professional/technical component policy · this policy describes the reimbursement methodology for...

REIMBURSEMENT POLICY

CMS-1500

Proprietary information of UnitedHealthcare Community Plan. Copyright 2018 UnitedHealthcare Services, Inc. 2018R0012C

Professional/Technical Component Policy

Policy Number 2018R0012C Annual Approval Date 7/12/2017 Approved By Reimbursement Policy Oversight Committee

IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY

You are responsible for submission of accurate claims. This reimbursement policy is intended to ensure that you are reimbursed based on the code or codes that correctly describe the health care services provided. UnitedHealthcare Community Plan reimbursement policies uses Current Procedural Terminology (CPT

®*), Centers for Medicare and

Medicaid Services (CMS) or other coding guidelines. References to CPT or other sources are for definitional purposes only and do not imply any right to reimbursement. This reimbursement policy applies to all health care services billed on CMS 1500 forms and, when specified, to those billed on UB04 forms. Coding methodology, industry-standard reimbursement logic, regulatory requirements, benefits design and other factors are considered in developing reimbursement policy. This information is intended to serve only as a general reference resource regarding UnitedHealthcare Community Plan’s reimbursement policy for the services described and is not intended to address every aspect of a reimbursement situation. Accordingly, UnitedHealthcare Community Plan may use reasonable discretion in interpreting and applying this policy to health care services provided in a particular case. Further, the policy does not address all issues related to reimbursement for health care services provided to UnitedHealthcare Community Plan enrollees. Other factors affecting reimbursement supplement, modify or, in some cases, supersede this policy. These factors include, but are not limited to: federal &/or state regulatory requirements, the physician or other provider

contracts, the enrollee’s benefit coverage documents, and/or other reimbursement, medical or drug policies. Finally, this policy may not be implemented exactly the same way on the different electronic claims processing systems used by UnitedHealthcare Community Plan due to programming or other constraints; however, UnitedHealthcare Community Plan strives to minimize these variations. UnitedHealthcare Community Plan may modify this reimbursement policy at any time by publishing a new version of the policy on this Website. However, the information presented in this policy is accurate and current as of the date of publication. *CPT Copyright American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association

Application

This reimbursement policy applies to UnitedHealthcare Community Plan Medicaid Product. This reimbursement policy applies to services reported using the 1500 Health Insurance Claim Form (a/k/a CMS-1500) or its electronic equivalent or its successor form. This policy applies to all products and all network and non-network physicians and other qualified health care professionals, including, but not limited to, non-network authorized and percent of charge contract physicians and other qualified health care professionals.

Payment Policies for Medicare & Retirement, UnitedHealthcare Community Plan Medicare and Employer & Individual please use this link. Medicare & Retirement and UnitedHealthcare Community Plan Medicare Policies are listed under Medicare Advantage Reimbursement Policies. Employer & Individual are listed under Reimbursement Policies-Commercial.

Table of Contents

Application

Policy Overview Reimbursement

UnitedHealthcare Community Plan Professional/Technical Splits Reimbursement Amounts for Professional/Technical Splits

https://www.unitedhealthcareonline.com/b2c/CmaAction.do?channelId=ca174ccb4726b010VgnVCM100000c520720a____


CMS-1500


Reimbursement for Professional/Technical Components Based on Place of Service Services Reported in a CMS Place of Service (POS) 24 (Ambulatory Surgical Center)

Duplicate or Repeat Services for Professional/Technical Eligible Codes Professional Component with an Evaluation and Management Service Modifiers

Definitions

Questions and Answers

Attachments

Resources

History

Policy

Overview

This policy describes the reimbursement methodology for Current Procedural Terminology (CPT®) and Healthcare Common Procedural Coding System (HCPCS) codes based on the Centers for Medicare and Medicaid Services (CMS) National Physician Fee Schedule (NPFS) Relative Value File, Professional Component (PC)/Technical Component (TC) Indicators.

NPFS PC/TC Indicator

Description

0 Physician Service Codes

1 Diagnostic Tests

2 Professional Component Only Codes

3 Technical Component Only Codes

4 Global Test Only Codes

5 Incident To Codes

6 Laboratory Physician Interpretation Codes

8 Physician interpretation codes

9 Not Applicable

Relative to these services, this policy also addresses information pertaining to Duplicate or Repeat Services, modifier usage, submissions based on place of service (POS), and the Professional Component with an Evaluation and Management service. Unless otherwise specified, for the purposes of this policy, Same Individual Physician or Other Health Care Professional is defined as the same individual rendering health care services reporting the same Federal Tax Identification number.

Reimbursement Guidelines

UnitedHealthcare Community Plan Professional/Technical Splits

UnitedHealthcare Community Plan uses the Center for Medicare and Medicaid Services' (CMS) PC/TC indicators as set forth in the "CMS Payment Policies" under the National Physician Fee Schedule Relative Value File to determine whether a CPT or HCPCS procedure code is eligible for separate professional and technical services reimbursement.

CPT or HCPCS codes assigned a CMS PC/TC Indicator 1 are comprised of a Professional Component and a Technical Component which together constitute the Global Service. The Professional Component (PC), (supervision and interpretation) is reported with modifier 26, and the Technical Component (TC) is reported with modifier TC.

The term “professional/technical split” is used to reference a Global Service assigned a PC/TC Indicator 1 that may be “split” into a Professional and Technical Component. CPT or HCPCS codes assigned a PC/TC Indicator 1 are listed in the National Physician Fee Schedule Relative Value File. Each Global Service is listed on a separate row followed immediately by separate rows listing the corresponding Technical Component, and Professional Component.


CMS-1500


CPT or HCPCS codes with CMS PC/TC indicators 0, 2, 3, 4, 5, 7, 8, and 9 are not considered eligible for reimbursement when submitted with modifiers 26 and/or TC.

CPT or HCPCS codes with CMS PC/TC indicator 6 are not considered eligible for reimbursement when submitted with modifier TC.

CMS publishes this information in the "Physician Fee Schedule, PFS Relative Value Files" page, accessible through the following website:

Physician Fee Schedule Relative Value Files

UnitedHealthcare Community Plan’s percentage splits are developed on a national level from the CMS Non-Facility Total Resource Based Relative Value Scale (RBRVS) based percentage splits. UnitedHealthcare Community Plan’s splits are updated quarterly and differ no more than 2.5% (for each CPT and HCPCS code) from the CMS Non-Facility Total RBRVS based percentage splits. The current splits are attached to this policy in the next section.

Services assigned a PC/TC Indicator 1 that CMS indicates may be carrier-priced, or those for which CMS does not develop RVUs are considered Gap Codes.

Gap Fill Codes: When data is available for Gap Codes, UnitedHealthcare Community Plan uses the relative values published in the first quarter update of the Optum The Essential RBRVS publication for the current calendar year.

2018 UnitedHealthcare Community Plan Professional Technical Component Policy Gap Fill Codes

Gap Codes that are eligible for PC/TC per CMS but do not have RVUs established, or data available for gap fill, are included in the "Codes Subject to the CMS PC/TC Concept Without RVU Splits" list below and are allowed at 100% of the Allowable Amount for both the Professional Component and Technical Component.

2018 UnitedHealthcare Community Plan Codes Subject to the Professional Technical Concept without RVU Splits

For additional information refer to the Questions and Answers section, Q&A #1.

Reimbursement Amounts for Professional/Technical Splits

The Professional and Technical Component reimbursement for PC/TC split eligible services is calculated at a percentage of the Global Service Allowable Amount, except when provided otherwise by a physician or other health care professional contract. When a contract applies, payments for PC/TC split eligible services are based on specific professional and technical fees contained within the contract's fee schedules or are paid at the percentage of charge level in the fee schedule. (Physicians and other health care professionals contracted at a percent of charge do not have further PC/TC reductions for PC/TC split eligible services unless it is specifically stated in their contracts.)

2018 UnitedHealthcare Community Plan Professional/Technical Component Split Codes (PC/TC Indicator 1 Diagnostic Tests)

When eligible for reimbursement, Professional/Technical Component codes with a CMS PC/TC indicator of 2, 3, 4, 5, 6, or 8 are reimbursed at 100% of the Allowable Amount.

For additional information, refer to the Questions and Answers section, Q&A #2.

Reimbursement for Professional/Technical Component Based on POS

Reimbursement of the Professional Component, the Technical Component, and the Global Service for codes assigned a PC/TC indicator 1, 2, 3, 4, 5, 6, 8 or 9 subject to the PC/TC concept according to the National Physician Fee Schedule Relative Value File are based upon physician and other health care professional specialty and CMS POS code set, as described below. CMS Place of Service Code Set For the purposes of this policy, a facility POS is considered POS 19, 21, 22, 23, 26, 34, 51, 52, 55, 56, 57 and 61. All other POS are considered non-facility.

http://www.cms.hhs.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.htmlhttp://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set.html


CMS-1500


For Services Furnished in a Mobile Unit Services furnished in a mobile unit are often provided to serve an entity for which another POS code exists. When this is the case, the POS for that entity should be reported. For example, a mobile unit may be sent to a physician’s office. Since the mobile unit is serving an entity for which an office POS already exists, the POS code 11 (office) for that location should be reported. However, if the mobile unit is not serving an entity which could be described by an existing POS code, report POS 15 (mobile unit). For PC/TC Indicator 8 Codes Furnished in a POS Other than POS 21 The CMS NPFS guidelines advise that payment should not be recognized for PC/TC Indicator 8 codes, which are defined as physician interpretation codes, furnished to patients in the outpatient or non-hospital setting (POS other than 21). In alignment with CMS, UnitedHealthcare Community Plan will not reimburse PC/TC Indicator 8 (CPT code 85060) when reported by a physician or other health care professional with a CMS POS code other than inpatient hospital (POS 21). For Services Furnished in a Facility (POS 19, 21, 22, 23, 26, 34, 51, 52, 55, 56, 57 or 61) Services that are provided in a facility POS and that are subject to the PC/TC concept or that have both a Professional Component and a Technical Component according to the CMS PC/TC indicators, UnitedHealthcare Community Plan will reimburse the interpreting physician or other health care professional only the Professional Component as the facility is reimbursed for the Technical Component of the service. To be considered for Professional Component reimbursement, a service or procedure must have a:

CMS PC/TC Indicator 1, and must be reported with modifier 26;

CMS PC/TC Indicator 2 (Professional Component Only Codes), and must be reported without modifier 26 or TC; or

CMS PC/TC Indicator 6 (Laboratory Physician Interpretation Codes) and must be reported with modifier 26. UnitedHealthcare Community Plan follows CMS PC/TC indicators to determine which clinical laboratory interpretive services provided in a facility setting qualify for Professional Component reimbursement. To be considered for Professional Component reimbursement, the clinical laboratory interpretive service code must have a:

CMS PC/TC Indicator 1 (Diagnostic Tests), and be reported with modifier 26;

CMS PC/TC Indicator 6 (Laboratory Physician Interpretation Codes), and be reported with modifier 26; or

CMS PC/TC Indicator 8 (Physician Interpretation Codes), and be reported without modifier 26. When a physician or other health care professional provides the equipment to perform the service or procedure in a facility POS only the facility may be reimbursed for the Technical Component of the service or procedure. Based on the CMS PC/TC indicators, UnitedHealthcare Community Plan considers the Technical Component to be a service or procedure that has a:

CMS PC/TC Indicator 1 (Diagnostic Test), and is reported with modifier TC; or

CMS PC/TC Indicator 3 (Technical Component Only Codes), and is reported without modifier TC. UnitedHealthcare Community Plan allows an exception for newborn hearing screening codes. UnitedHealthcare Community Plan allows the Global Service (PC/TC indicator 1) for CPT 92585, 92587, and 92588 and the Technical Component only (PC/TC indicator 3) for code 92586 to be reimbursed to the physician or other health care professional when the physician or other health care professional provides the equipment to perform the service in a facility POS 19, 21, 22, 23, 26, 34, 51, 52, 56, or 61. In the event that both a facility and a physician or other health care professional report the same newborn hearing screening codes (92585, 92587, and 92588) on the same day for the same member, the facility will be reimbursed for the Technical Component for CPT codes 92585, 92587 and 92588. CPT code 92586 will not be reimbursed to the physician or other health care professional when the facility has submitted a claim for this same service. For Services Furnished in a Non-Facility POS (POS other than 19, 21, 22, 23, 26, 34, 51, 52, 55, 56, 57 or 61) For services assigned a PC/TC Indicator 1 according to CMS, and provided in a non-facility POS, UnitedHealthcare Community Plan will consider reimbursement of the Professional Component and the Technical Component when eligible. Non-Allowed Services Furnished in a Facility POS Consistent with CMS, UnitedHealthcare Community Plan will not allow reimbursement to physicians and other healthcare professionals for "Incident To" codes identified with a CMS PC/TC indicator 5 when reported in a facility place of service (POS 19, 21, 22, 23, 26, 34, 51, 52, 56, or 61) regardless of whether a modifier is reported with the code. In addition, CPT coding guidelines for many of the PC/TC Indicator 5 codes specify that these codes are not intended to be reported by a physician in a facility setting.


CMS-1500


For services with a CMS PC/TC indicator 4 (standalone Global Test Only Codes), UnitedHealthcare Community Plan will not reimburse the physician or other health care professional when rendered in a facility POS. Global Test Only Codes with a PC/TC indicator 4 identify Standalone Codes that describe selected diagnostic tests for which there are separate associated codes that depict the Professional Component only (PC/TC indicator 2) and Technical Component only (PC/TC indicator 3). UnitedHealthcare Community Plan utilizes the CMS National Physician Fee Schedule (NPFS) PC/TC Indicators 3 or 9 to identify laboratory services that are not reimbursable to a Reference Laboratory or Non-Reference Laboratory in a facility setting.

CMS PC/TC Indicator 3 (Technical Component Only Codes)

CMS PC/TC Indicator 9 (PC/TC Concept Not Applicable) UnitedHealthcare Community Plan will not reimburse a Professional Component when a diagnostic laboratory service is provided either manually or with automated equipment, as these codes are not subject to the PC/TC concept or are Technical Component only codes. UnitedHealthcare Community Plan follows CMS PC/TC indicators in determining which services do not qualify for Professional Component reimbursement:

CMS PC/TC Indicator 3 (Technical Component Only Codes)

CMS PC/TC Indicator 9 (PC/TC Concept Not Applicable) 2018 UnitedHealthcare Community Plan Laboratory Codes with a (PC/TC Indicator 3 or 9 Diagnostic Tests) Note: UnitedHealthcare Community Plan will make an exception to this policy for reproductive medicine procedures 89250-89398 when the facility laboratory is not equipped to perform these specialized services and refers them to a reproductive laboratory. In the event that both a facility and a Reference Laboratory report the same service on the same day for the same member, only the facility laboratory may be reimbursed.

Services Reported in a CMS POS 24 (Ambulatory Surgical Center)

Consistent with CMS guidelines, UnitedHealthcare Community Plan will not reimburse physicians or other health care professionals for the Technical Component of services included in the Ambulatory Surgery Center Fee Schedule (ASCFS) Addendum BB and reported with a CMS POS 24 as the ambulatory surgical center (ASC) is reimbursed for the Technical Component.

The Technical Component of services reported on a CM-1500 claim form with an SG modifier (Ambulatory surgical center [ASC] facility service) is not reimbursed as a professional claim. Claim lines reported with modifier SG indicate a facility charge and are reimbursed as a facility claim.

PC/TC Indicator 1 Codes For codes included in the ASCFS Addendum BB PC/TC Indicator 1 Codes list, only the Professional Component (PC, modifier 26) will be reimbursed.

When reported globally (no modifier), the Technical Component of the code will not be reimbursed. When reported with modifier TC, the code will not be reimbursed.

PC/TC Indicator 3 Codes Codes included in the ASCFS Addendum BB PC/TC Indicator 3 Codes list will not be reimbursed as they represent Technical Component services only.

2018 ASCFS Addendum BB PC/TC Indicator 1 Codes 2018 ASCFS Addendum BB PC/TC Indicator 3 Codes Drug Administration Codes According to the CMS National Correct Coding Initiative (NCCI) Policy Manual, drug administration codes CPT 96360-96379, 96401-96425, and 96521-96523 are considered included in the facility payment when reported in POS 24. In alignment with CMS, UnitedHealthcare Community Plan will not reimburse drug administration codes 96360-96379, 96401-96425, and 96521-96523 reported by a physician or other health care professional in POS 24.

Duplicate or Repeat Services for Professional/Technical Eligible Codes


CMS-1500


This section of the policy applies to when Duplicate or Repeat Services are reported by the same or different physician or other health care professional. When services are eligible for reimbursement under this policy, only one physician or other health care professional will be reimbursed when Duplicate or Repeat Services are reported. Duplicate or Repeat Services are defined as identical CPT or HCPCS codes assigned a PC/TC indicator 1, 2, 3, 4, 6 or 8 submitted for the same patient on the same date of service on separate claim lines or on different claims regardless of the assigned Maximum Frequency per Day (MFD) value.

For services that have both a Professional and Technical Component (i.e., PC/TC Indicator 1, Diagnostic Tests) UnitedHealthcare Community Plan will also review the submission of modifier 26 and TC appended to the code to identify whether a Duplicate or Repeat Services has been reported.

Should the Same Individual Physician or Other Health Care Professional report the Professional Component (modifier 26) and the Technical Component (modifier TC) for the same PC/TC Indicator 1 service separately, UnitedHealthcare Community Plan will consider both services eligible for reimbursement unless subject to other portions of this policy.

Modifiers offer specific information and should be used appropriately. Separate consideration will be given to duplicate or repeat multiple submissions of the same code when the appropriate modifier is appended to the Duplicate or Repeat Service with one of the following modifiers:

Modifier 59 - Same or different physicians or other health care professionals

Modifier 76 - Same physicians or other health care professionals

Modifier 77 - Different physicians or other health care professionals

Modifier 91 - Same or different physicians or other health care professionals for repeat laboratory services

Modifier RT or LT - when reporting bilateral procedures

Modifier XE - Separate encounter

Modifier XP - Separate practitioner

Modifier XS - Separate structure

Modifier XU - Unusual non-overlapping service Additional anatomic modifiers - refer to Modifiers, Anatomic Modifier section.

*Note: CPT instructions state that modifier 59 should not be used when a more descriptive modifier is available. CMS guidelines cite that the –X {EPSU} modifiers are more selective versions of modifier 59 so it would be incorrect to include both modifiers on the same line. Please refer to the “Modifiers” section for a complete listing of modifiers and their descriptions.

For additional information, refer to the Questions and Answers section, Q&A #3.

UnitedHealthcare Community Plan follows a "first in, first out" claim payment methodology in determining which claim will be considered for reimbursement when claims for Duplicate or Repeat Services are received.

When the Same Individual Physician or Other Health Care Professional reports the global PC/TC Indicator 1 service (no modifier) or a standalone service (PC/TC Indicator 2, 3, or 4) more than once and on separate lines, separate consideration will only be given to those services reported with the appropriate modifier. Otherwise, the second and subsequent services received will not be separately reimbursed.

When the same PC/TC Indicator 6 or 8 service is reported more than once and on separate lines by the same or different physician or health care professional, separate consideration will only be given to those services reported with modifier 59, XE, XP, XS, XU or 91. Otherwise the second and subsequent services reported will not be separately reimbursed.

When the Same Individual Physician or Other Health Care Professional reports the global PC/TC Indicator 1 service (no modifier) and a modifier 26 or TC for the same service for the same member on the same date of service, separate consideration will only be given to those services reported with the appropriate modifier. Otherwise, the second and subsequent services will not be separately reimbursed.

When the same PC/TC Indicator 1 service is reported globally (no modifier) by different physicians or other health care professionals on the same date or service for the same member, UnitedHealthcare Community Plan will only consider separate reimbursement for the second claim when reported with an appropriate modifier. Otherwise, the second and subsequent services received will not be separately reimbursed.

When the same PC/TC Indicator 1 service is reported globally (no modifier) by one physician or other health care professional, and a different physician or other health care professional reports modifier 26 or TC for the same service for the same member on the same date of service, UnitedHealthcare Community Plan will consider


CMS-1500


separate reimbursement for the second claim when reported with an appropriate modifier. Otherwise, the second and subsequent services will not be separately reimbursed.

For example:

If the claim for the physician reporting the Global Service is received first and allowed, the subsequent claim received by a different physician for a single component (i.e., Professional or Technical Component) will be denied as duplicate.

If the claim for the physician reporting the Professional Component (modifier 26) service is received first and allowed, the subsequent claim received by a different physician for the Global Service will be reimbursed only for the Technical Component.

If the claim for the physician reporting the Technical Component (modifier TC) service is received first and allowed, the subsequent claim received by a different physician for the Global Service will be reimbursed only for the Professional Component.

Refer to the UnitedHealthcare Community Plan "Laboratory Services Policy" for additional information on duplicate charges for laboratory services. Refer to the UnitedHealthcare Community Plan “Maximum Frequency per Day Policy” for additional information on assigned MFD values.

Professional Component with an Evaluation and Management Service

With the exception of radiologic codes that describe fluoroscopic or ultrasonic guidance for placement of a needle, catheter, or tube, UnitedHealthcare Community Plan considers the interpretation (modifier 26) of a radiology service assigned a PC/TC Indicator 1 to be included in the Evaluation and Management (E/M) service when performed by the Same Individual Physician or Other Health Care Professional on the same date of service for the same patient as these services usually are not distinct from the E/M service when both are provided on the same day.

Physicians and other health care professionals who believe the Professional Component (modifier 26) for a PC/TC Indicator 1 radiology code is reimbursable in addition to the E/M service under this policy should submit written documentation either within a separate written report or within the E/M or antepartum record. UnitedHealthcare Community Plan may review the documentation based on American College of Radiology (ACR) guidelines to determine if the interpretation is separately reimbursable in addition to the E/M service. In order for separate reimbursement to be considered, the documentation must include at a minimum the following:

Procedures and materials The report or record should include a description of the studies and/or procedures performed and any contrast

media and/or radio-pharmaceuticals (including specific administered activities, concentration, volume, and route of administration when applicable), medications, catheters, or devices used, if not recorded elsewhere.

Findings The report or record should use appropriate anatomic, pathologic, and radiologic terminology to describe the

findings.

Impression Conclusion or diagnosis

UnitedHealthcare Community Plan does not require documentation when an E/M visit is billed on the same date of service by the same provider with the Professional Component (modifier 26) of a radiology service describing fluoroscopic or ultrasonic guidance for the placement of a catheter, needle or tube as the Professional Component is documented in the operative record. This exception applies to CPT codes 75989, 76930 - 76965, and 77001-77022.

UnitedHealthcare Community Plan considers the Professional Component (modifier 26) of non-radiological services which are subject to the PC/TC concept (PC/TC Indicator 1) as distinct and separate services from the E/M service when performed by the Same Individual Physician or Other Health Care Professional on the same date of service for the same patient and will separately reimburse for an interpretation (modifier 26) without submission of documentation.

2018 UnitedHealthcare Community Plan Evaluation and Management Codes for Professional/Technical Component Policy

For additional information, refer to the Questions and Answers section, Q&A #4 and Q&A #5. Refer to the UnitedHealthcare "Obstetrical Policy" for additional information on radiologic services performed by a Maternal-Fetal Medicine (MFM) Specialist.


CMS-1500


Modifiers

Modifier Description

TC

Technical Component Certain procedures are a combination of a physician or other qualified health care professional component and a technical component. When the technical component is reported separately, the service may be identified by adding the modifier ‘TC’ to the usual procedure number.

26

Professional Component Certain procedures are a combination of a physician or other qualified health care professional component and a technical component. When the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.

59

Distinct Procedural Service Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. However, when another already established modifier is appropriate it should be used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used.

76

Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional It may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. This circumstance may be reported by adding modifier 76 to the repeated procedure or service. Note: This modifier should not be appended to an E/M service.

77

Repeat Procedure by Another Physician or Other Qualified Health Care Professional It may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. This circumstance may be reported by adding modifier 77 to the repeated procedure or service. Note: This modifier should not be appended to an E/M service.

91

Repeat Clinical Diagnostic Laboratory Test In the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. Under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. Note: This modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. This modifier may not be used when other code(s) describe a series of test results (eg., glucose tolerance tests, evocative/suppression testing). This modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient.

XE Separate Encounter A Service That Is Distinct Because It Occurred During A Separate Encounter

XP Separate Practitioner A Service That Is Distinct Because It Was Performed By A Different Practitioner

XS Separate Structure A Service That Is Distinct Because It Was Performed On A Separate Organ/Structure

XU Unusual Non-Overlapping Service The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service

Anatomic Modifier Description


CMS-1500


E1 Upper left, eyelid

E2 Lower left, eyelid

E3 Upper right, eyelid

E4 Lower right, eyelid

F1 Left hand, second digit

F2 Left hand, third digit

F3 Left hand, fourth digit

F4 Left hand, fifth digit

F5 Right hand, thumb

F6 Right hand, second digit

F7 Right hand, third digit

F8 Right hand, fourth digit

F9 Right hand, fifth digit

FA Left hand, thumb

LC Left circumflex coronary artery

LD Left anterior descending coronary artery

LM Left main coronary artery

LT Left side

RC Right coronary artery

RI Ramus intermedius

RT Right side

T1 Left foot, second digit

T2 Left foot, third digit

T3 Left foot, fourth digit

T4 Left foot, fifth digit

T5 Right foot, great toe

T6 Right foot, second digit

T7 Right foot, third digit

T8 Right foot, fourth digit

T9 Right foot, fifth digit

TA Left foot, great toe

Back To Top

State Exceptions

All Medicaid Lines of Business Codes 90471 and 90472 are allowed in a facility place of service.

California Medicaid Allows the PC/TC Modifiers on HCPC codes Q0111, Q0112 and Q0113.

Louisiana Pay 26 modifier at 40%, TC not covered

Maryland Does not pay for the Drug Administration Codes in the services reported in a CMS Place of Service (POS) 24 (Ambulatory Surgical Center)

Wisconsin Per state regulation considers place of service (POS) 19 as a non-facility

Definitions

Allowable Amount Defined as the dollar amount eligible for reimbursement to the physician or health care


CMS-1500


professional on the claim. Contracted rate, reasonable charge, or billed charges are examples of an Allowable Amount, whichever is applicable. For percent of charge or discount contracts, the Allowable Amount is determined as the billed amount, less the discount.

Duplicate or Repeat Services

Identical CPT or HCPCS codes assigned a PC/TC indicator 1, 2, 3, 4, 6 or 8 submitted for the same patient on the same date of service on separate claim lines or on different claims regardless of the assigned Maximum Frequency per Day (MFD) value.

Gap Code A CPT or HCPCS code for which CMS does not develop RVUs. Note: Under the Professional/Technical Component Policy a Gap Code has a CMS PC/TC indicator 1 assignment.

Gap Fill Code A Gap Code that UnitedHealthcare Community Plan uses relative values based on the first quarter update of the Optum The Essential RBRVS publication for the current calendar year.

Global Service A Global Service includes both a Professional Component and a Technical Component. When a physician or other health care professional bills a Global Service, he or she is submitting for both the Professional Component and the Technical Component of that code. Submission of a Global Service asserts that the Same Individual Physician or Other Health Care Professional provided the supervision, interpretation and report of the professional services as well as the technician, equipment, and the facility needed to perform the procedure. In appropriate circumstances, the Global Service is identified by reporting the appropriate PC/TC split eligible procedure code with no modifier attached or by reporting a standalone code for global test only services.

Independent Laboratory

An Independent Laboratory is one that is independent both of an attending or consulting physician’s office and of a hospital that meets at least the requirements to qualify as an emergency hospital. An independent laboratory must meet Federal and State requirements for certification and proficiency testing under the Clinical Laboratories Improvement Act (CLIA).

Non-Reference Laboratory

A physician reporting laboratory procedures performed in their office, or a Pathologist.

Pathologist A Pathologist is a physician who specializes in diagnosing diseases by examining tissue, blood, and body fluids using advanced laboratory techniques.

Professional Component

The Professional Component represents the physician or other health care professional work portion (physician work/practice overhead/malpractice expense) of the procedure. The Professional Component is the physician or other health care professional supervision and interpretation of a procedure that is personally furnished to an individual patient, results in a written narrative report to be included in the patient's medical record, and directly contributes to the patient's diagnosis and/or treatment. In appropriate circumstances, it is identified by appending modifier 26 to the designated procedure code or by reporting a standalone code that describes the Professional Component only of a selected diagnostic test.

Reference Laboratory A Reference Laboratory that receives a Specimen from another, Referring Laboratory for testing and that actually performs the test is often referred to as an Independent Laboratory. Services billed by a Reference Laboratory should use modifier 90 to identify the Reference Laboratory services.

Relative Value Unit (RVU)

The assigned unit value of a particular CPT or HCPCS code. The associated RVU is from CMS NPFS Non-Facility Total value.

Resource-Based Relative Value Scale (RBRVS)

Payment schedule based on the relative values of services provided. The current RBRVS system ranks services according to the relative costs required to provide them. These costs are defined in terms of units, with more complex, more time consuming services having higher unit values than less complex, less time-consuming services. Furthermore, each service is compared to all other physician services so that each service is given a value that reflects its cost or value when compared to all other physician services.

Same Individual Physician or Other Health Care

The same individual rendering health care services reporting the same Federal Tax Identification number.


CMS-1500


Professional

Specimen Tissue or tissues that is (are) submitted for individual and separate attention, requiring individual examination and pathological diagnosis. Two or more such Specimens from the same patient (eg, separately identifiable endoscopic biopsies, skin lesions) are each appropriately assigned an individual code reflective of its proper level of service.

Standalone Code A Standalone Code describes a specific component of a selected diagnostic test. There is an associated code that describes the Professional Component only of the diagnostic test, an associated code that describes the Technical Component only, and another associated code that describes the global test only. An example is the series of codes used to describe electrocardiograms with at least 12 leads. CPT code 93010 describes the Professional Component only, 93005 describes the Technical Component only, and 93000 describes the global test only. Modifiers TC or 26 are not used to report these services as they are inherent within the code descriptions.

Technical Component The Technical Component is the performance (technician/equipment/facility) of the procedure. In appropriate circumstances, it is identified by appending modifier TC to the designated procedure code or by reporting a Standalone Code that describes the Technical Component only of a selected diagnostic test.

Questions and Answers

1

Q: Are the CMS Geographic Practice Cost Indices by Medicare Carrier and Locality considered when developing UnitedHealthcare Community Plan percentage splits?

A: No. The UnitedHealthcare Community Plan percentage splits are developed on a national level from the CMS Resource Based Relative Value Scale (RBRVS) percentage splits.

2

Q: If a physician or health care professional is contracted with specific rates for the Professional Component and the Technical Component, will their contracted rates be updated quarterly to reflect changes in CMS professional and technical rates?

A: No. As their fees for the Professional Component and the Technical Component are determined by their contract, the physician or health care professional will not be impacted by UnitedHealthcare Community Plan's quarterly updates to the percentage calculation methodology for Professional Component and Technical Component reimbursement.

3

Q: When does UnitedHealthcare Community Plan give consideration for repeat procedures by the same individual physician, another physician or other health care professional when reported with modifiers 76 or 77?

A: Repeat procedures must be identified with modifiers 76 or 77 as appropriate to indicate that subsequent procedures were performed at different episodes on the same day. Modifiers 76 or 77 should not be used to report multiple interpretations by the same or different physicians or other health care professionals for the same EKG or x-ray procedure for quality control purposes. However, when subsequent interpretations of the same procedure show a different finding that alters/contributes to the diagnosis and treatment of the patient, use of modifier 76 or 77 is appropriate. Note: It is inappropriate to use modifier 76 or 77 to indicate repeat laboratory services. Modifiers 59, XE, XP, XS or XU or 91 should be used to indicate repeat or distinct laboratory services, as appropriate according to the AMA and CMS. Separate consideration for reimbursement will not be given to laboratory codes reported with modifier 76 or 77.

4

Q: If a physician or other health care professional reports modifier 59, XE, XP, XS or XU in addition to modifier 26 on a PC/TC Indicator 1 code, e.g., 70110-26-59, to indicate that it is a separate and distinct service from the E/M service performed on the same date, will UnitedHealthcare Community Plan consider separate reimbursement for the radiology interpretation?

A: As outlined in the "Professional Component with an Evaluation and Management Service" section of this policy,


CMS-1500


written documentation should be submitted for consideration of separate reimbursement.

The CPT description for modifier 59 states "Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify procedures or services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances."

Modifiers 59, XE, XP, XS or XU are not appropriate to distinguish the interpretation from the E/M service. Therefore, UnitedHealthcare Community Plan requires submission of a distinctly identifiable signed written radiological report separate from the E/M service performed, even when modifier 59, XE, XP, XS or XU is reported, before separate reimbursement for the radiology interpretation will be considered.

5

Q: If a physician or other health care professional appends modifier 25 to the E/M code reported on the same day as the radiology interpretation, e.g., obstetrical ultrasound, by the same provider will this bypass the requirement of submitting supporting documentation to allow separate reimbursement for the radiology interpretation?

A: No, per CPT guidelines, modifier 25 is to be reported to identify a separate and distinct E/M service. However, in this scenario, it is the radiology interpretation that requires documentation review for separate reimbursement.

Attachments: Please right-click on the icon to open the file.

Evaluation and Management Codes

A list of Evaluation and Management codes that pertains to the Professional/Technical Component Policy.

Professional/Technical Component Codes (PC/TC Indicator 1 Diagnostic Tests)

A list of codes with a CMS PC/TC Indicator 1 with their percentage splits. These codes have both a Professional Component and a Technical Component. Modifiers 26 and TC can be used with these codes.

Codes Subject to the PC/TC Concept Without RVU Splits

A list of PC/TC Indicator 1 Diagnostic Test codes subject to the CMS PC/TC component concept without RVUs for one or more components. These codes are allowed at 100% for both the Professional Component and the Technical Component.

Gap Fill Codes

A list of PC/TC Indicator 1 Diagnostic Test codes subject to the CMS PC/TC component concept, for which CMS does not develop RVUs or which CMS states may be carrier-based. These are assigned gap fill RVUs from data published by CMS Carriers or are otherwise assigned RVUs by UnitedHealthcare Community Plan.

Standalone Professional Component Only Codes (PC/TC Indicator 2)

A list of codes with a CMS PC/TC Indicator 2. Modifiers 26 and TC cannot be used with these codes. These codes are allowed at 100% if modifier 26 or TC is not used.

Standalone Technical Component Only Codes (PC/TC Indicator 3)

A list of codes with a CMS PC/TC Indicator 3. This indicator identifies Standalone Codes that describe the Technical Component (i.e., staff and equipment costs) of selected diagnostic tests for which there is an associated code that describes the Professional Component of the diagnostic test only. Modifiers 26 and TC cannot be used with these codes. These codes are allowed at 100% if no modifier 26 or TC is used, and they are not reported in a facility POS.

Standalone Global Test Only Codes (PC/TC Indicator 4)

A list of codes with a CMS PC/TC Indicator 4. Modifiers 26 and TC cannot be used with these codes. These codes are allowed at 100% if modifier 26 or TC is not used, and they are not reported in a facility POS.

2018A Evaluation and Management Codes

Codes

0188T

0189T

92002

92004

92012

92014

99201

99202

99203

99204

99205

99211

99212

99213

99214

99215

99217

99218

99219

99220

99221

99222

99223

99224

99225

99226

99231

99232

99233

99234

99235

99236

99238

99239

99241

99242

99243

99244

99245

99251

99252

99253

99254

99255

99281

99282

99283

99284

99285

99304

99305

99306

99307

99308

99309

99310

99315

99316

99318

99324

99325

99326

99327

99328

99334

99335

99336

99337

99339

99340

99341

99342

99343

99344

99345

99347

99348

99349

99350

99374

99375

99377

99378

99379

99380

99381

99382

99383

99384

99385

99386

99387

99391

99392

99393

99394

99395

99396

99397

99429

99441

99442

99443

99444

99446

99447

99448

99449

99450

99455

99456

99460

99461

99462

99463

99468

99469

99471

99472

99475

99476

99477

99478

99479

99480

99483

99484

99492

99493

99494

99495

99496

99499

G0402

G0406

G0407

G0408

G0425

G0426

G0427

G0438

G0439

G0463

G0508

G0509

G9685

S0273

S0274

S0280

S0281

S0285

S0620

S0621

cwalto7File Attachment2018A Evaluation and Management Codes.pdf

2018 Pro Tech Component Codes for PCTC Indicator 1 Diagnostic Tests

Code Modifier RVU RBRVS Split RBRVS % Split RBRVSVariance

51725 5.37 1.000 100.00% 0.00%

51725 TC 3.17 0.590 60.00% 1.00%

51725 26 2.20 0.410 40.00% -1.00%

51726 7.59 1.000 100.00% 0.00%

51726 TC 5.13 0.676 70.00% 2.40%

51726 26 2.46 0.324 30.00% -2.40%

51727 8.93 1.000 100.00% 0.00%

51727 TC 5.86 0.656 65.00% -0.60%

51727 26 3.07 0.344 35.00% 0.60%

51728 9.10 1.000 100.00% 0.00%

51728 TC 6.08 0.668 65.00% -1.80%

51728 26 3.02 0.332 35.00% 1.80%

51729 9.77 1.000 100.00% 0.00%

51729 TC 6.13 0.627 65.00% 2.30%

51729 26 3.64 0.373 35.00% -2.30%

51736 0.44 1.000 100.00% 0.00%

51736 TC 0.20 0.455 45.00% -0.50%

51736 26 0.24 0.545 55.00% 0.50%

51741 0.45 1.000 100.00% 0.00%

51741 TC 0.21 0.467 45.00% -1.70%

51741 26 0.24 0.533 55.00% 1.70%

51784 1.98 1.000 100.00% 0.00%

51784 TC 0.90 0.455 45.00% -0.50%

51784 26 1.08 0.545 55.00% 0.50%

51785 7.86 1.000 100.00% 0.00%

51785 TC 5.25 0.668 65.00% -1.80%

51785 26 2.61 0.332 35.00% 1.80%

51792 6.09 1.000 100.00% 0.00%

51792 TC 4.50 0.739 75.00% 1.10%

51792 26 1.59 0.261 25.00% -1.10%

51797 3.24 1.000 100.00% 0.00%

51797 TC 2.08 0.642 65.00% 0.80%

51797 26 1.16 0.358 35.00% -0.80%

54240 3.04 1.000 100.00% 0.00%

54240 TC 1.04 0.342 35.00% 0.80%

54240 26 2.00 0.658 65.00% -0.80%

54250 3.49 1.000 100.00% 0.00%

54250 TC 0.32 0.092 10.00% 0.80%

54250 26 3.17 0.908 90.00% -0.80%

59020 2.02 1.000 100.00% 0.00%

59020 TC 0.95 0.470 45.00% -2.00%

59020 26 1.07 0.530 55.00% 2.00%

59025 1.38 1.000 100.00% 0.00%

59025 TC 0.52 0.377 40.00% 2.30%

59025 26 0.86 0.623 60.00% -2.30%

62252 2.43 1.000 100.00% 0.00%

62252 TC 1.08 0.444 45.00% 0.60%

62252 26 1.35 0.556 55.00% -0.60%

70015 4.09 1.000 100.00% 0.00%

70015 TC 2.39 0.584 60.00% 1.60%

70015 26 1.70 0.416 40.00% -1.60%

70030 0.79 1.000 100.00% 0.00%

70030 TC 0.55 0.696 70.00% 0.40%

70030 26 0.24 0.304 30.00% -0.40%

70100 0.93 1.000 100.00% 0.00%

70100 TC 0.67 0.720 70.00% -2.00%

70100 26 0.26 0.280 30.00% 2.00%

70110 1.07 1.000 100.00% 0.00%

70110 TC 0.71 0.664 65.00% -1.40%

70110 26 0.36 0.336 35.00% 1.40%

70120 0.94 1.000 100.00% 0.00%

70120 TC 0.68 0.723 70.00% -2.30%

70120 26 0.26 0.277 30.00% 2.30%

70130 1.53 1.000 100.00% 0.00%

70130 TC 1.04 0.680 70.00% 2.00%

70130 26 0.49 0.320 30.00% -2.00%

70134 1.41 1.000 100.00% 0.00%

70134 TC 0.92 0.652 65.00% -0.20%

70134 26 0.49 0.348 35.00% 0.20%

70140 0.84 1.000 100.00% 0.00%

70140 TC 0.54 0.643 65.00% 0.70%

70140 26 0.30 0.357 35.00% -0.70%

70150 1.17 1.000 100.00% 0.00%

70150 TC 0.79 0.675 70.00% 2.50%

70150 26 0.38 0.325 30.00% -2.50%

70160 0.93 1.000 100.00% 0.00%

70160 TC 0.68 0.731 75.00% 1.90%

70160 26 0.25 0.269 25.00% -1.90%

70170 1.48 1.000 100.00% 0.00%

70170 TC 1.05 0.709 70.00% -0.90%

70170 26 0.43 0.291 30.00% 0.90%

70190 1.01 1.000 100.00% 0.00%

70190 TC 0.69 0.683 70.00% 1.70%

70190 26 0.32 0.317 30.00% -1.70%

70200 1.20 1.000 100.00% 0.00%

70200 TC 0.79 0.658 65.00% -0.80%

70200 26 0.41 0.342 35.00% 0.80%

70210 0.84 1.000 100.00% 0.00%

70210 TC 0.59 0.702 70.00% -0.20%

70210 26 0.25 0.298 30.00% 0.20%

70220 1.06 1.000 100.00% 0.00%

70220 TC 0.70 0.660 65.00% -1.00%

70220 26 0.36 0.340 35.00% 1.00%

70240 0.87 1.000 100.00% 0.00%

70240 TC 0.59 0.678 70.00% 2.20%

70240 26 0.28 0.322 30.00% -2.20%

70250 1.03 1.000 100.00% 0.00%

70250 TC 0.67 0.650 65.00% 0.00%

70250 26 0.36 0.350 35.00% 0.00%

70260 1.29 1.000 100.00% 0.00%

70260 TC 0.79 0.612 60.00% -1.20%

70260 26 0.50 0.388 40.00% 1.20%

70300 0.42 1.000 100.00% 0.00%

70300 TC 0.25 0.595 60.00% 0.50%

70300 26 0.17 0.405 40.00% -0.50%

70310 1.05 1.000 100.00% 0.00%

70310 TC 0.82 0.781 80.00% 1.90%

70310 26 0.23 0.219 20.00% -1.90%

70320 1.49 1.000 100.00% 0.00%

70320 TC 1.14 0.765 75.00% -1.50%

70320 26 0.35 0.235 25.00% 1.50%

70328 0.86 1.000 100.00% 0.00%

70328 TC 0.60 0.698 70.00% 0.20%

70328 26 0.26 0.302 30.00% -0.20%

70330 1.33 1.000 100.00% 0.00%

70330 TC 0.98 0.737 75.00% 1.30%

70330 26 0.35 0.263 25.00% -1.30%

70332 2.00 1.000 100.00% 0.00%

70332 TC 1.23 0.615 60.00% -1.50%

70332 26 0.77 0.385 40.00% 1.50%

70336 9.12 1.000 100.00% 0.00%

70336 TC 7.03 0.771 75.00% -2.10%

70336 26 2.09 0.229 25.00% 2.10%

70350 0.55 1.000 100.00% 0.00%

70350 TC 0.27 0.491 50.00% 0.90%

70350 26 0.28 0.509 50.00% -0.90%

70355 0.59 1.000 100.00% 0.00%

70355 TC 0.27 0.458 45.00% -0.80%

70355 26 0.32 0.542 55.00% 0.80%

70360 0.80 1.000 100.00% 0.00%

70360 TC 0.56 0.700 70.00% 0.00%

70360 26 0.24 0.300 30.00% 0.00%

70370 2.03 1.000 100.00% 0.00%

70370 TC 1.58 0.778 80.00% 2.20%

70370 26 0.45 0.222 20.00% -2.20%

70371 2.52 1.000 100.00% 0.00%

70371 TC 1.33 0.528 55.00% 2.20%

70371 26 1.19 0.472 45.00% -2.20%

70380 0.91 1.000 100.00% 0.00%

70380 TC 0.67 0.736 75.00% 1.40%

70380 26 0.24 0.264 25.00% -1.40%

70390 2.66 1.000 100.00% 0.00%

70390 TC 2.12 0.797 80.00% 0.30%

70390 26 0.54 0.203 20.00% -0.30%

70450 3.28 1.000 100.00% 0.00%

70450 TC 2.07 0.631 65.00% 1.90%

70450 26 1.21 0.369 35.00% -1.90%

70460 4.62 1.000 100.00% 0.00%

70460 TC 3.00 0.649 65.00% 0.10%

70460 26 1.62 0.351 35.00% -0.10%

70470 5.42 1.000 100.00% 0.00%

70470 TC 3.61 0.666 65.00% -1.60%

70470 26 1.81 0.334 35.00% 1.60%

70480 6.59 1.000 100.00% 0.00%

70480 TC 4.77 0.724 70.00% -2.40%

70480 26 1.82 0.276 30.00% 2.40%

70481 7.80 1.000 100.00% 0.00%

70481 TC 5.83 0.747 75.00% 0.30%

70481 26 1.97 0.253 25.00% -0.30%

70482 8.50 1.000 100.00% 0.00%

70482 TC 6.44 0.758 75.00% -0.80%

70482 26 2.06 0.242 25.00% 0.80%

70486 3.94 1.000 100.00% 0.00%

70486 TC 2.72 0.690 70.00% 1.00%

70486 26 1.22 0.310 30.00% -1.00%

70487 4.74 1.000 100.00% 0.00%

70487 TC 3.14 0.662 65.00% -1.20%

70487 26 1.60 0.338 35.00% 1.20%

70488 5.78 1.000 100.00% 0.00%

70488 TC 3.97 0.687 70.00% 1.30%

70488 26 1.81 0.313 30.00% -1.30%

70490 4.76 1.000 100.00% 0.00%

70490 TC 2.93 0.616 60.00% -1.60%

70490 26 1.83 0.384 40.00% 1.60%

70491 5.75 1.000 100.00% 0.00%

70491 TC 3.78 0.657 65.00% -0.70%

70491 26 1.97 0.343 35.00% 0.70%

70492 6.93 1.000 100.00% 0.00%

70492 TC 4.62 0.667 65.00% -1.70%

70492 26 2.31 0.333 35.00% 1.70%

70496 8.29 1.000 100.00% 0.00%

70496 TC 5.80 0.700 70.00% 0.00%

70496 26 2.49 0.300 30.00% 0.00%

70498 8.27 1.000 100.00% 0.00%

70498 TC 5.78 0.699 70.00% 0.10%

70498 26 2.49 0.301 30.00% -0.10%

70540 7.68 1.000 100.00% 0.00%

70540 TC 5.76 0.750 75.00% 0.00%

70540 26 1.92 0.250 25.00% 0.00%

70542 9.11 1.000 100.00% 0.00%

70542 TC 6.80 0.746 75.00% 0.40%

70542 26 2.31 0.254 25.00% -0.40%

70543 11.44 1.000 100.00% 0.00%

70543 TC 8.40 0.734 75.00% 1.60%

70543 26 3.04 0.266 25.00% -1.60%

70544 9.28 1.000 100.00% 0.00%

70544 TC 7.57 0.816 80.00% -1.60%

70544 26 1.71 0.184 20.00% 1.60%

70545 9.20 1.000 100.00% 0.00%

70545 TC 7.49 0.814 80.00% -1.40%

70545 26 1.71 0.186 20.00% 1.40%

70546 13.70 1.000 100.00% 0.00%

70546 TC 11.60 0.847 85.00% 0.30%

70546 26 2.10 0.153 15.00% -0.30%

70547 9.33 1.000 100.00% 0.00%

70547 TC 7.61 0.816 80.00% -1.60%

70547 26 1.72 0.184 20.00% 1.60%

70548 10.19 1.000 100.00% 0.00%

70548 TC 8.05 0.790 80.00% 1.00%

70548 26 2.14 0.210 20.00% -1.00%

70549 14.24 1.000 100.00% 0.00%

70549 TC 11.68 0.820 80.00% -2.00%

70549 26 2.56 0.180 20.00% 2.00%

70551 6.55 1.000 100.00% 0.00%

70551 TC 4.43 0.676 70.00% 2.40%

70551 26 2.12 0.324 30.00% -2.40%

70552 9.08 1.000 100.00% 0.00%

70552 TC 6.54 0.720 70.00% -2.00%

70552 26 2.54 0.280 30.00% 2.00%

70553 10.71 1.000 100.00% 0.00%

70553 TC 7.46 0.697 70.00% 0.30%

70553 26 3.25 0.303 30.00% -0.30%

70554 12.74 1.000 100.00% 0.00%

70554 TC 9.73 0.764 75.00% -1.40%

70554 26 3.01 0.236 25.00% 1.40%

70555 20.94 1.000 100.00% 0.00%

70555 TC 17.38 0.830 85.00% 2.00%

70555 26 3.56 0.170 15.00% -2.00%

70557 40.55 1.000 100.00% 0.00%

70557 TC 36.09 0.890 90.00% 1.00%

70557 26 4.46 0.110 10.00% -1.00%

70558 44.64 1.000 100.00% 0.00%

70558 TC 39.73 0.890 90.00% 1.00%

70558 26 4.91 0.110 10.00% -1.00%

70559 42.09 1.000 100.00% 0.00%

70559 TC 37.46 0.890 90.00% 1.00%

70559 26 4.63 0.110 10.00% -1.00%

71045 0.56 1.000 100.00% 0.00%

71045 TC 0.30 0.536 55.00% 1.40%

71045 26 0.26 0.464 45.00% -1.40%

71046 0.86 1.000 100.00% 0.00%

71046 TC 0.55 0.640 65.00% 1.00%

71046 26 0.31 0.360 35.00% -1.00%

71047 1.10 1.000 100.00% 0.00%

71047 TC 0.70 0.636 65.00% 1.40%

71047 26 0.40 0.364 35.00% -1.40%

71048 1.18 1.000 100.00% 0.00%

71048 TC 0.72 0.610 60.00% -1.00%

71048 26 0.46 0.390 40.00% 1.00%

71100 0.94 1.000 100.00% 0.00%

71100 TC 0.62 0.660 65.00% -1.00%

71100 26 0.32 0.340 35.00% 1.00%

71101 1.08 1.000 100.00% 0.00%

71101 TC 0.69 0.639 65.00% 1.10%

71101 26 0.39 0.361 35.00% -1.10%

71110 1.13 1.000 100.00% 0.00%

71110 TC 0.71 0.628 65.00% 2.20%

71110 26 0.42 0.372 35.00% -2.20%

71111 1.33 1.000 100.00% 0.00%

71111 TC 0.86 0.647 65.00% 0.30%

71111 26 0.47 0.353 35.00% -0.30%

71120 0.84 1.000 100.00% 0.00%

71120 TC 0.55 0.655 65.00% -0.50%

71120 26 0.29 0.345 35.00% 0.50%

71130 1.02 1.000 100.00% 0.00%

71130 TC 0.70 0.686 70.00% 1.40%

71130 26 0.32 0.314 30.00% -1.40%

71250 4.61 1.000 100.00% 0.00%

71250 TC 2.95 0.640 65.00% 1.00%

71250 26 1.66 0.360 35.00% -1.00%

71260 5.56 1.000 100.00% 0.00%

71260 TC 3.79 0.682 70.00% 1.80%

71260 26 1.77 0.318 30.00% -1.80%

71270 6.66 1.000 100.00% 0.00%

71270 TC 4.69 0.704 70.00% -0.40%

71270 26 1.97 0.296 30.00% 0.40%

71275 8.49 1.000 100.00% 0.00%

71275 TC 5.90 0.695 70.00% 0.50%

71275 26 2.59 0.305 30.00% -0.50%

71550 11.76 1.000 100.00% 0.00%

71550 TC 9.68 0.823 80.00% -2.30%

71550 26 2.08 0.177 20.00% 2.30%

71551 12.95 1.000 100.00% 0.00%

71551 TC 10.49 0.810 80.00% -1.00%

71551 26 2.46 0.190 20.00% 1.00%

71552 16.41 1.000 100.00% 0.00%

71552 TC 13.20 0.804 80.00% -0.40%

71552 26 3.21 0.196 20.00% 0.40%

71555 11.32 1.000 100.00% 0.00%

71555 TC 8.77 0.775 80.00% 2.50%

71555 26 2.55 0.225 20.00% -2.50%

72020 0.63 1.000 100.00% 0.00%

72020 TC 0.41 0.651 65.00% -0.10%

72020 26 0.22 0.349 35.00% 0.10%

72040 0.94 1.000 100.00% 0.00%

72040 TC 0.62 0.660 65.00% -1.00%

72040 26 0.32 0.340 35.00% 1.00%

72050 1.28 1.000 100.00% 0.00%

72050 TC 0.83 0.648 65.00% 0.20%

72050 26 0.45 0.352 35.00% -0.20%

72052 1.58 1.000 100.00% 0.00%

72052 TC 1.06 0.671 65.00% -2.10%

72052 26 0.52 0.329 35.00% 2.10%

72070 0.96 1.000 100.00% 0.00%

72070 TC 0.64 0.667 65.00% -1.70%

72070 26 0.32 0.333 35.00% 1.70%

72072 0.98 1.000 100.00% 0.00%

72072 TC 0.67 0.684 70.00% 1.60%

72072 26 0.31 0.316 30.00% -1.60%

72074 1.10 1.000 100.00% 0.00%

72074 TC 0.79 0.718 70.00% -1.80%

72074 26 0.31 0.282 30.00% 1.80%

72080 0.95 1.000 100.00% 0.00%

72080 TC 0.63 0.663 65.00% -1.30%

72080 26 0.32 0.337 35.00% 1.30%

72081 1.09 1.000 100.00% 0.00%

72081 TC 0.71 0.651 65.00% -0.10%

72081 26 0.38 0.349 35.00% 0.10%

72082 1.76 1.000 100.00% 0.00%

72082 TC 1.30 0.739 75.00% 1.10%

72082 26 0.46 0.261 25.00% -1.10%

72083 2.12 1.000 100.00% 0.00%

72083 TC 1.60 0.755 75.00% -0.50%

72083 26 0.52 0.245 25.00% 0.50%

72084 2.47 1.000 100.00% 0.00%

72084 TC 1.86 0.753 75.00% -0.30%

72084 26 0.61 0.247 25.00% 0.30%

72100 0.99 1.000 100.00% 0.00%

72100 TC 0.67 0.677 70.00% 2.30%

72100 26 0.32 0.323 30.00% -2.30%

72110 1.38 1.000 100.00% 0.00%

72110 TC 0.93 0.674 65.00% -2.40%

72110 26 0.45 0.326 35.00% 2.40%

72114 1.74 1.000 100.00% 0.00%

72114 TC 1.27 0.730 75.00% 2.00%

72114 26 0.47 0.270 25.00% -2.00%

72120 1.15 1.000 100.00% 0.00%

72120 TC 0.83 0.722 70.00% -2.20%

72120 26 0.32 0.278 30.00% 2.20%

72125 5.22 1.000 100.00% 0.00%

72125 TC 3.70 0.709 70.00% -0.90%

72125 26 1.52 0.291 30.00% 0.90%

72126 6.45 1.000 100.00% 0.00%

72126 TC 4.71 0.730 75.00% 2.00%

72126 26 1.74 0.270 25.00% -2.00%

72127 7.64 1.000 100.00% 0.00%

72127 TC 5.84 0.764 75.00% -1.40%

72127 26 1.80 0.236 25.00% 1.40%

72128 5.11 1.000 100.00% 0.00%

72128 TC 3.68 0.720 70.00% -2.00%

72128 26 1.43 0.280 30.00% 2.00%

72129 6.48 1.000 100.00% 0.00%

72129 TC 4.74 0.731 75.00% 1.90%

72129 26 1.74 0.269 25.00% -1.90%

72130 7.69 1.000 100.00% 0.00%

72130 TC 5.88 0.765 75.00% -1.50%

72130 26 1.81 0.235 25.00% 1.50%

72131 5.09 1.000 100.00% 0.00%

72131 TC 3.66 0.719 70.00% -1.90%

72131 26 1.43 0.281 30.00% 1.90%

72132 6.45 1.000 100.00% 0.00%

72132 TC 4.71 0.730 75.00% 2.00%

72132 26 1.74 0.270 25.00% -2.00%

72133 7.62 1.000 100.00% 0.00%

72133 TC 5.81 0.762 75.00% -1.20%

72133 26 1.81 0.238 25.00% 1.20%

72141 6.37 1.000 100.00% 0.00%

72141 TC 4.25 0.667 65.00% -1.70%

72141 26 2.12 0.333 35.00% 1.70%

72142 9.25 1.000 100.00% 0.00%

72142 TC 6.70 0.724 70.00% -2.40%

72142 26 2.55 0.276 30.00% 2.40%

72146 6.38 1.000 100.00% 0.00%

72146 TC 4.26 0.668 65.00% -1.80%

72146 26 2.12 0.332 35.00% 1.80%

72147 9.18 1.000 100.00% 0.00%

72147 TC 6.64 0.723 70.00% -2.30%

72147 26 2.54 0.277 30.00% 2.30%

72148 6.37 1.000 100.00% 0.00%

72148 TC 4.25 0.667 65.00% -1.70%

72148 26 2.12 0.333 35.00% 1.70%

72149 9.13 1.000 100.00% 0.00%

72149 TC 6.58 0.721 70.00% -2.10%

72149 26 2.55 0.279 30.00% 2.10%

72156 10.77 1.000 100.00% 0.00%

72156 TC 7.52 0.698 70.00% 0.20%

72156 26 3.25 0.302 30.00% -0.20%

72157 10.79 1.000 100.00% 0.00%

72157 TC 7.54 0.699 70.00% 0.10%

72157 26 3.25 0.301 30.00% -0.10%

72158 10.75 1.000 100.00% 0.00%

72158 TC 7.49 0.697 70.00% 0.30%

72158 26 3.26 0.303 30.00% -0.30%

72159 11.57 1.000 100.00% 0.00%

72159 TC 9.02 0.780 80.00% 2.00%

72159 26 2.55 0.220 20.00% -2.00%

72170 0.90 1.000 100.00% 0.00%

72170 TC 0.65 0.722 70.00% -2.20%

72170 26 0.25 0.278 30.00% 2.20%

72190 1.07 1.000 100.00% 0.00%

72190 TC 0.76 0.710 70.00% -1.00%

72190 26 0.31 0.290 30.00% 1.00%

72191 8.65 1.000 100.00% 0.00%

72191 TC 6.09 0.704 70.00% -0.40%

72191 26 2.56 0.296 30.00% 0.40%

72192 4.13 1.000 100.00% 0.00%

72192 TC 2.58 0.625 65.00% 2.50%

72192 26 1.55 0.375 35.00% -2.50%

72193 6.39 1.000 100.00% 0.00%

72193 TC 4.73 0.740 75.00% 1.00%

72193 26 1.66 0.260 25.00% -1.00%

72194 7.36 1.000 100.00% 0.00%

72194 TC 5.62 0.764 75.00% -1.40%

72194 26 1.74 0.236 25.00% 1.40%

72195 8.97 1.000 100.00% 0.00%

72195 TC 6.89 0.768 75.00% -1.80%

72195 26 2.08 0.232 25.00% 1.80%

72196 9.85 1.000 100.00% 0.00%

72196 TC 7.38 0.749 75.00% 0.10%

72196 26 2.47 0.251 25.00% -0.10%

72197 12.07 1.000 100.00% 0.00%

72197 TC 8.94 0.741 75.00% 0.90%

72197 26 3.13 0.259 25.00% -0.90%

72198 11.35 1.000 100.00% 0.00%

72198 TC 8.82 0.777 80.00% 2.30%

72198 26 2.53 0.223 20.00% -2.30%

72200 0.80 1.000 100.00% 0.00%

72200 TC 0.55 0.688 70.00% 1.20%

72200 26 0.25 0.312 30.00% -1.20%

72202 0.93 1.000 100.00% 0.00%

72202 TC 0.66 0.710 70.00% -1.00%

72202 26 0.27 0.290 30.00% 1.00%

72220 0.80 1.000 100.00% 0.00%

72220 TC 0.55 0.688 70.00% 1.20%

72220 26 0.25 0.312 30.00% -1.20%

72240 2.77 1.000 100.00% 0.00%

72240 TC 1.48 0.534 55.00% 1.60%

72240 26 1.29 0.466 45.00% -1.60%

72255 2.78 1.000 100.00% 0.00%

72255 TC 1.46 0.525 55.00% 2.50%

72255 26 1.32 0.475 45.00% -2.50%

72265 2.60 1.000 100.00% 0.00%

72265 TC 1.43 0.550 55.00% 0.00%

72265 26 1.17 0.450 45.00% 0.00%

72270 3.62 1.000 100.00% 0.00%

72270 TC 1.70 0.470 45.00% -2.00%

72270 26 1.92 0.530 55.00% 2.00%

72275 3.27 1.000 100.00% 0.00%

72275 TC 2.16 0.661 65.00% -1.10%

72275 26 1.11 0.339 35.00% 1.10%

72285 3.17 1.000 100.00% 0.00%

72285 TC 1.47 0.464 45.00% -1.40%

72285 26 1.70 0.536 55.00% 1.40%

72295 2.75 1.000 100.00% 0.00%

72295 TC 1.52 0.553 55.00% -0.30%

72295 26 1.23 0.447 45.00% 0.30%

73000 0.79 1.000 100.00% 0.00%

73000 TC 0.55 0.696 70.00% 0.40%

73000 26 0.24 0.304 30.00% -0.40%

73010 0.86 1.000 100.00% 0.00%

73010 TC 0.60 0.698 70.00% 0.20%

73010 26 0.26 0.302 30.00% -0.20%

73020 0.65 1.000 100.00% 0.00%

73020 TC 0.42 0.646 65.00% 0.40%

73020 26 0.23 0.354 35.00% -0.40%

73030 0.83 1.000 100.00% 0.00%

73030 TC 0.56 0.675 70.00% 2.50%

73030 26 0.27 0.325 30.00% -2.50%

73040 2.86 1.000 100.00% 0.00%

73040 TC 2.08 0.727 75.00% 2.30%

73040 26 0.78 0.273 25.00% -2.30%

73050 1.01 1.000 100.00% 0.00%

73050 TC 0.71 0.703 70.00% -0.30%

73050 26 0.30 0.297 30.00% 0.30%

73060 0.82 1.000 100.00% 0.00%

73060 TC 0.58 0.707 70.00% -0.70%

73060 26 0.24 0.293 30.00% 0.70%

73070 0.77 1.000 100.00% 0.00%

73070 TC 0.54 0.701 70.00% -0.10%

73070 26 0.23 0.299 30.00% 0.10%

73080 0.89 1.000 100.00% 0.00%

73080 TC 0.64 0.719 70.00% -1.90%

73080 26 0.25 0.281 30.00% 1.90%

73085 2.71 1.000 100.00% 0.00%

73085 TC 1.89 0.697 70.00% 0.30%

73085 26 0.82 0.303 30.00% -0.30%

73090 0.73 1.000 100.00% 0.00%

73090 TC 0.49 0.671 65.00% -2.10%

73090 26 0.24 0.329 35.00% 2.10%

73092 0.77 1.000 100.00% 0.00%

73092 TC 0.54 0.701 70.00% -0.10%

73092 26 0.23 0.299 30.00% 0.10%

73100 0.89 1.000 100.00% 0.00%

73100 TC 0.64 0.719 70.00% -1.90%

73100 26 0.25 0.281 30.00% 1.90%

73110 0.99 1.000 100.00% 0.00%

73110 TC 0.74 0.747 75.00% 0.30%

73110 26 0.25 0.253 25.00% -0.30%

73115 3.02 1.000 100.00% 0.00%

73115 TC 2.21 0.732 75.00% 1.80%

73115 26 0.81 0.268 25.00% -1.80%

73120 0.80 1.000 100.00% 0.00%

73120 TC 0.56 0.700 70.00% 0.00%

73120 26 0.24 0.300 30.00% 0.00%

73130 0.90 1.000 100.00% 0.00%

73130 TC 0.65 0.722 70.00% -2.20%

73130 26 0.25 0.278 30.00% 2.20%

73140 0.91 1.000 100.00% 0.00%

73140 TC 0.71 0.780 80.00% 2.00%

73140 26 0.20 0.220 20.00% -2.00%

73200 5.08 1.000 100.00% 0.00%

73200 TC 3.65 0.719 70.00% -1.90%

73200 26 1.43 0.281 30.00% 1.90%

73201 6.30 1.000 100.00% 0.00%

73201 TC 4.64 0.737 75.00% 1.30%

73201 26 1.66 0.263 25.00% -1.30%

73202 7.86 1.000 100.00% 0.00%

73202 TC 6.12 0.779 80.00% 2.10%

73202 26 1.74 0.221 20.00% -2.10%

73206 9.28 1.000 100.00% 0.00%

73206 TC 6.73 0.725 75.00% 2.50%

73206 26 2.55 0.275 25.00% -2.50%

73218 10.39 1.000 100.00% 0.00%

73218 TC 8.46 0.814 80.00% -1.40%

73218 26 1.93 0.186 20.00% 1.40%

73219 11.42 1.000 100.00% 0.00%

73219 TC 9.11 0.798 80.00% 0.20%

73219 26 2.31 0.202 20.00% -0.20%

73220 14.16 1.000 100.00% 0.00%

73220 TC 11.10 0.784 80.00% 1.60%

73220 26 3.06 0.216 20.00% -1.60%

73221 6.73 1.000 100.00% 0.00%

73221 TC 4.79 0.712 70.00% -1.20%

73221 26 1.94 0.288 30.00% 1.20%

73222 10.75 1.000 100.00% 0.00%

73222 TC 8.43 0.784 80.00% 1.60%

73222 26 2.32 0.216 20.00% -1.60%

73223 13.33 1.000 100.00% 0.00%

73223 TC 10.27 0.770 75.00% -2.00%

73223 26 3.06 0.230 25.00% 2.00%

73225 11.56 1.000 100.00% 0.00%

73225 TC 9.12 0.789 80.00% 1.10%

73225 26 2.44 0.211 20.00% -1.10%

73501 0.85 1.000 100.00% 0.00%

73501 TC 0.58 0.682 70.00% 1.80%

73501 26 0.27 0.318 30.00% -1.80%

73502 1.17 1.000 100.00% 0.00%

73502 TC 0.85 0.726 75.00% 2.40%

73502 26 0.32 0.274 25.00% -2.40%

73503 1.46 1.000 100.00% 0.00%

73503 TC 1.05 0.719 70.00% -1.90%

73503 26 0.41 0.281 30.00% 1.90%

73521 1.06 1.000 100.00% 0.00%

73521 TC 0.74 0.698 70.00% 0.20%

73521 26 0.32 0.302 30.00% -0.20%

73522 1.38 1.000 100.00% 0.00%

73522 TC 0.95 0.688 70.00% 1.20%

73522 26 0.43 0.312 30.00% -1.20%

73523 1.60 1.000 100.00% 0.00%

73523 TC 1.14 0.713 70.00% -1.30%

73523 26 0.46 0.287 30.00% 1.30%

73525 2.92 1.000 100.00% 0.00%

73525 TC 2.09 0.716 70.00% -1.60%

73525 26 0.83 0.284 30.00% 1.60%

73551 0.79 1.000 100.00% 0.00%

73551 TC 0.55 0.696 70.00% 0.40%

73551 26 0.24 0.304 30.00% -0.40%

73552 0.93 1.000 100.00% 0.00%

73552 TC 0.66 0.710 70.00% -1.00%

73552 26 0.27 0.290 30.00% 1.00%

73560 0.88 1.000 100.00% 0.00%

73560 TC 0.64 0.727 75.00% 2.30%

73560 26 0.24 0.273 25.00% -2.30%

73562 1.01 1.000 100.00% 0.00%

73562 TC 0.74 0.733 75.00% 1.70%

73562 26 0.27 0.267 25.00% -1.70%

73564 1.12 1.000 100.00% 0.00%

73564 TC 0.80 0.714 70.00% -1.40%

73564 26 0.32 0.286 30.00% 1.40%

73565 1.01 1.000 100.00% 0.00%

73565 TC 0.76 0.752 75.00% -0.20%

73565 26 0.25 0.248 25.00% 0.20%

73580 3.31 1.000 100.00% 0.00%

73580 TC 2.49 0.752 75.00% -0.20%

73580 26 0.82 0.248 25.00% 0.20%

73590 0.81 1.000 100.00% 0.00%

73590 TC 0.57 0.704 70.00% -0.40%

73590 26 0.24 0.296 30.00% 0.40%

73592 0.77 1.000 100.00% 0.00%

73592 TC 0.54 0.701 70.00% -0.10%

73592 26 0.23 0.299 30.00% 0.10%

73600 0.84 1.000 100.00% 0.00%

73600 TC 0.60 0.714 70.00% -1.40%

73600 26 0.24 0.286 30.00% 1.40%

73610 0.89 1.000 100.00% 0.00%

73610 TC 0.64 0.719 70.00% -1.90%

73610 26 0.25 0.281 30.00% 1.90%

73615 3.02 1.000 100.00% 0.00%

73615 TC 2.20 0.728 75.00% 2.20%

73615 26 0.82 0.272 25.00% -2.20%

73620 0.74 1.000 100.00% 0.00%

73620 TC 0.52 0.703 70.00% -0.30%

73620 26 0.22 0.297 30.00% 0.30%

73630 0.83 1.000 100.00% 0.00%

73630 TC 0.59 0.711 70.00% -1.10%

73630 26 0.24 0.289 30.00% 1.10%

73650 0.77 1.000 100.00% 0.00%

73650 TC 0.54 0.701 70.00% -0.10%

73650 26 0.23 0.299 30.00% 0.10%

73660 0.80 1.000 100.00% 0.00%

73660 TC 0.61 0.763 75.00% -1.30%

73660 26 0.19 0.237 25.00% 1.30%

73700 5.09 1.000 100.00% 0.00%

73700 TC 3.66 0.719 70.00% -1.90%

73700 26 1.43 0.281 30.00% 1.90%

73701 6.39 1.000 100.00% 0.00%

73701 TC 4.73 0.740 75.00% 1.00%

73701 26 1.66 0.260 25.00% -1.00%

73702 7.76 1.000 100.00% 0.00%

73702 TC 6.03 0.777 80.00% 2.30%

73702 26 1.73 0.223 20.00% -2.30%

73706 10.06 1.000 100.00% 0.00%

73706 TC 7.37 0.733 75.00% 1.70%

73706 26 2.69 0.267 25.00% -1.70%

73718 8.70 1.000 100.00% 0.00%

73718 TC 6.77 0.778 80.00% 2.20%

73718 26 1.93 0.222 20.00% -2.20%

73719 9.69 1.000 100.00% 0.00%

73719 TC 7.38 0.762 75.00% -1.20%

73719 26 2.31 0.238 25.00% 1.20%

73720 12.05 1.000 100.00% 0.00%

73720 TC 9.00 0.747 75.00% 0.30%

73720 26 3.05 0.253 25.00% -0.30%

73721 6.73 1.000 100.00% 0.00%

73721 TC 4.79 0.712 70.00% -1.20%

73721 26 1.94 0.288 30.00% 1.20%

73722 10.82 1.000 100.00% 0.00%

73722 TC 8.50 0.786 80.00% 1.40%

73722 26 2.32 0.214 20.00% -1.40%

73723 13.31 1.000 100.00% 0.00%

73723 TC 10.26 0.771 75.00% -2.10%

73723 26 3.05 0.229 25.00% 2.10%

73725 11.36 1.000 100.00% 0.00%

73725 TC 8.80 0.775 80.00% 2.50%

73725 26 2.56 0.225 20.00% -2.50%

74018 0.77 1.000 100.00% 0.00%

74018 TC 0.51 0.662 65.00% -1.20%

74018 26 0.26 0.338 35.00% 1.20%

74019 0.94 1.000 100.00% 0.00%

74019 TC 0.61 0.649 65.00% 0.10%

74019 26 0.33 0.351 35.00% -0.10%

74021 1.10 1.000 100.00% 0.00%

74021 TC 0.71 0.645 65.00% 0.50%

74021 26 0.39 0.355 35.00% -0.50%

74022 1.26 1.000 100.00% 0.00%

74022 TC 0.80 0.635 65.00% 1.50%

74022 26 0.46 0.365 35.00% -1.50%

74150 4.24 1.000 100.00% 0.00%

74150 TC 2.54 0.599 60.00% 0.10%

74150 26 1.70 0.401 40.00% -0.10%

74160 6.53 1.000 100.00% 0.00%

74160 TC 4.72 0.723 70.00% -2.30%

74160 26 1.81 0.277 30.00% 2.30%

74170 7.43 1.000 100.00% 0.00%

74170 TC 5.43 0.731 75.00% 1.90%

74170 26 2.00 0.269 25.00% -1.90%

74174 10.98 1.000 100.00% 0.00%

74174 TC 7.88 0.718 70.00% -1.80%

74174 26 3.10 0.282 30.00% 1.80%

74175 8.69 1.000 100.00% 0.00%

74175 TC 6.12 0.704 70.00% -0.40%

74175 26 2.57 0.296 30.00% 0.40%

74176 5.68 1.000 100.00% 0.00%

74176 TC 3.20 0.563 55.00% -1.30%

74176 26 2.48 0.437 45.00% 1.30%

74177 8.82 1.000 100.00% 0.00%

74177 TC 6.22 0.705 70.00% -0.50%

74177 26 2.60 0.295 30.00% 0.50%

74178 9.99 1.000 100.00% 0.00%

74178 TC 7.14 0.715 70.00% -1.50%

74178 26 2.85 0.285 30.00% 1.50%

74181 8.00 1.000 100.00% 0.00%

74181 TC 5.92 0.740 75.00% 1.00%

74181 26 2.08 0.260 25.00% -1.00%

74182 10.85 1.000 100.00% 0.00%

74182 TC 8.38 0.772 75.00% -2.20%

74182 26 2.47 0.228 25.00% 2.20%

74183 12.10 1.000 100.00% 0.00%

74183 TC 8.97 0.741 75.00% 0.90%

74183 26 3.13 0.259 25.00% -0.90%

74185 11.42 1.000 100.00% 0.00%

74185 TC 8.88 0.778 80.00% 2.20%

74185 26 2.54 0.222 20.00% -2.20%

74190 1.68 1.000 100.00% 0.00%

74190 TC 1.01 0.601 60.00% -0.10%

74190 26 0.67 0.399 40.00% 0.10%

74210 2.20 1.000 100.00% 0.00%

74210 TC 1.69 0.768 75.00% -1.80%

74210 26 0.51 0.232 25.00% 1.80%

74220 2.50 1.000 100.00% 0.00%

74220 TC 1.84 0.736 75.00% 1.40%

74220 26 0.66 0.264 25.00% -1.40%

74230 3.65 1.000 100.00% 0.00%

74230 TC 2.89 0.792 80.00% 0.80%

74230 26 0.76 0.208 20.00% -0.80%

74235 5.03 1.000 100.00% 0.00%

74235 TC 3.27 0.650 65.00% 0.00%

74235 26 1.76 0.350 35.00% 0.00%

74240 3.19 1.000 100.00% 0.00%

74240 TC 2.20 0.690 70.00% 1.00%

74240 26 0.99 0.310 30.00% -1.00%

74241 3.31 1.000 100.00% 0.00%

74241 TC 2.33 0.704 70.00% -0.40%

74241 26 0.98 0.296 30.00% 0.40%

74245 4.83 1.000 100.00% 0.00%

74245 TC 3.53 0.731 75.00% 1.90%

74245 26 1.30 0.269 25.00% -1.90%

74246 3.57 1.000 100.00% 0.00%

74246 TC 2.59 0.725 75.00% 2.50%

74246 26 0.98 0.275 25.00% -2.50%

74247 3.99 1.000 100.00% 0.00%

74247 TC 3.01 0.754 75.00% -0.40%

74247 26 0.98 0.246 25.00% 0.40%

74249 5.18 1.000 100.00% 0.00%

74249 TC 3.88 0.749 75.00% 0.10%

74249 26 1.30 0.251 25.00% -0.10%

74250 2.92 1.000 100.00% 0.00%

74250 TC 2.25 0.771 75.00% -2.10%

74250 26 0.67 0.229 25.00% 2.10%

74251 11.83 1.000 100.00% 0.00%

74251 TC 10.85 0.917 90.00% -1.70%

74251 26 0.98 0.083 10.00% 1.70%

74260 9.83 1.000 100.00% 0.00%

74260 TC 9.11 0.927 95.00% 2.30%

74260 26 0.72 0.073 5.00% -2.30%

74261 13.76 1.000 100.00% 0.00%

74261 TC 10.34 0.751 75.00% -0.10%

74261 26 3.42 0.249 25.00% 0.10%

74262 15.41 1.000 100.00% 0.00%

74262 TC 11.85 0.769 75.00% -1.90%

74262 26 3.56 0.231 25.00% 1.90%

74263 21.57 1.000 100.00% 0.00%

74263 TC 18.34 0.850 85.00% 0.00%

74263 26 3.23 0.150 15.00% 0.00%

74270 4.24 1.000 100.00% 0.00%

74270 TC 3.26 0.769 75.00% -1.90%

74270 26 0.98 0.231 25.00% 1.90%

74280 6.02 1.000 100.00% 0.00%

74280 TC 4.61 0.766 75.00% -1.60%

74280 26 1.41 0.234 25.00% 1.60%

74283 5.94 1.000 100.00% 0.00%

74283 TC 3.01 0.507 50.00% -0.70%

74283 26 2.93 0.493 50.00% 0.70%

74290 1.97 1.000 100.00% 0.00%

74290 TC 1.51 0.766 75.00% -1.60%

74290 26 0.46 0.234 25.00% 1.60%

74300 1.49 1.000 100.00% 0.00%

74300 TC 0.97 0.651 65.00% -0.10%

74300 26 0.52 0.349 35.00% 0.10%

74301 0.86 1.000 100.00% 0.00%

74301 TC 0.56 0.651 65.00% -0.10%

74301 26 0.30 0.349 35.00% 0.10%

74328 3.37 1.000 100.00% 0.00%

74328 TC 2.36 0.700 70.00% 0.00%

74328 26 1.01 0.300 30.00% 0.00%

74329 2.91 1.000 100.00% 0.00%

74329 TC 1.89 0.649 65.00% 0.10%

74329 26 1.02 0.351 35.00% -0.10%

74330 4.81 1.000 100.00% 0.00%

74330 TC 3.51 0.730 75.00% 2.00%

74330 26 1.30 0.270 25.00% -2.00%

74340 3.08 1.000 100.00% 0.00%

74340 TC 2.31 0.750 75.00% 0.00%

74340 26 0.77 0.250 25.00% 0.00%

74355 4.15 1.000 100.00% 0.00%

74355 TC 3.03 0.730 75.00% 2.00%

74355 26 1.12 0.270 25.00% -2.00%

74360 3.33 1.000 100.00% 0.00%

74360 TC 2.53 0.760 75.00% -1.00%

74360 26 0.80 0.240 25.00% 1.00%

74363 3.46 1.000 100.00% 0.00%

74363 TC 2.25 0.650 65.00% 0.00%

74363 26 1.21 0.350 35.00% 0.00%

74400 3.10 1.000 100.00% 0.00%

74400 TC 2.40 0.774 75.00% -2.40%

74400 26 0.70 0.226 25.00% 2.40%

74410 3.14 1.000 100.00% 0.00%

74410 TC 2.44 0.777 80.00% 2.30%

74410 26 0.70 0.223 20.00% -2.30%

74415 3.85 1.000 100.00% 0.00%

74415 TC 3.15 0.818 80.00% -1.80%

74415 26 0.70 0.182 20.00% 1.80%

74420 3.33 1.000 100.00% 0.00%

74420 TC 2.83 0.850 85.00% 0.00%

74420 26 0.50 0.150 15.00% 0.00%

74425 1.85 1.000 100.00% 0.00%

74425 TC 1.35 0.730 75.00% 2.00%

74425 26 0.50 0.270 25.00% -2.00%

74430 1.08 1.000 100.00% 0.00%

74430 TC 0.62 0.574 55.00% -2.40%

74430 26 0.46 0.426 45.00% 2.40%

74440 2.27 1.000 100.00% 0.00%

74440 TC 1.75 0.771 75.00% -2.10%

74440 26 0.52 0.229 25.00% 2.10%

74445 2.79 1.000 100.00% 0.00%

74445 TC 1.20 0.430 45.00% 2.00%

74445 26 1.59 0.570 55.00% -2.00%

74450 2.04 1.000 100.00% 0.00%

74450 TC 1.57 0.770 75.00% -2.00%

74450 26 0.47 0.230 25.00% 2.00%

74455 2.33 1.000 100.00% 0.00%

74455 TC 1.86 0.798 80.00% 0.20%

74455 26 0.47 0.202 20.00% -0.20%

74470 2.08 1.000 100.00% 0.00%

74470 TC 1.33 0.639 65.00% 1.10%

74470 26 0.75 0.361 35.00% -1.10%

74485 2.62 1.000 100.00% 0.00%

74485 TC 1.88 0.718 70.00% -1.80%

74485 26 0.74 0.282 30.00% 1.80%

74710 1.03 1.000 100.00% 0.00%

74710 TC 0.54 0.524 50.00% -2.40%

74710 26 0.49 0.476 50.00% 2.40%

74712 13.96 1.000 100.00% 0.00%

74712 TC 9.68 0.693 70.00% 0.70%

74712 26 4.28 0.307 30.00% -0.70%

74713 6.75 1.000 100.00% 0.00%

74713 TC 4.10 0.607 60.00% -0.70%

74713 26 2.65 0.393 40.00% 0.70%

74740 2.11 1.000 100.00% 0.00%

74740 TC 1.57 0.744 75.00% 0.60%

74740 26 0.54 0.256 25.00% -0.60%

74742 2.51 1.000 100.00% 0.00%

74742 TC 1.63 0.649 65.00% 0.10%

74742 26 0.88 0.351 35.00% -0.10%

74775 2.47 1.000 100.00% 0.00%

74775 TC 1.58 0.640 65.00% 1.00%

74775 26 0.89 0.360 35.00% -1.00%

75557 9.33 1.000 100.00% 0.00%

75557 TC 6.04 0.647 65.00% 0.30%

75557 26 3.29 0.353 35.00% -0.30%

75559 12.59 1.000 100.00% 0.00%

75559 TC 8.53 0.678 70.00% 2.20%

75559 26 4.06 0.322 30.00% -2.20%

75561 12.29 1.000 100.00% 0.00%

75561 TC 8.66 0.705 70.00% -0.50%

75561 26 3.63 0.295 30.00% 0.50%

75563 14.62 1.000 100.00% 0.00%

75563 TC 10.45 0.715 70.00% -1.50%

75563 26 4.17 0.285 30.00% 1.50%

75565 1.55 1.000 100.00% 0.00%

75565 TC 1.20 0.774 75.00% -2.40%

75565 26 0.35 0.226 25.00% 2.40%

75571 2.92 1.000 100.00% 0.00%

75571 TC 2.10 0.719 70.00% -1.90%

75571 26 0.82 0.281 30.00% 1.90%

75572 8.08 1.000 100.00% 0.00%

75572 TC 5.61 0.694 70.00% 0.60%

75572 26 2.47 0.306 30.00% -0.60%

75573 11.02 1.000 100.00% 0.00%

75573 TC 7.44 0.675 70.00% 2.50%

75573 26 3.58 0.325 30.00% -2.50%

75574 12.01 1.000 100.00% 0.00%

75574 TC 8.65 0.720 70.00% -2.00%

75574 26 3.36 0.280 30.00% 2.00%

75600 5.67 1.000 100.00% 0.00%

75600 TC 4.98 0.878 90.00% 2.20%

75600 26 0.69 0.122 10.00% -2.20%

75605 3.90 1.000 100.00% 0.00%

75605 TC 2.32 0.595 60.00% 0.50%

75605 26 1.58 0.405 40.00% -0.50%

75625 3.88 1.000 100.00% 0.00%

75625 TC 2.29 0.590 60.00% 1.00%

75625 26 1.59 0.410 40.00% -1.00%

75630 4.82 1.000 100.00% 0.00%

75630 TC 2.32 0.481 50.00% 1.90%

75630 26 2.50 0.519 50.00% -1.90%

75635 12.48 1.000 100.00% 0.00%

75635 TC 9.11 0.730 75.00% 2.00%

75635 26 3.37 0.270 25.00% -2.00%

75705 7.17 1.000 100.00% 0.00%

75705 TC 3.89 0.543 55.00% 0.70%

75705 26 3.28 0.457 45.00% -0.70%

75710 4.87 1.000 100.00% 0.00%

75710 TC 2.42 0.497 50.00% 0.30%

75710 26 2.45 0.503 50.00% -0.30%

75716 5.53 1.000 100.00% 0.00%

75716 TC 2.79 0.505 50.00% -0.50%

75716 26 2.74 0.495 50.00% 0.50%

75726 4.22 1.000 100.00% 0.00%

75726 TC 2.65 0.628 65.00% 2.20%

75726 26 1.57 0.372 35.00% -2.20%

75731 4.87 1.000 100.00% 0.00%

75731 TC 3.24 0.665 65.00% -1.50%

75731 26 1.63 0.335 35.00% 1.50%

75733 5.23 1.000 100.00% 0.00%

75733 TC 3.42 0.654 65.00% -0.40%

75733 26 1.81 0.346 35.00% 0.40%

75736 4.52 1.000 100.00% 0.00%

75736 TC 2.96 0.655 65.00% -0.50%

75736 26 1.56 0.345 35.00% 0.50%

75741 4.24 1.000 100.00% 0.00%

75741 TC 2.45 0.578 60.00% 2.20%

75741 26 1.79 0.422 40.00% -2.20%

75743 4.77 1.000 100.00% 0.00%

75743 TC 2.48 0.520 50.00% -2.00%

75743 26 2.29 0.480 50.00% 2.00%

75746 4.29 1.000 100.00% 0.00%

75746 TC 2.71 0.632 65.00% 1.80%

75746 26 1.58 0.368 35.00% -1.80%

75756 4.88 1.000 100.00% 0.00%

75756 TC 3.26 0.668 65.00% -1.80%

75756 26 1.62 0.332 35.00% 1.80%

75774 2.45 1.000 100.00% 0.00%

75774 TC 1.96 0.800 80.00% 0.00%

75774 26 0.49 0.200 20.00% 0.00%

75801 7.47 1.000 100.00% 0.00%

75801 TC 6.20 0.830 85.00% 2.00%

75801 26 1.27 0.170 15.00% -2.00%

75803 7.77 1.000 100.00% 0.00%

75803 TC 6.06 0.780 80.00% 2.00%

75803 26 1.71 0.220 20.00% -2.00%

75805 7.47 1.000 100.00% 0.00%

75805 TC 6.35 0.850 85.00% 0.00%

75805 26 1.12 0.150 15.00% 0.00%

75807 8.05 1.000 100.00% 0.00%

75807 TC 6.44 0.800 80.00% 0.00%

75807 26 1.61 0.200 20.00% 0.00%

75809 2.80 1.000 100.00% 0.00%

75809 TC 2.12 0.757 75.00% -0.70%

75809 26 0.68 0.243 25.00% 0.70%

75810 14.09 1.000 100.00% 0.00%

75810 TC 12.54 0.890 90.00% 1.00%

75810 26 1.55 0.110 10.00% -1.00%

75820 3.27 1.000 100.00% 0.00%

75820 TC 2.28 0.697 70.00% 0.30%

75820 26 0.99 0.303 30.00% -0.30%

75822 3.84 1.000 100.00% 0.00%

75822 TC 2.36 0.615 60.00% -1.50%

75822 26 1.48 0.385 40.00% 1.50%

75825 3.81 1.000 100.00% 0.00%

75825 TC 2.22 0.583 60.00% 1.70%

75825 26 1.59 0.417 40.00% -1.70%

75827 3.93 1.000 100.00% 0.00%

75827 TC 2.33 0.593 60.00% 0.70%

75827 26 1.60 0.407 40.00% -0.70%

75831 3.97 1.000 100.00% 0.00%

75831 TC 2.40 0.605 60.00% -0.50%

75831 26 1.57 0.395 40.00% 0.50%

75833 4.70 1.000 100.00% 0.00%

75833 TC 2.63 0.560 55.00% -1.00%

75833 26 2.07 0.440 45.00% 1.00%

75840 4.20 1.000 100.00% 0.00%

75840 TC 2.57 0.612 60.00% -1.20%

75840 26 1.63 0.388 40.00% 1.20%

75842 5.03 1.000 100.00% 0.00%

75842 TC 2.90 0.577 60.00% 2.30%

75842 26 2.13 0.423 40.00% -2.30%

75860 4.08 1.000 100.00% 0.00%

75860 TC 2.49 0.610 60.00% -1.00%

75860 26 1.59 0.390 40.00% 1.00%

75870 4.20 1.000 100.00% 0.00%

75870 TC 2.57 0.612 60.00% -1.20%

75870 26 1.63 0.388 40.00% 1.20%

75872 4.20 1.000 100.00% 0.00%

75872 TC 2.57 0.612 60.00% -1.20%

75872 26 1.63 0.388 40.00% 1.20%

75880 3.56 1.000 100.00% 0.00%

75880 TC 2.56 0.719 70.00% -1.90%

75880 26 1.00 0.281 30.00% 1.90%

75885 4.43 1.000 100.00% 0.00%

75885 TC 2.49 0.562 55.00% -1.20%

75885 26 1.94 0.438 45.00% 1.20%

75887 4.44 1.000 100.00% 0.00%

75887 TC 2.50 0.563 55.00% -1.30%

75887 26 1.94 0.437 45.00% 1.30%

75889 4.06 1.000 100.00% 0.00%

75889 TC 2.51 0.618 60.00% -1.80%

75889 26 1.55 0.382 40.00% 1.80%

75891 4.09 1.000 100.00% 0.00%

75891 TC 2.52 0.616 60.00% -1.60%

75891 26 1.57 0.384 40.00% 1.60%

75893 3.40 1.000 100.00% 0.00%

75893 TC 2.63 0.774 75.00% -2.40%

75893 26 0.77 0.226 25.00% 2.40%

75894 29.29 1.000 100.00% 0.00%

75894 TC 27.24 0.930 95.00% 2.00%

75894 26 2.05 0.070 5.00% -2.00%

75898 3.82 1.000 100.00% 0.00%

75898 TC 1.26 0.330 35.00% 2.00%

75898 26 2.56 0.670 65.00% -2.00%

75901 5.07 1.000 100.00% 0.00%

75901 TC 4.40 0.868 85.00% -1.80%

75901 26 0.67 0.132 15.00% 1.80%

75902 2.04 1.000 100.00% 0.00%

75902 TC 1.50 0.735 75.00% 1.50%

75902 26 0.54 0.265 25.00% -1.50%

professional/technical component policy · this policy describes the reimbursement methodology for...

Documents