (I.C.) reimbursement for these codes until appropriate rates

can be developed.

(b) For entirely new codes that require new pricing and have Medicare assigned relative value

units (RVUs), EOHHS may list these codes and price them according to the rate methodology

used in setting physician rates. When RVUs are not available, EOHHS may apply Individual

Consideration in reimbursing for these new codes until appropriate rates can be developed.

(5) Administrative Bulletins. EOHHS may issue administrative bulletins to add, delete, or

otherwise update codes or modifiers, and to clarify its policy on and understanding of substantive

provisions of 101 CMR 316.00. EOHHS may also issue administrative bulletins to clarify to

which duly licensed or certified health care professionals or students the rate methods in this

regulation apply.

316.02: General Definitions

Meaning of Terms. The five-digit procedure codes and two-digit modifiers included in 101 CMR

316.00, and their corresponding descriptions, utilize the Healthcare Common Procedure Code

System (HCPCS) for Level I and Level II coding. Level I CPT-4 codes are obtained from the

Physicians’ 2018 Current Procedural Terminology (CPT), copyright 2017 by the American

Medical Association (AMA), unless otherwise specified. Level II codes are obtained from the

2018 HCPCS, maintained jointly by the Centers for Medicare & Medicaid Services (CMS), the

Blue Cross and Blue Shield Association, and the Health Insurance Association of America.

HCPCS is a listing of descriptive terms and identifying codes and modifiers for reporting medical

services and procedures performed by physicians and other health care professionals, as well as

associated nonphysician services. No fee schedules, basic unit value, relative value guides,

conversion factors, or scales are included in any part of the Physicians’ Current Procedure

Terminology. For code descriptions, see the anesthesia and surgery service code spreadsheets at

www.mass.gov/regulations/101-CMR-31600-surgery-and-anesthesia-services.

In addition, terms used in 101 CMR 316.00 have the meanings set forth in 101 CMR 316.02.

Eligible Provider. The rates established in these regulations apply in accordance with 101 CMR

316.01 to the following types of providers who meet conditions of participation of the

governmental unit purchasing such services, and to the extent specified by such governmental

unit. Eligible providers must provide such services in accordance with generally accepted

professional standards and in accordance with state licensing requirements and certification by

national credentialing bodies as required by law.

A licensed physician (other than an intern, resident, fellow, or house officer), licensed

podiatrist, and licensed dentist.

A provider of radiation oncology services. Radiation oncology services may be rendered

by eligible providers such as, but not limited to, independent radiation oncology centers. These

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Final Adoption

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101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00 SURGERY AND ANESTHESIA

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eligible providers must be physically and financially independent of a hospital or a physician’s

office.

A clinic licensed by the Massachusetts Department of Public Health in accordance with

105 CMR 140.000: Licensure of Clinics to provide surgical diagnostic services.

A freestanding birth center facility that is not operating under a hospital’s license, and is

licensed as a birth center by the Massachusetts Department of Public Health pursuant to 105

CMR 142.000: Operation and Maintenance of Birth Centers.

An advanced practice registered nurse who is authorized by the Board of Registration in

Nursing to practice as a certified nurse practitioner, certified nurse midwife, clinical nurse

specialist, psychiatric clinical nurse specialist, or a certified registered nurse anesthetist (CRNA).

A licensed physician assistant who is authorized by the Board of Registration for

Physician Assistants to practice as a physician assistant.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Facility Setting Fee. Payments for services provided by an individual eligible provider in a

hospital (including without limitation a hospital inpatient department, outpatient department,

emergency department, and hospital licensed health center), or skilled nursing facility or

freestanding ambulatory surgical center (ASC), will be made according to a facility setting fee

when an applicable facility setting fee has been established for that procedure.

Global Delivery. Includes direct provision and supervision of case management, maternal

education (including but not limited to nutrition, pregnancy and childbirth, and reproductive

health), and obstetrical risk assessment and monitoring, in addition to pelvic or Cesarean-section

delivery, all routine prenatal visits, and one postpartum visit.

Governmental Unit. The Commonwealth, any department, agency, board, or commission of the

Commonwealth and any political subdivision of the Commonwealth.

Individual Consideration (I.C.). Surgical procedures that are authorized but not listed in 101

CMR 316.00, surgical procedures performed in unusual circumstances, and services designated

I.C. are individually considered items. The governmental unit or purchaser analyzes the eligible

provider’s report of services rendered and charges submitted under the appropriate unlisted

services or procedures category. The governmental unit or purchaser determines appropriate

payment for procedures designated I.C. in accordance with the following standards and criteria:

(a) the amount of time required to perform the service;

(b) the degree of skill required to perform the service;

(c) the severity or complexity of the patient’s disease, disorder, or disability;

(d) any applicable relative-value studies;

(e) any complications or other circumstances that may be deemed relevant;

(f) the policies, procedures and practices of other third party insurers;

(g) the payment rate for prescribed drugs as set forth in 101 CMR 331.00: Prescribed Drugs;

and

(h) a copy of the current invoice from the supplier.

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Final Adoption

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101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00 SURGERY AND ANESTHESIA

4

Modifiers. Listed services may be modified under certain circumstances. When applicable, the

modifying circumstances should be identified by the addition of the appropriate two-digit number

or letters to the procedure code.

Primary Care Clinician (PCC) Plan. A managed care option administered by the MassHealth

agency through which enrolled members receive primary care and certain other medical services.

Publicly Aided Individual (or Publicly Aided Patient). A person who receives health care and

services for which a governmental unit is in whole or in part liable under a statutory program of

public assistance.

Separate Procedure. Some of the listed procedures are commonly carried out as an integral part

of a total service, and as such do not warrant a separate identification. When, however, such a

procedure is performed independently of, and is not immediately related to, other services, it may

be listed as a separate procedure in the procedure description. Thus, when a procedure that is

ordinarily a component of a larger procedure is performed alone for a specific purpose, it may be

considered to be a separate procedure.

Surgical Team Fee. Reimbursement for highly complex surgical procedures requiring the

expertise of several physicians (usually of different specialties) and other highly skilled,

specially-trained personnel. More than one surgeon may be performing parts of the procedure

simultaneously. The unit fee is payable to the director of the surgical team and includes all

assistant surgeon fees; there are no separate payments for assisting surgical services. The director

of the surgical team is expected to distribute the unit fee to the members of the surgical team.

Unlisted Procedure or Service. A service or procedure that may be provided that is not listed in

101 CMR 316.05. When reporting such a service, the appropriate "Unlisted Procedure" code may

be used to indicate the service.

316.03: General Rate Provisions

(1) Rate Determination. Rates of payment for services for which 101 CMR 316.00 applies are

the lowest of

(a) the eligible provider's usual fee to patients other than publicly aided patients;

(b) the eligible provider's actual charge submitted; or

(c) the allowable fees in accordance with 101 CMR 316.04 (for anesthesia services), or the

schedule of allowable fees set forth in 101 CMR 316.05 (for surgical services), as applicable,

and taking into account appropriate modifiers and any other applicable rate provision(s) in

accordance with 101 CMR 316.03.

(2) Supplemental Payment.

(a) Eligibility. An eligible provider who is a physician, certified nurse practitioner, physician

assistant, or CRNA is eligible for a supplemental payment for services to publicly aided

individuals eligible under Titles XIX and XXI of the Social Security Act if the following

conditions are met:

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101 CMR 316.00 SURGERY AND ANESTHESIA

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1. the eligible provider is employed by a nonprofit group practice that was established in

accordance with St.1997 c.163 and is affiliated with a Commonwealth-owned medical

school;

2. such nonprofit group practice must have been established on or before January 1, 2000,

in order to support the purposes of a teaching hospital affiliated with and appurtenant to a

Commonwealth-owned medical school; and

3. the services are provided at a teaching hospital affiliated with and appurtenant to a

Commonwealth-owned medical school.

(b) Payment Method. This supplemental payment may not exceed the difference between

1. payments to the eligible provider made pursuant to the rates applicable under 101

CMR 316.03(1), 101 CMR 317.03(1), and 101 CMR 318.03(1); and

2. the federal upper payment limit established by the Centers for Medicare & Medicaid

Services.

(3) Rate Variations Based on Practice Site. Payments for certain services provided by individual

eligible providers that can be routinely furnished in physicians’ offices are reduced when such

services are furnished in facility settings. 101 CMR 316.05 establishes facility setting fees applied

to services rendered in a facility when a practice site differential is warranted.

(4) Allowable Fee for Certain Eligible Providers. Payment for services provided by eligible

providers who are certified nurse practitioners, certified nurse midwives, clinical nurse

specialists, psychiatric clinical nurse specialists, and physician assistants as specified in 101 CMR

316.02, is 85% of the fees contained in 101 CMR 316.05.

(5) Global Surgical Package. The payment for a surgical procedure includes a standard package

of preoperative, intraoperative, and postoperative services. Reimbursement for these procedures

includes payment for services related to the surgery when furnished by the eligible provider who

performs the surgery. The services included in the global surgical package may be furnished in

any setting, e.g., in hospitals, ASCs, physicians' offices. Included in the global fee are

preoperative period of one day for major surgery and the postoperative period of 90 days for

major surgery, as determined by the Centers for Medicare & Medicaid Services (CMS). The

postoperative period for minor surgery is either 0 or 10 days depending on the procedure, as

determined by CMS. Visits to a patient in an intensive care or critical care unit are also included

if made by the surgeon.

(6) Obstetrical Services. Obstetrical fees contained in 101 CMR 316.05 are intended to include

only the procedure or procedures performed and care to the publicly aided patient while

hospitalized with the exception of global delivery (59400, 59510, 59610, 59618). Outpatient

antepartum and postpartum obstetrical care may be billed under the appropriate medical

procedure code in accordance with 101 CMR 317.00: Medicine. Medical problems complicating

labor and delivery management or medical complications of pregnancy may require additional

resources or services and should be identified by utilizing the appropriate procedure codes in 101

CMR 317.00: Medicine in addition to the procedure codes for maternity care listed in 101 CMR

316.05.

(7) Casts and Appliances. All maximum allowable fees include the initial application of a cast,

traction device, or similar appliance.

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Final Adoption

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(8) CPT Category III Codes. All surgery related CPT category III codes are included as a part of

this regulation and have an assigned fee of I.C.

(9) PCC Plan Enhanced Fee. Primary Care Clinicians (PCCs) receive an enhanced rate for

certain types of primary and preventive care visits provided to their PCC Plan members enrolled

with the PCC on the date of service. The enhanced fee specified in 114.3 CMR 53.03(1): PCC

Plan Enhanced Fee is added to the rate for the procedure code billed. The MassHealth agency

pays PCCs an enhanced fee for delivering primary care services in accordance with the terms of

the PCC provider contract.

(10) Multiple Endoscopy Procedures. When multiple endoscopy procedures are performed

through the same endoscope, payment is made for the endoscopy with the highest rate plus the

difference between the next highest rate and the base endoscopy. When two related endoscopies

and an unrelated endoscopy are performed, the special endoscopic payment rules apply to the

related endoscopies. Unrelated endoscopic procedures are treated as a separate surgery and

reimbursed using the payment rules for multiple surgery claims.

316.04: Maximum Allowable Fees - Anesthesia Services

(1) Anesthesia Services. Anesthesia services may include but are not limited to general,

regional, supplementation of local anesthesia, or other supportive services in order to afford the

patient the anesthesia care deemed optimal by the anesthesiologist or CRNA during any

procedure. These services include the usual preoperative and postoperative visits, the anesthesia

care during the procedure, the administration of fluids, and/or blood incident to the anesthesia or

surgery, and the usual monitoring procedures. Unusual forms of monitoring (e.g., intra-arterial,

central venous, and Swan-Ganz) are not included.

(2) Rate Determination. The administration of anesthesia is reported by the use of the anesthesia

five-digit procedure code (00100-01999) listed in 101 CMR 316.05(4)(a) and modifiers

applicable to anesthesia services listed in 101 CMR 316.04(7). Payment for anesthesia services is

determined by a system of base anesthesia units and time anesthesia units. The total anesthesia

reimbursement (the “Total Anesthesia Fee”) is the sum of the number of base anesthesia units

multiplied by the base anesthesia unit fee, plus the number of time anesthesia units multiplied by

the time anesthesia unit fee. Anesthesia time units are measured in minutes and one time

anesthesia unit equals one minute. Payable anesthesia time starts when the anesthesiologist or

CRNA begins to prepare the patient for the induction of anesthesia in the operating room or in an

equivalent area and ends when the anesthesiologist or CRNA is no longer in personal attendance,

that is, when the patient may be safely placed under postoperative supervision.

(3) Maximum Unit Fee. The maximum allowable fee for anesthesia services under 101 CMR

316.00 is $19.90 per base anesthesia unit and $1.33 per one minute time anesthesia unit.

(4) Multiple Surgery Procedures. When anesthesia is administered for multiple surgery

procedures, only the base anesthesia units for the procedure with the largest number of units is

used for the base anesthesia unit portion of the Total Anesthesia Fee calculation.

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(5) Personally Performed Anesthesia Services. Personally performed anesthesia services are

anesthesia procedures that are personally performed alone by either an anesthesiologist or a

CRNA. For a CRNA, personally performed anesthesia services are those that a CRNA performs

alone without medical direction of an anesthesiologist. Payment for personally performed

anesthesia services of an anesthesiologist, or for personally performed anesthesia services of a

CRNA for which the governmental unit provides separate payment, may be claimed by

appending the appropriate anesthesia modifier to the anesthesia procedure code. Payment for

personally performed anesthesia services by an anesthesiologist, or by a CRNA, is 100% of the

Total Anesthesia Fee; provided that, if a CRNA is employed by the facility in which the

personally performed anesthesia service is provided, governmental units may specify other

payment rules for the CRNA’s services, including, without limitation, specifying that there is no

separate payment for the CRNA’s services.

(6) Medical Direction of CRNA Anesthesia Services. Payment for an anesthesiologist’s medical

direction of a CRNA, or for the services of a CRNA performed with medical direction of an

anesthesiologist for which the governmental unit provides separate payment, may be claimed by

appending the appropriate anesthesia modifier to the anesthesia procedure code. If an

anesthesiologist provides medical direction of a CRNA, payment for the anesthesiologist’s

services is 50% of the Total Anesthesia Fee. Payment for the CRNA’s services performed with

medical direction of an anesthesiologist is 50% of the Total Anesthesia Fee; provided that, if a

CRNA is employed by the facility in which the anesthesia service is performed, governmental

units may specify other payment rules for the CRNA’s services, including, without limitation,

specifying that there is no separate payment for the CRNA’s services.

(7) Modifiers. For modifiers and related descriptions applicable to anesthesia services (AA, QK,

QY, QX, and QZ), please see section 101 CMR 316.05(3).

316.05: Maximum Allowable Fees - Surgical Services

(1) Surgical and Obstetrical Services. The allowable fees for surgical and obstetrical services are

the fees listed in 101 CMR 316.05(4)(b), subject to 101 CMR 316.03 and appropriate modifiers,

as applicable. (Anesthesia procedure codes (00100-01999) and corresponding base anesthesia

units for purposes of 101 CMR 316.04 are listed in 101 CMR 316.05(4)(a)).

(2) Unless otherwise specified, guidelines, notes, and definitions provided in the 2018 CPT

Coding Handbook are applicable to the use of the procedure codes and modifiers listed below, as

well as their corresponding descriptions. For code descriptions, see the anesthesia and surgery

service code spreadsheets at www.mass.gov/regulations/101-CMR-31600-surgery-and-

anesthesia-services.

(3) Modifiers.

(a) 26: Professional Component. The component of a service or procedure representing the

physician’s or other qualified health care professional’s work interpreting or performing the

service or procedure. (When the physician or other qualified health care professional

component is reported separately, the addition of modifier 26 to the procedure code will

allow payment of the professional component allowable fee (PC Fee) contained in 101 CMR

316.05(4)(b), adjusted by 101 CMR 316.03 as applicable.)

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101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

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(b) 50: Bilateral Procedure. Payment for bilateral procedures performed at the same

operative session must be identified by the appropriate service code and modifier 50. Only

one claim line is billed for both procedures. (The addition of modifier 50 to the bilateral code

will allow payment of 150% of the allowable fee contained in 101 CMR 316.05(4)(b),

adjusted by 101 CMR 316.03 as applicable, to the eligible provider for performance of both

bilateral procedures.)

(c) 51: Multiple Procedures. This modifier must be used to report multiple procedures

performed at the same session. The service code for the major procedure or service must be

reported without a modifier. The secondary, additional, or lesser procedure(s) must be

identified by adding modifier 51 to the end of the service code for the secondary

procedure(s). (The addition of modifier 51 to the second and subsequent procedure codes

allows payment of 50% of the allowable fee contained in 101 CMR 316.05(4)(b), adjusted by

101 CMR 316.03 as applicable, to the eligible provider. Note: This modifier should not be

used with designated “add-on” codes or with codes in which the narrative begins with “each

additional.”)

(d) 52: Reduced Services. Under certain circumstances, a service or procedure is partially

reduced or eliminated at the physician's or other qualified health care professional’s election.

Under these circumstances, the service provided can be identified by its usual procedure

number and addition of modifier 52, signifying that the service is reduced. This provides a

means of reporting reduced services without disturbing the identification of the basic service.

(e) 54: Surgical Care Only. When one eligible physician or other qualified health care

professional performs a surgical procedure and another provides preoperative and/or

postoperative management, surgical services may be identified by adding modifier 54 to the

appropriate procedure code. (This allows payment of 85% of the allowable fee contained in

101 CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as applicable, to the physician or other

qualified health care professional performing the surgery.)

(f) 55: Postoperative Management Only. When one eligible physician or other qualified

health care professional performs the postoperative management and another performed the

surgical procedure, the postoperative component may be identified by adding modifier 55 to

the appropriate procedure code. (This allows payment of 15% of the allowable fee contained

in 101 CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as applicable, to the physician or

other qualified health care professional.)

(g) 58: Staged or Related Procedure or Service by the Same Physician or Other Qualified

Health Care Professional During the Postoperative Period. It may be necessary to indicate

the performance of a procedure or service during the postoperative period was (a) planned or

anticipated (staged); (b) more extensive than original procedure; or (c) for therapy following

a surgical procedure. This circumstance may be reported by adding modifier 58 to the staged

or related procedure. Note: for treatment of a problem that requires a return to the

operating/procedure room (e.g., unanticipated clinical condition), see modifier 78.

(h) 59: Distinct Procedural Service. To identify a procedure distinct or independent from

other services performed on the same day add modifier 59 to the end of the appropriate

service code. Modifier 59 is used to identify services/procedures that are not normally

reported together, but are appropriate under certain circumstances, for example, different site

or organ system. However, when another already established modifier is appropriate, it

should be used rather than modifier 59.

(i) 62: Two Surgeons. When two eligible surgeons work together as primary surgeons

performing distinct part(s) of a procedure, each surgeon should report his/her distinct

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operative work by adding modifier 62 to the procedure code and any associated add-on

code(s) for that procedure as long as both surgeons continue to work together as primary

surgeons. Each surgeon should report the procedure once using the same procedure code. If

additional procedure(s) (including add-on procedure(s) are performed during the same

surgical session, separate codes(s) may also be reported with modifier 62 added.) (The

addition of modifier 62 to the procedure code allows payment of 57.5% of the allowable fee

contained in 101 CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as applicable, to each

surgeon. No separate payment will be made for assisting surgical services in these cases; it is

included in the total surgical fee listed.)

(j) 66: Surgical Team. This modifier must be used to identify highly complex procedures

(requiring the concomitant services of several eligible physicians, often of different

specialties, plus other highly skilled, specially trained personnel, and various types of

complex equipment) carried out under the “surgical team” concept. The unit fee is payable to

the director of the surgical team and includes all assistant surgeon fees; there are no separate

payments for assisting surgical services. The director of the surgical team is expected to

distribute the unit fee to the eligible members of the surgical team.

(k) 76: Repeat Procedure by Same Physician or Other Qualified Health Care Professional.

The physician or other qualified health care professional may need to indicate that a

procedure or service was repeated subsequent to the original procedure or service. This

circumstance may be reported by adding modifier 76 to the repeated procedure/service or the

separate five-digit modifier code 09976 may be used.

(l) 77: Repeat Procedure by Another Physician or Other Qualified Health Care Professional.

The physician or other qualified health care professional may need to indicate that a basic

procedure or service performed by another physician or other qualified health care

professional had to be repeated. This situation may be reported by adding modifier 77 to the

repeated procedure/service or the separate five-digit modifier code 09977 may be used.

(m) 78: Unplanned Return to the Operating/Procedure Room by the Same Physician or

Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure

During the Postoperative Period. The physician or other qualified health care professional

may need to indicate that another procedure was performed during that postoperative period

of the initial procedure. When this subsequent procedure is related to the first, and requires

the use of the operating room, it may be reported by adding modifier 78 to the related

procedure, or by using the separate five-digit modifier 09978. (For repeat procedures on the

same day, see modifier 76.)

(n) 79: Unrelated Procedure or Service by the Same Physician or Other Qualified Health

Care Professional During the Postoperative Period. The physician or other qualified health

care professional may need to indicate that the performance of a procedure or service during

the postoperative period was unrelated to the original procedure. This circumstance may be

reported by using modifier 79 or by using the separate five-digit modifier 09979. (For repeat

procedures on the same day, see modifier 76.)

(o) 80: Assistant Surgeon. Surgical assistant services may be identified by adding modifier

80 to the usual procedure code. (This allows payment of 15% of the allowable fee contained

in 101 CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as applicable, to the eligible

assistant surgeon.)

(p) 82: Assistant Surgeon (when qualified resident surgeon not available). Surgical assistant

services may be identified by adding modifier 82 to the usual procedure code when a

qualified resident surgeon is not available. (This allows payment of 15% of the allowable fee

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contained in 101 CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as applicable, to the

eligible assistant surgeon.)

(q) AA: Anesthesia Services Performed Personally by an Anesthesiologist. (This allows

payment of 100% of the Total Anesthesia Fee for the anesthesiologist’s services.)

(r) AS: Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for

Assistant at Surgery. (This allows payment of 15% of the allowable fee contained in 101

CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as applicable, for services of the eligible

physician assistant, certified nurse practitioner, or clinical nurse specialist assisting in

surgery.)

(s) E1: Upper left, eyelid.

(t) E2: Lower left, eyelid.

(u) E3: Upper right, eyelid.

(v) E4: Lower right, eyelid.

(w) F1: Left hand, second digit.

(x) F2: Left hand, third digit.

(y) F3: Left hand, fourth digit.

(z) F4: Left hand, fifth digit.

(aa) F5: Right hand, thumb.

(bb) F6: Right hand, second digit.

(cc) F7: Right hand, third digit.

(dd) F8: Right hand, fourth digit.

(ee) F9: Right hand, fifth digit.

(ff) FA: Left hand, thumb.

(gg) LC: Left circumflex coronary artery.

(hh) LD: Left anterior descending coronary artery.

(ii) LT: Left side: Used to identify procedures performed on the left side of the body.

(jj) PA: Surgical or other invasive procedure performed on the wrong body part. (This

modifier is applied to report Provider Preventable Conditions in accordance with 42 CFR

447.26 and results in nonpayment for services.)

(kk) PB: Surgical or other invasive procedure performed on the wrong patient. (This

modifier is applied to report Provider Preventable Conditions in accordance with 42 CFR

447.26 and results in nonpayment for services.)

(ll) PC: Wrong surgical or other invasive procedure performed on a patient. (This modifier is

applied to report Provider Preventable Conditions in accordance with 42 CFR 447.26 and

results in nonpayment for services.)

(mm) QK: Medical direction by a physician of two, three, or four concurrent anesthesia

procedures. (Use to indicate physician medical direction of multiple CRNAs. This allows

payment of 50% of the Total Anesthesia Fee for the physician’s services.)

(nn) QY: Medical direction of one CRNA by a physician. (Use to indicate physician medical

direction of one CRNA. This allows payment of 50% of the Total Anesthesia Fee for the

physician’s services.)

(oo) QX: CRNA anesthesia services with medical direction by a physician. (Use to indicate

CRNA anesthesia services with medical direction by a physician. This allows payment of

50% of the Total Anesthesia Fee for the CRNA’s services. Not for use if CRNA is employed

by the facility in which the anesthesia services were performed.)

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(pp) QZ: CRNA anesthesia services without medical direction by a physician. (This allows

payment of 100% of the Total Anesthesia Fee for the CRNA’s services. Not for use if CRNA

is employed by the facility in which the anesthesia services were performed.)

(qq) RC: Right coronary artery.

(rr) RT: Right side: Used to identify procedures performed on the right side of the body.

(ss) SA: Nurse practitioner rendering service in collaboration with a physician. (This

modifier is to be applied to service codes billed by a physician that were performed by a

certified nurse practitioner employed by the physician (the physician employer must be

practicing as an individual and not practicing as a professional corporation or as a member of

a group practice). A certified nurse practitioner billing under his/her own individual provider

number, or a group practice, should not use this modifier.)

(tt) T1: Left foot, second digit.

(uu) T2: Left foot, third digit,

(vv) T3: Left foot, fourth digit.

(ww) T4: Left foot, fifth digit.

(xx) T5: Right foot, great toe.

(yy) T6: Right foot, second digit.

(zz) T7: Right foot, third digit.

(aaa) T8: Right foot, fourth digit.

(bbb) T9: Right foot, fifth digit.

(ccc) TA: Left foot, great toe.

(ddd) TC: Technical component. The component of a service or procedure representing the

cost of rent, equipment, utilities, supplies, administrative and technical salaries and benefits,

and other overhead expenses of the service or procedures, excluding the physician’s

professional component. (When the technical component is reported separately, the addition

of modifier TC to the procedure code will allow payment of the technical component

allowable fee (TC Fee) contained in 101 CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as

applicable.)

(eee) XE: Separate encounter. A service that is distinct because it occurred during a separate

encounter.

(fff) XS: Separate structure. A service that is distinct because it was performed on a separate

organ/structure.

(ggg) XP: Separate practitioner. A service that is distinct because it was performed by a

different practitioner.

(hhh) XU: Unusual non-overlapping service. The use of a service that is distinct because it

does not overlap usual components of the main service.

(4) Procedure Codes; Fee Schedules.

(a) Anesthesia Services – List of Procedure Codes and Base Anesthesia Units.

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Anesthesia Table

Code Units

Description (see anesthesia service code spreadsheet at

www.mass.gov/regulations/101-CMR-31600-surgery-and-anesthesia-services) 00100 5

00102 6

00103 5

00104 4

00120 5

00124 4

00126 4

00140 5

00142 4

00144 6

00145 6

00147 4

00148 4

00160 5

00162 7

00164 4

00170 5

00172 6

00174 6

00176 7

00190 5

00192 7

00210 11

00211 10

00212 5

00214 9

00215 9

00216 15

00218 13

00220 10

00222 6

00300 5

00320 6

00322 3

00326 7

00350 10

00352 5

00400 3

00402 5

00404 5

00406 13

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Anesthesia Table

Code Units

Description (see anesthesia service code spreadsheet at

www.mass.gov/regulations/101-CMR-31600-surgery-and-anesthesia-services) 00410 4

00450 5

00452 6

00454 3

00470 6

00472 10

00474 13

00500 15

00520 6

00522 4

00524 4

00528 8

00529 11

00530 4

00532 4

00534 7

00537 7

00539 18

00540 12

00541 15

00542 15

00546 15

00548 17

00550 10

00560 15

00561 25

00562 20

00563 25

00566 25

00567 18

00580 20

00600 10

00604 13

00620 10

00622 13

00625 13

00626 15

00630 8

00632 7

00634 10

00635 4

00640 3

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Anesthesia Table

Code Units

Description (see anesthesia service code spreadsheet at

www.mass.gov/regulations/101-CMR-31600-surgery-and-anesthesia-services) 00670 13

00700 4

00702 4

00730 5 00731 5 00732 5

00750 4

00752 6

00754 7

00756 7

00770 15

00790 7

00792 13

00794 8

00796 30

00797 11

00800 4

00802 5 00811 5 00812 5 00813 5

00820 5

00830 4

00832 6

00834 5

00836 6

00840 6

00842 4

00844 7

00846 8

00848 8

00851 6

00860 6

00862 7

00864 8

00865 7

00866 10

00868 10

00870 5

00872 7

00873 5

00880 15

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Anesthesia Table

Code Units

Description (see anesthesia service code spreadsheet at

www.mass.gov/regulations/101-CMR-31600-surgery-and-anesthesia-services) 00882 10

00902 5

00904 7

00906 4

00908 6

00910 3

00912 5

00914 5

00916 5

00918 5

00920 3

00921 3

00922 6

00924 4

00926 4

00928 6

00930 4

00932 4

00934 6

00936 8

00938 4

00940 3

00942 4

00944 6

00948 4

00950 5

00952 4

01112 5

01120 6

01130 3

01140 15

01150 10

01160 4

01170 8

01173 12

01200 4

01202 4

01210 6

01212 10

01214 8

01215 10

01220 4

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Anesthesia Table

Code Units

Description (see anesthesia service code spreadsheet at

www.mass.gov/regulations/101-CMR-31600-surgery-and-anesthesia-services) 01230 6

01232 5

01234 8

01250 4

01260 3

01270 8

01272 4

01274 6

01320 4

01340 4

01360 5

01380 3

01382 3

01390 3

01392 4

01400 4

01402 7

01404 5

01420 3

01430 3

01432 6

01440 8

01442 8

01444 8

01462 3

01464 3

01470 3

01472 5

01474 5

01480 3

01482 4

01484 4

01486 7

01490 3

01500 8

01502 6

01520 3

01522 5

01610 5

01620 4

01622 4

01630 5

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Anesthesia Table

Code Units

Description (see anesthesia service code spreadsheet at

www.mass.gov/regulations/101-CMR-31600-surgery-and-anesthesia-services) 01634 9

01636 15

01638 10

01650 6

01652 10

01654 8

01656 10

01670 4

01680 3

01710 3

01712 5

01714 5

01716 5

01730 3

01732 3

01740 4

01742 5

01744 5

01756 6

01758 5

01760 7

01770 6

01772 6

01780 3

01782 4

01810 3

01820 3

01829 3

01830 3

01832 6

01840 6

01842 6

01844 6

01850 3

01852 4

01860 3

01916 5

01920 7

01922 7

01924 5

01925 7

01926 8

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Anesthesia Table

Code Units

Description (see anesthesia service code spreadsheet at

www.mass.gov/regulations/101-CMR-31600-surgery-and-anesthesia-services) 01930 5

01931 7

01932 6

01933 7

01935 5

01936 5

01951 3

01952 5

01953 1

01958 5

01960 5

01961 7

01962 8

01963 8

01964 4

01965 4

01966 4

01967 5

01968 2

01969 5

01990 7

01991 3

01992 5

01995 5

01996 3

01999 0

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(b) Surgical Services – Fee Schedule.

1. NFAC – “Nonfacility”: These amounts apply when service is performed in a non-

facility setting.

2. FAC – “Facility”: These amounts, also known as the Facility Setting Fee, apply when

service is performed in a facility setting.

3. Global Fee – These amounts apply when no site of service differential rate is specified.

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

10021 $97.79 $53.68 . . .

10022 $113.42 $50.65 . . .

10030 $638.48 $127.17 . . .

10035 $442.79 $67.37 . . .

10036 $387.42 $33.91 . . .

10040 $79.89 $68.93 . . .

10060 $93.42 $76.84 . . .

10061 $162.89 $141.28 . . .

10080 $144.87 $81.21 . . .

10081 $214.21 $132.49 . . .

10120 $122.30 $82.33 . . .

10121 $217.66 $144.83 . . .

10140 $130.05 $93.34 . . .

10160 $103.90 $75.77 . . .

10180 $194.98 $139.32 . . .

11000 $43.38 $22.06 . . .

11001 $16.89 $10.97 . . .

11004 . . $441.41 . .

11005 . . $592.35 . .

11006 . . $534.97 . .

11008 . . $208.12 . .

11010 $393.31 $217.14 . . .

11011 $424.58 $229.47 . . .

11012 $565.19 $328.04 . . .

11042 $93.50 $48.20 . . .

11043 $179.87 $120.06 . . .

11044 $245.94 $177.84 . . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

11045 $32.12 $19.99 . . .

11046 $56.83 $42.62 . . .

11047 $95.65 $75.82 . . .

11055 $38.50 $12.45 . . .

11056 $46.86 $17.55 . . .

11057 $52.56 $22.95 . . .

11100 $82.90 $37.90 . . .

11101 $25.68 $19.46 . . .

11200 $70.14 $58.30 . . .

11201 $14.71 $12.93 . . .

11300 $78.51 $27.29 . . .

11301 $96.16 $41.68 . . .

11302 $113.13 $48.89 . . .

11303 $124.66 $57.74 . . .

11305 $79.90 $30.46 . . .

11306 $97.91 $40.17 . . .

11307 $115.11 $51.76 . . .

11308 $120.49 $57.14 . . .

11310 $91.22 $36.74 . . .

11311 $88.30 $50.99 . . .

11312 $128.24 $60.74 . . .

11313 $147.78 $77.91 . . .

11400 $99.58 $63.75 . . .

11401 $118.82 $81.81 . . .

11402 $131.77 $89.72 . . .

11403 $151.77 $115.95 . . .

11404 $172.06 $127.05 . . .

11406 $245.00 $191.12 . . .

11420 $98.19 $64.73 . . .

11421 $124.71 $86.52 . . .

11422 $139.20 $106.92 . . .

11423 $159.66 $123.54 . . .

11424 $184.03 $140.50 . . .

11426 $259.87 $213.09 . . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

11440 $108.37 $82.61 . . .

11441 $133.63 $104.32 . . .

11442 $149.23 $114.88 . . .

11443 $176.92 $140.21 . . .

11444 $221.13 $177.61 . . .

11446 $305.60 $253.79 . . .

11450 $302.46 $196.47 . . .

11451 $384.09 $252.04 . . .

11462 $296.26 $188.19 . . .

11463 $389.22 $253.33 . . .

11470 $327.56 $219.20 . . .

11471 $404.15 $272.10 . . .

11600 $153.80 $93.70 . . .

11601 $182.10 $116.96 . . .

11602 $197.47 $128.48 . . .

11603 $224.63 $153.27 . . .

11604 $249.31 $168.19 . . .

11606 $353.94 $247.95 . . .

11620 $155.29 $94.89 . . .

11621 $183.13 $117.99 . . .

11622 $203.82 $134.83 . . .

11623 $237.89 $166.24 . . .

11624 $267.52 $187.58 . . .

11626 $320.67 $228.59 . . .

11640 $160.24 $98.36 . . .

11641 $189.57 $122.95 . . .

11642 $215.77 $144.71 . . .

11643 $252.84 $180.30 . . .

11644 $311.11 $222.58 . . .

11646 $403.79 $307.86 . . .

11719 $10.97 $5.94 . . .

11720 $25.85 $11.34 . . .

11721 $35.67 $19.09 . . .

11730 $78.99 $39.32 . . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

11732 $28.37 $15.64 . . .

11740 $40.10 $26.18 . . .

11750 $145.61 $113.05 . . .

11755 $107.20 $61.31 . . .

11760 $155.97 $92.02 . . .

11762 $223.90 $144.55 . . .

11765 $135.69 $75.00 . . .

11770 $219.18 $143.09 . . .

11771 $449.01 $335.32 . . .

11772 $544.92 $448.99 . . .

11900 $44.21 $24.37 . . .

11901 $55.10 $37.63 . . .

11920 $134.80 $88.91 . . .

11921 $156.87 $105.06 . . .

11922 $49.19 $22.84 . . .

11950 $58.48 $40.13 . . .

11951 $75.86 $55.13 . . .

11952 $102.16 $74.63 . . .

11954 $123.46 $88.52 . . .

11960 . . $745.47 . .

11970 . . $477.36 . .

11971 $377.41 $253.36 . . .

11976 $112.23 $72.26 . . .

11980 $74.32 $43.23 . . .

11981 $110.57 $62.90 . . .

11982 $125.12 $76.56 . . .

11983 $172.46 $133.38 . . .

12001 $70.98 $33.97 . . .

12002 $85.96 $44.51 . . .

12004 $100.80 $55.51 . . .

12005 $126.50 $71.73 . . .

12006 $149.65 $88.07 . . .

12007 $173.69 $111.22 . . .

12011 $86.73 $42.03 . . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

12013 $90.22 $43.74 . . .

12014 $104.94 $56.39 . . .

12015 $126.77 $70.81 . . .

12016 $160.22 $96.86 . . .

12017 . . $115.59 . .

12018 . . $131.15 . .

12020 $229.48 $151.32 . . .

12021 $131.25 $110.52 . . .

12031 $189.09 $120.70 . . .

12032 $242.48 $154.25 . . .

12034 $247.10 $161.83 . . .

12035 $303.95 $187.59 . . .

12036 $332.41 $216.35 . . .

12037 $375.94 $253.07 . . .

12041 $188.83 $118.37 . . .

12042 $229.41 $157.76 . . .

12044 $286.20 $168.07 . . .

12045 $320.47 $212.41 . . .

12046 $377.28 $239.91 . . .

12047 $409.38 $267.57 . . .

12051 $205.64 $135.17 . . .

12052 $233.51 $160.38 . . .

12053 $274.71 $170.79 . . .

12054 $286.22 $173.42 . . .

12055 $371.55 $239.80 . . .

12056 $433.26 $296.47 . . .

12057 $442.38 $315.96 . . .

13100 $266.53 $161.72 . . .

13101 $315.69 $199.93 . . .

13102 $96.03 $57.54 . . .

13120 $278.43 $186.35 . . .

13121 $339.82 $209.85 . . .

13122 $105.01 $66.23 . . .

13131 $305.95 $196.11 . . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

13132 $377.80 $246.94 . . .

13133 $140.24 $102.05 . . .

13151 $334.14 $225.18 . . .

13152 $401.08 $272.88 . . .

13153 $151.95 $109.91 . . .

13160 . . $625.77 . .

14000 $491.69 $396.06 . . .

14001 $629.35 $512.99 . . .

14020 $551.17 $449.03 . . .

14021 $687.12 $566.02 . . .

14040 $601.54 $498.80 . . .

14041 $743.91 $612.75 . . .

14060 $611.88 $531.05 . . .

14061 $801.01 $656.23 . . .

14301 $847.37 $691.64 . . .

14302 . . $171.23 . .

14350 . . $545.79 . .

15002 $274.31 $175.72 . . .

15003 $59.60 $35.03 . . .

15004 $317.33 $210.45 . . .

15005 $97.13 $69.89 . . .

15040 $205.21 $98.92 . . .

15050 $447.95 $351.73 . . .

15100 $672.71 $558.13 . . .

15101 $147.41 $85.83 . . .

15110 $625.87 $540.60 . . .

15111 $88.09 $78.91 . . .

15115 $644.15 $558.29 . . .

15116 $116.00 $103.56 . . .

15120 $668.95 $545.79 . . .

15121 $165.24 $103.06 . . .

15130 $528.87 $441.53 . . .

15131 $77.06 $70.25 . . .

15135 $663.03 $577.47 . . .

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25

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

15136 $73.18 $68.15 . . .

15150 $536.87 $487.72 . . .

15151 $92.66 $84.96 . . .

15152 $113.47 $105.47 . . .

15155 $565.60 $520.89 . . .

15156 $119.76 $112.95 . . .

15157 $134.42 $124.94 . . .

15200 $654.34 $526.74 . . .

15201 $117.76 $60.62 . . .

15220 $609.57 $484.63 . . .

15221 $109.02 $55.13 . . .

15240 $737.04 $632.82 . . .

15241 $146.52 $86.42 . . .

15260 $799.94 $678.84 . . .

15261 $171.39 $109.51 . . .

15271 $111.47 $65.58 . . .

15272 $21.28 $13.29 . . .

15273 $232.95 $155.38 . . .

15274 $55.78 $35.06 . . .

15275 $118.12 $74.30 . . .

15276 $26.93 $19.23 . . .

15277 $252.55 $173.20 . . .

15278 $66.42 $43.62 . . .

15570 $718.46 $574.87 . . .

15572 $697.91 $585.11 . . .

15574 $719.50 $602.26 . . .

15576 $636.55 $528.19 . . .

15600 $260.61 $165.57 . . .

15610 $285.64 $192.08 . . .

15620 $351.56 $259.18 . . .

15630 $366.76 $275.27 . . .

15650 $400.69 $302.10 . . .

15730 $1,282.20 $750.58

15731 $885.05 $791.20 . . .

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26

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

15733 - - $856.34

15734 $1,168.74 $1,020.41 . . .

15736 $1,030.95 $884.99 . . .

15738 $1,091.08 $954.00 . . .

15740 $803.73 $671.97 . . .

15750 . . $717.60 . .

15756 . . $1,808.54 . .

15757 . . $1,787.18 . .

15758 . . $1,789.60 . .

15760 $674.62 $558.56 . . .

15770 . . $528.06 . .

15775 $236.07 $172.71 . . .

15776 $390.98 $277.29 . . .

15777 . . $163.81 . .

15780 $670.13 $499.30 . . .

15781 $442.80 $344.21 . . .

15782 $513.63 $357.89 . . .

15783 $371.72 $285.86 . . .

15786 $196.62 $106.61 . . .

15787 $39.90 $13.55 . . .

15788 $377.29 $199.94 . . .

15789 $438.42 $327.98 . . .

15792 $363.12 $213.90 . . .

15793 $396.02 $293.28 . . .

15819 . . $575.88 . .

15820 $449.12 $403.53 . . .

15821 $482.77 $431.85 . . .

15822 $355.33 $310.33 . . .

15823 $483.91 $432.10 . . .

15824 . . I.C. . .

15825 . . I.C. . .

15826 . . I.C. . .

15828 . . I.C. . .

15829 . . I.C. . .

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27

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

15830 . . $910.53 . .

15832 . . $716.41 . .

15833 . . $672.82 . .

15834 . . $694.19 . .

15835 . . $724.26 . .

15836 . . $592.87 . .

15837 $630.26 $520.42 . . .

15838 . . $449.12 . .

15839 $694.42 $575.70 . . .

15840 . . $790.71 . .

15841 . . $1,252.08 . .

15842 . . $2,043.28 . .

15845 . . $796.31 . .

15847 . . I.C. . .

15850 $71.14 $31.76 . . .

15851 $79.48 $35.37 . . .

15852 . . $35.89 . .

15860 . . $84.77 . .

15876 . . I.C. . .

15877 . . I.C. . .

15878 . . I.C. . .

15879 . . I.C. . .

15920 . . $468.39 . .

15922 . . $611.74 . .

15931 . . $528.33 . .

15933 . . $658.17 . .

15934 . . $715.37 . .

15935 . . $846.60 . .

15936 . . $688.80 . .

15937 . . $800.51 . .

15940 . . $541.26 . .

15941 . . $699.54 . .

15944 . . $688.48 . .

15945 . . $758.86 . .

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28

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

15946 . . $1,268.80 . .

15950 . . $459.17 . .

15951 . . $688.46 . .

15952 . . $700.81 . .

15953 . . $777.40 . .

15956 . . $893.66 . .

15958 . . $911.10 . .

15999 . . I.C. . .

16000 $53.98 $35.32 . . .

16020 $65.36 $42.86 . . .

16025 $115.95 $86.64 . . .

16030 $146.15 $103.81 . . .

16035 . . $149.67 . .

16036 . . $61.66 . .

17000 $53.19 $42.23 . . .

17003 $4.50 $1.84 . . .

17004 $119.64 $78.48 . . .

17106 $270.17 $217.47 . . .

17107 $343.07 $272.90 . . .

17108 $502.77 $411.88 . . .

17110 $89.67 $55.92 . . .

17111 $105.61 $68.31 . . .

17250 $64.10 $29.16 . . .

17260 $75.01 $55.17 . . .

17261 $114.67 $72.03 . . .

17262 $139.16 $91.49 . . .

17263 $151.84 $101.51 . . .

17264 $162.73 $108.26 . . .

17266 $184.13 $126.40 . . .

17270 $119.93 $78.48 . . .

17271 $129.59 $87.25 . . .

17272 $147.75 $100.67 . . .

17273 $164.69 $113.47 . . .

17274 $193.91 $138.25 . . .

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29

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

17276 $223.84 $165.81 . . .

17280 $112.30 $71.44 . . .

17281 $140.90 $97.97 . . .

17282 $161.92 $113.06 . . .

17283 $193.06 $140.95 . . .

17284 $220.12 $164.16 . . .

17286 $280.65 $219.06 . . .

17311 $525.76 $294.53 . . .

17312 $310.52 $156.57 . . .

17313 $492.62 $264.06 . . .

17314 $298.35 $145.28 . . .

17315 $62.94 $41.33 . . .

17340 $40.04 $38.27 . . .

17360 $101.51 $76.94 . . .

17380 . . I.C. . .

17999 . . I.C. . .

19000 $91.41 $33.68 . . .

19001 $21.05 $16.90 . . .

19020 $376.04 $238.37 . . .

19030 $133.04 $60.51 . . .

19081 $569.59 $131.40 . . .

19082 $475.22 $65.75 . . .

19083 $551.49 $123.37 . . .

19084 $457.39 $61.84 . . .

19085 $851.59 $144.87 . . .

19086 $679.33 $72.09 . . .

19100 $119.60 $52.68 . . .

19101 $269.34 $170.45 . . .

19105 $1,783.76 $151.52 . . .

19110 $383.20 $265.37 . . .

19112 $361.98 $242.07 . . .

19120 $383.92 $318.19 . . .

19125 $424.75 $352.80 . . .

19126 . . $121.72 . .

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30

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

19260 . . $926.60 . .

19271 . . $1,264.68 . .

19272 . . $1,378.85 . .

19281 $193.77 $79.19 . . .

19282 $137.02 $39.61 . . .

19283 $218.54 $79.39 . . .

19284 $166.66 $39.94 . . .

19285 $426.21 $67.37 . . .

19286 $376.77 $33.91 . . .

19287 $713.69 $101.12 . . .

19288 $578.79 $50.60 . . .

19294 - - $132.20

19296 $3,300.83 $160.10 . . .

19297 . . $71.55 . .

19298 $858.15 $252.69 . . .

19300 $411.57 $320.97 . . .

19301 . . $498.82 . .

19302 . . $686.91 . .

19303 . . $771.45 . .

19304 . . $443.51 . .

19305 . . $863.12 . .

19306 . . $918.84 . .

19307 . . $916.31 . .

19316 . . $598.60 . .

19318 . . $858.74 . .

19324 . . $377.85 . .

19325 . . $502.01 . .

19328 . . $388.44 . .

19330 . . $496.48 . .

19340 . . $784.30 . .

19342 . . $722.25 . .

19350 $650.11 $526.94 . . .

19355 $545.84 $438.07 . . .

19357 . . $1,187.60 . .

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31

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

19361 . . $1,226.06 . .

19364 . . $2,139.31 . .

19366 . . $1,087.61 . .

19367 . . $1,393.05 . .

19368 . . $1,710.10 . .

19369 . . $1,587.41 . .

19370 . . $537.31 . .

19371 . . $613.74 . .

19380 . . $605.34 . .

19396 $223.06 $109.07 . . .

19499 . . I.C. . .

20005 $244.63 $182.15 . . .

20100 . . $464.44 . .

20101 $360.13 $159.69 . . .

20102 $392.17 $196.46 . . .

20103 $464.63 $270.41 . . .

20150 . . $700.56 . .

20200 $166.01 $73.04 . . .

20205 $229.71 $118.98 . . .

20206 $195.07 $46.74 . . .

20220 $137.24 $57.30 . . .

20225 $435.86 $85.61 . . .

20240 . . $119.97 . .

20245 . . $398.76 . .

20250 . . $301.60 . .

20251 . . $327.36 . .

20500 $82.74 $66.75 . . .

20501 $96.59 $29.67 . . .

20520 $162.94 $115.56 . . .

20525 $386.38 $193.93 . . .

20526 $60.29 $44.30 . . .

20527 $65.79 $51.58 . . .

20550 $46.31 $32.40 . . .

20551 $47.63 $33.12 . . .

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32

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

20552 $43.85 $29.64 . . .

20553 $50.59 $33.71 . . .

20555 . . $252.82 . .

20600 $37.34 $27.56 . . .

20604 $57.07 $35.45 . . .

20605 $39.22 $28.86 . . .

20606 $63.03 $40.53 . . .

20610 $47.00 $35.45 . . .

20611 $72.01 $47.44 . . .

20612 $47.92 $32.53 . . .

20615 $196.07 $128.86 . . .

20650 $164.68 $122.93 . . .

20660 . . $183.95 . .

20661 . . $393.63 . .

20662 . . $345.48 . .

20663 . . $368.05 . .

20664 . . $670.89 . .

20665 $83.98 $71.84 . . .

20670 $310.83 $116.61 . . .

20680 $493.65 $331.70 . . .

20690 . . $460.94 . .

20692 . . $873.08 . .

20693 . . $350.22 . .

20694 $338.20 $266.26 . . .

20696 . . $936.26 . .

20697 . . $1,665.14 . .

20802 . . $1,863.45 . .

20805 . . $2,551.50 . .

20808 . . $3,113.56 . .

20816 . . $1,599.05 . .

20822 . . $1,400.43 . .

20824 . . $1,570.97 . .

20827 . . $1,415.15 . .

20838 . . $1,883.27 . .

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33

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

20900 $338.17 $147.21 . . .

20902 . . $221.06 . .

20910 . . $324.63 . .

20912 . . $379.02 . .

20920 . . $310.74 . .

20922 $476.40 $387.87 . . .

20924 . . $396.50 . .

20926 . . $337.23 . .

20930 . . I.C. . .

20931 . . $84.66 . .

20936 . . I.C. . .

20937 . . $127.90 . .

20938 . . $139.90 . .

20939 - - $54.59

20950 $206.28 $71.56 . . .

20955 . . $1,952.75 . .

20956 . . $2,049.56 . .

20957 . . $1,911.91 . .

20962 . . $1,656.66 . .

20969 . . $2,157.47 . .

20970 . . $2,243.33 . .

20972 . . $1,848.21 . .

20973 . . $2,046.94 . .

20974 $61.09 $39.47 . . .

20975 . . $137.15 . .

20979 $41.45 $24.87 . . .

20982 $2,515.07 $297.20 . . .

20983 $6,081.44 $315.44 . . .

20985 . . $113.04 . .

20999 . . I.C. . .

21010 . . $583.32 . .

21011 $279.28 $205.56 . . .

21012 . . $265.12 . .

21013 $412.05 $314.94 . . .

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34

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

21014 . . $407.93 . .

21015 . . $555.63 . .

21016 . . $797.28 . .

21025 $715.98 $599.03 . . .

21026 $500.55 $401.06 . . .

21029 $613.37 $505.60 . . .

21030 $420.72 $336.04 . . .

21031 $322.46 $238.38 . . .

21032 $327.85 $235.77 . . .

21034 $1,043.91 $912.46 . . .

21040 $423.97 $336.63 . . .

21044 . . $692.50 . .

21045 . . $968.18 . .

21046 . . $893.87 . .

21047 . . $1,040.10 . .

21048 . . $915.93 . .

21049 . . $952.52 . .

21050 . . $666.09 . .

21060 . . $630.88 . .

21070 . . $484.15 . .

21073 $313.81 $201.01 . . .

21076 $796.73 $659.35 . . .

21077 $1,998.01 $1,656.05 . . .

21079 $1,346.30 $1,102.63 . . .

21080 $1,511.96 $1,227.14 . . .

21081 $1,397.13 $1,129.19 . . .

21082 $1,324.10 $1,062.07 . . .

21083 $1,264.52 $986.22 . . .

21084 $1,451.91 $1,143.11 . . .

21085 $609.46 $447.22 . . .

21086 $1,486.76 $1,227.11 . . .

21087 $1,484.23 $1,224.28 . . .

21088 . . I.C. . .

21089 . . I.C. . .

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35

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

21100 $844.10 $396.44 . . .

21110 $660.56 $550.12 . . .

21116 $119.75 $34.18 . . .

21120 $536.94 $421.18 . . .

21121 $655.00 $541.61 . . .

21122 . . $524.55 . .

21123 . . $745.57 . .

21125 $2,543.08 $622.17 . . .

21127 $3,691.75 $707.64 . . .

21137 . . $587.19 . .

21138 . . $706.01 . .

21139 . . $746.13 . .

21141 . . $1,056.73 . .

21142 . . $1,107.51 . .

21143 . . $1,114.54 . .

21145 . . $1,234.73 . .

21146 . . $1,214.24 . .

21147 . . $1,372.70 . .

21150 . . $1,323.29 . .

21151 . . $1,605.53 . .

21154 . . $1,629.29 . .

21155 . . $1,710.09 . .

21159 . . $1,952.66 . .

21160 . . $2,490.40 . .

21172 . . $1,446.71 . .

21175 . . $1,695.26 . .

21179 . . $1,154.92 . .

21180 . . $1,208.40 . .

21181 . . $579.86 . .

21182 . . $1,509.70 . .

21183 . . $1,802.30 . .

21184 . . $1,656.36 . .

21188 . . $1,271.55 . .

21193 . . $952.25 . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

21194 . . $1,129.31 . .

21195 . . $1,062.76 . .

21196 . . $1,175.84 . .

21198 . . $929.69 . .

21199 . . $837.28 . .

21206 . . $935.20 . .

21208 $1,560.10 $665.37 . . .

21209 $656.89 $493.17 . . .

21210 $1,899.40 $689.95 . . .

21215 $3,413.46 $716.84 . . .

21230 . . $559.40 . .

21235 $582.95 $450.31 . . .

21240 . . $886.17 . .

21242 . . $812.19 . .

21243 . . $1,341.61 . .

21244 . . $851.17 . .

21245 $888.50 $699.90 . . .

21246 . . $685.61 . .

21247 . . $1,219.15 . .

21248 $891.94 $719.92 . . .

21249 $1,215.36 $1,019.95 . . .

21255 . . $1,102.51 . .

21256 . . $955.21 . .

21260 . . $1,103.81 . .

21261 . . $1,651.47 . .

21263 . . $1,527.27 . .

21267 . . $1,260.15 . .

21268 . . $1,367.27 . .

21270 $772.62 $570.11 . . .

21275 . . $655.32 . .

21280 . . $452.21 . .

21282 . . $303.90 . .

21295 . . $144.88 . .

21296 . . $346.12 . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

21299 . . I.C. . .

21310 $108.76 $20.53 . . .

21315 $226.77 $121.08 . . .

21320 $209.34 $106.90 . . .

21325 . . $383.70 . .

21330 . . $456.30 . .

21335 . . $579.63 . .

21336 . . $518.33 . .

21337 $327.66 $235.88 . . .

21338 . . $581.45 . .

21339 . . $618.78 . .

21340 . . $594.21 . .

21343 . . $957.84 . .

21344 . . $1,095.34 . .

21345 $648.83 $517.08 . . .

21346 . . $725.83 . .

21347 . . $903.77 . .

21348 . . $944.55 . .

21355 $345.37 $254.18 . . .

21356 $403.52 $300.49 . . .

21360 . . $426.54 . .

21365 . . $872.26 . .

21366 . . $904.62 . .

21385 . . $539.68 . .

21386 . . $545.62 . .

21387 . . $562.52 . .

21390 . . $627.61 . .

21395 . . $784.97 . .

21400 $156.37 $125.88 . . .

21401 $358.65 $227.19 . . .

21406 . . $409.30 . .

21407 . . $509.82 . .

21408 . . $685.54 . .

21421 $616.53 $516.16 . . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

21422 . . $534.91 . .

21423 . . $646.71 . .

21431 . . $595.03 . .

21432 . . $519.91 . .

21433 . . $1,354.35 . .

21435 . . $988.28 . .

21436 . . $1,600.06 . .

21440 $478.75 $385.49 . . .

21445 $630.48 $508.20 . . .

21450 $513.35 $407.65 . . .

21451 $626.54 $522.02 . . .

21452 $500.08 $290.46 . . .

21453 $751.37 $640.05 . . .

21454 . . $472.48 . .

21461 $1,786.54 $763.02 . . .

21462 $1,890.09 $846.73 . . .

21465 . . $758.28 . .

21470 . . $950.26 . .

21480 $81.02 $24.47 . . .

21485 $579.15 $480.85 . . .

21490 . . $721.84 . .

21497 $607.88 $502.18 . . .

21499 . . I.C. . .

21501 $364.14 $253.71 . . .

21502 . . $411.42 . .

21510 . . $346.51 . .

21550 $212.95 $125.02 . . .

21552 . . $345.53 . .

21554 . . $565.88 . .

21555 $330.94 $240.04 . . .

21556 . . $413.43 . .

21557 . . $742.47 . .

21558 . . $1,038.89 . .

21600 . . $437.22 . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

21610 . . $902.53 . .

21615 . . $472.07 . .

21616 . . $576.79 . .

21620 . . $391.21 . .

21627 . . $421.52 . .

21630 . . $933.84 . .

21632 . . $927.03 . .

21685 . . $788.26 . .

21700 . . $283.70 . .

21705 . . $418.48 . .

21720 . . $355.52 . .

21725 . . $408.56 . .

21740 . . $781.47 . .

21742 . . I.C. . .

21743 . . I.C. . .

21750 . . $522.66 . .

21811 . . $463.78 . .

21812 . . $555.57 . .

21813 . . $723.26 . .

21820 $112.33 $115.29 . . .

21825 . . $419.40 . .

21899 . . I.C. . .

21920 $207.79 $126.96 . . .

21925 $353.27 $277.18 . . .

21930 $373.78 $284.37 . . .

21931 . . $362.77 . .

21932 . . $510.62 . .

21933 . . $567.64 . .

21935 . . $790.22 . .

21936 . . $1,083.26 . .

22010 . . $735.11 . .

22015 . . $713.04 . .

22100 . . $672.90 . .

22101 . . $659.66 . .

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40

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

22102 . . $616.08 . .

22103 . . $106.38 . .

22110 . . $804.62 . .

22112 . . $770.71 . .

22114 . . $774.66 . .

22116 . . $107.18 . .

22206 . . $1,866.87 . .

22207 . . $1,834.29 . .

22208 . . $443.67 . .

22210 . . $1,369.47 . .

22212 . . $1,144.01 . .

22214 . . $1,147.88 . .

22216 . . $276.94 . .

22220 . . $1,229.61 . .

22222 . . $1,208.22 . .

22224 . . $1,222.85 . .

22226 . . $276.22 . .

22310 $240.22 $220.09 . . .

22315 $692.92 $599.66 . . .

22318 . . $1,246.26 . .

22319 . . $1,377.06 . .

22325 . . $1,105.53 . .

22326 . . $1,139.32 . .

22327 . . $1,152.91 . .

22328 . . $213.64 . .

22505 . . $99.22 . .

22510 $1,457.71 $353.36 . . .

22511 $1,444.45 $331.82 . . .

22512 $809.36 $162.15 . . .

22513 $6,132.05 $416.38 . . .

22514 $6,127.91 $388.56 . . .

22515 $3,714.67 $173.65 . . .

22526 $1,981.49 $272.56 . . .

22527 $1,653.03 $122.93 . . .

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41

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

22532 . . $1,362.72 . .

22533 . . $1,277.51 . .

22534 . . $274.57 . .

22548 . . $1,492.72 . .

22551 . . $1,307.23 . .

22552 . . $302.27 . .

22554 . . $964.06 . .

22556 . . $1,277.08 . .

22558 . . $1,183.92 . .

22585 . . $250.63 . .

22586 . . $1,408.69 . .

22590 . . $1,206.49 . .

22595 . . $1,152.54 . .

22600 . . $989.86 . .

22610 . . $972.73 . .

22612 . . $1,221.46 . .

22614 . . $297.43 . .

22630 . . $1,198.82 . .

22632 . . $242.91 . .

22633 . . $1,418.51 . .

22634 . . $377.43 . .

22800 . . $1,043.94 . .

22802 . . $1,614.61 . .

22804 . . $1,863.41 . .

22808 . . $1,407.54 . .

22810 . . $1,554.98 . .

22812 . . $1,811.24 . .

22818 . . $1,679.86 . .

22819 . . $2,079.90 . .

22830 . . $628.14 . .

22840 . . $578.35 . .

22841 . . I.C. . .

22842 . . $580.32 . .

22843 . . $620.56 . .

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42

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

22844 . . $752.54 . .

22845 . . $554.09 . .

22846 . . $575.62 . .

22847 . . $632.17 . .

22848 . . $274.91 . .

22849 . . $998.06 . .

22850 . . $559.01 . .

22852 . . $536.80 . .

22853 - - $206.04 - -

22854 - - $266.74 - -

22855 . . $849.95 . .

22856 . . $1,241.62 . .

22857 . . $1,483.80 . .

22858 . . $379.30 . .

22859 - - $266.74 - -

22861 . . $1,554.52 . .

22862 . . $1,490.08 . .

22864 . . $1,558.01 . .

22865 . . $1,587.79 . .

22867 - - $782.15 - -

22868 - - $192.86 - -

22869 - - $434.02 - -

22870 - - $112.51 - -

22899 . . I.C. . .

22900 . . $435.64 . .

22901 . . $511.31 . .

22902 $347.07 $257.66 . . .

22903 . . $338.58 . .

22904 . . $804.28 . .

22905 . . $1,017.78 . .

22999 . . I.C. . .

23000 $470.91 $292.08 . . .

23020 . . $537.07 . .

23030 $354.38 $199.54 . . .

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43

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

23031 $345.07 $172.16 . . .

23035 . . $527.92 . .

23040 . . $560.82 . .

23044 . . $443.24 . .

23065 $172.72 $131.86 . . .

23066 $446.83 $280.15 . . .

23071 . . $325.10 . .

23073 . . $536.27 . .

23075 $373.38 $254.95 . . .

23076 . . $419.79 . .

23077 . . $882.03 . .

23078 . . $1,104.38 . .

23100 . . $390.24 . .

23101 . . $355.53 . .

23105 . . $497.94 . .

23106 . . $385.23 . .

23107 . . $514.46 . .

23120 . . $457.78 . .

23125 . . $552.13 . .

23130 . . $477.28 . .

23140 . . $416.01 . .

23145 . . $541.27 . .

23146 . . $484.67 . .

23150 . . $512.55 . .

23155 . . $617.31 . .

23156 . . $527.16 . .

23170 . . $433.14 . .

23172 . . $442.59 . .

23174 . . $585.41 . .

23180 . . $518.71 . .

23182 . . $509.02 . .

23184 . . $572.90 . .

23190 . . $443.72 . .

23195 . . $585.52 . .

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44

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

23200 . . $1,146.43 . .

23210 . . $1,371.14 . .

23220 . . $1,500.69 . .

23330 $192.31 $118.88 . . .

23333 . . $354.92 . .

23334 . . $836.31 . .

23335 . . $992.38 . .

23350 $106.06 $39.74 . . .

23395 . . $999.34 . .

23397 . . $883.95 . .

23400 . . $753.80 . .

23405 . . $487.23 . .

23406 . . $598.78 . .

23410 . . $640.12 . .

23412 . . $663.58 . .

23415 . . $543.55 . .

23420 . . $754.40 . .

23430 . . $581.97 . .

23440 . . $587.59 . .

23450 . . $733.29 . .

23455 . . $775.71 . .

23460 . . $845.60 . .

23462 . . $821.89 . .

23465 . . $864.40 . .

23466 . . $871.92 . .

23470 . . $933.46 . .

23472 . . $1,129.48 . .

23473 . . $1,259.76 . .

23474 . . $1,360.10 . .

23480 . . $637.81 . .

23485 . . $740.77 . .

23490 . . $655.56 . .

23491 . . $785.71 . .

23500 $173.28 $176.53 . . .

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45

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

23505 $278.58 $262.29 . . .

23515 . . $562.23 . .

23520 $177.44 $180.40 . . .

23525 $297.79 $274.11 . . .

23530 . . $429.68 . .

23532 . . $485.38 . .

23540 $177.79 $181.05 . . .

23545 $270.28 $244.52 . . .

23550 . . $440.75 . .

23552 . . $511.04 . .

23570 $183.64 $189.56 . . .

23575 $314.90 $294.18 . . .

23585 . . $761.92 . .

23600 $259.88 $244.19 . . .

23605 $365.48 $333.21 . . .

23615 . . $688.94 . .

23616 . . $963.49 . .

23620 $214.14 $203.18 . . .

23625 $298.83 $276.92 . . .

23630 . . $609.81 . .

23650 $247.52 $226.20 . . .

23655 . . $315.11 . .

23660 . . $454.32 . .

23665 $334.71 $310.43 . . .

23670 . . $681.59 . .

23675 $433.19 $392.34 . . .

23680 . . $722.06 . .

23700 . . $153.46 . .

23800 . . $796.27 . .

23802 . . $981.76 . .

23900 . . $1,075.57 . .

23920 . . $871.64 . .

23921 . . $367.21 . .

23929 . . I.C. . .

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46

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

23930 $282.07 $167.49 . . .

23931 $232.93 $126.34 . . .

23935 . . $396.69 . .

24000 . . $373.22 . .

24006 . . $550.59 . .

24065 $206.42 $132.70 . . .

24066 $498.87 $324.49 . . .

24071 . . $314.86 . .

24073 . . $535.45 . .

24075 $391.79 $257.96 . . .

24076 . . $422.52 . .

24077 . . $798.15 . .

24079 . . $1,018.67 . .

24100 . . $327.68 . .

24101 . . $391.99 . .

24102 . . $481.05 . .

24105 . . $277.12 . .

24110 . . $453.60 . .

24115 . . $573.84 . .

24116 . . $669.57 . .

24120 . . $413.87 . .

24125 . . $480.84 . .

24126 . . $506.32 . .

24130 . . $397.80 . .

24134 . . $581.25 . .

24136 . . $491.98 . .

24138 . . $526.11 . .

24140 . . $545.79 . .

24145 . . $461.81 . .

24147 . . $486.54 . .

24149 . . $916.82 . .

24150 . . $1,205.82 . .

24152 . . $1,034.59 . .

24155 . . $655.00 . .

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47

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

24160 . . $981.37 . .

24164 . . $568.62 . .

24200 $166.03 $110.07 . . .

24201 $435.73 $281.77 . . .

24220 $129.90 $53.81 . . .

24300 . . $332.87 . .

24301 . . $584.09 . .

24305 . . $451.27 . .

24310 . . $369.60 . .

24320 . . $607.24 . .

24330 . . $558.74 . .

24331 . . $611.19 . .

24332 . . $477.74 . .

24340 . . $478.39 . .

24341 . . $585.02 . .

24342 . . $603.90 . .

24343 . . $552.69 . .

24344 . . $852.59 . .

24345 . . $550.35 . .

24346 . . $852.53 . .

24357 . . $337.89 . .

24358 . . $409.02 . .

24359 . . $514.28 . .

24360 . . $688.21 . .

24361 . . $773.55 . .

24362 . . $822.46 . .

24363 . . $1,128.91 . .

24365 . . $495.60 . .

24366 . . $529.74 . .

24370 . . $1,201.41 . .

24371 . . $1,381.00 . .

24400 . . $635.63 . .

24410 . . $820.87 . .

24420 . . $766.29 . .

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48

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

24430 . . $820.88 . .

24435 . . $839.12 . .

24470 . . $442.16 . .

24495 . . $508.15 . .

24498 . . $673.30 . .

24500 $284.54 $257.89 . . .

24505 $393.60 $353.93 . . .

24515 . . $682.53 . .

24516 . . $668.66 . .

24530 $301.84 $271.93 . . .

24535 $482.10 $443.01 . . .

24538 . . $580.08 . .

24545 . . $722.81 . .

24546 . . $807.62 . .

24560 $254.97 $227.14 . . .

24565 $416.96 $380.84 . . .

24566 . . $561.43 . .

24575 . . $570.44 . .

24576 $270.68 $241.96 . . .

24577 $428.08 $390.77 . . .

24579 . . $651.50 . .

24582 . . $631.66 . .

24586 . . $841.25 . .

24587 . . $840.34 . .

24600 $286.00 $260.53 . . .

24605 . . $368.81 . .

24615 . . $554.63 . .

24620 . . $429.41 . .

24635 . . $526.06 . .

24640 $107.51 $71.99 . . .

24650 $208.58 $190.82 . . .

24655 $343.73 $311.46 . . .

24665 . . $510.29 . .

24666 . . $572.02 . .

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49

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

24670 $231.41 $208.02 . . .

24675 $358.08 $324.92 . . .

24685 . . $511.94 . .

24800 . . $645.52 . .

24802 . . $760.80 . .

24900 . . $568.62 . .

24920 . . $568.98 . .

24925 . . $427.18 . .

24930 . . $596.40 . .

24931 . . $623.02 . .

24935 . . $854.74 . .

24940 . . I.C. . .

24999 . . I.C. . .

25000 . . $266.64 . .

25001 . . $270.19 . .

25020 . . $455.36 . .

25023 . . $862.27 . .

25024 . . $600.36 . .

25025 . . $935.21 . .

25028 . . $414.39 . .

25031 . . $281.93 . .

25035 . . $452.04 . .

25040 . . $439.31 . .

25065 $204.98 $129.48 . . .

25066 . . $282.07 . .

25071 . . $330.60 . .

25073 . . $414.73 . .

25075 $382.75 $248.04 . . .

25076 . . $403.84 . .

25077 . . $684.52 . .

25078 . . $897.85 . .

25085 . . $352.13 . .

25100 . . $271.11 . .

25101 . . $316.80 . .

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50

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

25105 . . $378.28 . .

25107 . . $482.80 . .

25109 . . $421.13 . .

25110 . . $268.95 . .

25111 . . $252.64 . .

25112 . . $303.17 . .

25115 . . $592.48 . .

25116 . . $470.34 . .

25118 . . $299.94 . .

25119 . . $387.63 . .

25120 . . $389.44 . .

25125 . . $452.44 . .

25126 . . $463.28 . .

25130 . . $350.74 . .

25135 . . $432.04 . .

25136 . . $382.54 . .

25145 . . $404.13 . .

25150 . . $441.95 . .

25151 . . $454.79 . .

25170 . . $1,145.58 . .

25210 . . $382.44 . .

25215 . . $482.52 . .

25230 . . $339.12 . .

25240 . . $335.89 . .

25246 $130.88 $58.64 . . .

25248 . . $324.59 . .

25250 . . $411.57 . .

25251 . . $557.22 . .

25259 . . $330.34 . .

25260 . . $493.30 . .

25263 . . $486.30 . .

25265 . . $582.08 . .

25270 . . $383.69 . .

25272 . . $431.87 . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

25274 . . $518.00 . .

25275 . . $524.63 . .

25280 . . $440.78 . .

25290 . . $342.22 . .

25295 . . $409.43 . .

25300 . . $532.89 . .

25301 . . $501.84 . .

25310 . . $484.88 . .

25312 . . $557.82 . .

25315 . . $599.00 . .

25316 . . $709.51 . .

25320 . . $772.91 . .

25332 . . $655.60 . .

25335 . . $627.43 . .

25337 . . $695.30 . .

25350 . . $525.94 . .

25355 . . $584.85 . .

25360 . . $510.23 . .

25365 . . $708.57 . .

25370 . . $782.98 . .

25375 . . $739.27 . .

25390 . . $599.52 . .

25391 . . $772.40 . .

25392 . . $675.52 . .

25393 . . $882.96 . .

25394 . . $605.83 . .

25400 . . $625.24 . .

25405 . . $805.55 . .

25415 . . $746.75 . .

25420 . . $904.28 . .

25425 . . $747.18 . .

25426 . . $870.68 . .

25430 . . $570.17 . .

25431 . . $611.74 . .

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52

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

25440 . . $597.04 . .

25441 . . $730.74 . .

25442 . . $628.96 . .

25443 . . $607.99 . .

25444 . . $642.24 . .

25445 . . $562.30 . .

25446 . . $909.19 . .

25447 . . $646.30 . .

25449 . . $803.47 . .

25450 . . $404.55 . .

25455 . . $478.36 . .

25490 . . $559.62 . .

25491 . . $575.24 . .

25492 . . $702.50 . .

25500 $217.37 $198.71 . . .

25505 $397.07 $361.84 . . .

25515 . . $522.50 . .

25520 $438.65 $414.96 . . .

25525 . . $612.04 . .

25526 . . $740.84 . .

25530 $209.35 $188.92 . . .

25535 $385.36 $355.16 . . .

25545 . . $487.57 . .

25560 $221.08 $198.87 . . .

25565 $408.89 $367.74 . . .

25574 . . $525.17 . .

25575 . . $701.99 . .

25600 $262.13 $247.33 . . .

25605 $429.30 $402.36 . . .

25606 . . $518.68 . .

25607 . . $574.48 . .

25608 . . $642.66 . .

25609 . . $816.10 . .

25622 $242.24 $219.73 . . .

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53

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

25624 $376.10 $341.17 . . .

25628 . . $562.72 . .

25630 $241.84 $221.41 . . .

25635 $337.41 $299.52 . . .

25645 . . $442.50 . .

25650 $253.79 $237.21 . . .

25651 . . $381.11 . .

25652 . . $487.75 . .

25660 . . $320.49 . .

25670 . . $473.10 . .

25671 . . $415.52 . .

25675 $342.38 $310.70 . . .

25676 . . $489.52 . .

25680 . . $370.64 . .

25685 . . $569.68 . .

25690 . . $373.34 . .

25695 . . $493.22 . .

25800 . . $570.63 . .

25805 . . $656.47 . .

25810 . . $676.83 . .

25820 . . $482.50 . .

25825 . . $593.49 . .

25830 . . $746.10 . .

25900 . . $552.01 . .

25905 . . $495.49 . .

25907 . . $451.91 . .

25909 . . $532.88 . .

25915 . . $915.28 . .

25920 . . $541.38 . .

25922 . . $445.91 . .

25924 . . $472.32 . .

25927 . . $640.01 . .

25929 . . $459.78 . .

25931 . . $516.24 . .

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54

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

25999 . . I.C. . .

26010 $214.30 $108.90 . . .

26011 $316.07 $145.53 . . .

26020 . . $341.28 . .

26025 . . $331.81 . .

26030 . . $385.32 . .

26034 . . $421.11 . .

26035 . . $669.53 . .

26037 . . $442.58 . .

26040 . . $246.05 . .

26045 . . $367.26 . .

26055 $452.83 $246.17 . . .

26060 . . $209.29 . .

26070 . . $246.95 . .

26075 . . $261.76 . .

26080 . . $307.57 . .

26100 . . $262.30 . .

26105 . . $262.26 . .

26110 . . $253.19 . .

26111 . . $326.88 . .

26113 . . $429.05 . .

26115 $404.23 $261.82 . . .

26116 . . $412.79 . .

26117 . . $584.61 . .

26118 . . $818.18 . .

26121 . . $466.80 . .

26123 . . $652.14 . .

26125 . . $211.04 . .

26130 . . $362.45 . .

26135 . . $429.88 . .

26140 . . $394.89 . .

26145 . . $400.22 . .

26160 $464.20 $264.05 . . .

26170 . . $318.18 . .

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55

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

26180 . . $348.09 . .

26185 . . $429.30 . .

26200 . . $352.80 . .

26205 . . $469.69 . .

26210 . . $347.21 . .

26215 . . $439.50 . .

26230 . . $390.11 . .

26235 . . $386.30 . .

26236 . . $346.15 . .

26250 . . $841.99 . .

26260 . . $625.93 . .

26262 . . $491.88 . .

26320 . . $272.88 . .

26340 . . $267.44 . .

26341 $78.59 $58.76 . . .

26350 . . $561.45 . .

26352 . . $642.00 . .

26356 . . $692.59 . .

26357 . . $672.91 . .

26358 . . $745.40 . .

26370 . . $594.63 . .

26372 . . $688.38 . .

26373 . . $661.85 . .

26390 . . $651.33 . .

26392 . . $754.64 . .

26410 . . $446.80 . .

26412 . . $535.09 . .

26415 . . $599.52 . .

26416 . . $559.82 . .

26418 . . $457.98 . .

26420 . . $554.98 . .

26426 . . $392.14 . .

26428 . . $591.38 . .

26432 . . $394.14 . .

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56

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

26433 . . $418.66 . .

26434 . . $507.14 . .

26437 . . $488.53 . .

26440 . . $489.21 . .

26442 . . $755.65 . .

26445 . . $456.98 . .

26449 . . $545.23 . .

26450 . . $321.12 . .

26455 . . $316.53 . .

26460 . . $310.35 . .

26471 . . $482.13 . .

26474 . . $472.66 . .

26476 . . $456.19 . .

26477 . . $456.85 . .

26478 . . $487.04 . .

26479 . . $482.10 . .

26480 . . $591.97 . .

26483 . . $660.59 . .

26485 . . $633.64 . .

26489 . . $713.99 . .

26490 . . $614.00 . .

26492 . . $681.28 . .

26494 . . $615.88 . .

26496 . . $668.40 . .

26497 . . $674.12 . .

26498 . . $885.49 . .

26499 . . $647.01 . .

26500 . . $488.17 . .

26502 . . $546.04 . .

26508 . . $503.49 . .

26510 . . $467.35 . .

26516 . . $547.49 . .

26517 . . $642.08 . .

26518 . . $644.50 . .

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57

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

26520 . . $513.84 . .

26525 . . $514.22 . .

26530 . . $419.83 . .

26531 . . $488.00 . .

26535 . . $330.66 . .

26536 . . $561.40 . .

26540 . . $514.45 . .

26541 . . $624.57 . .

26542 . . $530.19 . .

26545 . . $539.87 . .

26546 . . $775.34 . .

26548 . . $593.14 . .

26550 . . $1,198.63 . .

26551 . . $2,200.38 . .

26553 . . $2,526.94 . .

26554 . . $2,556.47 . .

26555 . . $1,043.55 . .

26556 . . $2,627.14 . .

26560 . . $440.32 . .

26561 . . $724.51 . .

26562 . . $1,042.03 . .

26565 . . $529.73 . .

26567 . . $532.78 . .

26568 . . $704.32 . .

26580 . . $1,137.68 . .

26587 . . $706.97 . .

26590 . . $1,038.53 . .

26591 . . $345.54 . .

26593 . . $471.82 . .

26596 . . $587.47 . .

26600 $234.54 $220.33 . . .

26605 $255.49 $231.81 . . .

26607 . . $356.92 . .

26608 . . $374.83 . .

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58

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

26615 . . $452.20 . .

26641 $290.11 $263.46 . . .

26645 $332.09 $303.67 . . .

26650 . . $376.50 . .

26665 . . $494.24 . .

26670 $267.14 $241.08 . . .

26675 $355.29 $324.79 . . .

26676 . . $393.95 . .

26685 . . $452.46 . .

26686 . . $486.31 . .

26700 $253.32 $237.04 . . .

26705 $329.22 $300.21 . . .

26706 . . $345.46 . .

26715 . . $449.25 . .

26720 $158.00 $146.45 . . .

26725 $266.27 $238.73 . . .

26727 . . $368.92 . .

26735 . . $467.67 . .

26740 $183.08 $171.54 . . .

26742 $290.27 $262.14 . . .

26746 . . $579.42 . .

26750 $146.19 $146.48 . . .

26755 $248.27 $214.22 . . .

26756 . . $329.66 . .

26765 . . $394.39 . .

26770 $216.83 $199.95 . . .

26775 $302.74 $272.54 . . .

26776 . . $348.59 . .

26785 . . $430.17 . .

26820 . . $613.78 . .

26841 . . $568.16 . .

26842 . . $612.50 . .

26843 . . $576.60 . .

26844 . . $633.60 . .

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59

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

26850 . . $541.01 . .

26852 . . $620.16 . .

26860 . . $445.33 . .

26861 . . $79.49 . .

26862 . . $567.62 . .

26863 . . $176.24 . .

26910 . . $561.32 . .

26951 . . $514.09 . .

26952 . . $505.29 . .

26989 . . I.C. . .

26990 . . $488.03 . .

26991 $557.53 $406.53 . . .

26992 . . $746.80 . .

27000 . . $326.22 . .

27001 . . $418.79 . .

27003 . . $464.88 . .

27005 . . $563.38 . .

27006 . . $573.05 . .

27025 . . $712.37 . .

27027 . . $698.42 . .

27030 . . $726.15 . .

27033 . . $754.43 . .

27035 . . $891.13 . .

27036 . . $785.01 . .

27040 $276.67 $156.47 . . .

27041 . . $535.34 . .

27043 . . $362.51 . .

27045 . . $579.10 . .

27047 $368.19 $281.44 . . .

27048 . . $472.69 . .

27049 . . $1,036.36 . .

27050 . . $302.30 . .

27052 . . $450.82 . .

27054 . . $534.30 . .

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60

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

27057 . . $785.07 . .

27059 . . $1,398.53 . .

27060 . . $362.25 . .

27062 . . $357.37 . .

27065 . . $400.59 . .

27066 . . $631.60 . .

27067 . . $797.13 . .

27070 . . $660.70 . .

27071 . . $714.85 . .

27075 . . $1,619.22 . .

27076 . . $1,950.91 . .

27077 . . $2,190.93 . .

27078 . . $1,595.25 . .

27080 . . $398.64 . .

27086 $234.43 $130.80 . . .

27087 . . $487.06 . .

27090 . . $645.78 . .

27091 . . $1,237.82 . .

27093 $152.88 $54.59 . . .

27095 $197.01 $64.07 . . .

27096 $130.35 $66.39 . . .

27097 . . $524.11 . .

27098 . . $521.98 . .

27100 . . $637.99 . .

27105 . . $674.15 . .

27110 . . $751.56 . .

27111 . . $699.53 . .

27120 . . $1,007.78 . .

27122 . . $853.40 . .

27125 . . $880.02 . .

27130 . . $1,050.78 . .

27132 . . $1,297.34 . .

27134 . . $1,481.53 . .

27137 . . $1,140.73 . .

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61

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

27138 . . $1,184.91 . .

27140 . . $695.35 . .

27146 . . $997.48 . .

27147 . . $1,139.82 . .

27151 . . $1,230.46 . .

27156 . . $1,328.19 . .

27158 . . $1,097.07 . .

27161 . . $943.26 . .

27165 . . $1,067.59 . .

27170 . . $911.39 . .

27175 . . $518.66 . .

27176 . . $699.63 . .

27177 . . $865.13 . .

27178 . . $713.90 . .

27179 . . $758.01 . .

27181 . . $750.19 . .

27185 . . $474.76 . .

27187 . . $770.47 . .

27197 - - $94.08 - -

27198 - - $236.12 - -

27200 $143.01 $149.52 . . .

27202 . . $413.18 . .

27215 . . $485.48 . .

27216 . . $718.39 . .

27217 . . $674.62 . .

27218 . . $929.44 . .

27220 $414.66 $410.81 . . .

27222 . . $758.28 . .

27226 . . $820.08 . .

27227 . . $1,284.37 . .

27228 . . $1,462.74 . .

27230 $372.08 $369.71 . . .

27232 . . $581.43 . .

27235 . . $706.59 . .

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62

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

27236 . . $929.02 . .

27238 . . $360.40 . .

27240 . . $743.14 . .

27244 . . $955.73 . .

27245 . . $955.56 . .

27246 $301.37 $303.15 . . .

27248 . . $576.80 . .

27250 . . $136.43 . .

27252 . . $588.78 . .

27253 . . $730.34 . .

27254 . . $982.93 . .

27256 $232.90 $179.32 . . .

27257 . . $281.38 . .

27258 . . $861.64 . .

27259 . . $1,203.90 . .

27265 . . $312.55 . .

27266 . . $453.41 . .

27267 . . $340.52 . .

27268 . . $415.72 . .

27269 . . $960.72 . .

27275 . . $142.43 . .

27279 . . $537.16 . .

27280 . . $1,043.68 . .

27282 . . $643.21 . .

27284 . . $1,205.60 . .

27286 . . $1,270.58 . .

27290 . . $1,244.66 . .

27295 . . $971.64 . .

27299 . . I.C. . .

27301 $531.70 $390.18 . . .

27303 . . $496.73 . .

27305 . . $376.98 . .

27306 . . $280.67 . .

27307 . . $360.94 . .

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63

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

27310 . . $569.71 . .

27323 $217.41 $140.14 . . .

27324 . . $311.01 . .

27325 . . $427.38 . .

27326 . . $404.77 . .

27327 $366.82 $245.73 . . .

27328 . . $480.91 . .

27329 . . $799.67 . .

27330 . . $328.17 . .

27331 . . $371.80 . .

27332 . . $500.10 . .

27333 . . $457.82 . .

27334 . . $533.04 . .

27335 . . $594.47 . .

27337 . . $324.05 . .

27339 . . $582.42 . .

27340 . . $292.66 . .

27345 . . $376.52 . .

27347 . . $414.76 . .

27350 . . $508.33 . .

27355 . . $469.58 . .

27356 . . $573.62 . .

27357 . . $633.74 . .

27358 . . $213.63 . .

27360 . . $663.78 . .

27364 . . $1,203.85 . .

27365 . . $1,601.01 . .

27370 $126.63 $39.29 . . .

27372 $485.10 $315.74 . . .

27380 . . $465.35 . .

27381 . . $621.36 . .

27385 . . $451.87 . .

27386 . . $647.18 . .

27390 . . $351.16 . .

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64

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

27391 . . $450.54 . .

27392 . . $554.69 . .

27393 . . $396.34 . .

27394 . . $500.97 . .

27395 . . $683.17 . .

27396 . . $480.44 . .

27397 . . $702.04 . .

27400 . . $541.12 . .

27403 . . $499.25 . .

27405 . . $526.15 . .

27407 . . $604.48 . .

27409 . . $740.90 . .

27412 . . $1,281.84 . .

27415 . . $1,064.45 . .

27416 . . $759.82 . .

27418 . . $645.20 . .

27420 . . $579.47 . .

27422 . . $577.92 . .

27424 . . $582.44 . .

27425 . . $351.82 . .

27427 . . $555.00 . .

27428 . . $867.45 . .

27429 . . $970.76 . .

27430 . . $576.24 . .

27435 . . $629.80 . .

27437 . . $514.63 . .

27438 . . $654.02 . .

27440 . . $620.79 . .

27441 . . $640.12 . .

27442 . . $675.89 . .

27443 . . $627.60 . .

27445 . . $967.87 . .

27446 . . $899.16 . .

27447 . . $1,050.48 . .

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65

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

27448 . . $604.42 . .

27450 . . $785.34 . .

27454 . . $1,008.41 . .

27455 . . $731.77 . .

27457 . . $735.27 . .

27465 . . $958.29 . .

27466 . . $915.57 . .

27468 . . $956.35 . .

27470 . . $913.30 . .

27472 . . $979.75 . .

27475 . . $515.68 . .

27477 . . $569.25 . .

27479 . . $613.91 . .

27485 . . $522.04 . .

27486 . . $1,091.61 . .

27487 . . $1,361.74 . .

27488 . . $932.83 . .

27495 . . $875.22 . .

27496 . . $424.16 . .

27497 . . $452.33 . .

27498 . . $503.26 . .

27499 . . $544.32 . .

27500 $407.09 $374.82 . . .

27501 $393.34 $390.09 . . .

27502 . . $593.36 . .

27503 . . $624.27 . .

27506 . . $1,038.82 . .

27507 . . $754.32 . .

27508 $412.91 $387.16 . . .

27509 . . $503.53 . .

27510 . . $530.63 . .

27511 . . $771.99 . .

27513 . . $959.19 . .

27514 . . $748.88 . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

27516 $400.81 $375.05 . . .

27517 . . $524.69 . .

27519 . . $690.50 . .

27520 $257.11 $233.43 . . .

27524 . . $586.19 . .

27530 $241.02 $223.25 . . .

27532 $481.74 $450.35 . . .

27535 . . $695.49 . .

27536 . . $924.49 . .

27538 $373.13 $348.26 . . .

27540 . . $630.65 . .

27550 $397.31 $366.81 . . .

27552 . . $488.72 . .

27556 . . $678.20 . .

27557 . . $810.39 . .

27558 . . $920.81 . .

27560 $285.76 $262.37 . . .

27562 . . $367.07 . .

27566 . . $693.23 . .

27570 . . $118.97 . .

27580 . . $1,115.71 . .

27590 . . $617.77 . .

27591 . . $748.55 . .

27592 . . $527.61 . .

27594 . . $395.53 . .

27596 . . $560.55 . .

27598 . . $560.34 . .

27599 . . I.C. . .

27600 . . $319.89 . .

27601 . . $345.89 . .

27602 . . $379.70 . .

27603 $422.44 $304.01 . . .

27604 $397.63 $272.69 . . .

27605 $277.87 $145.52 . . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

27606 . . $221.35 . .

27607 . . $473.90 . .

27610 . . $509.09 . .

27612 . . $437.67 . .

27613 $203.46 $128.55 . . .

27614 $462.98 $317.31 . . .

27615 . . $790.83 . .

27616 . . $981.22 . .

27618 $359.59 $240.87 . . .

27619 . . $366.97 . .

27620 . . $357.23 . .

27625 . . $459.02 . .

27626 . . $483.91 . .

27630 $452.82 $288.79 . . .

27632 . . $322.11 . .

27634 . . $532.73 . .

27635 . . $459.84 . .

27637 . . $585.92 . .

27638 . . $595.41 . .

27640 . . $649.69 . .

27641 . . $522.35 . .

27645 . . $1,373.05 . .

27646 . . $1,189.78 . .

27647 . . $800.79 . .

27648 $134.06 $40.80 . . .

27650 . . $518.01 . .

27652 . . $535.39 . .

27654 . . $555.80 . .

27656 $512.65 $311.91 . . .

27658 . . $294.48 . .

27659 . . $378.85 . .

27664 . . $285.26 . .

27665 . . $324.99 . .

27675 . . $382.61 . .

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68

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

27676 . . $472.41 . .

27680 . . $337.73 . .

27681 . . $425.76 . .

27685 $534.93 $366.17 . . .

27686 . . $436.98 . .

27687 . . $357.48 . .

27690 . . $495.75 . .

27691 . . $587.18 . .

27692 . . $80.64 . .

27695 . . $374.26 . .

27696 . . $436.66 . .

27698 . . $502.07 . .

27700 . . $466.46 . .

27702 . . $752.26 . .

27703 . . $863.12 . .

27704 . . $451.76 . .

27705 . . $592.22 . .

27707 . . $318.74 . .

27709 . . $906.57 . .

27712 . . $856.67 . .

27715 . . $831.34 . .

27720 . . $681.51 . .

27722 . . $683.74 . .

27724 . . $979.40 . .

27725 . . $939.12 . .

27726 . . $750.74 . .

27727 . . $805.49 . .

27730 . . $445.23 . .

27732 . . $318.36 . .

27734 . . $511.47 . .

27740 . . $551.74 . .

27742 . . $607.87 . .

27745 . . $588.67 . .

27750 $275.17 $251.48 . . .

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69

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

27752 $422.57 $388.22 . . .

27756 . . $448.55 . .

27758 . . $693.31 . .

27759 . . $776.04 . .

27760 $265.82 $241.54 . . .

27762 $374.88 $339.95 . . .

27766 . . $478.68 . .

27767 $224.10 $225.58 . . .

27768 . . $345.99 . .

27769 . . $568.66 . .

27780 $244.40 $221.31 . . .

27781 $333.64 $307.89 . . .

27784 . . $559.32 . .

27786 $252.07 $226.90 . . .

27788 $332.73 $302.53 . . .

27792 . . $510.73 . .

27808 $266.88 $238.45 . . .

27810 $368.30 $332.47 . . .

27814 . . $602.71 . .

27816 $255.06 $227.53 . . .

27818 $381.32 $339.57 . . .

27822 . . $658.19 . .

27823 . . $745.52 . .

27824 $248.48 $241.08 . . .

27825 $427.43 $385.09 . . .

27826 . . $651.14 . .

27827 . . $843.85 . .

27828 . . $1,008.47 . .

27829 . . $536.78 . .

27830 $300.87 $279.25 . . .

27831 . . $307.42 . .

27832 . . $590.16 . .

27840 . . $289.20 . .

27842 . . $388.03 . .

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70

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

27846 . . $566.59 . .

27848 . . $632.13 . .

27860 . . $137.45 . .

27870 . . $802.91 . .

27871 . . $534.40 . .

27880 . . $707.90 . .

27881 . . $677.00 . .

27882 . . $465.47 . .

27884 . . $449.10 . .

27886 . . $513.03 . .

27888 . . $532.40 . .

27889 . . $502.13 . .

27892 . . $431.02 . .

27893 . . $472.14 . .

27894 . . $662.80 . .

27899 . . I.C. . .

28001 $225.57 $134.08 . . .

28002 $356.76 $250.76 . . .

28003 $568.13 $447.33 . . .

28005 . . $456.05 . .

28008 $351.40 $232.38 . . .

28010 $186.32 $166.78 . . .

28011 $257.66 $228.35 . . .

28020 $439.97 $286.31 . . .

28022 $398.10 $258.06 . . .

28024 $376.68 $242.26 . . .

28035 $427.80 $280.65 . . .

28039 $413.19 $276.70 . . .

28041 . . $363.91 . .

28043 $326.49 $208.65 . . .

28045 $402.76 $275.74 . . .

28046 . . $572.37 . .

28047 . . $832.36 . .

28050 $347.35 $222.71 . . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

28052 $366.23 $226.78 . . .

28054 $321.48 $195.06 . . .

28055 . . $296.69 . .

28060 $421.80 $282.94 . . .

28062 $475.80 $322.13 . . .

28070 $434.15 $281.68 . . .

28072 $412.80 $262.99 . . .

28080 $428.70 $293.39 . . .

28086 $446.55 $286.08 . . .

28088 $366.56 $224.45 . . .

28090 $384.63 $244.88 . . .

28092 $346.96 $214.31 . . .

28100 $493.31 $326.32 . . .

28102 . . $473.34 . .

28103 . . $310.19 . .

28104 $429.63 $279.52 . . .

28106 . . $366.14 . .

28107 $455.45 $296.46 . . .

28108 $360.58 $229.42 . . .

28110 $379.63 $230.41 . . .

28111 $400.87 $257.57 . . .

28112 $399.88 $248.59 . . .

28113 $482.04 $338.74 . . .

28114 $865.43 $661.73 . . .

28116 $608.35 $449.66 . . .

28118 $481.81 $326.37 . . .

28119 $428.00 $286.48 . . .

28120 $547.92 $393.37 . . .

28122 $485.12 $348.63 . . .

28124 $389.29 $262.87 . . .

28126 $324.75 $198.03 . . .

28130 . . $504.33 . .

28140 $480.93 $345.92 . . .

28150 $349.41 $223.28 . . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

28153 $337.53 $210.22 . . .

28160 $345.51 $215.24 . . .

28171 . . $664.68 . .

28173 . . $598.07 . .

28175 . . $386.11 . .

28190 $211.51 $106.40 . . .

28192 $384.49 $249.48 . . .

28193 $430.97 $291.81 . . .

28200 $399.89 $255.11 . . .

28202 $483.76 $336.91 . . .

28208 $387.13 $247.39 . . .

28210 $464.33 $322.80 . . .

28220 $367.48 $239.58 . . .

28222 $411.83 $276.23 . . .

28225 $335.84 $206.45 . . .

28226 $494.07 $309.02 . . .

28230 $355.68 $224.82 . . .

28232 $318.25 $193.90 . . .

28234 $335.97 $211.02 . . .

28238 $541.87 $383.77 . . .

28240 $361.03 $230.46 . . .

28250 $471.66 $320.37 . . .

28260 $553.01 $401.43 . . .

28261 $784.54 $608.67 . . .

28262 $1,164.11 $918.97 . . .

28264 $798.60 $594.90 . . .

28270 $401.14 $265.25 . . .

28272 $323.54 $202.74 . . .

28280 $421.85 $277.37 . . .

28285 $435.41 $300.11 . . .

28286 $369.74 $238.28 . . .

28288 $493.02 $342.32 . . .

28289 $591.52 $431.64 . . .

28291 $602.06 $385.05 - - -

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

28292 $639.42 $477.76 . . .

28295 $778.08 $430.87 - - -

28296 $577.58 $412.37 . . .

28297 $655.13 $457.35 . . .

28298 $584.43 $398.79 . . .

28299 $720.71 $532.11 . . .

28300 . . $510.86 . .

28302 . . $557.52 . .

28304 $664.81 $475.92 . . .

28305 . . $522.92 . .

28306 $499.35 $318.75 . . .

28307 $553.51 $354.85 . . .

28308 $461.63 $299.38 . . .

28309 . . $707.62 . .

28310 $446.39 $283.55 . . .

28312 $417.03 $253.60 . . .

28313 $430.60 $284.04 . . .

28315 $392.67 $257.96 . . .

28320 . . $478.88 . .

28322 $636.46 $454.67 . . .

28340 $469.44 $326.74 . . .

28341 $542.98 $388.43 . . .

28344 $380.20 $246.38 . . .

28345 $425.15 $289.25 . . .

28360 . . $719.28 . .

28400 $200.06 $182.30 . . .

28405 $313.00 $282.21 . . .

28406 . . $412.38 . .

28415 . . $864.58 . .

28420 . . $977.24 . .

28430 $190.66 $168.45 . . .

28435 $254.24 $225.52 . . .

28436 . . $355.73 . .

28445 . . $829.08 . .

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74

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

28446 . . $940.47 . .

28450 $174.18 $154.34 . . .

28455 $232.46 $207.88 . . .

28456 . . $256.00 . .

28465 . . $490.62 . .

28470 $176.71 $164.57 . . .

28475 $205.52 $180.94 . . .

28476 . . $282.21 . .

28485 . . $415.77 . .

28490 $118.45 $101.28 . . .

28495 $144.27 $120.28 . . .

28496 $363.05 $187.78 . . .

28505 $538.34 $394.16 . . .

28510 $100.22 $97.56 . . .

28515 $130.93 $114.94 . . .

28525 $460.77 $316.58 . . .

28530 $93.67 $82.72 . . .

28531 $286.31 $147.45 . . .

28540 $167.29 $150.11 . . .

28545 $234.47 $206.64 . . .

28546 $459.11 $262.82 . . .

28555 $706.81 $525.31 . . .

28570 $179.84 $151.12 . . .

28575 $291.43 $262.12 . . .

28576 . . $307.66 . .

28585 $686.26 $528.15 . . .

28600 $176.41 $150.65 . . .

28605 $261.25 $233.71 . . .

28606 . . $311.92 . .

28615 . . $621.57 . .

28630 $125.79 $85.82 . . .

28635 $140.61 $103.90 . . .

28636 $232.24 $145.19 . . .

28645 $531.38 $383.64 . . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

28660 $93.33 $69.94 . . .

28665 $122.82 $103.58 . . .

28666 . . $147.67 . .

28675 $474.81 $326.77 . . .

28705 . . $975.68 . .

28715 . . $734.80 . .

28725 . . $610.09 . .

28730 . . $575.59 . .

28735 . . $612.44 . .

28737 . . $541.98 . .

28740 $682.42 $490.57 . . .

28750 $657.38 $466.42 . . .

28755 $415.42 $262.35 . . .

28760 $638.25 $455.58 . . .

28800 . . $425.71 . .

28805 . . $570.47 . .

28810 . . $338.39 . .

28820 $459.29 $313.62 . . .

28825 $439.01 $294.52 . . .

28890 $261.85 $177.77 . . .

28899 . . I.C. . .

29000 $228.92 $133.88 . . .

29010 $191.37 $115.57 . . .

29015 $229.90 $140.78 . . .

29035 $157.16 $94.39 . . .

29040 $181.55 $114.34 . . .

29044 $230.59 $119.86 . . .

29046 $195.17 $124.11 . . .

29049 $66.77 $48.71 . . .

29055 $179.39 $108.93 . . .

29058 $97.19 $72.62 . . .

29065 $77.05 $53.96 . . .

29075 $69.58 $49.15 . . .

29085 $76.59 $53.20 . . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

29086 $63.66 $40.86 . . .

29105 $70.34 $46.36 . . .

29125 $52.26 $31.24 . . .

29126 $61.89 $38.20 . . .

29130 $32.42 $22.06 . . .

29131 $40.58 $25.48 . . .

29200 $23.60 $14.12 . . .

29240 $23.00 $14.42 . . .

29260 $23.04 $15.04 . . .

29280 $23.33 $15.63 . . .

29305 $198.94 $125.22 . . .

29325 $218.15 $139.40 . . .

29345 $108.41 $78.80 . . .

29355 $111.65 $82.93 . . .

29358 $128.66 $81.28 . . .

29365 $97.96 $68.65 . . .

29405 $65.62 $47.27 . . .

29425 $63.09 $44.73 . . .

29435 $92.89 $64.77 . . .

29440 $35.00 $22.57 . . .

29445 $106.73 $81.27 . . .

29450 $113.49 $87.73 . . .

29505 $67.36 $39.23 . . .

29515 $57.61 $38.96 . . .

29520 $25.08 $14.42 . . .

29530 $22.87 $14.29 . . .

29540 $20.50 $13.99 . . .

29550 $15.08 $8.86 . . .

29580 $42.06 $27.85 . . .

29581 $51.03 $9.88 . . .

29584 $57.88 $12.28 . . .

29700 $50.33 $25.76 . . .

29705 $52.86 $36.58 . . .

29710 $96.42 $63.85 . . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

29720 $68.33 $34.29 . . .

29730 $51.24 $34.96 . . .

29740 $78.44 $54.16 . . .

29750 $70.25 $51.90 . . .

29799 . . I.C. . .

29800 . . $401.03 . .

29804 . . $507.37 . .

29805 . . $370.19 . .

29806 . . $825.76 . .

29807 . . $806.13 . .

29819 . . $458.12 . .

29820 . . $419.31 . .

29821 . . $458.27 . .

29822 . . $445.86 . .

29823 . . $486.42 . .

29824 . . $524.65 . .

29825 . . $454.02 . .

29826 . . $135.13 . .

29827 . . $825.61 . .

29828 . . $712.81 . .

29830 . . $355.98 . .

29834 . . $382.28 . .

29835 . . $395.50 . .

29836 . . $447.03 . .

29837 . . $410.45 . .

29838 . . $459.60 . .

29840 . . $355.01 . .

29843 . . $379.55 . .

29844 . . $389.48 . .

29845 . . $452.14 . .

29846 . . $407.90 . .

29847 . . $419.25 . .

29848 . . $401.50 . .

29850 . . $483.26 . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

29851 . . $688.96 . .

29855 . . $610.57 . .

29856 . . $774.77 . .

29860 . . $516.13 . .

29861 . . $562.65 . .

29862 . . $633.04 . .

29863 . . $632.78 . .

29866 . . $812.38 . .

29867 . . $981.79 . .

29868 . . $1,244.14 . .

29870 $467.71 $323.82 . . .

29871 . . $403.05 . .

29873 . . $413.69 . .

29874 . . $420.47 . .

29875 . . $388.28 . .

29876 . . $514.03 . .

29877 . . $487.09 . .

29879 . . $517.80 . .

29880 . . $440.74 . .

29881 . . $425.00 . .

29882 . . $546.57 . .

29883 . . $656.13 . .

29884 . . $482.74 . .

29885 . . $587.16 . .

29886 . . $498.17 . .

29887 . . $582.88 . .

29888 . . $767.13 . .

29889 . . $950.89 . .

29891 . . $531.22 . .

29892 . . $459.84 . .

29893 $498.64 $341.42 . . .

29894 . . $392.96 . .

29895 . . $374.69 . .

29897 . . $397.55 . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

29898 . . $443.79 . .

29899 . . $806.56 . .

29900 . . $363.91 . .

29901 . . $418.67 . .

29902 . . $443.36 . .

29904 . . $498.25 . .

29905 . . $536.09 . .

29906 . . $563.58 . .

29907 . . $683.16 . .

29914 . . $776.84 . .

29915 . . $790.63 . .

29916 . . $791.81 . .

29999 . . I.C. . .

30000 $188.21 $93.76 . . .

30020 $190.74 $94.52 . . .

30100 $115.46 $54.47 . . .

30110 $187.88 $103.21 . . .

30115 . . $346.87 . .

30117 $728.78 $274.61 . . .

30118 . . $607.55 . .

30120 $414.60 $346.80 . . .

30124 . . $228.11 . .

30125 . . $482.58 . .

30130 . . $307.39 . .

30140 . . $357.52 . .

30150 . . $608.71 . .

30160 . . $609.34 . .

30200 $93.05 $47.15 . . .

30210 $121.97 $79.34 . . .

30220 $249.83 $99.13 . . .

30300 $152.84 $85.04 . . .

30310 . . $166.07 . .

30320 . . $355.43 . .

30400 . . $807.69 . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

30410 . . $939.54 . .

30420 . . $1,084.87 . .

30430 . . $774.62 . .

30435 . . $883.92 . .

30450 . . $1,179.88 . .

30460 . . $559.45 . .

30462 . . $1,222.68 . .

30465 . . $775.04 . .

30520 . . $496.98 . .

30540 . . $551.86 . .

30545 . . $694.69 . .

30560 $221.78 $110.75 . . .

30580 $522.54 $403.82 . . .

30600 $471.16 $350.66 . . .

30620 . . $500.83 . .

30630 . . $494.71 . .

30801 $189.29 $110.83 . . .

30802 $236.98 $152.01 . . .

30901 $75.57 $43.30 . . .

30903 $179.92 $61.79 . . .

30905 $220.22 $82.25 . . .

30906 $283.92 $106.27 . . .

30915 . . $455.11 . .

30920 . . $658.40 . .

30930 . . $98.74 . .

30999 . . I.C. . .

31000 $150.38 $84.65 . . .

31002 . . $155.64 . .

31020 $396.88 $291.19 . . .

31030 $559.09 $422.01 . . .

31032 . . $457.22 . .

31040 . . $602.15 . .

31050 . . $388.41 . .

31051 . . $514.49 . .

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81

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

31070 . . $352.90 . .

31075 . . $622.40 . .

31080 . . $822.38 . .

31081 . . $1,143.69 . .

31084 . . $916.02 . .

31085 . . $1,214.44 . .

31086 . . $893.38 . .

31087 . . $851.00 . .

31090 . . $818.86 . .

31200 . . $461.10 . .

31201 . . $588.85 . .

31205 . . $715.45 . .

31225 . . $1,472.10 . .

31230 . . $1,627.91 . .

31231 $172.81 $50.53 . . .

31233 $212.90 $106.91 . . .

31235 $242.01 $126.54 . . .

31237 $207.76 $126.35 . . .

31238 $206.84 $132.23 . . .

31239 . . $485.58 . .

31240 . . $125.89 . .

31241 - - $360.24

31253 - - $403.78

31254 . . $212.43 . .

31255 . . $310.75 . .

31256 . . $154.32 . .

31257 - - $359.48

31259 - - $381.08

31267 . . $246.94 . .

31276 . . $391.86 . .

31287 . . $180.84 . .

31288 . . $209.19 . .

31290 . . $899.72 . .

31291 . . $955.75 . .

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82

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

31292 . . $781.60 . .

31293 . . $847.69 . .

31294 . . $967.13 . .

31295 $1,716.02 $128.19 . . .

31296 $1,747.06 $153.30 . . .

31297 $1,718.68 $125.52 . . .

31298 $3,264.26 $206.09 - - -

31299 . . I.C. . .

31300 . . $1,041.06 . .

31360 . . $1,671.54 . .

31365 . . $2,053.96 . .

31367 . . $1,777.47 . .

31368 . . $1,981.78 . .

31370 . . $1,679.69 . .

31375 . . $1,583.77 . .

31380 . . $1,570.24 . .

31382 . . $1,727.23 . .

31390 . . $2,294.89 . .

31395 . . $2,430.83 . .

31400 . . $785.17 . .

31420 . . $658.86 . .

31500 . . $83.82 . .

31502 . . $27.16 . .

31505 $67.83 $39.40 . . .

31510 $170.15 $95.25 . . .

31511 $169.89 $101.50 . . .

31512 $164.60 $101.54 . . .

31513 . . $103.70 . .

31515 $149.74 $82.54 . . .

31520 . . $122.86 . .

31525 $203.41 $125.84 . . .

31526 . . $123.76 . .

31527 . . $152.17 . .

31528 . . $113.72 . .

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83

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

31529 . . $127.06 . .

31530 . . $155.01 . .

31531 . . $166.83 . .

31535 . . $148.87 . .

31536 . . $165.56 . .

31540 . . $189.54 . .

31541 . . $207.09 . .

31545 . . $283.85 . .

31546 . . $430.40 . .

31551 - - $1,134.17 - -

31552 - - $1,151.16 - -

31553 - - $1,256.32 - -

31554 - - $1,327.06 - -

31560 . . $245.30 . .

31561 . . $268.47 . .

31570 $271.04 $179.85 . . .

31571 . . $196.02 . .

31572 $409.68 $143.92 - - -

31573 $214.98 $118.96 - - -

31574 $857.97 $118.96 - - -

31575 $91.98 $60.60 . . .

31576 $181.70 $97.32 . . .

31577 $194.45 $117.47 . . .

31578 $224.38 $134.97 . . .

31579 $168.74 $110.71 . . .

31580 . . $974.11 . .

31584 . . $1,195.11 . .

31587 . . $784.55 . .

31590 . . $725.60 . .

31591 - - $838.64 - -

31592 - - $1,346.39 - -

31595 . . $611.25 . .

31599 . . I.C. . .

31600 . . $304.10 . .

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84

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

31601 . . $198.58 . .

31603 . . $171.62 . .

31605 . . $139.67 . .

31610 . . $566.15 . .

31611 . . $432.76 . .

31612 $67.01 $37.41 . . .

31613 . . $364.75 . .

31614 . . $603.57 . .

31615 $145.44 $100.73 . . .

31622 $245.40 $111.87 . . .

31623 $268.43 $114.18 . . .

31624 $253.63 $115.36 . . .

31625 $321.17 $131.68 . . .

31626 $749.54 $163.62 . . .

31627 $1,181.96 $75.24 . . .

31628 $337.93 $146.96 . . .

31629 $404.42 $155.12 . . .

31630 . . $155.05 . .

31631 . . $177.67 . .

31632 $59.34 $38.32 . . .

31633 $72.99 $49.31 . . .

31634 $1,549.55 $159.49 . . .

31635 $279.50 $146.27 . . .

31636 . . $171.34 . .

31637 . . $57.68 . .

31638 . . $195.59 . .

31640 . . $196.91 . .

31641 . . $200.17 . .

31643 . . $137.86 . .

31645 $261.09 $125.79 . . .

31646 $234.63 $108.80 . . .

31647 . . $172.37 . .

31648 . . $159.34 . .

31649 . . $53.80 . .

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85

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

31651 . . $60.80 . .

31652 $743.32 $181.97 . . .

31653 $789.33 $200.74 . . .

31654 $116.05 $52.39 . . .

31660 . . $163.75 . .

31661 . . $171.86 . .

31717 $212.08 $84.77 . . .

31720 . . $39.88 . .

31725 . . $68.93 . .

31730 $1,023.02 $112.89 . . .

31750 . . $1,131.12 . .

31755 . . $1,428.72 . .

31760 . . $1,061.37 . .

31766 . . $1,353.48 . .

31770 . . $1,016.77 . .

31775 . . $1,016.54 . .

31780 . . $913.43 . .

31781 . . $1,124.77 . .

31785 . . $843.77 . .

31786 . . $1,093.57 . .

31800 . . $590.10 . .

31805 . . $633.13 . .

31820 $348.10 $258.98 . . .

31825 $478.53 $376.98 . . .

31830 $355.35 $271.26 . . .

31899 . . I.C. . .

32035 . . $553.38 . .

32036 . . $597.17 . .

32096 . . $614.71 . .

32097 . . $614.67 . .

32098 . . $583.57 . .

32100 . . $617.53 . .

32110 . . $1,114.36 . .

32120 . . $666.99 . .

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86

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

32124 . . $708.35 . .

32140 . . $761.21 . .

32141 . . $1,158.60 . .

32150 . . $768.10 . .

32151 . . $767.77 . .

32160 . . $605.02 . .

32200 . . $871.99 . .

32215 . . $613.84 . .

32220 . . $1,210.87 . .

32225 . . $760.36 . .

32310 . . $698.01 . .

32320 . . $1,220.00 . .

32400 $121.23 $67.94 . . .

32405 $371.73 $81.58 . . .

32440 . . $1,192.61 . .

32442 . . $2,429.99 . .

32445 . . $2,695.12 . .

32480 . . $1,125.23 . .

32482 . . $1,206.18 . .

32484 . . $1,092.39 . .

32486 . . $1,781.64 . .

32488 . . $1,817.75 . .

32491 . . $1,124.16 . .

32501 . . $184.87 . .

32503 . . $1,375.39 . .

32504 . . $1,567.94 . .

32505 . . $712.56 . .

32506 . . $118.28 . .

32507 . . $118.12 . .

32540 . . $1,321.34 . .

32550 $639.93 $171.25 . . .

32551 . . $130.14 . .

32552 $145.80 $124.78 . . .

32553 $484.55 $152.06 . . .

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87

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

32554 $161.67 $69.59 . . .

32555 $235.74 $87.70 . . .

32556 $445.42 $96.05 . . .

32557 $422.72 $119.84 . . .

32560 $198.77 $59.62 . . .

32561 $72.74 $52.91 . . .

32562 $65.30 $47.54 . . .

32601 . . $235.07 . .

32604 . . $365.58 . .

32606 . . $350.98 . .

32607 . . $235.11 . .

32608 . . $287.77 . .

32609 . . $197.86 . .

32650 . . $511.45 . .

32651 . . $836.29 . .

32652 . . $1,265.27 . .

32653 . . $808.54 . .

32654 . . $901.30 . .

32655 . . $730.75 . .

32656 . . $615.26 . .

32658 . . $546.95 . .

32659 . . $561.32 . .

32661 . . $612.40 . .

32662 . . $682.73 . .

32663 . . $1,066.48 . .

32664 . . $651.91 . .

32665 . . $933.46 . .

32666 . . $666.97 . .

32667 . . $118.58 . .

32668 . . $118.28 . .

32669 . . $1,025.35 . .

32670 . . $1,217.38 . .

32671 . . $1,345.22 . .

32672 . . $1,158.34 . .

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88

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

32673 . . $929.73 . .

32674 . . $162.87 . .

32701 . . $164.00 . .

32800 . . $722.76 . .

32810 . . $689.64 . .

32815 . . $2,127.24 . .

32820 . . $1,020.91 . .

32850 . . I.C. . .

32851 . . $2,498.50 . .

32852 . . $2,730.00 . .

32853 . . $3,474.53 . .

32854 . . $3,694.52 . .

32855 . . I.C. . .

32856 . . I.C. . .

32900 . . $1,073.98 . .

32905 . . $1,021.50 . .

32906 . . $1,259.39 . .

32940 . . $939.60 . .

32960 $110.65 $76.31 . . .

32994 $5,200.68 $393.10 - - -

32997 . . $266.81 . .

32998 $1,992.72 $222.51 . . .

32999 . . I.C. . .

33010 . . $91.05 . .

33011 . . $91.51 . .

33015 . . $392.50 . .

33020 . . $672.11 . .

33025 . . $609.47 . .

33030 . . $1,521.02 . .

33031 . . $1,876.73 . .

33050 . . $764.17 . .

33120 . . $1,591.73 . .

33130 . . $1,051.69 . .

33140 . . $1,192.15 . .

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89

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

33141 . . $99.45 . .

33202 . . $592.09 . .

33203 . . $613.90 . .

33206 . . $354.67 . .

33207 . . $377.23 . .

33208 . . $408.05 . .

33210 . . $135.63 . .

33211 . . $138.69 . .

33212 . . $256.55 . .

33213 . . $267.20 . .

33214 . . $376.29 . .

33215 . . $237.93 . .

33216 . . $295.17 . .

33217 . . $289.16 . .

33218 . . $309.25 . .

33220 . . $309.50 . .

33221 . . $287.19 . .

33222 . . $270.23 . .

33223 . . $323.27 . .

33224 . . $391.62 . .

33225 . . $355.15 . .

33226 . . $375.65 . .

33227 . . $269.65 . .

33228 . . $281.18 . .

33229 . . $296.43 . .

33230 . . $304.42 . .

33231 . . $316.98 . .

33233 . . $188.62 . .

33234 . . $381.24 . .

33235 . . $497.95 . .

33236 . . $600.51 . .

33237 . . $645.20 . .

33238 . . $716.01 . .

33240 . . $290.32 . .

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90

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

33241 . . $177.01 . .

33243 . . $1,044.04 . .

33244 . . $666.78 . .

33249 . . $709.90 . .

33250 . . $1,113.76 . .

33251 . . $1,236.84 . .

33254 . . $1,045.87 . .

33255 . . $1,234.20 . .

33256 . . $1,484.66 . .

33257 . . $447.07 . .

33258 . . $501.24 . .

33259 . . $647.22 . .

33261 . . $1,248.11 . .

33262 . . $296.09 . .

33263 . . $307.62 . .

33264 . . $320.50 . .

33265 . . $1,038.81 . .

33266 . . $1,404.51 . .

33270 . . $455.35 . .

33271 . . $384.28 . .

33272 . . $270.31 . .

33273 . . $316.02 . .

33282 . . $184.81 . .

33284 . . $163.88 . .

33300 . . $1,857.46 . .

33305 . . $3,102.90 . .

33310 . . $896.02 . .

33315 . . $1,451.56 . .

33320 . . $810.28 . .

33321 . . $939.26 . .

33322 . . $1,058.77 . .

33330 . . $1,086.12 . .

33335 . . $1,425.72 . .

33340 - - $631.27 - -

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91

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

33361 . . $1,029.38 . .

33362 . . $1,124.22 . .

33363 . . $1,169.17 . .

33364 . . $1,224.12 . .

33365 . . $1,347.58 . .

33366 . . $1,457.31 . .

33367 . . $473.09 . .

33368 . . $562.93 . .

33369 . . $744.00 . .

33390 - - $1,501.40 - -

33391 - - $1,779.01 - -

33404 . . $1,337.16 . .

33405 . . $1,724.30 . .

33406 . . $2,183.77 . .

33410 . . $1,927.09 . .

33411 . . $2,545.63 . .

33412 . . $2,398.42 . .

33413 . . $2,461.32 . .

33414 . . $1,638.75 . .

33415 . . $1,542.75 . .

33416 . . $1,545.29 . .

33417 . . $1,276.18 . .

33418 . . $1,372.42 . .

33419 . . $322.35 . .

33420 . . $1,109.70 . .

33422 . . $1,275.33 . .

33425 . . $2,075.97 . .

33426 . . $1,810.49 . .

33427 . . $1,855.86 . .

33430 . . $2,125.82 . .

33460 . . $1,847.98 . .

33463 . . $2,345.16 . .

33464 . . $1,856.15 . .

33465 . . $2,092.62 . .

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92

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

33468 . . $1,867.16 . .

33470 . . $993.36 . .

33471 . . $1,062.30 . .

33474 . . $1,662.23 . .

33475 . . $1,771.26 . .

33476 . . $1,166.09 . .

33477 . . $997.90 . .

33478 . . $1,204.36 . .

33496 . . $1,270.95 . .

33500 . . $1,196.28 . .

33501 . . $864.03 . .

33502 . . $979.78 . .

33503 . . $1,019.48 . .

33504 . . $1,123.68 . .

33505 . . $1,569.40 . .

33506 . . $1,564.84 . .

33507 . . $1,314.71 . .

33508 . . $12.19 . .

33510 . . $1,469.54 . .

33511 . . $1,614.76 . .

33512 . . $1,833.83 . .

33513 . . $1,886.23 . .

33514 . . $1,985.64 . .

33516 . . $2,067.45 . .

33517 . . $141.47 . .

33518 . . $310.96 . .

33519 . . $411.24 . .

33521 . . $493.15 . .

33522 . . $553.33 . .

33523 . . $629.63 . .

33530 . . $397.27 . .

33533 . . $1,421.38 . .

33534 . . $1,671.53 . .

33535 . . $1,862.82 . .

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March 9, 2018

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93

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

33536 . . $2,007.89 . .

33542 . . $1,993.98 . .

33545 . . $2,348.18 . .

33548 . . $2,250.34 . .

33572 . . $174.11 . .

33600 . . $1,315.18 . .

33602 . . $1,276.91 . .

33606 . . $1,430.33 . .

33608 . . $1,377.15 . .

33610 . . $1,358.23 . .

33611 . . $1,575.05 . .

33612 . . $1,528.14 . .

33615 . . $1,524.91 . .

33617 . . $1,651.35 . .

33619 . . $2,083.41 . .

33620 . . $1,259.01 . .

33621 . . $714.17 . .

33622 . . $2,776.70 . .

33641 . . $1,252.24 . .

33645 . . $1,321.12 . .

33647 . . $1,387.56 . .

33660 . . $1,341.29 . .

33665 . . $1,460.44 . .

33670 . . $1,502.09 . .

33675 . . $1,504.78 . .

33676 . . $1,634.33 . .

33677 . . $1,697.63 . .

33681 . . $1,408.26 . .

33684 . . $1,524.43 . .

33688 . . $1,435.50 . .

33690 . . $922.38 . .

33692 . . $1,581.77 . .

33694 . . $1,575.05 . .

33697 . . $1,567.68 . .

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Final Adoption

March 9, 2018

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

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94

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

33702 . . $1,183.56 . .

33710 . . $1,656.65 . .

33720 . . $1,184.10 . .

33722 . . $1,241.82 . .

33724 . . $1,176.33 . .

33726 . . $1,551.05 . .

33730 . . $1,531.17 . .

33732 . . $1,261.92 . .

33735 . . $994.99 . .

33736 . . $1,078.69 . .

33737 . . $1,041.63 . .

33750 . . $966.09 . .

33755 . . $1,010.70 . .

33762 . . $1,030.53 . .

33764 . . $1,010.70 . .

33766 . . $1,019.06 . .

33767 . . $1,087.32 . .

33768 . . $315.84 . .

33770 . . $1,710.92 . .

33771 . . $1,762.09 . .

33774 . . $1,377.34 . .

33775 . . $1,491.80 . .

33776 . . $1,576.73 . .

33777 . . $1,524.72 . .

33778 . . $1,895.07 . .

33779 . . $1,880.69 . .

33780 . . $1,803.41 . .

33781 . . $1,871.10 . .

33782 . . $2,457.18 . .

33783 . . $2,822.28 . .

33786 . . $1,733.73 . .

33788 . . $1,234.08 . .

33800 . . $756.74 . .

33802 . . $833.38 . .

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Final Adoption

March 9, 2018

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00 SURGERY AND ANESTHESIA

95

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

33803 . . $880.30 . .

33813 . . $994.48 . .

33814 . . $1,167.57 . .

33820 . . $743.83 . .

33822 . . $820.32 . .

33824 . . $905.35 . .

33840 . . $950.72 . .

33845 . . $1,023.88 . .

33851 . . $975.79 . .

33852 . . $1,071.68 . .

33853 . . $1,401.96 . .

33860 . . $2,436.69 . .

33863 . . $2,387.41 . .

33864 . . $2,440.37 . .

33870 . . $1,912.99 . .

33875 . . $2,087.01 . .

33877 . . $2,759.09 . .

33880 . . $1,375.58 . .

33881 . . $1,182.16 . .

33883 . . $858.98 . .

33884 . . $311.18 . .

33886 . . $741.32 . .

33889 . . $598.14 . .

33891 . . $733.34 . .

33910 . . $1,998.03 . .

33915 . . $962.13 . .

33916 . . $3,186.89 . .

33917 . . $1,117.23 . .

33920 . . $1,458.90 . .

33922 . . $1,064.41 . .

33924 . . $216.58 . .

33925 . . $1,310.46 . .

33926 . . $1,953.76 . .

33927 - - $2,058.21 - -

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96

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

33928 - - I.C. - -

33929 - - I.C. - -

33930 . . I.C. . .

33933 . . I.C. . .

33935 . . $3,807.11 . .

33940 . . I.C. . .

33944 . . I.C. . .

33945 . . $3,684.58 . .

33946 . . $233.46 . .

33947 . . $258.07 . .

33948 . . $184.92 . .

33949 . . $179.89 . .

33951 . . $322.66 . .

33952 . . $324.76 . .

33953 . . $360.36 . .

33954 . . $363.05 . .

33955 . . $651.73 . .

33956 . . $633.95 . .

33957 . . $145.04 . .

33958 . . $142.14 . .

33959 . . $184.06 . .

33962 . . $181.67 . .

33963 . . $367.83 . .

33964 . . $381.16 . .

33965 . . $145.04 . .

33966 . . $178.53 . .

33967 . . $196.62 . .

33968 . . $25.64 . .

33969 . . $214.25 . .

33970 . . $268.62 . .

33971 . . $545.11 . .

33973 . . $389.78 . .

33974 . . $682.87 . .

33975 . . $996.92 . .

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Final Adoption

March 9, 2018

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00 SURGERY AND ANESTHESIA

97

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

33976 . . $1,211.87 . .

33977 . . $858.02 . .

33978 . . $1,013.67 . .

33979 . . $1,476.71 . .

33980 . . $1,354.91 . .

33981 . . $630.93 . .

33982 . . $1,501.88 . .

33983 . . $1,752.88 . .

33984 . . $216.23 . .

33985 . . $403.91 . .

33986 . . $403.01 . .

33987 . . $157.65 . .

33988 . . $588.23 . .

33989 . . $382.11 . .

33990 . . $333.08 . .

33991 . . $485.12 . .

33992 . . $156.74 . .

33993 . . $137.68 . .

33999 . . I.C. . .

34001 . . $749.13 . .

34051 . . $758.51 . .

34101 . . $464.54 . .

34111 . . $463.16 . .

34151 . . $1,075.38 . .

34201 . . $792.96 . .

34203 . . $736.15 . .

34401 . . $1,117.90 . .

34421 . . $564.08 . .

34451 . . $1,105.97 . .

34471 . . $825.92 . .

34490 . . $470.81 . .

34501 . . $755.55 . .

34502 . . $1,178.53 . .

34510 . . $918.51 . .

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Final Adoption

March 9, 2018

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00 SURGERY AND ANESTHESIA

98

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

34520 . . $769.73 . .

34530 . . $850.75 . .

34701 - - $996.76 - -

34702 - - $1,487.66 - -

34703 - - $1,122.99 - -

34704 - - $1,865.95 - -

34705 - - $1,236.75 - -

34706 - - $1,860.21 - -

34707 - - $929.03 - -

34708 - - $1,493.55 - -

34709 - - $260.88 - -

34710 - - $649.94 - -

34711 - - $240.85 - -

34712 - - $558.10 - -

34713 - - $104.33 - -

34714 - - $219.03 - -

34715 - - $244.41 - -

34716 - - $304.14 - -

34808 . . $157.57 . .

34812 . . $257.11 . .

34813 . . $180.17 . .

34820 . . $375.10 . .

34830 . . $1,349.94 . .

34831 . . $1,449.61 . .

34832 . . $1,445.10 . .

34833 . . $464.99 . .

34834 . . $208.68 . .

34839 . . I.C. . .

34841 . . I.C. . .

34842 . . I.C. . .

34843 . . I.C. . .

34844 . . I.C. . .

34845 . . I.C. . .

34846 . . I.C. . .

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Final Adoption

March 9, 2018

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00 SURGERY AND ANESTHESIA

99

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

34847 . . I.C. . .

34848 . . I.C. . .

35001 . . $863.25 . .

35002 . . $869.32 . .

35005 . . $846.83 . .

35011 . . $772.37 . .

35013 . . $966.13 . .

35021 . . $961.85 . .

35022 . . $1,079.63 . .

35045 . . $767.54 . .

35081 . . $1,341.42 . .

35082 . . $1,684.71 . .

35091 . . $1,371.91 . .

35092 . . $1,991.10 . .

35102 . . $1,450.55 . .

35103 . . $1,721.98 . .

35111 . . $1,178.33 . .

35112 . . $1,422.19 . .

35121 . . $1,260.69 . .

35122 . . $1,655.21 . .

35131 . . $1,067.96 . .

35132 . . $1,248.30 . .

35141 . . $851.80 . .

35142 . . $1,017.73 . .

35151 . . $955.65 . .

35152 . . $1,071.39 . .

35180 . . $735.29 . .

35182 . . $1,366.28 . .

35184 . . $803.52 . .

35188 . . $913.16 . .

35189 . . $1,173.98 . .

35190 . . $588.42 . .

35201 . . $733.74 . .

35206 . . $599.47 . .

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Final Adoption

March 9, 2018

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00 SURGERY AND ANESTHESIA

100

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

35207 . . $592.97 . .

35211 . . $1,054.71 . .

35216 . . $1,567.43 . .

35221 . . $1,115.25 . .

35226 . . $641.76 . .

35231 . . $949.47 . .

35236 . . $756.30 . .

35241 . . $1,071.83 . .

35246 . . $1,205.93 . .

35251 . . $1,301.85 . .

35256 . . $784.48 . .

35261 . . $816.77 . .

35266 . . $672.02 . .

35271 . . $1,051.82 . .

35276 . . $1,112.72 . .

35281 . . $1,242.48 . .

35286 . . $721.81 . .

35301 . . $871.74 . .

35302 . . $866.62 . .

35303 . . $959.19 . .

35304 . . $987.84 . .

35305 . . $945.80 . .

35306 . . $349.07 . .

35311 . . $1,112.98 . .

35321 . . $686.00 . .

35331 . . $1,114.59 . .

35341 . . $1,050.75 . .

35351 . . $984.02 . .

35355 . . $796.67 . .

35361 . . $1,177.14 . .

35363 . . $1,345.80 . .

35371 . . $632.13 . .

35372 . . $756.15 . .

35390 . . $121.54 . .

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Final Adoption

March 9, 2018

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00 SURGERY AND ANESTHESIA

101

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

35400 . . $113.55 . .

35500 . . $242.96 . .

35501 . . $1,146.13 . .

35506 . . $974.94 . .

35508 . . $1,037.89 . .

35509 . . $1,079.88 . .

35510 . . $941.50 . .

35511 . . $857.56 . .

35512 . . $934.21 . .

35515 . . $1,140.88 . .

35516 . . $933.91 . .

35518 . . $888.16 . .

35521 . . $946.85 . .

35522 . . $929.77 . .

35523 . . $990.35 . .

35525 . . $882.05 . .

35526 . . $1,308.48 . .

35531 . . $1,553.32 . .

35533 . . $1,147.30 . .

35535 . . $1,464.09 . .

35536 . . $1,291.45 . .

35537 . . $1,681.73 . .

35538 . . $1,795.20 . .

35539 . . $1,680.30 . .

35540 . . $1,873.41 . .

35556 . . $1,079.74 . .

35558 . . $952.42 . .

35560 . . $1,315.25 . .

35563 . . $1,021.98 . .

35565 . . $1,020.21 . .

35566 . . $1,285.97 . .

35570 . . $1,169.45 . .

35571 . . $1,024.36 . .

35572 . . $263.93 . .

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Final Adoption

March 9, 2018

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00 SURGERY AND ANESTHESIA

102

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

35583 . . $1,115.27 . .

35585 . . $1,292.55 . .

35587 . . $1,052.17 . .

35600 . . $193.37 . .

35601 . . $1,078.69 . .

35606 . . $903.83 . .

35612 . . $825.89 . .

35616 . . $844.34 . .

35621 . . $846.33 . .

35623 . . $1,006.80 . .

35626 . . $1,210.70 . .

35631 . . $1,420.84 . .

35632 . . $1,380.55 . .

35633 . . $1,540.07 . .

35634 . . $1,352.07 . .

35636 . . $1,225.32 . .

35637 . . $1,329.42 . .

35638 . . $1,357.16 . .

35642 . . $757.91 . .

35645 . . $785.95 . .

35646 . . $1,322.13 . .

35647 . . $1,198.60 . .

35650 . . $834.02 . .

35654 . . $1,055.08 . .

35656 . . $837.36 . .

35661 . . $838.36 . .

35663 . . $969.19 . .

35665 . . $905.04 . .

35666 . . $979.92 . .

35671 . . $865.04 . .

35681 . . $61.27 . .

35682 . . $269.69 . .

35683 . . $313.61 . .

35685 . . $151.63 . .

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Final Adoption

March 9, 2018

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00 SURGERY AND ANESTHESIA

103

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

35686 . . $122.56 . .

35691 . . $739.17 . .

35693 . . $633.14 . .

35694 . . $758.90 . .

35695 . . $808.29 . .

35697 . . $112.49 . .

35700 . . $116.76 . .

35701 . . $445.90 . .

35721 . . $354.99 . .

35741 . . $401.91 . .

35761 . . $306.59 . .

35800 . . $556.08 . .

35820 . . $1,529.14 . .

35840 . . $912.43 . .

35860 . . $649.42 . .

35870 . . $953.10 . .

35875 . . $460.74 . .

35876 . . $729.09 . .

35879 . . $712.52 . .

35881 . . $786.98 . .

35883 . . $930.88 . .

35884 . . $948.06 . .

35901 . . $367.12 . .

35903 . . $440.71 . .

35905 . . $1,288.48 . .

35907 . . $1,466.85 . .

36000 $20.88 $7.26 . . .

36002 $128.60 $83.01 . . .

36005 $268.83 $37.30 . . .

36010 $411.80 $94.12 . . .

36011 $689.12 $121.26 . . .

36012 $710.86 $134.70 . . .

36013 $651.42 $97.18 . . .

36014 $671.08 $116.54 . . .

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101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

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104

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

36015 $719.09 $134.05 . . .

36100 $407.33 $118.37 . . .

36140 $359.00 $78.62 . . .

36160 $406.21 $96.23 . . .

36200 $510.14 $116.36 . . .

36215 $927.56 $181.46 . . .

36216 $979.09 $210.78 . . .

36217 $1,623.94 $250.76 . . .

36218 $157.42 $40.76 . . .

36221 $903.95 $164.06 . . .

36222 $1,080.65 $225.30 . . .

36223 $1,266.41 $246.44 . . .

36224 $1,494.13 $274.32 . . .

36225 $1,237.89 $243.09 . . .

36226 $1,516.96 $274.94 . . .

36227 $201.38 $86.80 . . .

36228 $1,002.92 $177.47 . . .

36245 $1,131.94 $194.58 . . .

36246 $725.48 $205.58 . . .

36247 $1,301.36 $244.09 . . .

36248 $125.18 $38.73 . . .

36251 $1,174.65 $215.37 . . .

36252 $1,266.20 $285.61 . . .

36253 $1,880.94 $294.00 . . .

36254 $1,814.86 $331.84 . . .

36260 . . $482.32 . .

36261 . . $310.75 . .

36262 . . $238.72 . .

36299 . . I.C. . .

36400 $23.52 $15.53 . . .

36405 $21.01 $12.72 . . .

36406 $13.18 $6.38 . . .

36410 $13.48 $7.26 . . .

36415 . . I.C. . .

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Final Adoption

March 9, 2018

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105

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

36416 . . I.C. . .

36420 . . $40.24 . .

36425 . . $30.76 . .

36430 . . $28.75 . .

36440 . . $44.86 . .

36450 . . $90.17 . .

36455 . . $95.30 . .

36456 - - $84.77 - -

36460 . . $265.79 . .

36465 $1,339.25 $96.41 - - -

36466 $1,397.65 $122.59 - - -

36468 . . I.C. . .

36470 $120.93 $66.16 . . .

36471 $139.50 $77.92 . . .

36473 $1,247.82 $135.75 - - -

36474 $224.39 $68.03 - - -

36475 $1,268.53 $214.81 . . .

36476 $237.69 $103.57 . . .

36478 $990.59 $213.99 . . .

36479 $247.70 $104.10 . . .

36481 $1,691.76 $273.28 . . .

36482 $1,781.64 $142.92 - - -

36483 $116.67 $71.33 - - -

36500 . . $140.16 . .

36510 $72.24 $43.23 . . .

36511 . . $73.55 . .

36512 . . $74.14 . .

36513 . . $75.09 . .

36514 $446.83 $72.59 . . .

36516 $1,744.73 $52.39 . . .

36522 $1,171.86 $80.84 . . .

36555 $207.17 $91.11 . . .

36556 $186.88 $93.02 . . .

36557 $821.90 $253.44 . . .

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106

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

36558 $639.57 $216.78 . . .

36560 $1,100.41 $299.83 . . .

36561 $963.08 $275.00 . . .

36563 $1,087.08 $293.61 . . .

36565 $789.43 $268.05 . . .

36566 $4,558.41 $297.35 . . .

36568 $246.81 $75.98 . . .

36569 $204.27 $71.63 . . .

36570 $955.22 $245.24 . . .

36571 $1,073.22 $250.44 . . .

36575 $137.71 $27.27 . . .

36576 $312.35 $153.66 . . .

36578 $422.64 $169.50 . . .

36580 $176.12 $52.06 . . .

36581 $634.72 $154.20 . . .

36582 $904.36 $237.90 . . .

36583 $1,123.04 $260.88 . . .

36584 $168.34 $52.58 . . .

36585 $949.29 $221.84 . . .

36589 $129.78 $107.87 . . .

36590 $232.13 $159.29 . . .

36591 . . $19.41 . .

36592 . . $21.78 . .

36593 . . $25.79 . .

36595 $479.99 $143.95 . . .

36596 $109.24 $35.23 . . .

36597 $102.75 $47.98 . . .

36598 $90.42 $28.84 . . .

36600 $25.42 $12.10 . . .

36620 . . $39.22 . .

36625 . . $79.32 . .

36640 . . $93.70 . .

36660 . . $49.69 . .

36680 . . $44.55 . .

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107

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

36800 . . $95.11 . .

36810 . . $166.75 . .

36815 . . $111.57 . .

36818 . . $536.79 . .

36819 . . $566.33 . .

36820 . . $565.65 . .

36821 . . $514.19 . .

36823 . . $1,031.43 . .

36825 . . $620.91 . .

36830 . . $517.01 . .

36831 . . $478.17 . .

36832 . . $587.03 . .

36833 . . $629.23 . .

36835 . . $384.02 . .

36838 . . $879.38 . .

36860 $168.41 $86.99 . . .

36861 . . $100.32 . .

36901 $470.21 $114.38 - - -

36902 $1,006.77 $170.26 - - -

36903 $4,668.66 $232.84 - - -

36904 $1,465.79 $268.10 - - -

36905 $1,876.24 $336.40 - - -

36906 $5,650.55 $392.49 - - -

36907 $602.64 $97.87 - - -

36908 $2,240.25 $146.60 - - -

36909 $1,631.20 $139.51 - - -

37140 . . $1,746.98 . .

37145 . . $1,635.86 . .

37160 . . $1,680.43 . .

37180 . . $1,568.10 . .

37181 . . $1,769.04 . .

37182 . . $654.46 . .

37183 $4,960.94 $309.06 . . .

37184 $1,877.76 $353.28 . . .

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108

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

37185 $592.75 $127.92 . . .

37186 $1,139.22 $190.60 . . .

37187 $1,704.86 $314.81 . . .

37188 $1,475.46 $228.11 . . .

37191 $2,200.83 $185.18 . . .

37192 $1,273.41 $282.16 . . .

37193 $1,319.38 $283.72 . . .

37195 . . I.C. . .

37197 $1,254.85 $244.06 . . .

37200 . . $172.41 . .

37211 . . $307.28 . .

37212 . . $270.74 . .

37213 . . $191.30 . .

37214 . . $104.86 . .

37215 . . $769.57 . .

37216 . . I.C. . .

37217 . . $841.36 . .

37218 . . $633.32 . .

37220 $2,623.50 $317.69 . . .

37221 $3,878.93 $390.91 . . .

37222 $728.99 $142.77 . . .

37223 $2,164.05 $164.08 . . .

37224 $3,189.03 $350.59 . . .

37225 $9,232.43 $474.33 . . .

37226 $7,590.04 $411.18 . . .

37227 $12,478.57 $569.97 . . .

37228 $4,539.86 $427.42 . . .

37229 $9,089.52 $553.18 . . .

37230 $6,931.44 $544.88 . . .

37231 $11,196.30 $593.07 . . .

37232 $1,002.65 $155.29 . . .

37233 $1,202.08 $252.58 . . .

37234 $3,243.13 $217.57 . . .

37235 $3,405.85 $311.01 . . .

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109

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

37236 $3,431.20 $349.98 . . .

37237 $2,055.29 $163.40 . . .

37238 $3,514.44 $243.44 . . .

37239 $1,699.19 $114.62 . . .

37241 $3,989.20 $349.00 . . .

37242 $6,431.78 $385.11 . . .

37243 $8,175.30 $457.59 . . .

37244 $5,673.14 $535.11 . . .

37246 $1,774.48 $278.92 - - -

37247 $715.42 $138.12 - - -

37248 $1,224.80 $239.96 - - -

37249 $523.33 $117.57 - - -

37252 $1,169.01 $69.99 . . .

37253 $175.18 $55.86 . . .

37500 . . $591.40 . .

37501 . . I.C. . .

37565 . . $565.14 . .

37600 . . $548.41 . .

37605 . . $612.37 . .

37606 . . $451.60 . .

37607 . . $292.53 . .

37609 $247.87 $162.31 . . .

37615 . . $403.90 . .

37616 . . $843.53 . .

37617 . . $1,023.64 . .

37618 . . $299.03 . .

37619 . . $1,250.21 . .

37650 . . $393.42 . .

37660 . . $881.43 . .

37700 . . $195.50 . .

37718 . . $339.91 . .

37722 . . $371.54 . .

37735 . . $534.19 . .

37760 . . $475.95 . .

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110

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

37761 . . $428.96 . .

37765 $518.16 $349.70 . . .

37766 $613.95 $426.24 . . .

37780 . . $198.96 . .

37785 $283.01 $205.74 . . .

37788 . . $1,003.65 . .

37790 . . $391.48 . .

37799 . . I.C. . .

38100 . . $880.51 . .

38101 . . $885.06 . .

38102 . . $198.79 . .

38115 . . $967.95 . .

38120 . . $806.76 . .

38129 . . I.C. . .

38200 . . $89.90 . .

38204 . . $80.96 . .

38205 . . $65.26 . .

38206 . . $65.55 . .

38207 . . $36.08 . .

38208 . . $22.66 . .

38209 . . $9.64 . .

38210 . . $63.62 . .

38211 . . $57.47 . .

38212 . . $38.19 . .

38213 . . $9.64 . .

38214 . . $32.87 . .

38215 . . $38.19 . .

38220 $133.91 $47.76 . . .

38221 $136.19 $58.92 . . .

38222 $140.54 $62.97 - - -

38230 . . $154.47 . .

38232 . . $153.88 . .

38240 . . $176.58 . .

38241 . . $132.43 . .

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111

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

38242 . . $92.89 . .

38243 . . $92.54 . .

38300 $221.87 $145.48 . . .

38305 . . $369.74 . .

38308 . . $343.54 . .

38380 . . $449.03 . .

38381 . . $613.50 . .

38382 . . $471.63 . .

38500 $260.41 $196.17 . . .

38505 $102.77 $56.58 . . .

38510 $408.02 $325.71 . . .

38520 . . $359.30 . .

38525 . . $336.80 . .

38530 . . $425.07 . .

38542 . . $405.15 . .

38550 . . $392.27 . .

38555 . . $770.71 . .

38562 . . $542.65 . .

38564 . . $540.15 . .

38570 . . $389.47 . .

38571 . . $517.81 . .

38572 . . $714.73 . .

38573 - - $945.10 - -

38589 . . I.C. . .

38700 . . $631.82 . .

38720 . . $1,048.63 . .

38724 . . $1,136.98 . .

38740 . . $533.39 . .

38745 . . $671.56 . .

38746 . . $162.41 . .

38747 . . $202.05 . .

38760 . . $646.01 . .

38765 . . $988.88 . .

38770 . . $624.98 . .

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112

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

38780 . . $791.98 . .

38790 . . $64.81 . .

38792 . . $31.78 . .

38794 . . $238.29 . .

38900 . . $104.32 . .

38999 . . I.C. . .

39000 . . $385.55 . .

39010 . . $602.91 . .

39200 . . $672.77 . .

39220 . . $870.98 . .

39401 . . $236.81 . .

39402 . . $308.45 . .

39499 . . I.C. . .

39501 . . $650.20 . .

39503 . . $4,648.09 . .

39540 . . $661.66 . .

39541 . . $721.08 . .

39545 . . $685.37 . .

39560 . . $610.25 . .

39561 . . $950.62 . .

39599 . . I.C. . .

40490 $103.55 $57.36 . . .

40500 $410.84 $292.12 . . .

40510 $391.25 $284.37 . . .

40520 $395.47 $285.92 . . .

40525 . . $437.33 . .

40527 . . $489.17 . .

40530 $434.74 $320.75 . . .

40650 $358.98 $239.67 . . .

40652 $394.66 $280.97 . . .

40654 $459.47 $338.67 . . .

40700 . . $712.80 . .

40701 . . $795.22 . .

40702 . . $683.07 . .

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113

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

40720 . . $803.76 . .

40761 . . $848.97 . .

40799 . . I.C. . .

40800 $177.74 $108.75 . . .

40801 $260.35 $181.00 . . .

40804 $158.44 $95.67 . . .

40805 $308.28 $184.23 . . .

40806 $96.21 $26.63 . . .

40808 $156.63 $89.72 . . .

40810 $172.23 $104.73 . . .

40812 $238.59 $161.02 . . .

40814 $317.19 $249.39 . . .

40816 $331.08 $258.54 . . .

40818 $297.01 $224.18 . . .

40819 $261.98 $197.43 . . .

40820 $223.34 $143.70 . . .

40830 $221.01 $135.15 . . .

40831 $279.10 $183.17 . . .

40840 $656.03 $500.89 . . .

40842 $630.67 $479.68 . . .

40843 $871.08 $674.20 . . .

40844 $1,043.72 $831.14 . . .

40845 $1,167.36 $968.11 . . .

40899 . . I.C. . .

41000 $134.07 $91.43 . . .

41005 $190.39 $102.75 . . .

41006 $294.27 $203.67 . . .

41007 $288.35 $196.57 . . .

41008 $311.55 $218.59 . . .

41009 $330.51 $237.25 . . .

41010 $169.99 $88.87 . . .

41015 $371.72 $285.56 . . .

41016 $362.26 $286.76 . . .

41017 $365.68 $288.11 . . .

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114

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

41018 $413.46 $335.30 . . .

41019 . . $368.57 . .

41100 $138.49 $86.97 . . .

41105 $140.60 $89.97 . . .

41108 $122.81 $73.66 . . .

41110 $176.19 $107.20 . . .

41112 $276.58 $207.30 . . .

41113 $301.57 $228.73 . . .

41114 . . $509.61 . .

41115 $205.46 $124.34 . . .

41116 $275.21 $180.17 . . .

41120 . . $889.53 . .

41130 . . $1,085.03 . .

41135 . . $1,757.75 . .

41140 . . $1,781.78 . .

41145 . . $2,254.77 . .

41150 . . $1,789.27 . .

41153 . . $1,943.57 . .

41155 . . $2,422.60 . .

41250 $221.70 $124.00 . . .

41251 $240.17 $147.20 . . .

41252 $257.30 $168.18 . . .

41500 . . $342.62 . .

41510 . . $350.81 . .

41512 . . $545.30 . .

41520 $293.06 $211.64 . . .

41530 . . $311.06 . .

41599 . . I.C. . .

41800 $228.23 $121.64 . . .

41805 $216.86 $145.80 . . .

41806 $293.75 $213.81 . . .

41820 . . I.C. . .

41821 . . I.C. . .

41822 $242.37 $147.63 . . .

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115

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

41823 $353.35 $264.53 . . .

41825 $176.58 $99.89 . . .

41826 $262.04 $174.40 . . .

41827 $364.11 $250.13 . . .

41828 $252.97 $170.66 . . .

41830 $325.53 $232.56 . . .

41850 . . I.C. . .

41870 . . I.C. . .

41872 $303.81 $210.25 . . .

41874 $311.46 $208.73 . . .

41899 . . I.C. . .

42000 $131.25 $84.18 . . .

42100 $123.38 $89.04 . . .

42104 $178.71 $113.28 . . .

42106 $226.96 $145.54 . . .

42107 $378.50 $280.50 . . .

42120 . . $831.57 . .

42140 $210.79 $126.41 . . .

42145 . . $563.28 . .

42160 $191.95 $119.11 . . .

42180 $199.01 $147.79 . . .

42182 $258.38 $203.61 . . .

42200 . . $676.99 . .

42205 . . $702.74 . .

42210 . . $784.74 . .

42215 . . $525.09 . .

42220 . . $397.21 . .

42225 . . $714.00 . .

42226 . . $728.35 . .

42227 . . $687.40 . .

42235 . . $598.34 . .

42260 $655.10 $526.90 . . .

42280 $135.32 $87.94 . . .

42281 $167.79 $121.61 . . .

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116

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

42299 . . I.C. . .

42300 $171.64 $123.09 . . .

42305 . . $343.00 . .

42310 $131.35 $99.67 . . .

42320 $204.40 $140.75 . . .

42330 $189.93 $132.49 . . .

42335 $307.74 $207.67 . . .

42340 $378.48 $268.64 . . .

42400 $87.68 $44.16 . . .

42405 $241.57 $179.98 . . .

42408 $368.11 $260.34 . . .

42409 $273.35 $178.31 . . .

42410 . . $490.32 . .

42415 . . $830.63 . .

42420 . . $931.65 . .

42425 . . $657.97 . .

42426 . . $1,056.94 . .

42440 . . $326.93 . .

42450 $367.38 $287.73 . . .

42500 $353.47 $275.90 . . .

42505 $449.79 $363.04 . . .

42507 . . $415.43 . .

42509 . . $675.11 . .

42510 . . $515.70 . .

42550 $109.89 $49.49 . . .

42600 $389.66 $278.04 . . .

42650 $68.50 $47.18 . . .

42660 $102.72 $69.85 . . .

42665 $253.77 $164.66 . . .

42699 . . I.C. . .

42700 $155.64 $109.45 . . .

42720 $362.18 $309.78 . . .

42725 . . $647.72 . .

42800 $129.98 $90.01 . . .

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117

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

42804 $162.32 $91.85 . . .

42806 $181.50 $106.59 . . .

42808 $184.83 $129.46 . . .

42809 $165.41 $97.02 . . .

42810 $318.15 $234.06 . . .

42815 . . $448.67 . .

42820 . . $231.19 . .

42821 . . $240.04 . .

42825 . . $210.07 . .

42826 . . $201.18 . .

42830 . . $166.65 . .

42831 . . $180.34 . .

42835 . . $155.14 . .

42836 . . $192.89 . .

42842 . . $828.87 . .

42844 . . $1,131.77 . .

42845 . . $1,804.93 . .

42860 . . $151.93 . .

42870 . . $496.64 . .

42890 . . $1,163.99 . .

42892 . . $1,532.89 . .

42894 . . $1,921.50 . .

42900 . . $267.13 . .

42950 . . $675.53 . .

42953 . . $815.07 . .

42955 . . $637.88 . .

42960 . . $135.77 . .

42961 . . $339.04 . .

42962 . . $413.46 . .

42970 . . $324.58 . .

42971 . . $363.30 . .

42972 . . $406.23 . .

42999 . . I.C. . .

43020 . . $409.89 . .

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118

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

43030 . . $409.42 . .

43045 . . $998.82 . .

43100 . . $493.02 . .

43101 . . $778.17 . .

43107 . . $1,948.36 . .

43108 . . $3,502.17 . .

43112 . . $2,051.97 . .

43113 . . $3,467.86 . .

43116 . . $3,942.51 . .

43117 . . $1,879.47 . .

43118 . . $2,803.87 . .

43121 . . $2,182.61 . .

43122 . . $1,960.07 . .

43123 . . $3,600.34 . .

43124 . . $2,915.18 . .

43130 . . $616.41 . .

43135 . . $1,134.35 . .

43180 . . $432.85 . .

43191 . . $121.30 . .

43192 . . $134.04 . .

43193 . . $133.19 . .

43194 . . $149.50 . .

43195 . . $144.80 . .

43196 . . $154.63 . .

43197 $153.20 $64.38 . . .

43198 $169.52 $77.15 . . .

43200 $222.18 $73.85 . . .

43201 $224.56 $86.00 . . .

43202 $296.97 $85.87 . . .

43204 . . $111.59 . .

43205 . . $116.07 . .

43206 $267.62 $111.00 . . .

43210 . . $333.97 . .

43211 . . $190.78 . .

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119

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

43212 . . $152.65 . .

43213 $1,008.14 $208.15 . . .

43214 . . $155.85 . .

43215 $340.62 $115.91 . . .

43216 $337.87 $110.48 . . .

43217 $362.68 $130.86 . . .

43220 $942.47 $97.77 . . .

43226 $309.53 $107.31 . . .

43227 $570.99 $135.17 . . .

43229 $591.17 $160.39 . . .

43231 $324.82 $131.49 . . .

43232 $386.99 $161.38 . . .

43233 . . $184.05 . .

43235 $252.09 $101.39 . . .

43236 $314.87 $114.43 . . .

43237 . . $159.36 . .

43238 . . $188.65 . .

43239 $323.03 $114.30 . . .

43240 . . $314.91 . .

43241 . . $117.03 . .

43242 . . $213.03 . .

43243 . . $191.82 . .

43244 . . $199.02 . .

43245 $501.18 $142.93 . . .

43246 . . $161.65 . .

43247 $335.70 $144.43 . . .

43248 $330.49 $136.27 . . .

43249 $889.77 $125.90 . . .

43250 $368.95 $138.31 . . .

43251 $403.65 $159.68 . . .

43252 $295.19 $137.09 . . .

43253 . . $212.57 . .

43254 . . $218.65 . .

43255 $597.47 $163.43 . . .

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120

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

43257 . . $188.71 . .

43259 . . $183.73 . .

43260 . . $259.79 . .

43261 . . $272.57 . .

43262 . . $287.42 . .

43263 . . $287.58 . .

43264 . . $292.87 . .

43265 . . $347.36 . .

43266 . . $182.73 . .

43270 $613.22 $188.65 . . .

43273 . . $94.29 . .

43274 . . $370.77 . .

43275 . . $302.70 . .

43276 . . $386.05 . .

43277 . . $304.37 . .

43278 . . $347.09 . .

43279 . . $985.55 . .

43280 . . $826.22 . .

43281 . . $1,176.74 . .

43282 . . $1,322.02 . .

43283 . . $119.89 . .

43284 - - $514.61 - -

43285 - - $519.68 - -

43286 - - $2,557.90 - -

43287 - - $2,919.96 - -

43288 - - $3,045.93 - -

43289 . . I.C. . .

43300 . . $488.55 . .

43305 . . $861.11 . .

43310 . . $1,131.54 . .

43312 . . $1,228.01 . .

43313 . . $2,114.01 . .

43314 . . $2,384.04 . .

43320 . . $1,062.50 . .

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121

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

43325 . . $1,023.40 . .

43327 . . $628.77 . .

43328 . . $864.77 . .

43330 . . $1,015.38 . .

43331 . . $1,027.83 . .

43332 . . $886.38 . .

43333 . . $965.37 . .

43334 . . $953.89 . .

43335 . . $1,020.59 . .

43336 . . $1,156.01 . .

43337 . . $1,244.73 . .

43338 . . $87.77 . .

43340 . . $1,040.87 . .

43341 . . $1,072.67 . .

43351 . . $990.95 . .

43352 . . $820.43 . .

43360 . . $1,808.06 . .

43361 . . $1,943.38 . .

43400 . . $1,165.75 . .

43401 . . $1,186.33 . .

43405 . . $1,116.28 . .

43410 . . $810.02 . .

43415 . . $1,963.42 . .

43420 . . $799.25 . .

43425 . . $1,103.26 . .

43450 $171.99 $67.47 . . .

43453 $806.59 $72.63 . . .

43460 . . $168.75 . .

43496 . . I.C. . .

43499 . . I.C. . .

43500 . . $601.22 . .

43501 . . $1,026.26 . .

43502 . . $1,160.36 . .

43510 . . $721.61 . .

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122

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

43520 . . $525.67 . .

43605 . . $639.85 . .

43610 . . $748.50 . .

43611 . . $933.97 . .

43620 . . $1,489.48 . .

43621 . . $1,725.58 . .

43622 . . $1,759.17 . .

43631 . . $1,105.40 . .

43632 . . $1,545.88 . .

43633 . . $1,461.15 . .

43634 . . $1,610.21 . .

43635 . . $85.00 . .

43640 . . $900.84 . .

43641 . . $911.46 . .

43644 . . $1,321.37 . .

43645 . . $1,410.76 . .

43647 . . I.C. . .

43648 . . I.C. . .

43651 . . $503.07 . .

43652 . . $586.74 . .

43653 . . $442.52 . .

43659 . . I.C. . .

43752 . . $31.78 . .

43753 . . $16.69 . .

43754 $87.85 $26.56 . . .

43755 $113.35 $47.62 . . .

43756 $169.59 $40.50 . . .

43757 $238.88 $61.24 . . .

43760 $405.71 $36.22 . . .

43761 $91.20 $79.95 . . .

43770 . . $857.86 . .

43771 . . $974.42 . .

43772 . . $725.89 . .

43773 . . $972.42 . .

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123

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

43774 . . $734.12 . .

43775 . . $836.79 . .

43800 . . $709.97 . .

43810 . . $777.12 . .

43820 . . $1,023.35 . .

43825 . . $996.04 . .

43830 . . $538.73 . .

43831 . . $450.55 . .

43832 . . $795.47 . .

43840 . . $1,036.88 . .

43842 . . $928.03 . .

43843 . . $976.29 . .

43845 . . $1,496.55 . .

43846 . . $1,229.51 . .

43847 . . $1,358.19 . .

43848 . . $1,467.43 . .

43850 . . $1,243.47 . .

43855 . . $1,263.11 . .

43860 . . $1,246.75 . .

43865 . . $1,297.02 . .

43870 . . $546.27 . .

43880 . . $1,218.73 . .

43881 . . I.C. . .

43882 . . I.C. . .

43886 . . $283.14 . .

43887 . . $252.19 . .

43888 . . $355.82 . .

43999 . . I.C. . .

44005 . . $835.06 . .

44010 . . $664.19 . .

44015 . . $107.59 . .

44020 . . $744.89 . .

44021 . . $745.55 . .

44025 . . $754.15 . .

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124

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

44050 . . $715.66 . .

44055 . . $1,137.43 . .

44100 . . $84.78 . .

44110 . . $652.80 . .

44111 . . $754.82 . .

44120 . . $933.43 . .

44121 . . $183.75 . .

44125 . . $903.58 . .

44126 . . $1,875.95 . .

44127 . . $2,158.09 . .

44128 . . $185.03 . .

44130 . . $1,003.86 . .

44132 . . I.C. . .

44133 . . I.C. . .

44135 . . I.C. . .

44136 . . I.C. . .

44137 . . I.C. . .

44139 . . $92.13 . .

44140 . . $1,025.47 . .

44141 . . $1,401.01 . .

44143 . . $1,274.58 . .

44144 . . $1,354.24 . .

44145 . . $1,268.86 . .

44146 . . $1,628.87 . .

44147 . . $1,483.75 . .

44150 . . $1,440.03 . .

44151 . . $1,641.97 . .

44155 . . $1,606.80 . .

44156 . . $1,764.15 . .

44157 . . $1,656.02 . .

44158 . . $1,659.97 . .

44160 . . $950.26 . .

44180 . . $703.19 . .

44186 . . $500.64 . .

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125

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

44187 . . $857.06 . .

44188 . . $946.91 . .

44202 . . $1,060.43 . .

44203 . . $183.26 . .

44204 . . $1,178.46 . .

44205 . . $1,025.71 . .

44206 . . $1,343.97 . .

44207 . . $1,395.86 . .

44208 . . $1,528.32 . .

44210 . . $1,374.55 . .

44211 . . $1,686.74 . .

44212 . . $1,585.35 . .

44213 . . $143.37 . .

44227 . . $1,275.10 . .

44238 . . I.C. . .

44300 . . $644.84 . .

44310 . . $800.99 . .

44312 . . $456.78 . .

44314 . . $773.05 . .

44316 . . $1,079.76 . .

44320 . . $921.26 . .

44322 . . $780.34 . .

44340 . . $484.66 . .

44345 . . $808.96 . .

44346 . . $908.91 . .

44360 . . $118.31 . .

44361 . . $130.38 . .

44363 . . $155.88 . .

44364 . . $166.21 . .

44365 . . $147.11 . .

44366 . . $194.97 . .

44369 . . $199.29 . .

44370 . . $215.73 . .

44372 . . $193.88 . .

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126

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

44373 . . $156.07 . .

44376 . . $228.81 . .

44377 . . $241.50 . .

44378 . . $309.26 . .

44379 . . $329.07 . .

44380 $181.11 $49.36 . . .

44381 $833.08 $71.29 . . .

44382 $263.00 $62.56 . . .

44384 . . $123.63 . .

44385 $198.54 $60.57 . . .

44386 $280.43 $74.37 . . .

44388 $283.71 $127.09 . . .

44389 $360.21 $139.93 . . .

44390 $357.09 $171.16 . . .

44391 $626.08 $186.71 . . .

44392 $335.36 $160.38 . . .

44394 $377.22 $182.41 . . .

44401 $2,715.35 $194.89 . . .

44402 . . $211.06 . .

44403 . . $242.57 . .

44404 $344.12 $139.83 . . .

44405 $498.91 $148.66 . . .

44406 . . $184.95 . .

44407 . . $221.14 . .

44408 . . $186.79 . .

44500 . . $19.22 . .

44602 . . $1,074.53 . .

44603 . . $1,234.58 . .

44604 . . $806.99 . .

44605 . . $998.38 . .

44615 . . $823.28 . .

44620 . . $667.16 . .

44625 . . $781.44 . .

44626 . . $1,223.74 . .

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Final Adoption

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127

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

44640 . . $1,071.89 . .

44650 . . $1,108.38 . .

44660 . . $1,024.68 . .

44661 . . $1,188.00 . .

44680 . . $815.04 . .

44700 . . $785.93 . .

44701 . . $128.06 . .

44705 . . I.C. . .

44715 . . I.C. . .

44720 . . $208.08 . .

44721 . . $291.17 . .

44799 . . I.C. . .

44800 . . $587.88 . .

44820 . . $644.07 . .

44850 . . $576.77 . .

44899 . . I.C. . .

44900 . . $592.02 . .

44950 . . $491.38 . .

44955 . . $63.79 . .

44960 . . $667.95 . .

44970 . . $461.68 . .

44979 . . I.C. . .

45000 . . $329.75 . .

45005 $221.37 $126.92 . . .

45020 . . $443.02 . .

45100 . . $235.03 . .

45108 . . $284.42 . .

45110 . . $1,424.48 . .

45111 . . $835.66 . .

45112 . . $1,444.36 . .

45113 . . $1,472.19 . .

45114 . . $1,383.37 . .

45116 . . $1,256.77 . .

45119 . . $1,503.23 . .

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128

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

45120 . . $1,170.23 . .

45121 . . $1,326.48 . .

45123 . . $866.51 . .

45126 . . $2,148.93 . .

45130 . . $841.86 . .

45135 . . $1,048.10 . .

45136 . . $1,411.78 . .

45150 . . $307.29 . .

45160 . . $782.83 . .

45171 . . $471.97 . .

45172 . . $631.49 . .

45190 . . $542.18 . .

45300 $99.83 $42.40 . . .

45303 $800.10 $71.47 . . .

45305 $158.34 $61.23 . . .

45307 $187.36 $81.37 . . .

45308 $174.23 $68.53 . . .

45309 $182.16 $72.91 . . .

45315 $184.03 $83.07 . . .

45317 $195.64 $91.12 . . .

45320 $195.31 $84.58 . . .

45321 . . $82.92 . .

45327 . . $93.55 . .

45330 $136.58 $44.50 . . .

45331 $210.31 $57.24 . . .

45332 $252.62 $87.41 . . .

45333 $285.53 $78.28 . . .

45334 $502.77 $97.74 . . .

45335 $237.71 $57.11 . . .

45337 . . $94.59 . .

45338 $263.15 $99.42 . . .

45340 $405.40 $65.81 . . .

45341 . . $102.63 . .

45342 . . $139.05 . .

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129

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

45346 $2,605.93 $131.07 . . .

45347 . . $126.53 . .

45349 . . $160.37 . .

45350 $482.25 $83.74 . . .

45378 $303.82 $150.16 . . .

45379 $382.66 $193.17 . . .

45380 $378.12 $163.17 . . .

45381 $363.15 $163.30 . . .

45382 $646.23 $209.82 . . .

45384 $413.43 $183.98 . . .

45385 $392.89 $205.78 . . .

45386 $533.40 $171.60 . . .

45388 $2,729.11 $217.83 . . .

45389 . . $233.38 . .

45390 . . $265.61 . .

45391 . . $208.52 . .

45392 . . $245.14 . .

45393 . . $202.92 . .

45395 . . $1,530.49 . .

45397 . . $1,669.42 . .

45398 $595.67 $189.17 . . .

45399 . . I.C. . .

45400 . . $881.78 . .

45402 . . $1,171.07 . .

45499 . . I.C. . .

45500 . . $410.47 . .

45505 . . $464.11 . .

45520 $129.99 $31.99 . . .

45540 . . $816.91 . .

45541 . . $729.24 . .

45550 . . $1,127.23 . .

45560 . . $537.04 . .

45562 . . $863.73 . .

45563 . . $1,263.43 . .

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130

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

45800 . . $928.72 . .

45805 . . $1,120.76 . .

45820 . . $928.65 . .

45825 . . $1,079.09 . .

45900 . . $157.96 . .

45905 . . $132.74 . .

45910 . . $152.11 . .

45915 $265.81 $178.46 . . .

45990 . . $82.92 . .

45999 . . I.C. . .

46020 $219.05 $184.71 . . .

46030 $111.53 $70.68 . . .

46040 $425.03 $324.96 . . .

46045 . . $338.79 . .

46050 $163.69 $76.65 . . .

46060 . . $373.78 . .

46070 . . $181.09 . .

46080 $196.52 $122.79 . . .

46083 $141.70 $83.67 . . .

46200 $358.15 $258.97 . . .

46220 $165.82 $92.99 . . .

46221 $215.49 $150.95 . . .

46230 $217.81 $134.02 . . .

46250 $370.25 $246.79 . . .

46255 $403.11 $276.09 . . .

46257 . . $330.17 . .

46258 . . $361.59 . .

46260 . . $370.67 . .

46261 . . $406.75 . .

46262 . . $431.40 . .

46270 $404.43 $308.20 . . .

46275 $428.10 $325.37 . . .

46280 . . $368.41 . .

46285 $424.36 $324.58 . . .

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131

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

46288 . . $430.44 . .

46320 $146.93 $86.23 . . .

46500 $157.60 $98.09 . . .

46505 $225.99 $187.80 . . .

46600 $72.00 $32.32 . . .

46601 $109.74 $74.21 . . .

46604 $515.58 $51.93 . . .

46606 $184.62 $59.38 . . .

46607 $153.18 $99.30 . . .

46608 $189.03 $62.61 . . .

46610 $183.92 $62.53 . . .

46611 $142.06 $63.30 . . .

46612 $209.20 $71.82 . . .

46614 $103.66 $50.66 . . .

46615 $114.10 $71.76 . . .

46700 . . $510.38 . .

46705 . . $394.80 . .

46706 . . $130.58 . .

46707 . . $372.67 . .

46710 . . $820.08 . .

46712 . . $1,655.55 . .

46715 . . $419.33 . .

46716 . . $869.98 . .

46730 . . $1,423.46 . .

46735 . . $1,645.96 . .

46740 . . $1,644.76 . .

46742 . . $1,873.29 . .

46744 . . $2,685.81 . .

46746 . . $2,838.90 . .

46748 . . $3,081.70 . .

46750 . . $588.27 . .

46751 . . $468.37 . .

46753 . . $471.16 . .

46754 $234.30 $180.71 . . .

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132

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

46760 . . $854.62 . .

46761 . . $718.87 . .

46762 . . $722.85 . .

46900 $195.94 $108.30 . . .

46910 $207.28 $104.84 . . .

46916 $185.25 $113.60 . . .

46917 $370.88 $103.83 . . .

46922 $215.47 $105.63 . . .

46924 $435.78 $143.26 . . .

46930 $166.42 $117.86 . . .

46940 $181.93 $113.83 . . .

46942 $172.79 $102.32 . . .

46945 $249.86 $180.88 . . .

46946 $252.26 $178.83 . . .

46947 . . $296.58 . .

46999 . . I.C. . .

47000 $298.67 $81.06 . . .

47001 . . $78.55 . .

47010 . . $924.66 . .

47015 . . $880.82 . .

47100 . . $650.28 . .

47120 . . $1,776.77 . .

47122 . . $2,608.45 . .

47125 . . $2,335.34 . .

47130 . . $2,507.08 . .

47133 . . I.C. . .

47135 . . $4,097.51 . .

47140 . . $2,724.91 . .

47141 . . $3,254.12 . .

47142 . . $3,584.36 . .

47143 . . I.C. . .

47144 . . I.C. . .

47145 . . I.C. . .

47146 . . $248.80 . .

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133

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

47147 . . $290.05 . .

47300 . . $867.70 . .

47350 . . $1,048.76 . .

47360 . . $1,420.36 . .

47361 . . $2,302.51 . .

47362 . . $1,108.38 . .

47370 . . $951.73 . .

47371 . . $890.36 . .

47379 . . I.C. . .

47380 . . $1,100.81 . .

47381 . . $1,051.62 . .

47382 $4,165.91 $604.46 . . .

47383 $6,308.43 $379.89 . . .

47399 . . I.C. . .

47400 . . $1,641.07 . .

47420 . . $1,026.13 . .

47425 . . $1,034.68 . .

47460 . . $959.34 . .

47480 . . $675.38 . .

47490 . . $266.35 . .

47531 $306.63 $75.40 . . .

47532 $673.32 $168.81 . . .

47533 $1,101.04 $237.99 . . .

47534 $1,354.47 $315.55 . . .

47535 $911.53 $181.42 . . .

47536 $675.99 $115.82 . . .

47537 $331.68 $77.65 . . .

47538 $3,765.85 $257.99 . . .

47539 $4,108.59 $348.48 . . .

47540 $4,266.39 $415.98 . . .

47541 $972.01 $220.88 . . .

47542 $420.95 $100.60 . . .

47543 $1,098.59 $126.88 . . .

47544 $668.80 $166.66 . . .

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134

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

47550 . . $125.37 . .

47552 . . $244.63 . .

47553 . . $240.27 . .

47554 . . $370.29 . .

47555 . . $287.93 . .

47556 . . $327.67 . .

47562 . . $504.42 . .

47563 . . $547.38 . .

47564 . . $852.40 . .

47570 . . $585.46 . .

47579 . . I.C. . .

47600 . . $816.48 . .

47605 . . $859.01 . .

47610 . . $957.53 . .

47612 . . $969.35 . .

47620 . . $1,048.95 . .

47700 . . $799.04 . .

47701 . . $1,305.21 . .

47711 . . $1,187.05 . .

47712 . . $1,516.98 . .

47715 . . $1,018.52 . .

47720 . . $882.04 . .

47721 . . $1,036.95 . .

47740 . . $997.92 . .

47741 . . $1,123.39 . .

47760 . . $1,719.61 . .

47765 . . $2,307.42 . .

47780 . . $1,881.25 . .

47785 . . $2,467.44 . .

47800 . . $1,202.33 . .

47801 . . $778.64 . .

47802 . . $1,157.42 . .

47900 . . $1,047.56 . .

47999 . . I.C. . .

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135

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

48000 . . $1,426.36 . .

48001 . . $1,742.09 . .

48020 . . $896.70 . .

48100 . . $679.31 . .

48102 $432.90 $190.41 . . .

48105 . . $2,169.33 . .

48120 . . $846.37 . .

48140 . . $1,191.62 . .

48145 . . $1,239.62 . .

48146 . . $1,436.11 . .

48148 . . $953.06 . .

48150 . . $2,369.58 . .

48152 . . $2,187.95 . .

48153 . . $2,356.92 . .

48154 . . $2,212.04 . .

48155 . . $1,391.03 . .

48160 . . I.C. . .

48400 . . $82.24 . .

48500 . . $870.08 . .

48510 . . $836.62 . .

48520 . . $835.27 . .

48540 . . $990.37 . .

48545 . . $1,018.47 . .

48547 . . $1,363.66 . .

48548 . . $1,268.20 . .

48550 . . I.C. . .

48551 . . I.C. . .

48552 . . $177.54 . .

48554 . . $1,976.58 . .

48556 . . $977.30 . .

48999 . . I.C. . .

49000 . . $591.28 . .

49002 . . $799.06 . .

49010 . . $713.61 . .

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Final Adoption

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136

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

49020 . . $1,216.91 . .

49040 . . $765.67 . .

49060 . . $841.99 . .

49062 . . $563.83 . .

49082 $156.33 $58.33 . . .

49083 $239.96 $85.70 . . .

49084 . . $82.40 . .

49180 $131.51 $66.96 . . .

49185 $827.74 $96.44 . . .

49203 . . $917.31 . .

49204 . . $1,171.22 . .

49205 . . $1,341.80 . .

49215 . . $1,698.79 . .

49220 . . $696.97 . .

49250 . . $452.46 . .

49255 . . $609.13 . .

49320 . . $251.41 . .

49321 . . $266.22 . .

49322 . . $283.96 . .

49323 . . $491.77 . .

49324 . . $299.46 . .

49325 . . $318.78 . .

49326 . . $143.10 . .

49327 . . $98.97 . .

49329 . . I.C. . .

49400 $107.39 $72.75 . . .

49402 . . $655.27 . .

49405 $721.62 $165.89 . . .

49406 $721.91 $165.89 . . .

49407 $597.96 $177.24 . . .

49411 $447.48 $155.26 . . .

49412 . . $62.58 . .

49418 $1,194.21 $170.99 . . .

49419 . . $343.94 . .

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137

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

49421 . . $174.78 . .

49422 . . $291.51 . .

49423 $457.56 $56.38 . . .

49424 $120.57 $29.97 . . .

49425 . . $563.97 . .

49426 . . $468.50 . .

49427 . . $35.78 . .

49428 . . $330.65 . .

49429 . . $350.29 . .

49435 . . $90.66 . .

49436 . . $144.67 . .

49440 $860.85 $174.26 . . .

49441 $968.60 $200.29 . . .

49442 $800.56 $175.26 . . .

49446 $831.27 $127.21 . . .

49450 $557.89 $52.49 . . .

49451 $607.20 $71.02 . . .

49452 $748.71 $109.49 . . .

49460 $615.57 $37.64 . . .

49465 $135.11 $24.38 . . .

49491 . . $608.50 . .

49492 . . $731.94 . .

49495 . . $296.37 . .

49496 . . $472.21 . .

49500 . . $282.98 . .

49501 . . $451.14 . .

49505 . . $400.72 . .

49507 . . $449.59 . .

49520 . . $484.61 . .

49521 . . $548.37 . .

49525 . . $440.00 . .

49540 . . $514.67 . .

49550 . . $441.66 . .

49553 . . $484.17 . .

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138

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

49555 . . $458.71 . .

49557 . . $553.86 . .

49560 . . $564.79 . .

49561 . . $710.23 . .

49565 . . $588.49 . .

49566 . . $716.98 . .

49568 . . $202.34 . .

49570 . . $322.03 . .

49572 . . $397.07 . .

49580 . . $258.54 . .

49582 . . $372.44 . .

49585 . . $343.19 . .

49587 . . $366.85 . .

49590 . . $439.92 . .

49600 . . $542.13 . .

49605 . . $3,746.49 . .

49606 . . $853.70 . .

49610 . . $527.25 . .

49611 . . $465.28 . .

49650 . . $330.54 . .

49651 . . $428.80 . .

49652 . . $570.32 . .

49653 . . $710.79 . .

49654 . . $646.78 . .

49655 . . $789.63 . .

49656 . . $702.03 . .

49657 . . $1,006.78 . .

49659 . . I.C. . .

49900 . . $628.56 . .

49904 . . $1,101.45 . .

49905 . . $268.46 . .

49906 . . I.C. . .

49999 . . I.C. . .

50010 . . $570.91 . .

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139

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

50020 . . $791.43 . .

50040 . . $720.36 . .

50045 . . $744.51 . .

50060 . . $887.21 . .

50065 . . $938.26 . .

50070 . . $920.30 . .

50075 . . $1,130.59 . .

50080 . . $676.15 . .

50081 . . $991.09 . .

50100 . . $821.14 . .

50120 . . $738.03 . .

50125 . . $800.04 . .

50130 . . $802.37 . .

50135 . . $881.12 . .

50200 $507.58 $111.44 . . .

50205 . . $577.66 . .

50220 . . $809.58 . .

50225 . . $931.62 . .

50230 . . $992.38 . .

50234 . . $1,008.14 . .

50236 . . $1,138.81 . .

50240 . . $1,027.83 . .

50250 . . $945.59 . .

50280 . . $740.50 . .

50290 . . $698.84 . .

50300 . . I.C. . .

50320 . . $1,118.67 . .

50323 . . I.C. . .

50325 . . I.C. . .

50327 . . $164.27 . .

50328 . . $144.22 . .

50329 . . $135.56 . .

50340 . . $722.71 . .

50360 . . $1,850.71 . .

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140

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

50365 . . $2,173.21 . .

50370 . . $923.15 . .

50380 . . $1,527.98 . .

50382 $980.17 $211.27 . . .

50384 $779.48 $191.77 . . .

50385 $945.08 $181.22 . . .

50386 $614.07 $137.69 . . .

50387 $451.78 $76.07 . . .

50389 $246.01 $42.31 . . .

50390 . . $75.58 . .

50391 $95.31 $75.77 . . .

50395 . . $140.11 . .

50396 . . $93.17 . .

50400 . . $898.78 . .

50405 . . $1,084.04 . .

50430 $426.92 $131.44 . . .

50431 $132.32 $52.68 . . .

50432 $695.56 $173.59 . . .

50433 $937.56 $213.66 . . .

50434 $742.53 $164.01 . . .

50435 $390.80 $80.22 . . .

50500 . . $972.06 . .

50520 . . $864.62 . .

50525 . . $1,096.24 . .

50526 . . $1,149.69 . .

50540 . . $889.49 . .

50541 . . $713.77 . .

50542 . . $906.14 . .

50543 . . $1,154.57 . .

50544 . . $965.18 . .

50545 . . $1,038.62 . .

50546 . . $932.90 . .

50547 . . $1,237.20 . .

50548 . . $1,043.96 . .

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141

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

50549 . . I.C. . .

50551 $282.28 $228.69 . . .

50553 $299.96 $241.63 . . .

50555 $321.78 $263.75 . . .

50557 $328.68 $268.58 . . .

50561 $372.68 $306.36 . . .

50562 . . $451.10 . .

50570 . . $380.84 . .

50572 . . $411.92 . .

50574 . . $437.98 . .

50575 . . $552.97 . .

50576 . . $437.37 . .

50580 . . $471.23 . .

50590 $568.12 $443.48 . . .

50592 $2,115.81 $284.02 . . .

50593 $3,869.22 $376.17 . . .

50600 . . $730.75 . .

50605 . . $755.33 . .

50606 $431.89 $122.20 . . .

50610 . . $758.01 . .

50620 . . $704.65 . .

50630 . . $692.23 . .

50650 . . $804.28 . .

50660 . . $891.03 . .

50684 $86.39 $39.90 . . .

50686 $114.64 $69.04 . . .

50688 . . $63.53 . .

50690 $78.74 $55.64 . . .

50693 $875.38 $171.62 . . .

50694 $960.76 $221.47 . . .

50695 $1,170.27 $280.87 . . .

50700 . . $723.35 . .

50705 $1,418.11 $156.26 . . .

50706 $629.06 $146.17 . . .

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142

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

50715 . . $936.22 . .

50722 . . $794.62 . .

50725 . . $872.68 . .

50727 . . $396.58 . .

50728 . . $546.50 . .

50740 . . $933.56 . .

50750 . . $895.62 . .

50760 . . $872.05 . .

50770 . . $892.55 . .

50780 . . $857.74 . .

50782 . . $792.48 . .

50783 . . $878.05 . .

50785 . . $940.82 . .

50800 . . $718.39 . .

50810 . . $977.23 . .

50815 . . $951.24 . .

50820 . . $1,019.20 . .

50825 . . $1,284.07 . .

50830 . . $1,403.03 . .

50840 . . $956.86 . .

50845 . . $972.47 . .

50860 . . $735.08 . .

50900 . . $666.36 . .

50920 . . $688.41 . .

50930 . . $899.21 . .

50940 . . $690.83 . .

50945 . . $755.24 . .

50947 . . $1,077.40 . .

50948 . . $989.79 . .

50949 . . I.C. . .

50951 $294.59 $238.04 . . .

50953 $310.92 $252.30 . . .

50955 $332.95 $273.44 . . .

50957 $336.10 $275.11 . . .

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143

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

50961 $303.25 $246.41 . . .

50970 . . $288.78 . .

50972 . . $279.91 . .

50974 . . $366.64 . .

50976 . . $360.99 . .

50980 . . $274.66 . .

51020 . . $367.69 . .

51030 . . $373.66 . .

51040 . . $227.37 . .

51045 . . $382.36 . .

51050 . . $369.07 . .

51060 . . $456.04 . .

51065 . . $451.33 . .

51080 . . $320.79 . .

51100 $48.31 $30.25 . . .

51101 $100.29 $40.18 . . .

51102 $180.44 $112.64 . . .

51500 . . $497.33 . .

51520 . . $466.11 . .

51525 . . $667.96 . .

51530 . . $616.33 . .

51535 . . $606.71 . .

51550 . . $746.94 . .

51555 . . $982.40 . .

51565 . . $1,007.65 . .

51570 . . $1,145.35 . .

51575 . . $1,412.92 . .

51580 . . $1,470.20 . .

51585 . . $1,634.06 . .

51590 . . $1,498.03 . .

51595 . . $1,695.59 . .

51596 . . $1,822.60 . .

51597 . . $1,778.52 . .

51600 $150.78 $34.43 . . .

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144

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

51605 . . $29.99 . .

51610 $85.67 $50.73 . . .

51700 $66.27 $34.59 . . .

51701 $43.80 $21.60 . . .

51702 $56.83 $23.67 . . .

51703 $103.03 $63.36 . . .

51705 $72.73 $40.46 . . .

51710 $102.59 $62.62 . . .

51715 $229.64 $155.03 . . .

51720 $85.78 $62.10 . . .

51725 . . $151.16 $59.21 $91.95

51726 . . $213.73 $66.26 $147.48

51727 . . $252.73 $83.05 $169.68

51728 . . $255.23 $81.11 $174.12

51729 . . $274.98 $98.20 $176.79

51736 . . $12.32 $6.53 $5.79

51741 . . $12.62 $6.53 $6.09

51784 . . $155.12 $59.45 $95.66

51785 . . $212.34 $66.05 $146.29

51792 . . $172.62 $42.90 $129.71

51797 . . $90.56 $31.05 $59.51

51798 . . $15.72 . .

51800 . . $808.80 . .

51820 . . $857.97 . .

51840 . . $510.96 . .

51841 . . $605.10 . .

51845 . . $456.57 . .

51860 . . $577.72 . .

51865 . . $693.94 . .

51880 . . $364.94 . .

51900 . . $649.61 . .

51920 . . $660.45 . .

51925 . . $828.12 . .

51940 . . $1,273.33 . .

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145

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

51960 . . $1,080.07 . .

51980 . . $555.43 . .

51990 . . $582.75 . .

51992 . . $653.11 . .

51999 . . I.C. . .

52000 $162.64 $98.39 . . .

52001 $291.39 $223.00 . . .

52005 $213.24 $103.69 . . .

52007 $358.96 $128.91 . . .

52010 $299.35 $129.70 . . .

52204 $298.26 $110.26 . . .

52214 $537.66 $136.18 . . .

52224 $561.20 $157.36 . . .

52234 . . $191.08 . .

52235 . . $224.18 . .

52240 . . $304.03 . .

52250 . . $186.22 . .

52260 . . $163.48 . .

52265 $294.62 $126.75 . . .

52270 $284.55 $141.25 . . .

52275 $383.05 $192.97 . . .

52276 . . $205.58 . .

52277 . . $250.86 . .

52281 $217.35 $118.46 . . .

52282 . . $260.99 . .

52283 $217.80 $156.51 . . .

52285 $220.34 $152.24 . . .

52287 $248.39 $131.14 . . .

52290 . . $189.54 . .

52300 . . $218.00 . .

52301 . . $225.21 . .

52305 . . $216.38 . .

52310 $193.08 $117.88 . . .

52315 $326.16 $213.06 . . .

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Final Adoption

March 9, 2018

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146

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

52317 $645.98 $269.37 . . .

52318 . . $367.04 . .

52320 . . $191.49 . .

52325 . . $248.98 . .

52327 . . $202.45 . .

52330 $393.78 $204.59 . . .

52332 $397.34 $121.11 . . .

52334 . . $199.18 . .

52341 . . $220.70 . .

52342 . . $240.06 . .

52343 . . $267.09 . .

52344 . . $286.78 . .

52345 . . $306.14 . .

52346 . . $345.97 . .

52351 . . $235.12 . .

52352 . . $274.89 . .

52353 . . $304.03 . .

52354 . . $323.39 . .

52355 . . $362.28 . .

52356 . . $322.51 . .

52400 . . $371.77 . .

52402 . . $206.23 . .

52441 $1,021.47 $175.89 . . .

52442 $790.59 $46.85 . . .

52450 . . $368.05 . .

52500 . . $381.98 . .

52601 . . $657.63 . .

52630 . . $313.28 . .

52640 . . $248.24 . .

52647 $1,444.21 $504.77 . . .

52648 $1,484.80 $537.96 . . .

52649 . . $641.09 . .

52700 . . $344.46 . .

53000 . . $116.36 . .

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147

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

53010 . . $232.93 . .

53020 . . $75.38 . .

53025 . . $56.38 . .

53040 . . $306.90 . .

53060 $143.81 $128.41 . . .

53080 . . $328.96 . .

53085 . . $523.01 . .

53200 $121.54 $110.29 . . .

53210 . . $599.45 . .

53215 . . $722.08 . .

53220 . . $355.31 . .

53230 . . $472.36 . .

53235 . . $493.37 . .

53240 . . $334.00 . .

53250 . . $321.20 . .

53260 $157.93 $140.76 . . .

53265 $171.19 $145.13 . . .

53270 $162.88 $144.81 . . .

53275 . . $204.66 . .

53400 . . $623.98 . .

53405 . . $679.58 . .

53410 . . $760.43 . .

53415 . . $877.66 . .

53420 . . $664.40 . .

53425 . . $727.70 . .

53430 . . $748.24 . .

53431 . . $898.25 . .

53440 . . $585.94 . .

53442 . . $610.80 . .

53444 . . $616.78 . .

53445 . . $587.27 . .

53446 . . $501.32 . .

53447 . . $629.48 . .

53448 . . $997.52 . .

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148

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

53449 . . $476.96 . .

53450 . . $320.17 . .

53460 . . $357.60 . .

53500 . . $582.76 . .

53502 . . $380.06 . .

53505 . . $380.98 . .

53510 . . $492.43 . .

53515 . . $618.81 . .

53520 . . $434.69 . .

53600 $65.32 $49.33 . . .

53601 $64.10 $41.60 . . .

53605 . . $49.77 . .

53620 $91.13 $67.74 . . .

53621 $86.60 $56.10 . . .

53660 $56.32 $32.63 . . .

53661 $55.11 $31.42 . . .

53665 . . $29.71 . .

53850 $1,692.46 $475.01 . . .

53852 $1,553.86 $485.33 . . .

53855 $641.47 $63.84 . . .

53860 $1,275.83 $176.51 . . .

53899 . . I.C. . .

54000 $118.15 $85.29 . . .

54001 $146.33 $108.43 . . .

54015 . . $241.46 . .

54050 $105.44 $83.53 . . .

54055 $94.42 $73.11 . . .

54056 $113.89 $88.43 . . .

54057 $108.66 $75.21 . . .

54060 $142.83 $102.56 . . .

54065 $173.69 $136.39 . . .

54100 $158.63 $98.82 . . .

54105 $208.49 $166.74 . . .

54110 . . $492.20 . .

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March 9, 2018

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149

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

54111 . . $622.47 . .

54112 . . $730.07 . .

54115 $354.97 $332.77 . . .

54120 . . $492.60 . .

54125 . . $631.12 . .

54130 . . $925.70 . .

54135 . . $1,167.28 . .

54150 $121.72 $75.24 . . .

54160 $177.19 $113.54 . . .

54161 . . $153.66 . .

54162 $203.40 $155.73 . . .

54163 . . $172.31 . .

54164 . . $152.49 . .

54200 $85.54 $66.60 . . .

54205 . . $416.24 . .

54220 $161.78 $104.05 . . .

54230 $76.26 $62.35 . . .

54231 $110.11 $90.56 . . .

54235 $71.29 $57.67 . . .

54240 . . $80.38 $51.21 $29.18

54250 . . $94.18 $85.13 $9.05

54300 . . $499.67 . .

54304 . . $584.08 . .

54308 . . $557.24 . .

54312 . . $668.14 . .

54316 . . $812.96 . .

54318 . . $581.60 . .

54322 . . $598.62 . .

54324 . . $778.47 . .

54326 . . $735.66 . .

54328 . . $731.10 . .

54332 . . $830.20 . .

54336 . . $968.67 . .

54340 . . $445.25 . .

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150

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

54344 . . $793.26 . .

54348 . . $788.34 . .

54352 . . $1,099.76 . .

54360 . . $561.00 . .

54380 . . $622.47 . .

54385 . . $757.29 . .

54390 . . $1,009.01 . .

54400 . . $413.26 . .

54401 . . $515.46 . .

54405 . . $628.89 . .

54406 . . $569.04 . .

54408 . . $615.57 . .

54410 . . $669.35 . .

54411 . . $797.87 . .

54415 . . $412.92 . .

54416 . . $554.69 . .

54417 . . $699.07 . .

54420 . . $549.22 . .

54430 . . $499.57 . .

54435 . . $325.96 . .

54437 . . $531.02 . .

54438 . . $1,060.86 . .

54440 . . I.C. . .

54450 $54.60 $44.53 . . .

54500 . . $58.12 . .

54505 . . $164.61 . .

54512 . . $420.64 . .

54520 . . $254.97 . .

54522 . . $479.14 . .

54530 . . $395.03 . .

54535 . . $579.38 . .

54550 . . $385.23 . .

54560 . . $535.26 . .

54600 . . $356.40 . .

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101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00 SURGERY AND ANESTHESIA

151

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

54620 . . $235.40 . .

54640 . . $375.01 . .

54650 . . $554.02 . .

54660 . . $280.44 . .

54670 . . $317.30 . .

54680 . . $616.48 . .

54690 . . $564.71 . .

54692 . . $650.25 . .

54699 . . I.C. . .

54700 . . $167.45 . .

54800 . . $99.05 . .

54830 . . $292.27 . .

54840 . . $251.69 . .

54860 . . $327.86 . .

54861 . . $442.31 . .

54865 . . $281.55 . .

54900 . . $653.78 . .

54901 . . $860.50 . .

55000 $92.94 $66.59 . . .

55040 . . $264.94 . .

55041 . . $398.25 . .

55060 . . $298.33 . .

55100 $171.81 $130.95 . . .

55110 . . $303.38 . .

55120 . . $279.67 . .

55150 . . $384.18 . .

55175 . . $284.28 . .

55180 . . $540.17 . .

55200 $348.31 $218.33 . . .

55250 $422.22 $244.77 . . .

55300 . . $145.36 . .

55400 . . $396.01 . .

55500 . . $309.28 . .

55520 . . $350.19 . .

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March 9, 2018

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

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152

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

55530 . . $275.28 . .

55535 . . $336.75 . .

55540 $417.24

55550 . . $336.00 . .

55559 . . I.C. . .

55600 . . $330.08 . .

55605 . . $428.36 . .

55650 . . $559.72 . .

55680 . . $278.35 . .

55700 $172.75 $108.21 . . .

55705 . . $207.68 . .

55706 . . $292.04 . .

55720 . . $354.10 . .

55725 . . $463.67 . .

55801 . . $853.90 . .

55810 . . $1,022.22 . .

55812 . . $1,248.79 . .

55815 . . $1,372.09 . .

55821 . . $679.52 . .

55831 . . $734.82 . .

55840 . . $910.59 . .

55842 . . $910.26 . .

55845 . . $1,059.16 . .

55860 . . $680.79 . .

55862 . . $892.47 . .

55865 . . $1,036.01 . .

55866 . . $1,106.52 . .

55870 $137.82 $110.87 . . .

55873 $5,881.48 $597.19 . . .

55874 $3,138.37 $135.09 - - -

55875 . . $595.23 . .

55876 $107.42 $78.70 . . .

55899 . . I.C. . .

55920 . . $349.54 . .

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153

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

55970 . . I.C. . .

55980 . . I.C. . .

56405 $85.12 $84.52 . . .

56420 $95.74 $70.57 . . .

56440 . . $140.83 . .

56441 $112.39 $107.95 . . .

56442 . . $37.45 . .

56501 $102.81 $89.78 . . .

56515 $176.29 $155.86 . . .

56605 $64.29 $46.22 . . .

56606 $29.20 $22.68 . . .

56620 . . $402.52 . .

56625 . . $482.88 . .

56630 . . $709.37 . .

56631 . . $904.52 . .

56632 . . $1,052.70 . .

56633 . . $926.14 . .

56634 . . $994.88 . .

56637 . . $1,149.91 . .

56640 . . $1,154.42 . .

56700 . . $144.61 . .

56740 . . $231.41 . .

56800 . . $185.73 . .

56805 . . $889.22 . .

56810 . . $200.55 . .

56820 $87.39 $66.37 . . .

56821 $115.08 $88.43 . . .

57000 . . $145.65 . .

57010 . . $335.19 . .

57020 $71.60 $61.83 . . .

57022 . . $131.14 . .

57023 . . $238.77 . .

57061 $89.72 $76.99 . . .

57065 $151.42 $134.84 . . .

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154

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

57100 $69.42 $51.06 . . .

57105 $106.64 $98.35 . . .

57106 . . $381.51 . .

57107 . . $1,109.10 . .

57109 . . $1,315.26 . .

57110 . . $685.40 . .

57111 . . $1,233.49 . .

57112 . . $1,405.58 . .

57120 . . $393.00 . .

57130 $137.83 $123.03 . . .

57135 $149.31 $133.92 . . .

57150 $35.38 $22.06 . . .

57155 $342.36 $226.00 . . .

57156 $156.78 $114.44 . . .

57160 $60.03 $35.75 . . .

57170 $64.32 $50.58 . . .

57180 $110.68 $81.66 . . .

57200 . . $234.42 . .

57210 . . $284.07 . .

57220 . . $247.42 . .

57230 . . $304.94 . .

57240 . . $516.39 . .

57250 . . $519.38 . .

57260 . . $638.89 . .

57265 . . $699.08 . .

57267 . . $195.66 . .

57268 . . $374.21 . .

57270 . . $613.48 . .

57280 . . $731.20 . .

57282 . . $387.36 . .

57283 . . $529.39 . .

57284 . . $625.95 . .

57285 . . $516.89 . .

57287 . . $526.81 . .

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March 9, 2018

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155

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

57288 . . $552.29 . .

57289 . . $567.86 . .

57291 . . $476.42 . .

57292 . . $631.75 . .

57295 . . $368.76 . .

57296 . . $726.38 . .

57300 . . $433.44 . .

57305 . . $714.23 . .

57307 . . $818.77 . .

57308 . . $508.08 . .

57310 . . $360.06 . .

57311 . . $410.38 . .

57320 . . $414.53 . .

57330 . . $574.43 . .

57335 . . $874.62 . .

57400 . . $103.32 . .

57410 . . $83.19 . .

57415 . . $124.30 . .

57420 $91.44 $70.12 . . .

57421 $122.45 $95.21 . . .

57423 . . $698.65 . .

57425 . . $743.42 . .

57426 . . $648.86 . .

57452 $84.96 $71.34 . . .

57454 $118.46 $104.55 . . .

57455 $111.15 $84.80 . . .

57456 $104.97 $78.92 . . .

57460 $224.61 $125.13 . . .

57461 $252.79 $143.54 . . .

57500 $101.79 $58.86 . . .

57505 $80.37 $72.37 . . .

57510 $101.88 $89.15 . . .

57511 $113.30 $102.64 . . .

57513 $112.93 $104.05 . . .

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156

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

57520 $239.44 $213.38 . . .

57522 $204.86 $188.87 . . .

57530 . . $268.79 . .

57531 . . $1,387.76 . .

57540 . . $599.86 . .

57545 . . $645.20 . .

57550 . . $315.01 . .

57555 . . $461.52 . .

57556 . . $437.04 . .

57558 $97.12 $87.94 . . .

57700 . . $247.07 . .

57720 . . $238.21 . .

57800 $47.31 $37.54 . . .

58100 $85.01 $67.25 . . .

58110 $37.08 $31.16 . . .

58120 $201.08 $168.51 . . .

58140 . . $705.63 . .

58145 . . $421.91 . .

58146 . . $880.04 . .

58150 . . $774.74 . .

58152 . . $955.12 . .

58180 . . $737.35 . .

58200 . . $1,042.52 . .

58210 . . $1,403.75 . .

58240 . . $2,218.20 . .

58260 . . $633.39 . .

58262 . . $706.28 . .

58263 . . $757.31 . .

58267 . . $806.65 . .

58270 . . $674.78 . .

58275 . . $753.48 . .

58280 . . $803.15 . .

58285 . . $1,017.62 . .

58290 . . $879.19 . .

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157

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

58291 . . $949.62 . .

58292 . . $1,002.36 . .

58293 . . $1,041.56 . .

58294 . . $932.02 . .

58300 $77.17 $56.15 . . .

58301 $101.13 $70.41 . . .

58321 $60.41 $37.32 . . .

58322 $67.08 $44.58 . . .

58323 $11.87 $9.21 . . .

58340 $95.88 $45.55 . . .

58345 . . $209.09 . .

58346 . . $349.89 . .

58350 $75.90 $61.40 . . .

58353 $824.36 $168.56 . . .

58356 $1,543.45 $263.24 . . .

58400 . . $339.80 . .

58410 . . $624.74 . .

58520 . . $641.30 . .

58540 . . $694.71 . .

58541 . . $550.03 . .

58542 . . $627.81 . .

58543 . . $635.30 . .

58544 . . $691.07 . .

58545 . . $690.07 . .

58546 . . $858.05 . .

58548 . . $1,446.57 . .

58550 . . $676.29 . .

58552 . . $755.92 . .

58553 . . $868.15 . .

58554 . . $1,014.36 . .

58555 $246.63 $145.08 . . .

58558 $318.63 $203.76 . . .

58559 . . $260.73 . .

58560 . . $294.37 . .

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158

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

58561 . . $416.58 . .

58562 $328.46 $221.28 . . .

58563 $1,366.23 $260.70 . . .

58565 $2,085.42 $454.83 . . .

58570 . . $596.92 . .

58571 . . $684.40 . .

58572 . . $779.57 . .

58573 . . $925.16 . .

58575 - - $1,507.80 - -

58578 . . I.C. . .

58579 . . I.C. . .

58600 . . $382.77 . .

58605 . . $347.23 . .

58611 . . $80.33 . .

58615 . . $255.87 . .

58660 . . $515.35 . .

58661 . . $495.90 . .

58662 . . $542.88 . .

58670 . . $281.31 . .

58671 . . $280.85 . .

58672 . . $561.25 . .

58673 . . $609.80 . .

58674 - - $642.07 - -

58679 . . I.C. . .

58700 . . $597.17 . .

58720 . . $563.13 . .

58740 . . $675.40 . .

58750 . . $731.62 . .

58752 . . $705.25 . .

58760 . . $627.33 . .

58770 . . $693.72 . .

58800 $246.47 $230.49 . . .

58805 . . $311.57 . .

58820 . . $241.69 . .

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159

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

58822 . . $568.87 . .

58825 . . $534.77 . .

58900 . . $348.69 . .

58920 . . $577.38 . .

58925 . . $571.58 . .

58940 . . $403.65 . .

58943 . . $895.46 . .

58950 . . $861.17 . .

58951 . . $1,105.64 . .

58952 . . $1,250.23 . .

58953 . . $1,545.28 . .

58954 . . $1,678.37 . .

58956 . . $1,052.69 . .

58957 . . $1,208.26 . .

58958 . . $1,328.41 . .

58960 . . $741.86 . .

58970 $171.86 $153.50 . . .

58974 . . I.C. . .

58976 $196.11 $167.39 . . .

58999 . . I.C. . .

59000 $134.97 $84.03 . . .

59001 . . $185.91 . .

59012 . . $209.45 . .

59015 $163.20 $136.53 . . .

59020 . . $76.83 $38.21 $38.62

59025 . . $51.56 $30.72 $20.84

59030 . . $107.48 . .

59050 . . $52.12 . .

59051 . . $43.27 . .

59070 $311.16 $230.92 . . .

59072 . . $367.99 . .

59074 $298.00 $229.61 . . .

59076 . . $367.99 . .

59100 . . $612.02 . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

59120 . . $822.56 . .

59121 . . $824.06 . .

59130 . . $704.05 . .

59135 . . $654.27 . .

59136 . . $889.65 . .

59140 . . $311.88 . .

59150 . . $798.13 . .

59151 . . $773.85 . .

59160 $214.30 $179.54 . . .

59200 $76.64 $45.92 . . .

59300 $204.63 $154.10 . . .

59320 . . $158.12 . .

59325 . . $250.86 . .

59350 . . $202.53 . .

59400 . . $2,173.45 . .

59409 . . $839.04 . .

59410 . . $1,072.08 . .

59412 . . $78.58 . .

59414 . . $94.25 . .

59425 $478.48 $366.51 . . .

59426 $857.55 $647.36 . . .

59430 $194.81 $143.47 . . .

59510 . . $2,403.88 . .

59514 . . $943.39 . .

59515 . . $1,301.12 . .

59525 . . $364.22 . .

59610 . . $2,276.96 . .

59612 . . $942.04 . .

59614 . . $1,173.73 . .

59618 . . $2,434.61 . .

59620 . . $968.82 . .

59622 . . $1,335.74 . .

59812 $333.77 $308.30 . . .

59820 $400.70 $374.83 . . .

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161

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

59821 $402.77 $374.48 . . .

59830 . . $333.22 . .

59840 $166.94 $159.54 . . .

59841 $292.34 $274.58 . . .

59850 . . $275.40 . .

59851 . . $293.41 . .

59852 . . $399.47 . .

59855 . . $316.10 . .

59856 . . $370.42 . .

59857 . . $407.40 . .

59866 . . $170.29 . .

59870 . . $363.17 . .

59871 . . $101.63 . .

59897 . . I.C. . .

59898 . . I.C. . .

59899 . . I.C. . .

60000 $137.11 $122.61 . . .

60100 $89.31 $61.48 . . .

60200 . . $514.07 . .

60210 . . $547.34 . .

60212 . . $776.75 . .

60220 . . $549.16 . .

60225 . . $721.71 . .

60240 . . $709.64 . .

60252 . . $1,018.37 . .

60254 . . $1,292.99 . .

60260 . . $844.57 . .

60270 . . $1,050.87 . .

60271 . . $816.79 . .

60280 . . $350.63 . .

60281 . . $462.84 . .

60300 $96.11 $38.67 . . .

60500 . . $743.41 . .

60502 . . $988.71 . .

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162

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

60505 . . $1,067.49 . .

60512 . . $185.66 . .

60520 . . $798.18 . .

60521 . . $857.04 . .

60522 . . $1,035.30 . .

60540 . . $815.03 . .

60545 . . $933.48 . .

60600 . . $1,065.22 . .

60605 . . $1,309.82 . .

60650 . . $913.37 . .

60659 . . I.C. . .

60699 . . I.C. . .

61000 . . $86.96 . .

61001 . . $66.04 . .

61020 . . $77.45 . .

61026 . . $80.42 . .

61050 . . $67.10 . .

61055 . . $93.26 . .

61070 . . $45.02 . .

61105 . . $352.13 . .

61107 . . $236.58 . .

61108 . . $696.18 . .

61120 . . $570.11 . .

61140 . . $963.56 . .

61150 . . $1,016.67 . .

61151 . . $759.16 . .

61154 . . $969.31 . .

61156 . . $944.82 . .

61210 . . $276.76 . .

61215 . . $392.20 . .

61250 . . $625.77 . .

61253 . . $640.39 . .

61304 . . $1,247.99 . .

61305 . . $1,517.46 . .

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163

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

61312 . . $1,573.96 . .

61313 . . $1,506.23 . .

61314 . . $1,384.10 . .

61315 . . $1,566.30 . .

61316 . . $65.85 . .

61320 . . $1,441.01 . .

61321 . . $1,590.57 . .

61322 . . $1,799.73 . .

61323 . . $1,814.83 . .

61330 . . $1,282.06 . .

61332 . . $1,419.81 . .

61333 . . $1,455.63 . .

61340 . . $1,088.11 . .

61343 . . $1,661.90 . .

61345 . . $1,540.56 . .

61450 . . $1,454.80 . .

61458 . . $1,519.67 . .

61460 . . $1,597.31 . .

61480 . . $1,261.03 . .

61500 . . $1,012.41 . .

61501 . . $887.25 . .

61510 . . $1,658.03 . .

61512 . . $1,926.57 . .

61514 . . $1,440.20 . .

61516 . . $1,406.47 . .

61517 . . $65.87 . .

61518 . . $2,085.51 . .

61519 . . $2,213.23 . .

61520 . . $2,851.08 . .

61521 . . $2,375.77 . .

61522 . . $1,641.19 . .

61524 . . $1,565.58 . .

61526 . . $2,761.09 . .

61530 . . $2,327.47 . .

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164

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

61531 . . $927.24 . .

61533 . . $1,152.71 . .

61534 . . $1,238.31 . .

61535 . . $760.85 . .

61536 . . $1,953.86 . .

61537 . . $1,856.82 . .

61538 . . $2,015.50 . .

61539 . . $1,777.03 . .

61540 . . $1,656.60 . .

61541 . . $1,630.45 . .

61543 . . $1,614.79 . .

61544 . . $1,443.58 . .

61545 . . $2,413.13 . .

61546 . . $1,749.68 . .

61548 . . $1,196.78 . .

61550 . . $756.22 . .

61552 . . $903.90 . .

61556 . . $1,208.52 . .

61557 . . $1,221.05 . .

61558 . . $1,428.06 . .

61559 . . $1,630.95 . .

61563 . . $1,445.99 . .

61564 . . $1,765.84 . .

61566 . . $1,699.22 . .

61567 . . $1,944.00 . .

61570 . . $1,414.07 . .

61571 . . $1,504.64 . .

61575 . . $1,669.08 . .

61576 . . $2,826.54 . .

61580 . . $1,956.02 . .

61581 . . $2,101.70 . .

61582 . . $2,247.18 . .

61583 . . $2,210.75 . .

61584 . . $2,184.75 . .

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165

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

61585 . . $2,461.15 . .

61586 . . $1,866.89 . .

61590 . . $2,374.86 . .

61591 . . $2,408.54 . .

61592 . . $2,426.29 . .

61595 . . $1,840.13 . .

61596 . . $1,915.15 . .

61597 . . $2,147.44 . .

61598 . . $2,172.70 . .

61600 . . $1,671.56 . .

61601 . . $1,857.86 . .

61605 . . $1,710.47 . .

61606 . . $2,280.22 . .

61607 . . $2,094.06 . .

61608 . . $2,473.55 . .

61610 . . $1,201.76 . .

61611 . . $300.54 . .

61612 . . $1,129.33 . .

61613 . . $2,466.34 . .

61615 . . $1,789.20 . .

61616 . . $2,551.08 . .

61618 . . $992.41 . .

61619 . . $1,109.95 . .

61623 . . $431.48 . .

61624 . . $864.85 . .

61626 . . $663.88 . .

61630 . . $1,013.23 . .

61635 . . $1,091.72 . .

61640 . . $500.00 . .

61641 . . $175.51 . .

61642 . . $351.31 . .

61645 . . $589.80 . .

61650 . . $396.36 . .

61651 . . $168.30 . .

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166

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

61680 . . $1,697.67 . .

61682 . . $3,130.94 . .

61684 . . $2,154.58 . .

61686 . . $3,376.55 . .

61690 . . $1,642.11 . .

61692 . . $2,750.14 . .

61697 . . $3,182.95 . .

61698 . . $3,483.70 . .

61700 . . $2,566.79 . .

61702 . . $3,023.49 . .

61703 . . $1,035.53 . .

61705 . . $1,950.28 . .

61708 . . $1,650.49 . .

61710 . . $1,630.82 . .

61711 . . $1,960.93 . .

61720 . . $967.62 . .

61735 . . $1,194.70 . .

61750 . . $1,066.33 . .

61751 . . $1,052.07 . .

61760 . . $1,201.35 . .

61770 . . $1,225.49 . .

61781 . . $176.93 . .

61782 . . $136.58 . .

61783 . . $175.52 . .

61790 . . $673.47 . .

61791 . . $815.41 . .

61796 . . $772.95 . .

61797 . . $165.59 . .

61798 . . $1,049.48 . .

61799 . . $228.27 . .

61800 . . $117.02 . .

61850 . . $749.23 . .

61860 . . $1,188.73 . .

61863 . . $1,142.66 . .

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167

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

61864 . . $213.64 . .

61867 . . $1,724.29 . .

61868 . . $374.95 . .

61870 . . $880.55 . .

61880 . . $440.42 . .

61885 . . $400.21 . .

61886 . . $653.80 . .

61888 . . $302.97 . .

62000 . . $786.73 . .

62005 . . $945.72 . .

62010 . . $1,161.31 . .

62100 . . $1,215.47 . .

62115 . . $1,019.33 . .

62117 . . $1,275.12 . .

62120 . . $1,317.79 . .

62121 . . $1,240.36 . .

62140 . . $789.21 . .

62141 . . $868.37 . .

62142 . . $678.72 . .

62143 . . $791.54 . .

62145 . . $1,072.10 . .

62146 . . $944.35 . .

62147 . . $1,081.72 . .

62148 . . $95.47 . .

62160 . . $142.83 . .

62161 . . $1,154.99 . .

62162 . . $1,429.95 . .

62163 . . $861.53 . .

62164 . . $1,577.15 . .

62165 . . $1,183.45 . .

62180 . . $1,211.57 . .

62190 . . $675.80 . .

62192 . . $744.19 . .

62194 . . $356.44 . .

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168

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

62200 . . $1,044.32 . .

62201 . . $921.03 . .

62220 . . $784.53 . .

62223 . . $802.47 . .

62225 . . $405.30 . .

62230 . . $643.18 . .

62252 . . $67.38 $34.94 $32.44

62256 . . $460.19 . .

62258 . . $857.49 . .

62263 $532.75 $271.32 . . .

62264 $340.59 $187.23 . . .

62267 $199.17 $125.15 . . .

62268 . . $203.13 . .

62269 . . $210.89 . .

62270 $128.36 $60.56 . . .

62272 $163.08 $64.19 . . .

62273 $138.48 $89.03 . . .

62280 $247.30 $126.50 . . .

62281 $192.31 $122.74 . . .

62282 $237.65 $114.19 . . .

62284 $147.85 $67.32 . . .

62287 . . $447.93 . .

62290 $270.55 $135.84 . . .

62291 $268.65 $135.12 . . .

62292 . . $462.80 . .

62294 . . $623.92 . .

62302 $194.99 $96.10 . . .

62303 $202.98 $97.88 . . .

62304 $193.02 $94.73 . . .

62305 $210.82 $98.91 . . .

62320 $134.92 $81.12 - - -

62321 $203.06 $87.43 - - -

62322 $126.36 $69.87 - - -

62323 $199.88 $79.78 - - -

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169

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

62324 $116.71 $73.02 - - -

62325 $178.34 $83.81 - - -

62326 $123.46 $72.04 - - -

62327 $183.05 $76.62 - - -

62350 . . $313.30 . .

62351 . . $671.15 . .

62355 . . $211.83 . .

62360 . . $243.75 . .

62361 . . $281.05 . .

62362 . . $301.43 . .

62365 . . $232.45 . .

62367 $33.03 $19.71 . . .

62368 $45.30 $27.54 . . .

62369 $98.89 $27.83 . . .

62370 $103.36 $36.45 . . .

62380 - - I.C. - -

63001 . . $945.86 . .

63003 . . $943.57 . .

63005 . . $904.72 . .

63011 . . $843.96 . .

63012 . . $912.09 . .

63015 . . $1,130.69 . .

63016 . . $1,158.38 . .

63017 . . $957.68 . .

63020 . . $890.83 . .

63030 . . $746.57 . .

63035 . . $145.51 . .

63040 . . $1,065.65 . .

63042 . . $996.40 . .

63043 . . I.C. . .

63044 . . I.C. . .

63045 . . $985.55 . .

63046 . . $937.57 . .

63047 . . $848.43 . .

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170

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

63048 . . $160.57 . .

63050 . . $1,142.56 . .

63051 . . $1,309.76 . .

63055 . . $1,238.40 . .

63056 . . $1,134.38 . .

63057 . . $242.97 . .

63064 . . $1,348.69 . .

63066 . . $155.37 . .

63075 . . $1,037.89 . .

63076 . . $186.84 . .

63077 . . $1,148.70 . .

63078 . . $148.38 . .

63081 . . $1,343.57 . .

63082 . . $201.96 . .

63085 . . $1,457.11 . .

63086 . . $144.23 . .

63087 . . $1,836.04 . .

63088 . . $197.27 . .

63090 . . $1,503.77 . .

63091 . . $135.67 . .

63101 . . $1,762.88 . .

63102 . . $1,739.24 . .

63103 . . $222.68 . .

63170 . . $1,212.81 . .

63172 . . $1,057.49 . .

63173 . . $1,298.90 . .

63180 . . $1,132.56 . .

63182 . . $1,061.64 . .

63185 . . $875.38 . .

63190 . . $974.06 . .

63191 . . $1,036.03 . .

63194 . . $1,217.61 . .

63195 . . $1,169.20 . .

63196 . . $1,098.57 . .

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171

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

63197 . . $1,301.88 . .

63198 . . $1,293.20 . .

63199 . . $1,356.82 . .

63200 . . $1,165.51 . .

63250 . . $2,132.58 . .

63251 . . $2,292.82 . .

63252 . . $2,290.52 . .

63265 . . $1,269.42 . .

63266 . . $1,305.11 . .

63267 . . $1,047.01 . .

63268 . . $1,089.97 . .

63270 . . $1,573.96 . .

63271 . . $1,564.80 . .

63272 . . $1,434.45 . .

63273 . . $1,412.23 . .

63275 . . $1,365.05 . .

63276 . . $1,355.60 . .

63277 . . $1,183.23 . .

63278 . . $1,210.02 . .

63280 . . $1,600.50 . .

63281 . . $1,582.28 . .

63282 . . $1,491.80 . .

63283 . . $1,433.89 . .

63285 . . $1,979.96 . .

63286 . . $1,953.11 . .

63287 . . $2,080.47 . .

63290 . . $2,089.34 . .

63295 . . $249.62 . .

63300 . . $1,396.71 . .

63301 . . $1,667.63 . .

63302 . . $1,644.23 . .

63303 . . $1,744.04 . .

63304 . . $1,768.49 . .

63305 . . $1,841.06 . .

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172

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

63306 . . $1,773.82 . .

63307 . . $1,765.45 . .

63308 . . $244.27 . .

63600 . . $716.95 . .

63610 . . $333.78 . .

63615 . . $759.33 . .

63620 . . $849.68 . .

63621 . . $190.48 . .

63650 $1,094.15 $325.84 . . .

63655 . . $636.42 . .

63661 $467.95 $252.11 . . .

63662 . . $642.16 . .

63663 $637.55 $354.80 . . .

63664 . . $661.40 . .

63685 . . $286.51 . .

63688 . . $288.73 . .

63700 . . $906.97 . .

63702 . . $991.65 . .

63704 . . $1,259.02 . .

63706 . . $1,309.35 . .

63707 . . $707.61 . .

63709 . . $845.69 . .

63710 . . $833.75 . .

63740 . . $722.30 . .

63741 . . $519.85 . .

63744 . . $515.67 . .

63746 . . $462.98 . .

64400 $101.69 $54.62 . . .

64402 $103.17 $60.24 . . .

64405 $80.32 $48.94 . . .

64408 $80.92 $58.12 . . .

64410 $97.88 $54.06 . . .

64413 $100.74 $62.85 . . .

64415 $94.06 $49.95 . . .

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173

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

64416 . . $60.37 . .

64417 $103.51 $54.95 . . .

64418 $117.30 $59.57 . . .

64420 $90.23 $53.52 . . .

64421 $120.81 $71.96 . . .

64425 $104.41 $72.44 . . .

64430 $110.89 $64.11 . . .

64435 $108.58 $64.76 . . .

64445 $108.63 $55.63 . . .

64446 . . $60.67 . .

64447 $95.49 $50.78 . . .

64448 . . $54.46 . .

64449 . . $64.42 . .

64450 $64.34 $35.92 . . .

64455 $37.53 $26.87 . . .

64461 $118.29 $67.07 . . .

64462 $66.59 $42.31 . . .

64463 $129.36 $64.81 . . .

64479 $190.39 $104.23 . . .

64480 $90.77 $49.32 . . .

64483 $178.31 $89.19 . . .

64484 $70.37 $40.76 . . .

64486 $99.93 $49.01 . . .

64487 $123.27 $57.25 . . .

64488 $123.12 $61.84 . . .

64489 $172.97 $69.64 . . .

64490 $153.94 $84.07 . . .

64491 $75.02 $47.19 . . .

64492 $75.32 $47.78 . . .

64493 $140.18 $72.08 . . .

64494 $69.35 $40.63 . . .

64495 $69.65 $41.22 . . .

64505 $82.72 $68.51 . . .

64508 $47.95 $57.72 . . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

64510 $102.70 $58.29 . . .

64517 $145.72 $96.27 . . .

64520 $151.84 $63.90 . . .

64530 $154.96 $72.65 . . .

64550 $12.72 $6.80 . . .

64553 $167.27 $123.75 . . .

64555 $168.76 $121.09 . . .

64561 $665.19 $235.00 . . .

64566 $104.11 $23.58 . . .

64568 . . $504.39 . .

64569 . . $599.80 . .

64570 . . $499.82 . .

64575 . . $249.28 . .

64580 . . $234.11 . .

64581 . . $513.52 . .

64585 $197.16 $112.78 . . .

64590 $212.50 $126.05 . . .

64595 $199.01 $99.82 . . .

64600 $312.46 $169.75 . . .

64605 $591.46 $310.20 . . .

64610 $581.35 $370.55 . . .

64611 $91.36 $79.22 . . .

64612 $103.87 $92.03 . . .

64615 $109.59 $93.60 . . .

64616 $96.47 $82.56 . . .

64617 $153.38 $93.57 . . .

64620 $161.66 $135.31 . . .

64630 $182.61 $150.34 . . .

64632 $67.70 $54.08 . . .

64633 $343.02 $179.59 . . .

64634 $155.60 $53.75 . . .

64635 $339.16 $177.21 . . .

64636 $141.77 $47.03 . . .

64640 $107.70 $74.54 . . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

64642 $110.61 $83.37 . . .

64643 $72.16 $55.58 . . .

64644 $127.54 $91.42 . . .

64645 $88.99 $63.52 . . .

64646 $116.97 $89.73 . . .

64647 $138.20 $104.74 . . .

64650 $61.60 $32.29 . . .

64653 $76.13 $40.90 . . .

64680 $250.78 $131.17 . . .

64681 $275.21 $148.20 . . .

64702 . . $393.19 . .

64704 . . $251.26 . .

64708 . . $390.03 . .

64712 . . $447.56 . .

64713 . . $560.95 . .

64714 . . $498.87 . .

64716 . . $424.03 . .

64718 . . $464.50 . .

64719 . . $314.07 . .

64721 $338.11 $335.74 . . .

64722 . . $289.39 . .

64726 . . $216.93 . .

64727 . . $141.19 . .

64732 . . $294.44 . .

64734 . . $326.39 . .

64736 . . $313.50 . .

64738 . . $332.25 . .

64740 . . $361.92 . .

64742 . . $387.05 . .

64744 . . $377.31 . .

64746 . . $344.84 . .

64755 . . $702.43 . .

64760 . . $390.04 . .

64763 . . $391.27 . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

64766 . . $469.73 . .

64771 . . $469.40 . .

64772 . . $436.14 . .

64774 . . $325.40 . .

64776 . . $307.61 . .

64778 . . $111.05 . .

64782 . . $355.10 . .

64783 . . $171.49 . .

64784 . . $569.46 . .

64786 . . $830.21 . .

64787 . . $187.88 . .

64788 . . $311.42 . .

64790 . . $645.66 . .

64792 . . $907.45 . .

64795 . . $146.97 . .

64802 . . $524.65 . .

64804 . . $752.97 . .

64809 . . $770.12 . .

64818 . . $473.53 . .

64820 . . $566.14 . .

64821 . . $541.05 . .

64822 . . $541.05 . .

64823 . . $614.14 . .

64831 . . $537.30 . .

64832 . . $260.98 . .

64834 . . $577.69 . .

64835 . . $627.19 . .

64836 . . $629.30 . .

64837 . . $288.87 . .

64840 . . $777.85 . .

64856 . . $786.90 . .

64857 . . $819.93 . .

64858 . . $879.58 . .

64859 . . $196.43 . .

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177

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

64861 . . $1,020.91 . .

64862 . . $1,158.57 . .

64864 . . $689.64 . .

64865 . . $888.70 . .

64866 . . $909.32 . .

64868 . . $799.65 . .

64872 . . $93.98 . .

64874 . . $132.29 . .

64876 . . $136.78 . .

64885 . . $899.18 . .

64886 . . $1,019.88 . .

64890 . . $852.94 . .

64891 . . $910.61 . .

64892 . . $815.85 . .

64893 . . $886.79 . .

64895 . . $1,036.04 . .

64896 . . $1,122.77 . .

64897 . . $973.52 . .

64898 . . $1,055.31 . .

64901 . . $433.76 . .

64902 . . $510.49 . .

64905 . . $802.44 . .

64907 . . $1,044.31 . .

64910 . . $645.69 . .

64911 . . $793.73 . .

64912 - - $634.30 - -

64913 - - $126.99 - -

64999 . . I.C. . .

65091 . . $505.64 . .

65093 . . $500.29 . .

65101 . . $587.75 . .

65103 . . $613.19 . .

65105 . . $675.20 . .

65110 . . $967.22 . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

65112 . . $1,121.84 . .

65114 . . $1,177.64 . .

65125 $370.19 $233.11 . . .

65130 . . $582.41 . .

65135 . . $590.85 . .

65140 . . $642.01 . .

65150 . . $456.44 . .

65155 . . $671.97 . .

65175 . . $523.67 . .

65205 $44.41 $34.64 . . .

65210 $54.60 $41.87 . . .

65220 $45.66 $32.63 . . .

65222 $52.82 $40.98 . . .

65235 . . $564.23 . .

65260 . . $760.51 . .

65265 . . $856.14 . .

65270 $215.91 $110.80 . . .

65272 $403.67 $278.13 . . .

65273 . . $301.37 . .

65275 $461.41 $365.48 . . .

65280 . . $530.84 . .

65285 . . $875.38 . .

65286 $565.37 $392.46 . . .

65290 . . $386.67 . .

65400 $542.36 $479.29 . . .

65410 $114.35 $82.38 . . .

65420 $416.15 $301.27 . . .

65426 $523.88 $379.99 . . .

65430 $90.50 $81.62 . . .

65435 $63.44 $55.15 . . .

65436 $307.68 $294.95 . . .

65450 $259.67 $257.30 . . .

65600 $315.28 $273.83 . . .

65710 . . $876.29 . .

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179

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

65730 . . $970.77 . .

65750 . . $974.45 . .

65755 . . $969.24 . .

65756 . . $934.04 . .

65757 . . I.C. . .

65760 . . I.C. . .

65765 . . I.C. . .

65767 . . I.C. . .

65770 . . $1,107.75 . .

65771 . . I.C. . .

65772 $359.71 $323.00 . . .

65775 . . $437.96 . .

65778 $1,196.76 $45.63 . . .

65779 $997.20 $119.05 . . .

65780 . . $575.04 . .

65781 . . $1,053.83 . .

65782 . . $909.70 . .

65785 $1,748.84 $302.83 . . .

65800 $94.36 $71.56 . . .

65810 . . $369.47 . .

65815 $512.17 $379.23 . . .

65820 . . $596.00 . .

65850 . . $663.59 . .

65855 $219.46 $192.22 . . .

65860 $245.74 $199.84 . . .

65865 . . $375.94 . .

65870 . . $469.05 . .

65875 . . $500.43 . .

65880 . . $524.40 . .

65900 . . $760.43 . .

65920 . . $625.61 . .

65930 . . $504.62 . .

66020 $150.20 $104.60 . . .

66030 $133.87 $88.28 . . .

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180

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

66130 $554.13 $449.03 . . .

66150 . . $697.10 . .

66155 . . $696.54 . .

66160 . . $783.83 . .

66170 . . $773.58 . .

66172 . . $981.47 . .

66174 . . $748.65 . .

66175 . . $783.95 . .

66179 . . $853.57 . .

66180 . . $900.39 . .

66183 . . $816.76 . .

66184 . . $623.81 . .

66185 . . $670.92 . .

66220 . . $592.89 . .

66225 . . $735.60 . .

66250 $601.23 $442.24 . . .

66500 . . $282.75 . .

66505 . . $310.06 . .

66600 . . $660.83 . .

66605 . . $835.27 . .

66625 . . $341.14 . .

66630 . . $451.41 . .

66635 . . $455.78 . .

66680 . . $411.28 . .

66682 . . $507.99 . .

66700 $358.70 $311.62 . . .

66710 $350.11 $311.32 . . .

66711 . . $510.19 . .

66720 $379.06 $337.31 . . .

66740 $348.04 $311.62 . . .

66761 $237.43 $187.39 . . .

66762 $378.54 $338.57 . . .

66770 $419.91 $383.79 . . .

66820 . . $315.01 . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

66821 $264.07 $248.68 . . .

66825 . . $604.79 . .

66830 . . $563.37 . .

66840 . . $551.52 . .

66850 . . $627.18 . .

66852 . . $667.68 . .

66920 . . $596.39 . .

66930 . . $677.26 . .

66940 . . $619.19 . .

66982 . . $627.48 . .

66983 . . $584.47 . .

66984 . . $506.06 . .

66985 . . $610.37 . .

66986 . . $718.28 . .

66990 . . $70.73 . .

66999 . . I.C. . .

67005 . . $375.50 . .

67010 . . $429.90 . .

67015 . . $460.78 . .

67025 $579.03 $501.76 . . .

67027 . . $673.68 . .

67028 $80.38 $78.90 . . .

67030 . . $424.11 . .

67031 $309.44 $283.39 . . .

67036 . . $712.99 . .

67039 . . $762.88 . .

67040 . . $823.62 . .

67041 . . $908.95 . .

67042 . . $909.24 . .

67043 . . $959.30 . .

67101 $624.84 $533.95 . . .

67105 $571.92 $509.75 . . .

67107 . . $803.25 . .

67108 . . $1,034.05 . .

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182

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

67110 $607.26 $554.56 . . .

67113 . . $1,115.22 . .

67115 . . $397.17 . .

67120 $524.54 $442.83 . . .

67121 . . $718.30 . .

67141 $416.90 $387.29 . . .

67145 $418.99 $395.31 . . .

67208 $474.92 $458.05 . . .

67210 $411.49 $396.98 . . .

67218 . . $1,088.60 . .

67220 $424.81 $396.98 . . .

67221 $227.87 $167.18 . . .

67225 $23.26 $21.78 . . .

67227 $230.11 $203.17 . . .

67228 $269.81 $242.28 . . .

67229 . . $874.26 . .

67250 . . $620.18 . .

67255 . . $542.84 . .

67299 . . I.C. . .

67311 . . $473.89 . .

67312 . . $562.77 . .

67314 . . $533.38 . .

67316 . . $633.20 . .

67318 . . $558.02 . .

67320 . . $252.22 . .

67331 . . $239.27 . .

67332 . . $259.67 . .

67334 . . $236.06 . .

67335 . . $116.11 . .

67340 . . $280.64 . .

67343 . . $518.06 . .

67345 $190.65 $170.51 . . .

67346 . . $152.23 . .

67399 . . I.C. . .

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183

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

67400 . . $738.72 . .

67405 . . $631.73 . .

67412 . . $675.82 . .

67413 . . $679.46 . .

67414 . . $1,046.06 . .

67415 . . $81.66 . .

67420 . . $1,275.57 . .

67430 . . $983.19 . .

67440 . . $953.36 . .

67445 . . $1,105.53 . .

67450 . . $994.16 . .

67500 $60.54 $55.51 . . .

67505 $70.13 $63.91 . . .

67515 $76.18 $69.96 . . .

67550 . . $765.47 . .

67560 . . $783.88 . .

67570 . . $913.91 . .

67599 . . I.C. . .

67700 $218.75 $92.62 . . .

67710 $182.70 $77.89 . . .

67715 $194.08 $86.31 . . .

67800 $101.32 $81.78 . . .

67801 $128.80 $105.41 . . .

67805 $160.63 $130.14 . . .

67808 . . $293.02 . .

67810 $138.85 $55.66 . . .

67820 $39.38 $42.34 . . .

67825 $102.45 $96.82 . . .

67830 $215.97 $109.68 . . .

67835 . . $347.11 . .

67840 $222.22 $125.41 . . .

67850 $172.40 $107.56 . . .

67875 $138.35 $76.77 . . .

67880 $366.87 $292.56 . . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

67882 $449.81 $374.60 . . .

67900 $510.00 $402.23 . . .

67901 $604.82 $456.49 . . .

67902 . . $570.81 . .

67903 $472.48 $382.18 . . .

67904 $583.31 $472.28 . . .

67906 . . $400.50 . .

67908 $393.84 $337.29 . . .

67909 $427.58 $347.64 . . .

67911 . . $444.85 . .

67912 $712.72 $387.63 . . .

67914 $378.45 $261.21 . . .

67915 $237.02 $158.86 . . .

67916 $474.73 $341.79 . . .

67917 $482.18 $363.16 . . .

67921 $371.88 $248.12 . . .

67922 $234.95 $158.56 . . .

67923 $474.53 $341.89 . . .

67924 $505.41 $363.29 . . .

67930 $290.91 $188.47 . . .

67935 $472.80 $347.86 . . .

67938 $197.16 $92.35 . . .

67950 $456.63 $366.92 . . .

67961 $459.10 $360.51 . . .

67966 $610.45 $519.26 . . .

67971 . . $571.14 . .

67973 . . $733.81 . .

67974 . . $732.41 . .

67975 . . $540.51 . .

67999 . . I.C. . .

68020 $95.07 $87.67 . . .

68040 $49.54 $39.77 . . .

68100 $137.00 $76.90 . . .

68110 $181.87 $118.21 . . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

68115 $251.63 $145.93 . . .

68130 $431.93 $327.71 . . .

68135 $124.41 $119.97 . . .

68200 $32.84 $27.51 . . .

68320 $581.66 $428.59 . . .

68325 . . $521.43 . .

68326 . . $511.68 . .

68328 . . $560.09 . .

68330 $484.44 $366.31 . . .

68335 . . $513.19 . .

68340 $437.60 $317.39 . . .

68360 $425.89 $327.30 . . .

68362 . . $520.07 . .

68371 . . $328.33 . .

68399 . . I.C. . .

68400 $230.63 $104.51 . . .

68420 $259.94 $132.92 . . .

68440 $82.08 $79.71 . . .

68500 . . $772.38 . .

68505 . . $767.43 . .

68510 $355.92 $229.20 . . .

68520 . . $544.79 . .

68525 . . $205.68 . .

68530 $344.07 $203.14 . . .

68540 . . $736.61 . .

68550 . . $866.94 . .

68700 . . $478.40 . .

68705 $189.90 $132.17 . . .

68720 . . $598.64 . .

68745 . . $601.99 . .

68750 . . $623.18 . .

68760 $161.84 $116.25 . . .

68761 $118.62 $94.93 . . .

68770 . . $497.90 . .

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Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

68801 $81.30 $70.05 . . .

68810 $157.69 $121.87 . . .

68811 . . $133.52 . .

68815 $322.13 $176.46 . . .

68816 $531.00 $162.10 . . .

68840 $102.33 $93.44 . . .

68850 $48.22 $44.08 . . .

68899 . . I.C. . .

69000 $152.00 $94.86 . . .

69005 $172.69 $124.43 . . .

69020 $190.61 $114.52 . . .

69090 . . I.C. . .

69100 $80.83 $38.19 . . .

69105 $115.23 $50.69 . . .

69110 $371.61 $259.69 . . .

69120 . . $327.56 . .

69140 . . $712.52 . .

69145 $325.37 $201.32 . . .

69150 . . $832.12 . .

69155 . . $1,321.09 . .

69200 $80.47 $36.95 . . .

69205 . . $81.37 . .

69209 . . $10.53 . .

69210 $38.94 $25.33 . . .

69220 $90.12 $40.68 . . .

69222 $179.99 $110.42 . . .

69300 $595.52 $378.50 . . .

69310 . . $883.00 . .

69320 . . $1,241.88 . .

69399 . . I.C. . .

69420 $156.62 $96.82 . . .

69421 . . $119.26 . .

69424 $104.57 $49.51 . . .

69433 $164.91 $106.29 . . .

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Final Adoption

March 9, 2018

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00 SURGERY AND ANESTHESIA

187

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

69436 . . $128.04 . .

69440 . . $555.00 . .

69450 . . $440.31 . .

69501 . . $585.98 . .

69502 . . $774.98 . .

69505 . . $969.49 . .

69511 . . $989.67 . .

69530 . . $1,324.66 . .

69535 . . $2,122.65 . .

69540 $172.03 $103.04 . . .

69550 . . $840.85 . .

69552 . . $1,248.84 . .

69554 . . $1,923.22 . .

69601 . . $834.84 . .

69602 . . $869.21 . .

69603 . . $1,023.52 . .

69604 . . $888.00 . .

69605 . . $1,251.49 . .

69610 $307.12 $228.96 . . .

69620 $564.30 $391.40 . . .

69631 . . $711.14 . .

69632 . . $862.80 . .

69633 . . $838.20 . .

69635 . . $995.51 . .

69636 . . $1,113.50 . .

69637 . . $1,107.40 . .

69641 . . $833.21 . .

69642 . . $1,066.30 . .

69643 . . $977.28 . .

69644 . . $1,187.41 . .

69645 . . $1,168.43 . .

69646 . . $1,238.93 . .

69650 . . $645.67 . .

69660 . . $739.48 . .

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Final Adoption

March 9, 2018

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00 SURGERY AND ANESTHESIA

188

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

69661 . . $962.74 . .

69662 . . $921.20 . .

69666 . . $647.40 . .

69667 . . $647.67 . .

69670 . . $757.56 . .

69676 . . $667.27 . .

69700 . . $548.85 . .

69710 . . I.C. . .

69711 . . $692.12 . .

69714 . . $857.28 . .

69715 . . $1,052.78 . .

69717 . . $899.47 . .

69718 . . $1,063.28 . .

69720 . . $969.71 . .

69725 . . $1,486.31 . .

69740 . . $926.34 . .

69745 . . $1,089.04 . .

69799 . . I.C. . .

69801 $157.39 $98.47 . . .

69805 . . $836.60 . .

69806 . . $752.69 . .

69905 . . $734.48 . .

69910 . . $808.45 . .

69915 . . $1,215.65 . .

69930 . . $969.09 . .

69949 . . I.C. . .

69950 . . $1,403.14 . .

69955 . . $1,575.63 . .

69960 . . $1,513.93 . .

69970 . . $1,689.77 . .

69979 . . I.C. . .

69990 . . $163.90 . .

80500 $17.13 $15.06 . . .

80502 $55.57 $53.50 . . .

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Final Adoption

March 9, 2018

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00 SURGERY AND ANESTHESIA

189

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

83020 . . . $14.31 .

84165 . . . $14.31 .

84166 . . . $14.31 .

84181 . . . $14.31 .

84182 . . . $14.31 .

85060 . . $19.59 . .

85097 $72.11 $38.95 . . .

85390 . . . $14.31 .

85396 . . $16.25 . .

85576 . . . $14.31 .

86077 $44.28 $40.72 . . .

86078 $43.98 $40.72 . . .

86079 $43.39 $40.13 . . .

86153 . . . $26.67 .

86255 . . . $14.31 .

86256 . . . $14.31 .

86320 . . . $14.31 .

86325 . . . $14.31 .

86327 . . . $16.25 .

86334 . . . $14.31 .

86335 . . . $14.31 .

86486 . . $4.01 . .

86490 . . $58.19 . .

86510 . . $4.90 . .

86580 . . $6.38 . .

87164 . . . $14.31 .

87207 . . . $14.31 .

88104 . . $61.64 $23.29 $38.36

88106 . . $61.25 $15.79 $45.46

88108 . . $58.99 $18.27 $40.73

88112 . . $58.09 $22.40 $35.69

88120 . . $525.31 $46.24 $479.08

88121 . . $458.89 $40.08 $418.81

88125 . . $18.47 $10.61 $7.86

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Final Adoption

March 9, 2018

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00 SURGERY AND ANESTHESIA

190

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

88141 . . $25.89 . .

88160 . . $58.84 $21.07 $37.77

88161 . . $52.62 $20.19 $32.44

88162 . . $84.84 $31.82 $53.03

88172 . . $45.78 $29.33 $16.45

88173 . . $124.23 $57.29 $66.94

88177 . . $24.24 $18.02 $6.22

88182 . . $91.04 $28.96 $62.07

88184 . . $62.93 . .

88185 . . $38.49 . .

88187 . . $55.95 . .

88188 . . $71.41 . .

88189 . . $87.35 . .

88199 . . I.C. . .

88291 . . $25.04 . .

88299 . . I.C. . .

88300 . . $12.26 $3.51 $8.75

88302 . . $26.64 $5.75 $20.89

88304 . . $37.36 $9.07 $28.29

88305 . . $58.95 $30.66 $28.29

88307 . . $253.26 $67.59 $185.67

88309 . . $383.43 $119.73 $263.70

88311 . . $17.17 $10.20 $6.97

88312 . . $80.05 $21.86 $58.19

88313 . . $56.26 $9.61 $46.65

88314 . . $62.82 $17.95 $44.87

88319 . . $72.68 $21.88 $50.79

88321 $80.29 $67.26 . . .

88323 . . $111.09 $69.18 $41.91

88325 $136.42 $106.22 . . .

88329 $40.07 $29.12 . . .

88331 . . $76.62 $50.70 $25.92

88332 . . $40.55 $24.99 $15.56

88333 . . $80.45 $50.97 $29.48

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Final Adoption

March 9, 2018

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00 SURGERY AND ANESTHESIA

191

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

88334 . . $49.53 $31.30 $18.22

88341 . . $73.11 $21.59 $51.52

88344 . . $141.50 $31.49 $110.01

88346 . . $75.26 $29.50 $45.76

88348 . . $283.41 $61.12 $222.28

88350 . . $58.22 $22.10 $36.12

88355 . . $125.81 $64.65 $61.15

88356 . . $162.95 $94.36 $68.59

88358 . . $68.20 $35.47 $32.73

88360 . . $97.42 $43.67 $53.75

88361 . . $120.17 $46.88 $73.29

88362 . . $209.45 $86.85 $122.61

88363 $18.02 $15.36 . . .

88365 . . $144.77 $35.35 $109.41

88366 . . $213.87 $49.98 $163.89

88367 . . $86.37 $27.58 $58.79

88368 . . $92.20 $31.64 $60.56

88369 . . $87.71 $24.48 $63.23

88371 . . . $14.31 .

88372 . . . $14.31 .

88374 . . $283.20 $35.52 $247.68

88375 . . $38.43 . .

88377 . . $336.62 $51.18 $285.45

88380 . . $116.89 $45.21 $71.68

88381 . . $95.93 $19.81 $76.12

88387 . . $33.23 $25.66 $7.57

88388 . . $27.59 $19.43 $8.16

88399 . . I.C. . .

89049 $213.12 $49.99 . . .

89060 . . . $14.31 .

89220 . . $13.49 . .

89230 . . $4.31 . .

89240 . . I.C. . .

G0105 $414.57 $204.78 . . .

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Final Adoption

March 9, 2018

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 316.00 SURGERY AND ANESTHESIA

192

Code NFAC FAC Global PC TC Description (see surgical

services code spreadsheet at www.mass.gov/regulations/101

-CMR-31600-surgery-and-

anesthesia-services)

G0121 $414.80 $205.01 . . .

S2260 . . I.C. . .

316.06: Severability

The provisions of 101 CMR 316.00 are hereby declared to be severable, and if any such

provisions or the application of such provisions to any person or circumstances shall be held to be invalid

or unconstitutional, such invalidity shall not be construed to affect the validity or constitutionality of any

remaining provisions to eligible providers or circumstances other than those held invalid.

REGULATORY AUTHORITY

101 CMR 316.00: M.G.L. c. 118E.