provider type 12 hospital, outpatient...

Note:

Proc Code Description Mod Rate Rate Begin Date

10021 Fna w/o image 89.05 1/1/1981

10022 Fna w/image 91.58 1/1/1981

10030 Guide cathet fluid drainage 164.59 1/1/2014

10035 Perq dev soft tiss 1st imag 87.26 1/1/2016

10036 Perq dev soft tiss add imag 43.98 1/1/2016

10040 Acne surgery 65.52 1/1/1981

10060 Drainage of skin abscess 72.40 1/1/1981

10061 Drainage of skin abscess 150.59 1/1/1981

10080 Drainage of pilonidal cyst 74.57 1/1/1981

10081 Drainage of pilonidal cyst 157.83 1/1/1981

10120 Remove foreign body 62.26 1/1/1981

10121 Remove foreign body 177.74 1/1/1981

10140 Drainage of hematoma/fluid 95.93 1/1/1981

10160 Puncture drainage of lesion 64.79 1/1/1981

10180 Complex drainage wound 142.99 1/1/1981

11000 Debride infected skin 32.94 1/1/1981

11001 Debride infected skin add-on 15.92 1/1/1981

11004 Debride genitalia & perineum 547.57 1/1/2005

11005 Debride abdom wall 746.36 1/1/2005

11006 Debride genit/per/abdom wall 690.55 1/1/2005

11008 Remove mesh from abd wall 281.43 1/1/2005

11010 Debride skin at fx site 251.59 1/1/1981

11011 Debride skin musc at fx site 304.44 1/1/1981

11012 Deb skin bone at fx site 452.86 1/1/1981

11042 Deb subq tissue 20 sq cm/< 63.35 1/1/1981

CPT codes, descriptions and other data only are copyright © 2008 American Medical Association. All rights reserved. Applicable

FARS/DFARS apply. CPT is a registered trademark ® of the American Medical Association.

Provider Type 12 Hospital, Outpatient

Reimbursement Rates

The information contained in the schedule is made available to provide information and is not a guarantee

by the State or the Department or its employees as to the present accuracy of the information contained

herein. For example, coverage as well as an actual rate may have been revised or updated and may no

longer be the same as posted on the website.

Procedure codes with a rate of $0.00 are reimbursed at 62% of Usual and Customary charges unless noted

otherwise in Nevada Medicaid policy.

"J" and "Q" codes with a rate of $0.00 and that do not require an NDC number when billed are reimbursed at 85% of

AWP unless noted otherwise in Nevada Medicaid policy.

Date of last rate review: 1/1/2017A rate review may or may not result in a change to the reimbursement rate.

1/185


11043 Deb musc/fascia 20 sq cm/< 150.59 1/1/1981

11044 Deb bone 20 sq cm/< 196.20 1/1/1981

11055 Trim skin lesion 23.53 1/1/1981

11056 TRIM SKIN LESIONS 2 TO 4 33.30 1/1/1981

11057 Trim skin lesions over 4 43.44 1/1/1981

11100 Biopsy skin lesion 45.61 1/1/1981

11101 Biopsy skin add-on 23.16 1/1/1981

11200 Removal of skin tags <w/15 41.63 1/1/1981

11201 Remove skin tags add-on 15.92 1/1/1981

11300 SHAVE SKIN LESION 0.5 CM/< 28.23 1/1/1981

11301 SHAVE SKIN LESION 0.6-1.0 CM 47.42 1/1/1981


11303 SHAVE SKIN LESION >2.0 CM 68.41 1/1/1981

11305 Shave skin lesion 0.5 cm/< 36.92 1/1/1981


11307 Shave skin lesion 1.1-2.0 cm 62.98 1/1/1981

11308 SHAVE SKIN LESION >2.0 CM 77.83 1/1/1981

11310 Shave skin lesion 0.5 cm/< 41.26 1/1/1981



11313 Shave skin lesion >2.0 cm 90.86 1/1/1981

11400 Exc tr-ext b9+marg 0.5 cm< 49.23 1/1/1981

11401 Exc tr-ext b9+marg 0.6-1 cm 72.03 1/1/1981


11403 Exc tr-ext b9+marg 2.1-3cm/< 119.09 1/1/1981


11406 Exc tr-ext b9+marg >4.0 cm 164.34 1/1/1981

11420 Exc h-f-nk-sp b9+marg 0.5/< 58.64 1/1/1981

11421 Exc h-f-nk-sp b9+marg 0.6-1 84.70 1/1/1981

11422 Exc h-f-nk-sp b9+marg 1.1-2 110.77 1/1/1981

11423 Exc h-f-nk-sp b9+marg 2.1-3 133.94 1/1/1981

11424 Exc h-f-nk-sp b9+marg 3.1-4 158.19 1/1/1981

11426 Exc h-f-nk-sp b9+marg >4 cm 223.35 1/1/1981

11440 Exc face-mm b9+marg 0.5 cm/< 65.16 1/1/1981

11441 Exc face-mm b9+marg 0.6-1 cm 91.22 1/1/1981




11446 Exc face-mm b9+marg >4 cm 273.67 1/1/1981

11450 Removal sweat gland lesion 149.50 1/1/1981






2/185


11600 Exc tr-ext mal+marg 0.5 cm/< 95.93 1/1/1981

11601 Exc tr-ext mal+marg 0.6-1 cm 126.70 1/1/1981




11606 Exc tr-ext mal+marg >4 cm 206.70 1/1/1981

11620 Exc h-f-nk-sp mal+marg 0.5/< 93.75 1/1/1981

11621 Exc s/n/h/f/g mal+mrg 0.6-1 129.95 1/1/1981

11622 Exc s/n/h/f/g mal+mrg 1.1-2 152.04 1/1/1981

11623 Exc s/n/h/f/g mal+mrg 2.1-3 185.34 1/1/1981

11624 Exc s/n/h/f/g mal+mrg 3.1-4 213.94 1/1/1981

11626 Exc s/n/h/f/g mal+mrg >4 cm 268.24 1/1/1981

11640 Exc f/e/e/n/l mal+mrg 0.5cm< 108.60 1/1/1981

11641 Exc f/e/e/n/l mal+mrg 0.6-1 162.17 1/1/1981

11642 Exc f/e/e/n/l mal+mrg 1.1-2 190.77 1/1/1981

11643 Exc f/e/e/n/l mal+mrg 2.1-3 225.16 1/1/1981

11644 Exc f/e/e/n/l mal+mrg 3.1-4 291.04 1/1/1981

11646 Exc f/e/e/n/l mal+mrg >4 cm 378.29 1/1/1981

11719 Trim nail(s) any number 9.41 1/1/1981

11720 Debride nail 1-5 17.37 1/1/1981

11721 Debride nail 6 or more 29.68 1/1/1981

11730 REMOVAL OF NAIL PLATE 62.26 1/1/1981

11732 Remove nail plate add-on 31.85 1/1/1981

11740 Drain blood from under nail 19.91 1/1/1981

11750 Removal of nail bed 103.89 1/1/1981

11755 Biopsy nail unit 72.76 1/1/1981

11760 Repair of nail bed 112.94 1/1/1981

11762 Reconstruction of nail bed 192.58 1/1/1981

11765 EXCISION OF NAIL FOLD TOE 46.33 1/1/1981

11770 Remove pilonidal cyst simple 152.76 1/1/1981

11771 Remove pilonidal cyst exten 384.08 1/1/1981

11772 Remove pilonidal cyst compl 450.69 1/1/1981

11900 Inject skin lesions </w 7 28.59 1/1/1981

11901 Inject skin lesions >7 44.88 1/1/1981

11950 Tx contour defects 1 cc/< 51.04 1/1/1981

11951 Tx contour defects 1.1-5.0cc 66.24 1/1/1981

11952 Tx contour defects 5.1-10cc 93.03 1/1/1981

11954 Tx contour defects >10.0 cc 112.22 1/1/1981

11960 Insert tissue expander(s) 802.91 1/1/1981

11970 Replace tissue expander 484.35 1/1/1981

11971 Remove tissue expander(s) 239.64 1/1/1981

11976 Remove contraceptive capsule 98.10 1/1/1981

11980 Implant hormone pellet(s) 80.00 1/1/1981

11981 Insert drug implant device 82.17 1/1/1981

11982 Remove drug implant device 98.82 1/1/1981

3/185


11983 Remove/insert drug implant 183.17 1/1/1981

12001 Rpr s/n/ax/gen/trnk 2.5cm/< 83.98 1/1/1981

12002 Rpr s/n/ax/gen/trnk2.6-7.5cm 110.04 1/1/1981

12004 Rpr s/n/ax/gen/trk7.6-12.5cm 129.23 1/1/1981

12005 Rpr s/n/a/gen/trk12.6-20.0cm 161.09 1/1/1981

12006 Rpr s/n/a/gen/trk20.1-30.0cm 207.06 1/1/1981

12007 Rpr s/n/ax/gen/trnk >30.0 cm 235.66 1/1/1981

12011 Rpr f/e/e/n/l/m 2.5 cm/< 87.24 1/1/1981

12013 Rpr f/e/e/n/l/m 2.6-5.0 cm 116.56 1/1/1981

12014 Rpr f/e/e/n/l/m 5.1-7.5 cm 139.00 1/1/1981

12015 Rpr f/e/e/n/l/m 7.6-12.5 cm 175.93 1/1/1981

12016 Rpr fe/e/en/l/m 12.6-20.0 cm 216.47 1/1/1981

12017 Rpr fe/e/en/l/m 20.1-30.0 cm 261.00 1/1/1981

12018 Rpr f/e/e/n/l/m >30.0 cm 303.35 1/1/1981

12020 Closure of split wound 160.00 1/1/1981

12021 Closure of split wound 113.66 1/1/1981

12031 Intmd rpr s/a/t/ext 2.5 cm/< 115.11 1/1/1981

12032 Intmd rpr s/a/t/ext 2.6-7.5 147.69 1/1/1981

12034 Intmd rpr s/tr/ext 7.6-12.5 172.31 1/1/1981

12035 Intmd rpr s/a/t/ext 12.6-20 203.08 1/1/1981

12036 Intmd rpr s/a/t/ext 20.1-30 259.19 1/1/1981

12037 Intmd rpr s/tr/ext >30.0 cm 299.01 1/1/1981

12041 Intmd rpr n-hf/genit 2.5cm/< 126.33 1/1/1981

12042 Intmd rpr n-hf/genit2.6-7.5 163.26 1/1/1981

12044 Intmd rpr n-hf/genit7.6-12.5 187.51 1/1/1981

12045 Intmd rpr n-hf/genit12.6-20 219.73 1/1/1981

12046 Intmd rpr n-hf/genit20.1-30 270.77 1/1/1981

12047 Intmd rpr n-hf/genit >30.0cm 294.66 1/1/1981

12051 Intmd rpr face/mm 2.5 cm/< 152.76 1/1/1981

12052 Intmd rpr face/mm 2.6-5.0 cm 163.62 1/1/1981

12053 Intmd rpr face/mm 5.1-7.5 cm 183.53 1/1/1981

12054 Intmd rpr face/mm 7.6-12.5cm 201.63 1/1/1981

12055 Intmd rpr face/mm 12.6-20 cm 261.72 1/1/1981

12056 Intmd rpr face/mm 20.1-30.0 331.95 1/1/1981

12057 Intmd rpr face/mm >30.0 cm 376.48 1/1/1981

13100 Cmplx rpr trunk 1.1-2.5 cm 195.11 1/1/1981

13101 Cmplx rpr trunk 2.6-7.5 cm 242.17 1/1/1981

13102 Cmplx rpr trunk addl 5cm/< 72.03 1/1/1981

13120 Cmplx rpr s/a/l 1.1-2.5 cm 203.44 1/1/1981

13121 Cmplx rpr s/a/l 2.6-7.5 cm 263.17 1/1/1981

13122 Cmplx rpr s/a/l addl 5 cm/> 82.89 1/1/1981

13131 Cmplx rpr f/c/c/m/n/ax/g/h/f 235.30 1/1/1981



13151 Cmplx rpr e/n/e/l 1.1-2.5 cm 294.30 1/1/1981

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13152 Cmplx rpr e/n/e/l 2.6-7.5 cm 402.54 1/1/1981

13153 Cmplx rpr e/n/e/l addl 5cm/< 139.73 1/1/1981

13160 Late closure of wound 676.57 1/1/1981

14000 Tis trnfr trunk 10 sq cm/< 415.93 1/1/1981

14001 Tis trnfr trunk 10.1-30sqcm 569.06 1/1/1981

14020 Tis trnfr s/a/l 10 sq cm/< 470.60 1/1/1981

14021 Tis trnfr s/a/l 10.1-30 sqcm 673.68 1/1/1981

14040 Tis trnfr f/c/c/m/n/a/g/h/f 545.17 1/1/1981

14041 Tis trnfr f/c/c/m/n/a/g/h/f 755.13 1/1/1981

14060 Tis trnfr e/n/e/l 10 sq cm/< 603.09 1/1/1981

14061 Tis trnfr e/n/e/l10.1-30sqcm 821.37 1/1/1981

14350 Filleted finger/toe flap 641.10 1/1/1981

15050 Skin pinch graft 331.59 1/1/1981

15100 Skin splt grft trnk/arm/leg 605.98 1/1/1981

15101 Skin splt grft t/a/l add-on 99.18 1/1/1981

15120 Skn splt a-grft fac/nck/hf/g 657.75 1/1/1981

15121 Skn splt a-grft f/n/hf/g add 155.29 1/1/1981

15200 Skin full graft trunk 536.12 1/1/1981

15201 Skin full graft trunk add-on 79.64 1/1/1981

15220 Skin full graft sclp/arm/leg 559.29 1/1/1981

15221 Skin full graft add-on 70.95 1/1/1981

15240 Skin full grft face/genit/hf 636.03 1/1/1981


15260 Skin full graft een & lips 684.54 1/1/1981


15570 Skin pedicle flap trunk 616.84 1/1/1981

15572 Skin pedicle flap arms/legs 616.48 1/1/1981

15574 Pedcle fh/ch/ch/m/n/ax/g/h/f 668.25 1/1/1981

15576 Pedicle e/n/e/l/ntroral 594.04 1/1/1981

15600 Delay flap trunk 172.31 1/1/1981

15610 Delay flap arms/legs 199.46 1/1/1981

15620 Delay flap f/c/c/n/ax/g/h/f 252.31 1/1/1981

15630 Delay flap eye/nos/ear/lip 275.12 1/1/1981

15650 Transfer skin pedicle flap 310.23 1/1/1981

15732 Muscle-skin graft head/neck 1152.24 1/1/1981

15734 Muscle-skin graft trunk 1163.10 1/1/1981

15736 Muscle-skin graft arm 1088.89 1/1/1981

15738 Muscle-skin graft leg 1168.53 1/1/1981

15740 Island pedicle flap graft 670.78 1/1/1981

15750 Neurovascular pedicle flap 781.92 1/1/1981

15756 Free myo/skin flap microvasc 2263.94 1/1/1981

15757 Free skin flap microvasc 2276.98 1/1/1981

15758 Free fascial flap microvasc 2286.75 1/1/1981

15760 Composite skin graft 609.97 1/1/1981

15770 Derma-fat-fascia graft 538.65 1/1/1981

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15786 Abrasion lesion single 127.06 1/1/1981

15787 Abrasion lesions add-on 19.54 1/1/1981

15792 Chemical peel nonfacial 133.21 1/1/1981

15793 Chemical peel nonfacial 286.70 1/1/1981

15820 Revision of lower eyelid 468.79 1/1/1981

15821 Revision of lower eyelid 497.75 1/1/1981

15822 Revision of upper eyelid 418.83 1/1/1981

15823 Revision of upper eyelid 556.39 1/1/1981

15840 Nerve palsy fascial graft 912.60 1/1/1981

15841 Nerve palsy muscle graft 1514.24 1/1/1981

15842 Nerve palsy microsurg graft 2413.45 1/1/1981

15845 Skin and muscle repair face 823.55 1/1/1981

15850 Remove sutures same surgeon 41.63 1/1/1981

15851 Remove sutures diff surgeon 46.69 1/1/1981

15852 Dressing change not for burn 47.78 1/1/1981

15860 Test for blood flow in graft 108.23 1/1/1981

15920 Removal of tail bone ulcer 547.34 1/1/1981

15922 Removal of tail bone ulcer 699.02 1/1/1981

15931 Remove sacrum pressure sore 599.11 1/1/1981






15940 Remove hip pressure sore 614.67 1/1/1981





15950 Remove thigh pressure sore 513.67 1/1/1981






16000 Initial treatment of burn(s) 45.25 1/1/1981

16020 DRESS/DEBRID P-THICK BURN S 41.99 1/1/1981

16025 Dress/debrid p-thick burn m 100.27 1/1/1981

16030 Dress/debrid p-thick burn l 120.18 1/1/1981

16035 Incision of burn scab initi 210.68 1/1/1981

16036 Escharotomy addl incision 82.53 1/1/1981

17000 DESTRUCT PREMALG LESION 33.66 1/1/1981

17003 Destruct premalg les 2-14 8.68 1/1/1981

17004 Destroy premal lesions 15/> 155.66 1/1/1981

17106 Destruction of skin lesions 287.42 1/1/1981

6/185




17110 Destruct b9 lesion 1-14 35.11 1/1/1981

17111 DESTRUCT LESION 15 OR MORE 50.68 1/1/1981

17250 CHEMICAL CAUTERY TISSUE 27.87 1/1/1981

17260 DESTRUCTION OF SKIN LESIONS 49.59 1/1/1981


















17311 Mohs 1 stage h/n/hf/g 331.26 1/1/2007

17312 Mohs addl stage 176.33 1/1/2007

17313 Mohs 1 stage t/a/l 296.96 1/1/2007

17314 Mohs addl stage t/a/l 163.04 1/1/2007

17315 Mohs surg addl block 46.11 1/1/2007

19000 Drainage of breast lesion 44.88 1/1/1981

19001 Drain breast lesion add-on 22.08 1/1/1981

19020 Incision of breast lesion 277.29 1/1/1981

19030 Injection for breast x-ray 78.91 1/1/1981

19081 Bx breast 1st lesion strtctc 194.67 1/1/2014

19082 Bx breast add lesion strtctc 92.31 1/1/2014

19083 Bx breast 1st lesion us imag 182.31 1/1/2014

19084 Bx breast add lesion us imag 86.74 1/1/2014

19085 Bx breast 1st lesion mr imag 212.74 1/1/2014

19086 Bx breast add lesion mr imag 93.94 1/1/2014

19100 Bx breast percut w/o image 67.33 1/1/1981

19101 Biopsy of breast open 198.37 1/1/1981

19110 Nipple exploration 347.15 1/1/1981

19112 Excise breast duct fistula 270.05 1/1/1981

19120 Removal of breast lesion 347.15 1/1/1981

19125 Excision breast lesion 373.58 1/1/1981

19126 Excision addl breast lesion 159.64 1/1/1981

7/185


19260 Removal of chest wall lesion 976.67 1/1/1981

19271 Revision of chest wall 1205.46 1/1/1981

19272 Extensive chest wall surgery 1360.03 1/1/1981

19281 Perq device breast 1st imag 108.34 1/1/2014

19282 Perq device breast ea imag 51.56 1/1/2014

19283 Perq dev breast 1st strtctc 109.49 1/1/2014

19284 Perq dev breast add strtctc 51.94 1/1/2014

19285 Perq dev breast 1st us imag 92.83 1/1/2014

19286 Perq dev breast add us imag 44.60 1/1/2014

19287 Perq dev breast 1st mr guide 151.86 1/1/2014

19288 Perq dev breast add mr guide 66.69 1/1/2014

19296 Place po breast cath for rad 3708.28 9/1/2010

19316 Suspension of breast 740.29 1/1/1981

19318 Reduction of large breast 1042.56 1/1/1981

19324 Enlarge breast 406.16 1/1/1981

19325 Enlarge breast with implant 609.97 1/1/1981

19328 Removal of breast implant 411.23 1/1/1981

19330 Removal of implant material 515.12 1/1/1981

19340 Immediate breast prosthesis 384.08 1/1/1981

19342 Delayed breast prosthesis 767.07 1/1/1981

19350 Breast reconstruction 632.77 1/1/1981

19355 Correct inverted nipple(s) 533.58 1/1/1981


19361 Breast reconstr w/lat flap 1260.12 1/1/1981






19370 Surgery of breast capsule 570.87 1/1/1981

19371 Removal of breast capsule 664.99 1/1/1981

19380 Revise breast reconstruction 651.96 1/1/1981

19396 Design custom breast implant 121.63 1/1/1981

20005 I&d abscess subfascial 222.63 1/1/1981

20100 Explore wound neck 565.08 1/1/1981

20101 Explore wound chest 189.32 1/1/1981

20102 Explore wound abdomen 228.42 1/1/1981

20103 Explore wound extremity 330.86 1/1/1981

20150 Excise epiphyseal bar 905.72 1/1/1981

20200 Muscle biopsy 83.98 1/1/1981

20205 Deep muscle biopsy 132.49 1/1/1981

20206 Needle biopsy muscle 52.12 1/1/1981

20220 Bone biopsy trocar/needle 161.09 1/1/1981

20225 Bone biopsy trocar/needle 187.87 1/1/1981

20240 BONE BIOPSY OPEN SUPERFICIAL 288.15 1/1/1981

8/185


20245 BONE BIOPSY OPEN DEEP 562.18 1/1/1981

20250 Open bone biopsy 369.24 1/1/1981

20251 Open bone biopsy 419.55 1/1/1981

20500 Injection of sinus tract 196.20 1/1/1981

20501 Inject sinus tract for x-ray 39.09 1/1/1981

20520 Removal of foreign body 211.04 1/1/1981


20526 Ther injection carp tunnel 48.50 1/1/1981

20550 Inj tendon sheath/ligament 44.52 1/1/1981

20551 Inj tendon origin/insertion 48.50 1/1/1981

20552 Inj trigger point 1/2 muscl 48.50 1/1/1981

20553 INJECT TRIGGER POINTS 3/> 48.50 1/1/1981

20600 Drain/inj joint/bursa w/o us 40.54 1/1/1981

20604 Drain/inj joint/bursa w/us 47.42 1/1/2015





20612 Aspirate/inj ganglion cyst 38.73 1/1/1981

20615 Treatment of bone cyst 186.06 1/1/1981

20650 Insert and remove bone pin 213.21 1/1/1981

20660 Apply rem fixation device 168.33 1/1/1981

20661 Application of head brace 471.68 1/1/1981

20662 Application of pelvis brace 448.88 1/1/1981

20663 Application of thigh brace 417.02 1/1/1981

20664 Application of halo 680.19 1/1/1981

20665 Removal of fixation device 102.08 1/1/1981

20670 Removal of support implant 201.99 1/1/1981

20680 Removal of support implant 331.59 1/1/1981

20690 Apply bone fixation device 220.45 1/1/1981

20692 Apply bone fixation device 393.85 1/1/1981

20693 Adjust bone fixation device 738.48 1/1/1981

20694 Remove bone fixation device 413.40 1/1/1981

20802 Replantation arm complete 2840.25 1/1/1981

20805 Replant forearm complete 3448.41 1/1/1981

20808 Replantation hand complete 4648.44 1/1/1981

20816 Replantation digit complete 3118.99 1/1/1981

20822 Replantation digit complete 2794.27 1/1/1981

20824 Replantation thumb complete 3124.78 1/1/1981

20827 Replantation thumb complete 2818.17 1/1/1981

20838 Replantation foot complete 2733.82 1/1/1981

20900 Removal of bone for graft 461.18 1/1/1981

20902 Removal of bone for graft 656.30 1/1/1981

20910 Remove cartilage for graft 477.11 1/1/1981

20912 Remove cartilage for graft 544.08 1/1/1981

9/185


20920 Removal of fascia for graft 421.36 1/1/1981

20922 Removal of fascia for graft 515.12 1/1/1981

20924 Removal of tendon for graft 536.12 1/1/1981

20926 Removal of tissue for graft 479.28 1/1/1981

20930 Sp bone algrft morsel add-on 95.56 1/1/1981

20931 Sp bone algrft struct add-on 117.65 1/1/1981

20936 Sp bone agrft local add-on 100.63 1/1/1981

20937 Sp bone agrft morsel add-on 178.10 1/1/1981

20938 Sp bone agrft struct add-on 194.39 1/1/1981

20950 Fluid pressure muscle 133.57 1/1/1981

20955 Fibula bone graft microvasc 2764.95 1/1/1981

20956 Iliac bone graft microvasc 2741.06 1/1/1981

20957 Mt bone graft microvasc 2546.67 1/1/1981

20962 Other bone graft microvasc 2729.11 1/1/1981

20969 Bone/skin graft microvasc 3040.80 1/1/1981

20970 Bone/skin graft iliac crest 2901.06 1/1/1981

20972 Bone/skin graft metatarsal 2515.17 1/1/1981

20973 Bone/skin graft great toe 3016.18 1/1/1981

20974 Electrical bone stimulation 39.45 1/1/1981

20975 Electrical bone stimulation 166.52 1/1/1981

20979 Us bone stimulation 33.66 1/1/1981

20983 Ablate bone tumor(s) perq 419.82 1/1/2015

20985 Cptr-asst dir ms px 135.46 1/1/2008

21010 Incision of jaw joint 664.99 1/1/1981

21015 Resect face/scalp tum < 2 cm 492.68 1/1/1981

21025 Excision of bone lower jaw 663.90 1/1/1981

21026 Excision of facial bone(s) 386.61 1/1/1981

21029 Contour of face bone lesion 566.16 1/1/1981

21030 Excise max/zygoma b9 tumor 447.07 1/1/1981

21031 Remove exostosis mandible 212.49 1/1/1981

21032 Remove exostosis maxilla 222.63 1/1/1981

21034 Excise max/zygoma mal tumor 1046.54 1/1/1981

21040 Excise mandible lesion 153.12 1/1/1981

21044 Removal of jaw bone lesion 783.00 1/1/1981

21045 Extensive jaw surgery 1040.75 1/1/1981

21046 Remove mandible cyst complex 908.98 1/1/1981

21047 Excise lwr jaw cyst w/repair 1120.39 1/1/1981

21048 Remove maxilla cyst complex 935.04 1/1/1981

21049 Excis uppr jaw cyst w/repair 1058.12 1/1/1981

21050 Removal of jaw joint 877.12 1/1/1981

21060 Remove jaw joint cartilage 821.37 1/1/1981

21070 Remove coronoid process 566.89 1/1/1981

21073 Mnpj of tmj w/anesth 209.51 1/1/2008

21076 Prepare face/oral prosthesis 826.44 1/1/1981


10/185












21100 Maxillofacial fixation 300.46 1/1/1981

21110 Interdental fixation 370.32 1/1/1981

21116 Injection jaw joint x-ray 43.07 1/1/1981

21120 Reconstruction of chin 379.37 1/1/1981




21125 Augmentation lower jaw bone 712.77 1/1/1981

21127 Augmentation lower jaw bone 713.50 1/1/1981

21137 Reduction of forehead 688.88 1/1/1981



21141 Lefort i-1 piece w/o graft 1131.97 1/1/1981

21142 Lefort i-2 piece w/o graft 1253.96 1/1/1981

21143 Lefort i-3/> piece w/o graft 1173.24 1/1/1981

21145 Lefort i-1 piece w/ graft 1256.50 1/1/1981

21146 Lefort i-2 piece w/ graft 1283.29 1/1/1981

21147 Lefort i-3/> piece w/ graft 1312.61 1/1/1981

21150 Lefort ii anterior intrusion 1612.71 1/1/1981

21151 Lefort ii w/bone grafts 1919.32 1/1/1981

21154 Lefort iii w/o lefort i 2114.08 1/1/1981

21155 Lefort iii w/ lefort i 2365.67 1/1/1981

21159 Lefort iii w/fhdw/o lefort i 2653.82 1/1/1981

21160 Lefort iii w/fhd w/ lefort i 3024.51 1/1/1981

21172 Reconstruct orbit/forehead 1711.53 1/1/1981

21175 Reconstruct orbit/forehead 2177.06 1/1/1981

21179 Reconstruct entire forehead 1630.44 1/1/1981

21180 Reconstruct entire forehead 1699.95 1/1/1981

21181 Contour cranial bone lesion 720.74 1/1/1981

21182 Reconstruct cranial bone 2108.28 1/1/1981



21188 Reconstruction of midface 1494.69 1/1/1981

21193 Reconst lwr jaw w/o graft 1096.13 1/1/1981

21194 Reconst lwr jaw w/graft 1250.34 1/1/1981

11/185


21195 Reconst lwr jaw w/o fixation 1144.64 1/1/1981

21196 Reconst lwr jaw w/fixation 1241.29 1/1/1981

21198 Reconstr lwr jaw segment 1023.73 1/1/1981

21199 Reconstr lwr jaw w/advance 1045.45 1/1/1981

21206 Reconstruct upper jaw bone 910.43 1/1/1981

21208 Augmentation of facial bones 736.67 1/1/1981

21209 Reduction of facial bones 516.57 1/1/1981

21210 Face bone graft 722.19 1/1/1981

21215 Lower jaw bone graft 718.57 1/1/1981

21230 Rib cartilage graft 842.01 1/1/1981

21235 Ear cartilage graft 581.73 1/1/1981

21240 Reconstruction of jaw joint 1004.91 1/1/1981



21244 Reconstruction of lower jaw 832.60 1/1/1981

21245 Reconstruction of jaw 855.40 1/1/1981


21247 Reconstruct lower jaw bone 1678.59 1/1/1981



21255 Reconstruct lower jaw bone 1152.60 1/1/1981

21256 Reconstruction of orbit 1156.22 1/1/1981

21260 Revise eye sockets 1164.91 1/1/1981





21270 Augmentation cheek bone 779.74 1/1/1981

21275 Revision orbitofacial bones 868.43 1/1/1981

21280 Revision of eyelid 466.98 1/1/1981


21295 Revision of jaw muscle/bone 224.44 1/1/1981

21296 Revision of jaw muscle/bone 321.45 1/1/1981

21310 Closed tx nose fx w/o manj 28.96 1/1/1981

21315 Closed tx nose fx w/o stablj 107.87 1/1/1981

21320 Closed tx nose fx w/ stablj 152.76 1/1/1981

21325 Open tx nose fx uncomplicatd 291.04 1/1/1981

21330 Open tx nose fx w/skele fixj 430.05 1/1/1981

21335 Open tx nose & septal fx 617.21 1/1/1981

21336 Open tx septal fx w/wo stabj 443.81 1/1/1981

21337 Closed tx septal&nose fx 236.38 1/1/1981

21338 Open nasoethmoid fx w/o fixj 474.58 1/1/1981

21339 Open nasoethmoid fx w/ fixj 589.69 1/1/1981

21340 Perq tx nasoethmoid fx 759.11 1/1/1981

21343 Open tx dprsd front sinus fx 874.23 1/1/1981

12/185


21344 Open tx compl front sinus fx 1312.61 1/1/1981

21345 Closed tx nose/jaw fx 620.46 1/1/1981

21346 Opn tx nasomax fx w/fixj 804.00 1/1/1981

21347 Opn tx nasomax fx multple 875.67 1/1/1981

21348 Opn tx nasomax fx w/graft 1108.08 1/1/1981

21355 Perq tx malar fracture 245.43 1/1/1981

21356 Opn tx dprsd zygomatic arch 291.41 1/1/1981

21360 Opn tx dprsd malar fracture 473.49 1/1/1981

21365 Opn tx complx malar fx 1041.47 1/1/1981

21366 Opn tx complx malar w/grft 1245.28 1/1/1981

21385 Opn tx orbit fx transantral 663.54 1/1/1981

21386 Opn tx orbit fx periorbital 683.45 1/1/1981

21387 Opn tx orbit fx combined 708.43 1/1/1981

21390 Opn tx orbit periorbtl implt 727.62 1/1/1981

21395 Opn tx orbit periorbt w/grft 856.49 1/1/1981

21400 Closed tx orbit w/o manipulj 95.56 1/1/1981

21401 Closed tx orbit w/manipulj 270.77 1/1/1981

21406 Opn tx orbit fx w/o implant 551.68 1/1/1981

21407 Opn tx orbit fx w/implant 642.91 1/1/1981

21408 Opn tx orbit fx w/bone grft 891.60 1/1/1981

21421 Treat mouth roof fracture 462.63 1/1/1981



21431 Treat craniofacial fracture 599.47 1/1/1981





21440 Treat dental ridge fracture 247.97 1/1/1981

21445 Treat dental ridge fracture 409.42 1/1/1981

21450 Treat lower jaw fracture 227.33 1/1/1981









21480 Reset dislocated jaw 31.13 1/1/1981

21485 Reset dislocated jaw 284.53 1/1/1981

21490 Repair dislocated jaw 777.93 1/1/1981

21497 Interdental wiring 297.20 1/1/1981

21501 Drain neck/chest lesion 291.41 1/1/1981

21502 Drain chest lesion 558.92 1/1/1981

13/185


21510 Drainage of bone lesion 519.10 1/1/1981

21550 Biopsy of neck/chest 127.78 1/1/1981

21555 Exc neck les sc < 3 cm 267.51 1/1/1981

21556 Exc neck tum deep < 5 cm 348.60 1/1/1981

21557 Resect neck thorax tumor<5cm 656.30 1/1/1981

21600 Partial removal of rib 579.56 1/1/1981

21610 Partial removal of rib 1036.04 1/1/1981

21615 Removal of rib 708.79 1/1/1981

21616 Removal of rib and nerves 831.51 1/1/1981

21620 Partial removal of sternum 586.44 1/1/1981

21627 Sternal debridement 741.01 1/1/1981

21630 Extensive sternum surgery 1245.28 1/1/1981

21632 Extensive sternum surgery 1218.85 1/1/1981

21700 Revision of neck muscle 509.33 1/1/1981

21705 Revision of neck muscle/rib 685.62 1/1/1981



21740 Reconstruction of sternum 1172.51 1/1/1981

21742 Repair stern/nuss w/o scope 890.88 1/1/1981

21743 Repair sternum/nuss w/scope 1172.51 1/1/1981

21750 Repair of sternum separation 804.72 1/1/1981

21820 Treat sternum fracture 112.58 1/1/1981

21825 Treat sternum fracture 678.75 1/1/1981

21920 Biopsy soft tissue of back 109.32 1/1/1981

21925 Biopsy soft tissue of back 362.72 1/1/1981

21930 Exc back les sc < 3 cm 303.35 1/1/1981

21935 Resect back tum < 5 cm 1244.19 1/1/1981

22010 I&d p-spine c/t/cerv-thor 804.48 1/1/2006

22015 I&d abscess p-spine l/s/ls 797.46 1/1/2006

22100 Remove part of neck vertebra 736.30 1/1/1981

22101 Remove part thorax vertebra 763.09 1/1/1981

22102 Remove part lumbar vertebra 765.99 1/1/1981

22103 Remove extra spine segment 149.14 1/1/1981

22110 Remove part of neck vertebra 975.59 1/1/1981

22112 Remove part thorax vertebra 963.64 1/1/1981

22114 Remove part lumbar vertebra 955.68 1/1/1981

22116 Remove extra spine segment 149.14 1/1/1981

22210 Incis 1 vertebral seg cerv 1706.83 1/1/1981

22212 Incis 1 vertebral seg thorac 1377.41 1/1/1981

22214 Incis 1 vertebral seg lumbar 1405.64 1/1/1981

22216 Incis addl spine segment 386.97 1/1/1981

22220 Incis w/discectomy cervical 1524.38 1/1/1981

22222 Incis w/discectomy thoracic 1484.92 1/1/1981

22224 Incis w/discectomy lumbar 1513.52 1/1/1981

22226 Revise extra spine segment 385.16 1/1/1981

14/185


22310 Closed tx vert fx w/o manj 244.35 1/1/1981

22315 Closed tx vert fx w/manj 731.96 1/1/1981

22318 Treat odontoid fx w/o graft 1533.43 1/1/1981

22319 Treat odontoid fx w/graft 1736.51 1/1/1981

22325 Treat spine fracture 1341.93 1/1/1981

22326 Treat neck spine fracture 1457.05 1/1/1981

22327 Treat thorax spine fracture 1399.13 1/1/1981

22328 Treat each add spine fx 288.15 1/1/1981

22505 Manipulation of spine 200.18 1/1/1981

22510 Perq cervicothoracic inject 468.46 1/1/2015

22511 Perq lumbosacral injection 439.07 1/1/2015

22512 Vertebroplasty addl inject 212.89 1/1/2015

22548 Neck spine fusion 1837.51 1/1/1981


22556 Thorax spine fusion 1650.72 1/1/1981

22558 Lumbar spine fusion 1524.02 1/1/1981

22585 Additional spinal fusion 354.76 1/1/1981

22590 Spine & skull spinal fusion 1498.31 1/1/1981

22595 Neck spinal fusion 1412.16 1/1/1981


22610 Thorax spine fusion 1187.36 1/1/1981


22614 Spine fusion extra segment 413.04 1/1/1981


22632 Spine fusion extra segment 333.04 1/1/1981

22800 Post fusion </6 vert seg 1320.57 1/1/1981

22802 Post fusion 7-12 vert seg 2139.78 1/1/1981

22804 Post fusion 13/> vert seg 2469.20 1/1/1981

22808 Ant fusion 2-3 vert seg 1833.89 1/1/1981

22810 Ant fusion 4-7 vert seg 2036.25 1/1/1981

22812 Ant fusion 8/> vert seg 2217.25 1/1/1981

22818 Kyphectomy 1-2 segments 2192.99 1/1/1981

22819 Kyphectomy 3 or more 2387.75 1/1/1981

22830 Exploration of spinal fusion 848.52 1/1/1981

22840 Insert spine fixation device 802.19 1/1/1981








22848 Insert pelv fixation device 384.08 1/1/1981

22849 Reinsert spinal fixation 1333.97 1/1/1981

22850 Remove spine fixation device 746.80 1/1/1981

15/185



22853 INSJ BIOMECHANICAL DEVICE 263.16 1/1/2017




22900 Exc abdl tum deep < 5 cm 402.54 1/1/1981

23000 Removal of calcium deposits 442.72 1/1/1981

23020 Release shoulder joint 774.68 1/1/1981

23030 Drain shoulder lesion 310.23 1/1/1981

23031 Drain shoulder bursa 270.41 1/1/1981

23035 Drain shoulder bone lesion 971.97 1/1/1981

23040 Exploratory shoulder surgery 831.15 1/1/1981

23044 Exploratory shoulder surgery 705.17 1/1/1981

23065 Biopsy shoulder tissues 139.00 1/1/1981

23066 Biopsy shoulder tissues 405.07 1/1/1981

23075 Exc shoulder les sc < 3 cm 217.20 1/1/1981

23076 Exc shoulder tum deep < 5 cm 630.24 1/1/1981

23077 Resect shoulder tumor < 5 cm 1206.54 1/1/1981

23100 Biopsy of shoulder joint 583.18 1/1/1981

23101 Shoulder joint surgery 561.46 1/1/1981

23105 Remove shoulder joint lining 731.60 1/1/1981

23106 Incision of collarbone joint 601.28 1/1/1981

23107 Explore treat shoulder joint 757.30 1/1/1981

23120 Partial removal collar bone 661.01 1/1/1981

23125 Removal of collar bone 802.55 1/1/1981

23130 Remove shoulder bone part 690.33 1/1/1981

23140 Removal of bone lesion 599.11 1/1/1981



23150 Removal of humerus lesion 739.92 1/1/1981



23170 Remove collar bone lesion 712.41 1/1/1981

23172 Remove shoulder blade lesion 653.41 1/1/1981

23174 Remove humerus lesion 844.54 1/1/1981

23180 Remove collar bone lesion 969.79 1/1/1981

23182 Remove shoulder blade lesion 952.42 1/1/1981


23190 Partial removal of scapula 634.58 1/1/1981

23195 Removal of head of humerus 794.59 1/1/1981

23200 Resect clavicle tumor 1045.45 1/1/1981

23210 Resect scapula tumor 1049.80 1/1/1981

23220 Resect prox humerus tumor 1204.01 1/1/1981

23330 Remove shoulder foreign body 206.34 1/1/1981

23350 Injection for shoulder x-ray 51.76 1/1/1981

16/185


23395 Muscle transfer shoulder/arm 1243.10 1/1/1981

23397 Muscle transfers 1206.18 1/1/1981

23400 Fixation of shoulder blade 1122.20 1/1/1981

23405 Incision of tendon & muscle 716.76 1/1/1981

23406 Incise tendon(s) & muscle(s) 891.60 1/1/1981

23410 Repair rotator cuff acute 1000.20 1/1/1981

23412 Repair rotator cuff chronic 1056.31 1/1/1981

23415 Release of shoulder ligament 807.98 1/1/1981

23420 Repair of shoulder 1089.62 1/1/1981

23430 Repair biceps tendon 843.82 1/1/1981

23440 Remove/transplant tendon 879.66 1/1/1981

23450 Repair shoulder capsule 1058.48 1/1/1981






23470 Reconstruct shoulder joint 1299.21 1/1/1981

23472 Reconstruct shoulder joint 1525.83 1/1/1981

23480 Revision of collar bone 924.18 1/1/1981

23485 Revision of collar bone 1061.74 1/1/1981

23490 Reinforce clavicle 996.94 1/1/1981

23491 Reinforce shoulder bones 1113.87 1/1/1981

23500 Treat clavicle fracture 184.98 1/1/1981



23520 Treat clavicle dislocation 190.41 1/1/1981








23570 Treat shoulder blade fx 195.48 1/1/1981

23575 Treat shoulder blade fx 327.97 1/1/1981

23585 Treat scapula fracture 730.87 1/1/1981

23600 Treat humerus fracture 263.17 1/1/1981







23650 Treat shoulder dislocation 274.75 1/1/1981

17/185




23665 Treat dislocation/fracture 407.25 1/1/1981




23700 Fixation of shoulder 237.83 1/1/1981

23800 Fusion of shoulder joint 1138.49 1/1/1981

23802 Fusion of shoulder joint 1301.75 1/1/1981

23900 Amputation of arm & girdle 1440.39 1/1/1981

23920 Amputation at shoulder joint 1130.88 1/1/1981

23921 Amputation follow-up surgery 484.71 1/1/1981

23930 Drainage of arm lesion 271.86 1/1/1981

23931 Drainage of arm bursa 215.02 1/1/1981

23935 Drain arm/elbow bone lesion 743.54 1/1/1981

24000 Exploratory elbow surgery 473.49 1/1/1981

24006 Release elbow joint 719.29 1/1/1981

24065 Biopsy arm/elbow soft tissue 204.16 1/1/1981

24066 Biopsy arm/elbow soft tissue 456.84 1/1/1981

24075 Exc arm/elbow les sc < 3 cm 383.72 1/1/1981

24076 Ex arm/elbow tum deep < 5 cm 537.93 1/1/1981

24077 Resect arm/elbow tum < 5 cm 1020.84 1/1/1981

24100 Biopsy elbow joint lining 425.71 1/1/1981

24101 Explore/treat elbow joint 516.21 1/1/1981

24102 Remove elbow joint lining 633.50 1/1/1981

24105 Removal of elbow bursa 350.77 1/1/1981


24115 Remove/graft bone lesion 806.89 1/1/1981


24120 Remove elbow lesion 541.91 1/1/1981



24130 Removal of head of radius 525.26 1/1/1981

24134 Removal of arm bone lesion 1032.06 1/1/1981

24136 Remove radius bone lesion 594.40 1/1/1981

24138 Remove elbow bone lesion 645.08 1/1/1981

24140 Partial removal of arm bone 1014.68 1/1/1981

24145 Partial removal of radius 749.70 1/1/1981

24147 Partial removal of elbow 748.61 1/1/1981

24149 Radical resection of elbow 1024.09 1/1/1981

24150 Resect distal humerus tumor 1123.28 1/1/1981

24152 Resect radius tumor 792.78 1/1/1981

24155 Removal of elbow joint 852.14 1/1/1981

24160 Remove elbow joint implant 624.08 1/1/1981

24164 Remove radius head implant 524.17 1/1/1981

18/185


24200 Removal of arm foreign body 192.94 1/1/1981

24201 Removal of arm foreign body 452.50 1/1/1981

24220 Injection for elbow x-ray 68.41 1/1/1981

24300 Manipulate elbow w/anesth 364.53 1/1/1981

24301 Muscle/tendon transfer 770.69 1/1/1981

24305 Arm tendon lengthening 603.45 1/1/1981

24310 Revision of arm tendon 566.89 1/1/1981

24320 Repair of arm tendon 852.51 1/1/1981

24330 Revision of arm muscles 732.68 1/1/1981

24331 Revision of arm muscles 797.12 1/1/1981

24332 Tenolysis triceps 501.37 1/1/1981

24340 Repair of biceps tendon 625.53 1/1/1981

24341 Repair arm tendon/muscle 629.88 1/1/1981

24342 Repair of ruptured tendon 803.64 1/1/1981

24343 Repr elbow lat ligmnt w/tiss 664.99 1/1/1981

24344 Reconstruct elbow lat ligmnt 1003.46 1/1/1981

24345 Repr elbw med ligmnt w/tissu 664.99 1/1/1981

24346 Reconstruct elbow med ligmnt 1003.46 1/1/1981

24360 Reconstruct elbow joint 908.98 1/1/1981



24363 Replace elbow joint 1302.11 1/1/1981

24365 Reconstruct head of radius 653.04 1/1/1981

24366 Reconstruct head of radius 706.98 1/1/1981

24400 Revision of humerus 938.66 1/1/1981



24430 Repair of humerus 1029.16 1/1/1981

24435 Repair humerus with graft 1085.63 1/1/1981

24470 Revision of elbow joint 619.74 1/1/1981

24495 Decompression of forearm 724.36 1/1/1981

24498 Reinforce humerus 969.79 1/1/1981














19/185






24586 Treat elbow fracture 1068.62 1/1/1981


24600 Treat elbow dislocation 367.79 1/1/1981






24650 Treat radius fracture 200.54 1/1/1981




24670 Treat ulnar fracture 223.35 1/1/1981



24800 Fusion of elbow joint 841.65 1/1/1981

24802 Fusion/graft of elbow joint 1013.23 1/1/1981

24900 Amputation of upper arm 828.61 1/1/1981

24920 Amputation of upper arm 925.63 1/1/1981



24931 Amputate upper arm & implant 968.35 1/1/1981

24935 Revision of amputation 1132.33 1/1/1981

24940 Revision of upper arm 1143.92 1/1/1981

25000 Incision of tendon sheath 424.26 1/1/1981

25001 Incise flexor carpi radialis 304.44 1/1/1981

25020 Decompress forearm 1 space 680.19 1/1/1981

25023 Decompress forearm 1 space 1195.32 1/1/1981

25024 Decompress forearm 2 spaces 705.53 1/1/1981

25025 Decompress forearm 2 spaces 1138.49 1/1/1981

25028 Drainage of forearm lesion 601.28 1/1/1981

25031 Drainage of forearm bursa 557.48 1/1/1981

25035 Treat forearm bone lesion 919.11 1/1/1981

25040 Explore/treat wrist joint 656.66 1/1/1981

25065 Biopsy forearm soft tissues 172.67 1/1/1981

25066 Biopsy forearm soft tissues 487.61 1/1/1981

25075 Exc forearm les sc < 3 cm 421.73 1/1/1981

25076 Exc forearm tum deep < 3 cm 681.64 1/1/1981

25077 Resect forearm/wrist tum<3cm 992.24 1/1/1981

25085 Incision of wrist capsule 655.94 1/1/1981

25100 Biopsy of wrist joint 464.44 1/1/1981

20/185


25101 Explore/treat wrist joint 488.33 1/1/1981

25105 Remove wrist joint lining 668.61 1/1/1981

25107 Remove wrist joint cartilage 699.02 1/1/1981

25110 Remove wrist tendon lesion 499.92 1/1/1981

25111 Remove wrist tendon lesion 393.85 1/1/1981

25112 Reremove wrist tendon lesion 468.06 1/1/1981

25115 Remove wrist/forearm lesion 1016.13 1/1/1981

25116 Remove wrist/forearm lesion 907.53 1/1/1981

25118 Excise wrist tendon sheath 481.46 1/1/1981

25119 Partial removal of ulna 685.26 1/1/1981

25120 Removal of forearm lesion 816.67 1/1/1981

25125 Remove/graft forearm lesion 922.73 1/1/1981

25126 Remove/graft forearm lesion 911.15 1/1/1981

25130 Removal of wrist lesion 533.58 1/1/1981

25135 Remove & graft wrist lesion 628.07 1/1/1981

25136 Remove & graft wrist lesion 590.78 1/1/1981

25145 Remove forearm bone lesion 848.16 1/1/1981



25170 Resect radius/ulnar tumor 1130.52 1/1/1981

25210 Removal of wrist bone 575.94 1/1/1981

25215 Removal of wrist bones 793.14 1/1/1981



25246 Injection for wrist x-ray 75.29 1/1/1981

25248 Remove forearm foreign body 611.41 1/1/1981

25250 Removal of wrist prosthesis 612.14 1/1/1981

25251 Removal of wrist prosthesis 869.52 1/1/1981

25259 Manipulate wrist w/anesthes 360.55 1/1/1981

25260 Repair forearm tendon/muscle 969.79 1/1/1981






25275 Repair forearm tendon sheath 641.10 1/1/1981

25280 Revise wrist/forearm tendon 896.67 1/1/1981

25290 Incise wrist/forearm tendon 904.63 1/1/1981

25295 Release wrist/forearm tendon 845.27 1/1/1981

25300 Fusion of tendons at wrist 743.91 1/1/1981

25301 Fusion of tendons at wrist 734.49 1/1/1981

25310 Transplant forearm tendon 959.66 1/1/1981

25312 Transplant forearm tendon 1050.16 1/1/1981

25315 Revise palsy hand tendon(s) 1125.45 1/1/1981

25316 Revise palsy hand tendon(s) 1216.68 1/1/1981

21/185


25320 Repair/revise wrist joint 883.28 1/1/1981

25332 Revise wrist joint 926.35 1/1/1981

25335 Realignment of hand 1052.69 1/1/1981

25337 Reconstruct ulna/radioulnar 946.26 1/1/1981

25350 Revision of radius 998.03 1/1/1981

25355 Revision of radius 1078.76 1/1/1981

25360 Revision of ulna 991.88 1/1/1981

25365 Revise radius & ulna 1228.99 1/1/1981

25370 Revise radius or ulna 1239.48 1/1/1981

25375 Revise radius & ulna 1173.24 1/1/1981

25390 Shorten radius or ulna 1092.51 1/1/1981

25391 Lengthen radius or ulna 1287.27 1/1/1981

25392 Shorten radius & ulna 1169.62 1/1/1981

25393 Lengthen radius & ulna 1476.23 1/1/1981

25394 Repair carpal bone shorten 745.72 1/1/1981

25400 Repair radius or ulna 1139.21 1/1/1981

25405 Repair/graft radius or ulna 1374.87 1/1/1981

25415 Repair radius & ulna 1287.27 1/1/1981

25420 Repair/graft radius & ulna 1507.36 1/1/1981

25425 Repair/graft radius or ulna 1482.02 1/1/1981

25426 Repair/graft radius & ulna 1355.69 1/1/1981

25430 Vasc graft into carpal bone 655.22 1/1/1981

25431 Repair nonunion carpal bone 645.80 1/1/1981

25440 Repair/graft wrist bone 857.21 1/1/1981

25441 Reconstruct wrist joint 1009.61 1/1/1981





25446 Wrist replacement 1242.02 1/1/1981

25447 Repair wrist joints 859.75 1/1/1981

25449 Remove wrist joint implant 1213.78 1/1/1981

25450 Revision of wrist joint 848.16 1/1/1981

25455 Revision of wrist joint 964.36 1/1/1981

25490 Reinforce radius 1027.35 1/1/1981

25491 Reinforce ulna 1062.83 1/1/1981

25492 Reinforce radius and ulna 1124.73 1/1/1981

25500 Treat fracture of radius 212.13 1/1/1981






25530 Treat fracture of ulna 195.84 1/1/1981


22/185



25560 Treat fracture radius & ulna 210.68 1/1/1981



25575 Treat fracture radius/ulna 848.16 1/1/1981



25622 Treat wrist bone fracture 225.88 1/1/1981







25651 Pin ulnar styloid fracture 392.04 1/1/1981

25652 Treat fracture ulnar styloid 578.47 1/1/1981

25660 Treat wrist dislocation 403.99 1/1/1981


25671 Pin radioulnar dislocation 477.47 1/1/1981



25680 Treat wrist fracture 487.25 1/1/1981

25685 Treat wrist fracture 794.22 1/1/1981



25800 Fusion of wrist joint 820.65 1/1/1981

25805 Fusion/graft of wrist joint 912.96 1/1/1981

25810 Fusion/graft of wrist joint 870.61 1/1/1981

25820 Fusion of hand bones 671.87 1/1/1981

25825 Fuse hand bones with graft 785.17 1/1/1981

25830 Fusion radioulnar jnt/ulna 1060.66 1/1/1981

25900 Amputation of forearm 940.83 1/1/1981





25920 Amputate hand at wrist 742.82 1/1/1981

25922 Amputate hand at wrist 595.85 1/1/1981


25927 Amputation of hand 895.58 1/1/1981



26010 Drainage of finger abscess 210.32 1/1/1981

26011 Drainage of finger abscess 335.21 1/1/1981

26020 Drain hand tendon sheath 688.52 1/1/1981

23/185


26025 Drainage of palm bursa 700.47 1/1/1981

26030 Drainage of palm bursas 774.68 1/1/1981

26034 Treat hand bone lesion 819.56 1/1/1981

26035 Decompress fingers/hand 965.45 1/1/1981

26037 Decompress fingers/hand 778.30 1/1/1981

26040 Release palm contracture 624.81 1/1/1981


26055 Incise finger tendon sheath 402.90 1/1/1981

26060 Incision of finger tendon 402.18 1/1/1981

26070 Explore/treat hand joint 589.33 1/1/1981

26075 Explore/treat finger joint 624.45 1/1/1981

26080 Explore/treat finger joint 669.33 1/1/1981

26100 Biopsy hand joint lining 470.23 1/1/1981

26105 Biopsy finger joint lining 641.82 1/1/1981

26110 Biopsy finger joint lining 616.48 1/1/1981

26115 Exc hand les sc < 1.5 cm 449.60 1/1/1981

26116 Exc hand tum deep < 1.5 cm 754.40 1/1/1981

26117 Rad resect hand tumor < 3 cm 934.68 1/1/1981




26130 Remove wrist joint lining 813.05 1/1/1981

26135 Revise finger joint each 932.15 1/1/1981

26140 Revise finger joint each 872.05 1/1/1981

26145 Tendon excision palm/finger 897.76 1/1/1981

26160 Remove tendon sheath lesion 427.88 1/1/1981

26170 Removal of palm tendon each 520.55 1/1/1981

26180 Removal of finger tendon 562.18 1/1/1981

26185 Remove finger bone 549.87 1/1/1981

26200 Remove hand bone lesion 756.94 1/1/1981


26210 Removal of finger lesion 754.04 1/1/1981

26215 Remove/graft finger lesion 852.14 1/1/1981

26230 Partial removal of hand bone 751.15 1/1/1981

26235 Partial removal finger bone 731.60 1/1/1981

26236 Partial removal finger bone 697.21 1/1/1981

26250 Extensive hand surgery 966.90 1/1/1981

26260 Resect prox finger tumor 908.62 1/1/1981

26262 Resect distal finger tumor 793.86 1/1/1981

26320 Removal of implant from hand 658.11 1/1/1981

26340 Manipulate finger w/anesth 275.48 1/1/1981

26350 Repair finger/hand tendon 1011.06 1/1/1981

26352 Repair/graft hand tendon 1062.47 1/1/1981



24/185






26390 Revise hand/finger tendon 1018.66 1/1/1981


26410 Repair hand tendon 805.08 1/1/1981


26415 Excision hand/finger tendon 1019.39 1/1/1981

26416 Graft hand or finger tendon 1106.27 1/1/1981

26418 Repair finger tendon 790.97 1/1/1981

26420 Repair/graft finger tendon 956.76 1/1/1981






26437 Realignment of tendons 776.85 1/1/1981

26440 Release palm/finger tendon 905.00 1/1/1981

26442 Release palm & finger tendon 1067.53 1/1/1981

26445 Release hand/finger tendon 867.71 1/1/1981

26449 Release forearm/hand tendon 1049.80 1/1/1981

26450 Incision of palm tendon 481.09 1/1/1981

26455 Incision of finger tendon 468.06 1/1/1981

26460 Incise hand/finger tendon 448.15 1/1/1981

26471 Fusion of finger tendons 764.18 1/1/1981

26474 Fusion of finger tendons 724.00 1/1/1981

26476 Tendon lengthening 693.95 1/1/1981

26477 Tendon shortening 730.15 1/1/1981

26478 Lengthening of hand tendon 798.57 1/1/1981

26479 Shortening of hand tendon 757.66 1/1/1981

26480 Transplant hand tendon 1018.30 1/1/1981

26483 Transplant/graft hand tendon 1091.06 1/1/1981

26485 Transplant palm tendon 1076.58 1/1/1981

26489 Transplant/graft palm tendon 1042.56 1/1/1981

26490 Revise thumb tendon 911.15 1/1/1981

26492 Tendon transfer with graft 997.67 1/1/1981

26494 Hand tendon/muscle transfer 866.26 1/1/1981

26496 Revise thumb tendon 984.27 1/1/1981

26497 Finger tendon transfer 1016.85 1/1/1981

26498 Finger tendon transfer 1269.53 1/1/1981

26499 Revision of finger 917.30 1/1/1981

26500 Hand tendon reconstruction 815.94 1/1/1981

26502 Hand tendon reconstruction 867.35 1/1/1981

26508 Release thumb contracture 782.64 1/1/1981

25/185


26510 Thumb tendon transfer 762.01 1/1/1981

26516 Fusion of knuckle joint 865.90 1/1/1981

26517 Fusion of knuckle joints 960.74 1/1/1981

26518 Fusion of knuckle joints 975.95 1/1/1981

26520 Release knuckle contracture 920.56 1/1/1981

26525 Release finger contracture 924.91 1/1/1981

26530 Revise knuckle joint 1008.89 1/1/1981

26531 Revise knuckle with implant 1062.10 1/1/1981

26535 Revise finger joint 637.12 1/1/1981

26536 Revise/implant finger joint 942.64 1/1/1981

26540 Repair hand joint 816.31 1/1/1981

26541 Repair hand joint with graft 978.12 1/1/1981

26542 Repair hand joint with graft 830.42 1/1/1981

26545 Reconstruct finger joint 894.14 1/1/1981

26546 Repair nonunion hand 974.14 1/1/1981

26548 Reconstruct finger joint 941.56 1/1/1981

26550 Construct thumb replacement 1993.53 1/1/1981

26551 Great toe-hand transfer 3086.05 1/1/1981

26553 Single transfer toe-hand 2869.93 1/1/1981

26554 Double transfer toe-hand 3568.23 1/1/1981

26555 Positional change of finger 1600.76 1/1/1981

26556 Toe joint transfer 3125.50 1/1/1981

26560 Repair of web finger 693.95 1/1/1981



26565 Correct metacarpal flaw 837.66 1/1/1981

26567 Correct finger deformity 852.87 1/1/1981

26568 Lengthen metacarpal/finger 1111.34 1/1/1981

26580 Repair hand deformity 1373.06 1/1/1981

26587 Reconstruct extra finger 734.13 1/1/1981

26590 Repair finger deformity 1261.20 1/1/1981

26591 Repair muscles of hand 669.33 1/1/1981

26593 Release muscles of hand 722.55 1/1/1981

26596 Excision constricting tissue 749.70 1/1/1981

26600 Treat metacarpal fracture 188.60 1/1/1981





26641 Treat thumb dislocation 349.33 1/1/1981

26645 Treat thumb fracture 383.35 1/1/1981



26670 Treat hand dislocation 335.57 1/1/1981


26/185


26676 Pin hand dislocation 586.07 1/1/1981



26700 Treat knuckle dislocation 263.17 1/1/1981


26706 Pin knuckle dislocation 435.12 1/1/1981


26720 Treat finger fracture each 133.94 1/1/1981









26756 Pin finger fracture each 512.95 1/1/1981


26770 Treat finger dislocation 226.97 1/1/1981


26776 Pin finger dislocation 525.98 1/1/1981


26820 Thumb fusion with graft 943.37 1/1/1981

26841 Fusion of thumb 880.02 1/1/1981

26842 Thumb fusion with graft 930.70 1/1/1981

26843 Fusion of hand joint 843.46 1/1/1981

26844 Fusion/graft of hand joint 954.59 1/1/1981

26850 Fusion of knuckle 842.73 1/1/1981

26852 Fusion of knuckle with graft 924.91 1/1/1981

26860 Fusion of finger joint 702.64 1/1/1981

26861 Fusion of finger jnt add-on 110.04 1/1/1981

26862 Fusion/graft of finger joint 879.29 1/1/1981

26863 Fuse/graft added joint 248.69 1/1/1981

26910 Amputate metacarpal bone 841.65 1/1/1981

26951 Amputation of finger/thumb 682.73 1/1/1981

26952 Amputation of finger/thumb 806.17 1/1/1981

26990 Drainage of pelvis lesion 911.15 1/1/1981

26991 Drainage of pelvis bursa 633.50 1/1/1981


27000 Incision of hip tendon 519.10 1/1/1981




27006 Incision of hip tendons 808.70 1/1/1981

27025 Incision of hip/thigh fascia 862.28 1/1/1981

27/185


27030 Drainage of hip joint 1020.84 1/1/1981

27033 Exploration of hip joint 1043.64 1/1/1981

27035 Denervation of hip joint 1421.57 1/1/1981

27036 Excision of hip joint/muscle 1075.14 1/1/1981

27040 Biopsy of soft tissues 263.89 1/1/1981

27041 Biopsy of soft tissues 727.62 1/1/1981

27047 Exc hip/pelvis les sc < 3 cm 570.15 1/1/1981

27048 Exc hip/pelv tum deep < 5 cm 557.84 1/1/1981

27049 Resect hip/pelv tum < 5 cm 1084.91 1/1/1981

27050 Biopsy of sacroiliac joint 464.80 1/1/1981

27052 Biopsy of hip joint 573.77 1/1/1981

27054 Removal of hip joint lining 763.09 1/1/1981

27060 Removal of ischial bursa 494.85 1/1/1981

27062 Remove femur lesion/bursa 503.18 1/1/1981

27065 Remove hip bone les super 573.40 1/1/1981

27066 Remove hip bone les deep 909.34 1/1/1981

27067 Remove/graft hip bone lesion 1135.23 1/1/1981

27070 Part remove hip bone super 1115.68 1/1/1981

27071 Part removal hip bone deep 1185.18 1/1/1981

27075 Resect hip tumor 2338.88 1/1/1981

27076 Resect hip tum incl acetabul 1685.11 1/1/1981

27077 Resect hip tum w/innom bone 2743.59 1/1/1981

27078 Rsect hip tum incl femur 1175.05 1/1/1981

27080 Removal of tail bone 554.94 1/1/1981

27086 Remove hip foreign body 214.66 1/1/1981

27087 Remove hip foreign body 698.29 1/1/1981

27090 Removal of hip prosthesis 901.01 1/1/1981

27091 Removal of hip prosthesis 1510.98 1/1/1981

27093 Injection for hip x-ray 71.31 1/1/1981

27095 Injection for hip x-ray 81.45 1/1/1981

27096 Inject sacroiliac joint 67.69 1/1/1981

27097 Revision of hip tendon 679.47 1/1/1981

27098 Transfer tendon to pelvis 720.74 1/1/1981

27100 Transfer of abdominal muscle 961.83 1/1/1981

27105 Transfer of spinal muscle 957.49 1/1/1981

27110 Transfer of iliopsoas muscle 1031.33 1/1/1981

27111 Transfer of iliopsoas muscle 949.52 1/1/1981

27120 Reconstruction of hip socket 1299.58 1/1/1981

27122 Reconstruction of hip socket 1180.48 1/1/1981

27125 Partial hip replacement 1151.52 1/1/1981

27130 Total hip arthroplasty 1501.57 1/1/1981

27132 Total hip arthroplasty 1705.02 1/1/1981

27134 Revise hip joint replacement 2031.90 1/1/1981



28/185


27140 Transplant femur ridge 969.07 1/1/1981

27146 Incision of hip bone 1330.35 1/1/1981

27147 Revision of hip bone 1535.24 1/1/1981

27151 Incision of hip bones 1668.82 1/1/1981

27156 Revision of hip bones 1794.43 1/1/1981

27158 Revision of pelvis 1417.95 1/1/1981

27161 Incision of neck of femur 1253.60 1/1/1981

27165 Incision/fixation of femur 1322.74 1/1/1981

27170 Repair/graft femur head/neck 1213.42 1/1/1981

27175 Treat slipped epiphysis 632.77 1/1/1981




27179 Revise head/neck of femur 962.55 1/1/1981


27185 Revision of femur epiphysis 768.16 1/1/1981

27187 Reinforce hip bones 1084.19 1/1/1981

27197 CLSD TX PELVIC RING FX 116.90 1/1/2017

27198 CLSD TX PELVIC RING FX 296.52 1/1/2017

27200 Treat tail bone fracture 145.88 1/1/1981

27202 Treat tail bone fracture 1099.39 1/1/1981

27215 Treat pelvic fracture(s) 824.27 1/1/1981

27216 Treat pelvic ring fracture 1230.07 1/1/1981



27220 Treat hip socket fracture 477.11 1/1/1981

27222 Treat hip socket fracture 929.61 1/1/1981

27226 Treat hip wall fracture 1022.65 1/1/1981

27227 Treat hip fracture(s) 1642.75 1/1/1981

27228 Treat hip fracture(s) 1892.89 1/1/1981

27230 Treat thigh fracture 469.15 1/1/1981










27250 Treat hip dislocation 528.88 1/1/1981





29/185







27275 Manipulation of hip joint 232.40 1/1/1981

27280 Fusion of sacroiliac joint 1098.30 1/1/1981

27282 Fusion of pubic bones 926.35 1/1/1981

27284 Fusion of hip joint 1665.92 1/1/1981

27286 Fusion of hip joint 1676.42 1/1/1981

27290 Amputation of leg at hip 1629.00 1/1/1981

27295 Amputation of leg at hip 1332.52 1/1/1981

27301 Drain thigh/knee lesion 799.29 1/1/1981


27305 Incise thigh tendon & fascia 583.18 1/1/1981

27306 Incision of thigh tendon 478.92 1/1/1981

27307 Incision of thigh tendons 551.68 1/1/1981

27310 Exploration of knee joint 775.04 1/1/1981

27323 Biopsy thigh soft tissues 221.54 1/1/1981

27324 Biopsy thigh soft tissues 459.37 1/1/1981

27327 Exc thigh/knee les sc < 3 cm 423.17 1/1/1981

27328 Exc thigh/knee tum deep <5cm 502.09 1/1/1981

27329 Resect thigh/knee tum < 5 cm 1152.97 1/1/1981

27330 Biopsy knee joint lining 451.05 1/1/1981

27331 Explore/treat knee joint 533.58 1/1/1981

27332 Removal of knee cartilage 683.81 1/1/1981

27333 Removal of knee cartilage 629.88 1/1/1981

27334 Remove knee joint lining 738.11 1/1/1981

27335 Remove knee joint lining 823.55 1/1/1981

27340 Removal of kneecap bursa 404.35 1/1/1981

27345 Removal of knee cyst 532.50 1/1/1981

27347 Remove knee cyst 342.81 1/1/1981

27350 Removal of kneecap 684.18 1/1/1981

27355 Remove femur lesion 714.95 1/1/1981

27356 Remove femur lesion/graft 827.17 1/1/1981

27357 Remove femur lesion/graft 889.79 1/1/1981

27358 Remove femur lesion/fixation 302.99 1/1/1981

27360 Partial removal leg bone(s) 1137.40 1/1/1981

27365 Resect femur/knee tumor 1243.47 1/1/1981

27370 Injection for knee x-ray 50.68 1/1/1981


27380 Repair of kneecap tendon 626.62 1/1/1981

27381 Repair/graft kneecap tendon 828.25 1/1/1981

27385 Repair of thigh muscle 665.71 1/1/1981

27386 Repair/graft of thigh muscle 867.71 1/1/1981

30/185


27390 Incision of thigh tendon 533.22 1/1/1981



27393 Lengthening of thigh tendon 589.69 1/1/1981

27394 Lengthening of thigh tendons 755.85 1/1/1981

27395 Lengthening of thigh tendons 994.05 1/1/1981

27396 Transplant of thigh tendon 697.57 1/1/1981

27397 Transplants of thigh tendons 919.84 1/1/1981

27400 Revise thigh muscles/tendons 781.19 1/1/1981

27403 Repair of knee cartilage 687.80 1/1/1981

27405 Repair of knee ligament 736.67 1/1/1981

27407 Repair of knee ligament 835.85 1/1/1981

27409 Repair of knee ligaments 1001.29 1/1/1981

27418 Repair degenerated kneecap 874.23 1/1/1981

27420 Revision of unstable kneecap 789.16 1/1/1981

27422 Revision of unstable kneecap 785.54 1/1/1981

27424 Revision/removal of kneecap 784.09 1/1/1981

27425 Lat retinacular release open 495.94 1/1/1981

27427 Reconstruction knee 756.94 1/1/1981



27430 Revision of thigh muscles 783.36 1/1/1981

27435 Incision of knee joint 767.44 1/1/1981

27437 Revise kneecap 737.75 1/1/1981

27438 Revise kneecap with implant 903.19 1/1/1981

27440 Revision of knee joint 852.14 1/1/1981






27447 Total knee arthroplasty 1565.28 1/1/1981

27448 Incision of thigh 919.11 1/1/1981

27450 Incision of thigh 1114.59 1/1/1981

27454 Realignment of thigh bone 1341.93 1/1/1981

27455 Realignment of knee 1017.22 1/1/1981

27457 Realignment of knee 1012.87 1/1/1981

27465 Shortening of thigh bone 1116.04 1/1/1981

27466 Lengthening of thigh bone 1286.91 1/1/1981

27468 Shorten/lengthen thighs 1355.32 1/1/1981

27470 Repair of thigh 1287.27 1/1/1981

27472 Repair/graft of thigh 1392.25 1/1/1981

27475 Surgery to stop leg growth 721.46 1/1/1981



31/185



27486 Revise/replace knee joint 1425.91 1/1/1981

27487 Revise/replace knee joint 1798.77 1/1/1981

27488 Removal of knee prosthesis 1203.65 1/1/1981

27495 Reinforce thigh 1254.69 1/1/1981

27496 Decompression of thigh/knee 555.30 1/1/1981




27500 Treatment of thigh fracture 535.03 1/1/1981












27516 Treat thigh fx growth plate 447.79 1/1/1981



27520 Treat kneecap fracture 264.26 1/1/1981

27524 Treat kneecap fracture 762.73 1/1/1981

27530 Treat knee fracture 322.54 1/1/1981




27538 Treat knee fracture(s) 417.02 1/1/1981


27550 Treat knee dislocation 457.20 1/1/1981





27560 Treat kneecap dislocation 308.42 1/1/1981



27570 Fixation of knee joint 195.84 1/1/1981

27580 Fusion of knee 1448.36 1/1/1981

27590 Amputate leg at thigh 973.41 1/1/1981



32/185




27598 Amputate lower leg at knee 877.12 1/1/1981

27600 Decompression of lower leg 523.81 1/1/1981



27603 Drain lower leg lesion 600.55 1/1/1981

27604 Drain lower leg bursa 504.99 1/1/1981

27605 Incision of achilles tendon 259.19 1/1/1981

27606 Incision of achilles tendon 366.70 1/1/1981

27607 Treat lower leg bone lesion 817.75 1/1/1981

27610 Explore/treat ankle joint 746.08 1/1/1981

27612 Exploration of ankle joint 623.72 1/1/1981

27613 Biopsy lower leg soft tissue 197.29 1/1/1981

27614 Biopsy lower leg soft tissue 502.81 1/1/1981

27615 Resect leg/ankle tum < 5 cm 1159.84 1/1/1981

27618 Exc leg/ankle tum < 3 cm 461.55 1/1/1981

27619 Exc leg/ankle tum deep <5 cm 709.15 1/1/1981

27620 Explore/treat ankle joint 562.18 1/1/1981

27625 Remove ankle joint lining 712.77 1/1/1981

27626 Remove ankle joint lining 768.88 1/1/1981

27630 Removal of tendon lesion 459.37 1/1/1981

27635 Remove lower leg bone lesion 747.89 1/1/1981

27637 Remove/graft leg bone lesion 883.64 1/1/1981

27638 Remove/graft leg bone lesion 920.92 1/1/1981

27640 Partial removal of tibia 1175.41 1/1/1981

27641 Partial removal of fibula 1011.06 1/1/1981

27645 Resect tibia tumor 1308.63 1/1/1981

27646 Resect fibula tumor 1224.28 1/1/1981

27647 Resect talus/calcaneus tum 942.64 1/1/1981

27648 Injection for ankle x-ray 50.68 1/1/1981

27650 Repair achilles tendon 772.87 1/1/1981

27652 Repair/graft achilles tendon 811.60 1/1/1981

27654 Repair of achilles tendon 815.22 1/1/1981

27656 Repair leg fascia defect 452.86 1/1/1981

27658 Repair of leg tendon each 554.58 1/1/1981




27675 Repair lower leg tendons 624.45 1/1/1981

27676 Repair lower leg tendons 722.19 1/1/1981

27680 Release of lower leg tendon 554.94 1/1/1981

27681 Release of lower leg tendons 622.27 1/1/1981

27685 Revision of lower leg tendon 594.04 1/1/1981

27686 Revise lower leg tendons 689.24 1/1/1981

33/185


27687 Revision of calf tendon 592.59 1/1/1981

27690 Revise lower leg tendon 731.60 1/1/1981

27691 Revise lower leg tendon 841.28 1/1/1981

27692 Revise additional leg tendon 116.56 1/1/1981

27695 Repair of ankle ligament 622.27 1/1/1981

27696 Repair of ankle ligaments 710.60 1/1/1981

27698 Repair of ankle ligament 763.45 1/1/1981

27700 Revision of ankle joint 691.42 1/1/1981

27702 Reconstruct ankle joint 1071.15 1/1/1981

27703 Reconstruction ankle joint 1176.13 1/1/1981

27704 Removal of ankle implant 657.39 1/1/1981

27705 Incision of tibia 874.95 1/1/1981

27707 Incision of fibula 504.26 1/1/1981

27709 Incision of tibia & fibula 854.68 1/1/1981

27712 Realignment of lower leg 1129.44 1/1/1981

27715 Revision of lower leg 1183.37 1/1/1981

27720 Repair of tibia 1015.77 1/1/1981

27722 Repair/graft of tibia 1008.53 1/1/1981

27724 Repair/graft of tibia 1403.83 1/1/1981

27725 Repair of lower leg 1251.07 1/1/1981

27727 Repair of lower leg 1133.06 1/1/1981

27730 Repair of tibia epiphysis 686.71 1/1/1981

27732 Repair of fibula epiphysis 492.68 1/1/1981

27734 Repair lower leg epiphyses 753.32 1/1/1981

27740 Repair of leg epiphyses 761.28 1/1/1981

27742 Repair of leg epiphyses 791.33 1/1/1981

27745 Reinforce tibia 863.00 1/1/1981

27750 Treatment of tibia fracture 285.25 1/1/1981





27760 Cltx medial ankle fx 272.22 1/1/1981

27762 Cltx med ankle fx w/mnpj 438.38 1/1/1981

27766 Optx medial ankle fx 666.08 1/1/1981

27780 Treatment of fibula fracture 249.78 1/1/1981



27786 Treatment of ankle fracture 261.72 1/1/1981







34/185





27824 Treat lower leg fracture 291.41 1/1/1981





27829 Treat lower leg joint 559.65 1/1/1981

27830 Treat lower leg dislocation 321.09 1/1/1981



27840 Treat ankle dislocation 420.64 1/1/1981




27860 Fixation of ankle joint 240.73 1/1/1981

27870 Fusion of ankle joint open 1108.80 1/1/1981

27871 Fusion of tibiofibular joint 805.08 1/1/1981

27880 Amputation of lower leg 940.83 1/1/1981





27888 Amputation of foot at ankle 824.63 1/1/1981

27889 Amputation of foot at ankle 808.34 1/1/1981

27892 Decompression of leg 622.64 1/1/1981



28001 Drainage of bursa of foot 229.14 1/1/1981

28002 Treatment of foot infection 351.14 1/1/1981

28003 Treatment of foot infection 750.78 1/1/1981

28005 Treat foot bone lesion 751.51 1/1/1981

28008 Incision of foot fascia 426.43 1/1/1981

28010 Incision of toe tendon 322.54 1/1/1981

28011 Incision of toe tendons 431.50 1/1/1981

28020 Exploration of foot joint 466.25 1/1/1981

28022 Exploration of foot joint 432.59 1/1/1981

28024 Exploration of toe joint 431.14 1/1/1981

28035 Decompression of tibia nerve 417.38 1/1/1981

28043 Exc foot/toe tum sc < 1.5 cm 335.21 1/1/1981

28045 Exc foot/toe tum deep <1.5cm 417.38 1/1/1981

28046 Resect foot/toe tumor < 3 cm 847.80 1/1/1981

28050 Biopsy of foot joint lining 408.33 1/1/1981

28052 Biopsy of foot joint lining 382.27 1/1/1981

35/185


28054 Biopsy of toe joint lining 352.22 1/1/1981

28060 Partial removal foot fascia 465.17 1/1/1981

28062 Removal of foot fascia 532.86 1/1/1981

28070 Removal of foot joint lining 445.62 1/1/1981

28072 Removal of foot joint lining 445.62 1/1/1981

28080 Removal of foot lesion 359.46 1/1/1981

28086 Excise foot tendon sheath 470.23 1/1/1981

28088 Excise foot tendon sheath 412.31 1/1/1981


28092 Removal of toe lesions 381.18 1/1/1981

28100 Removal of ankle/heel lesion 528.88 1/1/1981

28102 Remove/graft foot lesion 662.09 1/1/1981





28108 Removal of toe lesions 375.75 1/1/1981

28110 Part removal of metatarsal 428.24 1/1/1981




28114 Removal of metatarsal heads 823.91 1/1/1981

28116 Revision of foot 566.89 1/1/1981

28118 Removal of heel bone 523.81 1/1/1981

28119 Removal of heel spur 459.74 1/1/1981

28120 Part removal of ankle/heel 596.21 1/1/1981

28122 Partial removal of foot bone 664.63 1/1/1981

28124 Partial removal of toe 489.78 1/1/1981


28130 Removal of ankle bone 673.32 1/1/1981

28140 Removal of metatarsal 586.07 1/1/1981

28150 Removal of toe 437.29 1/1/1981



28171 Resect tarsal tumor 709.88 1/1/1981

28173 Resect metatarsal tumor 699.74 1/1/1981

28175 Resect phalanx of toe tumor 515.85 1/1/1981

28190 Removal of foot foreign body 211.04 1/1/1981



28200 Repair of foot tendon 430.78 1/1/1981

28202 Repair/graft of foot tendon 543.36 1/1/1981

28208 Repair of foot tendon 411.59 1/1/1981

28210 Repair/graft of foot tendon 504.62 1/1/1981

28220 Release of foot tendon 433.31 1/1/1981

36/185


28222 Release of foot tendons 492.68 1/1/1981

28225 Release of foot tendon 364.53 1/1/1981

28226 Release of foot tendons 442.36 1/1/1981

28230 Incision of foot tendon(s) 436.93 1/1/1981

28232 Incision of toe tendon 389.87 1/1/1981

28234 Incision of foot tendon 372.49 1/1/1981

28238 Revision of foot tendon 614.31 1/1/1981

28240 Release of big toe 426.07 1/1/1981

28250 Revision of foot fascia 518.74 1/1/1981

28260 Release of midfoot joint 640.74 1/1/1981

28261 Revision of foot tendon 861.92 1/1/1981

28262 Revision of foot and ankle 1240.57 1/1/1981

28264 Release of midfoot joint 853.59 1/1/1981

28270 Release of foot contracture 481.82 1/1/1981

28272 Release of toe joint each 367.79 1/1/1981

28280 Fusion of toes 474.94 1/1/1981

28285 Repair of hammertoe 449.24 1/1/1981

28286 Repair of hammertoe 447.79 1/1/1981

28288 Partial removal of foot bone 502.45 1/1/1981

28289 CORRJ HALUX RIGDUS W/O IMPLT 664.99 1/1/1981

28292 CORRECTION HALLUX VALGUS 588.25 1/1/1981





28300 Incision of heel bone 759.11 1/1/1981

28302 Incision of ankle bone 744.63 1/1/1981

28304 Incision of midfoot bones 673.32 1/1/1981

28305 Incise/graft midfoot bones 784.81 1/1/1981

28306 Incision of metatarsal 493.40 1/1/1981



28309 Incision of metatarsals 953.50 1/1/1981

28310 Revision of big toe 491.59 1/1/1981

28312 Revision of toe 488.70 1/1/1981

28313 Repair deformity of toe 552.77 1/1/1981

28315 Removal of sesamoid bone 424.62 1/1/1981

28320 Repair of foot bones 728.70 1/1/1981

28322 Repair of metatarsals 669.70 1/1/1981

28340 Resect enlarged toe tissue 532.86 1/1/1981

28341 Resect enlarged toe 616.48 1/1/1981

28344 Repair extra toe(s) 364.17 1/1/1981

28345 Repair webbed toe(s) 537.20 1/1/1981

28360 Reconstruct cleft foot 1027.35 1/1/1981

28400 Treatment of heel fracture 269.69 1/1/1981

37/185




28415 Treat heel fracture 1270.25 1/1/1981

28420 Treat/graft heel fracture 1305.37 1/1/1981




28445 Treat ankle fracture 1148.98 1/1/1981

28450 Treat midfoot fracture each 233.12 1/1/1981


28456 Treat midfoot fracture 348.96 1/1/1981


28470 Treat metatarsal fracture 212.13 1/1/1981




28490 Treat big toe fracture 128.51 1/1/1981




28510 Treatment of toe fracture 129.23 1/1/1981

28515 Treatment of toe fracture 146.97 1/1/1981

28525 Treat toe fracture 371.77 1/1/1981

28530 Treat sesamoid bone fracture 153.85 1/1/1981

28531 Treat sesamoid bone fracture 278.01 1/1/1981

28540 Treat foot dislocation 225.88 1/1/1981



28555 Repair foot dislocation 582.09 1/1/1981









28630 Treat toe dislocation 157.83 1/1/1981



28645 Repair toe dislocation 342.09 1/1/1981




28675 Repair of toe dislocation 308.42 1/1/1981

38/185


28705 Fusion of foot bones 1366.55 1/1/1981





28737 Revision of foot bones 750.42 1/1/1981


28750 Fusion of big toe joint 654.13 1/1/1981



28800 Amputation of midfoot 676.21 1/1/1981

28805 Amputation thru metatarsal 686.35 1/1/1981

28810 Amputation toe & metatarsal 556.39 1/1/1981

28820 Amputation of toe 452.13 1/1/1981

28825 Partial amputation of toe 410.87 1/1/1981

29000 Application of body cast 157.83 1/1/1981







29049 Application of figure eight 59.00 1/1/1981

29055 Application of shoulder cast 128.51 1/1/1981

29058 Application of shoulder cast 81.08 1/1/1981

29065 Application of long arm cast 62.98 1/1/1981

29075 Application of forearm cast 56.47 1/1/1981

29085 Apply hand/wrist cast 59.73 1/1/1981

29086 Apply finger cast 44.52 1/1/1981

29105 Apply long arm splint 56.11 1/1/1981

29125 Apply forearm splint 39.45 1/1/1981

29126 Apply forearm splint 48.14 1/1/1981

29130 Application of finger splint 27.15 1/1/1981

29131 Application of finger splint 30.04 1/1/1981

29200 Strapping of chest 39.45 1/1/1981

29240 Strapping of shoulder 42.71 1/1/1981

29260 Strapping of elbow or wrist 34.75 1/1/1981

29280 Strapping of hand or finger 35.11 1/1/1981

29305 Application of hip cast 146.61 1/1/1981

29325 Application of hip casts 165.43 1/1/1981

29345 Application of long leg cast 97.74 1/1/1981


29358 Apply long leg cast brace 100.63 1/1/1981


29405 Apply short leg cast 61.54 1/1/1981

39/185




29440 Addition of walker to cast 33.66 1/1/1981

29445 Apply rigid leg cast 111.49 1/1/1981

29450 Application of leg cast 123.08 1/1/1981

29505 Application long leg splint 45.61 1/1/1981

29515 Application lower leg splint 47.78 1/1/1981

29520 Strapping of hip 36.92 1/1/1981

29530 Strapping of knee 36.20 1/1/1981

29540 Strapping of ankle and/or ft 32.21 1/1/1981

29550 Strapping of toes 30.04 1/1/1981

29580 Application of paste boot 36.56 1/1/1981

29581 Apply multlay comprs lwr leg 32.66 1/1/2010

29700 Removal/revision of cast 34.39 1/1/1981



29720 Repair of body cast 42.71 1/1/1981

29730 Windowing of cast 45.25 1/1/1981

29740 Wedging of cast 64.43 1/1/1981

29750 Wedging of clubfoot cast 76.02 1/1/1981

29800 Jaw arthroscopy/surgery 614.67 1/1/1981

29804 Jaw arthroscopy/surgery 653.41 1/1/1981

29805 Shoulder arthroscopy dx 372.13 1/1/1981

29806 Shoulder arthroscopy/surgery 1036.76 1/1/1981










29827 Arthroscop rotator cuff repr 1074.77 1/1/1981

29830 Elbow arthroscopy 474.94 1/1/1981

29834 Elbow arthroscopy/surgery 527.07 1/1/1981





29840 Wrist arthroscopy 546.98 1/1/1981

29843 Wrist arthroscopy/surgery 581.73 1/1/1981




40/185



29848 Wrist endoscopy/surgery 547.70 1/1/1981

29850 Knee arthroscopy/surgery 612.14 1/1/1981


29855 Tibial arthroscopy/surgery 848.89 1/1/1981

29856 Tibial arthroscopy/surgery 1071.88 1/1/1981

29860 Hip arthroscopy dx 645.44 1/1/1981

29861 Hip arthro w/fb removal 717.12 1/1/1981

29862 Hip arthr0 w/debridement 787.71 1/1/1981

29863 Hip arthr0 w/synovectomy 809.07 1/1/1981

29870 Knee arthroscopy dx 449.60 1/1/1981

29871 Knee arthroscopy/drainage 591.87 1/1/1981

















29891 Ankle arthroscopy/surgery 692.14 1/1/1981


29893 Scope plantar fasciotomy 431.50 1/1/1981






29900 Mcp joint arthroscopy dx 448.51 1/1/1981

29901 Mcp joint arthroscopy surg 494.49 1/1/1981

29902 Mcp joint arthroscopy surg 531.05 1/1/1981

30000 Drainage of nose lesion 113.30 1/1/1981

30020 Drainage of nose lesion 114.75 1/1/1981

30100 Intranasal biopsy 56.83 1/1/1981

30110 Removal of nose polyp(s) 97.74 1/1/1981

30115 Removal of nose polyp(s) 342.45 1/1/1981

30117 Removal of intranasal lesion 245.07 1/1/1981

41/185


30118 Removal of intranasal lesion 703.00 1/1/1981

30120 Revision of nose 424.26 1/1/1981

30124 Removal of nose lesion 246.16 1/1/1981

30125 Removal of nose lesion 532.86 1/1/1981

30130 Excise inferior turbinate 282.72 1/1/1981

30140 Resect inferior turbinate 308.78 1/1/1981

30150 Partial removal of nose 697.93 1/1/1981

30160 Removal of nose 713.14 1/1/1981

30200 Injection treatment of nose 48.14 1/1/1981

30210 Nasal sinus therapy 65.88 1/1/1981

30220 Insert nasal septal button 92.31 1/1/1981

30300 Remove nasal foreign body 54.66 1/1/1981



30400 Reconstruction of nose 729.43 1/1/1981



30430 Revision of nose 567.61 1/1/1981

30435 Revision of nose 875.67 1/1/1981

30450 Revision of nose 1285.82 1/1/1981

30460 Revision of nose 743.91 1/1/1981

30462 Revision of nose 1333.97 1/1/1981

30465 Repair nasal stenosis 826.08 1/1/1981

30520 Repair of nasal septum 448.51 1/1/1981

30540 Repair nasal defect 557.48 1/1/1981

30545 Repair nasal defect 794.59 1/1/1981

30560 Release of nasal adhesions 106.79 1/1/1981

30580 Repair upper jaw fistula 453.22 1/1/1981

30600 Repair mouth/nose fistula 434.03 1/1/1981

30620 Intranasal reconstruction 488.33 1/1/1981

30630 Repair nasal septum defect 553.13 1/1/1981

30801 Ablate inf turbinate superf 129.95 1/1/1981

30802 Ablate inf turbinate submuc 188.24 1/1/1981

30901 Control of nosebleed 60.81 1/1/1981



30906 Repeat control of nosebleed 144.43 1/1/1981

30915 Ligation nasal sinus artery 552.05 1/1/1981

30920 Ligation upper jaw artery 712.77 1/1/1981

30930 Ther fx nasal inf turbinate 131.40 1/1/1981

31000 Irrigation maxillary sinus 70.22 1/1/1981

31002 Irrigation sphenoid sinus 153.48 1/1/1981

31020 Exploration maxillary sinus 254.12 1/1/1981


31032 Explore sinus remove polyps 491.23 1/1/1981

42/185


31040 Exploration behind upper jaw 649.79 1/1/1981

31050 Exploration sphenoid sinus 401.82 1/1/1981

31051 Sphenoid sinus surgery 533.22 1/1/1981

31070 Exploration of frontal sinus 358.38 1/1/1981

31075 Exploration of frontal sinus 676.57 1/1/1981

31080 Removal of frontal sinus 793.14 1/1/1981






31090 Exploration of sinuses 716.03 1/1/1981

31200 Removal of ethmoid sinus 412.31 1/1/1981



31225 Removal of upper jaw 1340.12 1/1/1981

31230 Removal of upper jaw 1514.24 1/1/1981

31231 Nasal endoscopy dx 66.60 1/1/1981

31233 Nasal/sinus endoscopy dx 132.85 1/1/1981

31235 Nasal/sinus endoscopy dx 160.00 1/1/1981

31237 Nasal/sinus endoscopy surg 179.91 1/1/1981




31254 Revision of ethmoid sinus 288.15 1/1/1981



31267 Endoscopy maxillary sinus 338.10 1/1/1981

31276 Sinus endoscopy surgical 546.25 1/1/1981








31300 Removal of larynx lesion 1219.94 1/1/1981

31320 Diagnostic incision larynx 680.56 1/1/1981

31360 Removal of larynx 1397.68 1/1/1981

31365 Removal of larynx 1827.01 1/1/1981

31367 Partial removal of larynx 1763.66 1/1/1981





43/185



31390 Removal of larynx & pharynx 2173.81 1/1/1981

31395 Reconstruct larynx & pharynx 2547.75 1/1/1981

31400 Revision of larynx 999.12 1/1/1981

31420 Removal of epiglottis 989.70 1/1/1981

31500 Insert emergency airway 117.28 1/1/1981

31502 Change of windpipe airway 35.47 1/1/1981

31505 Diagnostic laryngoscopy 37.28 1/1/1981

31510 Laryngoscopy with biopsy 115.47 1/1/1981

31511 Remove foreign body larynx 113.66 1/1/1981

31512 Removal of larynx lesion 123.80 1/1/1981

31513 Injection into vocal cord 132.49 1/1/1981

31515 Laryngoscopy for aspiration 104.61 1/1/1981

31520 Dx laryngoscopy newborn 153.48 1/1/1981

31525 Dx laryngoscopy excl nb 161.09 1/1/1981

31526 Dx laryngoscopy w/oper scope 161.09 1/1/1981

31527 Laryngoscopy for treatment 194.75 1/1/1981

31528 Laryngoscopy and dilation 139.73 1/1/1981

31529 Laryngoscopy and dilation 166.15 1/1/1981

31530 Laryngoscopy w/fb removal 204.89 1/1/1981

31531 Laryngoscopy w/fb & op scope 223.71 1/1/1981

31535 Laryngoscopy w/biopsy 195.48 1/1/1981

31536 Laryngoscopy w/bx & op scope 221.54 1/1/1981

31540 Laryngoscopy w/exc of tumor 256.29 1/1/1981

31541 Larynscop w/tumr exc + scope 281.27 1/1/1981

31560 Laryngoscop w/arytenoidectom 332.31 1/1/1981

31561 Larynscop remve cart + scop 347.88 1/1/1981

31570 Laryngoscope w/vc inj 238.19 1/1/1981

31571 Laryngoscop w/vc inj + scope 261.00 1/1/1981

31575 Diagnostic laryngoscopy 65.88 1/1/1981

31576 Laryngoscopy with biopsy 118.01 1/1/1981

31577 LARGSC W/RMVL FOREIGN BDY(S) 146.61 1/1/1981

31578 LARGSC W/REMOVAL LESION 173.03 1/1/1981

31579 LARYNGOSCOPY TELESCOPIC 136.83 1/1/1981

31580 LARYNGOPLASTY LARYNGEAL WEB 1122.20 1/1/1981

31584 LARYNGOPLASTY FX RDCTJ FIXJ 1493.25 1/1/1981

31587 LARYNGOPLASTY CRICOID SPLIT 1030.25 1/1/1981

31590 Reinnervate larynx 750.42 1/1/1981

31595 Larynx nerve surgery 778.30 1/1/1981

31600 Incision of windpipe 394.58 1/1/1981





31611 Surgery/speech prosthesis 609.24 1/1/1981

44/185


31612 Puncture/clear windpipe 53.93 1/1/1981

31613 Repair windpipe opening 519.47 1/1/1981

31614 Repair windpipe opening 750.42 1/1/1981

31615 Visualization of windpipe 127.42 1/1/1981

31622 Dx bronchoscope/wash 152.40 1/1/1981

31623 Dx bronchoscope/brush 154.93 1/1/1981

31624 Dx bronchoscope/lavage 154.57 1/1/1981

31625 Bronchoscopy w/biopsy(s) 179.91 1/1/1981

31626 Bronchoscopy w/markers 213.74 1/1/2010

31627 Navigational bronchoscopy 103.97 1/1/2010

31628 Bronchoscopy/lung bx each 199.10 1/1/1981

31629 Bronchoscopy/needle bx each 178.10 1/1/1981

31630 Bronchoscopy dilate/fx repr 226.97 1/1/1981

31631 Bronchoscopy dilate w/stent 249.41 1/1/1981

31632 Bronchoscopy/lung bx addl 58.29 1/1/2004

31633 Bronchoscopy/needle bx addl 72.27 1/1/2004

31635 Bronchoscopy w/fb removal 207.06 1/1/1981

31640 Bronchoscopy w/tumor excise 284.53 1/1/1981

31641 Bronchoscopy treat blockage 278.74 1/1/1981

31643 Diag bronchoscope/catheter 177.74 1/1/1981

31645 Bronchoscopy clear airways 168.33 1/1/1981

31646 Bronchoscopy reclear airway 146.24 1/1/1981

31652 Bronch ebus samplng 1/2 node 235.49 1/1/2016

31653 Bronch ebus samplng 3/> node 259.88 1/1/2016

31654 Bronch ebus ivntj perph les 67.95 1/1/2016

31717 Bronchial brush biopsy 114.39 1/1/1981

31720 Clearance of airways 54.30 1/1/1981

31725 Clearance of airways 98.46 1/1/1981

31730 Intro windpipe wire/tube 152.76 1/1/1981

31750 Repair of windpipe 1128.35 1/1/1981



31766 Reconstruction of windpipe 1810.72 1/1/1981

31770 Repair/graft of bronchus 1507.73 1/1/1981

31775 Reconstruct bronchus 1553.34 1/1/1981

31780 Reconstruct windpipe 1200.39 1/1/1981

31781 Reconstruct windpipe 1528.00 1/1/1981

31785 Remove windpipe lesion 1177.22 1/1/1981

31786 Remove windpipe lesion 1510.62 1/1/1981

31800 Repair of windpipe injury 555.67 1/1/1981

31805 Repair of windpipe injury 944.45 1/1/1981

31820 Closure of windpipe lesion 482.18 1/1/1981

31825 Repair of windpipe defect 678.02 1/1/1981

31830 Revise windpipe scar 473.49 1/1/1981

32035 Thoracostomy w/rib resection 654.49 1/1/1981

45/185


32036 Thoracostomy w/flap drainage 720.38 1/1/1981

32100 Exploration of chest 1005.27 1/1/1981

32110 Explore/repair chest 1386.46 1/1/1981

32120 Re-exploration of chest 833.32 1/1/1981

32124 Explore chest free adhesions 887.26 1/1/1981

32140 Removal of lung lesion(s) 948.44 1/1/1981

32141 Remove/treat lung lesions 960.02 1/1/1981

32150 Removal of lung lesion(s) 949.52 1/1/1981

32151 Remove lung foreign body 965.81 1/1/1981

32160 Open chest heart massage 620.83 1/1/1981

32200 Drain open lung lesion 999.12 1/1/1981

32215 Treat chest lining 815.22 1/1/1981

32220 Release of lung 1487.82 1/1/1981

32225 Partial release of lung 956.40 1/1/1981

32310 Removal of chest lining 932.15 1/1/1981

32320 Free/remove chest lining 1479.49 1/1/1981

32400 NEEDLE BIOPSY CHEST LINING 89.41 1/1/1981

32405 Percut bx lung/mediastinum 99.18 1/1/1981

32440 Remove lung pneumonectomy 1531.98 1/1/1981

32442 Sleeve pneumonectomy 1630.81 1/1/1981

32445 Removal of lung extrapleural 1568.90 1/1/1981

32480 Partial removal of lung 1442.93 1/1/1981

32482 Bilobectomy 1516.05 1/1/1981

32484 Segmentectomy 1314.06 1/1/1981

32486 Sleeve lobectomy 1502.66 1/1/1981

32488 Completion pneumonectomy 1596.78 1/1/1981

32491 Lung volume reduction 1366.18 1/1/1981

32501 Repair bronchus add-on 254.84 1/1/1981

32540 Removal of lung lesion 988.98 1/1/1981

32550 Insert pleural cath 208.59 1/1/2008

32551 Insertion of chest tube 165.30 1/1/2008

32552 Remove lung catheter 163.57 1/1/2010

32553 Ins mark thor for rt perq 210.83 1/1/2010

32554 Aspirate pleura w/o imaging 98.09 1/1/2013

32555 Aspirate pleura w/ imaging 123.12 1/1/2013

32556 Insert cath pleura w/o image 134.98 1/1/2013

32557 Insert cath pleura w/ image 184.24 1/1/2013

32561 Lyse chest fibrin init day 73.44 1/1/2010

32562 Lyse chest fibrin subq day 65.73 1/1/2010

32601 Thoracoscopy diagnostic 361.63 1/1/1981

32604 Thoracoscopy wbx sac 541.91 1/1/1981

32606 Thoracoscopy w/bx med space 520.19 1/1/1981

32650 Thoracoscopy w/pleurodesis 764.54 1/1/1981

32651 Thoracoscopy remove cortex 867.71 1/1/1981

32652 Thoracoscopy rem totl cortex 1199.30 1/1/1981

46/185


32653 Thoracoscopy remov fb/fibrin 880.38 1/1/1981

32654 Thoracoscopy contrl bleeding 801.83 1/1/1981

32655 Thoracoscopy resect bullae 876.76 1/1/1981

32656 Thoracoscopy w/pleurectomy 898.48 1/1/1981

32658 Thoracoscopy w/sac fb remove 827.89 1/1/1981

32659 Thoracoscopy w/sac drainage 824.63 1/1/1981

32661 Thoracoscopy w/pericard exc 898.84 1/1/1981

32662 Thoracoscopy w/mediast exc 1084.55 1/1/1981

32663 Thoracoscopy w/lobectomy 1193.87 1/1/1981

32664 Thoracoscopy w/ th nrv exc 945.54 1/1/1981

32665 Thoracoscop w/esoph musc exc 988.98 1/1/1981

32701 Thorax stereo rad targetw/tx 248.08 1/1/2013

32800 Repair lung hernia 942.28 1/1/1981

32810 Close chest after drainage 920.56 1/1/1981

32815 Close bronchial fistula 1467.54 1/1/1981

32820 Reconstruct injured chest 1408.90 1/1/1981

32900 Removal of rib(s) 1305.01 1/1/1981

32905 Revise & repair chest wall 1346.27 1/1/1981

32906 Revise & repair chest wall 1649.27 1/1/1981

32940 Revision of lung 1264.82 1/1/1981

32960 Therapeutic pneumothorax 98.46 1/1/1981

32997 Total lung lavage 317.47 1/1/1981

33010 Drainage of heart sac 125.25 1/1/1981

33011 Repeat drainage of heart sac 126.70 1/1/1981

33015 Incision of heart sac 441.27 1/1/1981



33030 Partial removal of heart sac 1241.66 1/1/1981

33031 Partial removal of heart sac 1410.71 1/1/1981

33050 Resect heart sac lesion 983.19 1/1/1981

33120 Removal of heart lesion 1617.05 1/1/1981


33140 Heart revascularize (tmr) 1224.64 1/1/1981

33141 Heart tmr w/other procedure 261.36 1/1/1981

33206 Insert heart pm atrial 465.89 1/1/1981

33207 Insert heart pm ventricular 543.00 1/1/1981

33208 Insrt heart pm atrial & vent 550.24 1/1/1981

33210 Insert electrd/pm cath sngl 177.74 1/1/1981

33211 Insert card electrodes dual 184.25 1/1/1981

33212 Insert pulse gen sngl lead 386.97 1/1/1981

33213 Insert pulse gen dual leads 434.40 1/1/1981

33214 Upgrade of pacemaker system 528.52 1/1/1981

33215 Reposition pacing-defib lead 307.33 1/1/1981

33216 Insert 1 electrode pm-defib 398.20 1/1/1981

33217 Insert 2 electrode pm-defib 422.81 1/1/1981

47/185


33218 Repair lead pace-defib one 385.16 1/1/1981

33220 Repair lead pace-defib dual 385.16 1/1/1981

33221 Insert pulse gen mult leads 398.85 1/1/2012

33222 Relocation pocket pacemaker 345.34 1/1/1981

33223 Relocate pocket for defib 444.53 1/1/1981

33224 Insert pacing lead & connect 492.32 1/1/1981

33225 L ventric pacing lead add-on 436.21 1/1/1981

33226 Reposition l ventric lead 474.58 1/1/1981

33227 Remove&replace pm gen singl 380.71 1/1/2012

33228 Remv&replc pm gen dual lead 396.99 1/1/2012

33229 Remv&replc pm gen mult leads 413.27 1/1/2012

33230 Insrt pulse gen w/dual leads 429.15 1/1/2012

33231 Insrt pulse gen w/mult leads 445.43 1/1/2012

33233 Removal of pm generator 272.22 1/1/1981

33234 Removal of pacemaker system 498.11 1/1/1981

33235 Removal pacemaker electrode 607.07 1/1/1981

33236 Remove electrode/thoracotomy 875.31 1/1/1981



33240 Insrt pulse gen w/singl lead 506.07 1/1/1981

33241 Remove pulse generator 254.48 1/1/1981

33243 Remove eltrd/thoracotomy 1343.74 1/1/1981

33244 Remove elctrd transvenously 855.76 1/1/1981

33249 Insj/rplcmt defib w/lead(s) 890.52 1/1/1981

33250 Ablate heart dysrhythm focus 1352.43 1/1/1981



33262 Rmvl& replc pulse gen 1 lead 413.61 1/1/2012

33263 Rmvl & rplcmt dfb gen 2 lead 429.89 1/1/2012

33264 Rmvl & rplcmt dfb gen mlt ld 446.17 1/1/2012

33282 Implant pat-active ht record 334.85 1/1/1981

33284 Remove pat-active ht record 249.05 1/1/1981

33300 Repair of heart wound 1170.34 1/1/1981

33305 Repair of heart wound 1395.14 1/1/1981

33310 Exploratory heart surgery 1218.13 1/1/1981

33315 Exploratory heart surgery 1445.82 1/1/1981

33320 Repair major blood vessel(s) 1099.39 1/1/1981

33321 Repair major vessel 1347.72 1/1/1981

33322 Repair major blood vessel(s) 1349.89 1/1/1981

33330 Insert major vessel graft 1353.15 1/1/1981

33335 Insert major vessel graft 1865.02 1/1/1981

33404 Prepare heart-aorta conduit 1830.99 1/1/1981

33405 REPLACEMENT AORTIC VALVE OPN 2107.56 1/1/1981



48/185


33411 Replacement of aortic valve 2180.68 1/1/1981



33414 Repair of aortic valve 1934.52 1/1/1981

33415 Revision subvalvular tissue 1751.71 1/1/1981

33416 Revise ventricle muscle 1876.60 1/1/1981

33417 Repair of aortic valve 1837.51 1/1/1981

33420 Revision of mitral valve 1333.24 1/1/1981


33425 Repair of mitral valve 1677.14 1/1/1981



33430 Replacement of mitral valve 2040.95 1/1/1981

33460 Revision of tricuspid valve 1510.98 1/1/1981

33463 Valvuloplasty tricuspid 1619.95 1/1/1981

33464 Valvuloplasty tricuspid 1718.77 1/1/1981

33465 Replace tricuspid valve 1794.79 1/1/1981

33468 Revision of tricuspid valve 1987.74 1/1/1981

33470 Revision of pulmonary valve 1414.33 1/1/1981

33471 Valvotomy pulmonary valve 1434.60 1/1/1981


33475 Replacement pulmonary valve 2003.67 1/1/1981

33476 Revision of heart chamber 1577.95 1/1/1981

33477 Implant tcat pulm vlv perq 1309.42 1/1/2016


33496 Repair prosth valve clot 1775.24 1/1/1981

33500 Repair heart vessel fistula 1578.32 1/1/1981

33501 Repair heart vessel fistula 1121.83 1/1/1981

33502 Coronary artery correction 1501.21 1/1/1981

33503 Coronary artery graft 1377.41 1/1/1981

33504 Coronary artery graft 1652.53 1/1/1981

33505 Repair artery w/tunnel 1726.01 1/1/1981

33506 Repair artery translocation 2156.07 1/1/1981

33508 Endoscopic vein harvest 16.65 1/1/1981

33510 Cabg vein single 1775.97 1/1/1981

33511 Cabg vein two 1841.13 1/1/1981

33512 Cabg vein three 1945.02 1/1/1981

33513 Cabg vein four 1969.64 1/1/1981

33514 Cabg vein five 2022.13 1/1/1981

33516 Cabg vein six or more 2142.67 1/1/1981

33517 Cabg artery-vein single 139.73 1/1/1981

33518 Cabg artery-vein two 263.89 1/1/1981

33519 Cabg artery-vein three 387.34 1/1/1981

33521 Cabg artery-vein four 512.23 1/1/1981

33522 Cabg artery-vein five 636.39 1/1/1981

49/185


33523 Cabg art-vein six or more 759.47 1/1/1981

33530 Coronary artery bypass/reop 318.92 1/1/1981

33533 Cabg arterial single 1881.67 1/1/1981

33534 Cabg arterial two 1986.65 1/1/1981

33535 Cabg arterial three 2097.42 1/1/1981

33536 Cabg arterial four or more 2233.17 1/1/1981


33545 Repair of heart damage 2275.17 1/1/1981

33572 Open coronary endarterectomy 241.45 1/1/1981

33600 Closure of valve 1843.30 1/1/1981

33602 Closure of valve 1791.53 1/1/1981

33606 Anastomosis/artery-aorta 1934.89 1/1/1981

33608 Repair anomaly w/conduit 1929.82 1/1/1981

33610 Repair by enlargement 2000.05 1/1/1981

33611 Repair double ventricle 2098.15 1/1/1981

33612 Repair double ventricle 2226.30 1/1/1981

33615 Repair modified fontan 2101.77 1/1/1981

33617 Repair single ventricle 2324.40 1/1/1981

33619 Repair single ventricle 2839.52 1/1/1981

33641 Repair heart septum defect 1339.76 1/1/1981

33645 Revision of heart veins 1569.63 1/1/1981

33647 Repair heart septum defects 1834.97 1/1/1981

33660 Repair of heart defects 1857.78 1/1/1981


33670 Repair of heart chambers 1996.06 1/1/1981




33690 Reinforce pulmonary artery 1332.88 1/1/1981






33720 Repair of heart defect 1727.82 1/1/1981

33722 Repair of heart defect 1841.13 1/1/1981

33730 Repair heart-vein defect(s) 2060.86 1/1/1981

33732 Repair heart-vein defect 1821.22 1/1/1981




33750 Major vessel shunt 1337.59 1/1/1981



33764 Major vessel shunt & graft 1412.16 1/1/1981

50/185




33770 Repair great vessels defect 2257.43 1/1/1981










33786 Repair arterial trunk 2369.29 1/1/1981

33788 Revision of pulmonary artery 1673.16 1/1/1981

33800 Aortic suspension 1132.69 1/1/1981

33802 Repair vessel defect 1170.34 1/1/1981

33803 Repair vessel defect 1337.22 1/1/1981

33813 Repair septal defect 1403.83 1/1/1981


33820 Revise major vessel 1096.49 1/1/1981



33840 Remove aorta constriction 1384.65 1/1/1981





33860 Ascending aortic graft 2275.53 1/1/1981

33863 Ascending aortic graft 2632.10 1/1/1981

33870 Transverse aortic arch graft 2601.69 1/1/1981

33875 Thoracic aortic graft 2021.04 1/1/1981

33877 Thoracoabdominal graft 2522.41 1/1/1981

33910 Remove lung artery emboli 1560.94 1/1/1981

33915 Remove lung artery emboli 1280.39 1/1/1981

33916 Surgery of great vessel 1655.42 1/1/1981

33917 Repair pulmonary artery 1607.64 1/1/1981

33920 Repair pulmonary atresia 1970.36 1/1/1981

33922 Transect pulmonary artery 1475.15 1/1/1981

33924 Remove pulmonary shunt 309.51 1/1/1981

33967 Insert i-aort percut device 262.08 1/1/1981

33968 Remove aortic assist device 35.47 1/1/1981

33970 Aortic circulation assist 365.25 1/1/1981

33971 Aortic circulation assist 689.24 1/1/1981

33973 Insert balloon device 528.52 1/1/1981

33974 Remove intra-aortic balloon 991.15 1/1/1981

51/185


33975 Implant ventricular device 1104.10 1/1/1981

33976 Implant ventricular device 1252.88 1/1/1981

33977 Remove ventricular device 1201.84 1/1/1981

33978 Remove ventricular device 1330.71 1/1/1981

33979 Insert intracorporeal device 2520.24 1/1/1981

33980 Remove intracorporeal device 3243.15 1/1/1981

34001 Removal of artery clot 758.02 1/1/1981



34111 Removal of arm artery clot 584.63 1/1/1981



34203 Removal of leg artery clot 948.07 1/1/1981

34401 Removal of vein clot 1355.69 1/1/1981





34501 Repair valve femoral vein 979.93 1/1/1981

34502 Reconstruct vena cava 1537.77 1/1/1981

34510 Transposition of vein valve 1144.28 1/1/1981

34520 Cross-over vein graft 1075.50 1/1/1981

34530 Leg vein fusion 1014.32 1/1/1981

34800 Endovas aaa repr w/sm tube 1188.44 1/1/1981

34802 Endovas aaa repr w/2-p part 1311.16 1/1/1981

34804 Endovas aaa repr w/1-p part 1311.16 1/1/1981

34808 Endovas iliac a device addon 225.16 1/1/1981

34812 Xpose for endoprosth femorl 368.15 1/1/1981

34813 Femoral endovas graft add-on 261.72 1/1/1981

34820 Xpose for endoprosth iliac 531.77 1/1/1981

34825 Endovasc extend prosth init 711.33 1/1/1981

34826 Endovasc exten prosth addl 225.16 1/1/1981

34830 Open aortic tube prosth repr 1848.01 1/1/1981

34831 Open aortoiliac prosth repr 1997.87 1/1/1981

34832 Open aortofemor prosth repr 1997.87 1/1/1981

34833 Xpose for endoprosth iliac 654.49 1/1/1981

34834 Xpose endoprosth brachial 309.51 1/1/1981

34900 Endovasc iliac repr w/graft 970.88 1/1/1981

35001 Repair defect of artery 1137.76 1/1/1981

35002 Repair artery rupture neck 1186.63 1/1/1981



35013 Repair artery rupture arm 1221.75 1/1/1981


35022 Repair artery rupture chest 1290.53 1/1/1981

52/185


35045 Repair defect of arm artery 994.41 1/1/1981


35082 Repair artery rupture aorta 2145.93 1/1/1981






35112 Repair artery rupture spleen 1630.44 1/1/1981


35122 Repair artery rupture belly 1944.66 1/1/1981


35132 Repair artery rupture groin 1656.51 1/1/1981


35142 Repair artery rupture thigh 1291.25 1/1/1981


35152 Repair ruptd popliteal art 1411.43 1/1/1981

35180 Repair blood vessel lesion 802.55 1/1/1981

























35301 Rechanneling of artery 1093.60 1/1/1981



53/185










35390 Reoperation carotid add-on 174.48 1/1/1981

35400 Angioscopy 163.62 1/1/1981

35500 Harvest vein for bypass 346.79 1/1/1981

35501 Art byp grft ipsilat carotid 1106.27 1/1/1981

35506 Art byp grft subclav-carotid 1130.52 1/1/1981

35508 Art byp grft carotid-vertbrl 1078.39 1/1/1981

35509 Art byp grft contral carotid 1039.66 1/1/1981

35511 Art byp grft subclav-subclav 1178.31 1/1/1981

35515 Art byp grft subclav-vertbrl 1070.79 1/1/1981

35516 Art byp grft subclav-axilary 861.92 1/1/1981

35518 Art byp grft axillary-axilry 1180.12 1/1/1981

35521 Art byp grft axill-femoral 1245.64 1/1/1981

35526 Art byp grft aor/carot/innom 1643.48 1/1/1981

35531 Art byp grft aorcel/aormesen 1991.00 1/1/1981

35533 Art byp grft axill/fem/fem 1563.11 1/1/1981

35536 Art byp grft splenorenal 1751.35 1/1/1981

35556 Art byp grft fem-popliteal 1255.77 1/1/1981

35558 Art byp grft fem-femoral 1183.01 1/1/1981

35560 Art byp grft aortorenal 1777.05 1/1/1981

35563 Art byp grft ilioiliac 1345.91 1/1/1981

35565 Art byp grft iliofemoral 1294.51 1/1/1981

35566 Art byp fem-ant-post tib/prl 1554.06 1/1/1981

35571 Art byp pop-tibl-prl-other 1425.19 1/1/1981

35572 Harvest femoropopliteal vein 372.49 1/1/1981

35583 Vein byp grft fem-popliteal 1323.83 1/1/1981

35585 Vein byp fem-tibial peroneal 1719.86 1/1/1981

35587 Vein byp pop-tibl peroneal 1476.59 1/1/1981

35600 Harvest art for cabg add-on 280.91 1/1/1981

35601 Art byp common ipsi carotid 1009.25 1/1/1981

35606 Art byp carotid-subclavian 1074.05 1/1/1981

35612 Art byp subclav-subclavian 900.65 1/1/1981

35616 Art byp subclav-axillary 916.94 1/1/1981

35621 Art byp axillary-femoral 1131.61 1/1/1981

35623 Art byp axillary-pop-tibial 1341.21 1/1/1981

35626 Art byp aorsubcl/carot/innom 1552.61 1/1/1981

35631 Art byp aor-celiac-msn-renal 1877.69 1/1/1981

35636 Art byp spenorenal 1638.05 1/1/1981

54/185


35642 Art byp carotid-vertebral 1032.42 1/1/1981

35645 Art byp subclav-vertebrl 1033.51 1/1/1981

35646 Art byp aortobifemoral 1756.78 1/1/1981

35647 Art byp aortofemoral 1599.31 1/1/1981

35650 Art byp axillary-axillary 1061.38 1/1/1981

35654 Art byp axill-fem-femoral 1400.21 1/1/1981

35656 Art byp femoral-popliteal 1124.73 1/1/1981

35661 Art byp femoral-femoral 1067.53 1/1/1981

35663 Art byp ilioiliac 1231.16 1/1/1981

35665 Art byp iliofemoral 1186.27 1/1/1981

35666 Art byp fem-ant-post tib/prl 1351.70 1/1/1981

35671 Art byp pop-tibl-prl-other 1172.88 1/1/1981

35681 Composite byp grft pros&vein 87.24 1/1/1981

35682 Composite byp grft 2 veins 392.77 1/1/1981

35683 Composite byp grft 3/> segmt 464.44 1/1/1981

35685 Bypass graft patency/patch 221.54 1/1/1981

35686 Bypass graft/av fist patency 183.53 1/1/1981

35691 Art trnsposj vertbrl carotid 1034.59 1/1/1981

35693 Art trnsposj subclavian 887.98 1/1/1981

35694 Art trnsposj subclav carotid 1091.79 1/1/1981

35695 Art trnsposj carotid subclav 1090.71 1/1/1981

35700 Reoperation bypass graft 167.96 1/1/1981

35701 Exploration carotid artery 514.04 1/1/1981

35721 Exploration femoral artery 478.92 1/1/1981

35741 Exploration popliteal artery 523.09 1/1/1981

35761 Exploration of artery/vein 389.87 1/1/1981

35800 Explore neck vessels 438.38 1/1/1981

35820 Explore chest vessels 701.55 1/1/1981

35840 Explore abdominal vessels 597.66 1/1/1981

35860 Explore limb vessels 365.62 1/1/1981

35870 Repair vessel graft defect 1298.85 1/1/1981

35875 Removal of clot in graft 660.28 1/1/1981

35876 Removal of clot in graft 1045.45 1/1/1981

35879 Revise graft w/vein 933.59 1/1/1981

35881 Revise graft w/vein 1043.28 1/1/1981

35901 Excision graft neck 557.48 1/1/1981

35903 Excision graft extremity 695.04 1/1/1981

35905 Excision graft thorax 1810.00 1/1/1981

35907 Excision graft abdomen 1931.27 1/1/1981

36000 Place needle in vein 8.68 1/1/1981

36002 Pseudoaneurysm injection trt 113.66 1/1/1981

36005 Injection ext venography 49.23 1/1/1981

36010 Place catheter in vein 127.06 1/1/1981



55/185


36013 Place catheter in artery 121.99 1/1/1981



36100 Establish access to artery 161.45 1/1/1981



36160 Establish access to aorta 134.30 1/1/1981

36200 Place catheter in aorta 157.47 1/1/1981





36221 Place cath thoracic aorta 240.59 1/1/2013

36222 Place cath carotid/inom art 324.66 1/1/2013

36223 Place cath carotid/inom art 350.92 1/1/2013

36224 Place cath carotd art 382.22 1/1/2013

36225 Place cath subclavian art 349.32 1/1/2013

36226 Place cath vertebral art 382.98 1/1/2013

36227 Place cath xtrnl carotid 120.70 1/1/2013

36228 Place cath intracranial art 246.30 1/1/2013

36245 Ins cath abd/l-ext art 1st 247.24 1/1/1981

36246 Ins cath abd/l-ext art 2nd 275.48 1/1/1981

36247 Ins cath abd/l-ext art 3rd 327.97 1/1/1981

36248 Ins cath abd/l-ext art addl 53.21 1/1/1981

36260 Insertion of infusion pump 608.88 1/1/1981

36261 Revision of infusion pump 350.77 1/1/1981

36262 Removal of infusion pump 262.45 1/1/1981

36400 Bl draw < 3 yrs fem/jugular 18.10 1/1/1981

36405 Bl draw <3 yrs scalp vein 15.20 1/1/1981

36406 Bl draw <3 yrs other vein 9.41 1/1/1981

36410 Non-routine bl draw 3/> yrs 8.68 1/1/1981

36415 Routine venipuncture 3.98 1/1/1981

36416 Capillary blood draw 4.34 1/1/1981

36420 Vein access cutdown < 1 yr 53.21 1/1/1981

36425 Vein access cutdown > 1 yr 36.20 1/1/1981

36430 Blood transfusion service 38.01 1/1/1981

36440 Bl push transfuse 2 yr/< 52.49 1/1/1981

36450 Bl exchange/transfuse nb 114.75 1/1/1981

36455 Bl exchange/transfuse non-nb 129.23 1/1/1981

36456 PRTL EXCHANGE TRANSFUSE NB 107.02 1/1/2017

36460 Transfusion service fetal 360.19 1/1/1981

36468 INJECTION(S) SPIDER VEINS 25.70 1/1/1981

36470 Injection therapy of vein 59.00 1/1/1981

36471 Injection therapy of veins 85.43 1/1/1981

36473 ENDOVENOUS MCHNCHEM 1ST VEIN 172.84 1/1/2017

56/185


36481 Insertion of catheter vein 379.37 1/1/1981



36511 Apheresis wbc 92.31 1/1/1981

36512 Apheresis rbc 92.31 1/1/1981

36513 Apheresis platelets 92.31 1/1/1981

36514 Apheresis plasma 92.31 1/1/1981

36515 Apheresis adsorp/reinfuse 92.31 1/1/1981

36516 Apheresis selective 92.31 1/1/1981

36522 Photopheresis 107.51 1/1/1981

36555 Insert non-tunnel cv cath 141.30 1/1/2004

36556 Insert non-tunnel cv cath 126.77 1/1/2004

36557 Insert tunneled cv cath 316.15 1/1/2004







36568 Insert picc cath 103.86 1/1/2004

36569 Insert picc cath 97.20 1/1/2004

36570 Insert picvad cath 326.74 1/1/2004

36571 Insert picvad cath 325.60 1/1/2004

36575 Repair tunneled cv cath 60.30 1/1/2004

36576 Repair tunneled cv cath 213.05 1/1/2004

36578 Replace tunneled cv cath 241.37 1/1/2004

36580 Replace cvad cath 71.86 1/1/2004




36584 Replace picc cath 72.78 1/1/2004

36585 Replace picvad cath 306.45 1/1/2004

36589 Removal tunneled cv cath 105.50 1/1/2004

36590 Removal tunneled cv cath 204.87 1/1/2004

36591 Draw blood off venous device 20.64 1/1/2008

36592 Collect blood from picc 25.51 1/1/2008

36593 Declot vascular device 36.79 1/1/2008

36595 Mech remov tunneled cv cath 203.25 1/1/2004

36596 Mech remov tunneled cv cath 49.28 1/1/2004

36597 Reposition venous catheter 65.06 1/1/2004

36600 Withdrawal of arterial blood 15.92 1/1/1981

36620 Insertion catheter artery 53.93 1/1/1981




57/185


36680 Insert needle bone cavity 72.03 1/1/1981

36800 Insertion of cannula 155.66 1/1/1981



36819 Av fuse uppr arm basilic 823.18 1/1/1981

36820 Av fusion/forearm vein 823.18 1/1/1981

36821 Av fusion direct any site 556.39 1/1/1981

36823 Insertion of cannula(s) 1259.39 1/1/1981

36825 Artery-vein autograft 615.40 1/1/1981

36830 Artery-vein nonautograft 725.44 1/1/1981

36831 Open thrombect av fistula 475.66 1/1/1981

36832 Av fistula revision open 641.82 1/1/1981

36833 Av fistula revision 721.10 1/1/1981

36835 Artery to vein shunt 464.44 1/1/1981

36838 Dist revas ligation hemo 1263.15 1/1/2004

36860 External cannula declotting 127.42 1/1/1981

36861 Cannula declotting 154.21 1/1/1981

37140 Revision of circulation 1308.63 1/1/1981




37181 Splice spleen/kidney veins 1501.93 1/1/1981

37182 Insert hepatic shunt (tips) 923.10 1/1/1981

37183 Remove hepatic shunt (tips) 427.16 1/1/1981

37184 PRIM ART M-THRMBC 1ST VSL 462.54 1/1/2006

37185 PRIM ART M-THROMBECT ADD-ON 169.11 1/1/2006

37186 SEC ART M-THROMBECT ADD-ON 253.68 1/1/2006

37187 Venous mech thrombectomy 430.20 1/1/2006

37188 Venous m-thrombectomy add-on 311.10 1/1/2006

37191 Ins endovas vena cava filtr 265.61 1/1/2012

37192 Redo endovas vena cava filtr 411.12 1/1/2012

37193 Rem endovas vena cava filter 410.74 1/1/2012

37195 Thrombolytic therapy stroke 304.44 1/1/1981

37200 Transcatheter biopsy 234.21 1/1/1981

37236 Open/perq place stent 1st 499.49 1/1/2014

37237 Open/perq place stent ea add 233.41 1/1/2014

37238 Open/perq place stent same 349.96 1/1/2014

37239 Open/perq place stent ea add 162.90 1/1/2014

37241 VASC EMBOLIZE/OCCLUDE VENOUS 478.94 1/1/2014

37242 VASC EMBOLIZE/OCCLUDE ARTERY 534.80 1/1/2014

37243 VASC EMBOLIZE/OCCLUDE ORGAN 637.61 1/1/2014

37244 Vasc embolize/occlude bleed 743.72 1/1/2014

37252 Intrvasc us noncoronary 1st 93.78 1/1/2016

37253 Intrvasc us noncoronary addl 75.00 1/1/2016

37500 Endoscopy ligate perf veins 744.99 1/1/1981

58/185


37565 Ligation of neck vein 616.48 1/1/1981

37600 Ligation of neck artery 671.51 1/1/1981



37607 Ligation of a-v fistula 393.13 1/1/1981

37609 Temporal artery procedure 215.39 1/1/1981


37616 Ligation of chest artery 1080.93 1/1/1981

37617 Ligation of abdomen artery 1245.64 1/1/1981

37618 Ligation of extremity artery 333.76 1/1/1981

37619 Ligation of inf vena cava 1849.00 1/1/2012

37650 Revision of major vein 482.90 1/1/1981

37660 Revision of major vein 1170.34 1/1/1981

37700 Revise leg vein 273.67 1/1/1981

37735 Removal of leg veins/lesion 657.75 1/1/1981

37760 Ligate leg veins radical 646.89 1/1/1981

37765 Stab phleb veins xtr 10-20 472.33 1/1/2004

37766 Phleb veins - extrem 20+ 573.05 1/1/2004

37780 Revision of leg vein 266.43 1/1/1981

37785 Ligate/divide/excise vein 267.15 1/1/1981

37788 Revascularization penis 1389.35 1/1/1981

37790 Penile venous occlusion 586.07 1/1/1981

38100 Removal of spleen total 837.66 1/1/1981

38101 Removal of spleen partial 890.88 1/1/1981

38102 Removal of spleen total 261.00 1/1/1981

38115 Repair of ruptured spleen 908.62 1/1/1981

38120 Laparoscopy splenectomy 979.21 1/1/1981

38200 Injection for spleen x-ray 136.11 1/1/1981

38204 Bl donor search management 102.46 12/1/2010

38205 Harvest allogeneic stem cell 79.64 1/1/1981

38206 Harvest auto stem cells 79.64 1/1/1981

38207 Cryopreserve stem cells 65.16 1/1/1981

38208 Thaw preserved stem cells 71.31 1/1/1981

38209 Wash harvest stem cells 62.98 1/1/1981

38210 T-cell depletion of harvest 68.41 1/1/1981

38211 Tumor cell deplete of harvst 68.41 1/1/1981

38212 Rbc depletion of harvest 68.41 1/1/1981

38213 Platelet deplete of harvest 68.41 1/1/1981

38214 Volume deplete of harvest 56.83 1/1/1981

38215 Harvest stem cell concentrte 68.41 1/1/1981

38220 Bone marrow aspiration 57.19 1/1/1981

38221 Bone marrow biopsy 72.76 1/1/1981

38230 Bone marrow harvest allogen 268.26 10/1/2003

38240 Transplt allo hct/donor 118.01 1/1/1981

38241 Transplt autol hct/donor 117.28 1/1/1981

59/185


38242 Transplt allo lymphocytes 90.86 1/1/1981

38300 Drainage lymph node lesion 178.46 1/1/1981

38305 Drainage lymph node lesion 475.30 1/1/1981

38308 Incision of lymph channels 460.10 1/1/1981

38380 Thoracic duct procedure 587.52 1/1/1981



38500 Biopsy/removal lymph nodes 247.60 1/1/1981

38505 Needle biopsy lymph nodes 87.96 1/1/1981





38542 Explore deep node(s) neck 465.89 1/1/1981

38550 Removal neck/armpit lesion 470.23 1/1/1981

38555 Removal neck/armpit lesion 934.68 1/1/1981

38562 Removal pelvic lymph nodes 679.47 1/1/1981

38564 Removal abdomen lymph nodes 686.35 1/1/1981

38570 Laparoscopy lymph node biop 549.51 1/1/1981

38571 Laparoscopy lymphadenectomy 813.41 1/1/1981

38572 Laparoscopy lymphadenectomy 951.33 1/1/1981

38700 Removal of lymph nodes neck 838.03 1/1/1981



38740 Remove armpit lymph nodes 616.48 1/1/1981

38745 Remove armpit lymph nodes 834.41 1/1/1981

38746 Remove thoracic lymph nodes 263.89 1/1/1981

38747 Remove abdominal lymph nodes 265.70 1/1/1981

38760 Remove groin lymph nodes 786.62 1/1/1981

38765 Remove groin lymph nodes 1227.54 1/1/1981

38770 Remove pelvis lymph nodes 792.41 1/1/1981

38780 Remove abdomen lymph nodes 1037.13 1/1/1981

38790 Inject for lymphatic x-ray 68.05 1/1/1981

38792 Ra tracer id of sentinl node 27.87 1/1/1981

38794 Access thoracic lymph duct 228.42 1/1/1981



39200 Resect mediastinal cyst 947.71 1/1/1981

39220 Resect mediastinal tumor 1150.43 1/1/1981

39401 Mediastinoscpy w/medstnl bx 315.42 1/1/2016

39402 Mediastinoscpy w/lmph nod bx 411.66 1/1/2016

39501 Repair diaphragm laceration 834.41 1/1/1981

39503 Repair of diaphragm hernia 5010.80 1/1/1981



60/185


39545 Revision of diaphragm 904.63 1/1/1981

39560 Resect diaphragm simple 782.28 1/1/1981

39561 Resect diaphragm complex 1092.87 1/1/1981

40490 Biopsy of lip 70.59 1/1/1981

40500 Partial excision of lip 384.44 1/1/1981



40525 Reconstruct lip with flap 636.75 1/1/1981

40527 Reconstruct lip with flap 729.06 1/1/1981

40530 Partial removal of lip 463.72 1/1/1981

40650 Repair lip 341.00 1/1/1981

40652 Repair lip 436.93 1/1/1981

40654 Repair lip 513.31 1/1/1981

40700 Repair cleft lip/nasal 915.13 1/1/1981





40800 Drainage of mouth lesion 64.43 1/1/1981


40804 Removal foreign body mouth 125.25 1/1/1981

40805 Removal foreign body mouth 212.49 1/1/1981

40806 Incision of lip fold 45.61 1/1/1981

40808 Biopsy of mouth lesion 117.28 1/1/1981

40810 Excision of mouth lesion 144.43 1/1/1981

40812 Excise/repair mouth lesion 201.63 1/1/1981

40814 Excise/repair mouth lesion 289.23 1/1/1981


40818 Excise oral mucosa for graft 246.16 1/1/1981

40819 Excise lip or cheek fold 225.88 1/1/1981

40820 Treatment of mouth lesion 136.47 1/1/1981

40830 Repair mouth laceration 163.26 1/1/1981

40831 Repair mouth laceration 200.91 1/1/1981

40840 Reconstruction of mouth 575.21 1/1/1981











41010 Incision of tongue fold 175.57 1/1/1981

61/185






41100 Biopsy of tongue 163.98 1/1/1981

41105 Biopsy of tongue 146.97 1/1/1981

41108 Biopsy of floor of mouth 131.04 1/1/1981

41110 Excision of tongue lesion 158.55 1/1/1981




41115 Excision of tongue fold 163.98 1/1/1981


41120 Partial removal of tongue 729.06 1/1/1981

41130 Partial removal of tongue 808.34 1/1/1981

41135 Tongue and neck surgery 1538.13 1/1/1981

41140 Removal of tongue 1662.66 1/1/1981

41145 Tongue removal neck surgery 1989.19 1/1/1981

41150 Tongue mouth jaw surgery 1574.70 1/1/1981

41153 Tongue mouth neck surgery 1618.14 1/1/1981

41155 Tongue jaw & neck surgery 1865.74 1/1/1981

41250 REPAIR TONGUE LACERATION 142.62 1/1/1981

41251 Repair tongue laceration 161.09 1/1/1981

41252 Repair tongue laceration 205.61 1/1/1981

41500 Fixation of tongue 313.13 1/1/1981

41510 Tongue to lip surgery 337.74 1/1/1981

41520 Reconstruction tongue fold 222.63 1/1/1981

41800 DRAINAGE OF GUM LESION 100.27 1/1/1981

41805 Removal foreign body gum 127.42 1/1/1981

41806 Removal foreign body jawbone 203.08 1/1/1981

41820 Excision gum each quadrant 196.56 1/1/1981

41821 Excision of gum flap 44.52 1/1/1981

41822 Excision of gum lesion 131.40 1/1/1981






41830 Removal of gum tissue 243.98 1/1/1981

41850 Treatment of gum lesion 98.46 1/1/1981

41870 Gum graft 245.79 1/1/1981

41872 Repair gum 212.13 1/1/1981

41874 Repair tooth socket 214.66 1/1/1981

42000 Drainage mouth roof lesion 106.06 1/1/1981

42100 Biopsy roof of mouth 144.80 1/1/1981

62/185


42104 Excision lesion mouth roof 161.81 1/1/1981



42120 Remove palate/lesion 476.39 1/1/1981

42140 Excision of uvula 190.41 1/1/1981

42145 Repair palate pharynx/uvula 602.73 1/1/1981

42160 Treatment mouth roof lesion 173.39 1/1/1981

42180 Repair palate 183.89 1/1/1981

42182 Repair palate 267.88 1/1/1981

42200 Reconstruct cleft palate 846.71 1/1/1981






42226 Lengthening of palate 770.69 1/1/1981

42227 Lengthening of palate 718.93 1/1/1981

42235 Repair palate 530.69 1/1/1981

42260 Repair nose to lip fistula 635.67 1/1/1981

42280 Preparation palate mold 83.98 1/1/1981

42281 Insertion palate prosthesis 110.77 1/1/1981

42300 Drainage of salivary gland 151.31 1/1/1981




42330 Removal of salivary stone 132.49 1/1/1981



42400 Biopsy of salivary gland 45.97 1/1/1981

42405 Biopsy of salivary gland 259.55 1/1/1981

42408 Excision of salivary cyst 357.29 1/1/1981

42409 Drainage of salivary cyst 236.74 1/1/1981

42410 Excise parotid gland/lesion 682.00 1/1/1981





42440 Excise submaxillary gland 506.43 1/1/1981

42450 Excise sublingual gland 347.52 1/1/1981

42500 Repair salivary duct 361.27 1/1/1981

42505 Repair salivary duct 470.60 1/1/1981

42507 Parotid duct diversion 455.75 1/1/1981



42550 Injection for salivary x-ray 64.79 1/1/1981

63/185


42600 Closure of salivary fistula 401.09 1/1/1981

42650 Dilation of salivary duct 45.97 1/1/1981

42660 Dilation of salivary duct 87.60 1/1/1981

42665 Ligation of salivary duct 213.58 1/1/1981

42700 Drainage of tonsil abscess 136.83 1/1/1981

42720 Drainage of throat abscess 393.49 1/1/1981

42725 Drainage of throat abscess 752.23 1/1/1981

42800 Biopsy of throat 153.85 1/1/1981

42804 Biopsy of upper nose/throat 145.16 1/1/1981

42806 Biopsy of upper nose/throat 166.52 1/1/1981

42808 Excise pharynx lesion 210.32 1/1/1981

42809 Remove pharynx foreign body 138.28 1/1/1981

42810 Excision of neck cyst 302.63 1/1/1981

42815 Excision of neck cyst 531.41 1/1/1981

42820 Remove tonsils and adenoids 305.52 1/1/1981

42821 Remove tonsils and adenoids 330.86 1/1/1981

42825 Removal of tonsils 275.48 1/1/1981

42826 Removal of tonsils 276.20 1/1/1981

42830 Removal of adenoids 195.84 1/1/1981




42842 Extensive surgery of throat 644.72 1/1/1981



42860 Excision of tonsil tags 203.44 1/1/1981

42870 Excision of lingual tonsil 445.62 1/1/1981

42890 Partial removal of pharynx 925.63 1/1/1981

42892 Revision of pharyngeal walls 1102.65 1/1/1981

42894 Revision of pharyngeal walls 1557.68 1/1/1981

42900 Repair throat wound 355.84 1/1/1981

42950 Reconstruction of throat 605.98 1/1/1981

42953 Repair throat esophagus 701.55 1/1/1981

42955 Surgical opening of throat 542.63 1/1/1981

42960 Control throat bleeding 172.31 1/1/1981



42970 Control nose/throat bleeding 363.81 1/1/1981



43020 Incision of esophagus 579.56 1/1/1981

43030 Throat muscle surgery 569.42 1/1/1981

43045 Incision of esophagus 1244.91 1/1/1981

43100 Excision of esophagus lesion 654.13 1/1/1981

43101 Excision of esophagus lesion 1002.37 1/1/1981

64/185


43107 Removal of esophagus 2294.71 1/1/1981



43116 Partial removal of esophagus 1945.75 1/1/1981







43130 Removal of esophagus pouch 814.13 1/1/1981

43135 Removal of esophagus pouch 1046.18 1/1/1981

43180 Esophagoscopy rigid trnso 615.88 1/1/2015

43191 Esophagoscopy rigid trnso dx 135.49 1/1/2014

43192 Esophagoscp rig trnso inject 161.44 1/1/2014

43193 Esophagoscp rig trnso biopsy 192.18 1/1/2014

43194 Esophagoscp rig trnso rem fb 173.84 1/1/2014

43195 Esophagoscopy rigid balloon 192.56 1/1/2014

43196 Esophagoscp guide wire dilat 211.25 1/1/2014

43197 Esophagoscopy flex dx brush 85.60 1/1/2014

43198 Esophagosc flex trnsn biopsy 101.88 1/1/2014

43200 Esophagoscopy flexible brush 108.60 1/1/1981

43201 Esoph scope w/submucous inj 128.87 1/1/1981

43202 Esophagoscopy flex biopsy 117.28 1/1/1981

43204 Esoph scope w/sclerosis inj 209.23 1/1/1981

43205 Esophagus endoscopy/ligation 209.59 1/1/1981

43210 Egd esophagogastrc fndoplsty 433.56 1/1/2016

43211 Esophagoscop mucosal resect 262.46 1/1/2014

43212 Esophagoscop stent placement 207.14 1/1/2014

43213 Esophagoscopy retro balloon 291.80 1/1/2014

43214 Esophagosc dilate balloon 30 211.21 1/1/2014

43215 Esophagoscopy flex remove fb 149.50 1/1/1981

43216 Esophagoscopy lesion removal 139.00 1/1/1981

43217 Esophagoscopy snare les remv 163.62 1/1/1981

43220 Esophagoscopy balloon <30mm 124.52 1/1/1981

43226 Esoph endoscopy dilation 135.75 1/1/1981

43227 Esophagoscopy control bleed 200.54 1/1/1981

43231 Esophagoscop ultrasound exam 184.98 1/1/1981

43232 Esophagoscopy w/us needle bx 255.21 1/1/1981

43235 Egd diagnostic brush wash 139.00 1/1/1981

43236 Uppr gi scope w/submuc inj 159.64 1/1/1981

43237 Endoscopic us exam esoph 223.28 1/1/2004

43238 Egd us fine needle bx/aspir 276.27 1/1/2004

43239 Egd biopsy single/multiple 158.19 1/1/1981

43240 Egd w/transmural drain cyst 377.20 1/1/1981

65/185


43241 Egd tube/cath insertion 148.05 1/1/1981

43242 Egd us fine needle bx/aspir 377.92 1/1/1981

43243 Egd injection varices 250.50 1/1/1981

43244 Egd varices ligation 274.75 1/1/1981

43245 Egd dilate stricture 189.68 1/1/1981

43246 Egd place gastrostomy tube 237.11 1/1/1981

43247 Egd remove foreign body 189.32 1/1/1981

43248 Egd guide wire insertion 177.38 1/1/1981

43249 Esoph egd dilation <30 mm 164.34 1/1/1981

43250 Egd cautery tumor polyp 179.55 1/1/1981

43251 Egd remove lesion snare 205.61 1/1/1981

43255 Egd control bleeding any 258.10 1/1/1981

43259 Egd us exam duodenum/jejunum 271.13 1/1/1981

43260 Ercp w/specimen collection 322.54 1/1/1981

43261 Endo cholangiopancreatograph 339.19 1/1/1981

43262 Endo cholangiopancreatograph 397.83 1/1/1981

43263 Ercp sphincter pressure meas 390.23 1/1/1981

43264 Ercp remove duct calculi 476.39 1/1/1981

43265 Ercp lithotripsy calculi 532.86 1/1/1981

43280 Laparoscopy fundoplasty 1021.56 1/1/1981

43300 Repair of esophagus 644.72 1/1/1981

43305 Repair esophagus and fistula 1175.05 1/1/1981

43310 Repair of esophagus 1608.72 1/1/1981

43312 Repair esophagus and fistula 1838.23 1/1/1981

43313 Esophagoplasty congenital 2712.82 1/1/1981

43314 Tracheo-esophagoplasty cong 2976.36 1/1/1981

43320 Fuse esophagus & stomach 1196.04 1/1/1981

43325 Revise esophagus & stomach 1181.20 1/1/1981

43330 Esophagomyotomy abdominal 1153.69 1/1/1981

43331 Esophagomyotomy thoracic 1246.00 1/1/1981

43340 Fuse esophagus & intestine 1168.17 1/1/1981

43341 Fuse esophagus & intestine 1272.43 1/1/1981

43351 Surgical opening esophagus 1143.92 1/1/1981

43352 Surgical opening esophagus 971.97 1/1/1981

43360 Gastrointestinal repair 2085.84 1/1/1981

43361 Gastrointestinal repair 2301.95 1/1/1981

43400 Ligate esophagus veins 1207.99 1/1/1981

43401 Esophagus surgery for veins 1268.44 1/1/1981

43405 Ligate/staple esophagus 1154.78 1/1/1981

43410 Repair esophagus wound 891.96 1/1/1981

43415 Repair esophagus wound 1463.56 1/1/1981

43420 Repair esophagus opening 903.91 1/1/1981

43425 Repair esophagus opening 1267.72 1/1/1981

43450 Dilate esophagus 1/mult pass 77.10 1/1/1981

43453 Dilate esophagus 83.98 1/1/1981

66/185


43460 Pressure treatment esophagus 205.25 1/1/1981

43496 Free jejunum flap microvasc 5602.67 1/1/1981

43500 Surgical opening of stomach 635.31 1/1/1981

43501 Surgical repair of stomach 1130.16 1/1/1981

43502 Surgical repair of stomach 1303.56 1/1/1981

43510 Surgical opening of stomach 797.48 1/1/1981

43520 Incision of pyloric muscle 615.76 1/1/1981

43605 Biopsy of stomach 685.26 1/1/1981

43610 Excision of stomach lesion 838.75 1/1/1981

43611 Excision of stomach lesion 1014.68 1/1/1981

43620 Removal of stomach 1677.87 1/1/1981



43631 Removal of stomach partial 1274.60 1/1/1981





43640 Vagotomy & pylorus repair 975.59 1/1/1981

43641 Vagotomy & pylorus repair 989.34 1/1/1981

43651 Laparoscopy vagus nerve 591.50 1/1/1981

43652 Laparoscopy vagus nerve 704.81 1/1/1981

43653 Laparoscopy gastrostomy 479.65 1/1/1981

43752 Nasal/orogastric w/tube plmt 44.52 1/1/1981

43753 Tx gastro intub w/asp 22.35 1/1/2011

43754 Dx gastr intub w/asp spec 34.26 1/1/2011

43755 Dx gastr intub w/asp specs 62.56 1/1/2011

43756 Dx duod intub w/asp spec 56.27 1/1/2011

43757 Dx duod intub w/asp specs 81.18 1/1/2011

43760 Change gastrostomy tube 60.45 1/1/1981

43761 Reposition gastrostomy tube 108.60 1/1/1981

43800 Reconstruction of pylorus 793.14 1/1/1981

43810 Fusion of stomach and bowel 842.01 1/1/1981



43830 Place gastrostomy tube 567.25 1/1/1981



43840 Repair of stomach lesion 889.79 1/1/1981

43842 V-band gastroplasty 1160.93 1/1/1981

43846 Gastric bypass for obesity 1475.15 1/1/1981

43850 Revise stomach-bowel fusion 1377.41 1/1/1981




67/185


43870 Repair stomach opening 579.92 1/1/1981

43880 Repair stomach-bowel fistula 1390.44 1/1/1981

44005 Freeing of bowel adhesion 929.61 1/1/1981

44010 Incision of small bowel 744.99 1/1/1981

44015 Insert needle cath bowel 141.18 1/1/1981

44020 Explore small intestine 808.34 1/1/1981

44021 Decompress small bowel 827.89 1/1/1981

44025 Incision of large bowel 822.46 1/1/1981

44050 Reduce bowel obstruction 809.07 1/1/1981

44055 Correct malrotation of bowel 1215.95 1/1/1981

44100 Biopsy of bowel 119.46 1/1/1981

44110 Excise intestine lesion(s) 693.23 1/1/1981

44111 Excision of bowel lesion(s) 840.20 1/1/1981

44120 Removal of small intestine 970.88 1/1/1981



44126 Enterectomy w/o taper cong 1985.57 1/1/1981

44127 Enterectomy w/taper cong 2282.77 1/1/1981

44128 Enterectomy cong add-on 248.69 1/1/1981

44130 Bowel to bowel fusion 835.85 1/1/1981

44139 Mobilization of colon 120.54 1/1/1981

44140 Partial removal of colon 1202.56 1/1/1981







44150 Removal of colon 1490.71 1/1/1981

44151 Removal of colon/ileostomy 1656.15 1/1/1981



44160 Removal of colon 1070.43 1/1/1981

44202 Lap enterectomy 1265.55 1/1/1981

44203 Lap resect s/intestine addl 241.81 1/1/1981

44204 Laparo partial colectomy 1386.09 1/1/1981

44205 Lap colectomy part w/ileum 1226.81 1/1/1981

44206 Lap part colectomy w/stoma 1492.52 1/1/1981

44207 L colectomy/coloproctostomy 1633.34 1/1/1981

44208 L colectomy/coloproctostomy 1765.11 1/1/1981

44210 Laparo total proctocolectomy 1563.84 1/1/1981

44211 Lap colectomy w/proctectomy 1940.32 1/1/1981

44212 Laparo total proctocolectomy 1813.98 1/1/1981

44300 Open bowel to skin 734.49 1/1/1981

44310 Ileostomy/jejunostomy 1024.82 1/1/1981

68/185


44312 Revision of ileostomy 512.95 1/1/1981

44314 Revision of ileostomy 981.02 1/1/1981

44316 Devise bowel pouch 1347.00 1/1/1981

44320 Colostomy 1154.05 1/1/1981

44322 Colostomy with biopsies 878.93 1/1/1981

44340 Revision of colostomy 488.33 1/1/1981



44360 Small bowel endoscopy 152.76 1/1/1981

44361 Small bowel endoscopy/biopsy 167.24 1/1/1981






44370 Small bowel endoscopy/stent 249.41 1/1/1981




44377 Small bowel endoscopy/biopsy 306.25 1/1/1981


44379 S bowel endoscope w/stent 388.78 1/1/1981

44380 Small bowel endoscopy br/wa 71.31 1/1/1981

44381 Small bowel endoscopy br/wa 72.44 1/1/2015



44385 Endoscopy of bowel pouch 107.15 1/1/1981

44386 Endoscopy bowel pouch/biop 124.52 1/1/1981

44388 Colonoscopy thru stoma spx 163.98 1/1/1981

44389 Colonoscopy with biopsy 179.91 1/1/1981

44390 Colonoscopy for foreign body 216.83 1/1/1981

44391 Colonoscopy for bleeding 234.21 1/1/1981

44392 Colonoscopy & polypectomy 216.47 1/1/1981

44394 Colonoscopy w/snare 249.41 1/1/1981

44401 Colonoscopy with ablation 277.25 1/1/2015

44402 Colonoscopy w/stent plcmt 275.21 1/1/2015

44403 Colonoscopy w/resection 176.39 1/1/2015

44404 Colonoscopy w/injection 176.39 1/1/2015

44405 Colonoscopy w/dilation 176.39 1/1/2015

44406 Colonoscopy w/ultrasound 176.39 1/1/2015

44407 Colonoscopy w/ndl aspir/bx 176.39 1/1/2015

44408 Colonoscopy w/decompression 176.39 1/1/2015

44500 Intro gastrointestinal tube 32.58 1/1/1981

44602 Suture small intestine 906.08 1/1/1981

44603 Suture small intestine 1050.16 1/1/1981

69/185


44604 Suture large intestine 921.65 1/1/1981

44605 Repair of bowel lesion 1114.23 1/1/1981

44615 Intestinal stricturoplasty 915.86 1/1/1981

44620 Repair bowel opening 708.43 1/1/1981



44640 Repair bowel-skin fistula 1216.32 1/1/1981

44650 Repair bowel fistula 1262.65 1/1/1981

44660 Repair bowel-bladder fistula 1184.82 1/1/1981

44661 Repair bowel-bladder fistula 1373.06 1/1/1981

44680 Surgical revision intestine 901.01 1/1/1981

44700 Suspend bowel w/prosthesis 923.82 1/1/1981

44701 Intraop colon lavage add-on 162.17 1/1/1981

44800 Excision of bowel pouch 668.25 1/1/1981

44820 Excision of mesentery lesion 709.88 1/1/1981

44850 Repair of mesentery 637.48 1/1/1981

44900 Drain appendix abscess open 629.88 1/1/1981

44950 Appendectomy 602.00 1/1/1981

44955 Appendectomy add-on 83.98 1/1/1981

44960 Appendectomy 741.01 1/1/1981

44970 Laparoscopy appendectomy 513.31 1/1/1981

45000 Drainage of pelvic abscess 323.62 1/1/1981

45005 Drainage of rectal abscess 141.18 1/1/1981

45020 Drainage of rectal abscess 347.88 1/1/1981

45100 Biopsy of rectum 228.06 1/1/1981

45108 Removal of anorectal lesion 304.08 1/1/1981

45110 Removal of rectum 1616.33 1/1/1981

45111 Partial removal of rectum 999.84 1/1/1981


45113 Partial proctectomy 1709.36 1/1/1981



45119 Remove rectum w/reservoir 1713.70 1/1/1981


45121 Removal of rectum and colon 1571.44 1/1/1981

45123 Partial proctectomy 962.19 1/1/1981

45126 Pelvic exenteration 2503.59 1/1/1981

45130 Excision of rectal prolapse 940.47 1/1/1981

45135 Excision of rectal prolapse 1110.25 1/1/1981

45136 Excise ileoanal reservior 1565.28 1/1/1981

45150 Excision of rectal stricture 346.43 1/1/1981

45160 Excision of rectal lesion 872.78 1/1/1981

45190 Destruction rectal tumor 588.25 1/1/1981

45300 Proctosigmoidoscopy dx 24.61 1/1/1981

45303 Proctosigmoidoscopy dilate 28.96 1/1/1981

70/185


45305 Proctosigmoidoscopy w/bx 57.92 1/1/1981

45307 Proctosigmoidoscopy fb 57.19 1/1/1981

45308 Proctosigmoidoscopy removal 50.68 1/1/1981



45317 Proctosigmoidoscopy bleed 86.88 1/1/1981

45320 Proctosigmoidoscopy ablate 91.94 1/1/1981

45321 Proctosigmoidoscopy volvul 69.50 1/1/1981

45327 Proctosigmoidoscopy w/stent 97.74 1/1/1981

45330 Diagnostic sigmoidoscopy 57.19 1/1/1981

45331 Sigmoidoscopy and biopsy 65.16 1/1/1981

45332 Sigmoidoscopy w/fb removal 98.46 1/1/1981

45333 Sigmoidoscopy & polypectomy 99.18 1/1/1981

45334 Sigmoidoscopy for bleeding 148.42 1/1/1981

45335 Sigmoidoscopy w/submuc inj 77.10 1/1/1981

45337 Sigmoidoscopy & decompress 128.87 1/1/1981

45338 Sigmoidoscopy w/tumr remove 128.14 1/1/1981

45340 Sig w/tndsc balloon dilation 91.94 1/1/1981

45341 Sigmoidoscopy w/ultrasound 156.02 1/1/1981

45342 Sigmoidoscopy w/us guide bx 227.33 1/1/1981

45346 Sigmoidoscopy w/ablation 186.75 1/1/2015

45347 Sigmoidoscopy w/plcmt stent 174.97 1/1/2015

45349 Sigmoidoscopy w/resection 67.64 1/1/2015

45350 Sgmdsc w/band ligation 67.64 1/1/2015

45378 Diagnostic colonoscopy 209.96 1/1/1981

45379 Colonoscopy w/fb removal 261.72 1/1/1981

45380 Colonoscopy and biopsy 247.97 1/1/1981

45381 Colonoscopy submucous njx 225.88 1/1/1981

45382 Colonoscopy w/control bleed 304.80 1/1/1981

45384 Colonoscopy w/lesion removal 262.08 1/1/1981

45385 Colonoscopy w/lesion removal 294.30 1/1/1981

45386 Colonoscopy w/balloon dilat 245.07 1/1/1981

45388 Colonoscopy w/ablation 335.88 1/1/2015

45389 Colonoscopy w/stent plcmt 346.47 1/1/2015

45390 Colonoscopy w/resection 227.60 1/1/2015

45391 Colonoscopy w/endoscope us 275.47 1/1/2005

45392 Colonoscopy w/endoscopic fnb 347.38 1/1/2005

45393 Colonoscopy w/decompression 227.60 1/1/2015

45398 Colonoscopy w/band ligation 227.60 1/1/2015

45500 Repair of rectum 449.24 1/1/1981

45505 Repair of rectum 442.72 1/1/1981

45520 TREATMENT OF RECTAL PROLAPSE 29.32 1/1/1981

45540 Correct rectal prolapse 950.61 1/1/1981

45541 Correct rectal prolapse 790.60 1/1/1981

45550 Repair rectum/remove sigmoid 1297.04 1/1/1981

71/185


45560 Repair of rectocele 646.89 1/1/1981

45562 Exploration/repair of rectum 892.69 1/1/1981

45563 Exploration/repair of rectum 1360.75 1/1/1981

45800 Repair rect/bladder fistula 1005.99 1/1/1981

45805 Repair fistula w/colostomy 1223.56 1/1/1981

45820 Repair rectourethral fistula 1045.09 1/1/1981

45825 Repair fistula w/colostomy 1213.06 1/1/1981

45900 Reduction of rectal prolapse 141.54 1/1/1981

45905 Dilation of anal sphincter 125.97 1/1/1981

45910 Dilation of rectal narrowing 151.31 1/1/1981

45915 Remove rectal obstruction 165.43 1/1/1981

46020 Placement of seton 203.80 1/1/1981

46030 Removal of rectal marker 95.56 1/1/1981

46040 Incision of rectal abscess 320.00 1/1/1981


46050 Incision of anal abscess 99.55 1/1/1981


46070 Incision of anal septum 205.97 1/1/1981

46080 Incision of anal sphincter 162.53 1/1/1981

46083 Incise external hemorrhoid 115.84 1/1/1981

46200 Removal of anal fissure 228.42 1/1/1981

46220 Excise anal ext tag/papilla 83.98 1/1/1981

46221 Ligation of hemorrhoid(s) 121.63 1/1/1981

46230 Removal of anal tags 166.52 1/1/1981

46250 Remove ext hem groups 2+ 262.45 1/1/1981

46255 Remove int/ext hem 1 group 301.18 1/1/1981

46257 Remove in/ex hem grp & fiss 339.55 1/1/1981

46258 Remove in/ex hem grp w/fistu 360.55 1/1/1981

46260 Remove in/ex hem groups 2+ 413.40 1/1/1981

46261 Remove in/ex hem grps & fiss 445.98 1/1/1981

46262 Remove in/ex hem grps w/fist 469.87 1/1/1981

46270 Remove anal fist subq 250.86 1/1/1981

46275 Remove anal fist inter 290.68 1/1/1981

46280 Remove anal fist complex 383.35 1/1/1981

46285 Remove anal fist 2 stage 264.98 1/1/1981

46288 Repair anal fistula 445.62 1/1/1981

46320 Removal of hemorrhoid clot 123.80 1/1/1981

46500 Injection into hemorrhoid(s) 85.79 1/1/1981

46505 Chemodenervation anal musc 183.63 1/1/2006

46600 Diagnostic anoscopy spx 25.70 1/1/1981

46601 Diagnostic anoscopy 94.77 11/1/2016

46604 Anoscopy and dilation 69.14 1/1/1981

46606 Anoscopy and biopsy 43.44 1/1/1981

46608 Anoscopy remove for body 78.91 1/1/1981

46610 Anoscopy remove lesion 71.31 1/1/1981

72/185


46611 Anoscopy 97.01 1/1/1981

46612 Anoscopy remove lesions 124.89 1/1/1981

46614 Anoscopy control bleeding 106.06 1/1/1981

46615 Anoscopy 143.71 1/1/1981

46700 Repair of anal stricture 536.48 1/1/1981

46705 Repair of anal stricture 453.22 1/1/1981

46706 Repr of anal fistula w/glue 141.18 1/1/1981

46715 Rep perf anoper fistu 462.99 1/1/1981

46716 Rep perf anoper/vestib fistu 907.89 1/1/1981

46730 Construction of absent anus 1522.93 1/1/1981



46742 Repair of imperforated anus 2106.11 1/1/1981

46744 Repair of cloacal anomaly 2871.02 1/1/1981



46750 Repair of anal sphincter 620.83 1/1/1981


46753 Reconstruction of anus 482.18 1/1/1981

46754 Removal of suture from anus 139.00 1/1/1981



46762 Implant artificial sphincter 722.19 1/1/1981

46900 Destruction anal lesion(s) 103.17 1/1/1981


46916 Cryosurgery anal lesion(s) 134.66 1/1/1981

46917 Laser surgery anal lesions 135.75 1/1/1981

46922 Excision of anal lesion(s) 129.95 1/1/1981


46940 Treatment of anal fissure 123.08 1/1/1981

46942 Treatment of anal fissure 107.15 1/1/1981

46945 Remove by ligat int hem grp 160.36 1/1/1981

46946 Remove by ligat int hem grps 201.63 1/1/1981

47000 Needle biopsy of liver 98.10 1/1/1981

47001 Needle biopsy liver add-on 102.44 1/1/1981

47010 Open drainage liver lesion 971.97 1/1/1981

47015 Inject/aspirate liver cyst 897.03 1/1/1981

47100 Wedge biopsy of liver 701.91 1/1/1981

47120 Partial removal of liver 2031.90 1/1/1981

47122 Extensive removal of liver 3070.12 1/1/1981



47135 Transplantation of liver 4949.26 1/1/1981

47300 Surgery for liver lesion 882.55 1/1/1981

47350 Repair liver wound 1121.83 1/1/1981

73/185





47370 Laparo ablate liver tumor rf 962.55 1/1/1981

47371 Laparo ablate liver cryosurg 907.89 1/1/1981

47380 Open ablate liver tumor rf 1129.07 1/1/1981

47381 Open ablate liver tumor cryo 1116.40 1/1/1981

47382 Percut ablate liver rf 675.85 1/1/1981

47400 Incision of liver duct 1825.56 1/1/1981

47420 Incision of bile duct 1153.33 1/1/1981

47425 Incision of bile duct 1144.28 1/1/1981

47460 Incise bile duct sphincter 1058.85 1/1/1981

47480 Incision of gallbladder 686.71 1/1/1981

47490 Incision of gallbladder 565.80 1/1/1981

47531 Injection for cholangiogram 97.22 1/1/2016

47532 Injection for cholangiogram 218.85 1/1/2016

47533 Plmt biliary drainage cath 309.77 1/1/2016

47534 Plmt biliary drainage cath 410.83 1/1/2016

47535 Conversion ext bil drg cath 236.55 1/1/2016

47536 Exchange biliary drg cath 149.51 1/1/2016

47537 Removal biliary drg cath 100.98 1/1/2016

47538 Perq plmt bile duct stent 333.34 1/1/2016



47541 Plmt access bil tree sm bwl 286.48 1/1/2016

47542 Dilate biliary duct/ampulla 134.88 1/1/2016

47543 Endoluminal bx biliary tree 169.78 1/1/2016

47544 Removal duct glbldr calculi 217.80 1/1/2016

47550 Bile duct endoscopy add-on 163.62 1/1/1981

47552 Biliary endo perq dx w/speci 333.04 1/1/1981

47553 Biliary endoscopy thru skin 345.71 1/1/1981




47562 Laparoscopic cholecystectomy 646.53 1/1/1981

47563 Laparo cholecystectomy/graph 691.42 1/1/1981

47564 Laparo cholecystectomy/explr 816.31 1/1/1981

47570 Laparo cholecystoenterostomy 726.89 1/1/1981

47600 Removal of gallbladder 802.91 1/1/1981





47700 Exploration of bile ducts 960.02 1/1/1981

47701 Bile duct revision 1654.70 1/1/1981

74/185


47711 Excision of bile duct tumor 1350.98 1/1/1981

47712 Excision of bile duct tumor 1743.75 1/1/1981

47715 Excision of bile duct cyst 1090.34 1/1/1981

47720 Fuse gallbladder & bowel 964.36 1/1/1981

47721 Fuse upper gi structures 1139.21 1/1/1981



47760 Fuse bile ducts and bowel 1499.04 1/1/1981

47765 Fuse liver ducts & bowel 1479.49 1/1/1981



47800 Reconstruction of bile ducts 1368.36 1/1/1981

47801 Placement bile duct support 966.17 1/1/1981

47802 Fuse liver duct & intestine 1300.66 1/1/1981

47900 Suture bile duct injury 1181.56 1/1/1981

48000 Drainage of abdomen 1552.61 1/1/1981

48001 Placement of drain pancreas 1938.51 1/1/1981

48020 Removal of pancreatic stone 910.43 1/1/1981

48100 Biopsy of pancreas open 756.58 1/1/1981

48102 Needle biopsy pancreas 271.13 1/1/1981

48120 Removal of pancreas lesion 924.91 1/1/1981

48140 Partial removal of pancreas 1332.88 1/1/1981


48146 Pancreatectomy 1591.71 1/1/1981

48148 Removal of pancreatic duct 1045.45 1/1/1981


48152 Pancreatectomy 2549.92 1/1/1981

48153 Pancreatectomy 2768.93 1/1/1981

48154 Pancreatectomy 2566.94 1/1/1981

48155 Removal of pancreas 1519.67 1/1/1981

48160 Pancreas removal/transplant 2507.57 1/1/1981

48400 Injection intraop add-on 101.36 1/1/1981

48500 Surgery of pancreatic cyst 906.08 1/1/1981

48510 Drain pancreatic pseudocyst 847.80 1/1/1981

48520 Fuse pancreas cyst and bowel 910.43 1/1/1981

48540 Fuse pancreas cyst and bowel 1129.44 1/1/1981

48545 Pancreatorrhaphy 1065.72 1/1/1981

48547 Duodenal exclusion 1455.60 1/1/1981

49000 Exploration of abdomen 710.24 1/1/1981

49002 Reopening of abdomen 657.39 1/1/1981

49010 Exploration behind abdomen 765.26 1/1/1981

49020 Drainage abdom abscess open 1317.31 1/1/1981

49040 Drain open abdom abscess 830.42 1/1/1981

49060 Drain open retroperi abscess 972.69 1/1/1981

49062 Drain to peritoneal cavity 726.17 1/1/1981

75/185


49082 Abd paracentesis 76.60 1/1/2012

49083 Abd paracentesis w/imaging 117.95 1/1/2012

49180 Biopsy abdominal mass 89.05 1/1/1981

49185 Sclerotx fluid collection 124.74 1/1/2016

49215 Excise sacral spine tumor 1910.99 1/1/1981

49220 Multiple surgery abdomen 906.08 1/1/1981

49250 Excision of umbilicus 538.29 1/1/1981

49255 Removal of omentum 704.81 1/1/1981

49320 Diag laparo separate proc 323.26 1/1/1981

49321 Laparoscopy biopsy 335.21 1/1/1981

49322 Laparoscopy aspiration 365.25 1/1/1981

49323 Laparo drain lymphocele 540.46 1/1/1981

49400 Air injection into abdomen 103.89 1/1/1981

49405 Image cath fluid colxn visc 227.25 1/1/2014

49406 IMAGE CATH FLUID PERI/RETRO 227.64 1/1/2014

49407 IMAGE CATH FLUID TRNS/VGNL 242.48 1/1/2014

49412 Ins device for rt guide open 90.12 1/1/2011

49419 Insert tun ip cath w/port 409.42 1/1/1981

49421 Ins tun ip cath for dial opn 379.01 1/1/1981

49422 Remove tunneled ip cath 368.15 1/1/1981

49423 Exchange drainage catheter 82.53 1/1/1981

49424 Assess cyst contrast inject 45.97 1/1/1981

49425 Insert abdomen-venous drain 721.82 1/1/1981

49426 Revise abdomen-venous shunt 623.00 1/1/1981

49427 Injection abdominal shunt 53.21 1/1/1981

49428 Ligation of shunt 354.03 1/1/1981

49429 Removal of shunt 438.02 1/1/1981

49440 Place gastrostomy tube perc 220.28 1/1/2008

49441 Place duod/jej tube perc 238.92 1/1/2008

49442 Place cecostomy tube perc 198.07 1/1/2008

49446 Change g-tube to g-j perc 155.63 1/1/2008

49450 Replace g/c tube perc 63.12 1/1/2008

49451 Replace duod/jej tube perc 87.01 1/1/2008

49452 Replace g-j tube perc 135.86 1/1/2008

49460 Fix g/colon tube w/device 44.39 1/1/2008

49465 Fluoro exam of g/colon tube 29.36 1/1/2008

49491 Rpr hern preemie reduc 661.37 1/1/1981

49492 Rpr ing hern premie blocked 813.41 1/1/1981

49495 Rpr ing hernia baby reduc 378.29 1/1/1981

49496 Rpr ing hernia baby blocked 582.09 1/1/1981

49500 Rpr ing hernia init reduce 350.41 1/1/1981

49501 Rpr ing hernia init blocked 529.96 1/1/1981

49505 Prp i/hern init reduc >5 yr 460.10 1/1/1981

49507 Prp i/hern init block >5 yr 616.48 1/1/1981

49520 Rerepair ing hernia reduce 593.68 1/1/1981

76/185


49521 Rerepair ing hernia blocked 701.19 1/1/1981

49525 Repair ing hernia sliding 531.05 1/1/1981

49540 Repair lumbar hernia 629.88 1/1/1981

49550 Rpr rem hernia init reduce 518.02 1/1/1981

49553 Rpr fem hernia init blocked 565.80 1/1/1981

49555 Rerepair fem hernia reduce 562.54 1/1/1981

49557 Rerepair fem hernia blocked 658.47 1/1/1981

49560 Rpr ventral hern init reduc 694.67 1/1/1981

49561 Rpr ventral hern init block 824.63 1/1/1981

49565 Rerepair ventrl hern reduce 700.47 1/1/1981

49566 Rerepair ventrl hern block 833.68 1/1/1981

49568 Hernia repair w/mesh 266.07 1/1/1981

49570 Rpr epigastric hern reduce 362.00 1/1/1981

49572 Rpr epigastric hern blocked 420.64 1/1/1981

49580 Rpr umbil hern reduc < 5 yr 278.37 1/1/1981

49582 Rpr umbil hern block < 5 yr 455.75 1/1/1981

49585 Rpr umbil hern reduc > 5 yr 405.80 1/1/1981

49587 Rpr umbil hern block > 5 yr 464.08 1/1/1981

49590 Repair spigelian hernia 529.60 1/1/1981

49600 Repair umbilical lesion 685.26 1/1/1981





49650 Lap ing hernia repair init 381.18 1/1/1981

49651 Lap ing hernia repair recur 502.09 1/1/1981

49900 Repair of abdominal wall 756.21 1/1/1981

49904 Omental flap extra-abdom 1412.16 1/1/1981

49905 Omental flap intra-abdom 356.93 1/1/1981

49906 Free omental flap microvasc 3585.61 1/1/1981

50010 Exploration of kidney 700.10 1/1/1981

50020 Renal abscess open drain 1084.55 1/1/1981

50040 Drainage of kidney 1014.32 1/1/1981


50060 Removal of kidney stone 1129.44 1/1/1981

50065 Incision of kidney 1202.92 1/1/1981

50070 Incision of kidney 1194.23 1/1/1981




50100 Revise kidney blood vessels 1008.53 1/1/1981


50125 Explore and drain kidney 1004.55 1/1/1981



77/185


50200 Renal biopsy perq 137.19 1/1/1981

50205 Renal biopsy open 697.93 1/1/1981

50220 Remove kidney open 1024.09 1/1/1981

50225 Removal kidney open complex 1178.67 1/1/1981

50230 Removal kidney open radical 1272.79 1/1/1981

50234 Removal of kidney & ureter 1290.53 1/1/1981

50236 Removal of kidney & ureter 1506.64 1/1/1981

50240 Partial removal of kidney 1360.75 1/1/1981

50280 Removal of kidney lesion 940.11 1/1/1981

50290 Removal of kidney lesion 903.91 1/1/1981

50340 Removal of kidney 842.37 1/1/1981

50360 Transplantation of kidney 1949.37 1/1/1981

50365 Transplantation of kidney 2293.63 1/1/1981

50370 Remove transplanted kidney 925.99 1/1/1981

50380 Reimplantation of kidney 1342.65 1/1/1981

50382 Change ureter stent percut 283.44 1/1/2006

50384 Remove ureter stent percut 258.09 1/1/2006

50385 Change stent via transureth 229.13 1/1/2008

50386 Remove stent via transureth 173.65 1/1/2008

50387 CHANGE NEPHROURETERAL CATH 102.55 1/1/2006

50389 Remove renal tube w/fluoro 56.61 1/1/2006

50390 Drainage of kidney lesion 100.99 1/1/1981

50391 Instll rx agnt into rnal tub 100.39 1/1/2005

50395 Create passage to kidney 174.12 1/1/1981

50396 Measure kidney pressure 114.03 1/1/1981

50400 Revision of kidney/ureter 1140.66 1/1/1981

50405 Revision of kidney/ureter 1379.22 1/1/1981

50430 Njx px nfrosgrm &/urtrgrm 169.28 1/1/2016

50431 Njx px nfrosgrm &/urtrgrm 67.41 1/1/2016

50432 Plmt nephrostomy catheter 223.71 1/1/2016

50433 Plmt nephroureteral catheter 275.66 1/1/2016

50434 Convert nephrostomy catheter 211.48 1/1/2016

50435 Exchange nephrostomy cath 103.00 1/1/2016

50500 Repair of kidney wound 1202.92 1/1/1981

50520 Close kidney-skin fistula 1125.82 1/1/1981

50525 REPAIR RENAL-ABDOMEN FISTULA 1376.68 1/1/1981

50526 REPAIR RENAL-ABDOMEN FISTULA 1503.74 1/1/1981

50540 Revision of horseshoe kidney 1172.88 1/1/1981

50541 Laparo ablate renal cyst 880.74 1/1/1981

50542 Laparo ablate renal mass 1100.84 1/1/1981

50543 Laparo partial nephrectomy 1381.39 1/1/1981

50544 Laparoscopy pyeloplasty 1216.68 1/1/1981

50545 Laparo radical nephrectomy 1303.20 1/1/1981

50546 Laparoscopic nephrectomy 1121.11 1/1/1981

50548 Laparo remove w/ureter 1317.68 1/1/1981

78/185


50551 Kidney endoscopy 289.60 1/1/1981


50555 Kidney endoscopy & biopsy 338.83 1/1/1981

50557 Kidney endoscopy & treatment 342.45 1/1/1981


50562 Renal scope w/tumor resect 585.35 1/1/1981



50574 Kidney endoscopy & biopsy 574.85 1/1/1981




50590 Fragmenting of kidney stone 555.67 1/1/1981

50593 Perc cryo ablate renal tum 441.96 1/1/2008

50600 Exploration of ureter 960.74 1/1/1981

50605 Insert ureteral support 945.90 1/1/1981

50606 Endoluminal bx urtr rnl plvs 158.98 1/1/2016

50610 Removal of ureter stone 968.35 1/1/1981



50650 Removal of ureter 1045.45 1/1/1981

50660 Removal of ureter 1155.50 1/1/1981

50684 Injection for ureter x-ray 39.09 1/1/1981

50686 Measure ureter pressure 83.26 1/1/1981

50688 Change of ureter tube/stent 111.49 1/1/1981

50690 Injection for ureter x-ray 59.73 1/1/1981

50693 Plmt ureteral stent prq 221.24 1/1/2016



50700 Revision of ureter 932.87 1/1/1981

50705 Ureteral embolization/occl 203.58 1/1/2016

50706 Balloon dilate urtrl strix 189.39 1/1/2016

50715 Release of ureter 1226.45 1/1/1981


50725 Release/revise ureter 1134.87 1/1/1981

50727 Revise ureter 565.80 1/1/1981

50728 Revise ureter 783.36 1/1/1981

50740 Fusion of ureter & kidney 1098.67 1/1/1981

50750 Fusion of ureter & kidney 1158.40 1/1/1981

50760 Fusion of ureters 1105.18 1/1/1981

50770 Splicing of ureters 1156.95 1/1/1981

50780 Reimplant ureter in bladder 1096.86 1/1/1981




79/185


50800 Implant ureter in bowel 945.54 1/1/1981

50810 Fusion of ureter & bowel 1267.36 1/1/1981

50815 Urine shunt to intestine 1222.83 1/1/1981

50820 Construct bowel bladder 1322.38 1/1/1981

50825 Construct bowel bladder 1680.04 1/1/1981

50830 Revise urine flow 1834.61 1/1/1981

50840 Replace ureter by bowel 1227.54 1/1/1981

50845 Appendico-vesicostomy 1198.94 1/1/1981

50860 Transplant ureter to skin 939.02 1/1/1981

50900 Repair of ureter 842.37 1/1/1981

50920 Closure ureter/skin fistula 872.78 1/1/1981

50930 Closure ureter/bowel fistula 1155.86 1/1/1981


50945 Laparoscopy ureterolithotomy 947.71 1/1/1981

50947 Laparo new ureter/bladder 1420.12 1/1/1981

50948 Laparo new ureter/bladder 1297.77 1/1/1981

50951 Endoscopy of ureter 302.27 1/1/1981

50953 Endoscopy of ureter 322.90 1/1/1981

50955 Ureter endoscopy & biopsy 351.86 1/1/1981

50957 Ureter endoscopy & treatment 350.41 1/1/1981


50970 Ureter endoscopy 369.96 1/1/1981

50972 Ureter endoscopy & catheter 362.36 1/1/1981

50974 Ureter endoscopy & biopsy 475.66 1/1/1981



51020 Incise & treat bladder 477.47 1/1/1981

51030 Incise & treat bladder 490.87 1/1/1981

51040 Incise & drain bladder 339.91 1/1/1981

51045 Incise bladder/drain ureter 493.04 1/1/1981

51050 Removal of bladder stone 468.42 1/1/1981


51065 Remove ureter calculus 573.04 1/1/1981

51080 Drainage of bladder abscess 445.26 1/1/1981

51100 Drain bladder by needle 37.08 1/1/2008

51101 Drain bladder by trocar/cath 49.26 1/1/2008

51102 Drain bl w/cath insertion 236.08 1/1/2008

51500 Removal of bladder cyst 637.84 1/1/1981

51520 Removal of bladder lesion 613.95 1/1/1981



51535 Repair of ureter lesion 806.17 1/1/1981

51550 Partial removal of bladder 942.28 1/1/1981

51555 Partial removal of bladder 1246.00 1/1/1981

51565 Revise bladder & ureter(s) 1284.73 1/1/1981

80/185


51570 Removal of bladder 1425.19 1/1/1981

51575 Removal of bladder & nodes 1767.28 1/1/1981

51580 Remove bladder/revise tract 1817.96 1/1/1981

51585 Removal of bladder & nodes 2029.37 1/1/1981



51596 Remove bladder/create pouch 2254.89 1/1/1981

51597 Removal of pelvic structures 2183.58 1/1/1981

51600 Injection for bladder x-ray 44.88 1/1/1981

51605 Preparation for bladder xray 33.30 1/1/1981

51610 Injection for bladder x-ray 53.93 1/1/1981

51700 Irrigation of bladder 45.61 1/1/1981

51701 Insert bladder catheter 27.15 1/1/1981

51702 Insert temp bladder cath 29.68 1/1/1981

51703 Insert bladder cath complex 79.64 1/1/1981

51705 Change of bladder tube 64.07 1/1/1981

51710 Change of bladder tube 113.30 1/1/1981

51715 Endoscopic injection/implant 195.11 1/1/1981

51720 Treatment of bladder lesion 104.25 1/1/1981

51725 Simple cystometrogram TC 204.53 1/1/1981

51725 Simple cystometrogram 26 78.91 1/1/1981

51725 Simple cystometrogram 283.44 1/1/1981

51726 Complex cystometrogram TC 154.57 1/1/1981

51726 Complex cystometrogram 26 89.05 1/1/1981

51726 Complex cystometrogram 243.62 1/1/1981

51736 Urine flow measurement TC 32.94 1/1/1981

51736 Urine flow measurement 26 31.85 1/1/1981

51736 Urine flow measurement 64.79 1/1/1981

51741 ELECTRO-UROFLOWMETRY FIRST TC 58.28 1/1/1981

51741 ELECTRO-UROFLOWMETRY FIRST 26 59.73 1/1/1981

51741 ELECTRO-UROFLOWMETRY FIRST 118.01 1/1/1981

51784 Anal/urinary muscle study TC 107.87 1/1/1981

51784 Anal/urinary muscle study 26 80.00 1/1/1981

51784 Anal/urinary muscle study 187.87 1/1/1981

51785 Anal/urinary muscle study TC 111.49 1/1/1981

51785 Anal/urinary muscle study 26 79.64 1/1/1981

51785 Anal/urinary muscle study 191.13 1/1/1981

51792 URINARY REFLEX STUDY TC 114.03 1/1/1981

51792 URINARY REFLEX STUDY 26 60.09 1/1/1981

51792 URINARY REFLEX STUDY 174.12 1/1/1981

51797 Intraabdominal pressure test TC 163.98 1/1/1981

51797 Intraabdominal pressure test 26 83.62 1/1/1981

51797 Intraabdominal pressure test 247.60 1/1/1981

51798 Us urine capacity measure 20.99 1/1/1981

51800 Revision of bladder/urethra 1045.81 1/1/1981

81/185


51820 Revision of urinary tract 1124.73 1/1/1981

51840 Attach bladder/urethra 686.35 1/1/1981

51841 Attach bladder/urethra 842.01 1/1/1981

51845 Repair bladder neck 640.74 1/1/1981

51860 Repair of bladder wound 773.23 1/1/1981

51865 Repair of bladder wound 927.08 1/1/1981

51880 Repair of bladder opening 527.07 1/1/1981

51900 Repair bladder/vagina lesion 821.74 1/1/1981

51920 Close bladder-uterus fistula 755.13 1/1/1981

51925 Hysterectomy/bladder repair 994.41 1/1/1981

51940 Correction of bladder defect 1737.60 1/1/1981

51960 Revision of bladder & bowel 1402.38 1/1/1981

51980 Construct bladder opening 720.38 1/1/1981

51990 Laparo urethral suspension 754.77 1/1/1981

51992 Laparo sling operation 806.53 1/1/1981

52000 Cystoscopy 104.25 1/1/1981

52001 Cystoscopy removal of clots 137.19 1/1/1981

52005 Cystoscopy & ureter catheter 127.06 1/1/1981

52007 Cystoscopy and biopsy 156.02 1/1/1981

52010 Cystoscopy & duct catheter 156.02 1/1/1981

52204 Cystoscopy w/biopsy(s) 122.71 1/1/1981

52214 Cystoscopy and treatment 191.86 1/1/1981





52250 Cystoscopy and radiotracer 233.12 1/1/1981



52270 Cystoscopy & revise urethra 174.12 1/1/1981

52275 Cystoscopy & revise urethra 242.90 1/1/1981




52282 Cystoscopy implant stent 331.59 1/1/1981









52317 Remove bladder stone 347.88 1/1/1981

52318 Remove bladder stone 474.94 1/1/1981

82/185



52325 Cystoscopy stone removal 318.56 1/1/1981

52327 Cystoscopy inject material 269.32 1/1/1981



52334 Create passage to kidney 249.41 1/1/1981

52341 Cysto w/ureter stricture tx 324.71 1/1/1981

52342 Cysto w/up stricture tx 351.50 1/1/1981

52343 Cysto w/renal stricture tx 389.15 1/1/1981

52344 Cysto/uretero stricture tx 416.30 1/1/1981

52345 Cysto/uretero w/up stricture 443.08 1/1/1981

52346 Cystouretero w/renal strict 499.19 1/1/1981

52351 Cystouretero & or pyeloscope 303.71 1/1/1981

52352 Cystouretero w/stone remove 356.20 1/1/1981

52353 Cystouretero w/lithotripsy 412.68 1/1/1981

52354 Cystouretero w/biopsy 380.46 1/1/1981

52355 Cystouretero w/excise tumor 457.56 1/1/1981

52400 Cystouretero w/congen repr 594.76 1/1/1981

52441 Cystourethro w/implant 247.13 1/1/2015

52442 Cystourethro w/addl implant 84.84 1/1/2015

52450 Incision of prostate 544.81 1/1/1981

52500 Revision of bladder neck 586.07 1/1/1981

52601 Prostatectomy (turp) 789.16 1/1/1981

52630 Remove prostate regrowth 525.26 1/1/1981

52640 Relieve bladder contracture 473.49 1/1/1981

52647 Laser surgery of prostate 586.07 1/1/1981

52648 Laser surgery of prostate 723.63 1/1/1981

52649 Prostate laser enucleation 940.46 1/1/2008

52700 Drainage of prostate abscess 503.18 1/1/1981

53000 Incision of urethra 187.51 1/1/1981




53040 Drainage of urethra abscess 563.99 1/1/1981

53060 Drainage of urethra abscess 215.02 1/1/1981

53080 Drainage of urinary leakage 562.18 1/1/1981

53085 Drainage of urinary leakage 789.88 1/1/1981

53200 Biopsy of urethra 138.28 1/1/1981

53210 Removal of urethra 793.50 1/1/1981

53215 Removal of urethra 939.02 1/1/1981

53220 Treatment of urethra lesion 488.70 1/1/1981

53230 Removal of urethra lesion 613.95 1/1/1981

53235 Removal of urethra lesion 639.29 1/1/1981

53240 Surgery for urethra pouch 453.22 1/1/1981

53250 Removal of urethra gland 407.97 1/1/1981

83/185




53270 Removal of urethra gland 228.06 1/1/1981

53275 Repair of urethra defect 305.89 1/1/1981

53400 Revise urethra stage 1 814.50 1/1/1981

53405 Revise urethra stage 2 890.52 1/1/1981

53410 Reconstruction of urethra 987.89 1/1/1981


53420 Reconstruct urethra stage 1 883.28 1/1/1981

53425 Reconstruct urethra stage 2 962.92 1/1/1981


53431 Reconstruct urethra/bladder 1076.95 1/1/1981

53440 Male sling procedure 785.17 1/1/1981

53442 Remove/revise male sling 553.49 1/1/1981

53444 Insert tandem cuff 772.50 1/1/1981

53445 Insert uro/ves nck sphincter 876.40 1/1/1981

53446 Remove uro sphincter 717.12 1/1/1981

53447 Remove/replace ur sphincter 822.46 1/1/1981

53448 Remov/replc ur sphinctr comp 1289.44 1/1/1981

53449 Repair uro sphincter 630.96 1/1/1981

53450 Revision of urethra 433.67 1/1/1981


53500 Urethrlys transvag w/ scope 735.37 1/1/2004

53502 Repair of urethra injury 517.66 1/1/1981




53520 Repair of urethra defect 569.06 1/1/1981

53600 Dilate urethra stricture 64.43 1/1/1981

53601 DILATE URETHRA STRICTURE 53.21 1/1/1981




53660 Dilation of urethra 39.82 1/1/1981

53661 DILATION OF URETHRA 39.45 1/1/1981

53665 Dilation of urethra 39.82 1/1/1981

53850 Prostatic microwave thermotx 537.57 1/1/1981

53852 Prostatic rf thermotx 560.73 1/1/1981

54000 Slitting of prepuce 117.28 1/1/1981

54001 Slitting of prepuce 166.52 1/1/1981

54015 Drain penis lesion 328.69 1/1/1981

54050 DESTRUCTION PENIS LESION(S) 65.88 1/1/1981

54055 Destruction penis lesion(s) 100.99 1/1/1981

54056 Cryosurgery penis lesion(s) 69.50 1/1/1981

54057 Laser surg penis lesion(s) 101.72 1/1/1981

84/185


54060 Excision of penis lesion(s) 137.92 1/1/1981

54065 Destruction penis lesion(s) 178.10 1/1/1981

54100 Biopsy of penis 102.44 1/1/1981

54105 Biopsy of penis 219.01 1/1/1981

54110 Treatment of penis lesion 703.36 1/1/1981

54111 Treat penis lesion graft 880.74 1/1/1981

54112 Treat penis lesion graft 997.31 1/1/1981


54120 Partial removal of penis 695.04 1/1/1981

54125 Removal of penis 880.02 1/1/1981

54130 Remove penis & nodes 1236.23 1/1/1981

54135 Remove penis & nodes 1580.13 1/1/1981

54150 Circumcision w/regionl block 143.71 1/1/1981

54160 Circumcision neonate 165.79 1/1/1981

54161 Circum 28 days or older 206.70 1/1/1981

54162 Lysis penil circumic lesion 226.61 1/1/1981

54163 Repair of circumcision 212.49 1/1/1981

54164 Frenulotomy of penis 186.79 1/1/1981




54230 Prepare penis study 69.50 1/1/1981

54231 Dynamic cavernosometry 111.49 1/1/1981

54235 Penile injection 61.90 1/1/1981

54240 Penis study TC 44.88 1/1/1981

54240 Penis study 26 68.05 1/1/1981

54240 Penis study 113.30 1/1/1981

54250 Penis study TC 81.81 1/1/1981

54250 Penis study 26 115.11 1/1/1981

54250 Penis study 196.92 1/1/1981

54300 Revision of penis 741.01 1/1/1981









54328 Revise penis/urethra 1045.45 1/1/1981



54340 Secondary urethral surgery 724.36 1/1/1981



85/185


54352 Reconstruct urethra/penis 1592.80 1/1/1981

54360 Penis plastic surgery 797.12 1/1/1981

54380 Repair penis 936.13 1/1/1981

54385 Repair penis 1049.80 1/1/1981

54390 Repair penis and bladder 1394.78 1/1/1981

54400 Insert semi-rigid prosthesis 595.85 1/1/1981

54401 Insert self-contd prosthesis 678.02 1/1/1981

54405 Insert multi-comp penis pros 841.28 1/1/1981

54406 Remove muti-comp penis pros 704.45 1/1/1981

54408 Repair multi-comp penis pros 741.73 1/1/1981

54410 Remove/replace penis prosth 875.67 1/1/1981

54411 Remov/replc penis pros comp 954.95 1/1/1981

54415 Remove self-contd penis pros 523.45 1/1/1981

54416 Remv/repl penis contain pros 680.56 1/1/1981

54417 Remv/replc penis pros compl 836.94 1/1/1981




54437 Repair corporeal tear 686.09 1/1/2016

54440 Repair of penis 623.36 1/1/1981

54450 Preputial stretching 62.26 1/1/1981

54500 Biopsy of testis 68.05 1/1/1981

54505 Biopsy of testis 238.55 1/1/1981

54512 Excise lesion testis 531.77 1/1/1981

54520 Removal of testis 345.71 1/1/1981

54522 Orchiectomy partial 604.17 1/1/1981

54530 Removal of testis 540.82 1/1/1981

54535 Extensive testis surgery 765.26 1/1/1981

54550 Exploration for testis 491.59 1/1/1981

54560 Exploration for testis 706.62 1/1/1981

54600 Reduce testis torsion 439.46 1/1/1981

54620 Suspension of testis 314.57 1/1/1981

54640 Suspension of testis 438.02 1/1/1981

54650 Orchiopexy (fowler-stephens) 726.17 1/1/1981

54660 Revision of testis 338.47 1/1/1981

54670 Repair testis injury 413.04 1/1/1981

54680 Relocation of testis(es) 789.16 1/1/1981

54690 Laparoscopy orchiectomy 708.43 1/1/1981

54692 Laparoscopy orchiopexy 726.17 1/1/1981

54700 Drainage of scrotum 267.51 1/1/1981

54800 Biopsy of epididymis 120.54 1/1/1981

54830 Remove epididymis lesion 355.48 1/1/1981

54840 Remove epididymis lesion 345.34 1/1/1981

54860 Removal of epididymis 411.95 1/1/1981

54861 Removal of epididymis 545.17 1/1/1981

86/185


54900 Fusion of spermatic ducts 801.83 1/1/1981

54901 Fusion of spermatic ducts 1081.29 1/1/1981

55000 Drainage of hydrocele 74.93 1/1/1981

55040 Removal of hydrocele 344.26 1/1/1981

55041 Removal of hydroceles 477.47 1/1/1981

55060 Repair of hydrocele 354.03 1/1/1981

55100 Drainage of scrotum abscess 220.45 1/1/1981

55110 Explore scrotum 362.72 1/1/1981

55120 Removal of scrotum lesion 331.95 1/1/1981

55150 Removal of scrotum 462.27 1/1/1981

55175 Revision of scrotum 351.14 1/1/1981

55180 Revision of scrotum 661.37 1/1/1981

55200 Incision of sperm duct 281.63 1/1/1981

55250 Removal of sperm duct(s) 252.31 1/1/1981

55300 Prepare sperm duct x-ray 195.11 1/1/1981

55400 Repair of sperm duct 530.69 1/1/1981

55450 Ligation of sperm duct 258.83 1/1/1981

55500 Removal of hydrocele 363.44 1/1/1981

55520 Removal of sperm cord lesion 387.70 1/1/1981

55530 Revise spermatic cord veins 369.24 1/1/1981

55535 Revise spermatic cord veins 416.30 1/1/1981

55540 Revise hernia & sperm veins 475.66 1/1/1981

55550 Laparo ligate spermatic vein 397.47 1/1/1981

55600 Incise sperm duct pouch 414.49 1/1/1981

55605 Incise sperm duct pouch 515.85 1/1/1981

55650 Remove sperm duct pouch 703.00 1/1/1981

55680 Remove sperm pouch lesion 344.26 1/1/1981

55700 Biopsy of prostate 89.05 1/1/1981

55705 Biopsy of prostate 325.07 1/1/1981



55801 Removal of prostate 1062.83 1/1/1981

55810 Extensive prostate surgery 1326.36 1/1/1981








55860 Surgical exposure prostate 859.75 1/1/1981



55866 Laparo radical prostatectomy 1621.76 1/1/1981

55870 Electroejaculation 136.83 1/1/1981

87/185


55873 Cryoablate prostate 1153.69 1/1/1981

56405 I & d of vulva/perineum 108.60 1/1/1981

56420 Drainage of gland abscess 106.42 1/1/1981

56440 Surgery for vulva lesion 205.97 1/1/1981

56441 Lysis of labial lesion(s) 158.55 1/1/1981

56501 Destroy vulva lesions sim 115.47 1/1/1981

56515 Destroy vulva lesion/s compl 200.91 1/1/1981

56605 Biopsy of vulva/perineum 63.71 1/1/1981

56606 Biopsy of vulva/perineum 31.13 1/1/1981

56620 Partial removal of vulva 498.11 1/1/1981

56625 Complete removal of vulva 575.58 1/1/1981

56630 Extensive vulva surgery 801.83 1/1/1981







56700 Partial removal of hymen 183.53 1/1/1981

56740 Remove vagina gland lesion 298.28 1/1/1981

56800 Repair of vagina 265.34 1/1/1981

56805 Repair clitoris 1130.16 1/1/1981

56810 Repair of perineum 277.65 1/1/1981

56820 Exam of vulva w/scope 83.26 1/1/1981

56821 Exam/biopsy of vulva w/scope 114.75 1/1/1981

57000 Exploration of vagina 213.94 1/1/1981

57010 Drainage of pelvic abscess 397.83 1/1/1981

57020 Drainage of pelvic fluid 85.79 1/1/1981

57022 I & d vaginal hematoma pp 184.25 1/1/1981

57023 I & d vag hematoma non-ob 296.47 1/1/1981

57061 Destroy vag lesions simple 101.36 1/1/1981

57065 Destroy vag lesions complex 196.92 1/1/1981

57100 Biopsy of vagina 68.05 1/1/1981

57105 Biopsy of vagina 157.10 1/1/1981

57106 Remove vagina wall partial 357.29 1/1/1981

57107 Remove vagina tissue part 1332.16 1/1/1981

57109 Vaginectomy partial w/nodes 1590.99 1/1/1981

57110 Remove vagina wall complete 866.99 1/1/1981

57111 Remove vagina tissue compl 1584.11 1/1/1981

57112 Vaginectomy w/nodes compl 1691.62 1/1/1981

57120 CLOSURE OF VAGINA 484.71 1/1/1981

57130 Remove vagina lesion 183.17 1/1/1981

57135 Remove vagina lesion 196.92 1/1/1981

57150 TREAT VAGINA INFECTION 30.77 1/1/1981

57155 Insert uteri tandem/ovoids 393.85 1/1/1981

88/185


57160 Insert pessary/other device 51.76 1/1/1981

57170 Fitting of diaphragm/cap 50.68 1/1/1981

57180 Treat vaginal bleeding 122.71 1/1/1981

57200 Repair of vagina 278.01 1/1/1981

57210 Repair vagina/perineum 348.60 1/1/1981


57230 Repair of urethral lesion 396.02 1/1/1981

57240 Repair bladder & vagina 417.74 1/1/1981

57250 Repair rectum & vagina 375.75 1/1/1981

57260 Repair of vagina 531.77 1/1/1981

57265 Extensive repair of vagina 734.13 1/1/1981

57268 Repair of bowel bulge 445.62 1/1/1981

57270 Repair of bowel pouch 739.20 1/1/1981

57280 Suspension of vagina 901.38 1/1/1981

57282 Colpopexy extraperitoneal 564.72 1/1/1981

57284 Repair paravag defect open 793.50 1/1/1981

57287 Revise/remove sling repair 703.00 1/1/1981

57288 Repair bladder defect 783.73 1/1/1981

57289 Repair bladder & vagina 730.51 1/1/1981

57291 Construction of vagina 546.25 1/1/1981

57292 Construct vagina with graft 803.64 1/1/1981

57300 Repair rectum-vagina fistula 488.70 1/1/1981

57305 Repair rectum-vagina fistula 822.46 1/1/1981

57307 Fistula repair & colostomy 939.39 1/1/1981

57308 Fistula repair transperine 625.53 1/1/1981

57310 REPAIR URETHROVAGINAL LESION 452.50 1/1/1981

57311 Repair urethrovaginal lesion 517.66 1/1/1981

57320 Repair bladder-vagina lesion 531.41 1/1/1981

57330 Repair bladder-vagina lesion 748.61 1/1/1981

57335 Repair vagina 1124.01 1/1/1981

57400 Dilation of vagina 136.47 1/1/1981

57410 Pelvic examination 111.85 1/1/1981

57415 Remove vaginal foreign body 169.41 1/1/1981

57420 Exam of vagina w/scope 88.69 1/1/1981

57421 Exam/biopsy of vag w/scope 122.71 1/1/1981

57425 Laparoscopy surg colpopexy 923.72 1/1/2004

57452 Exam of cervix w/scope 57.55 1/1/1981

57454 Bx/curett of cervix w/scope 75.29 1/1/1981

57455 Biopsy of cervix w/scope 111.49 1/1/1981

57456 Endocerv curettage w/scope 104.61 1/1/1981

57460 Bx of cervix w/scope leep 160.00 1/1/1981

57461 Conz of cervix w/scope leep 193.67 1/1/1981

57500 Biopsy of cervix 58.64 1/1/1981

57505 Endocervical curettage 97.74 1/1/1981

57510 Cauterization of cervix 139.37 1/1/1981

89/185


57511 Cryocautery of cervix 106.06 1/1/1981

57513 Laser surgery of cervix 139.73 1/1/1981

57520 Conization of cervix 275.12 1/1/1981

57522 Conization of cervix 237.83 1/1/1981

57530 Removal of cervix 337.38 1/1/1981

57531 Removal of cervix radical 1669.54 1/1/1981

57540 Removal of residual cervix 741.73 1/1/1981

57545 Remove cervix/repair pelvis 792.41 1/1/1981

57550 Removal of residual cervix 375.03 1/1/1981

57555 Remove cervix/repair vagina 586.44 1/1/1981

57556 Remove cervix repair bowel 532.86 1/1/1981

57700 Revision of cervix 245.43 1/1/1981


57800 Dilation of cervical canal 44.88 1/1/1981

58100 Biopsy of uterus lining 87.24 1/1/1981

58110 Bx done w/colposcopy add-on 43.14 1/1/2006

58120 Dilation and curettage 229.14 1/1/1981

58140 Myomectomy abdom method 872.78 1/1/1981

58145 Myomectomy vag method 519.83 1/1/1981

58146 Myomectomy abdom complex 1099.39 1/1/1981

58150 Total hysterectomy 918.39 1/1/1981

58152 Total hysterectomy 1198.58 1/1/1981

58180 Partial hysterectomy 920.92 1/1/1981

58200 Extensive hysterectomy 1316.59 1/1/1981


58240 Removal of pelvis contents 2302.68 1/1/1981

58260 VAGINAL HYSTERECTOMY 785.54 1/1/1981

58262 VAG HYST INCLUDING T/O 887.62 1/1/1981

58263 Vag hyst w/t/o & vag repair 961.11 1/1/1981

58267 Vag hyst w/urinary repair 1017.22 1/1/1981

58270 Vag hyst w/enterocele repair 858.30 1/1/1981

58275 Hysterectomy/revise vagina 937.94 1/1/1981

58280 Hysterectomy/revise vagina 1004.55 1/1/1981


58290 Vag hyst complex 1097.58 1/1/1981

58291 Vag hyst incl t/o complex 1207.27 1/1/1981

58292 Vag hyst t/o & repair compl 1279.30 1/1/1981

58293 Vag hyst w/uro repair compl 1328.17 1/1/1981

58294 Vag hyst w/enterocele compl 1177.58 1/1/1981

58300 Insert intrauterine device 56.11 1/1/1981

58301 Remove intrauterine device 70.95 1/1/1981

58340 Catheter for hysterography 47.78 1/1/1981

58345 Reopen fallopian tube 250.50 1/1/1981

58346 Insert heyman uteri capsule 419.92 1/1/1981

58350 Reopen fallopian tube 85.07 1/1/1981

90/185


58353 Endometr ablate thermal 231.31 1/1/1981

58356 Endometrial cryoablation 362.71 1/1/2005

58400 Suspension of uterus 415.21 1/1/1981

58410 Suspension of uterus 768.16 1/1/1981

58520 Repair of ruptured uterus 719.65 1/1/1981

58540 Revision of uterus 850.33 1/1/1981

58545 Laparoscopic myomectomy 886.53 1/1/1981

58546 Laparo-myomectomy complex 1113.87 1/1/1981

58550 Laparo-asst vag hysterectomy 846.71 1/1/1981

58552 Laparo-vag hyst incl t/o 863.73 1/1/1981

58553 LAPARO-VAG HYST COMPLEX 1105.18 1/1/1981

58554 LAPARO-VAG HYST W/T/O COMPL 1093.24 1/1/1981

58555 Hysteroscopy dx sep proc 192.22 1/1/1981

58558 Hysteroscopy biopsy 274.39 1/1/1981

58559 Hysteroscopy lysis 348.96 1/1/1981

58560 Hysteroscopy resect septum 398.92 1/1/1981

58561 Hysteroscopy remove myoma 550.60 1/1/1981

58562 Hysteroscopy remove fb 300.46 1/1/1981

58563 Hysteroscopy ablation 350.05 1/1/1981

58600 Division of fallopian tube 352.95 1/1/1981

58605 Division of fallopian tube 321.09 1/1/1981

58611 Ligate oviduct(s) add-on 78.91 1/1/1981

58615 Occlude fallopian tube(s) 285.25 1/1/1981

58660 Laparoscopy lysis 678.02 1/1/1981

58661 Laparoscopy remove adnexa 656.66 1/1/1981

58662 Laparoscopy excise lesions 696.85 1/1/1981

58670 Laparoscopy tubal cautery 368.15 1/1/1981

58671 Laparoscopy tubal block 368.87 1/1/1981

58672 Laparoscopy fimbrioplasty 777.93 1/1/1981

58673 Laparoscopy salpingostomy 830.42 1/1/1981

58700 Removal of fallopian tube 693.95 1/1/1981

58720 Removal of ovary/tube(s) 690.69 1/1/1981

58740 Adhesiolysis tube ovary 811.24 1/1/1981

58750 Repair oviduct 892.33 1/1/1981

58752 Revise ovarian tube(s) 903.91 1/1/1981

58760 Fimbrioplasty 799.65 1/1/1981

58770 Create new tubal opening 842.73 1/1/1981

58800 Drainage of ovarian cyst(s) 330.50 1/1/1981

58805 Drainage of ovarian cyst(s) 376.11 1/1/1981

58820 Drain ovary abscess open 293.22 1/1/1981

58822 Drain ovary abscess percut 604.54 1/1/1981

58825 Transposition ovary(s) 650.51 1/1/1981

58900 Biopsy of ovary(s) 379.37 1/1/1981

58920 Partial removal of ovary(s) 663.18 1/1/1981

58925 Removal of ovarian cyst(s) 680.92 1/1/1981

91/185


58940 Removal of ovary(s) 454.31 1/1/1981

58943 Removal of ovary(s) 1125.09 1/1/1981

58950 Resect ovarian malignancy 1037.85 1/1/1981



58953 Tah rad dissect for debulk 1890.72 1/1/1981

58954 Tah rad debulk/lymph remove 2055.07 1/1/1981

58960 Exploration of abdomen 917.67 1/1/1981

59000 Amniocentesis diagnostic 134.28 9/8/2008

59001 Amniocentesis therapeutic 170.84 9/8/2008

59012 Fetal cord puncture prenatal 216.81 9/8/2008

59015 Chorion biopsy 159.26 9/8/2008

59020 Fetal contract stress test 62.26 9/8/2008

59025 Fetal non-stress test 40.90 9/8/2008

59030 Fetal scalp blood sample 131.02 9/8/2008

59050 Fetal monitor w/report 53.57 9/8/2008

59051 Fetal monitor/interpret only 44.88 9/8/2008

59070 Transabdom amnioinfus w/us 407.14 9/8/2008

59072 Umbilical cord occlud w/us 487.65 9/8/2008

59074 Fetal fluid drainage w/us 387.36 9/8/2008

59076 Fetal shunt placement w/us 487.65 9/8/2008

59100 Remove uterus lesion 794.48 9/8/2008

59120 Treat ectopic pregnancy 747.06 9/8/2008








59160 D & c after delivery 260.24 9/8/2008

59200 Insert cervical dilator 88.32 9/8/2008

59300 Episiotomy or vaginal repair 182.06 9/8/2008



59350 Repair of uterus 300.78 9/8/2008

59400 Obstetrical care 1599.45 9/8/2008



59412 Antepartum manipulation 127.76 9/8/2008

59414 Deliver placenta 121.62 9/8/2008

59425 Antepartum care only 414.07 9/8/2008

59426 Antepartum care only 710.14 9/8/2008

59430 Care after delivery 142.61 9/8/2008

59510 CESAREAN DELIVERY 1821.69 9/8/2008

92/185


59514 Cesarean delivery only 953.01 9/8/2008

59515 Cesarean delivery 1088.75 9/8/2008

59525 Remove uterus after cesarean 509.99 9/8/2008

59610 Vbac delivery 1701.16 9/8/2008

59612 Vbac delivery only 907.77 9/8/2008

59614 Vbac care after delivery 1012.01 9/8/2008

59618 Attempted vbac delivery 1919.78 9/8/2008

59620 ATTEMPTED VBAC DELIVERY ONLY 1033.72 9/8/2008

59622 Attempted vbac after care 1172.00 9/8/2008

59812 Treatment of miscarriage 312.36 9/8/2008

59820 Care of miscarriage 319.97 9/8/2008

59821 Treatment of miscarriage 340.23 9/8/2008

59830 Treat uterus infection 415.16 9/8/2008

59840 Abortion 283.77 9/8/2008

59841 Abortion 449.18 9/8/2008

59850 Abortion 364.85 9/8/2008

59851 Abortion 383.30 9/8/2008

59852 Abortion 536.77 9/8/2008

59855 Abortion 397.79 9/8/2008

59856 Abortion 471.26 9/8/2008

59857 Abortion 578.39 9/8/2008

59866 Abortion (mpr) 237.08 9/8/2008

59870 Evacuate mole of uterus 396.33 9/8/2008

59871 Remove cerclage suture 176.63 9/8/2008

60000 Drain thyroid/tongue cyst 153.48 1/1/1981

60100 Biopsy of thyroid 80.00 1/1/1981

60200 Remove thyroid lesion 642.91 1/1/1981

60210 Partial thyroid excision 689.24 1/1/1981

60212 Partial thyroid excision 973.41 1/1/1981

60220 Partial removal of thyroid 748.97 1/1/1981

60225 Partial removal of thyroid 876.40 1/1/1981

60240 Removal of thyroid 1000.56 1/1/1981


60254 Extensive thyroid surgery 1684.02 1/1/1981

60260 Repeat thyroid surgery 1097.22 1/1/1981



60280 Remove thyroid duct lesion 432.22 1/1/1981

60281 Remove thyroid duct lesion 575.58 1/1/1981

60300 Aspir/inj thyroid cyst 45.54 1/1/2008

60500 Explore parathyroid glands 961.47 1/1/1981

60502 Re-explore parathyroids 1202.92 1/1/1981

60505 Explore parathyroid glands 1308.99 1/1/1981

60512 Autotransplant parathyroid 245.79 1/1/1981

60520 Removal of thymus gland 1051.24 1/1/1981

93/185




60540 Explore adrenal gland 986.08 1/1/1981

60545 Explore adrenal gland 1165.64 1/1/1981

60600 Remove carotid body lesion 1239.12 1/1/1981

60605 Remove carotid body lesion 1517.50 1/1/1981

60650 Laparoscopy adrenalectomy 1127.99 1/1/1981

61000 Remove cranial cavity fluid 120.54 1/1/1981

61001 Remove cranial cavity fluid 116.20 1/1/1981

61020 Remove brain cavity fluid 123.08 1/1/1981

61026 Injection into brain canal 135.75 1/1/1981

61050 Remove brain canal fluid 119.46 1/1/1981

61055 Injection into brain canal 149.86 1/1/1981

61070 Brain canal shunt procedure 82.17 1/1/1981

61105 Twist drill hole 371.05 1/1/1981

61107 Drill skull for implantation 343.90 1/1/1981

61108 Drill skull for drainage 726.53 1/1/1981

61120 Burr hole for puncture 619.02 1/1/1981

61140 Pierce skull for biopsy 1092.51 1/1/1981

61150 Pierce skull for drainage 1197.13 1/1/1981


61154 Pierce skull & remove clot 1033.51 1/1/1981


61210 Pierce skull implant device 396.02 1/1/1981

61215 Insert brain-fluid device 380.82 1/1/1981

61250 Pierce skull & explore 720.74 1/1/1981

61253 Pierce skull & explore 836.22 1/1/1981

61304 Open skull for exploration 1471.89 1/1/1981

61305 Open skull for exploration 1773.80 1/1/1981

61312 Open skull for drainage 1660.13 1/1/1981




61316 Implt cran bone flap to abdo 90.86 1/1/1981



61322 Decompressive craniotomy 1813.62 1/1/1981

61323 Decompressive lobectomy 1875.88 1/1/1981

61330 Decompress eye socket 1691.98 1/1/1981

61332 Explore/biopsy eye socket 1942.49 1/1/1981

61333 Explore orbit/remove lesion 1733.61 1/1/1981

61340 Subtemporal decompression 1281.11 1/1/1981

61343 Incise skull (press relief) 2022.85 1/1/1981

61345 Relieve cranial pressure 1826.65 1/1/1981

61450 Incise skull for surgery 1711.53 1/1/1981

94/185


61458 Incise skull for brain wound 1821.58 1/1/1981



61500 Removal of skull lesion 1209.44 1/1/1981

61501 Remove infected skull bone 1016.85 1/1/1981

61510 Removal of brain lesion 1912.08 1/1/1981

61512 Remove brain lining lesion 2347.93 1/1/1981

61514 Removal of brain abscess 1703.93 1/1/1981


61517 Implt brain chemotx add-on 74.93 1/1/1981


61519 Remove brain lining lesion 2780.88 1/1/1981



61522 Removal of brain abscess 1950.45 1/1/1981




61531 Implant brain electrodes 1016.13 1/1/1981



61535 Remove brain electrodes 830.42 1/1/1981


61537 Removal of brain tissue 1772.93 1/1/2004




61541 Incision of brain tissue 1925.47 1/1/1981


61544 Remove & treat brain lesion 1714.79 1/1/1981

61545 Excision of brain tumor 2925.68 1/1/1981

61546 Removal of pituitary gland 2108.65 1/1/1981

61548 Removal of pituitary gland 1458.86 1/1/1981

61550 Release of skull seams 766.71 1/1/1981

61552 Release of skull seams 1121.47 1/1/1981

61556 Incise skull/sutures 1407.81 1/1/1981

61557 Incise skull/sutures 1523.29 1/1/1981

61558 Excision of skull/sutures 1521.48 1/1/1981

61559 Excision of skull/sutures 2203.49 1/1/1981

61563 Excision of skull tumor 1782.48 1/1/1981

61564 Excision of skull tumor 2245.12 1/1/1981


61567 Incision of brain tissue 2410.18 1/1/2004

61570 Remove foreign body brain 1615.24 1/1/1981

61571 Incise skull for brain wound 1769.45 1/1/1981

95/185


61575 Skull base/brainstem surgery 2273.72 1/1/1981

61576 Skull base/brainstem surgery 3198.99 1/1/1981

61580 Craniofacial approach skull 1975.07 1/1/1981




61584 Orbitocranial approach/skull 2335.98 1/1/1981


61586 Resect nasopharynx skull 1683.66 1/1/1981

61590 Infratemporal approach/skull 2689.66 1/1/1981

61591 Infratemporal approach/skull 2830.84 1/1/1981


61595 Transtemporal approach/skull 1951.90 1/1/1981

61596 Transcochlear approach/skull 2305.21 1/1/1981

61597 Transcondylar approach/skull 2514.81 1/1/1981

61598 Transpetrosal approach/skull 2203.49 1/1/1981

61600 Resect/excise cranial lesion 1641.67 1/1/1981






61610 Transect artery sinus 1774.16 1/1/1981



61613 Remove aneurysm sinus 2728.39 1/1/1981

61615 Resect/excise lesion skull 2152.45 1/1/1981

61616 Resect/excise lesion skull 2898.17 1/1/1981

61618 Repair dura 1175.77 1/1/1981

61619 Repair dura 1417.23 1/1/1981

61623 Endovasc tempory vessel occl 543.36 1/1/1981

61624 Transcath occlusion cns 1063.91 1/1/1981

61626 Transcath occlusion non-cns 862.64 1/1/1981

61630 Intracranial angioplasty 1281.36 12/1/2010

61635 Intracran angioplsty w/stent 1386.96 12/1/2010

61640 Dilate ic vasospasm init 630.50 12/1/2010

61641 Dilate ic vasospasm add-on 221.76 12/1/2010

61642 Dilate ic vasospasm add-on 443.53 12/1/2010

61645 Perq art m-thrombect &/nfs 785.53 1/1/2016

61680 Intracranial vessel surgery 2072.81 1/1/1981






96/185


61697 Brain aneurysm repr complx 3358.27 1/1/1981

61698 Brain aneurysm repr complx 3225.78 1/1/1981

61700 Brain aneurysm repr simple 3352.48 1/1/1981

61702 Inner skull vessel surgery 3214.92 1/1/1981

61703 Clamp neck artery 1212.70 1/1/1981

61705 Revise circulation to head 2356.98 1/1/1981



61711 Fusion of skull arteries 2422.86 1/1/1981

61720 Incise skull/brain surgery 1173.60 1/1/1981

61735 Incise skull/brain surgery 1405.64 1/1/1981

61750 Incise skull/brain biopsy 1241.29 1/1/1981

61751 Brain biopsy w/ct/mr guide 1207.99 1/1/1981


61770 Incise skull for treatment 1457.77 1/1/1981

61790 Treat trigeminal nerve 734.86 1/1/1981

61791 Treat trigeminal tract 1017.22 1/1/1981

61796 Srs cranial lesion simple 749.28 1/1/2009

61797 Srs cran les simple addl 204.22 1/1/2009

61798 Srs cranial lesion complex 749.28 1/1/2009

61799 Srs cran les complex addl 282.38 1/1/2009

61800 Apply srs headframe add-on 145.18 1/1/2009

61850 Implant neuroelectrodes 854.32 1/1/1981


61863 Implant neuroelectrode 1272.65 1/1/2004

61864 Implant neuroelectrde addl 305.33 1/1/2004

61867 Implant neuroelectrode 1913.39 1/1/2004

61868 Implant neuroelectrde addl 504.57 1/1/2004

61880 Revise/remove neuroelectrode 483.99 1/1/1981

61888 Revise/remove neuroreceiver 376.48 1/1/1981

62000 Treat skull fracture 726.89 1/1/1981

62005 Treat skull fracture 1041.83 1/1/1981

62010 Treatment of head injury 1343.02 1/1/1981

62100 Repair brain fluid leakage 1505.19 1/1/1981

62115 Reduction of skull defect 1401.30 1/1/1981

62117 Reduction of skull defect 1688.00 1/1/1981

62120 Repair skull cavity lesion 1553.34 1/1/1981

62121 Incise skull repair 1401.66 1/1/1981

62140 Repair of skull defect 933.23 1/1/1981

62141 Repair of skull defect 1039.30 1/1/1981

62142 Remove skull plate/flap 759.47 1/1/1981

62143 Replace skull plate/flap 917.67 1/1/1981

62145 Repair of skull & brain 1294.15 1/1/1981

62146 Repair of skull with graft 1114.96 1/1/1981

62147 Repair of skull with graft 1328.54 1/1/1981

97/185


62148 Retr bone flap to fix skull 122.35 1/1/1981

62160 Neuroendoscopy add-on 175.57 1/1/1981

62161 Dissect brain w/scope 1254.69 1/1/1981

62162 Remove colloid cyst w/scope 1618.50 1/1/1981

62163 Zneuroendoscopy w/fb removal 1025.54 1/1/1981

62164 Remove brain tumor w/scope 1746.28 1/1/1981

62165 Remove pituit tumor w/scope 1361.12 1/1/1981

62180 Establish brain cavity shunt 1447.27 1/1/1981



62194 Replace/irrigate catheter 289.60 1/1/1981


62201 Brain cavity shunt w/scope 1017.94 1/1/1981



62225 Replace/irrigate catheter 399.28 1/1/1981

62230 Replace/revise brain shunt 716.76 1/1/1981

62252 Csf shunt reprogram TC 40.54 1/1/1981

62252 Csf shunt reprogram 26 45.25 1/1/1981

62252 Csf shunt reprogram 85.43 1/1/1981

62256 Remove brain cavity shunt 501.73 1/1/1981

62258 Replace brain cavity shunt 987.89 1/1/1981

62263 Epidural lysis mult sessions 319.64 1/1/1981

62264 Epidural lysis on single day 224.07 1/1/1981

62268 Drain spinal cord cyst 288.15 1/1/1981

62269 Needle biopsy spinal cord 285.61 1/1/1981

62270 Spinal fluid tap diagnostic 61.90 1/1/1981

62272 Drain cerebro spinal fluid 78.19 1/1/1981

62273 Inject epidural patch 132.13 1/1/1981

62280 Treat spinal cord lesion 129.59 1/1/1981

62281 Treat spinal cord lesion 127.06 1/1/1981

62282 Treat spinal canal lesion 114.39 1/1/1981

62284 Injection for myelogram 81.08 1/1/1981

62287 Percutaneous diskectomy 512.95 1/1/1981

62290 Inject for spine disk x-ray 166.88 1/1/1981

62291 Inject for spine disk x-ray 158.55 1/1/1981

62292 Injection into disk lesion 515.12 1/1/1981

62294 Injection into spinal artery 744.63 1/1/1981

62302 Myelography lumbar injection 129.65 1/1/2015




62350 Implant spinal canal cath 420.64 1/1/1981

62351 Implant spinal canal cath 701.55 1/1/1981

62355 Remove spinal canal catheter 332.31 1/1/1981

98/185


62360 Insert spine infusion device 196.92 1/1/1981

62361 Implant spine infusion pump 356.93 1/1/1981

62362 Implant spine infusion pump 446.34 1/1/1981

62365 Remove spine infusion device 372.49 1/1/1981

62367 Analyze spine infus pump 18.82 1/1/1981

62368 Analyze sp inf pump w/reprog 28.23 1/1/1981

62369 Anal sp inf pmp w/reprg&fill 38.29 1/1/2012

62370 Anl sp inf pmp w/mdreprg&fil 51.34 1/1/2012

63001 Remove spine lamina 1/2 crvl 1147.54 1/1/1981

63003 Remove spine lamina 1/2 thrc 1160.21 1/1/1981

63005 Remove spine lamina 1/2 lmbr 1089.62 1/1/1981

63011 Remove spine lamina 1/2 scrl 1015.41 1/1/1981

63012 Remove lamina/facets lumbar 1067.90 1/1/1981

63015 Remove spine lamina >2 crvcl 1386.46 1/1/1981

63016 Remove spine lamina >2 thrc 1370.89 1/1/1981

63017 Remove spine lamina >2 lmbr 1158.76 1/1/1981

63020 Neck spine disk surgery 1091.43 1/1/1981

63030 Low back disk surgery 906.44 1/1/1981

63035 Spinal disk surgery add-on 202.35 1/1/1981

63040 Laminotomy single cervical 1335.05 1/1/1981

63042 Laminotomy single lumbar 1258.67 1/1/1981

63043 Laminotomy addl cervical 535.76 1/1/1981

63044 Laminotomy addl lumbar 508.97 1/1/1981

63045 Remove spine lamina 1 crvl 1199.66 1/1/1981

63046 REMOVE SPINE LAMINA 1 THRC 1153.33 1/1/1981

63047 Remove spine lamina 1 lmbr 1075.14 1/1/1981

63048 Remove spinal lamina add-on 209.96 1/1/1981

63055 DECOMPRESS SPINAL CORD THRC 1547.18 1/1/1981

63056 Decompress spinal cord lmbr 1429.90 1/1/1981

63057 Decompress spine cord add-on 333.04 1/1/1981

63064 Decompress spinal cord thrc 1745.92 1/1/1981

63066 Decompress spine cord add-on 212.49 1/1/1981



63077 Spine disk surgery thorax 1512.43 1/1/1981

63078 Spine disk surgery thorax 205.97 1/1/1981

63081 Remove vert body dcmprn crvl 1685.83 1/1/1981

63082 Remove vertebral body add-on 282.72 1/1/1981

63085 Remove vert body dcmprn thrc 1857.78 1/1/1981


63087 Remov vertbr dcmprn thrclmbr 2395.35 1/1/1981


63090 Remove vert body dcmprn lmbr 1892.89 1/1/1981


63101 Remove vert body dcmprn thrc 2190.93 1/1/2004

99/185


63102 Remove vert body dcmprn lmbr 2190.93 1/1/2004


63170 Incise spinal cord tract(s) 1400.94 1/1/1981

63172 Drainage of spinal cyst 1296.68 1/1/1981

63173 Drainage of spinal cyst 1565.65 1/1/1981

63180 Revise spinal cord ligaments 1322.74 1/1/1981

63182 Revise spinal cord ligaments 1409.99 1/1/1981

63185 Incise spine nrv half segmnt 1003.10 1/1/1981

63190 Incise spine nrv >2 segmnts 1200.03 1/1/1981

63191 Incise spine accessory nerve 1191.70 1/1/1981

63194 Incise spine & cord cervical 1380.66 1/1/1981

63195 Incise spine & cord thoracic 1325.64 1/1/1981

63196 Incise spine&cord 2 trx crvl 1542.84 1/1/1981

63197 Incise spine&cord 2 trx thrc 1468.99 1/1/1981

63198 Incise spin&cord 2 stgs crvl 1633.34 1/1/1981

63199 Incise spin&cord 2 stgs thrc 1765.11 1/1/1981

63200 Release spinal cord lumbar 1360.39 1/1/1981

63250 Revise spinal cord vsls crvl 2688.57 1/1/1981

63251 Revise spinal cord vsls thrc 2732.37 1/1/1981

63252 Revise spine cord vsl thrlmb 2716.44 1/1/1981

63265 Excise intraspinl lesion crv 1468.99 1/1/1981

63266 Excise intrspinl lesion thrc 1522.21 1/1/1981

63267 Excise intrspinl lesion lmbr 1238.04 1/1/1981

63268 Excise intrspinl lesion scrl 1225.73 1/1/1981

63270 Excise intrspinl lesion crvl 1817.24 1/1/1981

63271 Excise intrspinl lesion thrc 1830.99 1/1/1981

63272 Excise intrspinl lesion lmbr 1718.77 1/1/1981

63273 Excise intrspinl lesion scrl 1664.11 1/1/1981

63275 Bx/exc xdrl spine lesn crvl 1610.53 1/1/1981

63276 Bx/exc xdrl spine lesn thrc 1592.43 1/1/1981

63277 Bx/exc xdrl spine lesn lmbr 1422.66 1/1/1981

63278 Bx/exc xdrl spine lesn scrl 1415.78 1/1/1981

63280 Bx/exc idrl spine lesn crvl 1915.70 1/1/1981

63281 Bx/exc idrl spine lesn thrc 1897.96 1/1/1981

63282 Bx/exc idrl spine lesn lmbr 1787.19 1/1/1981

63283 Bx/exc idrl spine lesn scrl 1700.31 1/1/1981

63285 Bx/exc idrl imed lesn cervl 2412.73 1/1/1981

63286 Bx/exc idrl imed lesn thrc 2377.25 1/1/1981

63287 Bx/exc idrl imed lesn thrlmb 2453.63 1/1/1981

63290 Bx/exc xdrl/idrl lsn any lvl 2506.48 1/1/1981

63300 Remove vert xdrl body crvcl 1648.18 1/1/1981

63301 Remove vert xdrl body thrc 1812.89 1/1/1981

63302 Remove vert xdrl body thrlmb 1860.31 1/1/1981

63303 Remov vert xdrl bdy lmbr/sac 2003.67 1/1/1981

63304 Remove vert idrl body crvcl 1979.41 1/1/1981

100/185


63305 Remove vert idrl body thrc 2124.94 1/1/1981

63306 Remov vert idrl bdy thrclmbr 1960.95 1/1/1981

63307 Remov vert idrl bdy lmbr/sac 1986.29 1/1/1981


63600 Remove spinal cord lesion 803.27 1/1/1981

63610 Stimulation of spinal cord 483.27 1/1/1981

63615 Remove lesion of spinal cord 1074.41 1/1/1981

63620 Srs spinal lesion 749.28 1/1/2009

63621 Srs spinal lesion addl 234.82 1/1/2009



63685 Insrt/redo spine n generator 454.31 1/1/1981

63688 Revise/remove neuroreceiver 365.62 1/1/1981

63700 Repair of spinal herniation 1112.78 1/1/1981




63707 Repair spinal fluid leakage 798.57 1/1/1981

63709 Repair spinal fluid leakage 998.03 1/1/1981

63710 Graft repair of spine defect 985.00 1/1/1981

63740 Install spinal shunt 800.38 1/1/1981

63741 Install spinal shunt 523.45 1/1/1981

63744 Revision of spinal shunt 575.94 1/1/1981

63746 Removal of spinal shunt 470.96 1/1/1981

64400 N block inj trigeminal 53.93 1/1/1981

64402 N block inj facial 65.52 1/1/1981

64405 N block inj occipital 65.52 1/1/1981

64408 N block inj vagus 78.55 1/1/1981

64410 N block inj phrenic 68.78 1/1/1981

64413 N block inj cervical plexus 67.69 1/1/1981

64415 N block inj brachial plexus 69.50 1/1/1981

64416 N block cont infuse b plex 158.91 1/1/1981

64417 N block inj axillary 70.59 1/1/1981

64418 N block inj suprascapular 61.90 1/1/1981

64420 N block inj intercost sng 56.11 1/1/1981

64421 N block inj intercost mlt 79.64 1/1/1981

64425 N block inj ilio-ing/hypogi 83.98 1/1/1981

64430 N block inj pudendal 75.65 1/1/1981

64435 N block inj paracervical 81.81 1/1/1981

64445 N block inj sciatic sng 73.12 1/1/1981

64446 N blk inj sciatic cont inf 165.07 1/1/1981

64447 N block inj fem single 77.46 1/1/1981

64448 N block inj fem cont inf 151.67 1/1/1981

64449 N block inj lumbar plexus 154.45 1/1/2004

64450 N block other peripheral 62.26 1/1/1981

101/185


64461 Pvb thoracic single inj site 86.84 1/1/2016

64462 Pvb thoracic 2nd+ inj site 54.76 1/1/2016

64463 Pvb thoracic cont infusion 83.90 1/1/2016

64479 Inj foramen epidural c/t 110.41 1/1/1981

64480 Inj foramen epidural add-on 78.91 1/1/1981

64483 Inj foramen epidural l/s 95.56 1/1/1981

64484 Inj foramen epidural add-on 66.97 1/1/1981

64486 Tap block unil by injection 66.85 1/1/2015

64487 Tap block uni by infusion 76.75 1/1/2015

64488 Tap block bi injection 83.04 1/1/2015

64489 Tap block bi by infusion 92.57 1/1/2015

64490 Inj paravert f jnt c/t 1 lev 107.70 3/27/2015



64493 Inj paravert f jnt l/s 1 lev 92.31 3/27/2015



64505 N block spenopalatine gangl 66.24 1/1/1981

64508 N block carotid sinus s/p 61.54 1/1/1981

64510 N block stellate ganglion 57.19 1/1/1981

64517 N block inj hypogas plxs 121.83 1/1/2004

64520 N block lumbar/thoracic 64.43 1/1/1981

64530 N block inj celiac pelus 75.29 1/1/1981

64550 Apply neurostimulator 9.77 1/1/1981





64566 Neuroeltrd stim post tibial 32.32 1/1/2011




64585 Revise/remove neuroelectrode 170.50 1/1/1981

64590 Insrt/redo pn/gastr stimul 186.43 1/1/1981

64595 Revise/rmv pn/gastr stimul 150.95 1/1/1981

64600 Injection treatment of nerve 215.39 1/1/1981



64611 Chemodenerv saliv glands 99.38 1/1/2011

64612 Destroy nerve face muscle 137.19 1/1/1981

64615 Chemodenerv musc migraine 125.71 3/27/2015

64616 Chemodenerv musc neck dyston 115.06 1/1/2014

64617 Chemodener muscle larynx emg 121.21 1/1/2014



102/185


64632 N block inj common digit 68.88 1/1/2009


64642 Chemodenerv 1 extremity 1-4 114.22 1/1/2014

64643 Chemodenerv 1 extrem 1-4 ea 76.31 1/1/2014

64644 Chemodenerv 1 extrem 5/> mus 124.61 1/1/2014

64645 Chemodenerv 1 extrem 5/> ea 87.51 1/1/2014

64646 Chemodenerv trunk musc 1-5 123.51 1/1/2014

64647 Chemodenerv trunk musc 6/> 142.47 1/1/2014

64650 Chemodenerv eccrine glands 39.06 1/1/2006

64653 Chemodenerv eccrine glands 49.39 1/1/2006



64702 Revise finger/toe nerve 328.69 1/1/1981

64704 Revise hand/foot nerve 313.49 1/1/1981

64708 Revise arm/leg nerve 453.58 1/1/1981

64712 Revision of sciatic nerve 516.57 1/1/1981

64713 Revision of arm nerve(s) 695.04 1/1/1981

64714 Revise low back nerve(s) 563.63 1/1/1981

64716 Revision of cranial nerve 450.32 1/1/1981

64718 Revise ulnar nerve at elbow 455.03 1/1/1981

64719 Revise ulnar nerve at wrist 383.72 1/1/1981

64721 Carpal tunnel surgery 412.68 1/1/1981

64722 Relieve pressure on nerve(s) 316.38 1/1/1981

64726 Release foot/toe nerve 295.03 1/1/1981

64727 Internal nerve revision 193.30 1/1/1981

64732 Incision of brow nerve 333.04 1/1/1981

64734 Incision of cheek nerve 358.38 1/1/1981

64736 Incision of chin nerve 310.59 1/1/1981

64738 Incision of jaw nerve 392.77 1/1/1981

64740 Incision of tongue nerve 376.84 1/1/1981

64742 Incision of facial nerve 443.08 1/1/1981

64744 Incise nerve back of head 381.54 1/1/1981

64746 Incise diaphragm nerve 421.00 1/1/1981

64755 Incision of stomach nerves 783.36 1/1/1981

64760 Incision of vagus nerve 427.88 1/1/1981

64763 Incise hip/thigh nerve 519.47 1/1/1981

64766 Incise hip/thigh nerve 536.48 1/1/1981

64771 Sever cranial nerve 529.60 1/1/1981

64772 Incision of spinal nerve 498.47 1/1/1981

64774 Remove skin nerve lesion 361.63 1/1/1981

64776 Remove digit nerve lesion 360.19 1/1/1981

64778 Digit nerve surgery add-on 191.49 1/1/1981

64782 Remove limb nerve lesion 409.06 1/1/1981

64783 Limb nerve surgery add-on 229.50 1/1/1981

64784 Remove nerve lesion 671.51 1/1/1981

103/185


64786 Remove sciatic nerve lesion 1051.24 1/1/1981

64787 Implant nerve end 266.79 1/1/1981

64788 Remove skin nerve lesion 322.90 1/1/1981

64790 Removal of nerve lesion 768.16 1/1/1981

64792 Removal of nerve lesion 968.35 1/1/1981

64795 Biopsy of nerve 195.11 1/1/1981

64802 Sympathectomy cervical 565.44 1/1/1981

64804 Remove sympathetic nerves 867.71 1/1/1981



64820 Sympathectomy digital artery 672.23 1/1/1981



64823 Sympathectomy supfc palmar 725.08 1/1/1981

64831 Repair of digit nerve 673.32 1/1/1981

64832 Repair nerve add-on 352.58 1/1/1981

64834 Repair of hand or foot nerve 703.00 1/1/1981



64837 Repair nerve add-on 393.13 1/1/1981

64840 Repair of leg nerve 804.36 1/1/1981

64856 Repair/transpose nerve 940.11 1/1/1981

64857 Repair arm/leg nerve 988.26 1/1/1981

64858 Repair sciatic nerve 1136.68 1/1/1981

64859 Nerve surgery 261.00 1/1/1981

64861 Repair of arm nerves 1297.04 1/1/1981

64862 Repair of low back nerves 1277.49 1/1/1981

64864 Repair of facial nerve 830.79 1/1/1981

64865 Repair of facial nerve 1007.80 1/1/1981

64866 Fusion of facial/other nerve 988.98 1/1/1981

64868 Fusion of facial/other nerve 932.15 1/1/1981

64872 Subsequent repair of nerve 123.44 1/1/1981

64874 Repair & revise nerve add-on 184.98 1/1/1981

64876 Repair nerve/shorten bone 190.77 1/1/1981

64885 Nerve graft head/neck </4 cm 1142.47 1/1/1981

64886 Nerve graft head/neck >4 cm 1342.29 1/1/1981

64890 Nerve graft hand/foot </4 cm 1013.60 1/1/1981

64891 Nerve graft hand/foot >4 cm 863.73 1/1/1981

64892 Nerve graft arm/leg <4 cm 942.28 1/1/1981

64893 Nerve graft arm/leg >4 cm 1049.43 1/1/1981

64895 Nerve graft hand/foot </4 cm 1113.87 1/1/1981

64896 Nerve graft hand/foot >4 cm 1268.44 1/1/1981

64897 Nerve graft arm/leg </4 cm 1189.89 1/1/1981

64898 Nerve graft arm/leg >4 cm 1232.24 1/1/1981

64901 Nerve graft add-on 631.32 1/1/1981

104/185


64902 Nerve graft add-on 716.39 1/1/1981

64905 Nerve pedicle transfer 912.60 1/1/1981

64907 Nerve pedicle transfer 1217.40 1/1/1981

65091 Revise eye 682.37 1/1/1981

65093 Revise eye with implant 706.98 1/1/1981

65101 Removal of eye 720.74 1/1/1981

65103 Remove eye/insert implant 746.44 1/1/1981

65105 Remove eye/attach implant 800.38 1/1/1981

65110 Removal of eye 1135.23 1/1/1981

65112 Remove eye/revise socket 1287.27 1/1/1981

65114 Remove eye/revise socket 1376.32 1/1/1981

65125 Revise ocular implant 175.57 1/1/1981

65130 Insert ocular implant 703.36 1/1/1981

65135 Insert ocular implant 744.63 1/1/1981

65140 Attach ocular implant 770.33 1/1/1981

65150 Revise ocular implant 650.15 1/1/1981

65155 Reinsert ocular implant 806.17 1/1/1981

65175 Removal of ocular implant 666.80 1/1/1981

65205 Remove foreign body from eye 34.75 1/1/1981







65270 Repair of eye wound 164.34 1/1/1981







65290 Repair of eye socket wound 456.48 1/1/1981

65400 Removal of eye lesion 499.19 1/1/1981

65410 Biopsy of cornea 82.89 1/1/1981



65430 Corneal smear 82.89 1/1/1981

65435 Curette/treat cornea 50.68 1/1/1981

65436 Curette/treat cornea 348.96 1/1/1981

65450 Treatment of corneal lesion 380.46 1/1/1981

65600 Revision of cornea 187.87 1/1/1981

65710 Corneal transplant 969.07 1/1/1981



105/185





65767 Corneal tissue transplant 1394.78 1/1/1981

65770 Revise cornea with implant 1251.43 1/1/1981

65771 Radial keratotomy 759.47 1/1/1981

65772 Correction of astigmatism 406.88 1/1/1981

65775 Correction of astigmatism 544.81 1/1/1981

65778 Cover eye w/membrane 81.70 1/1/2011

65779 Cover eye w/membrane suture 316.05 1/1/2011

65780 Ocular reconst transplant 784.35 1/1/2004



65785 Impltj ntrstrml crnl rng seg 388.37 1/1/2016

65800 Drainage of eye 127.42 1/1/1981

65810 Drainage of eye 522.00 1/1/1981

65815 Drainage of eye 499.56 1/1/1981

65820 Relieve inner eye pressure 723.27 1/1/1981

65850 Incision of eye 789.88 1/1/1981

65855 TRABECULOPLASTY LASER SURG 286.70 1/1/1981

65860 Incise inner eye adhesions 254.84 1/1/1981





65900 Remove eye lesion 897.39 1/1/1981

65920 Remove implant of eye 630.60 1/1/1981

65930 Remove blood clot from eye 615.40 1/1/1981

66020 Injection treatment of eye 119.82 1/1/1981

66030 Injection treatment of eye 100.27 1/1/1981

66130 Remove eye lesion 545.53 1/1/1981

66150 Glaucoma surgery 729.43 1/1/1981




66172 Incision of eye 1162.38 1/1/1981

66174 Translum dil eye canal 1070.74 1/1/2011

66175 Trnslum dil eye canal w/stnt 1225.30 1/1/2011

66179 Aqueous shunt eye w/o graft 1137.11 1/1/2015

66180 Aqueous shunt eye w/graft 1022.28 1/1/1981

66184 Revision of aqueous shunt 830.20 1/1/2015

66185 Revise aqueous shunt eye 628.79 1/1/1981

66220 Repair eye lesion 672.59 1/1/1981

66225 Repair/graft eye lesion 784.09 1/1/1981

66250 Follow-up surgery of eye 471.32 1/1/1981

106/185


66500 Incision of iris 322.90 1/1/1981

66505 Incision of iris 344.26 1/1/1981

66600 Remove iris and lesion 665.35 1/1/1981

66605 Removal of iris 963.64 1/1/1981

66625 Removal of iris 451.41 1/1/1981

66630 Removal of iris 526.34 1/1/1981

66635 Removal of iris 487.97 1/1/1981

66680 Repair iris & ciliary body 444.17 1/1/1981

66682 Repair iris & ciliary body 527.79 1/1/1981

66700 Destruction ciliary body 451.77 1/1/1981

66710 Ciliary transsleral therapy 465.17 1/1/1981



66761 Revision of iris 319.64 1/1/1981

66762 Revision of iris 341.72 1/1/1981

66770 Removal of inner eye lesion 373.22 1/1/1981

66820 Incision secondary cataract 468.06 1/1/1981

66821 After cataract laser surgery 220.09 1/1/1981

66825 Reposition intraocular lens 710.60 1/1/1981

66830 Removal of lens lesion 577.75 1/1/1981

66840 Removal of lens material 561.46 1/1/1981



66920 Extraction of lens 616.84 1/1/1981



66982 Cataract surgery complex 865.90 1/1/1981

66983 Cataract surg w/iol 1 stage 581.73 1/1/1981

66984 Cataract surg w/iol 1 stage 685.26 1/1/1981

66985 Insert lens prosthesis 584.99 1/1/1981

66986 Exchange lens prosthesis 801.46 1/1/1981

66990 Ophthalmic endoscope add-on 83.98 1/1/1981

67005 Partial removal of eye fluid 320.37 1/1/1981

67010 Partial removal of eye fluid 386.61 1/1/1981

67015 Release of eye fluid 578.83 1/1/1981

67025 Replace eye fluid 552.77 1/1/1981

67027 Implant eye drug system 763.09 1/1/1981

67028 Injection eye drug 141.90 1/1/1981

67030 Incise inner eye strands 446.34 1/1/1981

67031 Laser surgery eye strands 262.08 1/1/1981

67036 Removal of inner eye fluid 802.91 1/1/1981

67039 Laser treatment of retina 1032.42 1/1/1981

67040 Laser treatment of retina 1186.27 1/1/1981

67041 Vit for macular pucker 1028.94 1/1/2008

67042 Vit for macular hole 1176.46 1/1/2008

107/185


67043 Vit for membrane dissect 1236.01 1/1/2008

67101 REPAIR DETACHED RETINA CRTX 629.51 1/1/1981

67105 REPAIR DETACHED RETINA PC 496.66 1/1/1981

67107 REPAIR DETACHED RETINA 1078.03 1/1/1981

67108 REPAIR DETACHED RETINA 1481.66 1/1/1981

67110 Repair detached retina 733.05 1/1/1981

67113 REPAIR RETINAL DETACH CPLX 1358.00 1/1/2008

67115 Release encircling material 453.94 1/1/1981

67120 Remove eye implant material 504.62 1/1/1981

67121 Remove eye implant material 875.67 1/1/1981

67141 Treatment of retina 467.34 1/1/1981

67145 Treatment of retina 365.62 1/1/1981

67208 Treatment of retinal lesion 528.15 1/1/1981



67220 Treatment of choroid lesion 873.86 1/1/1981

67221 Ocular photodynamic ther 226.25 1/1/1981

67225 Eye photodynamic ther add-on 45.97 1/1/1981

67227 DSTRJ EXTENSIVE RETINOPATHY 529.24 1/1/1981

67228 TREATMENT X10SV RETINOPATHY 766.35 1/1/1981

67229 TR RETINAL LES PRETERM INF 895.51 1/1/2008

67250 Reinforce eye wall 785.90 1/1/1981

67255 Reinforce/graft eye wall 794.59 1/1/1981

67311 Revise eye muscle 493.04 1/1/1981

67312 Revise two eye muscles 606.71 1/1/1981

67314 Revise eye muscle 547.70 1/1/1981

67316 Revise two eye muscles 669.33 1/1/1981

67318 Revise eye muscle(s) 576.30 1/1/1981

67320 Revise eye muscle(s) add-on 243.62 1/1/1981

67331 Eye surgery follow-up add-on 230.95 1/1/1981

67332 Rerevise eye muscles add-on 252.31 1/1/1981

67334 Revise eye muscle w/suture 223.35 1/1/1981

67335 Eye suture during surgery 140.09 1/1/1981

67340 Revise eye muscle add-on 278.37 1/1/1981

67343 Release eye tissue 553.49 1/1/1981

67345 Destroy nerve of eye muscle 164.71 1/1/1981


67405 Explore/drain eye socket 776.49 1/1/1981

67412 Explore/treat eye socket 966.17 1/1/1981


67414 Explr/decompress eye socket 1061.74 1/1/1981

67415 Aspiration orbital contents 98.10 1/1/1981



67440 Explore/drain eye socket 1194.96 1/1/1981

108/185


67445 Explr/decompress eye socket 1236.23 1/1/1981


67500 Inject/treat eye socket 38.01 1/1/1981



67550 Insert eye socket implant 902.82 1/1/1981

67560 Revise eye socket implant 914.05 1/1/1981

67570 Decompress optic nerve 1188.44 1/1/1981

67700 Drainage of eyelid abscess 74.21 1/1/1981

67710 Incision of eyelid 57.19 1/1/1981

67715 Incision of eyelid fold 68.78 1/1/1981

67800 Remove eyelid lesion 77.83 1/1/1981

67801 Remove eyelid lesions 106.06 1/1/1981

67805 Remove eyelid lesions 124.52 1/1/1981

67808 Remove eyelid lesion(s) 308.78 1/1/1981

67810 Biopsy eyelid & lid margin 83.62 1/1/1981

67820 Revise eyelashes 48.87 1/1/1981




67840 Remove eyelid lesion 115.11 1/1/1981

67850 Treat eyelid lesion 142.26 1/1/1981

67875 Closure of eyelid by suture 132.85 1/1/1981



67900 Repair brow defect 487.97 1/1/1981

67901 Repair eyelid defect 539.01 1/1/1981






67909 Revise eyelid defect 465.89 1/1/1981

67911 Revise eyelid defect 461.91 1/1/1981

67912 Correction eyelid w/implant 429.10 1/1/2004









67930 Repair eyelid wound 257.38 1/1/1981

67935 Repair eyelid wound 449.60 1/1/1981

109/185


67938 Remove eyelid foreign body 70.95 1/1/1981




67971 Reconstruction of eyelid 669.70 1/1/1981




68020 Incise/drain eyelid lining 76.74 1/1/1981

68040 Treatment of eyelid lesions 47.78 1/1/1981

68100 Biopsy of eyelid lining 76.02 1/1/1981

68110 Remove eyelid lining lesion 120.54 1/1/1981




68200 Treat eyelid by injection 27.87 1/1/1981

68320 Revise/graft eyelid lining 405.44 1/1/1981




68330 Revise eyelid lining 402.90 1/1/1981


68340 Separate eyelid adhesions 322.18 1/1/1981



68371 Harvest eye tissue alograft 371.64 1/1/2004

68400 Incise/drain tear gland 146.61 1/1/1981

68420 Incise/drain tear sac 182.81 1/1/1981

68440 Incise tear duct opening 52.85 1/1/1981

68500 Removal of tear gland 770.69 1/1/1981

68505 Partial removal tear gland 810.88 1/1/1981

68510 Biopsy of tear gland 259.55 1/1/1981

68520 Removal of tear sac 568.70 1/1/1981

68525 Biopsy of tear sac 249.78 1/1/1981

68530 Clearance of tear duct 259.91 1/1/1981

68540 Remove tear gland lesion 771.78 1/1/1981

68550 Remove tear gland lesion 906.08 1/1/1981

68700 Repair tear ducts 510.42 1/1/1981

68705 Revise tear duct opening 116.20 1/1/1981

68720 Create tear sac drain 645.08 1/1/1981

68745 Create tear duct drain 624.81 1/1/1981

68750 Create tear duct drain 649.42 1/1/1981

68760 Close tear duct opening 112.94 1/1/1981

68761 Close tear duct opening 90.86 1/1/1981

68770 Close tear system fistula 498.83 1/1/1981

110/185


68801 Dilate tear duct opening 57.55 1/1/1981

68810 Probe nasolacrimal duct 106.79 1/1/1981



68816 Probe nl duct w/balloon 196.07 1/1/2008

68840 Explore/irrigate tear ducts 85.43 1/1/1981

68850 Injection for tear sac x-ray 42.35 1/1/1981

69000 Drain external ear lesion 79.27 1/1/1981

69005 Drain external ear lesion 163.26 1/1/1981

69020 Drain outer ear canal lesion 85.43 1/1/1981

69100 Biopsy of external ear 46.69 1/1/1981

69105 Biopsy of external ear canal 72.03 1/1/1981

69110 Remove external ear partial 242.90 1/1/1981

69120 Removal of external ear 337.02 1/1/1981

69140 Remove ear canal lesion(s) 624.45 1/1/1981

69145 Remove ear canal lesion(s) 198.73 1/1/1981

69150 Extensive ear canal surgery 963.28 1/1/1981

69155 Extensive ear/neck surgery 1434.24 1/1/1981

69200 Clear outer ear canal 59.00 1/1/1981

69205 Clear outer ear canal 107.15 1/1/1981

69209 Remove impacted ear wax uni 12.98 1/1/2016

69210 Remove impacted ear wax uni 33.30 1/1/1981

69220 Clean out mastoid cavity 49.23 1/1/1981

69222 Clean out mastoid cavity 119.46 1/1/1981

69300 Revise external ear 414.85 1/1/1981

69310 Rebuild outer ear canal 797.12 1/1/1981

69320 Rebuild outer ear canal 1186.27 1/1/1981

69420 Incision of eardrum 81.08 1/1/1981

69421 Incision of eardrum 140.81 1/1/1981

69424 Remove ventilating tube 68.78 1/1/1981

69433 Create eardrum opening 93.03 1/1/1981

69436 Create eardrum opening 154.57 1/1/1981

69440 Exploration of middle ear 577.39 1/1/1981

69450 Eardrum revision 452.13 1/1/1981

69501 Mastoidectomy 667.52 1/1/1981

69502 Mastoidectomy 894.14 1/1/1981

69505 Remove mastoid structures 924.18 1/1/1981

69511 Extensive mastoid surgery 964.36 1/1/1981

69530 Extensive mastoid surgery 1322.38 1/1/1981

69535 Remove part of temporal bone 2373.27 1/1/1981

69540 Remove ear lesion 108.23 1/1/1981




69601 Mastoid surgery revision 972.33 1/1/1981

111/185






69610 Repair of eardrum 305.16 1/1/1981

69620 Repair of eardrum 359.82 1/1/1981

69631 Repair eardrum structures 741.73 1/1/1981

69632 Rebuild eardrum structures 944.09 1/1/1981


69635 Repair eardrum structures 952.06 1/1/1981



69641 Revise middle ear & mastoid 917.30 1/1/1981






69650 Release middle ear bone 701.91 1/1/1981

69660 Revise middle ear bone 840.56 1/1/1981



69666 Repair middle ear structures 709.88 1/1/1981

69667 Repair middle ear structures 709.15 1/1/1981

69670 Remove mastoid air cells 842.37 1/1/1981

69676 Remove middle ear nerve 720.38 1/1/1981

69700 Close mastoid fistula 540.46 1/1/1981

69710 Implant/replace hearing aid 2758.07 1/1/1981

69711 Remove/repair hearing aid 768.88 1/1/1981

69714 Implant temple bone w/stimul 987.17 1/1/1981

69715 Temple bne implnt w/stimulat 1250.34 1/1/1981

69717 Temple bone implant revision 1023.37 1/1/1981

69718 Revise temple bone implant 1265.91 1/1/1981

69720 Release facial nerve 1051.61 1/1/1981


69740 Repair facial nerve 1040.02 1/1/1981

69745 Repair facial nerve 1132.33 1/1/1981

69801 INCISE INNER EAR 637.12 1/1/1981

69805 Explore inner ear 955.68 1/1/1981

69806 Explore inner ear 893.77 1/1/1981

69820 Establish inner ear window 735.22 1/1/1981

69840 Revise inner ear window 739.92 1/1/1981

69905 Remove inner ear 811.24 1/1/1981

69910 Remove inner ear & mastoid 966.54 1/1/1981

69915 Incise inner ear nerve 1437.14 1/1/1981

112/185


69930 Implant cochlear device 1150.43 1/1/1981

69950 Incise inner ear nerve 1688.36 1/1/1981


69960 Release inner ear canal 1782.12 1/1/1981

69970 Remove inner ear lesion 1914.25 1/1/1981

69990 Microsurgery add-on 221.18 1/1/1981

70015 Contrast x-ray of brain TC 51.40 1/1/1981

70030 X-ray eye for foreign body TC 15.56 1/1/1981

70100 X-ray exam of jaw <4views TC 19.54 1/1/1981

70110 X-ray exam of jaw 4/> views TC 23.53 1/1/1981

70120 X-ray exam of mastoids TC 23.53 1/1/1981

70130 X-ray exam of mastoids TC 29.68 1/1/1981

70134 X-ray exam of middle ear TC 28.23 1/1/1981

70140 X-ray exam of facial bones TC 23.53 1/1/1981

70150 X-ray exam of facial bones TC 29.68 1/1/1981

70160 X-ray exam of nasal bones TC 19.54 1/1/1981

70170 X-ray exam of tear duct TC 36.20 1/1/1981

70190 X-ray exam of eye sockets TC 23.53 1/1/1981

70200 X-ray exam of eye sockets TC 29.68 1/1/1981

70210 X-ray exam of sinuses TC 23.53 1/1/1981

70220 X-ray exam of sinuses TC 29.68 1/1/1981

70240 X-ray exam pituitary saddle TC 15.56 1/1/1981

70250 X-ray exam of skull TC 23.53 1/1/1981

70260 X-ray exam of skull TC 33.66 1/1/1981

70300 X-ray exam of teeth TC 10.13 1/1/1981

70310 X-ray exam of teeth TC 15.56 1/1/1981

70320 Full mouth x-ray of teeth TC 29.68 1/1/1981

70328 X-ray exam of jaw joint TC 18.46 1/1/1981

70330 X-ray exam of jaw joints TC 31.85 1/1/1981

70332 X-ray exam of jaw joint TC 79.27 1/1/1981

70336 Magnetic image jaw joint TC 421.73 1/1/1981

70350 X-ray head for orthodontia TC 14.48 1/1/1981

70355 Panoramic x-ray of jaws TC 21.72 1/1/1981

70360 X-ray exam of neck TC 15.56 1/1/1981

70370 THROAT X-RAY & FLUOROSCOPY TC 49.23 1/1/1981

70371 SPEECH EVALUATION COMPLEX TC 79.27 1/1/1981

70380 X-ray exam of salivary gland TC 24.97 1/1/1981

70390 X-ray exam of salivary duct TC 67.33 1/1/1981

70450 Ct head/brain w/o dye TC 177.74 1/1/1981

70460 Ct head/brain w/dye TC 212.85 1/1/1981

70470 Ct head/brain w/o & w/dye TC 266.07 1/1/1981

70480 Ct orbit/ear/fossa w/o dye TC 177.74 1/1/1981

70481 Ct orbit/ear/fossa w/dye TC 212.85 1/1/1981

70482 Ct orbit/ear/fossa w/o&w/dye TC 266.07 1/1/1981

70486 Ct maxillofacial w/o dye TC 177.74 1/1/1981

113/185


70487 Ct maxillofacial w/dye TC 212.85 1/1/1981

70488 Ct maxillofacial w/o & w/dye TC 266.07 1/1/1981

70490 Ct soft tissue neck w/o dye TC 177.74 1/1/1981

70491 Ct soft tissue neck w/dye TC 212.85 1/1/1981

70492 Ct sft tsue nck w/o & w/dye TC 266.07 1/1/1981

70496 Ct angiography head TC 273.31 1/1/1981

70498 Ct angiography neck TC 273.31 1/1/1981

70540 Mri orbit/face/neck w/o dye TC 414.12 1/1/1981

70542 Mri orbit/face/neck w/dye TC 497.02 1/1/1981

70543 Mri orbt/fac/nck w/o &w/dye TC 919.84 1/1/1981

70544 Mr angiography head w/o dye TC 421.73 1/1/1981

70545 Mr angiography head w/dye TC 421.73 1/1/1981

70546 Mr angiograph head w/o&w/dye TC 822.10 1/1/1981

70547 Mr angiography neck w/o dye TC 421.73 1/1/1981

70548 Mr angiography neck w/dye TC 421.73 1/1/1981

70549 Mr angiograph neck w/o&w/dye TC 822.10 1/1/1981

70551 Mri brain stem w/o dye TC 421.73 1/1/1981

70552 Mri brain stem w/dye TC 505.35 1/1/1981

70553 Mri brain stem w/o & w/dye TC 936.85 1/1/1981

70554 Fmri brain by tech TC 518.77 1/1/2007

71010 Chest x-ray 1 view frontal TC 17.73 1/1/1981

71015 Chest x-ray stereo frontal TC 19.54 1/1/1981

71020 Chest x-ray 2vw frontal&latl TC 23.53 1/1/1981

71021 Chest x-ray frnt lat lordotc TC 28.23 1/1/1981

71022 Chest x-ray frnt lat oblique TC 28.23 1/1/1981

71023 Chest x-ray and fluoroscopy TC 29.68 1/1/1981

71030 Chest x-ray 4/> views TC 29.68 1/1/1981

71034 CHEST X-RAY&FLUORO 4/> VIEWS TC 54.66 1/1/1981

71035 Chest x-ray special views TC 19.54 1/1/1981

71100 X-ray exam ribs uni 2 views TC 21.72 1/1/1981

71101 X-ray exam unilat ribs/chest TC 24.97 1/1/1981

71110 X-ray exam ribs bil 3 views TC 29.68 1/1/1981

71111 X-ray exam ribs/chest4/> vws TC 33.66 1/1/1981

71120 X-ray exam breastbone 2/>vws TC 24.61 1/1/1981

71130 X-ray strenoclavic jt 3/>vws TC 26.42 1/1/1981

71250 Ct thorax w/o dye TC 222.26 1/1/1981

71260 Ct thorax w/dye TC 266.07 1/1/1981

71270 Ct thorax w/o & w/dye TC 332.67 1/1/1981

71275 Ct angiography chest TC 329.78 1/1/1981

71550 Mri chest w/o dye TC 416.30 1/1/1981

71551 Mri chest w/dye TC 498.83 1/1/1981

71552 Mri chest w/o & w/dye TC 913.68 1/1/1981

71555 Mri angio chest w or w/o dye TC 421.73 1/1/1981

72020 X-ray exam of spine 1 view TC 15.56 1/1/1981

72040 X-ray exam neck spine 2-3 vw TC 22.80 1/1/1981

114/185


72050 X-ray exam neck spine 4/5vws TC 33.66 1/1/1981

72052 X-ray exam neck spine 6/>vws TC 42.35 1/1/1981

72070 X-ray exam thorac spine 2vws TC 24.61 1/1/1981

72072 X-ray exam thorac spine 3vws TC 28.23 1/1/1981

72074 X-ray exam thorac spine4/>vw TC 34.39 1/1/1981

72080 X-RAY EXAM THORACOLMB 2/> VW TC 24.97 1/1/1981

72081 X-ray exam entire spi 1 vw TC 26.98 1/1/2016

72081 X-ray exam entire spi 1 vw 26 13.97 1/1/2016

72081 X-ray exam entire spi 1 vw 40.96 1/1/2016

72082 X-ray exam entire spi 2/3 vw TC 49.05 1/1/2016

72082 X-ray exam entire spi 2/3 vw 26 16.93 1/1/2016

72082 X-ray exam entire spi 2/3 vw 65.98 1/1/2016

72083 X-ray exam entire spi 4/5 vw TC 53.23 1/1/2016

72083 X-ray exam entire spi 4/5 vw 26 18.38 1/1/2016

72083 X-ray exam entire spi 4/5 vw 71.62 1/1/2016

72084 X-ray exam entire spi 6/> vw TC 64.27 1/1/2016

72084 X-ray exam entire spi 6/> vw 26 21.33 1/1/2016

72084 X-ray exam entire spi 6/> vw 85.60 1/1/2016

72100 X-ray exam l-s spine 2/3 vws TC 24.97 1/1/1981

72110 X-ray exam l-2 spine 4/>vws TC 34.39 1/1/1981

72114 X-ray exam l-s spine bending TC 44.52 1/1/1981

72120 X-ray bend only l-s spine TC 33.66 1/1/1981

72125 Ct neck spine w/o dye TC 222.26 1/1/1981

72126 Ct neck spine w/dye TC 266.07 1/1/1981

72127 Ct neck spine w/o & w/dye TC 332.67 1/1/1981

72128 Ct chest spine w/o dye TC 222.26 1/1/1981

72129 Ct chest spine w/dye TC 266.07 1/1/1981

72130 Ct chest spine w/o & w/dye TC 332.67 1/1/1981

72131 Ct lumbar spine w/o dye TC 222.26 1/1/1981

72132 Ct lumbar spine w/dye TC 266.07 1/1/1981

72133 Ct lumbar spine w/o & w/dye TC 332.67 1/1/1981

72141 Mri neck spine w/o dye TC 421.73 1/1/1981

72142 Mri neck spine w/dye TC 505.35 1/1/1981

72146 Mri chest spine w/o dye TC 467.70 1/1/1981

72147 Mri chest spine w/dye TC 505.35 1/1/1981

72148 Mri lumbar spine w/o dye TC 467.70 1/1/1981

72149 Mri lumbar spine w/dye TC 505.35 1/1/1981

72156 Mri neck spine w/o & w/dye TC 936.85 1/1/1981

72157 Mri chest spine w/o & w/dye TC 936.85 1/1/1981

72158 Mri lumbar spine w/o & w/dye TC 936.85 1/1/1981

72159 Mr angio spine w/o&w/dye TC 467.70 1/1/1981

72170 X-ray exam of pelvis TC 19.54 1/1/1981

72190 X-ray exam of pelvis TC 24.97 1/1/1981

72191 Ct angiograph pelv w/o&w/dye TC 317.11 1/1/1981

72192 Ct pelvis w/o dye TC 222.26 1/1/1981

115/185


72193 Ct pelvis w/dye TC 257.74 1/1/1981

72194 Ct pelvis w/o & w/dye TC 318.92 1/1/1981

72195 Mri pelvis w/o dye TC 416.30 1/1/1981

72196 Mri pelvis w/dye TC 498.83 1/1/1981

72197 Mri pelvis w/o & w/dye TC 922.37 1/1/1981

72198 Mr angio pelvis w/o & w/dye TC 421.73 1/1/1981

72200 X-ray exam si joints TC 19.54 1/1/1981

72202 X-ray exam si joints 3/> vws TC 23.53 1/1/1981

72220 X-ray exam sacrum tailbone TC 21.72 1/1/1981

72240 Myelography neck spine TC 178.82 1/1/1981

72255 Myelography thoracic spine TC 162.53 1/1/1981

72265 Myelography l-s spine TC 153.48 1/1/1981

72270 Myelogphy 2/> spine regions TC 229.50 1/1/1981

72275 Epidurography TC 82.89 1/1/1981

72285 Discography cerv/thor spine TC 315.30 1/1/1981

72295 X-ray of lower spine disk TC 295.39 1/1/1981

73000 X-ray exam of collar bone TC 19.54 1/1/1981

73010 X-ray exam of shoulder blade TC 19.54 1/1/1981

73020 X-ray exam of shoulder TC 17.73 1/1/1981

73030 X-ray exam of shoulder TC 21.72 1/1/1981

73040 Contrast x-ray of shoulder TC 79.27 1/1/1981

73050 X-ray exam of shoulders TC 24.97 1/1/1981

73060 X-ray exam of humerus TC 21.72 1/1/1981

73070 X-ray exam of elbow TC 19.54 1/1/1981

73080 X-ray exam of elbow TC 21.72 1/1/1981

73085 Contrast x-ray of elbow TC 79.27 1/1/1981

73090 X-ray exam of forearm TC 19.54 1/1/1981

73092 X-ray exam of arm infant TC 18.46 1/1/1981

73100 X-ray exam of wrist TC 18.46 1/1/1981

73110 X-ray exam of wrist TC 19.91 1/1/1981

73115 Contrast x-ray of wrist TC 60.09 1/1/1981

73120 X-ray exam of hand TC 18.46 1/1/1981

73130 X-ray exam of hand TC 19.91 1/1/1981

73140 X-ray exam of finger(s) TC 15.56 1/1/1981

73200 Ct upper extremity w/o dye TC 186.43 1/1/1981

73201 Ct upper extremity w/dye TC 222.26 1/1/1981

73202 Ct uppr extremity w/o&w/dye TC 279.10 1/1/1981

73206 Ct angio upr extrm w/o&w/dye TC 279.10 1/1/1981

73218 Mri upper extremity w/o dye TC 414.12 1/1/1981

73219 Mri upper extremity w/dye TC 497.02 1/1/1981

73220 Mri uppr extremity w/o&w/dye TC 919.84 1/1/1981

73221 Mri joint upr extrem w/o dye TC 414.12 1/1/1981

73222 Mri joint upr extrem w/dye TC 497.02 1/1/1981

73223 Mri joint upr extr w/o&w/dye TC 919.84 1/1/1981

73225 Mr angio upr extr w/o&w/dye TC 421.73 1/1/1981

116/185


73501 X-ray exam hip uni 1 view TC 21.28 1/1/2016

73501 X-ray exam hip uni 1 view 26 9.94 1/1/2016

73501 X-ray exam hip uni 1 view 31.22 1/1/2016

73502 X-ray exam hip uni 2-3 views TC 31.93 1/1/2016

73502 X-ray exam hip uni 2-3 views 26 11.78 1/1/2016

73502 X-ray exam hip uni 2-3 views 43.71 1/1/2016

73503 X-ray exam hip uni 4/> views TC 39.54 1/1/2016

73503 X-ray exam hip uni 4/> views 26 15.09 1/1/2016

73503 X-ray exam hip uni 4/> views 54.64 1/1/2016

73521 X-ray exam hips bi 2 views TC 29.65 1/1/2016

73521 X-ray exam hips bi 2 views 26 12.16 1/1/2016

73521 X-ray exam hips bi 2 views 41.81 1/1/2016

73522 X-ray exam hips bi 3-4 views TC 35.73 1/1/2016

73522 X-ray exam hips bi 3-4 views 26 15.82 1/1/2016

73522 X-ray exam hips bi 3-4 views 51.56 1/1/2016

73523 X-ray exam hips bi 5/> views TC 42.96 1/1/2016

73523 X-ray exam hips bi 5/> views 26 16.93 1/1/2016

73523 X-ray exam hips bi 5/> views 59.90 1/1/2016

73525 Contrast x-ray of hip TC 79.27 1/1/1981

73551 X-ray exam of femur 1 TC 20.51 1/1/2016

73551 X-ray exam of femur 1 26 8.83 1/1/2016

73551 X-ray exam of femur 1 29.35 1/1/2016

73552 X-ray exam of femur 2/> TC 24.32 1/1/2016

73552 X-ray exam of femur 2/> 26 9.94 1/1/2016

73552 X-ray exam of femur 2/> 34.27 1/1/2016

73560 X-ray exam of knee 1 or 2 TC 19.54 1/1/1981

73562 X-ray exam of knee 3 TC 21.72 1/1/1981

73564 X-ray exam knee 4 or more TC 23.53 1/1/1981

73565 X-ray exam of knees TC 18.46 1/1/1981

73580 Contrast x-ray of knee joint TC 98.82 1/1/1981

73590 X-ray exam of lower leg TC 19.54 1/1/1981

73592 X-ray exam of leg infant TC 18.46 1/1/1981

73600 X-ray exam of ankle TC 18.46 1/1/1981

73610 X-ray exam of ankle TC 19.91 1/1/1981

73615 Contrast x-ray of ankle TC 79.27 1/1/1981

73620 X-ray exam of foot TC 18.46 1/1/1981

73630 X-ray exam of foot TC 19.91 1/1/1981

73650 X-ray exam of heel TC 17.73 1/1/1981

73660 X-ray exam of toe(s) TC 15.56 1/1/1981

73700 Ct lower extremity w/o dye TC 186.43 1/1/1981

73701 Ct lower extremity w/dye TC 222.26 1/1/1981

73702 Ct lwr extremity w/o&w/dye TC 279.10 1/1/1981

73706 Ct angio lwr extr w/o&w/dye TC 279.10 1/1/1981

73718 Mri lower extremity w/o dye TC 414.12 1/1/1981

73719 Mri lower extremity w/dye TC 497.02 1/1/1981

117/185


73720 Mri lwr extremity w/o&w/dye TC 919.84 1/1/1981

73721 Mri jnt of lwr extre w/o dye TC 414.12 1/1/1981

73722 Mri joint of lwr extr w/dye TC 497.02 1/1/1981

73723 Mri joint lwr extr w/o&w/dye TC 919.84 1/1/1981

73725 Mr ang lwr ext w or w/o dye TC 421.73 1/1/1981

74000 X-ray exam of abdomen TC 19.54 1/1/1981



74022 X-ray exam series abdomen TC 28.23 1/1/1981

74150 Ct abdomen w/o dye TC 212.85 1/1/1981

74160 Ct abdomen w/dye TC 257.74 1/1/1981

74170 Ct abdomen w/o & w/dye TC 318.92 1/1/1981

74174 Ct angio abd&pelv w/o&w/dye TC 514.03 1/1/2012

74175 Ct angio abdom w/o & w/dye TC 317.11 1/1/1981

74176 Ct abd & pelvis w/o contrast TC 143.86 1/1/2011

74177 Ct abd & pelv w/contrast TC 274.34 1/1/2011

74178 Ct abd & pelv 1/> regns TC 362.57 1/1/2011

74181 Mri abdomen w/o dye TC 416.30 1/1/1981

74182 Mri abdomen w/dye TC 498.83 1/1/1981

74183 Mri abdomen w/o & w/dye TC 922.37 1/1/1981

74185 Mri angio abdom w orw/o dye TC 421.73 1/1/1981

74190 X-ray exam of peritoneum TC 49.23 1/1/1981

74210 CONTRST X-RAY EXAM OF THROAT TC 44.52 1/1/1981

74220 CONTRAST X-RAY ESOPHAGUS TC 44.52 1/1/1981

74230 CINE/VID X-RAY THROAT/ESOPH TC 49.23 1/1/1981

74235 Remove esophagus obstruction TC 98.82 1/1/1981

74240 X-RAY UPPER GI DELAY W/O KUB TC 55.38 1/1/1981

74241 X-RAY UPPER GI DELAY W/KUB TC 56.11 1/1/1981

74245 X-RAY UPPER GI&SMALL INTEST TC 89.77 1/1/1981

74246 CONTRST X-RAY UPPR GI TRACT TC 62.26 1/1/1981

74247 CONTRST X-RAY UPPR GI TRACT TC 64.07 1/1/1981

74249 Contrst x-ray uppr gi tract TC 97.01 1/1/1981

74250 X-RAY EXAM OF SMALL BOWEL TC 49.23 1/1/1981



74261 Ct colonography dx TC 307.17 1/1/2010

74262 Ct colonography dx w/dye TC 348.03 1/1/2010

74270 CONTRAST X-RAY EXAM OF COLON TC 64.79 1/1/1981

74280 Contrast x-ray exam of colon TC 84.70 1/1/1981

74283 Contrast x-ray exam of colon TC 96.65 1/1/1981

74290 CONTRAST X-RAY GALLBLADDER TC 28.23 1/1/1981

74300 X-ray bile ducts/pancreas TC 34.39 1/1/1981

74301 X-rays at surgery add-on TC 19.91 1/1/1981

74328 X-ray bile duct endoscopy TC 118.73 1/1/1981

74329 X-ray for pancreas endoscopy TC 118.73 1/1/1981

118/185


74330 X-ray bile/panc endoscopy TC 118.73 1/1/1981

74340 X-ray guide for gi tube TC 98.82 1/1/1981

74355 X-ray guide intestinal tube TC 98.82 1/1/1981

74360 X-ray guide gi dilation TC 118.73 1/1/1981

74363 X-ray bile duct dilation TC 229.50 1/1/1981

74400 Contrst x-ray urinary tract TC 64.07 1/1/1981





74430 Contrast x-ray bladder TC 39.82 1/1/1981

74440 X-ray male genital tract TC 42.35 1/1/1981

74445 X-ray exam of penis TC 42.35 1/1/1981

74450 X-ray urethra/bladder TC 55.38 1/1/1981

74455 X-ray urethra/bladder TC 60.09 1/1/1981

74470 X-ray exam of kidney lesion TC 47.06 1/1/1981

74485 X-ray guide gu dilation TC 118.73 1/1/1981

74710 X-ray measurement of pelvis TC 39.82 1/1/1981

74712 Mri fetal sngl/1st gestation TC 352.25 1/1/2016

74712 Mri fetal sngl/1st gestation 26 157.79 1/1/2016

74712 Mri fetal sngl/1st gestation 510.04 1/1/2016

74713 Mri fetal ea addl gestation TC 151.01 1/1/2016

74713 Mri fetal ea addl gestation 26 93.80 1/1/2016

74713 Mri fetal ea addl gestation 244.81 1/1/2016

74740 X-ray female genital tract TC 49.23 1/1/1981

74742 X-ray fallopian tube TC 118.73 1/1/1981

74775 X-ray exam of perineum TC 55.38 1/1/1981

75557 Cardiac mri for morph TC 421.00 1/1/2008

75559 Cardiac mri w/stress img TC 633.27 1/1/2008

75561 Cardiac mri for morph w/dye TC 597.36 1/1/2008

75563 Card mri w/stress img & dye TC 744.01 1/1/2008

75565 Card mri veloc flow mapping TC 81.36 1/1/2010

75571 Ct hrt w/o dye w/ca test TC 63.53 1/1/2010

75572 Ct hrt w/3d image TC 183.12 1/1/2010

75573 Ct hrt w/3d image congen TC 259.26 1/1/2010

75574 Ct angio hrt w/3d image TC 477.65 1/1/2010

75600 Contrast exam thoracic aorta TC 473.49 1/1/1981

75605 Contrast exam thoracic aorta TC 473.49 1/1/1981

75625 Contrast exam abdominl aorta TC 473.49 1/1/1981

75630 X-ray aorta leg arteries TC 494.13 1/1/1981

75635 Ct angio abdominal arteries TC 317.11 1/1/1981

75658 Artery x-rays arm TC 473.49 1/1/1981

75705 Artery x-rays spine TC 473.49 1/1/1981

75710 Artery x-rays arm/leg TC 473.49 1/1/1981

75716 Artery x-rays arms/legs TC 473.49 1/1/1981

119/185


75726 Artery x-rays abdomen TC 473.49 1/1/1981

75731 Artery x-rays adrenal gland TC 473.49 1/1/1981

75733 Artery x-rays adrenals TC 473.49 1/1/1981

75736 Artery x-rays pelvis TC 473.49 1/1/1981

75741 Artery x-rays lung TC 473.49 1/1/1981

75743 Artery x-rays lungs TC 473.49 1/1/1981

75746 Artery x-rays lung TC 473.49 1/1/1981

75756 Artery x-rays chest TC 473.49 1/1/1981

75774 Artery x-ray each vessel TC 473.49 1/1/1981

75801 Lymph vessel x-ray arm/leg TC 203.80 1/1/1981

75803 Lymph vessel x-ray arms/legs TC 203.80 1/1/1981

75805 Lymph vessel x-ray trunk TC 229.50 1/1/1981

75807 Lymph vessel x-ray trunk TC 229.50 1/1/1981

75809 Nonvascular shunt x-ray TC 29.68 1/1/1981

75810 Vein x-ray spleen/liver TC 473.49 1/1/1981

75820 Vein x-ray arm/leg TC 36.20 1/1/1981

75822 Vein x-ray arms/legs TC 55.74 1/1/1981

75825 Vein x-ray trunk TC 473.49 1/1/1981

75827 Vein x-ray chest TC 473.49 1/1/1981

75831 Vein x-ray kidney TC 473.49 1/1/1981

75833 Vein x-ray kidneys TC 473.49 1/1/1981

75840 Vein x-ray adrenal gland TC 473.49 1/1/1981

75842 Vein x-ray adrenal glands TC 473.49 1/1/1981

75860 Vein x-ray neck TC 473.49 1/1/1981

75870 Vein x-ray skull TC 473.49 1/1/1981

75872 Vein x-ray skull epidural TC 473.49 1/1/1981

75880 Vein x-ray eye socket TC 36.20 1/1/1981

75885 Vein x-ray liver w/hemodynam TC 473.49 1/1/1981

75887 Vein x-ray liver w/o hemodyn TC 473.49 1/1/1981

75889 Vein x-ray liver w/hemodynam TC 473.49 1/1/1981

75891 Vein x-ray liver TC 473.49 1/1/1981

75893 Venous sampling by catheter TC 473.49 1/1/1981

75894 X-rays transcath therapy TC 907.89 1/1/1981

75898 Follow-up angiography TC 39.82 1/1/1981

75901 Remove cva device obstruct TC 79.09 1/1/1980

75902 Remove cva lumen obstruct TC 79.09 1/1/1980

75952 Endovasc repair abdom aorta TC 2333.81 1/1/1981

75953 Abdom aneurysm endovas rpr TC 892.69 1/1/1981

75954 Iliac aneurysm endovas rpr TC 875.61 1/1/1980

75970 Vascular biopsy TC 434.03 1/1/1981

75984 Xray control catheter change TC 73.48 1/1/1981

75989 Abscess drainage under x-ray TC 118.73 1/1/1981

76000 Fluoroscope examination TC 49.23 1/1/1981

76001 Fluoroscope exam extensive TC 98.82 1/1/1981

76010 X-ray nose to rectum TC 19.54 1/1/1981

120/185


76080 X-ray exam of fistula TC 39.82 1/1/1981

76098 X-ray exam breast specimen TC 15.56 1/1/1981

76100 X-ray exam of body section TC 47.06 1/1/1981

76101 Complex body section x-ray TC 53.93 1/1/1981

76102 Complex body section x-rays TC 65.52 1/1/1981

76120 CINE/VIDEO X-RAYS TC 39.82 1/1/1981

76125 Cine/video x-rays add-on TC 29.68 1/1/1981

76376 3d render w/intrp postproces TC 132.59 1/1/2006

76377 3d render w/intrp postproces TC 141.49 1/1/2006

76380 Cat scan follow-up study TC 131.40 1/1/1981

76390 Mr spectroscopy TC 421.73 1/1/1981

76506 ECHO EXAM OF HEAD TC 53.93 1/1/1981

76510 Ophth us b & quant a TC 84.86 1/1/2005

76511 OPHTH US QUANT A ONLY TC 74.93 1/1/1981

76512 OPHTH US B W/NON-QUANT A TC 85.43 1/1/1981

76513 ECHO EXAM OF EYE WATER BATH TC 100.63 1/1/1981

76514 Echo exam of eye thickness TC 2.75 1/1/2004

76516 Echo exam of eye TC 69.50 1/1/1981

76519 Echo exam of eye TC 64.79 1/1/1981

76529 ECHO EXAM OF EYE TC 94.48 1/1/1981

76536 US EXAM OF HEAD AND NECK TC 53.93 1/1/1981

76604 US EXAM CHEST TC 49.23 1/1/1981

76641 Ultrasound breast complete TC 76.06 1/1/2015

76641 Ultrasound breast complete 113.60 1/1/2015

76642 Ultrasound breast limited TC 58.18 1/1/2015

76642 Ultrasound breast limited 93.14 1/1/2015

76700 Us exam abdom complete TC 74.21 1/1/1981

76705 Echo exam of abdomen TC 53.93 1/1/1981

76770 Us exam abdo back wall comp TC 74.21 1/1/1981

76775 US EXAM ABDO BACK WALL LIM TC 53.93 1/1/1981

76776 Us exam k transpl w/doppler TC 88.16 1/1/2007

76800 Us exam spinal canal TC 53.93 1/1/1981

76801 Ob us < 14 wks single fetus TC 43.49 1/1/1980

76802 Ob us < 14 wks addl fetus TC 31.08 1/1/1980

76805 Ob us >/= 14 wks sngl fetus TC 79.27 1/1/1981

76810 Ob us >/= 14 wks addl fetus TC 157.83 1/1/1981

76811 Ob us detailed sngl fetus TC 147.77 1/1/1980

76812 Ob us detailed addl fetus TC 54.00 1/1/1980

76813 OB US NUCHAL MEAS 1 GEST TC 70.76 1/1/2007

76814 Ob us nuchal meas add-on TC 37.10 1/1/2007

76815 OB US LIMITED FETUS(S) TC 53.93 1/1/1981

76816 Ob us follow-up per fetus TC 41.99 1/1/1981

76817 TRANSVAGINAL US OBSTETRIC TC 58.98 1/1/1980

76818 Fetal biophys profile w/nst TC 61.17 1/1/1981

76819 Fetal biophys profil w/o nst TC 61.17 1/1/1981

121/185


76820 Umbilical artery echo TC 65.31 1/1/2005

76821 Middle cerebral artery echo TC 65.31 1/1/2005

76825 Echo exam of fetal heart TC 74.21 1/1/1981




76830 Transvaginal us non-ob TC 57.55 1/1/1981

76831 Echo exam uterus TC 57.55 1/1/1981

76856 Us exam pelvic complete TC 57.55 1/1/1981

76857 Us exam pelvic limited TC 39.82 1/1/1981

76870 US EXAM SCROTUM TC 57.55 1/1/1981

76872 Us transrectal TC 57.55 1/1/1981

76873 Echograp trans r pros study TC 80.36 1/1/1981

76881 Us xtr non-vasc complete TC 94.19 1/1/2011

76882 Us xtr non-vasc lmtd TC 11.16 1/1/2011

76885 Us exam infant hips dynamic TC 57.55 1/1/1981

76886 Us exam infant hips static TC 53.93 1/1/1981

76930 Echo guide cardiocentesis TC 57.55 1/1/1981

76932 Echo guide for heart biopsy TC 57.55 1/1/1981

76936 Echo guide for artery repair TC 237.11 1/1/1981

76937 Us guide vascular access TC 18.60 1/1/2004

76940 Us guide tissue ablation TC 71.29 1/1/2004

76941 Echo guide for transfusion TC 57.55 1/1/1981

76942 Echo guide for biopsy TC 57.55 1/1/1981

76945 Echo guide villus sampling TC 57.55 1/1/1981

76946 Echo guide for amniocentesis TC 57.55 1/1/1981

76948 Echo guide ova aspiration TC 57.55 1/1/1981

76965 Echo guidance radiotherapy TC 209.59 1/1/1981

76970 Ultrasound exam follow-up TC 39.82 1/1/1981

76975 Gi endoscopic ultrasound TC 57.55 1/1/1981

76977 Us bone density measure TC 31.13 1/1/1981

77001 Fluoroguide for vein device TC 64.32 1/1/2007

77002 Needle localization by xray TC 49.56 1/1/2007

77003 FLUOROGUIDE FOR SPINE INJECT TC 45.41 1/1/2007

77011 Ct scan for localization TC 263.71 1/1/2007

77012 Ct scan for needle biopsy TC 263.74 1/1/2007

77014 Ct scan for therapy guide TC 99.13 1/1/2007

77021 Mr guidance for needle place TC 294.00 1/1/2007

77053 X-ray of mammary duct TC 84.38 1/1/2007

77054 X-ray of mammary ducts TC 109.73 1/1/2007

77058 Mri one breast TC 725.33 1/1/2007

77059 Mri both breasts TC 915.29 1/1/2007

77063 Breast tomosynthesis bi TC 27.36 1/1/2015

77063 Breast tomosynthesis bi 58.98 1/1/2015

77072 X-rays for bone age TC 13.62 1/1/2007

122/185


77073 X-rays bone length studies TC 29.13 1/1/2007

77074 X-rays bone survey limited TC 42.00 1/1/2007

77075 X-RAYS BONE SURVEY COMPLETE TC 62.81 1/1/2007

77076 X-rays bone survey infant TC 38.97 1/1/2007

77077 Joint survey single view TC 38.97 1/1/2007

77078 CT BONE DENSITY AXIAL TC 76.05 1/1/2007

77080 Dxa bone density axial TC 76.06 1/1/2007

77081 Dxa bone density/peripheral TC 29.13 1/1/2007

77084 Magnetic image bone marrow TC 293.99 1/1/2007

77085 Dxa bone density study TC 43.72 1/1/2015

77085 Dxa bone density study 59.56 1/1/2015

77086 Fracture assessment via dxa TC 28.50 1/1/2015

77086 Fracture assessment via dxa 37.71 1/1/2015

77280 Set radiation therapy field TC 130.68 1/1/1981



77293 Respirator motion mgmt simul TC 350.22 1/1/2014

77293 Respirator motion mgmt simul 457.25 1/1/2014

77295 3-d radiotherapy plan TC 1051.61 1/1/1981

77300 Radiation therapy dose plan TC 50.68 1/1/1981

77301 Radiotherapy dose plan imrt TC 1051.61 1/1/1981

77306 Telethx isodose plan simple TC 77.96 1/1/2015

77306 Telethx isodose plan simple 150.91 1/1/2015

77307 Telethx isodose plan cplx TC 142.64 1/1/2015

77307 Telethx isodose plan cplx 294.05 1/1/2015

77316 Brachytx isodose plan simple TC 120.95 1/1/2015

77316 Brachytx isodose plan simple 194.26 1/1/2015

77317 Brachytx isodose intermed TC 157.86 1/1/2015

77317 Brachytx isodose intermed 254.36 1/1/2015

77318 Brachytx isodose complex TC 214.17 1/1/2015

77318 Brachytx isodose complex 366.29 1/1/2015

77321 Special teletx port plan TC 152.04 1/1/1981

77331 Special radiation dosimetry TC 18.82 1/1/1981

77332 Radiation treatment aid(s) TC 50.68 1/1/1981



77338 Design mlc device for imrt TC 259.63 1/1/2010

77371 Srs multisource 1260.99 12/1/2015

77372 Srs linear based 1110.03 1/21/2013

77373 Sbrt delivery 1329.13 1/21/2013

77385 Ntsty modul rad tx dlvr smpl 1437.55 1/1/2015

77386 Ntsty modul rad tx dlvr cplx 0.00 1/1/2015

77387 Guidance for radiaj tx dlvr 66.47 1/1/2015

77401 Radiation treatment delivery 21.28 1/21/2013


123/185




77417 RADIOLOGY PORT IMAGES(S) 14.81 1/21/2013

77422 Neutron beam tx simple 44.48 1/21/2013

77423 Neutron beam tx complex 52.85 1/21/2013

77470 Special radiation treatment TC 419.92 1/1/1981

77600 Hyperthermia treatment TC 114.39 1/1/1981





77750 Infuse radioactive materials TC 50.31 1/1/1981

77761 Apply intrcav radiat simple TC 94.84 1/1/1981

77762 Apply intrcav radiat interm TC 136.11 1/1/1981

77763 Apply intrcav radiat compl TC 168.69 1/1/1981

77767 Hdr rdncl skn surf brachytx TC 182.92 1/1/2016

77767 Hdr rdncl skn surf brachytx 26 56.71 1/1/2016

77767 Hdr rdncl skn surf brachytx 239.63 1/1/2016

77768 Hdr rdncl skn surf brachytx TC 300.81 1/1/2016

77768 Hdr rdncl skn surf brachytx 26 75.13 1/1/2016

77768 Hdr rdncl skn surf brachytx 375.94 1/1/2016

77770 Hdr rdncl ntrstl/icav brchtx TC 236.16 1/1/2016

77770 Hdr rdncl ntrstl/icav brchtx 26 104.98 1/1/2016

77770 Hdr rdncl ntrstl/icav brchtx 341.14 1/1/2016







77778 APPLY INTERSTIT RADIAT COMPL TC 193.30 1/1/1981

77789 APPLY SURF LDR RADIONUCLIDE TC 17.01 1/1/1981

78012 Thyroid uptake measurement TC 83.55 1/1/2013

78013 Thyroid imaging w/blood flow TC 217.34 1/1/2013

78014 Thyroid imaging w/blood flow TC 247.98 1/1/2013

78015 Thyroid met imaging TC 97.01 1/1/1981

78016 Thyroid met imaging/studies TC 131.04 1/1/1981

78018 Thyroid met imaging body TC 204.16 1/1/1981

78020 Thyroid met uptake TC 51.76 1/1/1981

78070 Parathyroid planar imaging TC 69.14 1/1/1981

78071 Parathyrd planar w/wo subtrj TC 345.64 1/1/2013

78075 Adrenal cortex & medulla img TC 204.16 1/1/1981

78102 Bone marrow imaging ltd TC 77.46 1/1/1981

78103 Bone marrow imaging mult TC 119.46 1/1/1981

78104 Bone marrow imaging body TC 153.48 1/1/1981

124/185


78110 Plasma volume single TC 36.20 1/1/1981

78111 Plasma volume multiple TC 97.01 1/1/1981

78120 Red cell mass single TC 65.52 1/1/1981

78121 Red cell mass multiple TC 108.96 1/1/1981

78122 Blood volume TC 173.03 1/1/1981

78130 Red cell survival study TC 107.15 1/1/1981

78135 Red cell survival kinetics TC 183.17 1/1/1981

78140 Red cell sequestration TC 148.05 1/1/1981

78185 Spleen imaging TC 89.05 1/1/1981

78190 Platelet survival kinetics TC 215.02 1/1/1981

78191 Platelet survival TC 275.84 1/1/1981

78195 Lymph system imaging TC 153.48 1/1/1981

78201 Liver imaging TC 89.05 1/1/1981

78202 Liver imaging with flow TC 108.23 1/1/1981

78205 Liver imaging (3d) TC 222.26 1/1/1981

78206 Liver image (3d) with flow TC 215.02 1/1/1981

78215 Liver and spleen imaging TC 110.04 1/1/1981

78216 Liver & spleen image/flow TC 131.04 1/1/1981

78226 Hepatobiliary system imaging TC 330.32 1/1/2012

78227 Hepatobil syst image w/drug TC 458.68 1/1/2012

78230 Salivary gland imaging TC 82.53 1/1/1981

78231 Serial salivary imaging TC 119.46 1/1/1981

78232 Salivary gland function exam TC 132.85 1/1/1981

78258 Esophageal motility study TC 108.23 1/1/1981

78261 Gastric mucosa imaging TC 154.21 1/1/1981

78262 Gastroesophageal reflux exam TC 160.00 1/1/1981

78264 GASTRIC EMPTYING IMAG STUDY TC 155.29 1/1/1981

78265 Gastric emptying imag study TC 390.22 1/1/2016

78265 Gastric emptying imag study 26 50.36 1/1/2016

78265 Gastric emptying imag study 440.58 1/1/2016

78266 Gastric emptying imag study TC 467.07 1/1/2016

78266 Gastric emptying imag study 26 55.88 1/1/2016

78266 Gastric emptying imag study 522.95 1/1/2016

78270 Vit b-12 absorption exam TC 58.64 1/1/1981

78271 Vit b-12 absrp exam int fac TC 62.26 1/1/1981

78272 Vit b-12 absorp combined TC 87.60 1/1/1981

78278 Acute gi blood loss imaging TC 183.17 1/1/1981

78282 Gi protein loss exam TC 59.73 1/1/1981

78290 Meckels divert exam TC 114.39 1/1/1981

78291 Leveen/shunt patency exam TC 115.11 1/1/1981

78300 Bone imaging limited area TC 94.12 1/1/1981

78305 Bone imaging multiple areas TC 137.92 1/1/1981

78306 Bone imaging whole body TC 160.72 1/1/1981

78315 Bone imaging 3 phase TC 179.91 1/1/1981

78320 Bone imaging (3d) TC 222.26 1/1/1981

125/185


78350 Bone mineral single photon TC 28.96 1/1/1981

78414 Non-imaging heart function TC 54.30 1/1/1981

78428 Cardiac shunt imaging TC 85.43 1/1/1981

78445 Vascular flow imaging TC 70.22 1/1/1981

78451 Ht muscle image spect sing TC 160.10 1/1/2010

78452 Ht muscle image spect mult TC 309.40 1/1/2010

78453 Ht muscle image planar sing TC 149.32 1/1/2010

78454 Ht musc image planar mult TC 125.56 1/1/2010

78456 Acute venous thrombus image TC 152.76 1/1/1981

78457 Venous thrombosis imaging TC 100.27 1/1/1981

78458 Ven thrombosis images bilat TC 150.95 1/1/1981

78459 Heart muscle imaging (pet) TC 183.17 1/1/1981

78466 Heart infarct image TC 98.82 1/1/1981

78468 Heart infarct image (ef) TC 137.92 1/1/1981

78469 Heart infarct image (3d) TC 196.56 1/1/1981

78472 Gated heart planar single TC 207.78 1/1/1981

78473 Gated heart multiple TC 310.23 1/1/1981

78481 Heart first pass single TC 196.56 1/1/1981

78483 Heart first pass multiple TC 295.75 1/1/1981

78491 Heart image (pet) single TC 185.34 1/1/1981

78492 Heart image (pet) multiple TC 230.59 1/1/1981

78494 Heart image spect TC 263.17 1/1/1981

78496 Heart first pass add-on TC 263.17 1/1/1981

78579 Lung ventilation imaging TC 170.55 1/1/2012

78580 Lung perfusion imaging TC 129.23 1/1/1981

78582 Lung ventilat&perfus imaging TC 306.19 1/1/2012

78597 Lung perfusion differential TC 182.81 1/1/2012

78598 Lung perf&ventilat diferentl TC 296.23 1/1/2012

78600 Brain image < 4 views TC 108.23 1/1/1981

78601 Brain image w/flow < 4 views TC 128.14 1/1/1981

78605 Brain image 4+ views TC 128.14 1/1/1981

78606 Brain image w/flow 4 + views TC 145.52 1/1/1981

78607 Brain imaging (3d) TC 246.88 1/1/1981

78608 Brain imaging (pet) TC 1218.13 1/1/1981

78609 Brain imaging (pet) TC 1425.19 1/1/1981

78610 Brain flow imaging only TC 60.09 1/1/1981

78630 Cerebrospinal fluid scan TC 189.32 1/1/1981

78635 Csf ventriculography TC 96.29 1/1/1981

78645 Csf shunt evaluation TC 129.23 1/1/1981

78647 Cerebrospinal fluid scan TC 222.26 1/1/1981

78650 Csf leakage imaging TC 174.48 1/1/1981

78660 Nuclear exam of tear flow TC 80.00 1/1/1981

78700 Kidney imaging morphol TC 114.39 1/1/1981

78701 Kidney imaging with flow TC 133.57 1/1/1981

78707 K flow/funct image w/o drug TC 167.96 1/1/1981

126/185


78708 K flow/funct image w/drug TC 167.96 1/1/1981

78709 K flow/funct image multiple TC 167.96 1/1/1981

78710 Kidney imaging (3d) TC 222.26 1/1/1981

78725 Kidney function study TC 67.33 1/1/1981

78730 Urinary bladder retention TC 55.38 1/1/1981

78740 Ureteral reflux study TC 80.00 1/1/1981

78761 Testicular imaging w/flow TC 120.54 1/1/1981

78800 Tumor imaging limited area TC 128.14 1/1/1981

78801 Tumor imaging mult areas TC 158.55 1/1/1981

78802 Tumor imaging whole body TC 208.51 1/1/1981

78803 Tumor imaging (3d) TC 246.88 1/1/1981

78804 Tumor imaging whole body TC 179.17 1/1/2004

78805 Abscess imaging ltd area TC 128.14 1/1/1981

78806 Abscess imaging whole body TC 242.54 1/1/1981

78807 Nuclear localization/abscess TC 246.88 1/1/1981

78811 Pet image ltd area TC 608.94 1/1/2009

78812 Pet image skull-thigh TC 756.42 1/1/2009

78813 Pet image full body TC 783.97 1/1/2009

78814 Pet image w/ct lmtd TC 857.71 1/1/2009

78815 Pet image w/ct skull-thigh TC 947.84 1/1/2009

78816 Pet image w/ct full body TC 972.44 1/1/2009

79005 Nuclear rx oral admin TC 104.14 1/1/2005

79101 Nuclear rx iv admin TC 104.14 1/1/2005

79200 Nuclear rx intracav admin TC 98.82 1/1/1981

79300 Nuclr rx interstit colloid TC 55.74 1/1/1981

79403 Hematopoietic nuclear tx TC 172.37 1/1/2004

79440 Nuclear rx intra-articular TC 98.82 1/1/1981

79445 Nuclear rx intra-arterial TC 104.92 1/1/2005

80047 Metabolic panel ionized ca 15.26 1/1/2008

80048 Metabolic panel total ca 5.92 7/1/2005

80050 General health panel 24.56 1/1/2009

80051 Electrolyte panel 4.91 7/1/2005

80053 Comprehen metabolic panel 7.39 7/1/2005

80055 OBSTETRIC PANEL 49.38 3/1/2013

80061 Lipid panel 9.36 7/1/2005

80069 Renal function panel 6.07 7/1/2005

80074 Acute hepatitis panel 33.28 7/1/2005

80076 Hepatic function panel 5.72 7/1/2005

80081 Obstetric panel 96.87 1/1/2016

80150 Assay of amikacin 10.53 7/1/2005

80155 DRUG ASSAY CAFFEINE 9.65 1/1/2014

80156 Assay carbamazepine total 10.18 7/1/2005

80157 Assay carbamazepine free 9.27 7/1/2005

80158 ASSAY OF CYCLOSPORINE 12.62 7/1/2005

80159 DRUG ASSAY CLOZAPINE 12.61 1/1/2014

127/185


80162 Assay of digoxin total 9.28 7/1/2005

80164 Assay dipropylacetic acd tot 9.47 7/1/2005

80168 Assay of ethosuximide 11.42 7/1/2005

80169 DRUG ASSAY EVEROLIMUS 9.36 1/1/2014

80170 Assay of gentamicin 11.45 7/1/2005

80171 Drug screen quant gabapentin 9.04 1/1/2014

80173 Assay of haloperidol 10.18 7/1/2005

80175 Drug screen quan lamotrigine 9.04 1/1/2014

80176 Assay of lidocaine 10.27 7/1/2005

80177 Drug scrn quan levetiracetam 9.04 1/1/2014

80178 Assay of lithium 4.62 7/1/2005

80180 Drug scrn quan mycophenolate 12.31 1/1/2014

80183 Drug scrn quant oxcarbazepin 9.04 1/1/2014

80184 Assay of phenobarbital 8.01 7/1/2005

80185 Assay of phenytoin total 9.27 7/1/2005

80186 Assay of phenytoin free 9.62 7/1/2005

80188 Assay of primidone 11.58 7/1/2005

80190 Assay of procainamide 11.71 7/1/2005

80192 Assay of procainamide 11.71 7/1/2005

80194 Assay of quinidine 10.20 7/1/2005

80195 Assay of sirolimus 9.59 1/1/2006

80197 Assay of tacrolimus 9.59 7/1/2005

80198 Assay of theophylline 9.89 7/1/2005

80199 Drug screen quant tiagabine 12.31 1/1/2014

80200 Assay of tobramycin 11.27 7/1/2005

80201 Assay of topiramate 8.33 7/1/2005

80202 Assay of vancomycin 9.47 7/1/2005

80203 Drug screen quant zonisamide 9.04 1/1/2014

80299 Quantitative assay drug 9.57 7/1/2005

80305 DRUG TEST PRSMV DIR OPT OBS 14.21 1/1/2017

80306 DRUG TEST PRSMV INSTRMNT 18.95 1/1/2017

80307 DRUG TEST PRSMV CHEM ANLYZR 75.81 1/1/2017

80400 Acth stimulation panel 22.79 7/1/2005



80408 Aldosterone suppression eval 87.67 7/1/2005

80410 Calcitonin stimul panel 56.12 7/1/2005

80412 Crh stimulation panel 230.25 7/1/2005

80414 Testosterone response 36.09 7/1/2005

80415 Estradiol response panel 39.05 7/1/2005

80416 Renin stimulation panel 92.20 7/1/2005

80417 Renin stimulation panel 30.73 7/1/2005

80418 Pituitary evaluation panel 404.89 7/1/2005

80420 Dexamethasone panel 50.32 7/1/2005

80422 Glucagon tolerance panel 32.19 7/1/2005

128/185


80424 Glucagon tolerance panel 35.28 7/1/2005

80426 Gonadotropin hormone panel 103.70 7/1/2005

80428 Growth hormone panel 46.59 7/1/2005

80430 Growth hormone panel 54.80 7/1/2005

80432 Insulin suppression panel 94.37 7/1/2005

80434 Insulin tolerance panel 70.66 7/1/2005

80435 Insulin tolerance panel 71.93 7/1/2005

80436 Metyrapone panel 63.69 7/1/2005

80438 Trh stimulation panel 35.21 7/1/2005

80439 Trh stimulation panel 46.94 7/1/2005

80500 Lab pathology consultation 10.30 1/1/1980

80502 Lab pathology consultation 25.75 1/1/1980

81000 Urinalysis nonauto w/scope 2.22 7/1/2005

81001 Urinalysis auto w/scope 2.22 7/1/2005

81002 Urinalysis nonauto w/o scope 1.79 7/1/2005

81003 Urinalysis auto w/o scope 1.58 7/1/2005

81005 Urinalysis 1.52 7/1/2005

81007 Urine screen for bacteria 0.68 7/1/2005

81015 Microscopic exam of urine 2.12 7/1/2005

81020 Urinalysis glass test 2.58 7/1/2005

81025 Urine pregnancy test 4.43 7/1/2005

81050 Urinalysis volume measure 2.10 7/1/2005

82009 Test for acetone/ketones 3.16 7/1/2005

82010 Acetone assay 5.72 7/1/2005

82013 Acetylcholinesterase assay 7.81 7/1/2005

82016 Acylcarnitines qual 9.69 7/1/2005

82017 Acylcarnitines quant 11.79 7/1/2005

82024 Assay of acth 26.99 7/1/2005

82030 Assay of adp & amp 18.03 7/1/2005

82040 Assay of serum albumin 3.47 7/1/2005

82042 Assay of urine albumin 3.62 7/1/2005

82043 Microalbumin quantitative 4.05 7/1/2005

82044 Microalbumin semiquant 3.20 7/1/2005

82045 Albumin ischemia modified 23.72 7/1/2005

82075 Assay of breath ethanol 8.43 7/1/2005

82085 Assay of aldolase 6.79 7/1/2005

82088 Assay of aldosterone 28.47 7/1/2005

82103 Alpha-1-antitrypsin total 9.39 7/1/2005

82104 Alpha-1-antitrypsin pheno 10.11 7/1/2005

82105 ALPHA-FETOPROTEIN SERUM 11.70 7/1/2005

82106 Alpha-fetoprotein amniotic 11.70 7/1/2005

82107 Alpha-fetoprotein l3 25.95 1/1/2007

82108 Assay of aluminum 17.80 7/1/2005

82120 Amines vaginal fluid qual 2.63 7/1/2005

82127 Amino acid single qual 9.69 7/1/2005

129/185


82128 Amino acids mult qual 9.69 7/1/2005

82131 Amino acids single quant 11.79 7/1/2005

82135 Assay aminolevulinic acid 11.50 7/1/2005

82136 Amino acids quant 2-5 11.79 7/1/2005

82139 Amino acids quan 6 or more 11.79 7/1/2005

82140 Assay of ammonia 10.19 7/1/2005

82143 Amniotic fluid scan 4.81 7/1/2005

82150 Assay of amylase 4.54 7/1/2005

82154 Androstanediol glucuronide 20.15 7/1/2005

82157 Assay of androstenedione 20.46 7/1/2005

82160 Assay of androsterone 17.47 7/1/2005

82163 Assay of angiotensin ii 14.35 7/1/2005

82164 Angiotensin i enzyme test 10.20 7/1/2005

82172 Assay of apolipoprotein 10.83 7/1/2005

82175 Assay of arsenic 13.26 7/1/2005

82180 Assay of ascorbic acid 6.91 7/1/2005

82190 Atomic absorption 10.42 7/1/2005

82232 Assay of beta-2 protein 11.31 7/1/2005

82239 Bile acids total 11.98 7/1/2005

82240 Bile acids cholylglycine 18.57 7/1/2005

82247 Bilirubin total 3.51 7/1/2005

82248 Bilirubin direct 3.51 7/1/2005

82252 Fecal bilirubin test 3.18 7/1/2005

82261 Assay of biotinidase 11.79 7/1/2005

82270 Occult blood feces 2.27 7/1/2005

82271 Occult blood other sources 2.27 1/1/2006

82272 Occult bld feces 1-3 tests 2.27 1/1/2006

82274 Assay test for blood fecal 11.11 7/1/2005

82286 Assay of bradykinin 4.81 7/1/2005

82300 Assay of cadmium 16.17 7/1/2005

82306 Vitamin d 25 hydroxy 20.47 7/1/2005

82308 Assay of calcitonin 18.71 7/1/2005

82310 Assay of calcium 3.60 7/1/2005

82330 Assay of calcium 9.55 7/1/2005

82331 Calcium infusion test 3.62 7/1/2005

82340 Assay of calcium in urine 4.22 7/1/2005

82355 Calculus analysis qual 8.09 7/1/2005

82360 Calculus assay quant 9.00 7/1/2005

82365 Calculus spectroscopy 9.01 7/1/2005

82370 X-ray assay calculus 8.76 7/1/2005

82373 Assay c-d transfer measure 12.62 7/1/2005

82374 Assay blood carbon dioxide 3.42 7/1/2005

82375 Assay carboxyhb quant 9.00 1/1/2009

82376 Assay carboxyhb qual 4.10 7/1/2005

82378 Carcinoembryonic antigen 13.26 7/1/2005

130/185


82379 Assay of carnitine 11.79 7/1/2005

82380 Assay of carotene 6.45 7/1/2005

82382 Assay urine catecholamines 12.02 7/1/2005

82383 Assay blood catecholamines 17.51 7/1/2005

82384 Assay three catecholamines 17.64 7/1/2005

82387 Assay of cathepsin-d 14.54 7/1/2005

82390 Assay of ceruloplasmin 7.51 7/1/2005

82397 Chemiluminescent assay 9.87 7/1/2005

82415 Assay of chloramphenicol 8.86 7/1/2005

82435 Assay of blood chloride 3.22 7/1/2005

82436 Assay of urine chloride 3.51 7/1/2005

82438 Assay other fluid chlorides 3.42 7/1/2005

82441 Test for chlorohydrocarbons 4.20 7/1/2005

82465 Assay bld/serum cholesterol 3.04 7/1/2005

82480 Assay serum cholinesterase 5.51 7/1/2005

82482 Assay rbc cholinesterase 5.37 7/1/2005

82485 Assay chondroitin sulfate 14.43 7/1/2005

82495 Assay of chromium 14.18 7/1/2005

82507 Assay of citrate 19.43 7/1/2005

82523 Collagen crosslinks 13.06 7/1/2005

82525 Assay of copper 8.68 7/1/2005

82528 Assay of corticosterone 15.73 7/1/2005

82530 Cortisol free 11.68 7/1/2005

82533 Total cortisol 11.40 7/1/2005

82540 Assay of creatine 3.25 7/1/2005

82542 COLUMN CHROMOTOGRAPHY QUANT 12.62 7/1/2005

82550 Assay of ck (cpk) 4.56 7/1/2005

82552 Assay of cpk in blood 9.36 7/1/2005

82553 Creatine mb fraction 8.07 7/1/2005

82554 Creatine isoforms 8.29 7/1/2005

82565 Assay of creatinine 3.58 7/1/2005

82570 Assay of urine creatinine 3.62 7/1/2005

82575 Creatinine clearance test 6.60 7/1/2005

82585 Assay of cryofibrinogen 5.99 7/1/2005

82595 Assay of cryoglobulin 4.52 7/1/2005

82600 Assay of cyanide 13.56 7/1/2005

82607 Vitamin b-12 10.53 7/1/2005

82608 B-12 binding capacity 10.01 7/1/2005

82610 Cystatin c 9.50 1/1/2008

82615 Test for urine cystines 5.71 7/1/2005

82626 Dehydroepiandrosterone 17.66 7/1/2005

82627 Dehydroepiandrosterone 15.54 7/1/2005

82633 Desoxycorticosterone 21.64 7/1/2005

82634 Deoxycortisol 20.46 7/1/2005

82638 Assay of dibucaine number 8.56 7/1/2005

131/185


82652 Vit d 1 25-dihydroxy 26.89 7/1/2005

82656 Pancreatic elastase fecal 8.07 7/1/2005

82657 Enzyme cell activity 12.62 7/1/2005

82658 Enzyme cell activity ra 12.62 7/1/2005

82664 Electrophoretic test 24.00 7/1/2005

82668 Assay of erythropoietin 13.14 7/1/2005

82670 Assay of estradiol 19.53 7/1/2005

82671 Assay of estrogens 22.57 7/1/2005

82672 Assay of estrogen 15.15 7/1/2005

82677 Assay of estriol 16.90 7/1/2005

82679 Assay of estrone 17.45 7/1/2005

82693 Assay of ethylene glycol 10.41 7/1/2005

82696 Assay of etiocholanolone 16.48 7/1/2005

82705 Fats/lipids feces qual 3.56 7/1/2005

82710 Fats/lipids feces quant 11.74 7/1/2005

82715 Assay of fecal fat 12.03 7/1/2005

82725 Assay of blood fatty acids 9.31 7/1/2005

82726 Long chain fatty acids 12.62 7/1/2005

82728 Assay of ferritin 9.52 7/1/2005

82731 Assay of fetal fibronectin 25.96 7/1/2005

82735 Assay of fluoride 12.96 7/1/2005

82746 Assay of folic acid serum 10.28 7/1/2005

82747 Assay of folic acid rbc 12.11 7/1/2005

82759 Assay of rbc galactokinase 15.01 7/1/2005

82760 Assay of galactose 7.83 7/1/2005

82775 Assay galactose transferase 14.72 7/1/2005

82776 Galactose transferase test 5.86 7/1/2005

82784 Assay iga/igd/igg/igm each 4.68 7/1/2005

82785 Assay of ige 11.51 7/1/2005

82787 Igg 1 2 3 or 4 each 5.60 7/1/2005

82800 Blood ph 5.92 7/1/2005

82803 Blood gases any combination 13.53 7/1/2005

82805 Blood gases w/o2 saturation 19.83 7/1/2005

82810 Blood gases o2 sat only 6.10 7/1/2005

82820 Hemoglobin-oxygen affinity 6.63 7/1/2005

82930 Gastric analy w/ph ea spec 3.74 1/1/2011

82938 Gastrin test 12.36 7/1/2005

82941 Assay of gastrin 12.32 7/1/2005

82943 Assay of glucagon 9.99 7/1/2005

82945 Glucose other fluid 2.75 7/1/2005

82946 Glucagon tolerance test 10.53 7/1/2005

82947 Assay glucose blood quant 2.75 7/1/2005

82948 Reagent strip/blood glucose 2.22 7/1/2005

82950 Glucose test 3.32 7/1/2005

82951 Glucose tolerance test (gtt) 7.29 7/1/2005

132/185


82952 Gtt-added samples 2.75 7/1/2005

82955 Assay of g6pd enzyme 6.78 7/1/2005

82960 Test for g6pd enzyme 4.24 7/1/2005

82962 Glucose blood test 1.27 7/1/2005

82963 Assay of glucosidase 15.01 7/1/2005

82965 Assay of gdh enzyme 5.41 7/1/2005

82977 Assay of ggt 5.04 7/1/2005

82978 Assay of glutathione 9.96 7/1/2005

82979 Assay rbc glutathione 4.81 7/1/2005

82985 Assay of glycated protein 10.53 7/1/2005

83001 Assay of gonadotropin (fsh) 12.99 7/1/2005

83002 Assay of gonadotropin (lh) 12.94 7/1/2005

83003 Assay growth hormone (hgh) 11.65 7/1/2005

83009 H pylori (c-13) blood 47.06 7/1/2005

83010 Assay of haptoglobin quant 8.79 7/1/2005

83012 Assay of haptoglobins 12.02 7/1/2005

83013 H pylori (c-13) breath 47.06 7/1/2005

83014 H pylori drug admin 5.49 7/1/2005

83015 HEAVY METAL QUAL ANY ANAL 13.16 7/1/2005

83018 HEAVY METAL QUANT EACH NES 15.35 7/1/2005

83020 Hemoglobin electrophoresis 26 4.77 7/1/2005

83020 Hemoglobin electrophoresis 9.00 7/1/2005

83021 Hemoglobin chromotography 12.62 7/1/2005

83026 Hemoglobin copper sulfate 1.65 7/1/2005

83030 Fetal hemoglobin chemical 5.79 7/1/2005

83033 Fetal hemoglobin assay qual 4.17 7/1/2005

83036 Glycosylated hemoglobin test 6.79 7/1/2005

83037 Glycosylated hb home device 7.09 6/1/2009

83045 Blood methemoglobin test 3.47 7/1/2005

83050 Blood methemoglobin assay 5.12 7/1/2005

83051 Assay of plasma hemoglobin 5.11 7/1/2005

83060 Blood sulfhemoglobin assay 5.79 7/1/2005

83065 Assay of hemoglobin heat 4.81 7/1/2005

83068 Hemoglobin stability screen 5.92 7/1/2005

83069 Assay of urine hemoglobin 2.76 7/1/2005

83070 Assay of hemosiderin qual 3.32 7/1/2005

83080 Assay of b hexosaminidase 11.79 7/1/2005

83088 Assay of histamine 20.63 7/1/2005

83090 Assay of homocystine 11.79 7/1/2005

83150 Assay of homovanillic acid 13.53 7/1/2005

83491 Assay of corticosteroids 17 12.24 7/1/2005

83497 Assay of 5-hiaa 9.01 7/1/2005

83498 Assay of progesterone 17-d 18.98 7/1/2005

83499 Assay of progesterone 20- 17.62 7/1/2005

83500 Assay free hydroxyproline 15.83 7/1/2005

133/185


83505 Assay total hydroxyproline 16.98 7/1/2005

83516 Immunoassay nonantibody 8.07 7/1/2005

83518 Immunoassay dipstick 5.93 7/1/2005

83519 Ria nonantibody 9.44 7/1/2005

83520 Immunoassay quant nos nonab 9.05 7/1/2005

83525 Assay of insulin 7.99 7/1/2005

83527 Assay of insulin 9.05 7/1/2005

83528 Assay of intrinsic factor 11.11 7/1/2005

83540 Assay of iron 3.99 7/1/2005

83550 Iron binding test 4.89 7/1/2005

83570 Assay of idh enzyme 6.18 7/1/2005

83582 Assay of ketogenic steroids 9.90 7/1/2005

83586 Assay 17- ketosteroids 8.95 7/1/2005

83593 Fractionation ketosteroids 18.38 7/1/2005

83605 Assay of lactic acid 7.47 7/1/2005

83615 Lactate (ld) (ldh) enzyme 4.22 7/1/2005

83625 Assay of ldh enzymes 8.94 7/1/2005

83630 Lactoferrin fecal (qual) 8.07 7/1/2005

83631 Lactoferrin fecal (quant) 13.71 1/1/2006

83632 Placental lactogen 14.12 7/1/2005

83633 Test urine for lactose 3.85 7/1/2005

83655 Assay of lead 8.46 7/1/2005

83661 L/s ratio fetal lung 15.36 7/1/2005

83662 Foam stability fetal lung 13.22 7/1/2005

83663 Fluoro polarize fetal lung 13.22 7/1/2005

83664 Lamellar bdy fetal lung 13.22 7/1/2005

83670 Assay of lap enzyme 6.41 7/1/2005

83690 Assay of lipase 4.81 7/1/2005

83695 Assay of lipoprotein(a) 9.05 1/1/2006

83698 Assay lipoprotein pla2 23.72 1/1/2007

83700 Lipopro bld electrophoretic 7.86 1/1/2006

83701 Lipoprotein bld hr fraction 17.34 1/1/2006

83704 LIPOPROTEIN BLD QUAN PART 22.04 1/1/2006

83718 Assay of lipoprotein 5.72 7/1/2005

83719 Assay of blood lipoprotein 8.14 7/1/2005

83721 Assay of blood lipoprotein 6.67 7/1/2005

83727 Assay of lrh hormone 12.02 7/1/2005

83735 Assay of magnesium 4.68 7/1/2005

83775 Assay malate dehydrogenase 5.16 7/1/2005

83785 Assay of manganese 17.19 7/1/2005

83789 MASS SPECTROMETRY QUANT 12.62 7/1/2005

83825 Assay of mercury 11.36 7/1/2005

83835 Assay of metanephrines 11.84 7/1/2005

83857 Assay of methemalbumin 7.51 7/1/2005

83861 Microfluid analy tears 11.78 1/1/2011

134/185


83864 Mucopolysaccharides 13.91 7/1/2005

83872 Assay synovial fluid mucin 4.10 7/1/2005

83873 Assay of csf protein 12.03 7/1/2005

83874 Assay of myoglobin 9.03 7/1/2005

83876 Assay myeloperoxidase 9.45 1/1/2009

83880 Assay of natriuretic peptide 23.72 7/1/2005

83883 Assay nephelometry not spec 9.50 7/1/2005

83885 Assay of nickel 17.12 7/1/2005

83915 Assay of nucleotidase 7.79 7/1/2005

83916 Oligoclonal bands 14.05 7/1/2005

83918 Organic acids total quant 11.50 7/1/2005

83919 Organic acids qual each 11.50 7/1/2005

83921 Organic acid single quant 11.50 7/1/2005

83930 Assay of blood osmolality 4.62 7/1/2005

83935 Assay of urine osmolality 4.77 7/1/2005

83937 Assay of osteocalcin 20.86 7/1/2005

83945 Assay of oxalate 9.00 7/1/2005

83950 Oncoprotein her-2/neu 25.96 7/1/2005

83951 Oncoprotein dcp 27.12 1/1/2009

83970 Assay of parathormone 28.84 7/1/2005

83986 Assay ph body fluid nos 2.50 7/1/2005

83987 Exhaled breath condensate 11.37 1/1/2010

83992 Assay for phencyclidine 8.91 7/1/2005

83993 Assay for calprotectin fecal 13.71 1/1/2008

84030 Assay of blood pku 3.85 7/1/2005

84035 Assay of phenylketones 2.56 7/1/2005

84060 Assay acid phosphatase 5.16 7/1/2005

84061 Phosphatase forensic exam 5.54 7/1/2005

84066 Assay prostate phosphatase 6.75 7/1/2005

84075 Assay alkaline phosphatase 3.62 7/1/2005

84078 Assay alkaline phosphatase 4.68 7/1/2005

84080 Assay alkaline phosphatases 10.33 7/1/2005

84081 Assay phosphatidylglycerol 11.55 7/1/2005

84085 Assay of rbc pg6d enzyme 4.72 7/1/2005

84087 Assay phosphohexose enzymes 7.22 7/1/2005

84100 Assay of phosphorus 3.32 7/1/2005

84105 Assay of urine phosphorus 3.62 7/1/2005

84106 Test for porphobilinogen 3.00 7/1/2005

84110 Assay of porphobilinogen 5.91 7/1/2005

84112 Eval amniotic fluid protein 52.28 4/1/2012

84119 Test urine for porphyrins 6.02 7/1/2005

84120 Assay of urine porphyrins 10.28 7/1/2005

84126 Assay of feces porphyrins 17.80 7/1/2005

84132 Assay of serum potassium 3.22 7/1/2005

84133 Assay of urine potassium 3.01 7/1/2005

135/185


84134 Assay of prealbumin 10.19 7/1/2005

84135 Assay of pregnanediol 13.37 7/1/2005

84138 Assay of pregnanetriol 13.23 7/1/2005

84140 Assay of pregnenolone 14.45 7/1/2005

84143 Assay of 17-hydroxypregneno 15.95 7/1/2005

84144 Assay of progesterone 14.58 7/1/2005

84145 Procalcitonin (pct) 13.88 1/1/2010

84146 Assay of prolactin 13.54 7/1/2005

84150 Assay of prostaglandin 17.45 7/1/2005

84152 Assay of psa complexed 12.86 7/1/2005

84153 Assay of psa total 12.86 7/1/2005

84154 Assay of psa free 12.86 7/1/2005

84155 Assay of protein serum 2.56 7/1/2005

84156 Assay of protein urine 2.56 7/1/2005

84157 Assay of protein other 2.56 7/1/2005

84160 Assay of protein any source 3.62 7/1/2005

84163 Pappa serum 9.82 7/1/2005

84165 Protein e-phoresis serum 26 4.24 7/1/2005

84165 Protein e-phoresis serum 7.51 7/1/2005

84166 Protein e-phoresis/urine/csf 26 5.50 7/1/2005

84166 Protein e-phoresis/urine/csf 12.47 7/1/2005

84181 Western blot test 26 5.38 7/1/2005

84181 Western blot test 11.90 7/1/2005

84182 Protein western blot test 26 5.72 7/1/2005

84182 Protein western blot test 12.58 7/1/2005

84202 Assay rbc protoporphyrin 10.03 7/1/2005

84203 Test rbc protoporphyrin 6.02 7/1/2005

84206 Assay of proinsulin 12.45 7/1/2005

84207 Assay of vitamin b-6 19.63 7/1/2005

84210 Assay of pyruvate 7.59 7/1/2005

84220 Assay of pyruvate kinase 6.60 7/1/2005

84228 Assay of quinine 8.14 7/1/2005

84233 Assay of estrogen 25.96 7/1/2005

84234 Assay of progesterone 21.89 7/1/2005

84235 Assay of endocrine hormone 36.57 7/1/2005

84238 Assay nonendocrine receptor 25.55 7/1/2005

84244 Assay of renin 15.37 7/1/2005


84255 Assay of selenium 17.84 7/1/2005

84260 Assay of serotonin 21.64 7/1/2005

84270 Assay of sex hormone globul 15.19 7/1/2005

84275 Assay of sialic acid 9.39 7/1/2005

84285 Assay of silica 16.46 7/1/2005

84295 Assay of serum sodium 3.36 7/1/2005

84300 Assay of urine sodium 3.40 7/1/2005

136/185


84302 Assay of sweat sodium 3.40 7/1/2005

84305 Assay of somatomedin 14.86 7/1/2005

84307 Assay of somatostatin 12.78 7/1/2005

84311 Spectrophotometry 4.89 7/1/2005

84315 Body fluid specific gravity 1.75 7/1/2005

84375 Chromatogram assay sugars 13.70 7/1/2005

84376 Sugars single qual 3.85 7/1/2005

84377 Sugars multiple qual 3.85 7/1/2005

84378 Sugars single quant 8.06 7/1/2005

84379 Sugars multiple quant 8.06 7/1/2005

84392 Assay of urine sulfate 3.32 7/1/2005

84402 Assay of free testosterone 17.79 7/1/2005

84403 Assay of total testosterone 18.05 7/1/2005


84430 Assay of thiocyanate 8.14 7/1/2005

84431 Thromboxane urine 9.27 1/1/2010

84432 Assay of thyroglobulin 11.23 7/1/2005

84436 Assay of total thyroxine 4.81 7/1/2005

84437 Assay of neonatal thyroxine 4.52 7/1/2005

84439 Assay of free thyroxine 6.31 7/1/2005

84442 Assay of thyroid activity 10.33 7/1/2005

84443 Assay thyroid stim hormone 11.74 7/1/2005

84445 Assay of tsi globulin 35.53 7/1/2005

84446 Assay of vitamin e 9.91 7/1/2005

84449 Assay of transcortin 12.58 7/1/2005

84450 Transferase (ast) (sgot) 3.61 7/1/2005

84460 Alanine amino (alt) (sgpt) 3.71 7/1/2005

84466 Assay of transferrin 8.93 7/1/2005

84478 Assay of triglycerides 4.02 7/1/2005

84479 Assay of thyroid (t3 or t4) 4.52 7/1/2005

84480 Assay triiodothyronine (t3) 9.91 7/1/2005

84481 Free assay (ft-3) 11.84 7/1/2005

84482 T3 reverse 11.02 7/1/2005

84484 Assay of troponin quant 6.88 7/1/2005

84485 Assay duodenal fluid trypsin 5.25 7/1/2005

84488 Test feces for trypsin 5.10 7/1/2005

84490 Assay of feces for trypsin 5.32 7/1/2005

84510 Assay of tyrosine 7.27 7/1/2005

84512 Assay of troponin qual 5.39 7/1/2005

84520 Assay of urea nitrogen 2.76 7/1/2005

84525 Urea nitrogen semi-quant 2.63 7/1/2005

84540 Assay of urine/urea-n 3.32 7/1/2005

84545 Urea-n clearance test 4.62 7/1/2005

84550 Assay of blood/uric acid 3.16 7/1/2005

84560 Assay of urine/uric acid 3.32 7/1/2005

137/185


84577 Assay of feces/urobilinogen 8.72 7/1/2005

84578 Test urine urobilinogen 2.27 7/1/2005

84580 Assay of urine urobilinogen 4.97 7/1/2005

84583 Assay of urine urobilinogen 3.51 7/1/2005

84585 Assay of urine vma 10.83 7/1/2005

84586 Assay of vip 24.69 7/1/2005

84588 Assay of vasopressin 23.72 7/1/2005

84590 Assay of vitamin a 8.11 7/1/2005

84591 Assay of nos vitamin 8.11 7/1/2005

84597 Assay of vitamin k 9.58 7/1/2005

84600 Assay of volatiles 11.23 7/1/2005

84620 Xylose tolerance test 8.28 7/1/2005

84630 Assay of zinc 7.96 7/1/2005

84681 Assay of c-peptide 14.54 7/1/2005

84702 Chorionic gonadotropin test 9.82 7/1/2005

84703 Chorionic gonadotropin assay 5.25 7/1/2005

84704 Hcg free betachain test 9.81 1/1/2008

84830 Ovulation tests 7.02 7/1/2005

85002 Bleeding time test 3.15 7/1/2005

85004 Automated diff wbc count 4.52 7/1/2005

85007 Bl smear w/diff wbc count 2.41 7/1/2005

85008 Bl smear w/o diff wbc count 2.41 7/1/2005

85009 Manual diff wbc count b-coat 2.60 7/1/2005

85013 Spun microhematocrit 1.66 7/1/2005

85014 Hematocrit 1.66 7/1/2005

85018 Hemoglobin 1.66 7/1/2005

85025 Complete cbc w/auto diff wbc 5.43 7/1/2005

85027 Complete cbc automated 4.52 7/1/2005

85032 Manual cell count each 3.01 7/1/2005

85041 Automated rbc count 2.10 7/1/2005

85044 Manual reticulocyte count 3.01 7/1/2005

85045 Automated reticulocyte count 2.80 7/1/2005

85046 Reticyte/hgb concentrate 3.91 7/1/2005

85048 Automated leukocyte count 1.78 7/1/2005

85049 Automated platelet count 3.13 7/1/2005

85055 Reticulated platelet assay 12.65 7/1/2005

85060 Blood smear interpretation 12.32 1/1/1980

85097 Bone marrow interpretation 42.53 1/1/1980

85130 Chromogenic substrate assay 8.32 7/1/2005

85170 Blood clot retraction 2.53 7/1/2005

85175 Blood clot lysis time 3.18 7/1/2005

85210 Clot factor ii prothrom spec 9.07 7/1/2005

85220 BLOOC CLOT FACTOR V TEST 12.33 7/1/2005

85230 Clot factor vii proconvertin 12.52 7/1/2005

85240 Clot factor viii ahg 1 stage 12.52 7/1/2005

138/185


85244 Clot factor viii reltd antgn 14.27 7/1/2005

85245 Clot factor viii vw ristoctn 16.04 7/1/2005

85246 Clot factor viii vw antigen 16.04 7/1/2005

85247 Clot factor viii multimetric 16.04 7/1/2005

85250 Clot factor ix ptc/chrstmas 13.31 7/1/2005

85260 Clot factor x stuart-power 12.52 7/1/2005

85270 Clot factor xi pta 12.52 7/1/2005

85280 Clot factor xii hageman 13.53 7/1/2005

85290 Clot factor xiii fibrin stab 11.42 7/1/2005

85291 Clot factor xiii fibrin scrn 6.22 7/1/2005

85292 Clot factor fletcher fact 13.23 7/1/2005

85293 Clot factor wght kininogen 13.23 7/1/2005

85300 Antithrombin iii activity 8.28 7/1/2005

85301 Antithrombin iii antigen 7.56 7/1/2005

85302 Clot inhibit prot c antigen 8.40 7/1/2005

85303 Clot inhibit prot c activity 9.66 7/1/2005

85305 Clot inhibit prot s total 8.11 7/1/2005

85306 Clot inhibit prot s free 10.71 7/1/2005

85307 Assay activated protein c 10.71 7/1/2005

85335 Factor inhibitor test 9.00 7/1/2005

85337 Thrombomodulin 4.95 7/1/2005

85345 Coagulation time lee & white 3.01 7/1/2005

85347 Coagulation time activated 2.98 7/1/2005

85348 Coagulation time otr method 2.60 7/1/2005

85360 Euglobulin lysis 5.87 7/1/2005

85362 Fibrin degradation products 3.98 7/1/2005

85366 Fibrinogen test 5.86 7/1/2005

85370 Fibrinogen test 7.94 7/1/2005

85378 Fibrin degrade semiquant 4.99 7/1/2005

85379 Fibrin degradation quant 7.12 7/1/2005

85380 Fibrin degradj d-dimer 7.11 10/1/2009

85384 Fibrinogen activity 5.94 7/1/2005

85385 Fibrinogen antigen 5.94 7/1/2005

85390 Fibrinolysins screen i&r 26 2.63 7/1/2005

85390 Fibrinolysins screen i&r 3.61 7/1/2005

85396 Clotting assay whole blood 22.18 1/1/2004

85397 Clotting funct activity 16.75 1/1/2009

85400 Fibrinolytic plasmin 6.18 7/1/2005

85410 Fibrinolytic antiplasmin 5.39 7/1/2005

85415 Fibrinolytic plasminogen 12.02 7/1/2005



85441 Heinz bodies direct 2.95 7/1/2005

85445 Heinz bodies induced 4.77 7/1/2005

85460 Hemoglobin fetal 5.41 7/1/2005

139/185


85461 Hemoglobin fetal 4.64 7/1/2005

85475 Hemolysin acid 6.20 7/1/2005

85520 Heparin assay 9.15 7/1/2005

85525 Heparin neutralization 8.28 7/1/2005

85530 Heparin-protamine tolerance 9.91 7/1/2005

85536 Iron stain peripheral blood 4.52 7/1/2005

85540 Wbc alkaline phosphatase 6.02 7/1/2005

85547 Rbc mechanical fragility 6.02 7/1/2005

85549 Muramidase 13.11 7/1/2005

85555 Rbc osmotic fragility 4.68 7/1/2005

85557 Rbc osmotic fragility 9.33 7/1/2005

85576 Blood platelet aggregation 26 6.09 7/1/2005

85576 Blood platelet aggregation 15.01 7/1/2005

85597 Phospholipid pltlt neutraliz 12.57 7/1/2005

85598 Hexagnal phosph pltlt neutrl 12.64 1/1/2011

85610 Prothrombin time 2.75 7/1/2005

85611 Prothrombin test 2.76 7/1/2005

85612 Viper venom prothrombin time 6.69 7/1/2005

85613 Russell viper venom diluted 6.69 7/1/2005

85635 Reptilase test 6.89 7/1/2005

85651 Rbc sed rate nonautomated 2.49 7/1/2005

85652 Rbc sed rate automated 1.89 7/1/2005

85660 Rbc sickle cell test 3.86 7/1/2005

85670 Thrombin time plasma 4.04 7/1/2005

85675 Thrombin time titer 4.79 7/1/2005

85705 Thromboplastin inhibition 6.73 7/1/2005

85730 Thromboplastin time partial 4.20 7/1/2005

85732 Thromboplastin time partial 4.52 7/1/2005

85810 Blood viscosity examination 8.16 7/1/2005

86000 Agglutinins febrile antigen 4.88 7/1/2005

86001 Allergen specific igg 3.66 7/1/2005

86003 Allergen specific ige 3.66 7/1/2005

86005 Allergen specific ige 5.58 7/1/2005

86021 Wbc antibody identification 7.93 7/1/2005

86022 Platelet antibodies 12.83 7/1/2005

86023 Immunoglobulin assay 5.54 7/1/2005

86038 Antinuclear antibodies 8.45 7/1/2005

86039 Antinuclear antibodies (ana) 7.81 7/1/2005

86060 Antistreptolysin o titer 5.10 7/1/2005

86063 Antistreptolysin o screen 4.04 7/1/2005

86077 Phys blood bank serv xmatch 20.60 1/1/1980

86078 Phys blood bank serv reactj 20.60 1/1/1980

86140 C-reactive protein 3.62 7/1/2005

86141 C-reactive protein hs 9.05 7/1/2005

86146 Beta-2 glycoprotein antibody 17.78 7/1/2005

140/185


86147 Cardiolipin antibody ea ig 17.78 7/1/2005

86148 Anti-phospholipid antibody 11.23 7/1/2005

86155 Chemotaxis assay 11.17 7/1/2005

86156 Cold agglutinin screen 4.68 7/1/2005

86157 Cold agglutinin titer 5.64 7/1/2005

86160 Complement antigen 8.40 7/1/2005

86161 Complement/function activity 8.40 7/1/2005

86162 Complement total (ch50) 14.20 7/1/2005

86171 Complement fixation each 7.00 7/1/2005

86185 Counterimmunoelectrophoresis 6.25 7/1/2005

86200 Ccp antibody 9.05 1/1/2006

86215 Deoxyribonuclease antibody 9.26 7/1/2005

86225 Dna antibody native 9.61 7/1/2005

86226 Dna antibody single strand 8.47 7/1/2005

86235 Nuclear antigen antibody 11.70 7/1/2005

86243 Fc receptor 14.35 7/1/2005

86255 Fluorescent antibody screen 26 4.61 7/1/2005

86255 Fluorescent antibody screen 8.43 7/1/2005

86256 Fluorescent antibody titer 26 4.61 7/1/2005

86256 Fluorescent antibody titer 8.43 7/1/2005

86277 Growth hormone antibody 11.00 7/1/2005

86280 Hemagglutination inhibition 5.72 7/1/2005

86294 Immunoassay tumor qual 13.71 7/1/2005

86300 Immunoassay tumor ca 15-3 14.54 7/1/2005

86301 Immunoassay tumor ca 19-9 14.54 7/1/2005

86304 Immunoassay tumor ca 125 14.54 7/1/2005

86305 Human epididymis protein 4 14.90 1/1/2010

86308 Heterophile antibody screen 3.62 7/1/2005

86309 Heterophile antibody titer 4.52 7/1/2005

86310 Heterophile antibody absrbj 5.16 7/1/2005

86316 Immunoassay tumor other 14.54 7/1/2005

86317 Immunoassay infectious agent 10.48 7/1/2005

86318 Immunoassay infectious agent 9.05 7/1/2005

86320 Serum immunoelectrophoresis 26 6.10 7/1/2005

86320 Serum immunoelectrophoresis 15.66 7/1/2005

86325 Other immunoelectrophoresis 26 5.99 7/1/2005

86325 Other immunoelectrophoresis 15.62 7/1/2005

86327 Immunoelectrophoresis assay 26 6.74 7/1/2005

86327 Immunoelectrophoresis assay 15.86 7/1/2005

86329 Immunodiffusion nes 9.82 7/1/2005

86331 Immunodiffusion ouchterlony 8.38 7/1/2005

86332 Immune complex assay 17.03 7/1/2005

86334 Immunofix e-phoresis serum 26 6.13 7/1/2005

86334 Immunofix e-phoresis serum 15.61 7/1/2005

86335 Immunfix e-phorsis/urine/csf 26 6.66 7/1/2005

141/185


86335 Immunfix e-phorsis/urine/csf 20.50 7/1/2005

86336 Inhibin a 9.05 1/1/2008

86337 Insulin antibodies 14.97 7/1/2005

86340 Intrinsic factor antibody 10.53 7/1/2005

86341 Islet cell antibody 13.83 7/1/2005

86343 Leukocyte histamine release 8.71 7/1/2005

86344 Leukocyte phagocytosis 5.58 7/1/2005

86352 Cell function assay w/stim 48.65 1/1/2010

86353 Lymphocyte transformation 34.25 7/1/2005

86355 B cells total count 26.35 1/1/2006

86356 Mononuclear cell antigen 12.64 1/1/2008

86357 Nk cells total count 26.35 1/1/2006

86359 T cells total count 26.36 7/1/2005

86360 T cell absolute count/ratio 32.83 7/1/2005

86361 T cell absolute count 12.65 7/1/2005

86367 Stem cells total count 26.35 1/1/2006

86376 Microsomal antibody each 10.17 7/1/2005

86378 Migration inhibitory factor 13.76 7/1/2005

86382 Neutralization test viral 11.82 7/1/2005

86384 Nitroblue tetrazolium dye 7.96 7/1/2005

86403 Particle agglut antbdy scrn 7.12 7/1/2005

86406 Particle agglut antbdy titr 7.44 7/1/2005

86430 Rheumatoid factor test qual 3.97 7/1/2005

86431 Rheumatoid factor quant 3.97 7/1/2005

86480 Tb test cell immun measure 43.29 1/1/2006

86481 Tb ag response t-cell susp 43.61 1/1/2011

86485 Skin test candida 10.52 1/1/1980

86490 Coccidioidomycosis skin test 10.52 1/1/1980

86510 Histoplasmosis skin test 10.52 1/1/1980

86580 Tb intradermal test 13.33 1/1/1980

86590 Streptokinase antibody 7.71 7/1/2005

86592 Syphilis test non-trep qual 2.99 7/1/2005

86593 Syphilis test non-trep quant 3.08 7/1/2005

86602 Antinomyces antibody 7.12 7/1/2005

86603 Adenovirus antibody 8.99 7/1/2005

86606 Aspergillus antibody 10.52 7/1/2005

86609 Bacterium antibody 9.00 7/1/2005

86611 Bartonella antibody 7.12 7/1/2005

86612 Blastomyces antibody 9.02 7/1/2005

86615 Bordetella antibody 9.22 7/1/2005

86617 Lyme disease antibody 10.82 7/1/2005

86618 Lyme disease antibody 11.90 7/1/2005

86619 Borrelia antibody 9.35 7/1/2005

86622 Brucella antibody 6.24 7/1/2005

86625 Campylobacter antibody 9.17 7/1/2005

142/185


86628 Candida antibody 8.40 7/1/2005

86631 Chlamydia antibody 8.27 7/1/2005

86632 Chlamydia igm antibody 8.87 7/1/2005

86635 Coccidioides antibody 8.02 7/1/2005

86638 Q fever antibody 8.48 7/1/2005

86641 Cryptococcus antibody 10.07 7/1/2005

86644 Cmv antibody 10.06 7/1/2005

86645 Cmv antibody igm 11.78 7/1/2005

86648 Diphtheria antibody 10.63 7/1/2005

86651 Encephalitis californ antbdy 9.22 7/1/2005

86652 Encephaltis east eqne anbdy 9.22 7/1/2005

86653 Encephaltis st louis antbody 9.22 7/1/2005

86654 Encephaltis west eqne antbdy 9.22 7/1/2005

86658 Enterovirus antibody 9.11 7/1/2005

86663 Epstein-barr antibody 9.17 7/1/2005

86664 Epstein-barr nuclear antigen 10.69 7/1/2005

86665 Epstein-barr capsid vca 12.68 7/1/2005

86666 Ehrlichia antibody 7.12 7/1/2005

86668 Francisella tularensis 7.27 7/1/2005

86671 Fungus nes antibody 8.57 7/1/2005

86674 Giardia lamblia antibody 10.28 7/1/2005

86677 Helicobacter pylori antibody 10.15 7/1/2005

86682 Helminth antibody 9.09 7/1/2005

86684 Hemophilus influenza antibdy 11.07 7/1/2005

86687 HTLV-I ANTIBODY 5.87 7/1/2005

86688 HTLV-II ANTIBODY 9.79 7/1/2005

86689 HTLV/HIV CONFIRMJ ANTIBODY 13.53 7/1/2005

86692 Hepatitis delta agent antbdy 11.99 7/1/2005

86694 Herpes simplex nes antbdy 10.06 7/1/2005

86695 Herpes simplex type 1 test 9.22 7/1/2005

86696 Herpes simplex type 2 test 13.53 7/1/2005

86698 Histoplasma antibody 8.73 7/1/2005

86701 Hiv-1antibody 6.21 7/1/2005

86702 Hiv-2 antibody 9.44 7/1/2005

86703 Hiv-1/hiv-2 1 result antbdy 9.59 7/1/2005

86704 Hep b core antibody total 8.43 7/1/2005

86705 Hep b core antibody igm 8.23 7/1/2005

86706 Hep b surface antibody 7.51 7/1/2005

86707 Hepatitis be antibody 8.08 7/1/2005

86708 HEPATITIS A TOTAL ANTIBODY 8.66 7/1/2005

86709 Hepatitis a igm antibody 7.87 7/1/2005

86710 Influenza virus antibody 9.48 7/1/2005

86713 Legionella antibody 10.70 7/1/2005

86717 Leishmania antibody 8.57 7/1/2005

86720 Leptospira antibody 9.22 7/1/2005

143/185


86723 Listeria monocytogenes 9.22 7/1/2005

86727 Lymph choriomeningitis ab 8.99 7/1/2005

86729 Lympho venereum antibody 8.35 7/1/2005

86732 Mucormycosis antibody 9.22 7/1/2005

86735 Mumps antibody 9.12 7/1/2005

86738 Mycoplasma antibody 9.26 7/1/2005

86741 Neisseria meningitidis 9.22 7/1/2005

86744 Nocardia antibody 9.22 7/1/2005

86747 Parvovirus antibody 10.50 7/1/2005

86750 Malaria antibody 9.22 7/1/2005

86753 Protozoa antibody nos 8.66 7/1/2005

86756 Respiratory virus antibody 9.01 7/1/2005

86757 Rickettsia antibody 13.53 7/1/2005

86759 Rotavirus antibody 9.22 7/1/2005

86762 Rubella antibody 10.06 7/1/2005

86765 Rubeola antibody 9.00 7/1/2005

86768 Salmonella antibody 9.22 7/1/2005

86771 Shigella antibody 9.22 7/1/2005

86774 Tetanus antibody 10.35 7/1/2005

86777 Toxoplasma antibody 10.06 7/1/2005

86778 Toxoplasma antibody igm 10.07 7/1/2005

86780 Treponema pallidum 9.48 1/1/2010

86784 Trichinella antibody 8.78 7/1/2005

86787 Varicella-zoster antibody 9.00 7/1/2005

86788 West nile virus ab igm 11.77 1/1/2007

86789 West nile virus antibody 10.06 1/1/2007

86790 Virus antibody nos 9.00 7/1/2005

86793 Yersinia antibody 9.22 7/1/2005

86800 Thyroglobulin antibody 11.11 7/1/2005

86803 Hepatitis c ab test 9.98 7/1/2005

86804 Hep c ab test confirm 10.82 7/1/2005

86805 Lymphocytotoxicity assay 36.53 7/1/2005

86806 Lymphocytotoxicity assay 33.25 7/1/2005

86807 Cytotoxic antibody screening 17.88 7/1/2005

86808 Cytotoxic antibody screening 17.88 7/1/2005

86812 Hla typing a b or c 18.04 7/1/2005

86813 Hla typing a b or c 29.25 7/1/2005

86816 Hla typing dr/dq 19.46 7/1/2005

86817 Hla typing dr/dq 29.25 7/1/2005

86821 Lymphocyte culture mixed 29.25 7/1/2005

86822 Lymphocyte culture primed 25.54 7/1/2005

86825 Hla x-math non-cytotoxic 38.88 1/1/2010

86826 Hla x-match noncytotoxc addl 12.96 1/1/2010

86850 RBC ANTIBODY SCREEN 12.36 1/1/1980

86860 Rbc antibody elution 30.90 1/1/1980

144/185


86870 Rbc antibody identification 25.75 1/1/1980

86880 Coombs test direct 3.75 7/1/2005

86885 Coombs test indirect qual 4.00 7/1/2005

86886 Coombs test indirect titer 3.62 7/1/2005

86890 Autologous blood process 51.50 1/1/1980

86891 Autologous blood op salvage 111.33 1/1/1980

86900 Blood typing serologic abo 2.09 7/1/2005

86901 Blood typing serologic rh(d) 7.82 1/1/1980

86902 Blood type antigen donor ea 2.69 1/1/2011

86904 Blood typing patient serum 6.64 7/1/2005

86905 Blood typing rbc antigens 2.68 7/1/2005

86906 Bld typing serologic rh phnt 5.42 7/1/2005

86920 Compatibility test spin 20.60 1/1/1980

86921 Compatibility test incubate 20.80 10/1/2009

86922 Compatibility test antiglob 23.40 10/1/2009

86923 Compatibility test electric 19.50 3/1/2008

86927 Plasma fresh frozen 12.36 1/1/1980

86930 Frozen blood prep 36.05 1/1/1980

86931 Frozen blood thaw 46.35 1/1/1980

86932 Frozen blood freeze/thaw 46.35 1/1/1980

86940 Hemolysins/agglutinins auto 5.74 7/1/2005

86941 Hemolysins/agglutinins 8.47 7/1/2005

86945 Blood product/irradiation 5.15 1/1/1980

86950 Leukacyte transfusion 48.89 1/1/1980

86960 Vol reduction of blood/prod 25.93 12/1/2012

86965 Pooling blood platelets 12.32 1/1/1980

86970 Rbc pretx incubatj w/chemicl 6.18 1/1/1980

86971 Rbc pretx incubatj w/enzymes 6.18 1/1/1980

86972 Rbc pretx incubatj w/density 6.18 1/1/1980

86975 Rbc serum pretx incubj drugs 6.18 1/1/1980

86976 Rbc serum pretx id dilution 6.18 1/1/1980

86977 Rbc serum pretx incubj/inhib 6.18 1/1/1980

86978 Rbc pretreatment serum 6.18 1/1/1980

86985 Split blood or products 5.15 1/1/1980

87003 Small animal inoculation 11.77 7/1/2005

87015 Specimen infect agnt concntj 4.67 7/1/2005

87040 Blood culture for bacteria 7.22 7/1/2005

87045 Feces culture aerobic bact 6.60 7/1/2005

87046 Stool cultr aerobic bact ea 6.60 7/1/2005

87070 Culture othr specimn aerobic 6.02 7/1/2005

87071 Culture aerobic quant other 6.60 7/1/2005

87073 Culture bacteria anaerobic 6.60 7/1/2005

87075 Cultr bacteria except blood 6.62 7/1/2005

87076 Culture anaerobe ident each 5.65 7/1/2005

87077 Culture aerobic identify 5.65 7/1/2005

145/185


87081 Culture screen only 4.64 7/1/2005

87084 Culture of specimen by kit 6.02 7/1/2005

87086 Urine culture/colony count 5.64 7/1/2005

87088 Urine bacteria culture 5.66 7/1/2005

87101 Skin fungi culture 5.39 7/1/2005

87102 Fungus isolation culture 5.87 7/1/2005

87103 Blood fungus culture 6.31 7/1/2005

87106 Fungi identification yeast 7.22 7/1/2005

87107 Fungi identification mold 7.22 7/1/2005

87109 Mycoplasma 10.75 7/1/2005

87110 Chlamydia culture 13.69 7/1/2005

87116 Mycobacteria culture 7.56 7/1/2005

87118 Mycobacteric identification 7.65 7/1/2005

87140 Culture type immunofluoresc 3.90 7/1/2005

87143 Culture typing glc/hplc 8.76 7/1/2005

87147 Culture type immunologic 3.51 7/1/2005

87149 Dna/rna direct probe 14.02 7/1/2005

87150 Dna/rna amplified probe 25.14 1/1/2010

87152 Culture type pulse field gel 3.66 7/1/2005

87153 Dna/rna sequencing 82.61 1/1/2010

87158 Culture typing added method 3.66 7/1/2005

87164 Dark field examination 26 4.17 7/1/2005

87164 Dark field examination 7.51 7/1/2005

87166 Dark field examination 7.89 7/1/2005

87168 Macroscopic exam arthropod 2.99 7/1/2005

87169 Macroscopic exam parasite 2.99 7/1/2005

87172 Pinworm exam 2.99 7/1/2005

87176 Tissue homogenization cultr 4.12 7/1/2005

87177 Ova and parasites smears 6.22 7/1/2005

87181 Microbe susceptible diffuse 1.17 7/1/2005

87184 Microbe susceptible disk 4.82 7/1/2005

87185 Microbe susceptible enzyme 1.17 7/1/2005

87186 Microbe susceptible mic 6.04 7/1/2005

87187 Microbe susceptible mlc 7.24 7/1/2005

87188 Microbe suscept macrobroth 4.64 7/1/2005

87190 Microbe suscept mycobacteri 3.51 7/1/2005

87197 Bactericidal level serum 10.50 7/1/2005

87205 Smear gram stain 2.99 7/1/2005

87206 Smear fluorescent/acid stai 3.75 7/1/2005

87207 Smear special stain 26 2.98 7/1/2005

87207 Smear special stain 4.19 7/1/2005

87209 Smear complex stain 12.56 1/1/2006

87210 Smear wet mount saline/ink 2.99 7/1/2005

87220 Tissue exam for fungi 2.99 7/1/2005

87230 Assay toxin or antitoxin 13.80 7/1/2005

146/185


87250 Virus inoculate eggs/animal 13.66 7/1/2005

87252 Virus inoculation tissue 18.21 7/1/2005

87253 Virus inoculate tissue addl 14.11 7/1/2005

87254 Virus inoculation shell via 13.66 7/1/2005

87255 Genet virus isolate hsv 23.66 7/1/2005

87260 Adenovirus ag if 8.39 7/1/2005

87265 Pertussis ag if 8.39 7/1/2005

87267 Enterovirus antibody dfa 8.39 10/1/2009

87269 Giardia ag if 8.39 7/1/2005

87270 Chlamydia trachomatis ag if 8.39 7/1/2005

87271 Cytomegalovirus dfa 8.38 1/1/2008

87272 Cryptosporidium ag if 8.39 7/1/2005

87273 Herpes simplex 2 ag if 8.39 7/1/2005

87274 Herpes simplex 1 ag if 8.39 7/1/2005

87275 Influenza b ag if 8.39 7/1/2005

87276 Influenza a ag if 8.39 7/1/2005

87277 Legionella micdadei ag if 8.39 7/1/2005

87278 Legion pneumophilia ag if 8.39 7/1/2005

87279 Parainfluenza ag if 8.39 7/1/2005

87280 Respiratory syncytial ag if 8.39 7/1/2005

87281 Pneumocystis carinii ag if 8.39 7/1/2005

87283 Rubeola ag if 8.39 7/1/2005

87285 Treponema pallidum ag if 8.39 7/1/2005

87290 Varicella zoster ag if 8.39 7/1/2005

87299 Antibody detection nos if 8.39 7/1/2005

87300 Ag detection polyval if 8.39 7/1/2005

87301 ADENOVIRUS AG EIA 8.39 7/1/2005

87305 ASPERGILLUS AG IA 8.38 1/1/2007

87320 CHYLMD TRACH AG EIA 8.39 7/1/2005

87324 CLOSTRIDIUM AG EIA 8.39 7/1/2005

87327 CRYPTOCOCCUS NEOFORM AG EIA 8.39 7/1/2005

87328 CRYPTOSPORIDIUM AG EIA 8.39 7/1/2005

87329 GIARDIA AG EIA 8.39 7/1/2005

87332 CYTOMEGALOVIRUS AG EIA 8.39 7/1/2005

87335 E COLI 0157 AG EIA 8.39 7/1/2005

87336 ENTAMOEB HIST DISPR AG EIA 8.39 7/1/2005

87337 ENTAMOEB HIST GROUP AG EIA 8.39 7/1/2005

87338 HPYLORI STOOL EIA 8.39 7/1/2005

87339 H PYLORI AG EIA 8.39 7/1/2005

87340 HEPATITIS B SURFACE AG EIA 7.22 7/1/2005

87341 HEPATITIS B SURFACE AG EIA 7.22 7/1/2005

87350 HEPATITIS BE AG EIA 8.06 7/1/2005

87380 HEPATITIS DELTA AG EIA 11.48 7/1/2005

87385 HISTOPLASMA CAPSUL AG EIA 8.39 7/1/2005

87389 Hiv-1 ag w/hiv-1 & hiv-2 ab 31.16 3/27/2015

147/185


87390 HIV-1 AG EIA 12.33 7/1/2005

87391 HIV-2 AG EIA 12.33 7/1/2005

87400 INFLUENZA A/B AG EIA 8.39 7/1/2005

87420 RESP SYNCYTIAL AG EIA 8.39 7/1/2005

87425 ROTAVIRUS AG EIA 8.39 7/1/2005

87427 SHIGA-LIKE TOXIN AG EIA 8.39 7/1/2005

87430 STREP A AG EIA 8.39 7/1/2005

87449 AG DETECT NOS EIA MULT 8.39 7/1/2005

87450 AG DETECT NOS EIA SINGLE 6.70 7/1/2005

87451 AG DETECT POLYVAL EIA MULT 6.70 7/1/2005

87470 Bartonella dna dir probe 14.02 7/1/2005

87471 Bartonella dna amp probe 24.53 7/1/2005

87472 Bartonella dna quant 29.93 7/1/2005

87475 Lyme dis dna dir probe 14.02 7/1/2005

87476 Lyme dis dna amp probe 24.53 7/1/2005

87477 Lyme dis dna quant 29.93 7/1/2005

87480 Candida dna dir probe 14.02 7/1/2005

87481 Candida dna amp probe 24.53 7/1/2005

87482 Candida dna quant 29.17 7/1/2005

87485 Chylmd pneum dna dir probe 14.02 7/1/2005

87486 Chylmd pneum dna amp probe 24.53 7/1/2005

87487 Chylmd pneum dna quant 29.93 7/1/2005

87490 Chylmd trach dna dir probe 14.02 7/1/2005

87491 Chylmd trach dna amp probe 24.53 7/1/2005

87492 Chylmd trach dna quant 24.43 7/1/2005

87493 C diff amplified probe 25.14 1/1/2010

87495 Cytomeg dna dir probe 14.02 7/1/2005

87496 Cytomeg dna amp probe 24.53 7/1/2005

87497 Cytomeg dna quant 29.93 7/1/2005

87498 Enterovirus probe&revrs trns 24.52 1/1/2007

87500 Vanomycin dna amp probe 24.52 1/1/2008

87501 Influenza dna amp prob 1+ 36.11 1/1/2011

87502 Influenza dna amp probe 59.87 1/1/2011

87503 Influenza dna amp prob addl 14.61 1/1/2011

87510 Gardner vag dna dir probe 14.02 7/1/2005

87511 Gardner vag dna amp probe 24.53 7/1/2005

87512 Gardner vag dna quant 29.17 7/1/2005

87515 Hepatitis b dna dir probe 14.02 7/1/2005

87516 Hepatitis b dna amp probe 24.53 7/1/2005

87517 Hepatitis b dna quant 29.93 7/1/2005

87520 Hepatitis c rna dir probe 14.02 7/1/2005

87521 Hepatitis c probe&rvrs trnsc 24.53 7/1/2005

87522 Hepatitis c revrs trnscrpj 29.93 7/1/2005

87525 Hepatitis g dna dir probe 14.02 7/1/2005

87526 Hepatitis g dna amp probe 24.53 7/1/2005

148/185


87527 Hepatitis g dna quant 29.17 7/1/2005

87528 Hsv dna dir probe 14.02 7/1/2005

87529 Hsv dna amp probe 24.53 7/1/2005

87530 Hsv dna quant 29.93 7/1/2005

87531 Hhv-6 dna dir probe 14.02 7/1/2005

87532 Hhv-6 dna amp probe 24.53 7/1/2005

87533 Hhv-6 dna quant 29.17 7/1/2005

87534 Hiv-1 dna dir probe 14.02 7/1/2005

87535 Hiv-1 probe&reverse trnscrpj 24.53 7/1/2005

87536 Hiv-1 quant&revrse trnscrpj 59.45 7/1/2005

87537 Hiv-2 dna dir probe 14.02 7/1/2005

87538 Hiv-2 probe&revrse trnscripj 24.53 7/1/2005

87539 Hiv-2 quant&revrse trnscripj 29.93 7/1/2005

87540 Legion pneumo dna dir prob 14.02 7/1/2005

87541 Legion pneumo dna amp prob 24.53 7/1/2005

87542 Legion pneumo dna quant 29.17 7/1/2005

87550 Mycobacteria dna dir probe 14.02 7/1/2005

87551 Mycobacteria dna amp probe 24.53 7/1/2005

87552 Mycobacteria dna quant 29.93 7/1/2005

87555 M.tuberculo dna dir probe 14.02 7/1/2005

87556 M.tuberculo dna amp probe 24.53 7/1/2005

87557 M.tuberculo dna quant 29.93 7/1/2005

87560 M.avium-intra dna dir prob 14.02 7/1/2005

87561 M.avium-intra dna amp prob 24.53 7/1/2005

87562 M.avium-intra dna quant 29.93 7/1/2005

87580 M.pneumon dna dir probe 14.02 7/1/2005

87581 M.pneumon dna amp probe 24.53 7/1/2005

87582 M.pneumon dna quant 29.17 7/1/2005

87590 N.gonorrhoeae dna dir prob 14.02 7/1/2005

87591 N.gonorrhoeae dna amp prob 24.53 7/1/2005

87592 N.gonorrhoeae dna quant 29.93 7/1/2005

87623 Hpv low-risk types 24.53 1/1/2015

87624 Hpv high-risk types 24.53 1/1/2015

87625 Hpv types 16 & 18 only 24.53 1/1/2015

87640 Staph a dna amp probe 24.52 1/1/2007

87641 Mr-staph dna amp probe 24.52 1/1/2007

87650 Strep a dna dir probe 14.02 7/1/2005

87651 Strep a dna amp probe 24.53 7/1/2005

87652 Strep a dna quant 29.17 7/1/2005

87653 Strep b dna amp probe 24.52 1/1/2007

87660 Trichomonas vagin dir probe 14.02 7/1/2005

87797 Detect agent nos dna dir 14.02 7/1/2005

87798 Detect agent nos dna amp 24.53 7/1/2005

87799 Detect agent nos dna quant 29.93 7/1/2005

87800 Detect agnt mult dna direc 28.02 7/1/2005

149/185


87801 Detect agnt mult dna ampli 49.04 7/1/2005

87802 Strep b assay w/optic 8.39 7/1/2005

87803 Clostridium toxin a w/optic 8.39 7/1/2005

87804 Influenza assay w/optic 8.39 7/1/2005

87807 Rsv assay w/optic 8.39 7/1/2005

87808 Trichomonas assay w/optic 8.38 1/1/2007

87809 Adenovirus assay w/optic 8.38 1/1/2008

87810 Chylmd trach assay w/optic 8.39 7/1/2005

87850 N. gonorrhoeae assay w/optic 8.39 7/1/2005

87880 Strep a assay w/optic 8.39 7/1/2005

87899 Agent nos assay w/optic 8.39 7/1/2005

87900 Phenotype infect agent drug 91.06 1/1/2006

87901 Genotype dna hiv reverse t 179.85 7/1/2005

87902 Genotype dna/rna hep c 179.85 7/1/2005

87903 Phenotype dna hiv w/culture 341.36 7/1/2005

87904 Phenotype dna hiv w/clt add 91.06 7/1/2005

87905 Sialidase enzyme assay 8.92 1/1/2009

87906 Genotype dna/rna hiv 90.56 1/1/2011

88104 Cytopath fl nongyn smears TC 6.18 1/1/1980

88104 Cytopath fl nongyn smears 26 37.20 1/1/1980

88104 Cytopath fl nongyn smears 46.50 1/1/1980

88106 Cytopath fl nongyn filter TC 6.18 1/1/1980

88106 Cytopath fl nongyn filter 26 37.20 1/1/1980

88106 Cytopath fl nongyn filter 46.50 1/1/1980

88108 Cytopath concentrate tech TC 13.95 1/1/1980

88108 Cytopath concentrate tech 26 55.80 1/1/1980

88108 Cytopath concentrate tech 69.75 1/1/1980

88112 Cytopath cell enhance tech TC 57.88 1/1/2004

88112 Cytopath cell enhance tech 26 66.61 1/1/2004

88112 Cytopath cell enhance tech 124.49 1/1/2004

88120 Cytp urne 3-5 probes ea spec TC 440.87 1/1/2011

88120 Cytp urne 3-5 probes ea spec 26 56.17 1/1/2011

88120 Cytp urne 3-5 probes ea spec 497.05 1/1/2011

88121 Cytp urine 3-5 probes cmptr TC 369.61 1/1/2011

88121 Cytp urine 3-5 probes cmptr 26 50.05 1/1/2011

88121 Cytp urine 3-5 probes cmptr 419.66 1/1/2011

88125 Forensic cytopathology TC 5.15 1/1/1980

88125 Forensic cytopathology 26 69.75 1/1/1980

88125 Forensic cytopathology 77.50 1/1/1980

88130 Sex chromatin identification 10.52 7/1/2005

88140 Sex chromatin identification 5.59 7/1/2005

88141 Cytopath c/v interpret 32.22 1/1/1980

88142 Cytopath c/v thin layer 14.16 7/1/2005

88143 Cytopath c/v thin layer redo 14.16 7/1/2005

88147 Cytopath c/v automated 7.95 7/1/2005

150/185


88148 Cytopath c/v auto rescreen 10.62 7/1/2005

88150 Cytopath c/v manual 7.39 7/1/2005

88152 Cytopath c/v auto redo 7.39 7/1/2005

88153 Cytopath c/v redo 7.39 7/1/2005

88154 Cytopath c/v select 7.39 7/1/2005

88155 Cytopath c/v index add-on 4.19 7/1/2005

88160 Cytopath smear other source TC 4.12 1/1/1980

88160 Cytopath smear other source 26 31.00 1/1/1980

88160 Cytopath smear other source 37.20 1/1/1980







88164 Cytopath tbs c/v manual 7.39 7/1/2005

88165 Cytopath tbs c/v redo 7.39 7/1/2005

88166 Cytopath tbs c/v auto redo 7.39 7/1/2005

88167 Cytopath tbs c/v select 7.39 7/1/2005

88172 Cytp dx eval fna 1st ea site TC 4.65 1/1/1980

88172 Cytp dx eval fna 1st ea site 26 18.60 1/1/1980

88172 Cytp dx eval fna 1st ea site 23.25 1/1/1980

88173 Cytopath eval fna report TC 7.44 1/1/1980

88173 Cytopath eval fna report 26 29.76 1/1/1980

88173 Cytopath eval fna report 37.20 1/1/1980

88174 Cytopath c/v auto in fluid 14.92 1/1/2008

88175 Cytopath c/v auto fluid redo 18.51 1/1/2008

88177 Cytp fna eval ea addl TC 7.08 1/1/2011

88177 Cytp fna eval ea addl 26 23.03 1/1/2011

88177 Cytp fna eval ea addl 30.12 1/1/2011

88182 Cell marker study TC 12.37 1/1/1980

88182 Cell marker study 26 49.50 1/1/1980

88182 Cell marker study 61.87 1/1/1980

88184 Flowcytometry/ tc 1 marker 52.89 1/1/2005

88185 Flowcytometry/tc add-on 26.06 1/1/2005

88187 Flowcytometry/read 2-8 69.90 1/1/2005

88188 Flowcytometry/read 9-15 87.19 1/1/2005

88189 Flowcytometry/read 16 & > 114.84 1/1/2005

88230 Tissue culture lymphocyte 81.39 7/1/2005

88233 Tissue culture skin/biopsy 98.32 7/1/2005

88235 Tissue culture placenta 102.88 7/1/2005

88237 Tissue culture bone marrow 88.24 7/1/2005

88239 Tissue culture tumor 103.06 7/1/2005

88240 Cell cryopreserve/storage 7.06 7/1/2005

88241 Frozen cell preparation 7.06 7/1/2005

151/185


88245 Chromosome analysis 20-25 103.99 7/1/2005


88249 Chromosome analysis 100 120.99 7/1/2005





88267 Chromosome analys placenta 125.59 7/1/2005

88269 Chromosome analys amniotic 116.20 7/1/2005

88271 Cytogenetics dna probe 14.97 7/1/2005

88272 Cytogenetics 3-5 18.71 7/1/2005

88273 Cytogenetics 10-30 22.45 7/1/2005

88274 Cytogenetics 25-99 24.32 7/1/2005

88275 Cytogenetics 100-300 28.06 7/1/2005

88280 Chromosome karyotype study 17.54 7/1/2005

88283 Chromosome banding study 35.01 7/1/2005

88285 Chromosome count additional 13.28 7/1/2005

88289 Chromosome study additional 10.00 7/1/2005

88291 Cyto/molecular report 8.58 1/1/1980

88300 Surgical path gross TC 3.09 1/1/1980

88300 Surgical path gross 26 18.60 1/1/1980

88300 Surgical path gross 23.25 1/1/1980

88302 Tissue exam by pathologist TC 5.15 1/1/1980

88302 Tissue exam by pathologist 26 54.25 1/1/1980

88302 Tissue exam by pathologist 62.00 1/1/1980













88311 Decalcify tissue TC 1.03 1/1/1980

88311 Decalcify tissue 26 10.85 1/1/1980

88311 Decalcify tissue 12.40 1/1/1980

88312 Special stains group 1 TC 5.27 1/1/1980

88312 Special stains group 1 26 21.08 1/1/1980

88312 Special stains group 1 26.35 1/1/1980

88313 Special stains group 2 TC 2.48 1/1/1980

88313 Special stains group 2 26 9.92 1/1/1980

152/185


88313 Special stains group 2 12.40 1/1/1980

88314 Histochemical stains add-on TC 2.48 1/1/1980

88314 Histochemical stains add-on 26 9.92 1/1/1980

88314 Histochemical stains add-on 12.40 1/1/1980

88319 Enzyme histochemistry TC 2.48 1/1/1980

88319 Enzyme histochemistry 26 9.92 1/1/1980

88319 Enzyme histochemistry 12.40 1/1/1980

88321 Microslide consultation 124.00 1/1/1980

88323 Microslide consultation TC 9.27 1/1/1980

88323 Microslide consultation 26 55.80 1/1/1980

88323 Microslide consultation 69.75 1/1/1980

88325 Comprehensive review of data 100.75 1/1/1980

88329 Path consult introp 62.00 1/1/1980

88331 Path consult intraop 1 bloc TC 10.30 1/1/1980

88331 Path consult intraop 1 bloc 26 77.50 1/1/1980

88331 Path consult intraop 1 bloc 93.00 1/1/1980

88332 Path consult intraop addl TC 13.95 1/1/1980

88332 Path consult intraop addl 26 31.00 1/1/1980

88332 Path consult intraop addl 69.75 1/1/1980

88333 Intraop cyto path consult 1 TC 22.30 1/1/2006

88333 Intraop cyto path consult 1 26 65.09 1/1/2006

88333 Intraop cyto path consult 1 87.38 1/1/2006

88334 Intraop cyto path consult 2 TC 13.60 1/1/2006

88334 Intraop cyto path consult 2 26 31.99 1/1/2006

88334 Intraop cyto path consult 2 45.59 1/1/2006

88341 IMMUNOHISTO ANTB ADDL SLIDE TC 24.14 1/1/2015

88341 IMMUNOHISTO ANTB ADDL SLIDE 35.38 1/1/2015

88342 IMMUNOHISTO ANTIBODY STAIN TC 13.95 1/1/1980

88342 IMMUNOHISTO ANTIBODY STAIN 26 55.80 1/1/1980

88342 IMMUNOHISTO ANTIBODY STAIN 69.75 1/1/1980

88344 Immunohisto antibody slide TC 40.88 1/1/2015

88344 Immunohisto antibody slide 61.53 1/1/2015

88346 IMMUNOFLUORESCENT STUDY TC 24.80 1/1/1980

88346 IMMUNOFLUORESCENT STUDY 26 99.20 1/1/1980

88346 IMMUNOFLUORESCENT STUDY 124.00 1/1/1980

88348 Electron microscopy TC 77.50 1/1/1980

88348 Electron microscopy 26 310.00 1/1/1980

88348 Electron microscopy 387.50 1/1/1980

88355 Analysis skeletal muscle TC 39.92 1/1/1980

88355 Analysis skeletal muscle 26 159.68 1/1/1980

88355 Analysis skeletal muscle 199.60 1/1/1980

88356 Analysis nerve TC 62.88 1/1/1980

88356 Analysis nerve 26 251.55 1/1/1980

88356 Analysis nerve 314.44 1/1/1980

88358 Analysis tumor TC 56.87 1/1/1980

153/185


88358 Analysis tumor 26 227.51 1/1/1980

88358 Analysis tumor 284.39 1/1/1980

88360 Tumor immunohistochem/manual TC 50.52 1/1/2005

88360 Tumor immunohistochem/manual 26 62.82 1/1/2005

88360 Tumor immunohistochem/manual 113.34 1/1/2005

88361 Tumor immunohistochem/comput TC 87.54 1/1/2004

88361 Tumor immunohistochem/comput 26 56.28 1/1/2004

88361 Tumor immunohistochem/comput 143.82 1/1/2004

88362 Nerve teasing preparations TC 45.82 1/1/1980

88362 Nerve teasing preparations 26 183.29 1/1/1980

88362 Nerve teasing preparations 229.12 1/1/1980

88363 Xm archive tissue molec anal 41.33 1/1/2011

88364 Insitu hybridization (fish) TC 37.27 1/1/2015

88364 Insitu hybridization (fish) 51.27 1/1/2015


88365 Insitu hybridization (fish) 26 74.26 1/1/1980




88367 Insitu hybridization auto TC 143.27 1/1/2005

88367 Insitu hybridization auto 26 73.20 1/1/2005

88367 Insitu hybridization auto 216.47 1/1/2005

88368 Insitu hybridization manual TC 116.84 1/1/2005

88368 Insitu hybridization manual 26 79.37 1/1/2005

88368 Insitu hybridization manual 196.21 1/1/2005

88369 M/phmtrc alysishquant/semiq TC 25.85 1/1/2015

88369 M/phmtrc alysishquant/semiq 38.72 1/1/2015

88371 Protein western blot tissue 26 3.96 7/1/2005

88371 Protein western blot tissue 10.32 7/1/2005

88372 Protein analysis w/probe 26 6.22 7/1/2005

88372 Protein analysis w/probe 15.90 7/1/2005

88373 M/phmtrc alys ishquant/semiq TC 20.72 1/1/2015

88373 M/phmtrc alys ishquant/semiq 31.57 1/1/2015





88381 MICRODISSECTION MANUAL TC 156.41 1/1/2008

88381 MICRODISSECTION MANUAL 26 52.04 1/1/2008

88381 MICRODISSECTION MANUAL 208.45 1/1/2008

88387 Tiss exam molecular study TC 8.19 1/1/2010

88387 Tiss exam molecular study 26 31.79 1/1/2010

88387 Tiss exam molecular study 39.99 1/1/2010

88388 Tiss ex molecul study add-on TC 4.11 1/1/2010

88388 Tiss ex molecul study add-on 26 19.69 1/1/2010

154/185


88388 Tiss ex molecul study add-on 23.79 1/1/2010

88720 Bilirubin total transcut 3.66 1/1/2009

88738 Hgb quant transcutaneous 3.60 1/1/2010

88740 Transcutaneous carboxyhb 3.66 1/1/2009

88741 Transcutaneous methb 3.66 1/1/2009

89050 Body fluid cell count 3.31 7/1/2005

89051 Body fluid cell count 3.85 7/1/2005

89055 LEUKOCYTE ASSESSMENT FECAL 2.99 7/1/2005

89060 Exam synovial fluid crystals 26 3.38 7/1/2005

89060 Exam synovial fluid crystals 5.00 7/1/2005

89125 Specimen fat stain 2.42 7/1/2005

89160 Exam feces for meat fibers 2.58 7/1/2005

89190 Nasal smear for eosinophils 3.32 7/1/2005

89220 Sputum specimen collection 15.77 3/1/2008

89230 Collect sweat for test 4.15 3/1/2008

89310 Semen analysis w/count 6.02 7/1/2005

90460 Im admin 1st/only component 7.80 1/1/2011

90471 Immunization admin 7.80 1/1/2011

90472 Immunization admin each add 7.80 1/1/2011

90473 Immune admin oral/nasal 7.80 1/1/2011

90474 Immune admin oral/nasal addl 7.80 1/1/2011

90581 ANTHRAX VACCINE SC OR IM 113.17 1/1/1980

90585 Bcg vaccine percut 161.54 1/1/1980

90586 Bcg vaccine intravesical 148.66 1/1/1980

90654 Flu vacc iiv3 no preserv id 18.60 12/1/2012

90675 Rabies vaccine im 129.23 1/1/1980

90676 Rabies vaccine id 67.39 1/1/1980

90690 Typhoid vaccine oral 27.08 1/1/1980

90691 Typhoid vaccine im 37.85 1/1/1980

90717 YELLOW FEVER VACCINE SUBQ 52.92 1/1/1980

90740 HEPB VACC 3 DOSE IMMUNSUP IM 102.77 1/1/1980

90747 HEPB VACC 4 DOSE IMMUNSUP IM 102.77 1/1/1980

90748 HIB-HEPB VACCINE IM 45.54 1/1/1980

90785 Psytx complex interactive 4.40 1/1/2013

90845 Psychoanalysis 79.69 1/1/1980

90847 FAMILY PSYTX W/PT 50 MIN 97.85 1/1/1980

90853 Group psychotherapy 29.85 1/1/1980

90863 Pharmacologic mgmt w/psytx 44.31 1/1/2013

90869 Tcran magn stim redetemine 439.37 1/1/2012

90870 Electroconvulsive therapy 83.39 1/1/1980

90875 Psychophysiological therapy 67.08 1/1/1980

90876 Psychophysiological therapy 97.85 1/1/1980

90901 Biofeedback train any meth 39.69 1/1/1980

90911 Biofeedback peri/uro/rectal 56.92 1/1/1980

91010 Esophagus motility study TC 70.16 1/1/1980

155/185


91010 Esophagus motility study 125.54 1/1/1980

91013 Esophgl motil w/stim/perfus TC 12.32 1/1/2011

91013 Esophgl motil w/stim/perfus 26 9.04 1/1/2011

91013 Esophgl motil w/stim/perfus 21.36 1/1/2011

91020 Gastric motility studies TC 80.31 1/1/1980

91020 Gastric motility studies 143.39 1/1/1980

91022 Duodenal motility study TC 127.14 1/1/2006

91022 Duodenal motility study 26 63.11 1/1/2006

91022 Duodenal motility study 190.24 1/1/2006

91030 Acid perfusion of esophagus TC 62.46 1/1/1980

91030 Acid perfusion of esophagus 102.46 1/1/1980

91034 Gastroesophageal reflux test TC 158.92 1/1/2005

91034 Gastroesophageal reflux test 26 42.83 1/1/2005

91034 Gastroesophageal reflux test 201.75 1/1/2005

91035 G-esoph reflx tst w/electrod TC 329.97 1/1/2005

91035 G-esoph reflx tst w/electrod 26 69.03 1/1/2005

91035 G-esoph reflx tst w/electrod 399.00 1/1/2005

91037 Esoph imped function test TC 84.93 1/1/2005

91037 Esoph imped function test 26 42.83 1/1/2005

91037 Esoph imped function test 127.76 1/1/2005

91038 Esoph imped funct test > 1hr TC 60.58 1/1/2005

91038 Esoph imped funct test > 1hr 26 48.45 1/1/2005

91038 Esoph imped funct test > 1hr 109.03 1/1/2005

91040 Esoph balloon distension tst TC 347.59 1/1/2005

91040 Esoph balloon distension tst 26 42.83 1/1/2005

91040 Esoph balloon distension tst 390.41 1/1/2005

91065 Breath hydrogen/methane test TC 144.00 1/1/1980

91065 Breath hydrogen/methane test 152.62 1/1/1980

91110 Gi tract capsule endoscopy TC 656.41 1/1/2004

91110 Gi tract capsule endoscopy 26 159.69 1/1/2004

91110 Gi tract capsule endoscopy 816.10 1/1/2004

91117 Colon motility 6 hr study 131.66 1/1/2011

91120 Rectal sensation test TC 342.12 1/1/2005

91120 Rectal sensation test 26 43.15 1/1/2005

91120 Rectal sensation test 385.28 1/1/2005

91122 Anal pressure record TC 71.08 1/1/1980

91122 Anal pressure record 149.54 1/1/1980

91200 LIVER ELASTOGRAPHY TC 19.38 1/1/2015

91200 LIVER ELASTOGRAPHY 32.49 1/1/2015

92002 Eye exam new patient 58.77 1/1/1980

92004 Eye exam new patient 107.39 1/1/1980

92012 Eye exam establish patient 53.23 1/1/1980

92014 Eye exam&tx estab pt 1/>vst 79.39 1/1/1980

92015 Determine refractive state 60.31 1/1/1980

92018 New eye exam & treatment 114.77 1/1/1980

156/185


92019 Eye exam & treatment 61.23 1/1/1980

92020 Special eye evaluation 42.15 1/1/1980

92060 Special eye evaluation TC 14.15 1/1/1980

92060 Special eye evaluation 45.85 1/1/1980

92065 Orthoptic/pleoptic training TC 33.54 1/1/1980

92065 Orthoptic/pleoptic training 50.16 1/1/1980

92081 Visual field examination(s) TC 54.16 1/1/1980

92081 Visual field examination(s) 70.77 1/1/1980





92100 Serial tonometry exam(s) 53.23 1/1/1980

92132 Cmptr ophth dx img ant segmt TC 14.21 1/1/2011

92132 Cmptr ophth dx img ant segmt 26 19.39 1/1/2011

92132 Cmptr ophth dx img ant segmt 33.60 1/1/2011

92133 Cmptr ophth img optic nerve TC 14.21 1/1/2011

92133 Cmptr ophth img optic nerve 26 26.84 1/1/2011

92133 Cmptr ophth img optic nerve 41.05 1/1/2011

92134 Cptr ophth dx img post segmt TC 14.21 1/1/2011

92134 Cptr ophth dx img post segmt 26 26.84 1/1/2011

92134 Cptr ophth dx img post segmt 41.05 1/1/2011

92136 Ophthalmic biometry TC 56.31 1/1/1980

92136 Ophthalmic biometry 81.54 1/1/1980

92145 Corneal hysteresis deter TC 6.12 1/1/2015

92145 Corneal hysteresis deter 13.94 1/1/2015

92225 Special eye exam initial 19.39 1/1/1980

92226 Special eye exam subsequent 17.54 1/1/1980

92227 Remote dx retinal imaging 10.75 1/1/2011

92228 Remote retinal imaging mgmt TC 11.69 1/1/2011

92228 Remote retinal imaging mgmt 26 15.88 1/1/2011

92228 Remote retinal imaging mgmt 27.58 1/1/2011

92230 Eye exam with photos 74.46 1/1/1980

92235 FLUORESCEIN ANGRPH UNI/BI TC 73.23 1/1/1980

92235 FLUORESCEIN ANGRPH UNI/BI 111.39 1/1/1980

92240 ICG ANGIOGRAPHY UNI/BI TC 152.31 1/1/1980

92240 ICG ANGIOGRAPHY UNI/BI 204.01 1/1/1980

92250 Eye exam with photos TC 37.85 1/1/1980

92250 Eye exam with photos 58.16 1/1/1980

92260 Ophthalmoscopy/dynamometry 14.15 1/1/1980

92265 Eye muscle evaluation TC 28.00 1/1/1980

92265 Eye muscle evaluation 65.85 1/1/1980

92270 Electro-oculography TC 25.54 1/1/1980

92270 Electro-oculography 63.69 1/1/1980

92275 Electroretinography TC 28.85 1/1/1980

157/185


92275 Electroretinography 72.62 1/1/1980

92283 Color vision examination TC 21.85 1/1/1980

92283 Color vision examination 29.54 1/1/1980

92284 Dark adaptation eye exam TC 53.54 1/1/1980

92284 Dark adaptation eye exam 64.00 1/1/1980

92285 Eye photography TC 23.08 1/1/1980

92285 Eye photography 32.62 1/1/1980

92286 Internal eye photography 117.54 1/1/1980

92287 Internal eye photography 126.77 1/1/1980

92310 Contact lens fitting 72.62 1/1/1980




92314 Prescription of contact lens 50.77 1/1/1980

92315 Rx cntact lens aphakia 1 eye 44.62 1/1/1980

92316 Rx cntact lens aphakia 2 eye 54.46 1/1/1980

92317 Rx corneoscleral cntact lens 45.23 1/1/1980

92325 Modification of contact lens 12.62 1/1/1980

92326 Replacement of contact lens 51.39 1/1/1980

92340 Fit spectacles monofocal 33.54 1/1/1980

92341 Fit spectacles bifocal 37.85 1/1/1980

92342 Fit spectacles multifocal 40.31 1/1/1980

92352 Fit aphakia spectcl monofocl 33.54 1/1/1980

92353 Fit aphakia spectcl multifoc 39.69 1/1/1980

92354 Fit spectacles single system 271.70 1/1/1980

92355 Fit spectacles compound lens 131.70 1/1/1980

92358 Aphakia prosth service temp 30.77 1/1/1980

92370 Repair & adjust spectacles 28.00 1/1/1980

92371 Repair & adjust spectacles 19.69 1/1/1980

92502 Ear and throat examination 89.85 1/1/1980

92504 Ear microscopy examination 41.23 1/1/1980

92507 Speech/hearing therapy 66.16 1/1/1980

92508 Speech/hearing therapy 64.92 1/1/1980

92511 Nasopharyngoscopy 70.46 1/1/1980

92512 Nasal function studies 53.85 1/1/1980

92516 Facial nerve function test 44.00 1/1/1980

92520 Laryngeal function studies 41.23 1/1/1980

92521 Evaluation of speech fluency 100.70 1/1/2014

92522 Evaluate speech production 81.63 1/1/2014

92523 Speech sound lang comprehen 169.77 1/1/2014

92524 Behavral qualit analys voice 85.28 1/1/2014

92526 Oral function therapy 67.39 7/1/2006

92531 Spontaneous nystagmus study 24.31 1/1/1980

92532 Positional nystagmus test 28.00 1/1/1980

92533 Caloric vestibular test 44.62 1/1/1980

158/185


92534 Optokinetic nystagmus test 19.69 1/1/1980

92537 Caloric vstblr test w/rec 35.95 1/1/2016

92538 Caloric vstblr test w/rec 18.28 1/1/2016

92540 Basic vestibular evaluation TC 14.54 1/1/2010

92540 Basic vestibular evaluation 26 67.45 1/1/2010

92540 Basic vestibular evaluation 81.99 1/1/2010

92541 Spontaneous nystagmus test TC 40.62 1/1/1980

92541 Spontaneous nystagmus test 60.31 1/1/1980

92542 Positional nystagmus test TC 39.69 1/1/1980

92542 Positional nystagmus test 55.69 1/1/1980

92544 Optokinetic nystagmus test TC 39.69 1/1/1980

92544 Optokinetic nystagmus test 52.31 1/1/1980

92545 Oscillating tracking test TC 39.08 1/1/1980

92545 Oscillating tracking test 50.46 1/1/1980

92546 Sinusoidal rotational test TC 67.39 1/1/1980

92546 Sinusoidal rotational test 80.93 1/1/1980

92547 Supplemental electrical test 40.62 1/1/1980

92548 Posturography TC 61.85 1/1/1980

92548 Posturography 87.08 1/1/1980

92550 Tympanometry & reflex thresh 17.75 1/1/2010

92551 Pure tone hearing test air 8.62 1/1/1980

92552 Pure tone audiometry air 14.46 1/1/1980

92553 Audiometry air & bone 21.54 1/1/1980

92555 Speech threshold audiometry 12.62 1/1/1980

92556 Speech audiometry complete 19.08 1/1/1980

92557 Comprehensive hearing test 39.69 1/1/1980

92558 Evoked auditory test qual 9.77 12/1/2012

92559 Group audiometric testing 27.69 1/1/1980

92560 Bekesy audiometry screen 16.62 1/1/1980

92561 Bekesy audiometry diagnosis 23.69 1/1/1980

92562 Loudness balance test 13.54 1/1/1980

92563 Tone decay hearing test 12.62 1/1/1980

92564 Sisi hearing test 16.00 1/1/1980

92565 Stenger test pure tone 13.23 1/1/1980

92567 Tympanometry 17.85 1/1/1980

92568 Acoustic refl threshold tst 12.62 1/1/1980

92570 Acoustic immitance testing 27.09 1/1/2010

92571 Filtered speech hearing test 12.92 1/1/1980

92572 Staggered spondaic word test 3.08 1/1/1980

92575 Sensorineural acuity test 9.85 1/1/1980

92576 Synthetic sentence test 14.77 1/1/1980

92577 Stenger test speech 24.00 1/1/1980

92579 Visual audiometry (vra) 24.00 1/1/1980

92582 Conditioning play audiometry 24.00 1/1/1980

92583 Select picture audiometry 29.54 1/1/1980

159/185


92584 Electrocochleography 81.54 1/1/1980

92585 Auditor evoke potent compre TC 60.31 1/1/1980

92585 Auditor evoke potent compre 84.00 1/1/1980

92586 Auditor evoke potent limit 60.31 1/1/1980

92587 Evoked auditory test limited TC 43.08 1/1/1980

92587 Evoked auditory test limited 49.54 1/1/1980

92588 Evoked auditory tst complete TC 48.92 1/1/1980

92588 Evoked auditory tst complete 66.16 1/1/1980

92590 Hearing aid exam one ear 33.23 1/1/1980

92591 Hearing aid exam both ears 48.92 1/1/1980

92592 Hearing aid check one ear 15.08 1/1/1980

92593 Hearing aid check both ears 21.54 1/1/1980

92594 Electro hearng aid test one 16.00 1/1/1980

92595 Electro hearng aid tst both 24.31 1/1/1980

92596 Ear protector evaluation 19.69 1/1/1980

92597 Oral speech device eval 91.39 1/1/1980

92601 Cochlear implt f/up exam <7 114.16 1/1/1980

92602 Reprogram cochlear implt 7/> 80.31 1/1/1980

92603 Cochlear implt f/up exam 7/> 76.92 1/1/1980

92604 Reprogram cochlear implt 7/> 52.62 1/1/1980

92605 Ex for nonspeech device rx 86.64 12/1/2012

92606 Non-speech device service 77.69 12/1/2012

92607 Ex for speech device rx 1hr 95.08 1/1/1980

92608 Ex for speech device rx addl 19.08 1/1/1980

92609 Use of speech device service 51.69 1/1/1980

92610 Evaluate swallowing function 37.23 1/1/1980

92611 Motion fluoroscopy/swallow 40.31 1/1/1980

92612 ENDOSCOPY SWALLOW (FEES) VID 149.23 1/1/1980

92614 LARYNGOSCOPIC SENSORY VID 115.08 1/1/1980

92616 Fees w/laryngeal sense test 157.23 1/1/1980

92620 Auditory function 60 min 38.48 1/1/2005

92621 Auditory function + 15 min 9.98 1/1/2005

92625 Tinnitus assessment 37.84 1/1/2005

92626 Eval aud rehab status 72.57 1/1/2006

92627 Eval aud status rehab add-on 18.31 1/1/2006

92950 Heart/lung resuscitation cpr 176.00 1/1/1980

92953 Temporary external pacing 14.77 1/1/1980

92960 Cardioversion electric ext 143.70 1/1/1980

92961 Cardioversion electric int 207.70 1/1/1980

92970 Cardioassist internal 155.70 1/1/1980

92971 Cardioassist external 84.31 1/1/1980

92973 Prq coronary mech thrombect 151.70 1/1/1980

92974 Cath place cardio brachytx 176.93 1/1/1980

92975 Dissolve clot heart vessel 328.62 1/1/1980

92977 Dissolve clot heart vessel 258.78 1/1/1980

160/185


92978 ENDOLUMINL IVUS OCT C 1ST TC 145.85 1/1/1980

92978 ENDOLUMINL IVUS OCT C 1ST 228.01 1/1/1980

92979 ENDOLUMINL IVUS OCT C EA TC 73.85 1/1/1980

92979 ENDOLUMINL IVUS OCT C EA 138.47 1/1/1980

92986 Revision of aortic valve 1049.87 1/1/1980





92997 Pul art balloon repr percut 540.01 1/1/1980

92998 Pul art balloon repr percut 263.08 1/1/1980

93000 Electrocardiogram complete 22.46 1/1/1980

93005 Electrocardiogram tracing 14.46 1/1/1980

93010 Electrocardiogram report 8.00 1/1/1980

93015 Cardiovascular stress test 88.00 1/1/1980




93024 Cardiac drug stress test TC 36.92 1/1/1980

93024 Cardiac drug stress test 89.85 1/1/1980

93040 Rhythm ecg with report 11.69 1/1/1980

93041 Rhythm ecg tracing 4.92 1/1/1980

93042 Rhythm ecg report 6.77 1/1/1980

93050 Art pressure waveform analys 15.56 1/1/2016

93224 Ecg monit/reprt up to 48 hrs 134.77 1/1/1980




93228 Remote 30 day ecg rev/report 22.07 1/1/2009

93229 Remote 30 day ecg tech supp 663.83 12/1/2012

93260 Prgrmg dev eval impltbl sys TC 19.05 1/1/2015

93260 Prgrmg dev eval impltbl sys 58.53 1/1/2015

93261 Interrogate subq defib TC 19.05 1/1/2015

93261 Interrogate subq defib 53.51 1/1/2015

93268 Ecg record/review 140.62 1/1/1980

93270 Remote 30 day ecg rev/report 40.31 1/1/1980

93271 Ecg/monitoring and analysis 77.23 1/1/1980

93272 Ecg/review interpret only 23.08 1/1/1980

93278 Ecg/signal-averaged TC 38.15 1/1/1980

93278 Ecg/signal-averaged 49.54 1/1/1980

93279 Pm device progr eval sngl TC 17.43 1/1/2009

93279 Pm device progr eval sngl 48.56 1/1/2009

93280 Pm device progr eval dual TC 19.94 1/1/2009

93280 Pm device progr eval dual 57.29 1/1/2009

93281 Pm device progr eval multi TC 23.43 1/1/2009

161/185


93281 Pm device progr eval multi 67.00 1/1/2009

93282 Prgrmg eval implantable dfb TC 21.22 1/1/2009

93282 Prgrmg eval implantable dfb 62.00 1/1/2009





93285 Ilr device eval progr TC 16.49 1/1/2009

93285 Ilr device eval progr 42.02 1/1/2009

93286 Peri-px pacemaker device evl TC 10.77 1/1/2009

93286 Peri-px pacemaker device evl 23.84 1/1/2009

93287 Peri-px device eval & prgr TC 12.38 1/1/2009

93287 Peri-px device eval & prgr 31.32 1/1/2009

93288 Pm device eval in person TC 16.80 1/1/2009

93288 Pm device eval in person 37.65 1/1/2009

93289 Interrog device eval heart TC 19.94 1/1/2009

93289 Interrog device eval heart 57.60 1/1/2009

93290 Icm device eval TC 9.54 1/1/2009

93290 Icm device eval 27.88 1/1/2009

93291 Ilr device interrogate TC 14.89 1/1/2009

93291 Ilr device interrogate 36.07 1/1/2009

93292 Wcd device interrogate TC 11.75 1/1/2009

93292 Wcd device interrogate 32.60 1/1/2009

93293 Pm phone r-strip device eval TC 37.76 1/1/2009

93293 Pm phone r-strip device eval 52.40 1/1/2009

93294 Pm device interrogate remote 31.77 1/1/2009

93295 Dev interrog remote 1/2/mlt 57.29 1/1/2009

93296 Pm/icd remote tech serv 31.90 1/1/2009

93297 Icm device interrogat remote 22.07 1/1/2009

93298 Ilr device interrogat remote 25.54 1/1/2009

93303 Echo transthoracic TC 124.00 1/1/1980

93303 Echo transthoracic 181.85 1/1/1980

93304 Echo transthoracic TC 63.39 1/1/1980

93304 Echo transthoracic 96.62 1/1/1980

93306 Tte w/doppler complete TC 172.00 1/1/2009

93306 Tte w/doppler complete 233.93 1/1/2009

93307 Tte w/o doppler complete TC 124.00 1/1/1980

93307 Tte w/o doppler complete 165.85 1/1/1980

93308 Tte f-up or lmtd TC 63.39 1/1/1980

93308 Tte f-up or lmtd 87.39 1/1/1980

93312 Echo transesophageal TC 123.70 1/1/1980

93312 Echo transesophageal 222.16 1/1/1980




162/185







93318 Echo transesophageal intraop TC 104.93 1/1/1980

93318 Echo transesophageal intraop 322.78 1/1/1980

93320 Doppler echo exam heart TC 55.69 1/1/1980

93320 Doppler echo exam heart 72.92 1/1/1980

93321 Doppler echo exam heart TC 36.62 1/1/1980

93321 Doppler echo exam heart 43.39 1/1/1980

93325 Doppler color flow add-on TC 94.16 1/1/1980

93325 Doppler color flow add-on 97.85 1/1/1980

93350 Stress tte only TC 57.54 1/1/1980

93350 Stress tte only 123.39 1/1/1980

93351 Stress tte complete 241.74 1/1/2009

93352 Admin ecg contrast agent 33.71 1/1/2009

93355 Echo transesophageal (tee) 199.98 1/1/2015

93451 Right heart cath TC 570.40 1/1/2011

93451 Right heart cath 26 137.94 1/1/2011

93451 Right heart cath 708.35 1/1/2011

93452 Left hrt cath w/ventrclgrphy TC 544.88 1/1/2011

93452 Left hrt cath w/ventrclgrphy 26 241.91 1/1/2011

93452 Left hrt cath w/ventrclgrphy 786.80 1/1/2011

93453 R&l hrt cath w/ventriclgrphy TC 712.54 1/1/2011

93453 R&l hrt cath w/ventriclgrphy 26 316.99 1/1/2011

93453 R&l hrt cath w/ventriclgrphy 1029.54 1/1/2011

93454 Coronary artery angio s&i TC 567.57 1/1/2011

93454 Coronary artery angio s&i 26 243.77 1/1/2011

93454 Coronary artery angio s&i 811.35 1/1/2011

93455 Coronary art/grft angio s&i TC 665.28 1/1/2011

93455 Coronary art/grft angio s&i 26 281.29 1/1/2011

93455 Coronary art/grft angio s&i 946.58 1/1/2011

93456 R hrt coronary artery angio TC 703.40 1/1/2011

93456 R hrt coronary artery angio 26 311.87 1/1/2011

93456 R hrt coronary artery angio 1015.27 1/1/2011

93457 R hrt art/grft angio TC 800.76 1/1/2011

93457 R hrt art/grft angio 26 349.78 1/1/2011

93457 R hrt art/grft angio 1150.55 1/1/2011

93458 L hrt artery/ventricle angio TC 681.66 1/1/2011

93458 L hrt artery/ventricle angio 26 297.44 1/1/2011

93458 L hrt artery/ventricle angio 979.11 1/1/2011

93459 L hrt art/grft angio TC 746.57 1/1/2011

93459 L hrt art/grft angio 26 334.60 1/1/2011

93459 L hrt art/grft angio 1081.18 1/1/2011

163/185


93460 R&l hrt art/ventricle angio TC 784.38 1/1/2011

93460 R&l hrt art/ventricle angio 26 372.79 1/1/2011

93460 R&l hrt art/ventricle angio 1157.17 1/1/2011

93461 R&l hrt art/ventricle angio TC 914.54 1/1/2011

93461 R&l hrt art/ventricle angio 26 411.37 1/1/2011

93461 R&l hrt art/ventricle angio 1325.92 1/1/2011

93462 L hrt cath trnsptl puncture 189.36 1/1/2011

93463 Drug admin & hemodynmic meas 100.21 1/1/2011

93464 Exercise w/hemodynamic meas TC 145.60 1/1/2011

93464 Exercise w/hemodynamic meas 26 88.23 1/1/2011

93464 Exercise w/hemodynamic meas 233.84 1/1/2011

93503 Insert/place heart catheter 118.77 1/1/1980

93505 Biopsy of heart lining TC 64.62 1/1/1980

93505 Biopsy of heart lining 266.16 1/1/1980

93530 Rt heart cath congenital TC 543.71 1/1/1980

93530 Rt heart cath congenital 734.48 1/1/1980

93531 R & l heart cath congenital TC 1553.27 1/1/1980

93531 R & l heart cath congenital 1932.36 1/1/1980





93561 Cardiac output measurement TC 18.15 1/1/1980

93561 Cardiac output measurement 39.39 1/1/1980

93562 Card output measure subsq TC 10.46 1/1/1980

93562 Card output measure subsq 17.23 1/1/1980

93563 Inject congenital card cath 51.55 1/1/2011

93564 Inject hrt congntl art/grft 52.52 1/1/2011

93565 Inject l ventr/atrial angio 39.68 1/1/2011

93566 Inject r ventr/atrial angio 156.58 1/1/2011

93567 Inject suprvlv aortography 129.08 1/1/2011

93568 Inject pulm art hrt cath 141.44 1/1/2011

93571 Heart flow reserve measure TC 145.85 1/1/1980

93571 Heart flow reserve measure 228.93 1/1/1980

93572 Heart flow reserve measure TC 73.85 1/1/1980

93572 Heart flow reserve measure 141.23 1/1/1980

93580 Transcath closure of asd 833.56 1/1/1980

93581 Transcath closure of vsd 1112.34 1/1/1980

93582 Perq transcath closure pda 615.35 1/1/2014

93583 Perq transcath septal reduxn 684.85 1/1/2014

93600 Bundle of his recording TC 63.39 1/1/1980

93600 Bundle of his recording 161.23 1/1/1980

93602 Intra-atrial recording TC 36.00 1/1/1980

93602 Intra-atrial recording 134.16 1/1/1980

93603 Right ventricular recording TC 54.46 1/1/1980

164/185


93603 Right ventricular recording 151.70 1/1/1980

93609 Map tachycardia add-on TC 87.69 1/1/1980

93609 Map tachycardia add-on 320.01 1/1/1980

93610 Intra-atrial pacing TC 44.31 1/1/1980

93610 Intra-atrial pacing 183.39 1/1/1980

93612 Intraventricular pacing TC 52.31 1/1/1980

93612 Intraventricular pacing 191.39 1/1/1980

93613 Electrophys map 3d add-on 322.78 1/1/1980

93615 Esophageal recording 53.54 1/1/1980

93616 Esophageal recording TC 10.46 1/1/1980

93616 Esophageal recording 74.77 1/1/1980

93618 Heart rhythm pacing TC 127.70 1/1/1980

93618 Heart rhythm pacing 324.62 1/1/1980

93619 Electrophysiology evaluation TC 248.62 1/1/1980

93619 Electrophysiology evaluation 584.94 1/1/1980







93623 Stimulation pacing heart TC 105.85 1/1/1980

93623 Stimulation pacing heart 235.70 1/1/1980

93624 Electrophysiologic study TC 64.31 1/1/1980

93624 Electrophysiologic study 285.85 1/1/1980

93631 Heart pacing mapping TC 205.54 1/1/1980

93631 Heart pacing mapping 555.09 1/1/1980

93640 Evaluation heart device TC 230.78 1/1/1980

93640 Evaluation heart device 392.93 1/1/1980








93660 Tilt table evaluation TC 52.00 1/1/1980

93660 Tilt table evaluation 137.85 1/1/1980

93662 Intracardiac ecg (ice) TC 111.70 1/1/1980

93662 Intracardiac ecg (ice) 248.01 1/1/1980

93701 Bioimpedance cv analysis 31.08 1/1/1980

93702 Bis xtracell fluid analysis 103.78 1/1/2015

93724 Analyze pacemaker system TC 127.70 1/1/1980

93724 Analyze pacemaker system 350.78 1/1/1980

93740 Temperature gradient studies 12.31 1/1/1980

165/185


93745 Set-up cardiovert-defibrill 0.00 1/1/2005

93750 Interrogation vad in person 44.85 1/1/2010

93770 Measure venous pressure 8.62 1/1/1980

93784 Ambulatory bp monitoring 37.85 1/1/1980

93786 Ambulatory bp recording 30.15 1/1/1980

93788 Ambulatory bp analysis 43.39 1/1/1980

93790 Review/report bp recording 8.00 1/1/1980

93880 Extracranial bilat study TC 124.00 1/1/1980

93880 Extracranial bilat study 151.08 1/1/1980

93882 Extracranial uni/ltd study TC 81.85 1/1/1980

93882 Extracranial uni/ltd study 100.62 1/1/1980

93886 Intracranial complete study TC 139.70 1/1/1980

93886 Intracranial complete study 183.39 1/1/1980

93888 Intracranial limited study TC 93.54 1/1/1980

93888 Intracranial limited study 121.85 1/1/1980

93890 Tcd vasoreactivity study TC 156.96 1/1/2005

93890 Tcd vasoreactivity study 26 45.68 1/1/2005

93890 Tcd vasoreactivity study 202.63 1/1/2005

93892 Tcd emboli detect w/o inj TC 163.36 1/1/2005

93892 Tcd emboli detect w/o inj 26 52.23 1/1/2005

93892 Tcd emboli detect w/o inj 215.59 1/1/2005

93893 Tcd emboli detect w/inj TC 159.20 1/1/2005

93893 Tcd emboli detect w/inj 26 52.23 1/1/2005

93893 Tcd emboli detect w/inj 211.43 1/1/2005

93922 Upr/l xtremity art 2 levels TC 39.08 1/1/1980

93922 Upr/l xtremity art 2 levels 50.16 1/1/1980

93923 Upr/lxtr art stdy 3+ lvls TC 73.23 1/1/1980

93923 Upr/lxtr art stdy 3+ lvls 93.85 1/1/1980

93924 Lwr xtr vasc stdy bilat TC 79.69 1/1/1980

93924 Lwr xtr vasc stdy bilat 102.77 1/1/1980

93925 Lower extremity study TC 124.31 1/1/1980

93925 Lower extremity study 150.47 1/1/1980

93926 Lower extremity study TC 82.77 1/1/1980

93926 Lower extremity study 100.62 1/1/1980

93930 Upper extremity study TC 132.00 1/1/1980

93930 Upper extremity study 152.62 1/1/1980

93931 Upper extremity study TC 87.69 1/1/1980

93931 Upper extremity study 101.54 1/1/1980

93970 Extremity study TC 137.54 1/1/1980

93970 Extremity study 168.31 1/1/1980

93971 Extremity study TC 91.69 1/1/1980

93971 Extremity study 111.70 1/1/1980

93975 Vascular study TC 156.00 1/1/1980

93975 Vascular study 236.31 1/1/1980


166/185


93976 Vascular study 157.85 1/1/1980


93978 Vascular study 157.54 1/1/1980


93979 Vascular study 105.23 1/1/1980

93980 Penile vascular study TC 116.31 1/1/1980

93980 Penile vascular study 171.70 1/1/1980

93981 Penile vascular study TC 107.39 1/1/1980

93981 Penile vascular study 126.77 1/1/1980

93982 Aneurysm pressure sens study 33.85 1/1/2008

93990 Doppler flow testing TC 82.77 1/1/1980

93990 Doppler flow testing 94.16 1/1/1980

94010 Breathing capacity test TC 24.92 1/1/1980

94010 Breathing capacity test 32.62 1/1/1980

94011 Spirometry up to 2 yrs old 83.23 1/1/2010

94012 Spirmtry w/brnchdil inf-2 yr 127.93 1/1/2010

94013 Meas lung vol thru 2 yrs 27.03 1/1/2010

94014 Patient recorded spirometry 32.00 1/1/1980

94015 Patient recorded spirometry 9.54 1/1/1980

94016 Review patient spirometry 22.15 1/1/1980

94060 EVALUATION OF WHEEZING TC 42.15 1/1/1980

94060 EVALUATION OF WHEEZING 55.39 1/1/1980

94070 Evaluation of wheezing TC 104.93 1/1/1980

94070 Evaluation of wheezing 130.46 1/1/1980

94150 Vital capacity test TC 19.69 1/1/1980

94150 Vital capacity test 23.08 1/1/1980

94200 Lung function test (mbc/mvv) TC 10.15 1/1/1980

94200 Lung function test (mbc/mvv) 15.08 1/1/1980

94250 Expired gas collection TC 18.46 1/1/1980

94250 Expired gas collection 23.69 1/1/1980

94375 Respiratory flow volume loop TC 12.31 1/1/1980

94375 Respiratory flow volume loop 25.54 1/1/1980

94400 Co2 breathing response curve TC 20.00 1/1/1980

94400 Co2 breathing response curve 36.92 1/1/1980

94450 Hypoxia response curve TC 24.00 1/1/1980

94450 Hypoxia response curve 40.92 1/1/1980

94452 Hast w/report TC 30.45 1/1/2005

94452 Hast w/report 26 13.12 1/1/2005

94452 Hast w/report 43.56 1/1/2005

94453 Hast w/oxygen titrate TC 45.18 1/1/2005

94453 Hast w/oxygen titrate 26 16.86 1/1/2005

94453 Hast w/oxygen titrate 62.04 1/1/2005

94620 Pulmonary stress test/simple TC 49.23 1/1/1980

94620 Pulmonary stress test/simple 76.62 1/1/1980

94621 Pulm stress test/complex TC 28.00 1/1/1980

167/185


94621 Pulm stress test/complex 88.62 1/1/1980

94640 Airway inhalation treatment 24.31 1/1/1980

94642 Aerosol inhalation treatment 64.92 1/1/1980

94644 Cbt 1st hour 30.23 1/1/2007

94645 Cbt each addl hour 11.58 1/1/2007

94660 Pos airway pressure cpap 46.16 1/1/1980

94662 Neg press ventilation cnp 32.00 10/1/2003

94664 Evaluate pt use of inhaler 18.15 1/1/1980

94667 Chest wall manipulation 33.85 1/1/1980

94668 Chest wall manipulation 24.62 1/1/1980

94669 Mechanical chest wall oscill 32.15 1/1/2014

94680 Exhaled air analysis o2 TC 36.31 1/1/1980

94680 Exhaled air analysis o2 47.69 1/1/1980

94681 Exhaled air analysis o2/co2 TC 43.69 1/1/1980

94681 Exhaled air analysis o2/co2 52.62 1/1/1980

94690 Exhaled air analysis TC 51.39 1/1/1980

94690 Exhaled air analysis 54.46 1/1/1980

94726 Pulm funct tst plethysmograp TC 39.82 1/1/2012

94726 Pulm funct tst plethysmograp 26 11.30 1/1/2012

94726 Pulm funct tst plethysmograp 51.13 1/1/2012

94727 Pulm function test by gas TC 28.70 1/1/2012

94727 Pulm function test by gas 26 11.30 1/1/2012

94727 Pulm function test by gas 40.00 1/1/2012

94728 Pulm funct test oscillometry TC 28.70 1/1/2012

94728 Pulm funct test oscillometry 26 11.30 1/1/2012

94728 Pulm funct test oscillometry 40.00 1/1/2012

94729 Co/membane diffuse capacity TC 43.35 1/1/2012

94729 Co/membane diffuse capacity 26 7.56 1/1/2012

94729 Co/membane diffuse capacity 50.91 1/1/2012

94750 Pulmonary compliance study TC 32.62 1/1/1980

94750 Pulmonary compliance study 42.46 1/1/1980

94760 Measure blood oxygen level 4.00 1/1/1980



94770 Exhaled carbon dioxide test 36.31 1/1/1980

94772 Breath recording infant TC 0.00 1/1/1980

94772 Breath recording infant 0.00 1/1/1980

95004 Percut allergy skin tests 3.39 1/1/1980

95024 Icut allergy test drug/bug 4.92 1/1/1980

95027 Icut allergy titrate-airborn 4.92 1/1/1980

95028 Icut allergy test-delayed 7.39 1/1/1980

95044 Allergy patch tests 6.46 1/1/1980

95052 Photo patch test 8.00 1/1/1980

95056 Photosensitivity tests 5.85 1/1/1980

95060 Eye allergy tests 11.38 1/1/1980

168/185


95065 Nose allergy test 6.46 1/1/1980

95070 Bronchial allergy tests 70.16 1/1/1980

95071 Bronchial allergy tests 89.23 1/1/1980

95115 Immunotherapy one injection 12.62 1/1/1980

95117 Immunotherapy injections 16.00 1/1/1980

95120 Immunotherapy one injection 16.31 1/1/1980

95125 Immunotherapy 2/> injections 20.00 1/1/1980

95130 Immntx 1 sting insect 28.00 1/1/1980

95131 Immntx 2 sting insects 35.69 1/1/1980




95144 Antigen therapy services 10.15 1/1/1980








95180 Rapid desensitization 116.62 1/1/1980

95250 Glucose monitoring cont 96.93 1/1/1980

95251 Gluc monitor cont phys i&r 22.80 1/1/2006

95782 Polysom <6 yrs 4/> paramtrs 1017.15 1/1/2013

95783 Polysom <6 yrs cpap/bilvl 1065.11 1/1/2013

95800 Slp stdy unattended TC 136.78 1/1/2011

95800 Slp stdy unattended 26 53.25 1/1/2011

95800 Slp stdy unattended 190.03 1/1/2011

95801 Slp stdy unatnd w/anal TC 42.25 1/1/2011

95801 Slp stdy unatnd w/anal 26 46.99 1/1/2011

95801 Slp stdy unatnd w/anal 89.25 1/1/2011

95805 Multiple sleep latency test 259.08 1/1/1980

95806 Sleep study unatt&resp efft 200.93 1/1/1980

95807 Sleep study attended 408.32 1/1/1980

95808 Polysom any age 1-3> param 403.39 1/1/1980

95810 Polysom 6/> yrs 4/> param 667.71 1/1/1980

95811 Polysom 6/>yrs cpap 4/> parm 685.25 1/1/1980

95812 Eeg 41-60 minutes 164.93 1/1/1980

95813 Eeg over 1 hour 236.01 1/1/1980

95816 Eeg awake and drowsy 147.08 1/1/1980

95819 Eeg awake and asleep 176.62 1/1/1980

95822 Eeg coma or sleep only 96.00 1/1/1980

95824 Eeg cerebral death only 87.69 1/1/1980

95827 Eeg all night recording 123.39 1/1/1980

95829 Surgery electrocorticogram 1207.72 1/1/1980

169/185


95830 Insert electrodes for eeg 175.39 1/1/1980

95857 Cholinesterase challenge 38.15 1/1/1980

95860 Muscle test one limb 69.23 1/1/1980

95861 Muscle test 2 limbs 96.62 1/1/1980



95865 Muscle test larynx TC 22.81 1/1/2006

95865 Muscle test larynx 26 75.79 1/1/2006

95865 Muscle test larynx 98.60 1/1/2006

95866 Muscle test hemidiaphragm TC 7.41 1/1/2006

95866 Muscle test hemidiaphragm 26 58.85 1/1/2006

95866 Muscle test hemidiaphragm 66.26 1/1/2006

95867 Muscle test cran nerv unilat 56.00 1/1/1980

95868 Muscle test cran nerve bilat 78.77 1/1/1980

95869 Muscle test thor paraspinal 24.31 1/1/1980

95870 Muscle test nonparaspinal 24.31 1/1/1980

95872 Muscle test one fiber 89.23 1/1/1980

95873 Guide nerv destr elec stim TC 7.08 1/1/2006

95873 Guide nerv destr elec stim 26 17.21 1/1/2006

95873 Guide nerv destr elec stim 24.28 1/1/2006

95874 Guide nerv destr needle emg TC 7.08 1/1/2006

95874 Guide nerv destr needle emg 26 17.53 1/1/2006

95874 Guide nerv destr needle emg 24.61 1/1/2006

95875 Limb exercise test 81.54 1/1/1980

95885 Musc tst done w/nerv tst lim TC 36.51 1/1/2012

95885 Musc tst done w/nerv tst lim 26 16.35 1/1/2012

95885 Musc tst done w/nerv tst lim 52.87 1/1/2012

95886 Musc test done w/n test comp TC 38.46 1/1/2012

95886 Musc test done w/n test comp 26 43.76 1/1/2012

95886 Musc test done w/n test comp 82.23 1/1/2012

95887 Musc tst done w/n tst nonext TC 39.11 1/1/2012

95887 Musc tst done w/n tst nonext 26 34.28 1/1/2012

95887 Musc tst done w/n tst nonext 73.40 1/1/2012

95905 Motor &/ sens nrve cndj test TC 64.10 1/1/2010

95905 Motor &/ sens nrve cndj test 26 2.51 1/1/2010

95905 Motor &/ sens nrve cndj test 66.61 1/1/2010

95907 Nvr cndj tst 1-2 studies 88.91 1/1/2013

95908 Nrv cndj tst 3-4 studies 109.65 1/1/2013

95909 Nrv cndj tst 5-6 studies 131.41 1/1/2013

95910 Nrv cndj test 7-8 studies 172.94 1/1/2013



95913 Nrv cndj test 13/> studies 283.41 1/1/2013

95921 Autonomic nrv parasym inervj 52.00 1/1/1980

95922 Autonomic nrv adrenrg inervj 56.92 1/1/1980

170/185


95923 Autonomic nrv syst funj test 112.00 1/1/1980

95924 Ans parasymp & symp w/tilt 138.14 1/1/2013

95925 Somatosensory testing 54.46 1/1/1980



95928 C motor evoked uppr limbs TC 76.90 1/1/2005

95928 C motor evoked uppr limbs 26 69.13 1/1/2005

95928 C motor evoked uppr limbs 146.03 1/1/2005

95929 C motor evoked lwr limbs TC 82.99 1/1/2005

95929 C motor evoked lwr limbs 26 69.13 1/1/2005

95929 C motor evoked lwr limbs 152.12 1/1/2005

95930 Visual evoked potential test 38.46 1/1/1980

95933 Blink reflex test 53.23 1/1/1980

95937 Neuromuscular junction test 40.92 1/1/1980

95938 Somatosensory testing TC 241.38 1/1/2012

95938 Somatosensory testing 26 40.34 1/1/2012


95939 C motor evoked upr&lwr limbs TC 333.24 1/1/2012

95939 C motor evoked upr&lwr limbs 26 106.28 1/1/2012

95939 C motor evoked upr&lwr limbs 439.52 1/1/2012

95943 Parasymp&symp hrt rate test 0.00 1/1/2013

95950 Ambulatory eeg monitoring 220.62 1/1/1980

95951 Eeg monitoring/videorecord 1476.96 1/1/1980

95953 Eeg monitoring/computer 348.62 1/1/1980

95954 Eeg monitoring/giving drugs 223.08 1/1/1980

95955 Eeg during surgery 110.46 1/1/1980

95956 Eeg monitor technol attended 508.94 1/1/1980

95957 Eeg digital analysis 148.00 1/1/1980

95958 Eeg monitoring/function test 254.47 1/1/1980

95961 Electrode stimulation brain 186.16 1/1/1980

95962 Electrode stim brain add-on 194.77 1/1/1980

95965 Meg spontaneous 1791.74 1/1/1980

95966 Meg evoked single 894.18 1/1/1980

95967 Meg evoked each addl 752.02 1/1/1980

95970 Analyze neurostim no prog 20.92 1/1/1980

95971 Analyze neurostim simple 35.39 1/1/1980

95972 Analyze neurostim complex 72.62 1/1/1980

95974 Cranial neurostim complex 142.16 1/1/1980

95975 Cranial neurostim complex 80.00 1/1/1980

95978 Analyze neurostim brain/1h 175.86 1/1/2005

95979 Analyz neurostim brain addon 81.16 1/1/2005

95980 Io anal gast n-stim init 31.85 1/1/2008

95981 Io anal gast n-stim subsq 22.70 1/1/2008

95982 Io ga n-stim subsq w/reprog 34.20 1/1/2008

95990 Spin/brain pump refil & main 49.54 1/1/1980

171/185


95991 Spin/brain pump refil & main 73.88 1/1/2004

95992 Canalith repositioning proc 35.15 1/1/2009

96000 Motion analysis video/3d 79.39 1/1/1980

96001 Motion test w/ft press meas 94.77 1/1/1980

96002 Dynamic surface emg 18.46 1/1/1980

96003 Dynamic fine wire emg 17.23 1/1/1980

96004 Phys review of motion tests 81.54 1/1/1980

96110 Developmental screen w/score 11.68 7/14/2010

96125 Cognitive test by hc pro GN 75.73 1/1/2008

96127 Brief emotional/behav assmt 4.82 1/1/2015

96150 Assess hlth/behave init 22.77 1/1/1980

96151 Assess hlth/behave subseq 22.15 1/1/1980

96152 Intervene hlth/behave indiv 21.23 1/1/1980

96153 Intervene hlth/behave group 4.62 1/1/1980

96154 Interv hlth/behav fam w/pt 20.62 1/1/1980

96360 Hydration iv infusion init 49.56 1/1/2009

96361 Hydrate iv infusion add-on 14.53 1/1/2009

96365 Ther/proph/diag iv inf init 60.27 1/1/2009

96366 Ther/proph/diag iv inf addon 19.19 1/1/2009

96367 Tx/proph/dg addl seq iv inf 30.24 1/1/2009

96368 Ther/diag concurrent inf 17.94 1/1/2009

96369 Sc ther infusion up to 1 hr 130.96 1/1/2009

96370 Sc ther infusion addl hr 13.83 1/1/2009

96371 Sc ther infusion reset pump 63.47 1/1/2009

96372 Ther/proph/diag inj sc/im 18.20 1/1/2009

96373 Ther/proph/diag inj ia 15.69 1/1/2009

96374 Ther/proph/diag inj iv push 47.61 1/1/2009

96375 Tx/pro/dx inj new drug addon 20.83 1/1/2009

96376 Tx/pro/dx inj same drug adon 11.60 1/1/2009

96401 Chemo anti-neopl sq/im 44.36 1/1/2006

96402 Chemo hormon antineopl sq/im 38.61 1/1/2006

96405 Chemo intralesional up to 7 76.92 1/1/1980

96406 Chemo intralesional over 7 119.39 1/1/1980

96409 Chemo iv push sngl drug 103.41 1/1/2006

96411 Chemo iv push addl drug 59.81 1/1/2006

96413 Chemo iv infusion 1 hr 146.06 1/1/2006

96415 Chemo iv infusion addl hr 32.87 1/1/2006

96416 Chemo prolong infuse w/pump 157.06 1/1/2006

96417 Chemo iv infus each addl seq 71.36 1/1/2006

96420 Chemo ia push tecnique 40.31 1/1/1980

96422 Chemo ia infusion up to 1 hr 40.00 1/1/1980

96423 Chemo ia infuse each addl hr 15.39 1/1/1980

96425 Chemotherapy infusion method 46.16 1/1/1980

96440 Chemotherapy intracavitary 333.24 1/1/1980

96446 Chemotx admn prtl cavity 164.15 1/1/2011

172/185


96450 Chemotherapy into cns 277.85 1/1/1980

96521 Refill/maint portable pump 129.44 1/1/2006

96522 Refill/maint pump/resvr syst 93.50 1/1/2006

96523 Irrig drug delivery device 23.70 1/1/2006

96542 Chemotherapy injection 196.00 1/1/1980

96567 Photodynamic tx skin 53.23 1/1/1980

96570 Photodynmc tx 30 min add-on 50.16 1/1/1980

96571 Photodynamic tx addl 15 min 24.92 1/1/1980

96900 Ultraviolet light therapy 15.08 1/1/1980

96902 Trichogram 20.92 1/1/1980

96910 Photochemotherapy with uv-b 44.92 1/1/1980

96912 Photochemotherapy with uv-a 50.77 1/1/1980

96920 Laser tx skin < 250 sq cm 131.08 1/1/1980

96921 Laser tx skin 250-500 sq cm 134.16 1/1/1980

96922 Laser tx skin >500 sq cm 184.62 1/1/1980

96931 Rcm celulr subcelulr img skn 0.00 1/1/2016






97010 Hot or cold packs therapy 3.38 1/1/1980

97012 Mechanical traction therapy 11.62 7/1/2006

97014 Electric stimulation therapy 12.01 7/1/2006

97016 Vasopneumatic device therapy 10.41 7/1/2006

97018 Paraffin bath therapy 6.06 7/1/2006

97022 Whirlpool therapy 13.85 1/1/1980

97024 Diathermy eg microwave 3.83 7/1/2006

97026 Infrared therapy 3.83 7/1/2006

97028 Ultraviolet therapy 4.76 7/1/2006

97032 Electrical stimulation 14.77 1/1/1980

97033 Electric current therapy 12.62 7/1/2006

97034 Contrast bath therapy 11.34 7/1/2006

97035 Ultrasound therapy 9.54 1/1/1980

97036 Hydrotherapy 19.90 7/1/2006

97110 Therapeutic exercises 23.08 1/1/1980

97112 Neuromuscular reeducation 24.00 1/1/1980

97113 Aquatic therapy/exercises 25.27 7/1/2006

97116 Gait training therapy 19.69 1/1/1980

97124 Massage therapy 17.91 7/1/2006

97140 Manual therapy 1/> regions 21.39 7/1/2006

97150 Group therapeutic procedures 15.39 1/1/1980

97530 Therapeutic activities 28.74 7/1/2006

97532 Cognitive skills development 19.41 7/1/2006

97533 Sensory integration 20.69 7/1/2006

173/185


97535 Self care mngment training 25.85 1/1/1980

97542 Wheelchair mngment training 21.32 7/1/2006

97597 Rmvl devital tis 20 cm/< 40.70 1/1/2005

97598 Rmvl devital tis addl 20cm/< 51.66 1/1/2005

97602 Wound(s) care non-selective 14.46 1/1/1980

97605 Neg press wound tx </=50 cm 32.86 6/1/2008

97606 Neg press wound tx >50 cm 35.27 6/1/2008

97607 Neg press wnd tx </=50 sq cm 35.27 12/1/2015

97608 Neg press wound tx >50 cm 35.27 12/1/2015

97760 Orthotic mgmt and training 25.79 1/1/2006

97761 Prosthetic training 23.53 1/1/2006

97762 C/o for orthotic/prosth use 21.85 1/1/2006

98925 Osteopath manj 1-2 regions 26.46 1/1/1980





98940 Chiropract manj 1-2 regions 22.15 1/1/1980

98941 Chiropract manj 3-4 regions 30.77 1/1/1980

98942 Chiropractic manj 5 regions 40.00 1/1/1980

98960 Self-mgmt educ & train 1 pt 20.52 6/1/2009

98961 Self-mgmt educ/train 2-4 pt 10.12 6/1/2009

98962 Self-mgmt educ/train 5-8 pt 6.45 11/1/2011

99050 Medical services after hrs 15.08 1/1/1980

99058 Office emergency care 19.69 1/1/1980

99060 Out of office emerg med serv 19.69 7/1/2008

99070 Special supplies phys/qhp 15.50 9/1/2008

99090 Computer data analysis 85.92 1/1/1980

99153 MOD SED SAME PHYS/QHP EA 9.83 1/1/2017

99155 MOD SED OTH PHYS/QHP <5 YRS 81.46 1/1/2017

99156 MOD SED OTH PHYS/QHP 5/>YRS 66.47 1/1/2017

99157 MOD SED OTHER PHYS/QHP EA 50.40 1/1/2017

99170 Anogenital exam child w imag 121.23 1/1/1980

99175 Induction of vomiting 45.23 1/1/1980

99177 Ocular instrumnt screen bil 0.00 1/1/2016

99184 Hypothermia ill neonate 206.25 1/1/2015

99188 App topical fluoride varnish 12.30 1/1/2015

99195 Phlebotomy 14.15 1/1/1980

99201 Office/outpatient visit new 29.54 1/1/1980





99211 Office/outpatient visit est 17.85 1/1/1980


174/185





99221 Initial hospital care 56.62 1/1/1980



99231 Subsequent hospital care 28.31 1/1/1980



99238 Hospital discharge day 57.23 1/1/1980

99239 Hospital discharge day 78.77 1/1/1980

99241 Office consultation 41.23 1/1/1980





99251 Inpatient consultation 30.15 1/1/1980





99281 Emergency dept visit 13.85 1/1/1980





99291 Critical care first hour 180.93 1/1/1980

99292 Critical care addl 30 min 93.85 1/1/1980

99304 Nursing facility care init 54.40 1/1/2006



99307 Nursing fac care subseq 28.17 1/1/2006




99315 Nursing fac discharge day 60.00 1/1/1980

99316 Nursing fac discharge day 78.77 1/1/1980

99318 Annual nursing fac assessmnt 54.40 1/1/2006

99324 Domicil/r-home visit new pat 48.54 1/1/2006





99334 Domicil/r-home visit est pat 37.61 1/1/2006


175/185




99341 Home visit new patient 51.08 1/1/1980





99347 Home visit est patient 40.31 1/1/1980




99354 PROLONG E&M/PSYCTX SERV O/P 103.69 1/1/1980

99355 PROLONG E&M/PSYCTX SERV O/P 96.62 1/1/1980

99356 Prolonged service inpatient 74.46 1/1/1980

99357 Prolonged service inpatient 75.39 1/1/1980

99360 Physician standby services 91.08 1/1/1980

99374 Home health care supervision 82.46 1/1/1980

99375 Home health care supervision 105.85 1/1/1980

99377 Hospice care supervision 82.46 1/1/1980

99378 Hospice care supervision 118.77 1/1/1980

99379 Nursing fac care supervision 82.16 1/1/1980

99380 Nursing fac care supervision 110.46 1/1/1980

99381 Init pm e/m new pat infant 59.07 5/23/2006

99382 Init pm e/m new pat 1-4 yrs 59.07 5/23/2006

99383 Prev visit new age 5-11 59.07 5/23/2006



99391 Per pm reeval est pat infant 59.07 5/23/2006

99392 Prev visit est age 1-4 59.07 5/23/2006




99401 Preventive counseling indiv FP 35.08 1/1/1980

99406 Behav chng smoking 3-10 min 12.46 10/13/2011

99407 Behav chng smoking > 10 min 24.32 10/13/2011

99415 Prolong clincl staff svc 8.53 1/1/2016

99416 Prolong clincl staff svc add 4.77 1/1/2016

A0160 Noner transport case worker 0.28 3/1/2010

A4216 Sterile water/saline, 10 ml 0.45 1/1/2004

A4217 Sterile water/saline, 500 ml 2.66 1/1/2004

A4218 Sterile saline or water 4.75 9/1/2008

A4221 SUPP NON-INSULIN INF CATH/WK 22.26 1/1/1980

A4222 Infusion supplies with pump 44.17 1/1/1980

A4223 Infusion supplies w/o pump 43.86 12/1/2012

A4233 ALKALIN BATT FOR GLUCOSE MON UE 4.98 1/1/2006

176/185


A4233 ALKALIN BATT FOR GLUCOSE MON RR 0.67 1/1/2006

A4233 ALKALIN BATT FOR GLUCOSE MON NU 6.58 1/1/2006

A4234 J-CELL BATT FOR GLUCOSE MON UE 4.98 1/1/2006

A4234 J-CELL BATT FOR GLUCOSE MON RR 0.67 1/1/2006

A4234 J-CELL BATT FOR GLUCOSE MON NU 6.58 1/1/2006

A4235 LITHIUM BATT FOR GLUCOSE MON UE 4.98 1/1/2006

A4235 LITHIUM BATT FOR GLUCOSE MON RR 0.67 1/1/2006

A4235 LITHIUM BATT FOR GLUCOSE MON NU 6.58 1/1/2006

A4236 SILVR OXIDE BATT GLUCOSE MON UE 4.98 1/1/2006

A4236 SILVR OXIDE BATT GLUCOSE MON RR 0.67 1/1/2006

A4236 SILVR OXIDE BATT GLUCOSE MON NU 6.58 1/1/2006

A4248 Chlorhexidine antisept 1.73 9/1/2008

A4261 Cervical cap contraceptive 46.65 9/1/2008

A4264 Intratubal occlusion device 1245.00 1/1/2011

A4310 Insert tray w/o bag/cath 7.72 1/1/1980

A4311 Catheter w/o bag 2-way latex 14.84 1/1/1980

A4312 Cath w/o bag 2-way silicone 18.04 1/1/1980

A4313 Catheter w/bag 3-way 18.52 1/1/1980

A4314 Cath w/drainage 2-way latex 21.50 1/1/1980

A4315 Cath w/drainage 2-way silcne 26.39 1/1/1980

A4316 Cath w/drainage 3-way 28.40 1/1/1980

A4320 Irrigation tray 5.33 1/1/1980

A4322 Irrigation syringe 3.04 1/1/1980

A4326 Male external catheter 10.79 1/1/1980

A4327 Fem urinary collect dev cup 42.27 1/1/1980

A4328 Fem urinary collect pouch 10.45 1/1/1980

A4330 Stool collection pouch 7.15 1/1/1980

A4331 Extension drainage tubing 3.18 1/1/1980

A4332 Lube sterile packet 0.12 1/1/1980

A4333 Urinary cath anchor device 2.20 1/1/1980

A4334 Urinary cath leg strap 4.93 1/1/1980

A4338 Indwelling catheter latex 12.26 1/1/1980

A4340 Indwelling catheter special 26.99 1/1/1980

A4344 Cath indw foley 2 way silicn 16.02 1/1/1980

A4346 Cath indw foley 3 way 19.25 1/1/1980

A4349 Disposable male external cat 2.02 6/1/2009

A4351 Straight tip urine catheter 1.81 1/1/1980

A4352 Coude tip urinary catheter 6.42 1/1/1980

A4353 Intermittent urinary cath 7.00 1/1/1980

A4354 Cath insertion tray w/bag 11.80 1/1/1980

A4355 Bladder irrigation tubing 7.86 1/1/1980

A4356 Ext ureth clmp or compr dvc 39.33 1/1/1980

A4357 Bedside drainage bag 9.70 1/1/1980

A4358 Urinary leg or abdomen bag 6.63 1/1/1980

A4409 Ost skn barr convex <=4 sq i 6.22 1/1/1980

177/185


A4410 Ost skn barr extnd >4 sq 9.04 1/1/1980

A4411 Ost skn barr extnd =4sq 5.10 7/1/2006

A4412 Ost pouch drain high output 2.70 7/1/2006

A4413 2 pc drainable ost pouch 5.50 1/1/1980

A4414 Ost sknbar w/o conv<=4 sq in 4.93 1/1/1980

A4415 Ost skn barr w/o conv >4 sqi 6.00 1/1/1980

A4416 Ost pch clsd w barrier/filtr 2.75 1/1/2004

A4417 Ost pch w bar/bltinconv/fltr 3.72 1/1/2004

A4418 Ost pch clsd w/o bar w filtr 1.81 1/1/2004

A4419 Ost pch for bar w flange/flt 1.74 1/1/2004

A4422 Ost pouch absorbent material 0.12 1/1/1980

A4423 Ost pch for bar w lk fl/fltr 1.86 1/1/2004

A4424 Ost pch drain w bar & filter 4.75 1/1/2004

A4425 Ost pch drain for barrier fl 3.58 1/1/2004

A4426 Ost pch drain 2 piece system 2.73 1/1/2004

A4427 Ost pch drain/barr lk flng/f 2.78 1/1/2004

A4428 Urine ost pouch w faucet/tap 6.51 1/1/2004

A4429 Urine ost pouch w bltinconv 8.25 1/1/2004

A4430 Ost urine pch w b/bltin conv 8.52 1/1/2004

A4431 Ost pch urine w barrier/tapv 6.22 1/1/2004

A4432 Os pch urine w bar/fange/tap 3.59 1/1/2004

A4433 Urine ost pch bar w lock fln 3.34 1/1/2004

A4434 Ost pch urine w lock flng/ft 3.76 1/1/2004

A4450 Non-waterproof tape 0.09 1/1/1980

A4452 Waterproof tape 0.36 1/1/1980

A4455 Adhesive remover per ounce 1.22 1/1/1980

A4456 Adhesive remover, wipes 0.26 1/1/2010

A4481 Tracheostoma filter 0.38 1/1/1980

A4550 Surgical trays 34.14 1/1/1982

A4556 Electrodes, pair 12.14 1/1/1980

A4557 Lead wires, pair 17.94 1/1/1980

A4558 Conductive gel or paste 5.45 1/1/1980

A4570 Splint 20.13 1/1/1982

A4590 Special casting material 45.29 1/1/1984

A4605 Trach suction cath close sys NU 16.40 1/1/2005

A4614 Hand-held pefr meter 23.78 1/1/1980

A4619 Face tent 1.21 1/1/1980

A4623 Tracheostomy inner cannula 5.57 1/1/1980

A4624 Tracheal suction tube NU 2.63 1/1/1980

A4625 Trach care kit for new trach 6.58 1/1/1980

A4626 Tracheostomy cleaning brush 2.78 1/1/1980

A4628 Oropharyngeal suction cath NU 3.65 1/1/1980

A4629 Tracheostomy care kit 4.61 1/1/1980

A4640 Alternating pressure pad UE 38.13 1/1/1980

A4640 Alternating pressure pad RR 6.45 1/1/1980

178/185


A4640 Alternating pressure pad NU 53.82 1/1/1980

A4642 In111 satumomab 460.80 2/15/2012

A5056 1 pc ost pouch w filter 4.97 1/1/2012

A5057 1 pc ost pou w built-in conv 10.24 1/1/2012

A5061 Pouch drainable w barrier at 3.52 1/1/1980

A5062 Drnble ostomy pouch w/o barr 2.09 1/1/1980

A5063 Drain ostomy pouch w/flange 2.17 1/1/1980

A5071 Urinary pouch w/barrier 6.01 1/1/1980

A5072 Urinary pouch w/o barrier 3.43 1/1/1980

A5073 Urinary pouch on barr w/flng 3.18 1/1/1980

A5081 Stoma plug or seal, any type 2.81 1/1/1980

A5082 Continent stoma catheter 10.11 1/1/1980

A5093 Ostomy accessory convex inse 1.95 1/1/1980

A5102 Bedside drain btl w/wo tube 20.69 1/1/1980

A5105 Urinary suspensory 40.76 1/1/1980

A5112 Urinary leg bag 34.62 1/1/1980

A5113 Latex leg strap 4.70 1/1/1980

A5114 Foam/fabric leg strap 8.94 1/1/1980

A7002 Tubing used w suction pump NU 3.83 1/1/1980

A7003 Nebulizer administration set NU 2.74 1/1/1980

A7004 Disposable nebulizer sml vol NU 1.80 1/1/1980

A7005 Nondisposable nebulizer set NU 30.83 1/1/1980

A7006 Filtered nebulizer admin set NU 9.54 1/1/1980

A7009 Nebulizer reservoir bottle NU 42.04 1/1/1980

A7010 Disposable corrugated tubing NU 23.59 1/1/1980

A7012 Nebulizer water collec devic NU 3.78 1/1/1980

A7013 Disposable compressor filter NU 0.83 1/1/1980

A7014 Compressor nondispos filter NU 4.49 1/1/1980

A7015 Aerosol mask used w nebulize NU 1.88 1/1/1980

A7016 Nebulizer dome & mouthpiece NU 7.25 1/1/1980

A7017 Nebulizer not used w oxygen UE 100.52 1/1/1980

A7017 Nebulizer not used w oxygen RR 13.40 1/1/1980

A7017 Nebulizer not used w oxygen NU 134.04 1/1/1980

A7027 Combination oral/nasal mask NU 179.35 1/1/2008

A7028 Repl oral cushion combo mask NU 49.54 1/1/2008

A7029 Repl nasal pillow comb mask NU 20.24 1/1/2008

A7032 Replacement nasal cushion NU 40.53 1/1/1980

A7033 Replacement nasal pillows NU 28.41 1/1/1980

A7034 Nasal application device NU 117.64 1/1/1980

A7035 Pos airway press headgear NU 39.75 1/1/1980

A7036 Pos airway press chinstrap NU 18.20 1/1/1980

A7037 Pos airway pressure tubing NU 41.02 1/1/1980

A7038 Pos airway pressure filter NU 5.39 1/1/1980

A7040 One way chest drain valve 36.86 1/1/2005

A7041 Water seal drain container 69.26 1/1/2005

179/185


A7045 Repl exhalation port for pap UE 14.60 6/1/2009

A7045 Repl exhalation port for pap RR 1.95 6/1/2009

A7045 Repl exhalation port for pap NU 19.47 6/1/2009

A7527 Trach/laryn tube plug/stop 3.58 6/1/2009

A9500 Tc99m sestamibi 81.54 2/15/2012

A9501 Technetium tc-99m teboroxime 52.55 2/15/2012

A9502 Tc99m tetrofosmin 72.53 2/15/2012

A9503 Tc99m medronate 24.99 2/15/2012

A9504 Tc99m apcitide 24.55 2/15/2012

A9505 Tl201 thallium 26.76 2/15/2012

A9507 In111 capromab 901.82 2/15/2012

A9508 I131 iodobenguate, dx 20.39 2/15/2012

A9509 Iodine i-123 sod iodide mil 113.90 2/15/2012

A9510 Tc99m disofenin 53.53 2/15/2012

A9512 Tc99m pertechnetate 6.28 2/15/2012

A9516 Iodine i-123 sod iodide mic 31.93 2/15/2012

A9517 I131 iodide cap, rx 18.12 2/15/2012

A9521 Tc99m exametazime 432.53 2/15/2012

A9524 I131 serum albumin, dx 74.41 2/15/2012

A9526 Nitrogen n-13 ammonia 164.35 2/15/2012

A9527 Iodine i-125 sodium iodide 11.01 2/15/2012

A9528 Iodine i-131 iodide cap, dx 22.91 2/15/2012

A9537 Tc99m mebrofenin 36.19 2/15/2012

A9538 Tc99m pyrophosphate 31.87 2/15/2012

A9539 Tc99m pentetate 30.86 2/15/2012

A9540 Tc99m maa 24.89 2/15/2012

A9541 Tc99m sulfur colloid 39.38 2/15/2012

A9548 In111 pentetate 327.64 2/15/2012

A9552 F18 fdg 209.74 2/15/2012

A9555 Rb82 rubidium 176.51 2/15/2012

A9560 Tc99m labeled rbc 64.19 2/15/2012

A9561 Tc99m oxidronate 26.03 2/15/2012

A9562 Tc99m mertiatide 121.43 2/15/2012

A9567 Technetium tc-99m aerosol 33.67 2/15/2012

A9568 Technetium tc99m arcitumomab 18.87 2/15/2012

A9569 Technetium tc-99m auto wbc 517.30 2/15/2012

A9570 Indium in-111 auto wbc 525.12 2/15/2012

A9571 Indium in-111 auto platelet 797.71 2/15/2012

A9572 Indium in-111 pentetreotide 690.43 2/15/2012

A9576 Inj prohance multipack 2.34 2/15/2012

A9577 Inj multihance 4.11 2/15/2012

A9578 Inj multihance multipack 3.97 2/15/2012

A9579 Gad-base mr contrast nos,1ml 3.81 2/15/2012

A9580 Sodium fluoride f-18 206.58 2/15/2012

A9581 Gadoxetate disodium inj 13.18 2/15/2012

180/185


A9582 Iodine i-123 iobenguane 1270.11 2/15/2012

A9583 Gadofosveset trisodium inj 16.18 2/15/2012

A9700 Echocardiography contrast 33.81 2/15/2012

E1039 Transport chair pt wt >300lb RR 22.65 8/1/2008

E2365 U1 sealed leadacid battery UE 82.75 1/1/2004

E2365 U1 sealed leadacid battery RR 11.03 1/1/2004

E2365 U1 sealed leadacid battery NU 110.31 1/1/2004

G0101 Ca screen;pelvic/breast exam TS 35.99 1/1/1980

G0101 Ca screen;pelvic/breast exam 35.99 1/1/1980

G0102 Prostate ca screening; dre 16.42 1/1/2008

G0108 Diab manage trn per indiv 30.89 1/1/1980

G0109 Diab manage trn ind/group 17.82 1/1/1980

G0202 SCR MAMMO BI INCL CAD TC 103.63 1/1/2008

G0202 SCR MAMMO BI INCL CAD 26 36.91 1/1/2008

G0202 SCR MAMMO BI INCL CAD 140.54 1/1/2008

G0204 DX MAMMO INCL CAD BI TC 102.05 1/1/2008

G0204 DX MAMMO INCL CAD BI 26 45.76 1/1/2008

G0204 DX MAMMO INCL CAD BI 147.80 1/1/2008

G0206 DX MAMMO INCL CAD UNI TC 82.67 1/1/2008

G0206 DX MAMMO INCL CAD UNI 26 39.61 1/1/2008

G0206 DX MAMMO INCL CAD UNI 119.58 1/1/2008

G0277 Hbot, full body chamber, 30m 42.64 1/1/2015

G0279 Tomosynthesis, mammo screen TC 27.36 1/1/2015

G0279 Tomosynthesis, mammo screen 58.98 1/1/2015

G0339 Robot lin-radsurg com, first 3803.23 3/1/2009

G0340 Robt lin-radsurg fractx 2-5 2579.82 3/1/2009

G0378 Hospital observation per hr 10.42 6/1/2008

G0433 Elisa hiv-1/hiv-2 screen 9.64 4/1/2011

G0435 Oral hiv-1/hiv-2 screen 8.43 4/1/2011

G0442 Annual alcohol screen 15 min 16.33 10/17/2011

G0443 Brief alcohol misuse counsel 23.44 10/17/2011

G0444 Depression screen annual 16.33 10/14/2011

G0445 High inten beh couns std 30m 23.44 11/8/2011

G0446 Intens behave ther cardio dx 23.44 11/8/2011

G0449 Annual obesity screen 15 min 23.44 11/29/2011

G0451 Devlopment test interpt&rep 9.49 1/1/2012

G0480 DRUG TEST DEF 1-7 CLASSES 75.94 1/1/2016

G0481 ABLE TO IDDEF 8-14 CLASSES 116.84 1/1/2016

G0482 DRUG TEST DEF 15-21 CLASSES 157.72 1/1/2016

G0483 DRUG TEST DEF 22+ CLASSES 204.46 1/1/2016

G0500 MOD SEDAT ENDO SERVICE >5YRS 52.34 1/1/2017

G0502 INIT PSYCH CARE MANAG, 70MIN 124.75 1/1/2017

G0503 SUBSEQ PSYCH CARE MAN,60MI 110.30 1/1/2017

G0504 INIT/SUB PSYCH CARE ADD 30 M 57.64 1/1/2017

G0505 COG/FUNC ASSESSMENT OUTPT 207.53 1/1/2017

181/185


G0506 COMP ASSES CARE PLAN CCM SVC 55.66 1/1/2017

G0507 CARE MANAGE SERV MINIMUM 20 41.64 1/1/2017

G0508 CRIT CARE TELEHEA CONSULT 60 174.06 1/1/2017

G0509 CRIT CARE TELEHEA CONSULT 50 167.85 1/1/2017

G6002 Stereoscopic x-ray guidance TC 58.18 1/1/2015

G6002 Stereoscopic x-ray guidance 78.81 1/1/2015

G6003 Radiation treatment delivery 172.32 1/1/2015












G6016 Delivery comp imrt 425.32 1/1/2015

L0466 Tlso r fram soft ant pre cst 374.99 1/1/1980

L0984 Protect body sock ea pre ots 51.46 1/1/1980

L1810 Ko elastic with joints 97.80 1/1/1980

L1820 Ko elas w/ condyle pads & jo 119.08 1/1/1980

L1830 Ko immob canvas long pre ots 87.80 1/1/1980

L1831 Knee orth pos locking joint 231.26 1/1/2004

L1832 Ko adj jnt pos r sup pre cst 546.47 1/1/1980

L1902 AFO ANKLE GAUNTLET PRE OTS 68.86 1/1/1980

L1904 AFO MOLDED ANKLE GAUNTLET 471.98 1/1/1980

L1906 AFO MULTILIG ANK SUP PRE OTS 120.70 1/1/1980

L1907 Afo supramalleolar custom 442.14 1/1/2004

L1930 Afo plastic 237.44 1/1/1980

L1945 Afo molded plas rig ant tib 929.10 1/1/1980

L1960 Afo pos solid ank plastic mo 556.33 1/1/1980

L1970 Afo plastic molded w/ankle j 581.72 1/1/1980

L2036 Kafo plas doub free knee mol 1669.84 1/1/1980

L2037 Kafo plas sing free knee mol 1671.72 1/1/1980

L2050 Hkafo torsion cable hip pelv 478.11 1/1/1980

L2200 Limited ankle motion ea jnt 47.72 1/1/1980

L2210 Dorsiflexion assist each joi 67.47 1/1/1980

L2220 Dorsi & plantar flex ass/res 82.19 1/1/1980

L2275 Plastic mod low ext pad/line 117.73 1/1/1980

L2280 Molded inner boot 454.48 1/1/1980

L2300 Abduction bar jointed adjust 270.23 1/1/1980

L2380 Torsion straight knee joint 123.56 1/1/1980

L2385 Straight knee joint heavy du 134.43 1/1/1980

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L2397 Suspension sleeve lower ext 99.48 1/1/1980

L2405 Knee joint drop lock ea jnt 68.50 1/1/1980

L2760 Extension per extension per 60.98 1/1/1980

L2768 Ortho sidebar disconnect 102.38 1/1/1980

L2780 Non-corrosive finish 67.92 1/1/1980

L2785 Drop lock retainer each 31.81 1/1/1980

L2795 Knee control full kneecap 85.28 1/1/1980

L2800 Knee cap medial or lateral p 107.06 1/1/1980

L2810 Knee control condylar pad 78.39 1/1/1980

L2820 Soft interface below knee se 87.16 1/1/1980

L2830 Soft interface above knee se 94.30 1/1/1980

L3150 Abduct rotation bar w/o shoe 33.00 1/1/1980

L3170 Foot plas heel stabi pre ots 39.99 7/1/2006

L3260 Ambulatory surgical boot eac 15.42 7/1/2006

L3265 Plastazote sandal each 17.00 7/1/2006

L3650 So 8 abd restraint pre ots 58.25 6/1/2009

L3660 So 8 ab rstr can/web pre ots 89.62 1/1/1980

L3670 So acro/clav can web pre ots 111.06 1/1/1980

L3740 Cuffs adj lock w/ active con 1049.67 1/1/1980

L3760 Eo withjoint, prefabricated 357.62 1/1/1980

L3762 Eo rigid w/o joints pre ots 76.89 1/1/1980

L3806 Whfo w/joint(s) custom fab 365.35 6/1/2009

L3807 Whfo w/o joints pre cst 178.81 1/1/1980

L3808 Whfo, rigid w/o joints 365.79 6/1/2009

L3906 Who w/o joints cf 388.08 1/1/1980

L3908 Who cock-up nonmolde pre ots 58.85 1/1/1980

L3912 Hfo flexion glove pre ots 93.14 1/1/1980

L3917 Metacarp fx orthosis pre cst 75.54 1/1/2004

L3923 Hfo without joints pre cst 27.82 1/1/1980

L3956 Add joint upper ext orthosis 721.81 1/1/1980

L3960 Sewho airplan desig abdu pos 721.81 6/1/2009

L3962 Sewho erbs palsey design abd 704.68 7/1/2006

L3980 Up ext fx orthos humeral nos 303.63 6/1/2009

L3982 Upper ext fx orthosis rad/ul 366.65 1/1/1980

L3984 Upper ext fx orthosis wrist 338.05 1/1/1980

L3995 Sock fracture or equal each 28.06 1/1/1980

L3999 Upper limb orthosis nos 1279.73 1/1/1980

L4350 Ankle control ortho pre ots 89.72 6/1/2009

L4360 Pneumat walking boot pre cst 243.17 1/1/1980

L4370 Pneum full leg splnt pre ots 142.11 1/1/1980

L4386 Non-pneum walk boot pre cst 124.58 1/1/1980

L4392 Replace afo soft interface 18.19 1/1/1980

L4394 Replace foot drop spint 13.25 1/1/1980

L4396 Static or dynami afo pre cst 129.66 1/1/1980

L5000 Sho insert w arch toe filler 481.95 1/1/1980

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L5321 Ak open end sach 3514.44 6/1/2009

L5611 Ak 4 bar link w/fric swing 1589.32 1/1/1980

L5620 Test socket below knee 234.56 1/1/1980

L5624 Test socket above knee 333.46 1/1/1980

L5629 Below knee acrylic socket 254.87 1/1/1980

L5631 Ak/knee disartic acrylic soc 352.37 1/1/1980

L5637 Below knee total contact 307.69 1/1/1980

L5649 Isch containmt/narrow m-l so 1536.84 1/1/1980

L5650 Tot contact ak/knee disart s 522.01 1/1/1980

L5651 Ak flex inner socket ext fra 963.10 1/1/1980

L5652 Suction susp ak/knee disart 349.64 1/1/1980

L5671 Bk/ak locking mechanism 531.87 6/1/2009

L5673 Socket insert w lock mech 628.41 1/1/2004

L5676 Bk knee joints single axis p 387.48 1/1/1980

L5679 Socket insert w/o lock mech 523.67 1/1/2004

L5700 Replace socket below knee 2928.30 1/1/1980

L5701 Replace socket above knee 3635.72 1/1/1980

L5704 Custom shape cover bk 489.05 1/1/1980

L5850 Endo ak/hip knee extens assi 102.59 1/1/1980

L5910 Endo below knee alignable sy 290.45 1/1/1980

L5920 Endo ak/hip alignable system 425.51 1/1/1980

L5940 Endo bk ultra-light material 427.54 1/1/1980

L5950 Endo ak ultra-light material 623.94 1/1/1980

L5962 Below knee flex cover system 628.52 1/1/1980

L5972 Flexible keel foot 376.85 1/1/1980

L5981 Flex-walk sys low ext prosth 2626.94 1/1/1980

L5986 Multi-axial rotation unit 677.59 1/1/1980

L6380 Postop dsg cast chg wrst/elb 1037.38 1/1/1980

L6382 Postop dsg cast chg elb dis/ 1305.03 1/1/1980

L6384 Postop dsg cast chg shlder/t 1692.25 1/1/1980

L6386 Postop ea cast chg & realign 429.41 1/1/1980

L6388 Postop applicat rigid dsg on 438.41 1/1/1980

L8420 Prosthetic sock multi ply bk 20.80 1/1/1980

L8440 Shrinker below knee 44.72 1/1/1980

L8470 Pros sock single ply bk 7.14 1/1/1980

L8511 Indwelling trach insert 57.26 1/1/2004

L8512 Gel cap for trach voice pros 1.70 1/1/2004

L8513 Trach pros cleaning device 4.08 1/1/2004

L8514 Repl trach puncture dilator 74.24 1/1/2004

L8606 Synthetic implnt urinary 1ml 182.61 1/1/1980

L8615 Coch implant headset replace 370.34 5/1/2008

L8616 Coch implant microphone repl 86.26 5/1/2008

L8617 Coch implant trans coil repl 75.34 5/1/2008

L8618 Coch implant tran cable repl 21.53 5/1/2008

L8621 REPL ZINC AIR BATTERY 0.51 11/1/2007

184/185


L8622 Repl alkaline battery 0.27 11/1/2007

L8631 Mcp joint repl 2 pc or more 1794.63 1/1/2004

L8659 Interphalangeal joint repl 1519.23 1/1/2004

P9051 Blood, l/r, cmv-neg 181.87 9/1/2008

P9053 Plt, pher, l/r cmv-neg, irr 604.70 9/1/2008

P9055 Plt, aph/pher, l/r, cmv-neg 516.48 9/1/2008

P9056 Blood, l/r, irradiated 198.12 9/1/2008

P9057 Rbc, frz/deg/wsh, l/r, irrad 345.16 9/1/2008

P9058 Rbc, l/r, cmv-neg, irrad 296.45 9/1/2008

P9059 Plasma, frz between 8-24hour 80.49 9/1/2008

P9060 Fr frz plasma donor retested 82.78 9/1/2008

Q0091 Obtaining screen pap smear 19.74 9/1/2003

Q3014 TELEHEALTH FACILITY FEE 24.24 2/1/2014

Q4020 Cast sup lng arm splnt ped f 32.71 7/1/2001

Q4049 Finger splint, static 37.38 7/1/2001

T1015 Clinic service 75.31 3/1/2010

T1023 Program intake assessment 150.62 3/1/2010

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provider type 12 hospital, outpatient...

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