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,
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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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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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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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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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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(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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(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.)
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
11
(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.
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
12
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
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
13
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
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
14
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
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
15
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
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
16
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
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
17
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
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
18
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
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
19
(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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
20
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
21
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
22
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
23
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
24
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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. . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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. . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
36
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
37
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
38
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
39
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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. . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
51
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
66
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
67
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
71
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
72
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 - - -
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
73
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
75
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
76
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
77
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
78
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
79
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
80
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 - -
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
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 - -
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
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 . .
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. . .
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 . .
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 . .
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 . .
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 . .
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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. . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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. . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
160
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 - - -
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
174
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
175
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
176
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
178
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
181
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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. . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
184
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 . . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
185
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 . .
Final Adoption
March 9, 2018
101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
101 CMR 316.00 SURGERY AND ANESTHESIA
186
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 . . .
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 . .
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 . . .
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
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
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 . . .
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.